I have been insisting for decades that pathological narcissism is contagious, exactly like every virus-borne disease. And I've been mocked and ridiculed and made to pay a price for this contention.
Many clinicians and later on my peers and colleagues in academia disputed this claim. They said there is no known vector. There's no pathogen that can transmit mental illness and that therefore any such claims are outrageous and they just serve to addle the muddled brains of the great unwashed.
And while I fully concur with regards to the great unwashed, I beg to disagree when it comes to contagion.
Now finally I have proof, a study of 713,000 people over many years that has demonstrated conclusively that mental illness is contagious and infectious, and even succeeded to identify one or two of their transmission mechanisms.
My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited. I'm a professor of clinical psychology and business management in CIAPS United Kingdom, Cambridge, United Kingdom, and formerly a visiting professor in Southern Federal University in Russia.
Where else?
Okay, and apropos Russia, let's immediately talk about mental illness. Is mental illness transmissible?
It's a new study offered by Alho, Goewill, Niemi, etc. And it's titled Transmission of Mental Disorders in Adolescent Peer Networks. It was published in a very, very prestigious JAMA Psychiatry, Journal of American Medical Association Psychiatry, in May, I mean, last month, 2023.
I read to you the key points from the study and then we will go into an analysis.
And I'm quoting.
Question, is having peers with a mental disorder in the same social network during adolescence associated with later risk of mental disorder?
Findings. In this cohort study, including more than 700,000 individuals in Finland, analysis of nationwide interlinked registry data found that having classmates diagnosed with a mental disorder in the ninth grade of comprehensive school was associated with increased risk of receiving mental health diagnosis later in life. The increased risk remained after adjusting for an array of parental school level and area level confounders.
So let me summarize this for you.
The study found that if you had mentally ill peers in the ninth grade, you were more likely to develop mental illness later in life.
Contagion, anyone?
Meaning, say the authors, the findings of this study suggest that mental disorders might be socially transmitted within adolescent peer networks.
Teens with classmates who have had mental illness have a significantly greater risk of psychiatric diagnosis later in life, even after controlling for parents, mental health, history, and other factors.
Okay, this research is new evidence, but only the latest, by the way. There are already a few other studies, although when I suggested contagion in the 1990s, this was unheard of. There was not a single study about this issue.
But this research is evidence. It seems that adolescents within peer networks or within peer groups do somehow transmit mental disorders.
And we are not talking only about depression and anxiety, which everyone knows from daily experience, are contagious. When you're around a sour puss, downcast, depressed, anxious person, you tend to become a bit depressed in actions yourself. We all know this.
We're talking about other mental illnesses so this transmission applies to mental illnesses with a biological template, apply to other disorders which in theory at least should not be transmissible.
So, having a classmate with a mental illness of any kind was associated with a 3% higher risk for subsequent psychiatric diagnosis.
But this is very misleading because the risk was much higher in the first year of follow-up.
In other words, immediately after exposure to mental illness in a peer, in a classmate, the risk was actually 13% higher. And it was very strong for a variety of mental illnesses including mood anxiety and eating disorders. 13% is a substantial number and this is the biggest the largest study ever 700,000000 ninth graders were followed up for 18 years longitudinal studies. It's one of the biggest studies ever in psychology, by the way.
So the numbers defy expectations. The numbers are statistically significant.
It doesn't prove that if you're around someone with mental illness, you are inevitably, ineluctably going to end up with mental illness or mental health or psychiatric diagnosis. That's not what the study says. That's not what I'm saying.
What I'm saying is that certain behaviors are contagious in the sense that they lead to imitation and emulation, for example, as a form of defense.
If you're around a psychopath or a narcissist, your only defense is to become more narcissistic and psychopathic, and hence the vector of contagion.
Lead investigator, UC Alho, said the associations observed in the study are not necessarily causal. The study did not investigate the mechanisms that explain the observed association.
So there have been, as I told you, there have been previous studies which describe what is known as clustering.
For example, there have been studies about clusters of suicides. There have been studies about clusters of depression and anxiety disorders. Mood symptoms, eating disorders, and even some other psychiatric illnesses. Clustering has been documented in the past, not only among adolescents, by the way, but in adult social networks.
But most of these were self-selecting samples of peer groups. So most of these were self-selecting samples of peer groups. So most of these studies were flawed as far as methodology.
When you self-select, when you decide to participate in a study, you may have an axe to grind, or you may have a hidden agenda, or you may be unconsciously motivated to produce a certain result.
The Finnish study, this study, the recent one, didn't discriminate. Everyone was included. 713,000 people.
So there was no self-selection. It's a really huge study.
And the authors wrote, investigating the transmission of mental disorders is especially important in childhood and adolescence. Yet despite few survey studies reporting that adolescents may experience increased mental health symptoms when exposed to friends or peers with mental health problems, large-scale studies on the potential peer influences or mental disorders in youth are lacking.
So 713,809 students in 9th grade, half of them boys, half of them girls born between 1985 and 1997. 47,000 of them were excluded. They had mental health diagnosis before the study began.
So the authors were very careful not to contaminate a study with pre-existing conditions.
