Thread by @drjanaway

Narcissism: explanation thread

Trigger warnings: narcissism, symptoms.

This thread explores the concept of narcissism, its role in mental disorders, and addresses misunderstandings around it. This includes stigma.

As always, subjective understanding may differ.

please #rt

Before we go forward it is helpful to separate ‘narcissism’ – a set of defences, thoughts, and behaviors, from ‘narcissistic personality disorder’ – a diagnosis based on the enduring and overwhelming effect of this on daily life.

A little history - the myth of Narcissus in Greek mythology tells the story of its beautiful namesake, revered for his beauty. After rejection from a wanted love became intoxicated with is own reflection, drowning in his pursuit of it.

Most of the popular understanding of narcissism hinges on the idea of a 'large ego' or, indeed, obsession with one's self. From a psychological standpoint, this is not incorrect, but misses the crucial driving force. It is not love for ones self, but thinly veiled loathing.

We will return to the story of Narcissus later, as often the mythology captures tenets of the truth as we understand it, but to truly understand how difficult narcissism can be for both the person and their peers, we need to delve deeper.

As always, narcissism has multiple explanations with different levels of agreement. In mental health, we choose to make categorical definitions based on the presence and severity of symptoms, especially when talking about 'disorder.' So let's start with the defence.

When we consider narcissistic defenses, they are all about the ego protecting itself, and finding love in itself due to a fear or inability to relate to others. This can be due to a number of factors, but is generally argued to occur at a very young age.

As per my thread on #eupd , most aspects of the more powerful and enduring elements of personality are laid down in the infantile years. Narcissism, like EUPD, is tied closely to early attachments and their relationship to safety.

The inability to bond with external 'objects' in a 'healthy way' (i.e secure relationships with care givers,) means that the infant must turn its 'love' onto itself, which is a stormy place filled with threats of annihilation and obsession.

The infant is caught in a place where it must believe its own grandiose power to influence the world around it, but at the same time feels a deep sense of shame and insecurity about itself. This is a balance of internal drives which becomes very fragile.

As all internal drives must relate to the outside world, and are shaped by them, the power sought within the love for the self must be expressed externally, and this is the belief of being special compared to others, and seeing others as subservient to self.

This is not a categorically conscious belief or behaviour, but arguably one of an unconscious place, quick, enduring, and not designed to be hurtful to others, but to protect the infant (and later adult) from perceived annihilation in its absence.

Remember, the unconscious mind is not rational, it sees any threat to the ego as death, so even the slightest challenge to the fragile psychic structure it has built is received as a huge danger. In adult life, we can loosely link this to hypersensitivity to criticism.

Thinking of a narcissitic personality structure as a dynamic function, i.e something constantly rebuilt and remodelled on a basic template, helps to understand its role. It is a malleable defense to the outside and internal world, ' an ego defense.'

Put simply, any threat to the love of oneself, a castle built on deep insecurity about a fear of being unloveable, becomes tragic and threatening. Thus the defense must be strong, violent, and hypervigilant. This is torture for the person.

To put it more clearly, it is a problem of object relations. An object, in psychology, is an internal representation of an external or internal thing, and whole object is seen as it is, a whole human, and a part object as to what a human may serve.

Narcissism often relies on 'part-object' relations, i.e this person can be this to me, because the difficulty in forming 'whole object' relations, stemming back to early rejection, means that tolerating potential rejection or less than admiration is intolerable.

Thus, the narcissistic defense is all about setting ones self in a place of godliness, immune to rejection, wanted by all. When you consider the root cause is a hidden feeling of immense failure, ugliness and isolation, this makes sense.

When we think of the 'defenses' involved we classically reduce these to projection and splitting. Projection is to take ones own negative perceptions of the self and place them onto others, i.e 'you are hateful, ugly' because 'I am.'

Splitting, as discussed in my EUPD thread, is also a function of infantile defenses, splitting the good and bad parts of the world off, including the good and bad parts of the self, to make them tolerable. The bad in the self is excised, and the good of the world is taken in.

In narcissism, the bad is so feared that anything not feeding the ego is bad, and must be projected, split off, and removed from consciousness. The inability to do so, or external barriers against it, are met with great pain.

Once again, although the pain is conscious, the splitting and projection are not, the person has no idea the deep reason for their pain, but may feel rejected, or undermined, which give clues to the deep internal state.

