Healthy esteem v. narcissism

Regarding “Reflecting on narcissism” (February Monitor), I question the validity of today’s measures of self-esteem. The problem began 20 years ago with parents and teachers who labeled esteem as internalizing that one was “special.” Unfortunately, this belief too easily becomes: “therefore I’m better than everyone.”

If we’re going to differentiate healthy esteem from narcissism, we need to rethink our definitions. For example, those possessing a healthy sense of self are aware that arrogance is not part of the picture, nor are they strangers to humility. Furthermore, they are not intimidated by nor feel inferior to others who show excellence. This is not an ideal; I know people like this, andsuspect that we all do, though it may not be the norm.

Contrary to the narcissist, who makes friends but has difficulty keeping them, those with high levels of esteem are able to permanently maintain their relationships. Why? Because they are empathetic and nonjudgmental and, as a consequence, others in their presence feel less competitive and therefore less stress.

Finally, the logic of removing narcissistic personality disorder from the fifth edition of the DSM seems to be that since self-absorbed behaviors are becoming the norm, they are not pathological. This is analogous to the AMA removing influenza from its DP Codes because it’s so common.

D.M. Brown, PhD
Franklin Pierce University

Clarifying the role of the USPHS

The Monitor’s December article “Pioneer woman” highlights the importance of culturally competent services and developing psychology internships for Native American communities, but it also incorrectly portrays United States Public Health Service (USPHS) crisis mental health services for Native American communities, and does not acknowledge the ongoing successful collaborations of federal, state and tribal entities in responding to crises in Native American communities.

Native American tribal communities are sovereign nations within the United States and, much like a state, can request support from the federal government in emergency situations. Tribes experiencing mental health crises, including suspected “suicide clusters,” have requested assistance from the federal government, and USPHS mental health providers may respond for a limited period of time within a larger community crisis response. The deployed teams provide short-term crisis services, consultation for health systems, and community training. Comparing the provision of mental health services during a crisis with routine care is very misleading; drawing conclusions about the effectiveness of UPSHS responses based on anecdotal reports is unscientific, and representing them as such in the Monitor is inconsistent with the quality of work typically presented.

USPHS teams follow a public health leadership model for disaster response, the Mercy Model, that promotes existing community strengths and resources to implement population-based programs that increase service capacity in a sustainable manner. Ironically, this leadership process has been published in APA and other peer-reviewed journals (McGuinness, Perez, & Coady, 2009; McGuinness, Coady, Perez et al, 2008) and was presented at the 2007 APA convention.

The tribes where USPHS mental health teams responded have witnessed reduction of suicide attempts and completions. This was only possible through the successful collaboration that was misrepresented in the article.

Adit Bhagwat, PhD
Jeff Coady, PsyD
Megan Corso, PsyD
Bryan Davidson, PhD
Anne Dobmeyer, PhD
John Golden, PhD
Jeffrey Goodie, PhD
Christine Hunter, PhD
Christopher Hunter, PhD
Robert Krick, PhD
Robin Lewis, PsyD
Amy Park, PhD
Heather Silvio, PhD
Dennis Slate, PsyD
Michael Tilus, PsyD
Robin Toblin, PhD

U.S. Public Health Service

Please send letters to Sara Martin, Monitor editor. Letters should be no more than 250 words and may be edited.