This episode is independent educational commentary based on publicly available material, which may be incomplete or inaccurate. We have not evaluated Elizabeth Holmes, Billy Evans, or anyone discussed in this podcast. All psychological interpretations are speculative. They're certainly not diagnoses, they're not factual findings, and they're certainly not any allegations of wrongdoing. We do not claim knowledge of anyone's private thoughts, motives, or mental health.
Good morning, Dr. Malisberg.
Good morning. How's it going?
Not too bad. I've been kind of thinking about whether We should turn this podcast into a Nathan Fielder podcast. After this, we should do direct analysis of the YouTube comments themselves and the personalities of the YouTube comments, because I got to say, there are some interesting things floating around in there.
Yeah. And I think what's funny is at the beginning, you talked about how the movie is a projective test. And then you that came so alive in some of the comments.
Yeah, well, it's certainly a lot more popular than our last attempt at pop culture stuff, you know, film and culture stuff, which was Seinfeld. You thought that one was going to be a little more popular, but no one really listened to that one.
Yeah, well, let's, you know, this one is, we're doing a part two of You Can See Everything. I think we're just going to continue. As requested by many in the comments. Continue on just some random... Nothing we're doing is a diagnosis or actual truth of what we think of the actual people. I think we're just having fun introducing some psychological concepts that can help give people a lens in a way of interpreting a wonderful movie.
Yeah, I think probably the main thing I wanted to put at the outset based on just the impressions that people are having from the film is that people seem to wonder Whether criminal or very bad behavior can be explained through the lens of things like trauma, neurodivergence, etc. I'd like to issue a warning here. I think that here trying to medicalize human behavior that falls within the range of normal even when it's an extreme in the range of normal or human behavior that's rationally driven Turning that into a medical diagnosis is a mistake because then there's this implicit philosophical understanding or belief that it's out of control.
And whether or not something is part of a mental disorder or a diagnosis is different from whether or not someone does it willfully or that they don't have control over it. And even that is a separate question from whether or not someone should be responsible for it in some way.
Absolutely. And I think we, you know, just to explain what we saw in the comments, I saw comments saying that could this all be explained by Elizabeth Holmes' neurodivergence or autism? Could this be entirely explained? Could her character be entirely explained by Mm-hmm.
I wish you wouldn't ask me if that was okay. I think there's already enough people who think I'm this tyrant, grandiose person. He's just controlling everything. But anyway, go on.
We both took a few hits in the comments, but listen, that's how the world works. So I want to go into a little bit more detail about the repetition compulsion because I think it's so important. And I want to talk a little bit about transactional analysis and how it relates to repetition compulsion.
That's, I think, a great topic. I just don't like using the term repetition compulsion. I feel like it smacks of psychoanalysis and it's kind of unnecessary. Saying repetition compulsion implies that people don't control over it. And I think it's difficult to control, certainly. I think we repeat automatically. I like to just talk about the tendency to repeat. That's my little nitpick, but let's go on.
Yeah, I totally agree. And actually, one thing I caught when we were talking about it, you said, like, That's the thesis of the film. It's so obvious. And I think one thing you miss is I think we think about this stuff so much. Every therapist or every psychiatrist I've talked to, it's immediately obvious that this was a theme of the film. And I think we actually lose sight of the fact that for a lot of people, this isn't an obvious thing.
And a lot of people actually miss this aspect. So the part I want to talk about... You know, Billy in the film talks about how him and Elizabeth never argue and and that they're just perfectly aligned. And as I kind of mentioned in the last podcast, Elizabeth just supernatural, like supernaturally desires exactly what Billy's desires. And this I love the line. It was just like, do you think that when you look at the other, her previous relationships, do you get the sense that she's comfortable expressing her needs and opinions?
Obviously referencing the relationship with her and Sunny. So the way that I make sense of, of, It's an unconscious tendency to recreate painful experiences from the past, even if they come at A good example I can think of is I have a friend with a very absent dad, and she always mysteriously finds herself in relationships with very distant or very unavailable relationships. More recently, she started dating a guy that he was on vacation from France and then they met on Tinder and he lives in France and she's in New York and they get to see each other once every few months.
It almost seems like she keeps kind of finding these relationships. So Freud felt that we repeat our patterns, often traumatic patterns, and it's very typically in relationships. Now, there's a few ways of understanding why do we do this? Why do we repeat things from the past? Some people say that these are the things that are familiar to us. So we have a preference for things that are familiar rather than the things that make us feel good.
A better way to explain it is that we're trying to gain mastery over something that originally we felt helpless and we felt like it was happening to us. And by recreating it ourselves, we're actually the one who has the power So in the distant father example, the unconscious desire to master the experience of the absent father is, you know, this time I'm going to get this distant person to actually realize how important I am and actually love me and change their ways.
So the tragedy of the need to repeat is instead of mastering the experience, usually what we do is we repeat the same things over and over endlessly.
Um, you know, it's important stuff. It's classical stuff. The way you've described it is very, uh, consistent, I would say with mainstream psychoanalytic understanding of repetition, but I, I gotta take issue with some of it. Absolutely. Um, why referring it to Freud only, I think is going to bias people. This is an observation only from Freud. I think every philosopher, human, human studier, ordinary person, they know we tend to repeat.
