“I Can Achieve and Do Anything If I Only Put My Mind to It”

By Sam Vaknin
Author of “Malignant Self-love: Narcissism Revisited”
From an early age we are taught (at least in the USA) that there is no limit to what we can achieve; that if we wish to accomplish something all we need to do is set ourselves goals and then apply ourselves to their attainment. With time and dedication, we are told, positive outcomes are guaranteed and ineluctable no matter how high we set the bar. There are no unrealistic aspirations – only insufficient perspiration and lacking inspiration!
This is a narcissistic and delusional narrative. It is counterproductive because in reality we do have limitations, we suffer defeats, and we make mistakes. No one is infallible, invincible, omnipotent, or omniscient.
But, exposed to this onslaught of propaganda, aimed at boosting our self-esteem and puffing up our self-confidence, when, inevitably, we fail in some of our endeavors – we tend to blame ourselves: “If only I had tried harder”, or “I am such a loser, a lazy good-for-nothing, I never get it right!”
Such inner sadistic voices tend to deplete our energy and discourage us from trying again. In hock to the official line that casts us as absolute masters of our own fate, we’d rather abstain than be proven wrong. By attributing failures to our failings, we become the reification of our own “bad fortune” or “indolence”. We give up on life’s challenges, engulfed by fatalism and defeatism.
Some of us choose another path: “If I botched and bungled it, surely I didn’t want it that badly” (a reaction known as “cognitive dissonance”). This kind of self-deception is equally self-destructive. It teaches us that nothing really matters, everything is fun and games and should not be taken too seriously. Reality and personal history are what you make of them and are subjects to re-writing, reframing, and outright confabulation.
How to avoid these pitfalls?
First, you should develop a realistic gauge of your fortes and weaknesses, talents and shortcomings, skills and limitations. Make a list of your own positive and negative traits. Ask others – family members, friends, co-workers, people who know you well – to commit to paper their observations: your good and bad sides. If they are reluctant to risk your ire find a way to allow them to submit their input anonymously.
Now, compare the lists: the one that you have generated with the ones others have provided. Are they largely in agreement? If they are, it means that you know yourself well and that you evaluate your capabilities or lack thereof courageously and objectively.
If, however, there is an abyss between the way you see yourself and the way others view you, something is wrong with your self-assessment.
Concentrate on the questionnaires of those who know you best, longest, and in a variety of situations. Single out their responses which conflict with yours. Proceed to grade these answers on a scale of 1 to 5 with 5 being “I completely agree”. Isolate those reactions and descriptions that you have rated most highly. Are you ready to change your mind about some issues? Do you recognize yourself in some of this feedback? Give yourself time to digest all this conflicting information. Think about it hard and long. Can you come up with incidents and events in the past which support your view – or theirs? Try to return to your list and re-do it in light of these new data.
This protracted inner dialog is important. You are bound to emerge from it with a better, more functional appraisal of yourself. You will learn to set goals that are realistic are are unlikely to result in frustration and emotional pain. Getting acquainted with your limitations is the first step towards a balanced, mentally hale life. You and your nearest and dearest will benefit from it immensely.
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Loving Gaze, Adulating Gaze

By Sam Vaknin
Author of “Malignant Self-love: Narcissism Revisited”

In the film “The Beaver”, the character played by Mel Gibson suffers from depression. He latches on to a tattered puppet in the shape of a beaver and communicates exclusively through it. The Beaver is everything its ostensible master isn’t: daring, creative, exuberant, omnipotent, and omniscient, gregarious, resourceful, charismatic, and charming; a good father, good CEO, and good company all around. In short: The Beaver is the reification of the protagonist’s False Self.

When his wife (Jodi Foster) confronts him, having exposed his confabulations and the need to let go of the contraption, The Beaver rages at her and asserts its superiority, invincibility, and brilliance. The depressive Walter – the True Self – is derided by The Beaver as a dysfunctional wreck, utterly dependent on the former’s ministrations and the interference it runs on his behalf. The film ends unrealistically with Walter mutilating his body – literally – in order to rid himself of the domineering and all-pervasive appendage. “Unrealistically” because narcissists never succeed in resuscitating their dilapidated and crushed True Self. The narcissist IS his False Self: in real life, Walter should have been devoured and consumed by The Beaver – but then we would not have had a typical, syrupy Happy Ending, now, would we?

Both the True Self and the False Self depend on the gaze of others. The False Self relies on adulation and attention – narcissistic supply – for the maintenance of the precarious, confabulated, fantastic, grandiose, and counterfactual narrative that is the narcissist’s persona, his public face. Without a constant flow of such high-quality input and feedback, without the adulating gaze, the narcissist crumbles like a house of ephemeral cards and resorts to a variety of dysfunctional, self-destructive, and self-defeating behaviors and defense mechanisms.

Similarly and equally, the True Self needs a loving gaze to sustain itself. Another person’s love serves two purposes: it confirms the existence of the True Self as a lovable object and thus lays the groundwork and facilitates the necessary and sufficient conditions for self-love; and it allows the True Self to perceive the existence of a “safe”, loving, and holding other. Such insight is at the very foundation of empathy.

Do the False and True Selves ever fight it out, David vs. Goliath, Good vs. Evil, The Beaver vs. Walter?

Alas, they never do. The False Self is concocted by the narcissist to fend off hurt. It is a perfect, impenetrable, impermeable shield, a cocoon; it rewards the narcissist by flooding him with warm, fuzzy, exhilarating feelings; and it sustains the narcissist’s delusions and fantasies. The False Self is the narcissist’s dreams come true. In other words: as far as the narcissist is concerned, the False Self is adaptive and functional. The narcissist is emotionally invested in the False Self and he despises the True Self for having failed to cope with the exigencies and vicissitudes of the narcissist’s life.

PCL-R (Psychopathy Checklist Revised) Test: What’s Wrong with Psychological Tests

The second edition of the PCL-R test, originally designed by the controversial maverick Canadian criminologist Robert Hare in 1980 and again in 1991, contains 20 items designed to rate symptoms which are common among psychopaths in forensic populations (such as prison inmates or child molesters). It is designed to cover the major psychopathic traits and behaviours: callous, selfish, remorseless use of others (Factor 1), chronically unstable and antisocial lifestyle (Factor 2), interpersonal and affective deficits, an impulsive lifestyle and antisocial behaviour.

The twenty traits assessed by the PCL-R score are: glib and superficial charm; grandiose (exaggeratedly high) estimation of self; need for stimulation; pathological lying; cunning and manipulativeness; lack of remorse or guilt; shallow affect (superficial emotional responsiveness); callousness and lack of empathy; parasitic lifestyle; poor behavioral controls; sexual promiscuity; early behavior problems; lack of realistic long-term goals; impulsivity; irresponsibility; failure to accept responsibility for own actions; many short-term marital relationships; juvenile delinquency; revocation of conditional release; and criminal versatility.

Psychopaths score between 30 and 40. Normal people score between 0 and 5. But Hare himself was known to label as psychopaths people with a score as low as 13. The PCL-R is, therefore, an art rather than science and is leaves much to the personal impressions of those who administer it.

The PCL-R is based on a structured interview and collateral data gathered from family, friends, and colleagues and from documents. The questions comprising the structured interview are so transparent and self-evident that it is easy to lie one’s way through the test and completely skew its results. Moreover, scoring by the diagnostician is highly subjective (which is why the DSM and the ICD stick to observable behaviours in its criteria for Antisocial or Dissocial Personality Disorder).

The hope is that information gathered outside the scope of the structured interview will serve to rectify such potential abuse, diagnostic bias, and manipulation by both testee and tester. The PCL-R, in other words, relies on the truthfulness of responses provided by notorious liars (psychopaths) and on the biased memories of multiple witnesses, all of them close to the psychopath and with an axe to grind.

The PCL-R is not the only bad apple in an otherwise healthy crop. Psychological tests are far from scientifically rigorous.

Personality assessment is perhaps more an art form than a science. In an attempt to render it as objective and standardized as possible, generations of clinicians came up with psychological tests and structured interviews. These are administered under similar conditions and use identical stimuli to elicit information from respondents. Thus, any disparity in the responses of the subjects can and is attributed to the idiosyncrasies of their personalities.

Moreover, most tests restrict the repertory of permitted of answers. “True” or “false” are the only allowed reactions to the questions in the Minnesota Multiphasic Personality Inventory II (MMPI-2), for instance. Scoring or keying the results is also an automatic process wherein all “true” responses get one or more points on one or more scales and all “false” responses get none.

This limits the involvement of the diagnostician to the interpretation of the test results (the scale scores). Admittedly, interpretation is arguably more important than data gathering. Thus, inevitably biased human input cannot and is not avoided in the process of personality assessment and evaluation. But its pernicious effect is somewhat reined in by the systematic and impartial nature of the underlying instruments (tests).

Still, rather than rely on one questionnaire and its interpretation, most practitioners administer to the same subject a battery of tests and structured interviews. These often vary in important aspects: their response formats, stimuli, procedures of administration, and scoring methodology. Moreover, in order to establish a test’s reliability, many diagnosticians administer it repeatedly over time to the same client. If the interpreted results are more or less the same, the test is said to be reliable.

The outcomes of various tests must fit in with each other. Put together, they must provide a consistent and coherent picture. If one test yields readings that are constantly at odds with the conclusions of other questionnaires or interviews, it may not be valid. In other words, it may not be measuring what it claims to be measuring.

Thus, a test quantifying one’s grandiosity must conform to the scores of tests which measure reluctance to admit failings or propensity to present a socially desirable and inflated facade (“False Self”). If a grandiosity test is positively related to irrelevant, conceptually independent traits, such as intelligence or depression, it does not render it valid.

Most tests are either objective or projective. The psychologist George Kelly offered this tongue-in-cheek definition of both in a 1958 article titled “Man’s construction of his alternatives” (included in the book “The Assessment of Human Motives”, edited by G.Lindzey):

“When the subject is asked to guess what the examiner is thinking, we call it an objective test; when the examiner tries to guess what the subject is thinking, we call it a projective device.”