So ultimately there were 600,000 students in 860 schools. And they were followed until they were first diagnosed with mental disorder until they died or emigrated or ended or the end of a study in 2019 18 years later on average these 660,000 people were followed for up to 11 and a half years.
And so they gathered the diagnosis from Finnish registries of inpatient, outpatient, primary care, and the diagnosis were according to the ICD 9 and ICD 10.
So they included substance misuse disorders, schizophrenia spectrum disorders, mood disorders, anxiety disorders, eating disorders, emotional and social functioning disorders, hyperkinetic and conduct disorders, etc. The whole gamut.
The authors adjusted. The authors adjusted.
The study is very, very well done. It's a really impressive study because they control for a variety of variables not only in the children, but in the parents, in the environment, age, gender, you name it.
So, for example, they adjusted everything for sex, birth year, school, the size of the class, the urbanicity of the area, how urban it is, how rustic it is, area level morbidity, how common these disorders were in the residential area and the residence of the students. Area level education, employment rate, parental education level, parental mentalhealth, and then they did a random intercept for each school.
It's really one of the best constructed studies I've ever come across. And all I do, all I've been doing in the last 30 years is read such studies. So I'm really truly impressed.
Overall, a quarter of the students were diagnosed with a mental disorder. So the risk of having been diagnosed with any mental disorder was 3% higher during the entire follow-up period.
But again, it's very misleading because as I told you, the risk was 13% higher in the first year of fallout, and it remained 5% higher in year 4 and 5 and so on so forth.
And the risk also doubled or tripled if there were more than one classmate who were mentally ill.
So if you were exposed to one classmate, your risk was X. If you were exposed to two classmates, your risk was 2x.
A clear proof, absolute proof of contagion, you know.
And the risk was significantly increased for mood, anxiety and eating disorders in each follow-up time window.
They noted a dose response relationship. The more classmates with psychiatric illness, the greater the risk for later mental illness.
They say, these findings suggest that mental disorders may be transmitted within adolescent peer networks. And they describe the spread of mental disorders among classmates as transmission, as contagion. It's contagion.
This is not the first time.
The word transmission has been used in literature prior to that to describe clustering, describe clusters.
But Alho said, the chief, the lead author said that he believes the transmission is, I hope it's a he, I mean, I don't know Finnish names. Alho said that transmission is an accurate term because there are potential mechanisms by which mental health disorders spread, exactly like viruses or bacteria.
The more students are diagnosed, the more others are diagnosed around them.
And additionally, probably more students might be diagnosed when disorders are normalized through increased awareness, and receptivity to diagnosis of treatment.
As stigma goes down, the chances of being diagnosed go higher.
The rate of disorders might also have increased, especially the first year of follow-up, if there were no students in the peer network who had been diagnosed.
So, in other words, there isn't an impact of discouragement, an impact of stigma.
If you're exposed to someone who has been diagnosed, you are more likely to be diagnosed because this is less stigmatized, it's less terrifying.
But otherwise, you're likely to hide your mental health condition and mental health symptoms.
This is especially true in adolescence and early or young adulthood, especially true. And among many, many people, well into adulthood. Stigma is still there.
The authors noted that it's, I quote, inconceivable that long-term exposure to a depressive individual, no, I'm sorry, exactly the opposite. They said that it is conceivable that long-term exposure to a depressive individual could lead to gradual development of depressive symptoms through the well-established neural mechanisms of emotional contagion.
So this is a very important study, and my repeated claim over three decades, that narcissism, to some extent, psychopathy are contagious.
This means that we can think of new treatments, new modalities to cope with this.
So Dr. Trivedi made a comment on the study for Medscape Medical News. He's a distinguished chair of the mental health in southwestern medical school, Dallas.
He said the theory that having classmates with psychiatric illness could normalize these conditions has merit.
When someone is diagnosed or receives treatment, their peers kind of get implicit permission to be able to then express their own symptoms or express their own problems, which they may have been hiding or not recognized, he said.
Trevedi disagreed, though, with the author's suggestion that the rate of disorders might also have increased if not classmates had received psychiatric diagnosis, noting that it was unlikely that a student would not have been exposed to depression, anxiety or another mood disorders through a peer or family members.
Remember, given how common this is, how common these illnesses are.
In other words, we could conceive of idealized situations, but they are not realistic.
Realistically, we are all exposed to someone with a mental illness. And when we are exposed to someone with a mental illness, it normalizes our mental illness. And we feel comfortable to be diagnosed.
This might be one contagion mechanism, but I suspect that there are others, exactly like the authors, I suspect that there are other transmission mechanisms.
Trivedi said the numbers are slightly higher than I would have expected.
Peer influence, and having this type of impact is something that has not been shown before.
And the study is notable because it uses comprehensive registries. So the data integrity is very solid.
The results, said Trivedi, offer some potential new directions for treatment, such as adding peer support. That has been found useful in adult treatment, but has been less utilized with adolescents.
So, hooray to Finland and the European Union, who financed the study. And it's a promising start of a totally new direction in psychiatry, let's call it infectious psychiatry of contagion. A new field altogether.
And I've been vindicated after 30 years. And of course, I'm gloating and it makes me feel good and grandiose because of who I am.