Habit is extremely powerful. Habit is basically how our brains and neurons work. You know, neurons that repeatedly fire together, wire together. What we do gets stronger. What we don't do gets weaker, right? That's just learning and neuroscience and We know that's true. So when we translate into a therapy context, that's where we see repetition compulsion, but it's a fundamental human thing. The other thing that I would say is that, you know, Freud always wrote hypotheses and then his followers would then say, this is what's happening, you know?
And then they overstate things. I think they attribute too much meaning to repetition, like saying it's a desire for mastery. Just like how certain old school psychoanalysts and older, not just older, newer psychoanalysts that still say things like, oh, people commit crimes because they have a desire to be punished. To me, that's a projection of the thinker. Why do people repeat? I think simply because it's so hard to change that biological systems tend to find a pattern and stick to it.
It's homeostasis. Homeostasis is the most preserved evolutionary state. Homeostasis is what's natural in the world, right? It takes energy to change. And so it's painful and discomforting then for any biological system that has subjectivity to try to do any change. And that's simply it. There's no unconscious desire to do anything in particular other than to remain the same. That's what I think.
I'm going to take this one step further.
And that's Freud, too, by the way. That's death drive. But go on.
Because I actually wanted when I wanted to talk about transactional analysis, which is considered a post Freudian concept. Have you ever read the games people play by Eric Byrne? It's sort of like a.
I've always meant to, but I only know it in second order from my training, but go on.
So it's something, it kind of is defunct, like it never actually took off clinically. But the main concept I think is really helpful for formulating kind of ideas that are going on.
And it kind of talks about how- I heard it was really big back when it came out. And then I think that's where the I'm okay, you're okay stuff comes from. I think you can see that in the old Simpsons episodes. I know you don't watch the Simpsons, Dr. Malzberg. But yeah, one of the first three seasons of The Simpsons, it's the one where Bart goes to therapy, group therapy or something.
Be like the boy, if anyone is a big fan. I think that's actually a reference to Eric Burns' games people play. Anyway, go on.
So the important part is, as you said, It's not like there's just one dynamic that the person is after in any sort of complex behavioral sequence. So the unit of analysis and transactional analysis isn't a single behavior. It's not a single interaction. It's the entire recurring sequence. So, you know, any sort of interpersonal relationship or interaction or pattern, it's not an isolated relationship. It's not an isolated event, but it's a part of a larger predictable pattern.
In this pattern, a lot of it has to do with like childhood object relation kind of things. But the gist is each person occupies a role. And then the big part is that there's some sort of psychological payoff in each kind of act, but also a big payoff at the end. And it almost plays off the way my brain understands it. It's almost like a little play where there's like a part one, part two, part three, and then the big finale.
So the dynamic that I see Elizabeth stuck in, and again, I think this is the kind of thing that's obvious to the psychologically minded, but for a lot of people, this probably wasn't that obvious. Part one is she idealizes a powerful, controlling partner. Part two, she experiences this control as something that's protective, as beneficial. It serves a function. Their relationship is wonderful, magical, and each person is getting a lot of benefit out of it.
Part three is her own needs become subordinated to the partner in increasing degrees. So at first it's probably as simple as he makes helpful decisions with regards to the money, but then it kind of, it grows and it grows and it grows and it grows. Part four is resentment accumulates. So as a result of constantly subordinating their own needs, their own desires, their own wishes, without being consciously aware of it, this person is becoming more and more and more resentful.
Part five is the relationship deteriorates in a very spectacular fashion, like how we saw it with Theranos and Sunny. And then part six, which is what I would consider the payoff, the partner is reinterpreted as controlling, abusive, And in this whole structure, we see two very opposing self-states. And I think we see different self-states. People occupy different self-states. This is a very common thing, but the flavor and what the self-states are differ for each person.
The first state Now, hold on.
I want to raise a bit of an objection. Absolutely. You've described an accurate and extremely classical set of stages in a particular type of relationship dynamic. I don't know if we really have the evidence for that in the objective evidence from either real life or the structure of the film. I think it's strongly implied that In a bit of the film, you can see everything. And I absolutely think that many, many people online and offline viewers are projecting this understanding into the film.
Because this is actually really common. This kind of, if you want to call it a game, if you want to call it a pattern, I think you see this a lot in relationships where people have... Weakness or problems with their personality and emotional development. That's true, right? But can we actually say that's what's happening? I'm not entirely sure about that.
And I agree. I think this is definitely an interpretation. This is taking a small amount of evidence. And I think what I'm seeing is I'm really mapping what I saw with her and Sunny's relationship from my very superficial understanding of it and seeing just the first half of the play kind of play out in the documentary. Do I have perfect evidence? No, but this is how I think it maps pretty well, in my opinion.
Well, this is what I'm going to say. If this is a true pattern, I want to see it more than twice. I like to say twice is a coincidence, three times is a pattern. That's a little conservative, but I want to see more because the steps you talk about where the resentment accumulates unconsciously and that causes some kind of blow up, I don't think you necessarily see that.
And I don't think that's necessarily happening here, right? That happens when you have someone with more emotional instability. That happens when somebody is essentially more classically borderline, as people like to talk about it, and that there's a lot of aggression. And I'm not sure that's what's happening, right? If we take the film for what it is, there's not much aggression at all. There's just sort of humming along.
The blowup happens externally. If we want to pretend that what's portrayed in, let's say, the dropout is accurate, the blowup happens because of external factors, not internal factors within that dyad, the relationship. So anyway, I'd like to go ahead and get to that point that you were going to get to.
