Narcissism Revisited (with Iranian Psychoanalyst Ali Reza Bornamanesh)

Uploaded 10/20/2023, approx. 48 minute read

And as my first question, I wanted to explain about the classification of the narcissism.

And as you completely know, that very recent classification published by Gillen Ogabart. And as you know, he's talking about the two types of very common narcissism, thin-skinned, thinnest, keen, narcissistic personality and thickest in narcissistic personality.

And I would be so happy to explain about the type of classification and your own classification for narcissistic personality disorder. Thank you.

Well, of course, I have the utmost respect for Gillen Ogabart and others, but I never understood why everyone feels the need to rename already well established and well observed clinical entities.

So I don't think I don't see the need to rename covert narcissism and overt narcissism, thin skinned and thick skin. We have a perfectly, perfectly stable classificatory taxonomic system established in 1989, distinguishing between fragile, vulnerable, shy narcissists, also known as covert narcissism. And the overt, in your face, aggressive narcissist known as overt narcissism.

Now, the only difference between these two types, and it is actually the only difference, is that the covert narcissist consistently fails to obtain narcissistic supply.

So the covert narcissist is always in a state, is in a permanent state of collapse.

Now to explain some of the terms, narcissistic supply simply means attention by other people, input, feedback that is used to regulate the narcissist's sense of self-esteem, self-confidence, sense of self-worth. The narcissist uses this input from the environment to uphold or buttress or support a grandiose, fantastic, inflated view of himself.

Exactly. And when the narcissist fails to obtain this supply, when other people refuse to provide the narcissist with input or feedback, the narcissist goes through a process called collapse.

And if the narcissist is in a permanent state of collapse, permanent state of deficient narcissistic supply or not available narcissistic supply, the permanent state of collapse is known as covert narcissism.

Apart from this, the covert narcissist is very similar to the overt narcissist.

For example, the covert narcissist is grandiose. The covert narcissist has a cognitive distortion, he falsifies reality to support a view of himself, which is counterfactual, which is not real, which is delusional and fantastic. Exactly like the overt, exactly like the overt, the covert narcissist is exploitative, manipulative, Machiavellian and so on and so forth.

Because the covert narcissist is unable to obtain supply directly, the covert narcissist tries to obtain supply indirectly through, for example, other narcissist by being passive aggressive, by being manipulative.

So the covert narcissist is a narcissist that is underground under the radar and a constant failure, lives in a state of constant failure and defeat.

And so because of that, this kind of narcissist is anxious, shy, fragile, vulnerable and so on.

My next question is, what's the differential diagnostic for the antisocial personality disorder and covert narcissistic personality disorder?

They are very similar and sometimes very hard to differentiate these two types of personality disorders.

Antisocial personality disorder is, in my opinion, at least not a real clinical entity, not a real mental illness. It is an inability to function within society as most people do. Inability to accept social norms and mores and conventions and rules, defiance, recklessness, inability to properly evaluate the outcomes or consequences of your own actions, impulsivity and so on and so forth. It's more of character than a mental illness. It's a character type. It's a personality type rather than a mental illness.

Indeed, the diagnostic criteria that define antisocial personality disorder are mostly relational and societal. They're not really psychological. In other words, the diagnostic criteria describe how the person with antisocial personality disorder relates to other people, to society, to authority, and so on and so forth.

We have many narcissists who are also antisocial and they are known as malignant narcissists. They were first described by Otto Kemberg in 1975.

The major differences between classic narcissists and antisocial, including psychopaths, psychopathy as an extreme form of antisocial personality disorder, although I must say that the profession of psychology or psychiatry did not accept psychopathy as a diagnosis. There is no psychopathy in the diagnostic and statistical manual.

Exactly. This is a totally extra-curricular, so-called pseudo-diagnosis.

But the differences, there are some differences.

For example, narcissists heavily depend and are addicted to input from other people, attention. Narcissists are dependent on other people for self-regulation. They need other people in order to regulate their own sense of self-worth and emotion. Abuse them.

Well, the abuse is a way to coerce other people to provide narcissistic supply.

Psychopaths don't need other people at all. They don't need them. They're loners. Most of them are loners. Most of them are not.