The scoring of objective tests is computerized (no human input). Examples of such standardized instruments include the MMPI-II, the California Psychological Inventory (CPI), and the Millon Clinical Multiaxial Inventory II. Of course, a human finally gleans the meaning of the data gathered by these questionnaires. Interpretation ultimately depends on the knowledge, training, experience, skills, and natural gifts of the therapist or diagnostician.

Projective tests are far less structured and thus a lot more ambiguous. As L. K.Frank observed in a 1939 article titled “Projective methods for the study of personality”:

“(The patient’s responses to such tests are projections of his) way of seeing life, his meanings, signficances, patterns, and especially his feelings.”

In projective tests, the responses are not constrained and scoring is done exclusively by humans and involves judgment (and, thus, a modicum of bias). Clinicians rarely agree on the same interpretation and often use competing methods of scoring, yielding disparate results. The diagnostician’s personality comes into prominent play. The best known of these “tests” is the Rorschach set of inkblots.

Here are a few examples:

I. MMPI-2 Test

The MMPI (Minnesota Multiphasic Personality Inventory), composed by Hathaway (a psychologist) and McKinley (a physician) is the outcome of decades of research into personality disorders. The revised version, the MMPI-2 was published in 1989 but was received cautiously. MMPI-2 changed the scoring method and some of the normative data. It was, therefore, hard to compare it to its much hallowed (and oft validated) predecessor.

The MMPI-2 is made of 567 binary (true or false) items (questions). Each item requires the subject to respond: “This is true (or false) as applied to me”. There are no “correct” answers. The test booklet allows the diagnostician to provide a rough assessment of the patient (the “basic scales”) based on the first 370 queries (though it is recommended to administer all of 567 of them).

Based on numerous studies, the items are arranged in scales. The responses are compared to answers provided by “control subjects”. The scales allow the diagnostician to identify traits and mental health problems based on these comparisons. In other words, there are no answers that are “typical to paranoid or narcissistic or antisocial patients”. There are only responses that deviate from an overall statistical pattern and conform to the reaction patterns of other patients with similar scores. The nature of the deviation determines the patient’s traits and tendencies – but not his or her diagnosis!

The interpreted outcomes of the MMPI-2 are phrased thus: “The test results place subject X in this group of patients who, statistically-speaking, reacted similarly. The test results also set subject X apart from these groups of people who, statistically-speaking, responded differently”. The test results would never say: “Subject X suffers from (this or that) mental health problem”.

There are three validity scales and ten clinical ones in the original MMPI-2, but other scholars derived hundreds of additional scales. For instance: to help in diagnosing personality disorders, most diagnosticians use either the MMPI-I with the Morey-Waugh-Blashfield scales in conjunction with the Wiggins content scales – or (more rarely) the MMPI-2 updated to include the Colligan-Morey-Offord scales.

The validity scales indicate whether the patient responded truthfully and accurately or was trying to manipulate the test. They pick up patterns. Some patients want to appear normal (or abnormal) and consistently choose what they believe are the “correct” answers. This kind of behavior triggers the validity scales. These are so sensitive that they can indicate whether the subject lost his or her place on the answer sheet and was responding randomly! The validity scales also alert the diagnostician to problems in reading comprehension and other inconsistencies in response patterns.

The clinical scales are dimensional (though not multiphasic as the test’s misleading name implies). They measure hypochondriasis, depression, hysteria, psychopathic deviation, masculinity-femininity, paranoia, psychasthenia, schizophrenia, hypomania, and social introversion. There are also scales for alcoholism, post-traumatic stress disorder, and personality disorders.

The interpretation of the MMPI-2 is now fully computerized. The computer is fed with the patients’ age, sex, educational level, and marital status and does the rest. Still, many scholars have criticized the scoring of the MMPI-2.

II. MCMI-III Test

The third edition of this popular test, the Millon Clinical Multiaxial Inventory (MCMI-III), has been published in 1996. With 175 items, it is much shorter and simpler to administer and to interpret than the MMPI-II. The MCMI-III diagnoses personality disorders and Axis I disorders but not other mental health problems. The inventory is based on Millon’s suggested multiaxial model in which long-term characteristics and traits interact with clinical symptoms.

The questions in the MCMI-III reflect the diagnostic criteria of the DSM. Millon himself gives this example (Millon and Davis, Personality Disorders in Modern Life, 2000, pp. 83-84):

“… (T)he first criterion from the DSM-IV dependent personality disorder reads ‘Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others,’ and its parallel MCMI-III item reads ‘People can easily change my ideas, even if I thought my mind was made up.'”

The MCMI-III consists of 24 clinical scales and 3 modifier scales. The modifier scales serve to identify Disclosure (a tendency to hide a pathology or to exaggerate it), Desirability (a bias towards socially desirable responses), and Debasement (endorsing only responses that are highly suggestive of pathology). Next, the Clinical Personality Patterns (scales) which represent mild to moderate pathologies of personality, are: Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive (Sadistic), Compulsive, Negativistic, and Masochistic. Millon considers only the Schizotypal, Borderline, and Paranoid to be severe personality pathologies and dedicates the next three scales to them.

The last ten scales are dedicated to Axis I and other clinical syndromes: Anxiety Disorder, Somatoform Disorder, Bipolar Manic Disorder, Dysthymic Disorder, Alcohol Dependence, Drug Dependence, Posttraumatic Stress, Thought Disorder, Major Depression, and Delusional Disorder.

Scoring is easy and runs from 0 to 115 per each scale, with 85 and above signifying a pathology. The configuration of the results of all 24 scales provides serious and reliable insights into the tested subject.

Critics of the MCMI-III point to its oversimplification of complex cognitive and emotional processes, its over-reliance on a model of human psychology and behavior that is far from proven and not in the mainstream (Millon’s multiaxial model), and its susceptibility to bias in the interpretative phase.

III. Rorschach Inkblot Test

The Swiss psychiatrist Hermann Rorschach developed a set of inkblots to test subjects in his clinical research. In a 1921 monograph (published in English in 1942 and 1951), Rorschach postulated that the blots evoke consistent and similar responses in groups patients. Only ten of the original inkblots are currently in diagnostic use. It was John Exner who systematized the administration and scoring of the test, combining the best of several systems in use at the time (e.g., Beck, Kloper, Rapaport, Singer).

The Rorschach inkblots are ambiguous forms, printed on 18X24 cm. cards, in both black and white and color. Their very ambiguity provokes free associations in the test subject. The diagnostician stimulates the formation of these flights of fantasy by asking questions such as “What is this? What might this be?”. S/he then proceed to record, verbatim, the patient’s responses as well as the inkblot’s spatial position and orientation. An example of such record would read: “Card V upside down, child sitting on a porch and crying, waiting for his mother to return.”

Having gone through the entire deck, the examiner than proceeds to read aloud the responses while asking the patient to explain, in each and every case, why s/he chose to interpret the card the way s/he did. “What in card V prompted you to think of an abandoned child?”. At this phase, the patient is allowed to add details and expand upon his or her original answer. Again, everything is noted and the subject is asked to explain what is the card or in his previous response gave birth to the added details.

Scoring the Rorschach test is a demanding task. Inevitably, due to its “literary” nature, there is no uniform, automated scoring system.

IV. TAT Diagnostic Test

The Thematic Appreciation Test (TAT) is similar to the Rorschach inkblot test. Subjects are shown pictures and asked to tell a story based on what they see. Both these projective assessment tools elicit important information about underlying psychological fears and needs. The TAT was developed in 1935 by Morgan and Murray. Ironically, it was initially used in a study of normal personalities done at Harvard Psychological Clinic.

The test comprises 31 cards. One card is blank and the other thirty include blurred but emotionally powerful (or even disturbing) photographs and drawings. Originally, Murray came up with only 20 cards which he divided to three groups: B (to be shown to Boys Only), G (Girls Only) and M-or-F (both sexes).

The cards expound on universal themes. Card 2, for instance, depicts a country scene. A man is toiling in the background, tilling the field; a woman partly obscures him, carrying books; an old woman stands idly by and watches them both. Card 3BM is dominated by a couch against which is propped a little boy, his head resting on his right arm, a revolver by his side, on the floor.

Card 6GF again features a sofa. A young woman occupies it. Her attention is riveted by a pipe-smoking older man who is talking to her. She is looking back at him over her shoulder, so we don’t have a clear view of her face. Another generic young woman appears in card 12F. But this time, she is juxtaposed against a mildly menacing, grimacing old woman, whose head is covered with a shawl. Men and boys seem to be permanently stressed and dysphoric in the TAT. Card 13MF, for instance, shows a young lad, his lowered head buried in his arm. A woman is bedridden across the room.

With the advent of objective tests, such as the MMPI and the MCMI, projective tests such as the TAT have lost their clout and luster. Today, the TAT is administered infrequently. Modern examiners use 20 cards or less and select them according to their “intuition” as to the patient’s problem areas. In other words, the diagnostician first decides what may be wrong with the patient and only then chooses which cards will be shown in the test! Administered this way, the TAT tends to become a self-fulfilling prophecy and of little diagnostic value.

The patient’s reactions (in the form of brief narratives) are recorded by the tester verbatim. Some examiners prompt the patient to describe the aftermath or outcomes of the stories, but this is a controversial practice.

The TAT is scored and interpreted simultaneously. Murray suggested to identify the hero of each narrative (the figure representing the patient); the inner states and needs of the patient, derived from his or her choices of activities or gratifications; what Murray calls the “press”, the hero’s environment which imposes constraints on the hero’s needs and operations; and the thema, or the motivations developed by the hero in response to all of the above.

Clearly, the TAT is open to almost any interpretative system which emphasizes inner states, motivations, and needs. Indeed, many schools of psychology have their own TAT exegetic schemes. Thus, the TAT may be teaching us more about psychology and psychologists than it does about their patients!

Methodologically, the scorer notes four items for each card:

I. Location – Which parts of the inkblot were singled out or emphasized in the subject’s responses. Did the patient refer to the whole blot, a detail (if so, was it a common or an unusual detail), or the white space.

II. Determinant – Does the blot resemble what the patient saw in it? Which parts of the blot correspond to the subject’s visual fantasy and narrative? Is it the blot’s form, movement, color, texture, dimensionality, shading, or symmetrical pairing?