Yeah, what's interesting is I agree. I think if there weren't external factors, if the company took off, if X, Y, Z, I think the first half of the structure would have been prolonged for a much longer period of time.
Yeah, but then in a couple where one person is much more classically borderline, emotionally unstable, that will happen even if everything is peachy keen. Correct. Even if everything is perfect. And I think that often the opposing partner, let's call him opposing... Can try to make things right when really it's not an external problem. It's a dynamic interpersonal problem. And there's the mistake. Absolutely. Just a little note there.
And the two different self-states, I actually agree. These are self-states that we typically see more often in borderline personality disorder, which we very explicitly said, this is not how we view Elizabeth Holmes. Again, we're not making any diagnoses, but we're especially not making that one. Yeah.
I am implying something about people who are reading into this strongly when they view the film a certain way. Sorry, folks.
Another thing that you did last time is you talked about how the film is a projection and what you see is a reflection on you. And I was like, dude, I'm about to talk about narcissism, psychopathy, manipulation. I'm going to feel a little odd talking about these things knowing it's a projection. But anyway, the two different self-states. It's only human. The first self-state is idealized submission. You know, like the other person takes care of me.
It's good that they make decisions for me in return. I think as Elizabeth puts it, I'm going to build monuments of love. It's this beautiful union. The second self-state is righteous resentment. He controlled me. He took advantage of me. He blew up my life. This was an oppressive relationship. Those are pretty common self-states that we see, as we're kind of saying, in particular types of pathology. So if you were to say, you know, oh, Elizabeth is just submissive to controlling men she's being taken advantage of, you're really missing Elizabeth's participation in the whole shebang.
I agree. I also think that's going to be an unpopular take. I think the theme these days in at least modern Western society is Is to pick out one submissive victim and one controlling actor. Yes. That we tend to de-emphasize or even ignore the passive participants. And I'm not going to just right out say that that's right or wrong necessarily from a societal standpoint. What I will say is that clinically it's unhelpful.
When we... Only view a subject clinically as a receiver of all kinds of negative things. And we don't see how they either passively or actively continue their circumstances or fail to improve their circumstances. There is no hope for change. There is no hope to stop that repetition. Now, another thing I wanted to add is as you talked about this, I thought, you know, it's interesting. It's the same sequence, but stops at some point for stable relationships that are maybe a little too enmeshed and dependent.
And whether or not that's normal or not or healthy or not probably depends on culture, right? If people have this idealization and kind of a dynamic of one person in charge and the other person is submissive, and by the way, if you actually pay attention, this happens across gender lines, you know, the man or the woman, or it can happen in same-sex couples where one person is very submissive and one person is very controlling.
But if they just never develop any kind of resentment or fighting about it, then you just get Probably a lot
of couples.
Where can you draw the line between what's normal and what's pathological? It's very dangerous, I think, and it's very easy for a clinician to impose their own values.
Absolutely. And one of the big themes of transactional analysis is that a successful relationship isn't two people who aren't playing games. A successful relationship is two people who are playing the same game on the opposite side of the coin. Or they develop a stable game. The game can have minor problems or minor quote-unquote payoffs that are negative. But they're stable and they work for the individual. So...
You keep talking about this concept of essentially pathologizing, whereas I think you're trying to interpret these things as normal, maybe relatively extreme versions of normal, but normal. In the beginning, you talked about the normal neurodivergence, normal autism, normal narcissism. Can you kind of explain a little bit more detail in terms of what you mean by that? What do you mean by that there's danger in saying that this is pathological, this is something different?
I think we need to give a little context. If you're a clinician today working in the Western world or maybe even outside the Western world, I think we are in the apex time right now since the advent of any kind of psychiatry or psychology dealing with pathology, you know, abnormal mental states or harmful mental states. We are in the first time that it has become popular, very, very popular.
To have and identify with certain mental conditions and to have certain diagnoses. We just have a different culture about it today. And we've probably tipped over into a lot of over diagnosis that causes harm. And why might that happen? It's because over the last few decades, we as a field, a professional field, have created certain diagnostic categories that were originally capturing very, very severe and divergent and impairing Aspects that were basically stuff that most people could have.
And then we were saying, for example, only the top 10% of having problems with this is something of clinical interest. And then slowly and gradually over several decades and then suddenly very quickly after modern mass media and the internet, we started to say, even if you have a little bit of this, you have the full on disorder. I don't know if that's comprehensible to an average listener, but clinicians, I think most of them know what I'm talking about.
I think the big thing that I see more and more often is I think diagnostic labels initially can kind of help people understand themselves better because it's putting words to experience that before they didn't have words to. And what we've seen more and more is that the The diagnostic label is actually allowing less insight and less self-understanding because when the diagnostic label covers so many broad, extreme, it's just like this extremely broad umbrella question.
Yeah, I guess autism is actually a good place to start. And I like to kind of give this example. I have
Two different patients, they both have the same diagnosis, autism spectrum disorder, even under my more stringent way of viewing this. One of them essentially works, does everything that they need to do. Has friends, family, and partners, right? The other one, all he does is spin around and hit people. Completely nonverbal, needs 100% around-the-clock care. If this single diagnosis accurately describes both these people, then that makes that diagnosis kind of useless, right, as a category.
If you make your diagnostic category super broad, then it doesn't tell us anything at all. So what should we do instead? Well, I think instead we should be talking about traits versus disorder. We should be saying people can have certain traits, certain behaviors, and certain problems, but those are present to a greater or lesser degree across the whole population. And we're going to leave it to the clinic and professionals to talk about when it gets to a level of disorder.