While the narcissist heavily depends on other people for feedback and input and attention and admiration and adulation and so on and so forth, whereas a psychopath constantly interacts with other people within a shared fantasy or in an abusive relationship, narcissists are always surrounded by many other people. The psychopath couldn't care less about people. The psychopath can spend decades and years alone, totally alone. That's the first thing. The second thing is psychopathy is goal-oriented.

Psychopath wants sex, money, access, power, something. Psychopath wants something.

And then to accomplish this goal, the psychopath would do anything to anyone. There are no limitations to what the psychopath would do. No inhibitions, no rules, no laws, nothing. The narcissist is not this way. The narcissist is not goal-oriented.

The narcissist's only goal is narcissistic supply, attention, being noticed. So the narcissist is not interested in money. The narcissist is interested in money as a way to obtain attention. Not interested in power.

Narcissists are interested to be in a position of power because that way he will get a lot of attention. It's all about attention.

While the psychopath is interested in money, is interested in power for its own sake, not because of the attention, but because he wants power, he wants money.

So these are subtle differences.

The psychopathic narcissist, also known as malignant narcissist, is a narcissist who uses psychopathic strategies and psychopathic techniques in order to obtain narcissistic supply.

So it's very misleading because this kind of narcissist appears to be anti-social, appears to be psychopathic when actually he is not. He's just using the psychopath's playbook to obtain supply. That's all.

So these are the differences.

I believe personally that all these so-called personality disorders should become one, one personality disorder, one diagnosis, with different emphasis, different dimensions.

And that all of these disorders are actually post-traumatic conditions.

Narcissists, borderlines, they've experienced trauma as children. There are many types of trauma. For example, your mother is spoiling you, idolizing you, doesn't allow you to interact with your peers, isolate you from reality. It's also kind of trauma.

So when a child experiences trauma, some children, not all children, but some children choose dysfunctional solutions such as narcissism, such as codependency, such as borderline. And I think all these so-called personality disorders should be reconceived completely as post-traumatic conditions.

Now, why is this important? How we define them?

Because we have no cures, no healing, no treatments for personality disorder. We have many, many psychiatrists and psychologists and therapists that claim that they can cure or heal personality disorders. They are liars, they are corner artists, they are charlatans. There is no effective treatment modality for personality disorders, with one exception, one exception, borderline, where we have dialectical behavior therapy, which is very efficient. That's the only exception. Otherwise, we cannot treat antisocial personality disorder. We have zero results with narcissistic personality disorder. We can modify some behaviors in the short term period.

So if we think of these conditions as personality disorders, we give up. There's no hope.

But if we were to think of these conditions as post-traumatic conditions, we have many very successful therapies for trauma, many. But we are not using them.

When a narcissist comes to you, you're not using trauma therapy. You're using CBT, you're using, you know, but you're not using trauma therapies, which we have, and they're great. They're working wonderfully.

So if you redefine narcissistic personality disorder as a trauma condition, maybe there is cure. Maybe we can help the patient, you know, but you need to really conceive, you need to change software the way you see the situation.

Additionally, one last comment. When a narcissist comes for treatment, there is a mistake of treating the narcissist as if he were an adult.

When a narcissist sits in your clinic, you try to create a therapeutic alliance with a narcissist. You make a plan with a narcissist, a treatment plan with a narcissist. You agree on goals of the therapy. You then make a alliance or a contract with a narcissist as to how the therapy will progress. This is nonsense. The narcissist is a two-year-old. These are all cases of arrested development.

These people that look like adults, they're not adults, they're children.

And so we need to use child psychology with narcissists and with borderlines. We need to use child psychology, not adult psychology. These are not adults.

But in this politically correct age, where you're not allowed to say such things, you know, unfortunately, especially in the West, there is mega failure, massive failure. We are unable to give help to these patients because we insist that they have a problem with their personality and they are adults when actually they have a problem with trauma and they're children. So of course they're getting the wrong treatment and of course they're not getting, they're no reason.

Interesting. Interesting.

And another question come to my mind that what is the diagnostic differentiate between the history and personality and this kind of narcissistic personality disorder?

As you know, the common characters between these two types of personality disorders, attention seeking. And as you know, the history and personality needs attention. And as you mentioned and well explained, the narcissistic needs attention and admires.

So what is the differential diagnostic for these two type of personality disorders?