III. Content – Which of Exner’s 27 content categories was selected by the patient (human figure, animal detail, blood, fire, sex, X-ray, and so on)?

IV. Popularity – The patient’s responses are compared to the overall distribution of answers among people tested hitherto. Statistically, certain cards are linked to specific images and plots. For example: card I often provokes associations of bats or butterflies. The sixth most popular response to card IV is “animal skin or human figure dressed in fur” and so on.

V. Organizational Activity – How coherent and organized is the patient’s narrative and how well does s/he link the various images together?

VI. Form Quality – How well does the patient’s “percept” fit with the blot? There are four grades from superior (+) through ordinary (0) and weak (w) to minus (-). Exner defined minus as:

“(T)he distorted, arbitrary, unrealistic use of form as related to the content offered, where an answer is imposed on the blot area with total, or near total, disregard for the structure of the area.”

The interpretation of the test relies on both the scores obtained and on what we know about mental health disorders. The test teaches the skilled diagnostician how the subject processes information and what is the structure and content of his internal world. These provide meaningful insights into the patient’s defenses, reality test, intelligence, fantasy life, and psychosexual make-up.

Still, the Rorschach test is highly subjective and depends inordinately on the skills and training of the diagnostician. It, therefore, cannot be used to reliably diagnose patients. It merely draws attention to the patients’ defenses and personal style.

V. Structured Interviews

The Structured Clinical Interview (SCID-II) was formulated in 1997 by First, Gibbon, Spitzer, Williams, and Benjamin. It closely follows the language of the DSM-IV Axis II Personality Disorders criteria. Consequently, there are 12 groups of questions corresponding to the 12 personality disorders. The scoring is equally simple: either the trait is absent, subthreshold, true, or there is “inadequate information to code”.

The feature that is unique to the SCID-II is that it can be administered to third parties (a spouse, an informant, a colleague) and still yield a strong diagnostic indication. The test incorporates probes (sort of “control” items) that help verify the presence of certain characteristics and behaviors. Another version of the SCID-II (comprising 119 questions) can also be self-administered. Most practitioners administer both the self-questionnaire and the standard test and use the former to screen for true answers in the latter.

The Structured Interview for Disorders of Personality (SIDP-IV) was composed by Pfohl, Blum and Zimmerman in 1997. Unlike the SCID-II, it also covers the self-defeating personality disorder from the DSM-III. The interview is conversational and the questions are divided into 10 topics such as Emotions or Interests and Activities. Succumbing to “industry” pressure, the authors also came up with a version of the SIDP-IV in which the questions are grouped by personality disorder. Subjects are encouraged to observe the “five year rule”:

“What you are like when you are your usual self … Behaviors. cognitions, and feelings that have predominated for most of the last five years are considered to be representative of your long-term personality functioning …”

The scoring is again simple. Items are either present, subthreshold, present, or strongly present.

VI. Disorder-specific Tests

There are dozens of psychological tests that are disorder-specific: they aim to diagnose specific personality disorders or relationship problems. Example: the Narcissistic Personality Inventory (NPI) which is used to diagnose the Narcissistic Personality Disorder (NPD).

The Borderline Personality Organization Scale (BPO), designed in 1985, sorts the subject’s responses into 30 relevant scales. These indicates the existence of identity diffusion, primitive defenses, and deficient reality testing.

Other much-used tests include the Personality Diagnostic Questionnaire-IV, the Coolidge Axis II Inventory, the Personality Assessment Inventory (1992), the excellent, literature-based, Dimensional assessment of Personality Pathology, and the comprehensive Schedule of Nonadaptive and Adaptive Personality and Wisconsin Personality Disorders Inventory.

Having established the existence of a personality disorder, most diagnosticians proceed to administer other tests intended to reveal how the patient functions in relationships, copes with intimacy, and responds to triggers and life stresses.

The Relationship Styles Questionnaire (RSQ) (1994) contains 30 self-reported items and identifies distinct attachment styles (secure, fearful, preoccupied, and dismissing). The Conflict Tactics Scale (CTS) (1979) is a standardized scale of the frequency and intensity of conflict resolution tactics and stratagems (both legitimate and abusive) used by the subject in various settings (usually in a couple).

The Multidimensional Anger Inventory (MAI) (1986) assesses the frequency of angry responses, their duration, magnitude, mode of expression, hostile outlook, and anger-provoking triggers.

Yet, even a complete battery of tests, administered by experienced professionals sometimes fails to identify abusers with personality disorders. Offenders are uncanny in their ability to deceive their evaluators.

APPENDIX: Common Problems with Psychological Laboratory Tests

Psychological laboratory tests suffer from a series of common philosophical, methodological, and design problems.

A. Philosophical and Design Aspects

  1. Ethical – Experiments involve the patient and others. To achieve results, the subjects have to be ignorant of the reasons for the experiments and their aims. Sometimes even the very performance of an experiment has to remain a secret (double blind experiments). Some experiments may involve unpleasant or even traumatic experiences. This is ethically unacceptable.
  1. The Psychological Uncertainty Principle – The initial state of a human subject in an experiment is usually fully established. But both treatment and experimentation influence the subject and render this knowledge irrelevant. The very processes of measurement and observation influence the human subject and transform him or her – as do life’s circumstances and vicissitudes.
  1. Uniqueness – Psychological experiments are, therefore, bound to be unique, unrepeatable, cannot be replicated elsewhere and at other times even when they are conducted with the SAME subjects. This is because the subjects are never the same due to the aforementioned psychological uncertainty principle. Repeating the experiments with other subjects adversely affects the scientific value of the results.
  1. The undergeneration of testable hypotheses – Psychology does not generate a sufficient number of hypotheses, which can be subjected to scientific testing. This has to do with the fabulous (=storytelling) nature of psychology. In a way, psychology has affinity with some private languages. It is a form of art and, as such, is self-sufficient and self-contained. If structural, internal constraints are met – a statement is deemed true even if it does not satisfy external scientific requirements.

B. Methodology

1. Many psychological lab tests are not blind. The experimenter is fully aware who among his subjects has the traits and behaviors that the test is supposed to identify and predict. This foreknowledge may give rise to experimenter effects and biases. Thus, when testing for the prevalence and intensity of fear conditioning among psychopaths (e.g., Birbaumer, 2005), the subjects were first diagnosed with psychopathy (using the PCL-R questionnaire) and only then underwent the experiment. Thus, we are left in the dark as to whether the test results (deficient fear conditioning) can actually predict or retrodict psychopathy (i.e., high PCL-R scores and typical life histories).

2. In many cases, the results can be linked to multiple causes. This gives rise to questionable cause fallacies in the interpretation of test outcomes. In the aforementioned example, the vanishingly low pain aversion of psychopaths may have more to do with peer-posturing  than with a high tolerance of pain: psychopaths may simply be too embarrassed to “succumb” to pain; any admission of vulnerability is perceived by them as a threat to an omnipotent and grandiose self-image that is sang-froid and, therefore, impervious to pain. It may also be connected to inappropriate affect.

3. Most psychological lab tests involve tiny samples (as few as 3 subjects!) and interrupted time series. The fewer the subjects, the more random and less significant are the results. Type III errors and issues pertaining to the processing of data garnered in interrupted time series are common.

4. The interpretation of test results often verges on metaphysics rather than science. Thus, the Birbaumer test established that subjects who scored high on the PCL-R have different patterns of skin conductance (sweating in anticipation of painful stimuli) and brain activity. It did not substantiate, let alone prove, the existence or absence of specific mental states or psychological constructs.

5. Most lab tests deal with tokens of certain types of phenomena. Again: the fear conditioning (anticipatory aversion) test pertains only to reactions in anticipation of an instance (token) of a certain type of pain. It does not necessarily apply to other types of pain or to other tokens of this type or any other type of pain.

6. Many psychological lab tests give rise to the petitio principii (begging the question) logical fallacy. Again, let us revisit Birbaumer’s test. It deals with people whose behavior is designated as “antisocial”. But what constitute antisocial traits and conduct? The answer is culture-bound. Not surprisingly, European psychopaths score far lower on the PCL-R than their American counterparts. The very validity of the construct “psychopath” is, therefore, in question: psychopathy seems to be merely what the PCL-R measures!

7. Finally, the “Clockwork Orange” objection: psychological lab tests have frequently been abused by reprehensible regimes for purposes of social control  and social engineering.

Obama’s Narcissism Made Worse in First Year in Office

Predictably, Barack Obama’s narcissistic behaviours grew worse and more visible during his first year in office. As I noted in a radio interview (an observation later picked up by George F. Will), Obama’s first person “pronoun density” has increased since his inauguration. Properly measured, first person pronoun density reflects the number of times a person substitutes first person pronouns for more appropriate third and other person pronouns. Thus, to say: “My country, right or wrong” is not indicative of a narcissistic self-preoccupation; but the sentence: “The Russians were afraid of me” is improper because, clearly, the Russians are not afraid of any single individual: they are afraid of what he or she represents. Thus, context counts. It is wrong to merely count the times Obama has used “I”, “my”, or “mine” in his speeches and utterances (as George F. Will did).

Obama’s pronoun density has doubled between January 20, 2009 and October 2009. It then subsided, though it is still about 50% over the level exhibited during his election campaign. This would seem to indicate that his pathological narcissism has been exacerbated in office as he was probably basking in media attention and the trappings of power. The backlash, such as it was, against several of his more egregious behaviours and faux-pas led him to modify his conduct and pay closer attention to his syntax and grammar: Obama is now acting modest. False modesty is another hallmark of raging, malignant narcissism.

Obama’s body language has become more pronounced and haughty while in office. For example: I measured the number of times he tilted his head upwards and in an angle during speeches and public appearances (literally gazing skywards and avoiding eye contact with his public). The frequency of this particular gesture increased dramatically (almost threefold!) this past year. It is part and parcel of the narcissist’s “haughty posture” and his attempt to project omniscience, vision, and a cosmic-messianic mission. Similarly telling gestures and postures have proliferated after Obama has assumed office.