But if we're going to do ordinary rational understanding and analysis of ourselves and other people, we should just simply understand the traits and the behavioral patterns that people can get into.
You provide a great example because I think for anyone who's listening and trying to, you know, give, what's it called when you, the opposite of steel man, they're trying to make us hear that as negatively as possible. You're not saying that one does have autism and one doesn't. What you're saying is that there's a lot more, autism is a very, very, very, very small slice of what's going on in that person's life and doesn't fully explain the entirety of what they do, what their behaviors are, what their symptoms are.
It's a small slice. And when we make that slice the entirety of an individual's identity, that's when we get into what you're describing of like these two people who live entirely different lives. The label just isn't that helpful to kind of understand what's going on.
So you mentioned. So the answer to whether a single trauma, even the full PTSD, neurodivergence or autism can explain a situation like what's seen in the film. I would say the answer is flatly no. And why? Well, I'm hoping we'll explain a little bit right here.
Well, yeah, so let's start with autism. You mentioned kind of thinking about traits. Can you give us just a little bit more color so we can understand what you mean by that? What are the different traits? Yeah, talk to us a little bit about that.
You know, we actually have another episode talking about this in more detail if people are interested. But very briefly, I would say that there are levels of autistic traits that can essentially exist within the population. Some might pick on this and say, hey, those aren't autistic traits. Those are systematizing traits or those are other traits. But let's just agree to disagree if that's the case. I would say that people who tend to have very specific And constrained interests, people who struggle with social communication and understanding social cues, people who like to organize their understanding of the world into a very predictable system, people who are sensitive to certain types of stimuli, who like routines, who don't do well with change, These are all people who might have autistic traits, right?
It doesn't mean you have autistic disorder. It doesn't mean necessarily that you should be diagnosed with autism spectrum disorder even if you can find a large group of psychiatrists and psychologists who would do so with the right funds. You can find these ads on Reddit. What does it mean for you? Well, that kind of depends on what else is going on in your life, right? If you create an identity entirely around having this set of traits and having a disorder, you might create an entirely different life for yourself and the people around you.
Compared to 30 years ago, where maybe someone would have thought, this is a little bit of an oddball. This is a nerd. Because he's doing exactly the same things that today we would call a medical disorder, right? There are pros and cons to each approach. But there are more dangers, I think, than we realize to taking the latter modern approach than the classical approach.
Well, let's bring this back to the movie. You can see everything. You know, I saw in the comments a lot of people saying, like, isn't this an example of just neurodivergence, that there was some inability to understand as a result of the way her mind works. And then other people are saying, like, you're projecting psychopathy onto this brain. Neurodivergent female. Now, I kind of want to talk about a few of these examples and kind of see how you make sense of them or how you think about them.
I think the big one that I saw in our comments was the Abbott and Costellos who's on first. You know, quickly recap. She thinks that it's funny because they're just two people talking past each other. She misses the heart of the joke that that's the name of the players. And In the scene, Billy protects her and does the running away, but he says, like, oh, she just thinks differently.
You don't get that she thinks differently. This is an example that, like, her brain is a different type of brain. Obviously, undertones there of neurodivergence.
Yeah, that's an interesting one. First of all, if we stipulate that there was no fakeness, if she wasn't putting on any kind of falseness at that moment, I would say one moment like that alone, again, only tells us about traits, right? It doesn't tell us anything about disorder, and it particularly does not allow us to come to much in terms of conclusions about why someone did what they did in terms of a criminal charge or some kind of a behavior.
You shouldn't try to conflate one observation in a context to an unrelated context. Now, in the film, they connect it to a different context in talking to investors, and I think we'll talk about that in a bit. But for me, I don't find that convincing as evidence, the who's on first moment. Like we talked about in the first episode, every single moment on film is involving subjects who know they are being filmed.
And what's more, these are subjects who know that there are a lot of stakes on the line. So just like in a forensic psychiatry analysis of a moment of any person's behavior, we need to consider all the different possibilities, not just the possibilities that are medical diagnoses like autism or neurodiversity, right? We want to consider rational behaviors. So first of all, there's a strong rational component there that Simply being seen as confused or weak will make people sympathize with you, right?
That's one possibility. Bald faced, uh, acting or lying. The other possibility is that, um, it could have been normal inattention. Or again, normal variation in the ability of people to be interested or understand jokes. There is no requirement that everyone actually understands this. This is actually an older cultural joke that I think requires some kind of context and introduction. You know, you didn't do some kind of a big survey of everybody out there with or without diagnoses and say how many people understood this joke or not.
I actually thought about this in foreign audiences. When they show this to other languages, how is it going to be possible to understand, right? So there could just be normal misunderstanding of jokes involved as well.
I think that one's severely underappreciated. I actually remember being in middle school and showing this joke being shown to people. And I literally remember half the people got it and half the people didn't. And I think now, you know, the people who are interested in this film tends to be. The 30-year-old plus crowd. The nerds. Nerds. World nerds. And I remember showing this to people and being like, you don't get it.
I think it's a lack of mentalization that this actually, most people didn't get it originally. I remember as a kid, it was a running thing of half, you'd show it to people and they didn't get it. And it was funny because they wouldn't get it. Yeah. Yeah.
And then that is linked in the film, right, to another moment.