So if we consider this way of defending one's self against the world and the deeper self-loathing and fear, we realise it is very fragile, but like any enduring defense, quickly erected.

And how we see people with narcissistic personalities, or enhanced defenses, are those of being 'selfish, egotistical, arrogant', but one must realise this is a matter of survival, regardless of the consequences on others.

This does not mean those acting on the defense are not liable for their actions, once they learn them, but their motivations are often unclear to them. Unfortunately, the role of being a part object can also be very painful, so finding help is important.

So let us now turn back to the concept of Narcissistic personality disorder, an idea now dated by the introduction of the new categorisation of a general 'personality disorder' introduced in the ICD 11, which removes previous subcategories.

Myself, I am still very much unsure of how practical this will be in helping to understand a persons needs, but can understand the motivation behind it, as well as many of the conceptual arguments. As long as we can understand the nature beneath a general label, it has use.

How we define the difference between a personality and a 'disordered' personality depends on the nature and severity of relationships to the world and self, functional problems as a result, and harm. For NPD, we can use the DSM-5 definitions quite well (abridged)

'a pervasive pattern of grandiosity (in fantasy of behaviour), need for admiration, and lack of empathy.. beginning in childhood or early adulthood and present in a variety of contexts, as indicated by 5 + of :

- grandiose sense of self importance and exaggeration of achievement
- preoccupation with fantasy of unlimited success
- belief in being special and limits relationships to those of 'equal measure'
- requires excessive admiration
- sense of entitlement

- interpersonally exploitative (uses others)
- lacks empathy
- envious of others, believes others are envious of them
- shows arrogant attitude

Immediately we can see 3 things

1) Most of these symptoms can be understood in the view of an insecure and terrified ego needing to be loved
2) the effect on society is held deeply in the symptoms
3) not just one symptom = disorder

So thinking back we can already see the role of the ego needing to love itself primarily being exercised in the symptoms categorised here, i.e the need for admiration, fear of rejection, use of people as part-objects, all speak of deep insecurity.

We often use insecurity as an insult, and unfortunately this is quite a loaded cannon, as it is often correct, but also may be a projection of ones own feelings.

Life for people with NPD can be extremely challenging. The oft look for positions of power and careers/partners that will fit their need for esteem, but in doing so bring themselves to a position of enduring public judgement and risk.

One odd element of psychic defenses is that they often create the very threats they wish to defend against, thus a person with low self esteem will seek a career in something where they are mainly valued on an aesthetic element.

In the short term this could be great for their self-esteem, but the fragility of it means the chance of rejection is high. This is true across many career fields, and to an extent, narcissism can be a driver of success, if it does not cause disorder.

So why medicalise it? For the same reason any other psychological disorder is, because often it needs help. People with NPD are often in great pain, or cause pain to others, and will often ask for help for other reasons (Depression etc.)

The mainstay of treatments is talking therapy, hoping to address the underlying psychic structures. However, the person with NPD, once realising the impact of their behaviours, can choose to make different choices.

This will be hard, as the defensive structure will perceive any step down as annihilation, so progress can be slow.

One last note on stigma. Within all of mental health, it seems that only NPD is the one always insulted in society regardless of people's understanding. It seems okay to call people 'a narcissist' as if it is some great sin, and yet when you understand it..

you understand they are in great pain and attempting, however unhelpfully, to remove this. Unfortunately, the very hate they fear is often brought back on upon them, so the defenses thicken and react more strongly.

Examples of such can be the #alphamale stereotype, where a deep fear of rejection leads to the creation of a fantasy self of huge strength, wealth and power, fragile and sensitive to rejection, hurting themselves and others in the process.

In an ideal world, the one I choose to work in, we must try to help these people, make it known to them that they can be loved, and that they can find peace in themselves.

Ofcourse, I have presented the above from a limited view point, and people will have very polarised views given their experiences. None of what I am saying suggests I validate any behaviour causing people pain, I am just trying to help people understand it.

As always, any comments welcome.

And to return to Narcissus, he simply wanted to be loved, so much so that rejection made his love for himself destroy him. Such is narcissism. Maybe if narcissus could be shown he has value, he would have avoided the river.

Sources:

ICD11/10
DSMV
OTSP
Psychoanalytic Diagnosis
Lots of Freud
A bit of Melanie Klein
Symptoms in the mind
My clinical experience