Monday, 29 September 2008

Narcissistic disorder as a social trait

The narcissist is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion.

The narcissistic landscape is fraught with contradictions. The narcissist depends on people - but hates and despises them. He wants to control them unconditionally - but is also looking to punish himself savagely. He is terrified of persecution ("persecutory delusions") - but seeks the company of his own "persecutors" compulsively.

The narcissist is the victim of incompatible inner dynamics, ruled by numerous vicious circles, pushed and pulled simultaneously by irresistible forces. A minority of narcissists choose the schizoid solution. They choose, in effect, to disengage, both emotionally and socially.


xtina said...

NPD is difficult to diagnose for several reasons. First, some people with NPD function sufficiently well that they do not come to the attention of therapists. Second, narcissists are prone to lie about themselves; thus it may take a long time for a therapist to notice discrepancies between a patient's version of his or her life and information gained from others or from public records. Third, many traits and behaviors associated with NPD may be attributed to other mental disorders. Low functioning narcissists are often diagnosed as having borderline personality disorder(BPD), particularly if they are female; if they are male, they may be diagnosed as having antisocial personality disorder(ASPD). If the person with NPD has a substance abuse disorder, some of their narcissistic behaviors may be written off to the mood-altering substance. More recently, some psychiatrists have pointed to a tendency to confuse narcissistic behaviors in people with NPD who have had a traumatic experience with full-blown post-traumatic stress disorder(PTSD). Given the lack of clarity in the differential diagnosis of NPD, some therapists are calling for a fundamental revision of DSM-IV-TRdefinitions of the personality disorders.

An additional complication is posed by economic considerations. The coming of managed care has meant that third-party payers (insurance companies) prefer short-term psychotherapy that concentrates on a patient's acute problems rather than on underlying chronic issues. Since narcissists are reluctant to trust others or form genuine interpersonal bonds, there is a strong possibility that many therapists do not recognize NPD in patients that they are treating for only a few weeks or months.
The Diagnostic and Statistical Manual (DSM) IV-TR uses this language to describe the malignant narcissist:

"An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts."

So, what matters is that these characteristics, often found in healthy people, appear jointly and not separately or intermittently and that they are all-pervasive (invade, penetrate, and mould every aspect, nook, and cranny of the personality):

1.That grandiose fantasies are abundantly discernible;
2.That grandiose (often ridiculous) behaviors are present;
3.That there is an over-riding need for admiration and adulation or attention ("narcissistic supply");
4.That the person lacks empathy (regards other people as two dimensional cartoon figures and abstractions, unable to "stand in their shoes");
5.That these traits and behaviors begin, at the latest, in early adolescence;
6.That the narcissistic behaviors pervade all the social and emotional interactions of the narcissist.

xtina said...

Proposed Amended Criteria for the Narcissistic Personality Disorder

* Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognized as superior without commensurate achievements);

* Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;

* Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);

* Requires excessive admiration, adulation, attention and affirmation - or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);

* Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;

* Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;

* Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;

* Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;

* Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.

xtina said...

The Schizoid and Paranoid Personality Disorders

The basic dynamic of this particular brand of co-morbidity goes like this:

1. The narcissist feels superior, unique, entitled and better than his fellow men. He thus tends to despise them, to hold them in contempt and to regard them as lowly and subservient beings.

2. The narcissist feels that his time is invaluable, his mission of cosmic importance, his contributions to humanity priceless. He, therefore, demands total obedience and catering to his ever-changing needs. Any demands on his time and resources is deemed to be both humiliating and wasteful.

3. But the narcissist is dependent on input from other people for the performance of certain ego functions (such as the regulation of his sense of self worth). Without Narcissistic Supply (adulation, adoration, attention), the narcissist shrivels and withers and is dysphoric (=depressed).

4. The narcissist resents this dependence. He is furious at himself for his neediness and - in a typical narcissistic maneuver (called "alloplastic defence") - he blames others for his anger. He displaces his rage and its roots.

5. Many narcissists are paranoids. This means that they are afraid of people and of what people might do to them. Wouldn't you be scared and paranoid if your very life depended continually on the goodwill of others? The narcissist's very life depends on others providing him with Narcissistic Supply. He becomes suicidal if they stop doing so.

6. To counter this overwhelming feeling of helplessness (=dependence on Narcissistic Supply), the narcissist becomes a control freak. He sadistically manipulates others to satisfy his needs. He derives pleasure from the utter subjugation of his human environment.

7. Finally, the narcissist is a latent masochist. He seeks punishment, castigation and ex-communication. This self-destruction is the only way to validate powerful voices he had internalized as a child ("you are a bad, rotten, hopeless child").

xtina said...

The narcissistic landscape is fraught with contradictions. The narcissist depends on people - but hates and despises them. He wants to control them unconditionally - but is also looking to punish himself savagely. He is terrified of persecution ("persecutory delusions") - but seeks the company of his own "persecutors" compulsively.

The narcissist is the victim of incompatible inner dynamics, ruled by numerous vicious circles, pushed and pulled simultaneously by irresistible forces. A minority of narcissists choose the schizoid solution. They choose, in effect, to disengage, both emotionally and socially.