So he links it to, I think it was earlier in the film. Yeah, yeah, because he talks about it. The Theranos machine. She says this machine can run analysis on every single blood test. And Nathan points out, like, Elizabeth, we know that's not true. This is the whole shebang in terms of why you got in trouble. And what she was sticking to was that theoretically it can.
It has the capacity once those blood tests are figured out. And the whole thing is like any ordinary person hears that sentence and interprets it can do those blood tests as it has the ability right now.
Yeah, that's an interesting moment to me because I think there's not a small amount of people who bought it, bought that moment. To me, I think that moment is bold-faced love. Okay, that's my conclusion on that one. And that doesn't require a diagnosis.
And that's not a psychological, that's an opinion. Exactly.
Why do I think that? Why do I think that? It's because I think a moment like this actually shows me more convincingly that neither Nathan Fielder nor Elizabeth Holmes have anything approaching an autistic disorder. Okay, because the concrete use of language in autism should actually do the opposite. In general, people who have autistic disorders and use language in a very concrete way tend to be particularly detailed about their use of language.
And they don't have this kind of metaphorical or Abstract, theoretical way of thinking. They are concrete. They are being very direct. The level of mental steps that it takes to translate that the machine can do all these tests into some kind of a future-oriented Maybe what if kind of thing that to me is the talent of an artist. OK, or the talent of someone who is a little bit more open to experience, dissociative, dreamlike.
OK, or a liar. OK, so those I'm not buying that one. I don't see that as plausibly related to a neurodevelopmental condition.
Absolutely, I agree. And I think there was almost like a, to me in that moment, there was a showiness to the lack of understanding. Whereas the Avid Costello felt, to me, it just felt a little bit more authentic.
Whereas the like- Because you got to compare the apparent level of impairment at one moment to the global functioning of a person, right? I could maybe believe it if you see a person whose general level of functioning is extremely low. And that they are essentially a very low intellectual functioning. But unfortunately, you know, for Holmes, there's a lot of evidence that she's very high functioning, understands language quite well and is able to be very sophisticated with it.
And, uh, is interpersonally very sophisticated as well. Uh, you know, that, that's my understanding of it.
You know what, you know what it felt like to me? Um, cause it felt like, I feel like Billy in the Abbott and Costello thing jumped on the ability to like present this to the world. In my head, I pictured the SpongeBob, like look at it. If like, do you know what I'm talking about? Where Patrick's holding SpongeBob to the crowd and be like, look at it.
I feel like this was Billie's opportunity to say, yeah, see? Her brain just can't get these concepts. Everyone, see? You could see this. That's how I felt.
I think people are going to doubt that you could be so prepared. I would say don't underestimate the power of acting techniques and improv. If you inhabit and live a character and the opportunity around How can this not lead us to narcissism? Well... That depends on what you mean by narcissism. So we should talk about that. Yeah. One more thing about autism. I will acknowledge that it is easy to conflate and confuse personality conditions with autistic problems, autistic traits and spectrum stuff.
This is always a challenging area, I think, for child and adolescent psychiatrists to try to tease out. Because some people might seem callous as a person, not caring about the feelings and outcomes of other people, right? This is traditionally something we see in people with psychopathic traits. A little narcissism can cause that as well. But is that personality or is it simply that they lack conscious understanding or have a lot of difficulty understanding the emotions of others?
Right. Is it inability or lack of interest? That's the dividing line. We want that dividing line between autism and personality disorders. Right. And I will emphasize again, most people of autism are not personality disorder. They're generally pretty nice people. Aggression too. Right. We definitely see in more severe autistic conditions, aggressive outbursts, and that's usually due to poor emotional regulation, right? Often triggered by things like changes in routine, unexpected outcomes, or simply mood problems that are secondary to the autism.
That's hard to differentiate in some cases from the general aggressive temperament that you see in people with borderline type problems, narcissistic problems, and types of psychopathy, where they will act on aggression because they enjoy it or because they don't feel negative consequences that most people do, like guilt and remorse. These are very difficult things to tell apart in many cases.
Yeah, from the outside, because I think what you're describing is, you know, calculated aggression versus, you know, instinctual aggression as a result of difficulties.
But even the antisocial psychopath can have non-valculated aggression, right? So it just gets very murky, is my point.
Yeah, and, you know, we're not going to be talking about this today, but right now there's a cultural bias towards certain diagnoses that are looked at much more positively than other ones. All right, let's move a little bit into narcissism and how that's at play here.
Right. So there's ordinary and healthy narcissism. I think that's something that is hard or something that's more challenging for people to acknowledge or feel about today because narcissism has been solidly picked as a villainous tendency for many people today. And yes, pathological narcissism is definitely a big problem. It's just that we want to separate, again, ordinary traits from disorder. And the same argument can be made for psychopathy, actually.
That one gets a lot more uncomfortable, I think, because psychopaths tend to have a lot more negative effects on individuals in society. But it's arguable that some degree of psychopathic traits, rather than disorder, are adaptive, both for individuals and groups. What are the ordinary aspects here? Well, grandiosity, pride, ambition, and a willingness to do what it takes to be the best, right? These are not necessarily pathological and these are not necessarily the result of pathological narcissism and psychopathy.
Same thing with attention seeking, being very concerned about your self portrayal, image, status, being less concerned about other people or being more comfortable with lies and aggression. These are all potentially adaptive alongside the ways they hurt people.