Another sign of Obama’s growing malignant narcissism is his lowered Adversity Tolerance Threshold. I compared the number of times he snapped at critics and journalists during the election campaign and after he became President. The frequency of such temper tantrums has increased, though not drastically. Obama is still maintaining thespian self-control when it comes to the media and to his carefully-cultivated public image. Where he doesn’t bother anymore to project benevolence and maturity is with his staff: he is markedly and openly more aggressive and dismissive of his co-workers, underlings, crew, and team, clearly relishing his quasi-sadistic outbursts and their public verbal whipping.

In the following text, titled “Barack Obama – Narcissist or Merely Narcissistic?”, I was the first to suugest that Barack Obama may be suffering from Narcissistic Personality Disorder (NPD):

“Barack Obama appears to be a narcissist. Scroll down for a detailed treatment.

Granted, only a qualified mental health diagnostician can determine whether someone suffers from Narcissistic Personality Disorder (NPD) and this, following lengthy tests and personal interviews. Read the Disclaimer below. But, in the absence of access to Barack Obama, one has to rely on his overt performance and on testimonies by his closest, nearest and dearest.

Narcissistic leaders are nefarious and their effects pernicious. They are subtle, refined, socially-adept, manipulative, possessed of thespian skills, and convincing. Both types equally lack empathy and are ruthless and relentless or driven.

Perhaps it is time to require each candidate to high office in the USA to submit to a rigorous physical and mental checkup with the results made public.

I. Upbringing and Childhood

Obama’s early life was decidedly chaotic and replete with traumatic and mentally bruising dislocations. Mixed-race marriages were even less common then. His parents went through a divorce when he was an infant (two years old). Obama saw his father only once again, before he died in a car accident. Then, his mother re-married and Obama had to relocate to Indonesia: a foreign land with a radically foreign culture, to be raised by a step-father. At the age of ten, he was whisked off to live with his maternal (white) grandparents. He saw his mother only intermittently in the following few years and then she vanished from his life in 1979. She died of cancer in 1995.

Pathological narcissism is a reaction to prolonged abuse and trauma in early childhood or early adolescence. The source of the abuse or trauma is immaterial: the perpetrators could be dysfunctional or absent parents, teachers, other adults, or peers.

II. Behavior Patterns

The narcissist:

  • Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised 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.

Narcissism is a defense mechanism whose role is to deflect hurt and trauma from the victim’s “True Self” into a “False Self” which is omnipotent, invulnerable, and omniscient. This False Self is then used by the narcissist to garner narcissistic supply from his human environment. Narcissistic supply is any form of attention, both positive and negative and it is instrumental in the regulation of the narcissist’s labile sense of self-worth.

Perhaps the most immediately evident trait of patients with Narcissistic Personality Disorder (NPD) is their vulnerability to criticism and disagreement. Subject to negative input, real or imagined, even to a mild rebuke, a constructive suggestion, or an offer to help, they feel injured, humiliated and empty and they react with disdain (devaluation), rage, and defiance.

From my book “Malignant Self Love – Narcissism Revisited”:

“To avoid such intolerable pain, some patients with Narcissistic Personality Disorder (NPD) socially withdraw and feign false modesty and humility to mask their underlying grandiosity. Dysthymic and depressive disorders are common reactions to isolation and feelings of shame and inadequacy.”

Owing to their lack of empathy, disregard for others, exploitativeness, sense of entitlement, and constant need for attention (narcissistic supply), narcissists are rarely able to maintain functional and healthy interpersonal relationships.

Many narcissists are over-achievers and ambitious. Some of them are even talented and skilled. But they are incapable of team work because they cannot tolerate setbacks. They are easily frustrated and demoralized and are unable to cope with disagreement and criticism. Though some narcissists have meteoric and inspiring careers, in the long-run, all of them find it difficult to maintain long-term professional achievements and the respect and appreciation of their peers. The narcissist’s fantastic grandiosity, frequently coupled with a hypomanic mood, is typically incommensurate with his or her real accomplishments (the “grandiosity gap”).

An important distinction is between cerebral and somatic narcissists. The cerebrals derive their Narcissistic Supply from their intelligence or academic achievements and the somatics derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical “conquests”.

Another crucial division within the ranks of patients with Narcissistic Personality Disorder (NPD) is between the classic variety (those who meet five of the nine diagnostic criteria included in the DSM), and the compensatory kind (their narcissism compensates for deep-set feelings of inferiority and lack of self-worth).

Obama displays the following behaviors, which are among the hallmarks of pathological narcissism:

  • Subtly misrepresents facts and expediently and opportunistically shifts positions, views, opinions, and “ideals” (e.g., about campaign finance, re-districting). These flip-flops do not cause him overt distress and are ego-syntonic (he feels justified in acting this way). Alternatively, refuses to commit to a standpoint and, in the process, evidences a lack of empathy.

    Ignores data that conflict with his fantasy world, or with his inflated and grandiose self-image. This has to do with magical thinking. Obama already sees himself as president because he is firmly convinced that his dreams, thoughts, and wishes affect reality. Additionally, he denies the gap between his fantasies and his modest or limited real-life achievements (for instance, in 12 years of academic career, he hasn’t published a single scholarly paper or book).

    Feels that he is above the law, incl. and especially his own laws.

    Talks about himself in the 3rd person singular or uses the regal “we” and craves to be the exclusive center of attention, even adulation

    Has a messianic-cosmic vision of himself and his life and his “mission”. Consequently, sets unrealistic goals within unrealistic timeframes.

    Sets ever more complex rules in a convoluted world of grandiose fantasies with its own language (jargon)

    Displays false modesty and unctuous “folksiness” but unable to sustain these behaviors (the persona, or mask) for long. It slips and the true Obama is revealed: haughty, aloof, distant, and disdainful of simple folk and their lives.

    Sublimates aggression and holds grudges.

    Behaves as an eternal adolescent (e.g., his choice of language, youthful image he projects, demands indulgence and feels entitled to special treatment, even though his objective accomplishments do not justify it).

III. Body Language

Many complain of the incredible deceptive powers of the narcissist. They find themselves involved with narcissists (emotionally, in business, or otherwise) before they have a chance to discover their true character. Shocked by the later revelation, they mourn their inability to separate from the narcissist and their gullibility.

Narcissists are an elusive breed, hard to spot, harder to pinpoint, impossible to capture. Even an experienced mental health diagnostician with unmitigated access to the record and to the person examined would find it fiendishly difficult to determine with any degree of certainty whether someone suffers from a full fledged Narcissistic Personality Disorder – or merely possesses narcissistic traits, a narcissistic style, a personality structure (“character”), or a narcissistic “overlay” superimposed on another mental health problem.

Moreover, it is important to distinguish between traits and behavior patterns that are independent of the patient’s cultural-social context (i.e., which are inherent, or idiosyncratic) – and reactive patterns, or conformity to cultural and social morals and norms. Reactions to severe life crises or circumstances are also often characterized by transient pathological narcissism, for instance (Ronningstam and Gunderson, 1996). But such reactions do not a narcissist make.

When a person belongs to a society or culture that has often been described as narcissistic by scholars (such as Theodore Millon) and social thinkers (e.g., Christopher Lasch) – how much of his behavior can be attributed to his milieu and which of his traits are really his?

The Narcissistic Personality Disorder is rigorously defined in the DSM IV-TR with a set of strict criteria and differential diagnoses.

Narcissism is regarded by many scholars to be an adaptative strategy (“healthy narcissism“). It is considered pathological in the clinical sense only when it becomes a rigid personality structure replete with a series of primitive defence mechanisms (such as splitting, projection, projective identification, or intellectualization) – and when it leads to dysfunctions in one or more areas of the patient’s life.

Pathological narcissism is the art of deception. The narcissist projects a False Self and manages all his social interactions through this concocted fictional construct.

When the narcissist reveals his true colors, it is usually far too late. His victims are unable to separate from him. They are frustrated by this acquired helplessness and angry at themselves for having they failed to see through the narcissist earlier on.

But the narcissist does emit subtle, almost subliminal, signals (“presenting symptoms”) even in a first or casual encounter. Compare the following list to Barack Obama’s body language during his public appearances.

These are:

“Haughty” body language – The narcissist adopts a physical posture which implies and exudes an air of superiority, seniority, hidden powers, mysteriousness, amused indifference, etc. Though the narcissist usually maintains sustained and piercing eye contact, he often refrains from physical proximity (he is “territorial”).

The narcissist takes part in social interactions – even mere banter – condescendingly, from a position of supremacy and faux “magnanimity and largesse”. But he rarely mingles socially and prefers to remain the “observer”, or the “lone wolf”.

Entitlement markers – The narcissist immediately asks for “special treatment” of some kind. Not to wait his turn, to have a longer or a shorter therapeutic session, to talk directly to authority figures (and not to their assistants or secretaries), to be granted special payment terms, to enjoy custom tailored arrangements – or to get served first.

The narcissist is the one who – vocally and demonstratively – demands the undivided attention of the head waiter in a restaurant, or monopolizes the hostess, or latches on to celebrities in a party. The narcissist reacts with rage and indignantly when denied his wishes and if treated equally with others whom he deems inferior.

Idealization or devaluation – The narcissist instantly idealizes or devalues his interlocutor. This depends on how the narcissist appraises the potential his converser has as a Narcissistic Supply Source. The narcissist flatters, adores, admires and applauds the “target” in an embarrassingly exaggerated and profuse manner – or sulks, abuses, and humiliates her.

Narcissists are polite only in the presence of a potential Supply Source. But they are unable to sustain even perfunctory civility and fast deteriorate to barbs and thinly-veiled hostility, to verbal or other violent displays of abuse, rage attacks, or cold detachment.

The “membership” posture – The narcissist always tries to “belong”. Yet, at the very same time, he maintains his stance as an outsider. The narcissist seeks to be admired for his ability to integrate and ingratiate himself without investing the efforts commensurate with such an undertaking.

For instance: if the narcissist talks to a psychologist, the narcissist first states emphatically that he never studied psychology. He then proceeds to make seemingly effortless use of obscure professional terms, thus demonstrating that he mastered the discipline all the same, as an autodidact – which proves that he is exceptionally intelligent or introspective.