I don't think there is. I just said that I think all these so-called different diagnoses should become one diagnosis. I think each person develops a need for a highly specific type of supply. Each person has his own drug or her own drug.

But then each person goes about obtaining a narcissistic supply in different ways.

But if we should look at the commonalities, for example, people with narcissistic personality disorder misjudge reality badly. For example, they misjudge the nature of a relationship. They think the relationship is very intimate when it's not so. There is impaired reality testing. There's a problem with reality testing with in-history on it.

Personality disorder and the same in narcissistic personality. So the narcissist misjudges reality dramatically.

Here's one common element. The other common element is the need for attention. The next common element between histrionic and borderline is emotional dysregulation. The histrionic and the borderline are emotionally dysregulating. They're dramatic. The drama queens or kings, you know, they're very dramatic.

All these types, narcissistic, histrionic and borderline, they use external regulation. In other words, they use other people, input from other people, to regulate their internal environment. The narcissist uses input from other people to regulate his sense of self-worth. The borderline uses input from other people to regulate her emotions and moods. And the histrionic uses input from other people to regulate her intimacy needs and have grandiose self-perception as irresistible, sexually irresistible.

So they are all using external input and external feedback to regulate the internal environment.

I think this is such a striking common denominator that we should seriously begin to think that it's one disorder with different manifestations, different aspects.

Now we have this, for example, we have this, for example, in psychotic disorders.

In psychotic disorders, we have a common construct, the psychosis. And then we have different manifestations of psychosis. We have this in other fields in psychology. We have this eating disorders. Eating disorders, we have a common denominator of, you know, the need for control and so on. And then we have different types of eating disorders.

But there is one eating disorder, is a single construct. Psychosis is a single construct.

Only in personality disorders, we don't regard them as a single construct, but we say each one of them is totally separate, has nothing to do with the others.

And what is the outcome of this nonsensical thinking that you have to diagnose multiple personality disorders in the same individual.

So you have comorbidity. Yes, very typical to diagnose borderline and narcissistic and sometimes psychopathic in the same person. So something is wrong. Something is seriously wrong in this approach.

And as you know, in axis one, there are several comorbidities, but most of the experts in this area and the psychotropics believe that the most of the comorbidity belongs to the axis one.

But as you know, they are trying to have a neat and strict diagnostic for the personality disorder. That's interesting.

And the variety, the variance in depression, for example, is much bigger than the variance in personality disorder.

In other words, the family of depressive disorders, depressive illnesses contains many, many variants of depression that have little to do with each other. For example, dysthymia and major depression have almost nothing to do with each other. Yet they all call depression.

In personality disorders, the disorders are much closer, much, much closer than in depression. And yet we refuse to unify them. Why? We unified all the depressive disorders and we call all of them depression, even though they are much different to each other than personalities.

So, you know, we should have one personality disorder with different manifestations.

And indeed the 11th edition, from the International Classification of Diseases, ICD-11, they are going in this direction. They are unifying all the personality disorders with different emphasis. They call it emphasis.

So, you would have a diagnosis of personality disorder with narcissistic emphasis, with borderline emphasis.

But they have so much in common that it is crazy to separate these diagnosis totally against all clinical practice.

Ask any practitioner, they will tell you that a patient can be one day borderline, the next day narcissistic and the next day psychopath. And then again, exactly. Anyone will tell you this from clinical practice. Anyone, you know, and also schizoid.

And some days the same patient will be paranoid. Anyone will tell you this.

So, these distinctions, these so-called differential diagnosis, they're wrong. They're wrong. They are opposed to all clinical practice. Absolutely. I don't know where these people, these people are academics. They don't have clinical experience.

You know, the clash between academic knowledge and clinical experience lately is enormous.

Take for example, the issue of narcissism. If you talk to clinicians, they would tell you that every narcissist is sometimes overt and sometimes covert. Every clinician will tell you this.

But if you talk to academics who have never treated a patient in their lives, they will tell you it's not true. Narcissist is either this or this.

Recently, fortunately, it's beginning to change. But, you know, there is a breakdown between academic knowledge and clinical experience, which is very, very detrimental to the field.

Because in this cousin, in this break, in this abyss between academia and clinical practice, you have self-styled experts on YouTube. And people are listening to these people, to these so-called experts on YouTube, because they are getting different information from academics and from clinicians.