I think the thing that we see more and more today is people think of narcissism as it's just this one thing. Like there's a monolithic, I forget who I heard talk about this, but there's like a monolithic, the narcissist. And every person who's the narcissist, therefore, is they don't care about other They only care about themselves. It's all the same thing. Now, narcissism in itself, every person has degrees of narcissism.
There's healthy narcissism. There's so many different terms that we kind of need to differentiate themselves. I guess the reason why I'm bringing it up is just to say that
There are degrees and it can exist in a adaptive way even if we personally dislike it. I know there are people out there who genuinely believe that human society can exist without things like profit, selfishness and hurt and sacrifice and that everyone can be kind. I would refer to an evolutionary theory here. If you have one group in a Environment that is willing to lie, cheat, steal, attack, and is very motivated to give themselves resources over others.
And then you have another group that feels strongly about being fair and not hurting other people. Depending on the environmental context, one group will win over another. And so probably the reason why all of these traits persist within our societies is because there are circumstances where it actually benefits groups, even if it can hurt individuals. I just don't believe that we can live in a utopia where there are no politicians, CEOs, or you could argue surgeons.
Well, so you're talking about, you know, there's almost like you're talking about ordinary narcissism, how it's present in every kind of individual and there's degrees to it. But then I think, you know, something you made kind of, you kept talking about the last one is that by making it as if it's something that is totally different from the rest of us, we're not acknowledging that it's kind of everywhere.
But there's also... You know, clinical narcissistic personality disorder. There's also, you know, something can happen where there's such a high degree, even if there's a spectrum, that it is categorically a different thing in a sense. So how do we know, I guess, when it kind of crosses into pathology? I think it would be, you know, naive to also say that because it's present in everyone, that it's never to a degree that it's, you know, pathology.
What are the signs, symptoms? What do we see in the person that it is, what you would categorize as pathology?
Yeah, that gets us into that difficult question again about where we draw the line between the medical condition and another. And that's a very deep philosophical debate we can have. But I would say that practically it kind of depends on the context because just because something is not a medical disorder in the clinic doesn't mean that it's not a problem for the people around them, right? Or that it's not a problem for a person in their relationship.
So you have to consider the context when we talk about that. But broadly speaking, for a clinical level, Of narcissistic personality, I would generally want to see that there is such rigid preservation and defense of an identity that has been chosen by the subject, that it defeats their own long-term goals and functioning. That their ego and their emotions is so fragile, I'm using ego in the ordinary layperson sense of the word, that they suffer.
That they feel depressed and empty when they're not validated or admired. And that they have such a poor understanding of other people's motivations and desires that they only attune themselves to the ones that matter to their identity or their well-being. Because that keeps you from working well, living well with others. You might see also problems in work. Functioning, basically. They won't be able to do well in work and studies, or they'll do really, really well until they collapse, right?
Because of this strong tendency to do all or nothing stuff, to totally idealize or devalue certain aspects of themselves or others. And that's basically the vein that we're going to see for clinical narcissistic personality disorder rather than healthy or ordinary narcissism.
To me, the key to understanding narcissism is that underneath what we see, the grandiosity, the arrogance, the need for admiration, there's a deeper psychological injury, what we call the narcissistic injury. And at its core, that injury is the experience that who you really are is somehow unacceptable. Now, how this develops, it can occur in a bazillion different ways. But the basic idea is that early in life, the environment, typically the parents, need you to be substantially different from who you actually are.
Maybe the parents need you to be successful. They need you to not show any weakness. There's something that tells you that the parts of who you really are, you need to suppress. So you learn that there's parts that are unacceptable. So the individual starts to So, rather than becoming and showing the world who you really are, you become who you think you need to be in order to be loved and valued.
Is that the person deep down inherently feels like they're not valuable. And the solution is to earn the value. So, you know, if I can just be successful enough, powerful enough, etc. enough. Then I'll be worthwhile. So relationships for individuals like this, it's not another person who has their own sense of identity. It's just extensions of their own self-worth. Now, the important thing to know is that The grandiosity and the worthlessness are two sides of the same coin.
So the appearance of excessive love, of excessive grandiosity in a psychodynamic formulation is better understood as just like a profound suppression, push down, inability to accept who the person truly is. So, yeah, that's kind of how I think about narcissism and the difference between, you know, this all happens to small degrees in everyone. And narcissistic personality disorder is when there's a severe detriment to the person's identity and there's probably no awareness of their real self.
I think you filled in the gap very nicely there and emphasizing how the narcissistic personality has dysfunction in its orientation towards other people, right? I sort of went after the traits maybe, but you're getting a little closer to the core there. And that is actually an area of ongoing debate right now in the personality disorder literature and research, whether we should define disorders as traits only, severe traits, or whether it's a matter of interpersonal functioning.
I think a hybrid approach is best, but I tend to try to split the difference. I suppose we should also talk briefly before we get into specific moments from the film, antisocial personality, which is not the same as, but is very related to psychopathy. Where do we draw the line? Well, I don't want to get into DSM rules. That's a little boring. I would say that some degree of being a cutthroat and aggressive person that doesn't care about other people will probably help you along.
At least if you compare it, let's say to someone who's pathologically guilty, right? Understand, probably intuitively, that someone who always blames themselves, always takes it upon themselves to help others, and never acts even an iota of selfishness throughout their life, that actually would be very dysfunctional. Especially trying to navigate social situations where people have different degrees of selfishness. But where can we consider that it's probably getting clinically, socially problematic?