In general, the narcissist always prefers show-off to substance. One of the most effective methods of exposing a narcissist is by trying to delve deeper. The narcissist is shallow, a pond pretending to be an ocean. He likes to think of himself as a Renaissance man, a Jack of all trades. The narcissist never admits to ignorance in any field – yet, typically, he is ignorant of them all. It is surprisingly easy to penetrate the gloss and the veneer of the narcissist’s self-proclaimed omniscience.

Bragging and false autobiographyThe narcissist brags incessantly. His speech is peppered with “I”, “my”, “myself”, and “mine”. He describes himself as intelligent, or rich, or modest, or intuitive, or creative – but always excessively, implausibly, and extraordinarily so.

The narcissist’s biography sounds unusually rich and complex. His achievements – incommensurate with his age, education, or renown. Yet, his actual condition is evidently and demonstrably incompatible with his claims. Very often, the narcissist lies or his fantasies are easily discernible. He always name-drops and appropriates other people’s experiences and accomplishments.

Emotion-free language – The narcissist likes to talk about himself and only about himself. He is not interested in others or what they have to say, unless they constitute potential Sources of Supply and in order to obtain said supply. He acts bored, disdainful, even angry, if he feels that they are intruding on his precious time and, thus, abusing him.

In general, the narcissist is very impatient, easily bored, with strong attention deficits – unless and until he is the topic of discussion. One can publicly dissect all aspects of the intimate life of a narcissist without repercussions, providing the discourse is not “emotionally tinted”.

If asked to relate directly to his emotions, the narcissist intellectualizes, rationalizes, speaks about himself in the third person and in a detached “scientific” tone or composes a narrative with a fictitious character in it, suspiciously autobiographical. Narcissists like to refer to themselves in mechanical terms, as efficient automata or machines.

Seriousness and sense of intrusion and coercion – The narcissist is dead serious about himself. He may possess a subtle, wry, and riotous sense of humor, scathing and cynical, but rarely is he self-deprecating. The narcissist regards himself as being on a constant mission, whose importance is cosmic and whose consequences are global. If a scientist – he is always in the throes of revolutionizing science. If a journalist – he is in the middle of the greatest story ever. If a novelist – he is on his way to a Booker or Nobel prize.

This self-misperception is not amenable to light-headedness or self-effacement. The narcissist is easily hurt and insulted (narcissistic injury). Even the most innocuous remarks or acts are interpreted by him as belittling, intruding, or coercive. His time is more valuable than others’ – therefore, it cannot be wasted on unimportant matters such as mere banter or going out for a walk.

Any suggested help, advice, or concerned inquiry are immediately cast by the narcissist as intentional humiliation, implying that the narcissist is in need of help and counsel and, thus, imperfect and less than omnipotent. Any attempt to set an agenda is, to the narcissist, an intimidating act of enslavement. In this sense, the narcissist is both schizoid and paranoid and often entertains ideas of reference.

These – the lack of empathy, the aloofness, the disdain, the sense of entitlement, the constricted sense of humor, the unequal treatment and the paranoia – render the narcissist a social misfit. The narcissist is able to provoke in his milieu, in his casual acquaintances, even in his psychotherapist, the strongest, most avid and furious hatred and revulsion. To his shock, indignation and consternation, he invariably induces in others unbridled aggression.

He is perceived to be asocial at best and, often, antisocial. This, perhaps, is the strongest presenting symptom. One feels ill at ease in the presence of a narcissist for no apparent reason. No matter how charming, intelligent, thought provoking, outgoing, easy going and social the narcissist is – he fails to secure the sympathy of others, a sympathy he is never ready, willing, or able to reciprocate.

IV. Narcissistic and psychopathic Leaders

The narcissistic or psychopathic leader is the culmination and reification of his period, culture, and civilization. He is likely to rise to prominence in narcissistic societies.

The malignant narcissist invents and then projects a false, fictitious, self for the world to fear, or to admire. He maintains a tenuous grasp on reality to start with and this is further exacerbated by the trappings of power. The narcissist’s grandiose self-delusions and fantasies of omnipotence and omniscience are supported by real life authority and the narcissist’s predilection to surround himself with obsequious sycophants.

The narcissist’s personality is so precariously balanced that he cannot tolerate even a hint of criticism and disagreement. Most narcissists are paranoid and suffer from ideas of reference (the delusion that they are being mocked or discussed when they are not). Thus, narcissists often regard themselves as “victims of persecution”.

The narcissistic leader fosters and encourages a personality cult with all the hallmarks of an institutional religion: priesthood, rites, rituals, temples, worship, catechism, mythology. The leader is this religion’s ascetic saint. He monastically denies himself earthly pleasures (or so he claims) in order to be able to dedicate himself fully to his calling.

The narcissistic leader is a monstrously inverted Jesus, sacrificing his life and denying himself so that his people – or humanity at large – should benefit. By surpassing and suppressing his humanity, the narcissistic leader became a distorted version of Nietzsche’s “superman”.

But being a-human or super-human also means being a-sexual and a-moral.

In this restricted sense, narcissistic leaders are post-modernist and moral relativists. They project to the masses an androgynous figure and enhance it by engendering the adoration of nudity and all things “natural” – or by strongly repressing these feelings. But what they refer to as “nature” is not natural at all.

The narcissistic leader invariably proffers an aesthetic of decadence and evil carefully orchestrated and artificial – though it is not perceived this way by him or by his followers. Narcissistic leadership is about reproduced copies, not about originals. It is about the manipulation of symbols – not about veritable atavism or true conservatism.

In short: narcissistic leadership is about theatre, not about life. To enjoy the spectacle (and be subsumed by it), the leader demands the suspension of judgment, depersonalization, and de-realization. Catharsis is tantamount, in this narcissistic dramaturgy, to self-annulment.

Narcissism is nihilistic not only operationally, or ideologically. Its very language and narratives are nihilistic. Narcissism is conspicuous nihilism – and the cult’s leader serves as a role model, annihilating the Man, only to re-appear as a pre-ordained and irresistible force of nature.

Narcissistic leadership often poses as a rebellion against the “old ways” – against the hegemonic culture, the upper classes, the established religions, the superpowers, the corrupt order. Narcissistic movements are puerile, a reaction to narcissistic injuries inflicted upon a narcissistic (and rather psychopathic) toddler nation-state, or group, or upon the leader.

Minorities or “others” – often arbitrarily selected – constitute a perfect, easily identifiable, embodiment of all that is “wrong”. They are accused of being old, they are eerily disembodied, they are cosmopolitan, they are part of the establishment, they are “decadent”, they are hated on religious and socio-economic grounds, or because of their race, sexual orientation, origin … They are different, they are narcissistic (feel and act as morally superior), they are everywhere, they are defenceless, they are credulous, they are adaptable (and thus can be co-opted to collaborate in their own destruction). They are the perfect hate figure. Narcissists thrive on hatred and pathological envy.

This is precisely the source of the fascination with Hitler, diagnosed by Erich Fromm – together with Stalin – as a malignant narcissist. He was an inverted human. His unconscious was his conscious. He acted out our most repressed drives, fantasies, and wishes. He provides us with a glimpse of the horrors that lie beneath the veneer, the barbarians at our personal gates, and what it was like before we invented civilization. Hitler forced us all through a time warp and many did not emerge. He was not the devil. He was one of us. He was what Arendt aptly called the banality of evil. Just an ordinary, mentally disturbed, failure, a member of a mentally disturbed and failing nation, who lived through disturbed and failing times. He was the perfect mirror, a channel, a voice, and the very depth of our souls.

The narcissistic leader prefers the sparkle and glamour of well-orchestrated illusions to the tedium and method of real accomplishments. His reign is all smoke and mirrors, devoid of substances, consisting of mere appearances and mass delusions. In the aftermath of his regime – the narcissistic leader having died, been deposed, or voted out of office – it all unravels. The tireless and constant prestidigitation ceases and the entire edifice crumbles. What looked like an economic miracle turns out to have been a fraud-laced bubble. Loosely-held empires disintegrate. Laboriously assembled business conglomerates go to pieces. “Earth shattering” and “revolutionary” scientific discoveries and theories are discredited. Social experiments end in mayhem.

It is important to understand that the use of violence must be ego-syntonic. It must accord with the self-image of the narcissist. It must abet and sustain his grandiose fantasies and feed his sense of entitlement. It must conform with the narcissistic narrative.

Thus, a narcissist who regards himself as the benefactor of the poor, a member of the common folk, the representative of the disenfranchised, the champion of the dispossessed against the corrupt elite – is highly unlikely to use violence at first.

The pacific mask crumbles when the narcissist has become convinced that the very people he purported to speak for, his constituency, his grassroots fans, the prime sources of his narcissistic supply – have turned against him. At first, in a desperate effort to maintain the fiction underlying his chaotic personality, the narcissist strives to explain away the sudden reversal of sentiment. “The people are being duped by (the media, big industry, the military, the elite, etc.)”, “they don’t really know what they are doing”, “following a rude awakening, they will revert to form”, etc.

When these flimsy attempts to patch a tattered personal mythology fail – the narcissist is injured. Narcissistic injury inevitably leads to narcissistic rage and to a terrifying display of unbridled aggression. The pent-up frustration and hurt translate into devaluation. That which was previously idealized – is now discarded with contempt and hatred.

This primitive defense mechanism is called “splitting”. To the narcissist, things and people are either entirely bad (evil) or entirely good. He projects onto others his own shortcomings and negative emotions, thus becoming a totally good object. A narcissistic leader is likely to justify the butchering of his own people by claiming that they intended to kill him, undo the revolution, devastate the economy, or the country, etc.

The “small people”, the “rank and file”, the “loyal soldiers” of the narcissist – his flock, his nation, his employees – they pay the price. The disillusionment and disenchantment are agonizing. The process of reconstruction, of rising from the ashes, of overcoming the trauma of having been deceived, exploited and manipulated – is drawn-out. It is difficult to trust again, to have faith, to love, to be led, to collaborate. Feelings of shame and guilt engulf the erstwhile followers of the narcissist. This is his sole legacy: a massive post-traumatic stress disorder.