So, they don't know who to trust. So, they go online and they listen to total frauds and charlatans and nonsense, unbelievable nonsense. The amount of narcissism is mind-boggling. Mind-boggling.

I would say that 98% of all the information on narcissism online is nonsense, misinformation, wrong. That's bad. This makes sense to me because as an Iranian psychoanalyze and a United Psychoanalyzes, we just believe in tricky classification, neurosis, psychosis and the pervert. And this kind of classification, I think that is very helpful in clinical setting because this prevent for stigmatized clients.

And as you completely know, the DSM-5 and the ICD-10 is creating for the drug industries, the psychiatric drug industries and insurance. And they must have a diagnosis because they have a cure and the cure is the kind of drugs and they have to sell their drugs. And as you know, the Lacasse, very well explained this kind of confluence.

Also, the insurance company insisted, they said, if you want me to reimburse you as a therapist, you only need to tell me what is the diagnosis. Give me a number. Exactly. I have to provide a code, a diagnostic code. Otherwise you will not get paid. So it's money, 100% money.

It's not science, it's money. You know the Diagnostic and Statistical Manual Committee that was sitting for 10 years to write the fifth edition, edition five. They created wonderful new texts for narcissistic personality disorder, for borderline personality disorder and so on, paranoid, antisocial. They created wonderful new texts, much better than the DSM-4. But they were put under such enormous political and money pressure that they decided to maintain the text of the DSM-4 in the DSM-5. This has never happened before. And they put the new texts, the new much improved texts, much better texts, they put them in the end as appendices.

So you find, for example, you find alternative model of narcissistic personality disorder that is on page 767 of the fifth edition of the Diagnostic and Statistical Manual and the diagnostic criteria of edition four. So you must diagnose by edition four.

If you want to in the evening, when you have free time, you can read the alternative model, which is 100 times better than the DSM-4. I swear to you, much better, reflects the latest knowledge and so on.

So yes, the money corrupted the profession completely there in my view.


And coming back to the scientific aspect of our discussions, I think that you are supporting from the Freud opinion about the narcissistic because he believes that they are uncurable versus the co-host that believes, and as you know, he is well known as a Mr. Psychoanalyzed in his time at the United States. And I'm sure that you are very well know all of his publication and because you are talking about the kind of collapse, and as you know, the collapse belongs to the court and court believe that we have to try to grow this kind of collapse in this kind of personality.

But my question is how you can match these two opinions because you are believing in the kind of collapse in personality growing and at the same time, you believe that in the Freud opinion about the un-curable narcissistic personalities.

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Thank you. And I will answer, I will attempt to answer your question as I see it.

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Okay. So there have been shifting perceptions of narcissism. As far as Freud was concerned, narcissism was a misallocation of cathexis, a misallocation of emotional investment, emotional energy. And so Freud said that it was normal and healthy to affect yourself, to be invested emotionally in yourself, including erotically, including sexually, because the libido is composed of a sex drive and a life force.

So if you direct your libido at yourself, then of course you become your own sexual object. And also your life force is internalized.

So he said, this is healthy. This is a good, very important and necessary stage in personal development and growth.

But if this continues beyond a certain point into adulthood and so on, then it becomes pathological and dysfunctional.

So as far as Freud was concerned, narcissism in itself was not a pathology. It was as long as it was age appropriate.

But if you continued to invest your emotional energy and so on and so forth in yourself, when you grow up, when you grow up, when you became an adult, that's when the pathology, that's when it becomes pathological.

So this was a cathexis approach, approach of emotional investment.

Then Jung came along and Jung said that narcissism actually is never a pathology. Narcissism has to do with introversion. It is an integral part of personal development and growth and so on and so forth.

Freud in the 1970s, mind you, much, much, much later, medicalized, created self-psychology and he medicalized, in effect, narcissism. He coined the phrase narcissistic personality disorder. And he was the first to describe narcissistic injury in terms that today we would call narcissistic mortification.

And he suggested that narcissistic injury, which today we call mortification, could be an engine of healing and growth in narcissism.

And with this, I fully agree, mortification provides a window of opportunity for self-reflection and introspection and perhaps some dynamic change in the narcissism.

But mortification is very rare and narcissistic defenses immediately kick in to somehow compensate for the mortification.