When people simply cannot, rather than selectively in a non-disruptive way, when people cannot follow the rules or control their aggression to the degree that it's just getting the attention of the law, right? They enforce the law selectively because there's limited resources. And when someone starts to enforce the law more, that's a sign of something. Now you can get into the cultural and different impact aspects of that.
That's a different debate. We also look at functioning. Right. There are high functioning psychopaths and then there actually are mostly low functioning psychopaths. Most psychopaths are low functioning. They're probably incarcerated. They're very impulsive. They frequently get into conflicts and they can't maintain good standing with any This is a true group of people that can be identified. And I do think part of the problem with medicalization today Is that people are ignoring antisocial aspects and psychopathic aspects, even in the extreme versions and Essentially letting them run amok out in the community back when we would protect the community and other people against people with very strong tendencies like this.
And there's also a matter of gray, right? There's probably a group of people who have psychopathic traits who if you gave them a strict system of punishments and outcomes, they're high functioning enough that they would follow those rules. But if you loosen or blur boundaries and lines in order to try to be kind to everybody, then people of psychopathic tendencies will take advantage of that.
I think an important thing to kind of point out is, as we mentioned earlier, it's not like there's a category of people that are narcissistic and then a totally separate category that are antisocial and psychopathy. We were talking a little bit before, patients with psychopathy or antisocial personality disorder often We often have an underlying narcissistic personality structure. Now, a lot of the features of narcissism, the grandiosity, the manipulation, the self involvement, the constant need for achievement, for presenting an amazing view Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack, Substack.
Psychopathy is not a totally separate thing. Psychopathy often has this structure and then often what we call like super ego deficits. So there's absolutely no guilt. There's often on top of this a desire to kind of get over on other people, to manipulate, to use other people. Yeah.
So then why do many people feel or think that Billy from the film is narcissistic?
So, you know, we had a few comments. And I'm actually, I want to, I'm really curious. I think we disagreed on one of the first scenes of the movie. Billy takes the eggs out of Elizabeth's hands. And I'm curious how you think about it.
Yeah. Well, before we even talk about each scene, just a quick note. I think there's a big problem today in that people only want to apply personality disorder diagnoses to the people they dislike. And they think that the people they like should not have a diagnosis. I don't like Billy. And how he's portrayed in the film. But I just always keep that in mind. I think as human beings, we have a tendency to try to vilify others.
So we want to be fair and balanced the best we can. I suppose the term fair and balanced is also infected in our culture, so I should use something else. But anyway, the eggs, I just, as someone who has some enthusiasm for cooking, I think it's factual that Elizabeth Holmes was not being the eggs right. And we had a text exchange about this, right?
Yeah, I think it was pretty funny because as someone who makes eggs very crappily, I thought it was a very wonderful demonstration of narcissistic pathology.
Well, I think maybe it could be a sign of my obsessive and compulsive nature, but you got to beat the eggs with the right tool and fast enough so you can get them to emulsify and you get nice and fluffy eggs in the pan every time. And then I think you told me that you actually mix your eggs in the pan with a silicone spatula, completely impermissible, terrible.
Yeah. So I set the picture. I was like, oh, no, I just use this little spatula and I mix it in the pan. And Dr. Fu acted as if what I said was complete psychosis.
It's a culinary set. But anyway, tell me what you noticed about the egg scene, the egg bowl scene.
So, yeah. And did you say the egg bowl?
Ah, I heard egg bowl. There's a little Freudian slip there.
Anyway, go on. That's terrible. All right. So in terms of how my brain was kind of running while it happened. So she's mixing up the eggs. And then... And he takes it out of her hand. Nathan looks and is like, wait, what was that? And he said like, oh, I just wanted to help her so she could focus on talking to you. And then she clarifies like, no, I don't mix them correctly.
You need to do it more vigorously. In terms of how, what I'm thinking while I'm watching that is, you know you're being filmed. You know that this is, your whole purpose is to show like we have this healthy, look how normal our life is. And he can't even help himself from seeing that she's mixing the eggs. Like, even for a minute, he can't hold it back. What to me was really telling was just his instant, like, oh, no, no, I just wanted to help her focus.
Like, his brain could instantly come up... With a reason as to why this was a harmless, this was nothing. This is, I'm actually helping her. And then she kind of reveals the cracks in terms of the relationship. She reveals that like, no, he needs his eggs done a particular way. I thought it was pretty, I don't think it's controlling to a massive degree. And kind of as we were saying before, I don't think you can point to one situation and say like, this is evidence of anything.
But I do think it's a bit, it's on the red flag spectrum.
I think it's an interesting Rorschach, because to me, it's kind of normal. I think it's normal for couples to staunchly disagree on how one of them does a certain task, right? And I'm sure if you followed things around enough, you'd probably see the opposite happen at some point. If anything, it would be more narcissistic Uh, for someone to completely control their behaviors in front of somebody in the camera, it was almost a humanizing moment to me, uh, the egg thing.
But of course, I'm absolutely sure that the moment arouses certain types of feelings and memories that are gonna be very different in different people. So we're all gonna come to different conclusions, just like a Rorschach test.
Absolutely. Now, I think that this was a harmless thing that, you know, every couple, I'm sure I have tons of examples that another person could point out and say, like, look how controlling that is. But as we were kind of talking before, it works in our relationship. It's not, you know, every single couple kind of has something like that. Our next few examples are not things that every couple has just these little quirks.
