But buried in the "Online Exclusive" bonus letters-to-the-editor is this:
Just finished reading your article on David Arndt "What went wrong?" As a practicing psychiatrist with long time experience with treatment of addictions, I could not stop asking myself why nobody involved in his case apparently considered whether David has bipolar disorder. His life pattern so well described by you is very typical. His escalating drug abuse along with deteriorating professional functional are indicative as well. It seems to me that drug dependence as well as all other doings came secondary to underlying mental illness.
Narcissistic PD patients never get so self-destructive. At no point of their life they are liked by anybody.
Bela Bochkarev, MD, Uxbridge
Oh, well. OK. Good to know. But I'm not done with the amateur tele-psychiatry yet. Not to put too fine a point on it, I never meant to say Dr. Arndt met DSM criteria for a personality disorder; he just has narcissistic traits. He found a place where his personality didn't get in the way, and he prospered -- like an obsessive who gets to organize closets for a living. It's only when he started his own practice, had less oversight and more responsibility, that things started to unravel for him. Is this worsening bipolar disease, or just exposing fixed, maladaptive personality traits? As good as Swidey's article was, it's no basis for making a diagnosis.