So you need to be an extremely skilled therapist to make good use of mortification because your window is small and it's closing fast.

These were three different approaches to narcissism, totally different approach.

And we haven't made peace. We haven't created an integrative framework, which is precisely what I'm trying to do. I'm not sure that I'm successful, but that is my agenda at least to somehow integrate all these insights into a single framework.

And that's why you ask me, some elements are from Freud, some elements are from Cogut, some elements from Jung and many, many elements from object relations schools, such as in country and Fairbairn and Winnicott, Donald Winnicott and others.

So I borrowed from all of them and I tried to create an integrative picture, integrated picture, synthesize everything into a deeper understanding of narcissism as a post-traumatic condition.

And to accomplish this, I use the concept of fantasy. Fantasy not only as a defense mechanism, but fantasy is an organizing principle. Fantasy is a narrative that rules the narcissist's life. Fantasy is an artificial environment, also known as paracosm, into which the narcissist tries to force other people to belong. He tries to introduce other people, coerce them into the fantasy.

And so I recast narcissism as a post-traumatic condition that the solution was to give up on reality and to substitute for it with fantasy and then to try to convert everyone to this new religion of fantasy and to make them members of the fantasy, figments of the fantasy.

This is very similar to a cult. It's a cult approach in effect and I borrow heavily from cult psychology. I also borrow heavily from the psychology of religion and taking into account where you are, I'm not going to discuss this very deeply, but suffice it to say that I consider narcissism as a form of religion.

Think about it this way. The child is traumatized.

So what the child abused, so what the child tries to do, the child creates a God, the child creates a deity, a divinity and this divinity, this God, this new God is the false self. The false self is everything the child is not.

The false self knows everything. It's all-knowing, it's omniscient. The false self is all-powerful, is omnipotent. The false self is perfect and brilliant. The false self is God.

The child invents a primitive religion with a Godhead, with a God figure and then the child starts with human sacrifice. It's a pagan religion. The child sacrifices first and foremost himself. It's a human sacrifice.

The child sacrifices to the false self, the true self and then the child goes.

When the child becomes an adult, the child continues with human sacrifices. His intimate partners, his children, his friends, they are all sacrificed to the false self like human sacrifice.

It's a religion. That's why the narcissist keeps creating cults based on fantasy, sects. This cult can have two people, the narcissist and his wife. This cult can have 40 million people, Donald Trump and his followers.

So the cults, the size of the cult doesn't matter. The principles are identical.

There's a fantasy, a central fantasy and everyone is forced to belong to that fantasy, to conform to it.

When you think of fantasy as the glue in the understanding of narcissism, suddenly everything fits because the fantasy demands catharsis, emotional investment.

This is Freud.

The fantasy is self-centered, is internalized. The fantasy involves introjects, involves internal objects that is Jung and the object relations goals.

And the fantasy, fantasy when it is challenged, especially dramatically, especially publicly, creates mortification and injury and opportunity for some transformation and that is called mortification.

So I unified everything in a new framework which involves fantasy as the core and every known, everything I know about narcissism from all these schools, not only Freud and not only psychoanalytic and psychodynamic schools, but social learning, Banduis, social learning and many and many other schools.

I borrowed from trauma schools and from, I once counted and I borrowed from well over 37 treatment modalities and dozens of schools of psychology to create the coherent, coherent theory of narcissism that I'm proposing.

But one thing is important to understand.

It's not a theory of narcissism. It's a theory of a new psychology because narcissism is at the center and at the core of literally every known mental illness and every known mental process and every known mental trait or psychology is founded on narcissism.

As long as we define narcissism as a pathology or dysfunction or problem with cathexics and so on, we didn't see this.

But the minute you define narcissism as a religion and an alternative to reality, you suddenly realize everything is narcissism, maybe with the exception of biological disorders, like schizophrenia. I'm not being able to say that.

And even in schizophrenia, you have grandiose psychosis. Many psychotics are very grandiose.

And even with psychosis, you have the same situation like narcissism.

Psychotics and narcissists cannot tell the difference between internal objects and external objects. They cannot even tell the difference between inside and outside reality and fantasy.

It can even, this work, what I'm doing can even explain psychosis deeply.