DISCLAIMER

I am not a mental health professional. Still, I have dedicated the last 12 years to the study of personality disorders in general and the Narcissistic Personality Disorder (NPD) in particular. I have authored nine (9) books about these topics, one of which is a Barnes and Noble best-seller (“Malignant Self-love: Narcissism Revisited”). My work is widely cited in scholarly tomes and publications and in the media. My books and the content of my Web site are based on correspondence since 1996 with hundreds of people suffering from the Narcissistic Personality Disorder (narcissists) and with thousands of their family members, friends, therapists, and colleagues.

The Narcissist in Therapy

Interview granted to The New Therapist
By Sam Vaknin
Author of “Malignant Self Love – Narcissism Revisited”

Q. Have you ever been in psychotherapy? If so, was it with a view to managing your narcissism? If not would you consider psychotherapy to be potentially useful to yourself or not?

A. I have attended therapy twice. Once in an attempt to pre-empt the breakdown of the first romantic affair I have had and the second time, I was compelled to by a court order. The first time around, I was not even aware that I had a personality disorder, let alone that I should manage it. The second time around – in the throes of a total meltdown of my world – I finally grasped that something was seriously amiss and was, indeed, in quest for a cure. Alas, psychotherapy proved utterly useless. In my case, it failed to even modify the more egregious forms of misconduct and ill-adaptation. This has to do with the fact that my pathology involves heavy emotional investment (cathexis) in a grandiose, inflated, omnipotent, omniscient, and brilliant False Self. I perceived therapy to be a direct and assaultive challenge to this entrenched self-image.

Q. If forced to choose a therapeutic modality, what would you consider the most potentially valuable for yourself and why?

A. I would opt for CBT (a cognitive-behavioural therapy). It strikes me as cerebral, analytic, and “intellectual”: precisely the traits I admire and which form the dimensions of my self-imputed identity. I feel less threatened when I can avoid directly confronting my emotions. Additionally, CBTs propagate, however subversively and inadvertently, a mechanistic (almost behavioural) view of the psyche. I like it. I often compare myself to a machine or a robot. Positive reinforcements, verbal cues, the emphasis on cognition, inner tapes and narratives (the equivalent of programming) all strike a cord within me.

Q. Pathologically narcissistic clients, it would seem, often end up being forced into therapy more by a difficult context in which they find themselves (a narcissistic wound, the end of a relationship, court-mandated clients, etc.) than as  a result of their soul-searching or awareness that their narcissistic pathology is something that would warrant further understanding. Research also suggests that they are prone to early termination of psychotherapeutic treatments because of the narcissistic wounds they suffer when the therapist will not serve solely as a source of narcissistic supply, but attempts to get beneath this constant need for affirmation. In short, pathological narcissists appear to be difficult to get into therapy and, often, very difficult to keep in therapy. In light of the above, and with reference to the understanding you have of what is of value  to you in preventing your own narcissistic impulses from causing you longer-term difficulties, can you look at a few ideas that you might recommend to therapists who wish to be of as much value as possible to their pathologically narcissistic clients? You have suggested that pathological narcissism cannot be cured. I suspect many therapists might agree in large part with that idea on the basis of their disappointing results with narcissistic clients.  But, as you suggest, therapists might be able to help manage their expressions of narcissism to help moderate the damaging effects of too rampant a narcissistic engagement with other parts of their world. What, if any, are the therapeutic techniques/approaches/ ideas that you think might be most effective in this more humble goal of managing narcissistic pathology.

A. I see most of the problems with the therapist, not with his or her narcissistic client. Therapists must learn to moderate their expectations and control their own narcissistic defences and impulses. Here are a few tips: (1) it is not possible to establish a therapeutic alliance with the narcissist. Equally impossible is to set the agenda. The therapist must learn to let the narcissist win the inevitable power plays and mind games early on, so as to get them out of the way; (2) the therapist should not let the narcissist corrupt him or the therapeutic settings. Narcissists often offer rewards or “bribes” in return for acquiescence and obsequiousness; (3) the aims of the therapy should be modest and infinitesimally incremental. Progress should be marked and attributed to the narcissist, not to the therapist; (4) the therapy should emphasize adaptive behaviour modification, not reinterpretation, reframing, or “healing”. The therapist should let the narcissist identify areas of dysfunction and discomfort zones and, thus, to direct the therapy towards these sore points; (5) The therapist should never take sides (e.g., sympathize with the narcissist’s long-suffering wife), should never challenge the narcissist’s delusions, grandiose fantasies, and False Self, and should never used the reality test as a measure of the narcissist’s accomplishments in therapy. Narcissism is, by definition, a variant of fantastic realism. It is useful to regard the narcissist as an artist, an auteur: his life is his masterpiece. Narcissism is not merely a mental health disorder: it is also an organizing principle and an exegetic framework; Finally (6) Wherever and whenever not detrimental to therapeutic goals, the therapist should provide the narcissist with narcissistic supply in the form of affirmation, acceptance, deserved accolades, sympathy, and appreciation (but not adulation!)

Q. How would you recommend therapists respond most valuably for narcissistic clients when their clients attempt repeatedly to devalue the therapist?

A. The narcissist constantly tests authority figures such as the therapist: are they for real? Are they faking their knowledge, emotions, judgements, opinions, values? Are they reliable: can the narcissist trust their promises and threats? How far will they go? Will they truly punish the narcissist? Are they intelligent as their academic credentials imply? How do they stand in comparison and in relation to the narcissist? This puerile power politics is a part and parcel of the constant, far-reaching, and all-pervasive mind game that the narcissist plays with all his nearest (and dearest). He understands interpersonal interactions in terms of matrices of influence and superiority-inferiority, not as collaborative modes. It is, therefore, very counterproductive to engage in one-upmanship with the narcissist. The therapist should avoid this minefield by conceding defeat immediately when the issue rises. Such “surrender” may “awaken” the narcissist and render him aware of his own pettiness and infantile behaviour. The therapy can then move on to more fertile grounds.

Q. As I read through the tomes you have penned on the subject of narcissism, at least three thoughts occur rather forcefully to me:

1. Your knowledge of the body of professional knowledge on, and insights into, the dynamics of narcissism are so impressive that I feel naturally and ungrudgingly inclined to provide the affirmation you indicate have driven you to become so competent in this field. That is often the case with narcissists in therapy: They are instantly impressive on first meeting but eventually turn out to be insatiably desirous of so much of this mirroring that they overwhelm the therapist. Freud suggested that insight is necessary and sufficient for the cure in therapy.

2. To what extent does your insight on your narcissism moderate or “cure” or help you to manage your pathological expression of it? To what extent do you believe that insight is sufficient for the “cure” in your case?

3. Do you really wish to moderate your narcissistic tendencies or do you feel that they serve you reasonably well in the general cut and thrust of life?

A. Thank you for (1). Yes, the narcissist’s need for narcissistic supply (the mirroring of his perfect, brilliant, omniscient, and omnipotent False Self) is insatiable and overwhelming. He perceives everyone around him – his therapist included and especially – as potential or actual sources of narcissistic supply. It is a delicate balancing act: not giving the narcissist his “due” is likely to alienate and enrage him (he has a strong sense of entitlement, often incommensurate with his real-life achievements), give him too much supply and he clings and extorts. Either way, the therapy is doomed.

Regarding (2): Cognitive understanding of the disorder does not constitute a transforming INSIGHT. In other words, it has no emotional correlate. I did not INTERNALIZE what I have leaned and what I know and understand about my disorder. This new gained knowledge did not become a motivating part of me. It remains an inert and indifferent piece of “wisdom”, with minor influence on my psyche. When I first found out about the Narcissistic Personality Disorder (NPD), I really believed that I could change. I fervently wanted to. This was especially true since my whole world was in shambles. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply are all transforming life crises. I admitted to my problem only having been abandoned, having been rendered destitute, and devastated. I felt that I don’t want any more of this. I wanted to change. And there often were signs that I am changing. And then it faded. I reverted to old form. The “progress” I had made was ephemeral: it evaporated virtually overnight. Many narcissists report the same process of progression followed by recidivist remission and many therapists refuse to treat narcissists because of the Sisyphean frustration involved. I never said that narcissists cannot CHANGE – only that they cannot HEAL. There is a huge difference between behavior modification and a permanent alteration of the psychodynamic landscape. Narcissistic behavior CAN be modified using a cocktail of talk therapy, conditioning, and medication. I have yet to encounter a healed narcissist, though. The emphasis in therapy should thus be placed on accommodating the needs of those closest to the narcissist: spouse, children, colleagues, friends, not on “treating” the narcissist. When the narcissist’s abrasiveness, rage, mood swings, reckless and impulsive behaviors are modified, those around him benefit most. The narcissist’s therapy should devolve into a form of social engineering.

Finally, with respect to your point (3) above:

The narcissist can get better, but rarely does he get well (“heal”). The reason is the narcissist’s enormous life-long, irreplaceable and indispensable emotional investment in his disorder. It serves two critical functions, which together maintain the precariously balanced house of cards called the narcissist’s personality. His disorder endows the narcissist with a sense of uniqueness, of “being special” and it provides him with a rational explanation of his behaviour (an “alibi”). Narcissism is, therefore, a successful adaptive strategy. Thus, paradoxically, the disorder becomes an integral and inseparable part of the narcissist’s inflated self-esteem and vacuous grandiose fantasies.

His False Self (the pivot of his pathological narcissism) is a self-reinforcing mechanism. The narcissist thinks that he is unique BECAUSE he has a False Self. His False Self IS the centre of his “specialness”. Any therapeutic “attack” on the integrity and functioning of the False Self constitutes a threat to the narcissist’s ability to regulate his wildly fluctuating sense of self-worth and an effort to “reduce” him to other people’s mundane and mediocre existence.

The few narcissists that are willing to admit that something is terribly wrong with them, displace their alloplastic defences. Instead of blaming the world, other people, or circumstances beyond their control – they now blame their “disease”. Their disorder become a catch-all, universal explanation for everything that is wrong in their lives and every derided, indefensible and inexcusable behaviour. Their narcissism becomes a “licence to kill”, a liberating force which sets them outside human rules and codes of conduct. Such freedom is so intoxicating and empowering that it is difficult to give up. The narcissist is emotionally attached to only one thing: his disorder. The narcissist loves his disorder, desires it passionately, cultivates it tenderly, is proud of its “achievements” (and in my case, makes a living off it). His emotions are misdirected. Where normal people love others and empathize with them, the narcissist loves his False Self and identifies with it to the exclusion of all else – his True Self included.