That's true. My next example is invoking his power of attorney over Elizabeth's. I can literally do anything, is how he says it.
And it was about, I think, him posting as well on Twitter.
So he was posting on Twitter angry things that are clearly not Elizabeth's voice. And then he points out that he actually has power of attorney over it. Yeah.
You know, I think that one most people can more easily agree is problematic. But to play devil's advocate, you know, when you're in prison... You're trying to accomplish certain business needs. It's probably reasonable to have a power of attorney assigned to somebody so they can take care of things for you, right? Why might you post on behalf of someone? You know, that was a puzzler more for me.
And why would you do it in such a poor fashion? I think that probably reflects a couple of things. I think it reflects the use of a person as a brand or a social media entity rather than a human being. And I think we got to acknowledge that the moment someone enters the field of social media, you are no longer just a person. You have become an entity of some kind.
You have become some kind of a brand, or at least you could have that potential. A lot of people probably don't post to their own Twitter accounts, right? A lot of people probably have a team or at least a person who handles that. That's a job today. So in a sense, that's normative. What I can criticize is I don't think he was doing a very good job.
I kind of feel like he had poor estimation of his own tweet quality and whether or not it would go over well. And I think I saw something. I don't know if it was a fake tweet or something. Didn't he just recently decide to get off Twitter? I thought I saw something about that. So for me, I have more objections to that in terms of how well it's executed rather than the fact that it's happening.
Yeah, and I think the tweets that they showed, it was clear aggression that was kind of being put out on Twitter. I feel like he replied like, fuck you to someone. Things that we were kind of talking about before, Elizabeth Holmes doesn't have that type of aggression. So it really was not a reflection of how her voice works. Now, our next example was how he responded to Amanda Seyfried's criticism.
You know, I think he was talking about someone doing something bad to them. And I got this feeling that like, Someone different kind of came out. He's like, I'm going to ruin their lives. I've got vengeance in my heart. He says how I'm very strategic. I'm well resourced. And I know people who can do just about anything to harm people. To me, that was something coming out.
I would love to hear you interpret this as a cutesy wootsy.
Well, you know, that's a little clearer. And it's interesting that he would display that, you know, on film. It's a bit of a moment, especially in our society today where we frown a lot on aggression, perhaps to an extreme degree. It does also bring to mind some commentators speculate about substance use for him. They found him to be a sniffler, calling back to Seinfeld, if we will.
I don't have a good explanation for that one. People get angry. You know, it was kind of like a late night around the dinner table moment. Would I say something like that? No. Would most people I know say something like that? No. What most people say, things like that while they're intoxicated, entirely possible. I don't know what he was on. So that's the only devil's advocate, normal explanation that's coming to mind for me.
Otherwise, it probably does reflect some level of greater aggression, feelings that people are after you. Oh yeah, he also carries a gun around, huh? And also a willingness to, and a desire to exact revenge. Now, I don't know his context. I don't know his personal situation. Maybe there could be some pretty wild things going on that would justify that kind of response and that kind of thinking as a rational response.
Who knows? This is going to be unrelated to anything in the film. This is just this small tidbit. I'm going to describe some features of narcissistic and antisocial personality structures. Grandiosity. Interpersonal exploitation. Treating others as extensions of the self. That was unrelated. Feel free to make any connections out there. You mentioned Seinfeld. I actually had another Seinfeld connection. George, well, I think a lot of people were questioning like, oh, is Elizabeth just controlling Billy?
What is Billy getting out of this relationship? And I don't actually think this is what's occurring, but do you remember when George is talking about how the ideal, I think he actually dates a woman who's in prison and that the ideal relationship is a woman who's in prison?
That's got to be season eight or nine, right? I don't really remember that.
At all times, he knows where she is. He's got limited obligations. He doesn't need to go on dates. To him, it's the perfect relationship.
And then, you know, I'm going to say, George is a relatable guy. We've all got a little bit of madness, you know, hatred, aggression, and awfulness within us. Be wary. We got to be able to, you know, recognize and control for the safety of ourselves and others, these kinds of things when they show up. But if we live our lives thinking we're these angels and nobody else is like us and people who are bad are bad and we got to do everything we can to stomp them out.
Well, that's how we create a more chaotic and split up society, in my opinion. So sorry, going to be a little kumbaya about it.
I heard you say you're playing the devil's advocate. I think there is an important role in terms of humanizing and normalizing these features. When we make this stuff about us versus them, we really miss that all these aspects are a part of ourselves. The best writers in regards to understanding personality are the ones who can find the pieces inside of them that are in the other people.
Yeah. So I think that's such an important part is really trying to see ourselves in other people and see that they are not different from us, that we all have these capacities for evil, for good. And by othering other people, we actually reinforce the problem.
Yeah. It's all about balance in the end. Well, I think that's our time for today. Not sure if we left a lot of lingering questions or not, but I think I've exhausted my capabilities on this topic unless we want to go into more navel-gazing, as we mentioned, and analyze each people's individual comments, which would probably be a bit cruel. So I don't know if we'll do anything like that, really.
I think we'll wrap it up here. But I hope people enjoy our less clinical episodes. Yeah.
Yeah, apologies to those who want more clinical content. Don't worry, more will be coming.
I don't think anyone wants more clinical content, but yeah, we'll see. We'll see. Have a good one.
Bye.
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