Of course, there's always a genetic component. There is biochemical component, neurobiological component. The body is always involved. Everything is mediated through the brain. Of course, the body should be involved and medicine should be involved.

But when we try to explain how we experience our brain, not what is happening in the brain.

Yeah, okay. Many things are happening in the brain, but how do we experience this?

Then we come to psychology.

Psychology is how we experience our bodies, our physiology and our brain. We call it mind, we call it psyche. That's simply the way we experience the processes and everything, the work of our brain.

And it's a meta description, meta level, another level. And so on that meta level, narcissism can explain everything. I can use narcissism, my work on narcissism, I mean, I can use it to easily explain psychosis and borderline and narcissism and psychopathy and bipolar. And I mean, you name it, depression, I can explain everything with this simple, relatively simple principle.

Mental illness is about renouncing reality and adopting fantasy. Period.

With this simple principle, I can explain everything.

And from this simple principle, I can derive numerous treatment modalities for almost everything.

Now, Freud at the time tried to do the same thing with the concept of conscious and unconscious. He said that all the processes, there are processes in the unconscious that need to be brought to consciousness and so on.

And our reaction, all this, it was the same.

Freud was trying to create a unifying principle. And he didn't succeed so much, I think. And I think he didn't succeed so much because he started off with some wrong thing, the wrong assumptions, my view.

I know it's considered arrogant to criticize Freud and so on and so forth. But I think we need to do it.

A hundred years have passed and we know a little more.

Freud started with the pleasure principle and with sex as the exclusive explanations of human psychology. And I think that limited him.

He was a genius, an unequal genius, but even a genius can fall prey to his own assumptions.

So Freud assumed that everything is about sex and everything is about the pleasure principle initially. Much, much later, about 20 years later, he introduced the reality principle much later.

So then he said there was a conflict between the reality principle and the pleasure principle. And he had to invent a whole, a whole bivvy, a whole set of structures, the id, the superego, the ego, this, that he never gave up really on his original explanations of human psychology, which were patently wrong. I'm sorry to say.

And I'm not the only one who is saying so patently wrong.

No, you cannot reduce all of human psychology to sex. I'm sorry to say. And you cannot reduce all of human psychology to the pursuit of pleasure.

Yes, pursuit of pleasure is important, but I'm not even sure it's the most important thing.

I think people do many, many things not because of pleasure and not with the anticipation of pleasure.

They go to war, they sacrifice, they do many things. They are altruistic. All these behaviors are not commensurate with the pleasure principle.

So that's why Freud failed in his project of a unified theory of psychology, because his assumptions were too narrow. And his perception of people, I think, was substantially wrong, I think.

As you know, later Freud published a book aimed beyond the pleasure principles. And because of his challenge with the sadomasochistic clients that they challenged with the pleasure principles, and he tries to explain that this kind of client tried to get a pleasure from their pain and sufferings. That was Freud's mistake.

He never gave up on this. He never to the day he died never gave up on the importance of sex, the centrality of sex, and the pleasure principle. And Jung broke up with Freud because of that.

There was a debate. And Adler, the same, he broke up with Freud because of that. Everyone ended up breaking up with Freud because of this obsession with and so on.

So what I'm proposing is a unified theory of clinical psychology, a unified theory that is based on the dichotomy between reality and fantasy. So I think it's a much bigger principle that can accommodate many variations of human behavior.

This makes sense. Yes.

My question is, as you believe that the narcissistic personality disorder is uncurable, as the same as the Freud, but the question is, is the narcissistic injury, and as you know, the first reaction when someone feels that he's or her optimal narcissistic capacity injured by someone else, is there any clinical approach to cure this kind of narcissistic injury?

First of all, we should distinguish narcissistic injury from narcissistic mortification. Narcissistic injury just generates narcissistic defenses, such as devaluation or aggression, externalized aggression. Aggression, yes. Aggression. Narcissistic injury is a localized event. It's highly specific and the narcissist has a highly specific reaction and then it's over. It's forgotten.

Narcissism mortification is when the totality of the narcissist's delusion, this narrative, is challenged in public in front of people that matter to the narcissist and in a humility. So it touches the shame. Shame is the core of narcissism. It releases the shame and the narcissist is so overwhelmed that the narcissist becomes clinically indistinguishable from borderline. He becomes emotionally dysregulated with mortification.