Q. If, as you suggest, recidivism is endemic among narcissists and it is a growing problem in the institutions of modern society, do you think there would there be any value in considering more broad-based – even public health-oriented – initiatives that might help to curb the most maladaptive behaviour of pathological narcissists? If so, what would you imagine might be most effective?

A. Governments maintain registries of sex offenders and impose a variety of restrictions on them. Similarly, the authorities should maintain registries of people diagnosed with antisocial, narcissistic, and borderline personality disorders (as well as paranoid-schizophrenics and anyone else whose mental disability may harm society). They should impose limitations on their freedoms. Like sex offenders, albeit owing to different reasons, narcissists and psychopaths are highly recidivistic, lack remorse or empathy, and are predatory. Like sex offenders, they blend well with “normal” people and, like them, they constitute a clear and present danger to their milieu.

The risk of stigmatizing the sick should be offset against concerns of public safety. The risk of driving people away from seeking professional help when they most need it is not great with narcissists and psychopaths: they rarely seek help, or attend therapy. The benefits to society from monitoring these incorrigible misfits and from denying them their “hunting fields” would be immense even in the short-term.

Q. Do you trust the diagnostic systems used to identify pathologically narcissistic people and the medical professionals who use them enough to accurately sort the “bad” narcissists from the “healthy” ones? Is there not a danger of the inherently subjective nature of personality disorder diagnosis prejudicing some people who might fall on the right side of the alleged borderline between pathological and healthy?

A. Narcissists and psychopaths are unlikely to come to the attention of mental health practitioners and be diagnosed unless they have committed some transgression, or have ruined their own lives and the lives of people around them completely. Thus, psychological testing in these cases is likely to be augmented by “anamnetic” case history. More generally, I trust structured interviews and tests such as the MMPI-II to reveal the truth and to be resistant to attempts at manipulation. Don’t forget that narcissists and psychopaths do not feel that they have anything to hide: they are actually proud of their traits and behaviour patterns! They are unlikely to “fake” it for long. Admittedly, pathological narcissism is a spectrum and only the most extreme patients (malignant and psychopathic narcissists), who constitute a clear and present danger to their environment, should be registered and restrained.

The Body as a Torture Chamber

There is one place in which one’s privacy, intimacy, integrity and inviolability are guaranteed: one’s body, a unique temple and a familiar territory of sensa and personal history. The process of chronic disease invades, defiles and desecrates this shrine. It does so publicly, enhancing the sufferer’s sense of helplessness and utter humiliation. Hence the all-pervasive, long-lasting, and, frequently, irreversible effects and outcomes of long-term, intractable illness.

In a way, the torture victim’s own body is rendered his worst enemy. It is corporeal agony that compels the patient to mutate, his identity to fragment, his ideals and principles to crumble. The body becomes an accomplice of the affliction, an uninterruptible channel of communication, a treasonous, poisoned territory.

It fosters a humiliating dependency of the abused on medicines, doctors, and bureaucracies. The impersonal character of modern healthcare objectifies the patient, further adding to his or her alienation. Bodily needs denied in the course of the ailment – sleep, toilet, food, water – are wrongly perceived by the victim as the direct causes of his degradation and dehumanization. As he sees it, he is rendered bestial not by the inadequacies of society and medicine but by his own flesh.

The concept of “body” can easily be extended to “family”, or “home”. One’s sickness often affects kin and kith, compatriots, or colleagues. The inexorable processes of degeneration and decrepitude disrupt the continuity of “surroundings, habits, appearance, relations with others”, as the CIA put it in one of its torture manuals. A sense of cohesive self-identity depends crucially on the familiar and the continuous. By attacking both one’s biological body and one’s “social body”, the patient’s psyche is strained to the point of dissociation.

Beatrice Patsalides describes this transmogrification thus in “Ethics of the Unspeakable: Torture Survivors in Psychoanalytic Treatment” (it applies equally well to hospital settings, for instance, or to the patient’s death-bed):

“As the gap between the ‘I’ and the ‘me’ deepens, dissociation and alienation increase. The subject that, under torture (read: disease – SV), was forced into the position of pure object has lost his or her sense of interiority, intimacy, and privacy. Time is experienced now, in the present only, and perspective – that which allows for a sense of relativity – is foreclosed. Thoughts and dreams attack the mind and invade the body as if the protective skin that normally contains our thoughts, gives us space to breathe in between the thought and the thing being thought about, and separates between inside and outside, past and present, me and you, was lost.”

Illness robs the patient of the most basic modes of relating to reality and, thus, is the equivalent of cognitive death. Space and time are warped by sleep deprivation. The self (“I”) is shattered. The chronically sick have nothing familiar to hold on to: family, home, personal belongings, loved ones, language, name. Gradually, they lose their mental resilience and sense of freedom. They feel alien: unable to communicate, relate, attach, or empathize with others.

Terminal or debilitating illness splinters early childhood grandiose narcissistic fantasies of uniqueness, omnipotence, invulnerability, and impenetrability. But it enhances the fantasy of merger with an idealized and omnipotent (though not benign) other: the medical doctor, often the inflictor of agony. The twin processes of individuation and separation are reversed.

Being treated for an illness is the ultimate act of perverted intimacy. The medical professional invades the victim’s body, or probes his psyche (if he is a psychiatrist). Bed-ridden, deprived of contact with others and starved for human interactions, the patient bonds with his caregiver (hence pathological phenomena such as the Munchhausen Syndrome). “Traumatic bonding”, akin to the Stockholm Syndrome, is about hope and the search for meaning in the brutal and indifferent and nightmarish universe of the hospital or the outpatient clinic.

The medical doctor becomes the black hole at the centre of the victim’s surrealistic galaxy, sucking in the sufferer’s universal need for solace. The victim tries to “control” his caregiver by becoming one with him (introjecting him) and by appealing to the practitioner’s presumably merely desensitized humanity and empathy.

This bonding is especially strong when the doctor and the patient form a dyad and “collaborate” in the rituals and acts of treatment (for instance, when the victim is asked to select the implements and the types of surgery to be inflicted or to choose between two equally vile and agonizing “cures”).

The psychologist Shirley Spitz offers this powerful overview of the contradictory nature of torture in a seminar titled “The Psychology of Torture” (1989). Substitute the words “chronic and terminal illness” for “torture” in the following text:

“Torture is an obscenity in that it joins what is most private with what is most public. Torture entails all the isolation and extreme solitude of privacy with none of the usual security embodied therein… Torture entails at the same time all the self-exposure of the utterly public with none of its possibilities for camaraderie or shared experience. (The presence of an all powerful other with whom to merge, without the security of the other’s benign intentions.)

A further obscenity of torture is the inversion it makes of intimate human relationships. The interrogation is a form of social encounter in which the normal rules of communicating, of relating, of intimacy are manipulated. Dependency needs are elicited by the interrogator, but not so they may be met as in close relationships, but to weaken and confuse. Independence that is offered in return for ‘betrayal’ is a lie. Silence is intentionally misinterpreted either as confirmation of information or as guilt for ‘complicity’.

Torture combines complete humiliating exposure with utter devastating isolation. The final products and outcome of torture are a scarred and often shattered victim and an empty display of the fiction of power.”

Obsessed by endless ruminations, demented by pain and a continuum of sleeplessness, the patient regresses, shedding all but the most primitive defence mechanisms: splitting, narcissism, dissociation, Projective Identification, introjection, and cognitive dissonance. The sick person constructs an alternative world, suffering in extremis from depersonalization and derealisation, hallucinations, ideas of reference, delusions, and psychotic episodes.

Some patients come to crave pain – very much as self-mutilators do – because it is a proof and a reminder of their individuated existence otherwise blurred by the incessant process of disease. Pain shields the sufferer from disintegration and capitulation. It preserves the veracity of his unthinkable and unspeakable experiences. Pain is like a decoration for valour and courage under fire: something to be proud of and flaunt.

These dual processes of the patient’s alienation, on the one hand and his addiction to anguish on the other hand complement his view of himself as increasingly “inhuman”, or “subhuman”. The medical doctor assumes the position of the sole authority, the exclusive fount of meaning and interpretation, the source of both evil and good. The patient is self-vitiated.

Illness can be perceived as a reprogramming the patient to succumb to an alternative exegesis of the world, proffered by the medical profession. It is an act of deep, indelible, traumatic indoctrination. The sick typically swallow whole and assimilate the doctors’ point of view and their opinions (regarding the patients as objects, statistics, or corpses-in-the-making) and at times, as a result, are rendered suicidal, self-destructive, or self-defeating.

Chronic disease has no cut-off date. The sounds, the voices, the smells, the sensations reverberate long after each episode has ended: both in nightmares and in waking moments. The patient’s ability to trust the rationality and benevolence of the world has been irrevocably undermined. Social institutions are perceived as precariously poised on the verge of an ominous, Kafkaesque mutation. Nothing is either safe or credible anymore.

Long-term patients typically react by undulating between emotional numbing and increased arousal: insomnia, irritability, restlessness, and attention deficits. Recollections of the traumatic events intrude in the form of dreams, night terrors, flashbacks, and distressing associations.

The sick develop compulsive rituals to fend off obsessive thoughts. Other psychological sequelae reported include cognitive impairment, reduced capacity to learn, memory disorders, sexual dysfunction, social withdrawal, inability to maintain long-term relationships, or even mere intimacy, phobias, ideas of reference and superstitions, delusions, hallucinations, psychotic microepisodes, and emotional flatness.

Depression and anxiety are very common. These are forms and manifestations of self-directed aggression. The sufferer rages at his own victimhood and resultant multiple dysfunctions. He feels shamed by his new disabilities and responsible, or even guilty, somehow, for his predicament and the dire consequences borne by his nearest and dearest. His sense of self-worth and self-esteem are crippled.

In a nutshell, the terminally and chronically ill suffer from Complex Post-Traumatic Stress Disorder (PTSD). Their strong feelings of anxiety, guilt, and shame are also typical of victims of childhood abuse, torture, domestic violence, and rape. They feel anxious because the disease’s “behaviour”, progression, and trajectory are seemingly arbitrary and unpredictable – or mechanically and inhumanly regular.