"A surprising ... fact in the process of self-splitting is the sudden change of the object relation that has become intolerable, into narcissism. The man abandoned by all gods escapes completely from reality and creates for himself another world in which he ... can achieve everything that he wants. as been unloved, even tormented, he now splits off from himself a part which in the form of a helpful, loving, often motherly minder commiserates with the tormented remainder of the self, nurses him and decides for him ... with the deepest wisdom and most penetrating intelligence. He is ... a guardian angel (that) sees the suffering or murdered child from the outside, he wanders through the whole universe seeking help, invents phantasies for the child that cannot be saved in any other way ... But in the moment of a very strong, repeated trauma even this guardian angel must confess his own helplessness and well-meaning deceptive swindles ... and then nothing else remains but suicide ..."

[Ferenczi and Sandor - "Notes and Fragments" - International Journal of Psychoanalysis - Vol XXX (1949), p. 234]

The study of narcissism is a century old and the two scholarly debates central to its conception are still undecided. Is there such a thing as HEALTHY adult narcissism (Kohut) - or are all the manifestations of narcissism in adulthood pathological (Freud, Kernberg)? Moreover, is pathological narcissism the outcome of verbal, sexual, physical, or psychological abuse (the overwhelming view) - or, on the contrary, the sad result of spoiling the child and idolizing it (Millon, the late Freud)?

The second debate is easier to resolve if one agrees to adopt a more comprehensive definition of "abuse". Overweening, smothering, spoiling, overvaluing, and idolizing the child - are all forms of parental abuse.

This is because, as Horney pointed out, the child is dehumanized and instrumentalized. His parents love him not for what he really is - but for what they wish and imagine him to be: the fulfillment of their dreams and frustrated wishes. The child becomes the vessel of his parents' discontented lives, a tool, the magic brush with which they can transform their failures into successes, their humiliation into victory, their frustrations into happiness. The child is taught to ignore reality and to occupy the parental fantastic space. Such an unfortunate child feels omnipotent and omniscient, perfect and brilliant, worthy of adoration and entitled to special treatment. The faculties that are honed by constantly brushing against bruising reality - empathy, compassion, a realistic assessment of one's abilities and limitations, realistic expectations of oneself and of others, personal boundaries, team work, social skills, perseverance and goal-orientation, not to mention the ability to postpone gratification and to work hard to achieve it - are all lacking or missing altogether. The child turned adult sees no reason to invest in his skills and education, convinced that his inherent genius should suffice. He feels entitled for merely being, rather than for actually doing (rather as the nobility in days gone by felt entitled not by virtue of its merit but as the inevitable, foreordained outcome of its birth right). In other words, he is not meritocratic - but aristocratic. In short: a narcissist is born.

But such a mental structure is brittle, susceptible to criticism and disagreement, vulnerable to the incessant encounter with a harsh and intolerant world. Deep inside, narcissists of both kinds (those wrought by "classic" abuse and those yielded by being idolized) - feel inadequate, phony, fake, inferior, and deserving of punishment. This is Millon's mistake. He makes a distinction between several types of narcissists. He wrongly assumes that the "classic" narcissist is the outcome of overvaluation, idolization, and spoiling and, thus, is possessed of supreme, unchallenged, self-confidence, and is devoid of all self-doubt. According to Millon, it is the "compensatory" narcissist that falls prey to nagging self-doubts, feelings of inferiority, and a masochistic desire for self-punishment. Yet, the distinction is both wrong and unnecessary. There is only ONE type of narcissist - though there are TWO developmental paths to it. And ALL narcissists are besieged by deeply ingrained (though at times not conscious) feelings of inadequacy, fears of failure, masochistic desires to be penalized, a fluctuating sense of self-worth (regulated by Narcissistic Supply), and an overwhelming sensation of fakeness.

The Grandiosity Gap (between a fantastically grandiose - and unlimited - self-image and actual - limited - accomplishments and achievements) is grating. Its recurrence threatens the precariously balanced house of cards that is the narcissistic personality. The narcissist finds, to his chagrin, that people out there are much less admiring, accommodating and accepting than his parents. As he grows old, the narcissist often become the target of constant derision and mockery, a sorry sight indeed. His claims for superiority appear less plausible and substantial the more and the longer he makes them.

Pathological narcissism - originally a defense mechanism intended to shield the narcissist from an injurious world - becomes the main source of hurt, a generator of injuries, counterproductive and dangerous. Overwhelmed by negative or absent Narcissistic Supply, the narcissist is forced to let go of it.

The narcissist then resorts to self-delusion. Unable to completely ignore contrarian opinion and data - he transmutes them. Unable to face the dismal failure that he is, the narcissist partially withdraws from reality. To soothe and salve the pain of disillusionment, he administers to his aching soul a mixture of lies, distortions, half-truths and outlandish interpretations of events around him. These solutions can be classified thus:

The Delusional Narrative Solution

The narcissist constructs a narrative in which he figures as the hero - brilliant, perfect, irresistibly handsome, destined for great things, entitled, powerful, wealthy, the centre of attention, etc. The bigger the strain on this delusional charade - the greater the gap between fantasy and reality - the more the delusion coalesces and solidifies.