At that point, therapeutic intervention is possible because all the narcissist defenses are down. They're deactivated. The narcissist is in a state of decompensation. So he's totally decompensated, he's suicidal, he's emotionally dysregulated and there's a window of opportunity.

If there is therapeutic intervention in that minute and the therapist knows what he's doing because it's a very complex condition, then some transformation can be affected.

If however the narcissist is left on his own or the therapist doesn't know what he's doing, the narcissist will create in due time two types of defenses against the mortification.

One is known as internal defense and one is known as external defense. They were first described by Libby.

Internal defense means I am in control, I made them do it to me. They humiliated me, they shamed me, they disgraced me.

Yes, but I pushed them to do it. I wanted them to do it. I controlled the whole situation. This is internal defense.

So this restores the grandiosity and at that minute the therapist can do nothing anymore. The narcissism is restored.

The other defense against mortification is these people are evil. They're animals, they misbehaved, they conspired against me, they are malevolent, they deserve to be punished and I'm going to punish them. They're vindictive, vindictiveness.

So then again the narcissism is restored. There is a very narrow window of opportunity before these defenses are activated.

And yes, theoretically if you catch the narcissist that specifics, second and give him the right tools, then yeah, it's possible.

And so I came up with a new treatment modality called therapy. I'm not allowed to practice it because I'm not a licensed therapist so I never practice called therapy but I teach it to therapists.

Call therapy re-traumatizes the narcissist. This is not my invention. It is the work of FOA mainly. So called therapy FOA, F O A is a scholar. So I re-traumatize the narcissist. I create artificial mortification in the therapy.

And then when the narcissist is in a state of mortification in a controlled environment in the therapy, I then intervene. I don't intervene. I teach therapists to intervene.

So there is intervention at that moment. So I said to myself, why should we wait 40 years until the narcissist is mortified or maybe will never be mortified? Why don't we create mortification in the therapy, in the clinic?

And so the narcissist comes, there are a set of procedures and techniques to traumatize the narcissist so that we recreate the primary trauma.

The narcissist then disintegrates, decompensates. It's very dangerous time. Narcissist becomes suicidal, emotionally dysregulated.

So there needs to be constant supervision on the therapist and the therapist with the narcissist. Three layers, two layers. Yes, structures. It's very dangerous, very dangerous game, but no other way to reach the therapist, sorry, the narcissist. No other way.

You need to destroy these mega structures of defenses, resistances. You need to destroy them. There's no other way.

And the only way to do this is to create artificial mortification.

Then the narcissist goes through another process of learning and growing and never mind all that. We have a chance at least.

Then we have a chance. At least. That's the philosophy behind Cortello.

This makes sense. I believe so because it's very dangerous and I'm thinking that this is a hard technique. It's a kind of attack.

Narcissistic organization and we may sometimes expect the narcissistic aggression and rage.

And as you know, I'm reminding a famous sentence from the Winnicott.

The most important thing is not retaliating. Sometimes the client feel that we are retaliating.

Is grandiosity by attacking him or her.


And it is very dangerous technique and amazing. Dangerous the therapist, dangerous to the client.

But many people, narcissists reach rock bottom. Narcissists lose all their friends, all their money, their family, their freedom very often.

There's nothing to lose, you understand? Nothing to lose.

It's a cancer of the soul. Cancer of the soul. Chemotherapy and radiation in cancer, they're destructive. They destroy your body.

But there's no other way to fight cancer.

So in therapy with narcissists, we can do one of two things. We can collaborate with the grandiosity of the narcissist. We can collaborate.

We can also challenge the narcissist. We can say, you are definitely intelligent enough to accomplish this change. No, you are powerful enough to control yourself or to transform yourself.

So we are collaborating with the narcissist infantile grandiosity to induce change. Or we destroy the grandiosity by frontal attack, which is cold therapy.

I have from 28 years of experience in this field, I have come to the conclusion that collaborating with the narcissist grandiosity can obtain short term behavior modification, but it is short term. And then it rebounds.

The narcissist grandiosity becomes even more.

And then the therapist becomes an enemy, a persecutory object. And the narcissist confronts the therapist.

There's also countertransference and so on. We'll not talk about this, but you know, I don't know of any effective modality. I'm sorry to say I wish I could. I don't know.