They feel guilty and disgraced because, to restore a semblance of order to their shattered world and a modicum of dominion over their chaotic life, they need to transform themselves into the cause of their own degradation and the accomplices of their torment.

Inevitably, in the aftermath of bodily trauma and protracted illness, the victims feel helpless and powerless. This loss of control over one’s life and body is manifested physically in impotence, attention deficits, and insomnia. This is often exacerbated by the disbelief many patients encounter when they try to share their experiences, especially if they are unable to produce scars, or other “objective” proof of their ordeal. Language cannot communicate such an intensely private experience as pain.

Spitz makes the following observation:

“Pain is also unsharable in that it is resistant to language… All our interior states of consciousness: emotional, perceptual, cognitive and somatic can be described as having an object in the external world… This affirms our capacity to move beyond the boundaries of our body into the external, sharable world. This is the space in which we interact and communicate with our environment. But when we explore the interior state of physical pain we find that there is no object ‘out there’ – no external, referential content. Pain is not of, or for, anything. Pain is. And it draws us away from the space of interaction, the sharable world, inwards. It draws us into the boundaries of our body.”

Bystanders resent and shun the sick because they make them feel anxious. The ill threaten the healthy person’s sense of security and her much-needed belief in predictability, justice, and rule of natural law. The patients, on their part, do not believe that it is possible to effectively communicate to “outsiders” what they have been through. The torture chambers known as hospital wards are “another galaxy”. This is how Auschwitz was described by the author K. Zetnik in his testimony in the Eichmann trial in Jerusalem in 1961.

But, more often, continued attempts to repress fearful memories result in psychosomatic illnesses (conversion). The patient wishes to forget the pain, to avoid re-experiencing the often life threatening episodes and eruptions and to shield his human environment from the horrors. In conjunction with the patient’s pervasive distrust, this is frequently interpreted as recalcitrance or hostility.

Narcissistic Injury, Narcissistic Wound, and Narcissistic Scar

Narcissistic Injury

An occasional or circumstantial threat (real or imagined) to the narcissist’s grandiose and fantastic self-perception (False Self) as perfect, omnipotent, omniscient, and entitled to special treatment and recognition, regardless of his actual accomplishments (or lack thereof).

Narcissistic Wound

A repeated or recurrent identical or similar threat (real or imagined) to the narcissist’s grandiose and fantastic self-perception (False Self) as perfect, omnipotent, omniscient, and entitled to special treatment and recognition, regardless of his actual accomplishments (or lack thereof).

Narcissistic Scar

A repeated or recurrent psychological defence against a narcissistic wound. Such a narcissistic defence is intended to sustain and preserve the narcissist’s grandiose and fantastic self-perception (False Self) as perfect, omnipotent, omniscient, and entitled to special treatment and recognition, regardless of his actual accomplishments (or lack thereof).

Narcissists invariably react with narcissistic rage to narcissistic injury.

These two terms bear clarification (also see note):

Narcissistic Injury

Any threat (real or imagined) to the narcissist’s grandiose and fantastic self-perception (False Self) as perfect, omnipotent, omniscient, and entitled to special treatment and recognition, regardless of his actual accomplishments (or lack thereof).

The narcissist actively solicits Narcissistic Supply adulation, compliments, admiration, subservience, attention, being feared from others in order to sustain his fragile and dysfunctional Ego. Thus, he constantly courts possible rejection, criticism, disagreement, and even mockery.

The narcissist is, therefore, dependent on other people. He is aware of the risks associated with such all-pervasive and essential dependence. He resents his weakness and dreads possible disruptions in the flow of his drug: Narcissistic Supply. He is caught between the rock of his habit and the hard place of his frustration. No wonder he is prone to raging, lashing and acting out, and to pathological, all-consuming envy (all expressions of pent-up aggression).

The narcissist’s thinking is magical. In his own mind, the narcissist is brilliant, perfect, omnipotent, omniscient, and unique. Compliments and observations that accord with this inflated self-image (“The False Self“) are taken for granted and as a matter of course.

Having anticipated the praise as fully justified and in accordance with (his) “reality”, the narcissist feels that his traits, behavior, and “accomplishments” have made the accolades and kudos happen, have generated them, and have brought them into being. He “annexes” positive input and feels, irrationally, that its source is internal, not external; that it is emanating from inside himself, not from outside, independent sources. He, therefore, takes positive narcissistic supply lightly.

The narcissist treats disharmonious input – criticism, or disagreement, or data that negate the his self-perception – completely differently. He accords a far greater weight to these types of countervailing, challenging, and destabilizing information because they are felt by him to be “more real” and coming verily from the outside. Obviously, the narcissist cannot cast himself as the cause and source of opprobrium, castigation, and mockery.

This sourcing and weighing asymmetry is the reason for the narcissist’s disproportionate reactions to perceived insults. He simply takes them as more “real” and more “serious”. The narcissist is constantly on the lookout for slights. He is hypervigilant. He perceives every disagreement as criticism and every critical remark as complete and humiliating rejection: nothing short of a threat. Gradually, his mind turns into a chaotic battlefield of paranoia and ideas of reference.

Most narcissists react defensively. They become conspicuously indignant, aggressive, and cold. They detach emotionally for fear of yet another (narcissistic) injury. They devalue the person who made the disparaging remark, the critical comment, the unflattering observation, the innocuous joke at the narcissist’s expense.

By holding the critic in contempt, by diminishing the stature of the discordant conversant – the narcissist minimises the impact of the disagreement or criticism on himself. This is a defence mechanism known as cognitive dissonance.

Narcissistic Rage

Narcissists can be imperturbable, resilient to stress, and sangfroid. Narcissistic rage is not a reaction to stress it is a reaction to a perceived slight, insult, criticism, or disagreement (in other words, to narcissistic injury). It is intense and disproportional to the “offence”.

Raging narcissists usually perceive their reaction to have been triggered by an intentional provocation with a hostile purpose. Their targets, on the other hand, invariably regard raging narcissists as incoherent, unjust, and arbitrary.

Narcissistic rage should not be confused with anger, though they have many things in common.

It is not clear whether action diminishes anger or anger is used up in action but anger in healthy persons is diminished through action and expression. It is an aversive, unpleasant emotion. It is intended to generate action in order to reduce frustration. Anger is coupled with physiological arousal.

Another enigma is:

Do we become angry because we say that we are angry, thus identifying the anger and capturing it – or do we say that we are angry because we are angry to begin with?

Anger is provoked by adverse treatment, deliberately or unintentionally inflicted. Such treatment must violate either prevailing conventions regarding social interactions or some otherwise a deeply ingrained sense of what is fair and what is just. The judgement of fairness or justice is a cognitive function impaired in the narcissist.

Anger is induced by numerous factors. It is almost a universal reaction. Any threat to one’s welfare (physical, emotional, social, financial, or mental) is met with anger. So are threats to one’s affiliates, nearest, dearest, nation, favourite football club, pet and so on. The territory of anger includes not only the angry person himself, but also his real and perceived environment and social milieu.

Threats are not the only situations to incite anger. Anger is also the reaction to injustice (perceived or real), to disagreements, and to inconvenience (discomfort) caused by dysfunction.

Still, all manner of angry people narcissists or not suffer from a cognitive deficit and are worried and anxious. They are unable to conceptualise, to design effective strategies, and to execute them. They dedicate all their attention to the here and now and ignore the future consequences of their actions. Recent events are judged more relevant and weighted more heavily than any earlier ones. Anger impairs cognition, including the proper perception of time and space.

In all people, narcissists and normal, anger is associated with a suspension of empathy. Irritated people cannot empathise. Actually, “counter-empathy” develops in a state of aggravated anger. The faculties of judgement and risk evaluation are also altered by anger. Later provocative acts are judged to be more serious than earlier ones – just by “virtue” of their chronological position.

Yet, normal anger results in taking some action regarding the source of frustration (or, at the very least, the planning or contemplation of such action). In contrast, pathological rage is mostly directed at oneself, displaced, or even lacks a target altogether.

Narcissists often vent their anger at “insignificant” people. They yell at a waitress, berate a taxi driver, or publicly chide an underling. Alternatively, they sulk, feel anhedonic or pathologically bored, drink, or do drugs – all forms of self-directed aggression.

From time to time, no longer able to pretend and to suppress their rage, they have it out with the real source of their anger. Then they lose all vestiges of self-control and rave like lunatics. They shout incoherently, make absurd accusations, distort facts, and air long-suppressed grievances, allegations and suspicions.

These episodes are followed by periods of saccharine sentimentality and excessive flattering and submissiveness towards the victim of the latest rage attack. Driven by the mortal fear of being abandoned or ignored, the narcissist repulsively debases and demeans himself.

Most narcissists are prone to be angry. Their anger is always sudden, raging, frightening and without an apparent provocation by an outside agent. It would seem that narcissists are in a CONSTANT state of rage, which is effectively controlled most of the time. It manifests itself only when the narcissist’s defences are down, incapacitated, or adversely affected by circumstances, inner or external.

Pathological anger is neither coherent, not externally induced. It emanates from the inside and it is diffuse, directed at the “world” and at “injustice” in general. The narcissist is capable of identifying the IMMEDIATE cause of his fury. Still, upon closer scrutiny, the cause is likely to be found lacking and the anger excessive, disproportionate, and incoherent.

It might be more accurate to say that the narcissist is expressing (and experiencing) TWO layers of anger, simultaneously and always. The first layer, of superficial ire, is indeed directed at an identified target, the alleged cause of the eruption. The second layer, however, incorporates the narcissist’s self-aimed wrath.

Narcissistic rage has two forms:

I. Explosive – The narcissist flares up, attacks everyone in his immediate vicinity, causes damage to objects or people, and is verbally and psychologically abusive.

II. Pernicious or Passive-Aggressive (P/A) – The narcissist sulks, gives the silent treatment, and is plotting how to punish the transgressor and put her in her proper place. These narcissists are vindictive and often become stalkers. They harass and haunt the objects of their frustration. They sabotage and damage the work and possessions of people whom they regard to be the sources of their mounting wrath.