Finally, if it is sufficiently protracted, it replaces reality and the narcissist's reality test deteriorates. He withdraws his bridges and may become schizotypal, catatonic, or schizoid.

The Antisocial Solution

The narcissist renounces reality. To his mind, those who pusillanimously fail to recognize his unbound talents, innate superiority, overarching brilliance, benevolent nature, entitlement, cosmically important mission, perfection, etc. - do not deserve consideration. The narcissist's natural affinity with the criminal - his lack of empathy and compassion, his deficient social skills, his disregard for social laws and morals - now erupt and blossom. He becomes a full fledged antisocial (sociopath or psychopath). He ignores the wishes and needs of others, he breaks the law, he violates all rights - natural and legal, he holds people in contempt and disdain, he derides society and its codes, he punishes the ignorant ingrates - that, to his mind, drove him to this state - by acting criminally and by jeopardizing their safety, lives, or property.

The Paranoid Schizoid Solution

When narcissism fails as a defense mechanism, the narcissist develops paranoid narratives: self-directed confabulations which place him at the center of others' allegedly malign attention. The narcissist becomes his own audience and self-sufficient as his own, sometimes exclusive, source of narcissistic supply.

The narcissist develops persecutory delusions. He perceives slights and insults where none were intended. He becomes subject to ideas of reference (people are gossiping about him, mocking him, prying into his affairs, cracking his e-mail, etc.). He is convinced that he is the centre of malign and mal-intentioned attention. People are conspiring to humiliate him, punish him, abscond with his property, delude him, impoverish him, confine him physically or intellectually, censor him, impose on his time, force him to action (or to inaction), frighten him, coerce him, surround and besiege him, change his mind, part with his values, victimize or even murder him, and so on.

Some narcissists withdraw completely from a world populated with such minacious and ominous objects (really projections of internal objects and processes). They avoid all social contact, except the most necessary. They refrain from meeting people, falling in love, having sex, talking to others, or even corresponding with them. In short: they become schizoids - not out of social shyness, but out of what they feel to be their choice. "This evil, hopeless world does not deserve me" - goes the inner refrain - "and I shall waste none of my time and resources on it."

The Paranoid Aggressive (Explosive) Solution

Other narcissists who develop persecutory delusions, resort to an aggressive stance, a more violent resolution of their internal conflict. They become verbally, psychologically, situationally (and, very rarely, physically) abusive. They insult, castigate, chastise, berate, demean, and deride their nearest and dearest (often well wishers and loved ones). They explode in unprovoked displays of indignation, righteousness, condemnation, and blame. Theirs is an exegetic Bedlam. They interpret everything - even the most innocuous, inadvertent, and innocent comment - as designed to provoke and humiliate them. They sow fear, revulsion, hate, and malignant envy. They flail against the windmills of reality - a pathetic, forlorn, sight. But often they cause real and lasting damage - fortunately, mainly to themselves.

The Masochistic Avoidant Solution

The narcissist is angered by the lack of narcissistic supply. He directs some of this fury inwards, punishing himself for his "failure". This masochistic behavior has the added "benefit" of forcing the narcissist's closest to assume the roles of dismayed spectators or of persecutors and thus, either way, to pay him the attention that he craves.

Self-administered punishment often manifests as self-handicapping masochism - a narcissistic cop-out. By undermining his work, his relationships, and his efforts, the increasingly fragile narcissist avoids additional criticism and censure (negative supply). Self-inflicted failure is the narcissist's doing and thus proves that he is the master of his own fate.

Masochistic narcissists keep finding themselves in self-defeating circumstances which render success impossible - and "an objective assessment of their performance improbable" (Millon, 2000). They act carelessly, withdraw in mid-effort, are constantly fatigued, bored, or disaffected and thus passive-aggressively sabotage their lives. Their suffering is defiant and by "deciding to abort" they reassert their omnipotence.

The narcissist's pronounced and public misery and self-pity are compensatory and "reinforce (his) self-esteem against overwhelming convictions of worthlessness" (Millon, 2000). His tribulations and anguish render him, in his eyes, unique, saintly, virtuous, righteous, resilient, and significant. They are, in other words, self-generated narcissistic supply.

Thus, paradoxically, the worst his anguish and unhappiness, the more relieved and elated such a narcissist feels!

tereza zusammen ;) said...

maybe you find interesting
Derrida recounts the story of Echo and Narcissus...

xtina said...

I looked it up and its great, but the video stops at the most critical point:"how two blind people love each other?that's the question"
I guess he would go on in his favorite manner, saying that "we do only what we cannot do", that the impossible love, is the only love, beyond the limits of the self.
And that's the basis of all tragedies.

tereza zusammen ;) said...

there is no answer to that question i'm afraid, or at least, he has no answer..but perhaps Janus would be more appropriate for Narcissus than Echo. after all, it's all about a passage

and by the way interesting work Xtina!

xtina said...

the appreciation is mutual!