Cold therapy, perhaps is the last, last chance is just to bombard the cancer with radiation and chemotherapy and, you know, and hope for the best. Hope for the best.

There is also a question, ethical question. When the narcissist is left without his grandiosity, what is left?

How the narcissist then becomes clinically borderline?

He doesn't have defenses against the external world and the external world can dysregulating very often. And also the narcissist doesn't have any other coping strategies and mechanisms. That's all he knows.

He knows just fantasy, grandiosity. If you take this away from him, what do you have?

You have a two year old child who is emotionally dysregulated all the time.

So the aftercare, after the clinical therapy, there must be another stage aftercare to help thenarcissist to somehow evolve into an adult with some more functional defense, because we all have defenses, of course. We all have psychological defense mechanisms. We all falsify reality. We all in this sense, pathological in some sense, but they are good.

I mean, there are levels of pathology.

The narcissism is a pathology of absence. The narcissist doesn't exist. There is an emptiness, empty schizoic core, exactly like borderline. And the narcissist is an absence pretending to be a presence.

What is this pretension?

The fantasy. There's nothing to the narcissist except the fantasy.

Take away the story, take away the narrative. Nothing there.

It's like you, you see this beautiful robe and there is a human figure in the robe. But when you take away the robe, there's nothing there.

So it's a terrifying condition, honestly, terrifying condition for the therapist as well.

Because don't underestimate what the narcissist can do to a therapist.

Don't underestimate. There is vicarious trauma.

Narcissists can traumatize the therapist. They often do.

Narcissists tap into the therapist's shadow, into the therapist's own defense, narcissistic defenses.

Narcissists trigger therapies.

To work with a narcissist is a very dangerous proposition for the therapist.

Narcissists are very good at finding your buttons, pushing them, for your vulnerabilities, exploiting them, corrupting the process. They're very good at this.

And so you're faced with a serious enemy when you are with a narcissist. There's no alliance here. Forget this total nonsense of therapeutic alliance. Total alliance is a war.

And as you know, most of the therapists refuse to visit this kind of client. They refer to the other therapists because they know how they can attack to the therapist's optimal narcissism. And they know as a very high level boxer that the weakness of everyone and where can put their face. These are predators. They're predators.

And they're not everyone is prey. The therapist is prey also is a victim, potential victim.

So this is reflexive.

Narcissist is not like psychopaths. Psychopath is planning, cunning, skimming, premeditated, intentional, deliberate. Narcissist is not like that. Narcissist is like a virus. It's reflexive. It's instinctual.

And so he will find your vulnerability. He will find your chinks and he will push your buttons and he will make you disintegrate if you're not careful as a therapist.

But how they know is kind of because they have something. They are something that I call cold empathy. Cold empathy is combination of cognitive empathy and reflexive empathy, but no emotional component. So they can scan you and they will empathize with you cognitively and analyze you. And so they will know everything about you, but it will not provoke them any emotion.

For example, the narcissist will scan you and say, this is a very sad person, but the narcissist will not be sad for you. Will not empathize with you. He will just say, Wonderful. This is a sad person. I can push the sad button. I can push him to be more sad. And that way I will have control over him. I will manipulate him through his sadness.

So it's all a situation of control. It's about control. Of course, narcissists are terrified of losing control because as children, they lost control.

So it's all about control. They need to control you.

But the extent of the control is not like the psychopath. The psychopath wants to control you to take your money. So the control is limited. They control you for the money and then they take the money. They lose interest. They go.

The narcissist wants to control you to the point that you don't exist anymore, that you cannot threaten the control. If you disappear, the control is total. So the narcissist converts you into an internal object, introjects you, makes you an internal object and then narcissist interacts with the internal object only, not with you. You cease to exist.

So the control in the case of narcissism is absolute total.

Narcissist wants you to become ancient Egyptian money. Nothing less because only then the narcissist can be sure that you are under control, that you will not abandon him, for example, that you will not be trained, that you will not challenge him, that you will not attack his grandiose.

Sorry, I'm sorry?

There was a eruption. Yeah, short. One second. Don't worry about it.

Yes, amazing, amazing explanation about the kind of attacking.


But in our Iranian culture, we cannot see a lot of narcissistic persons who come to the therapy. And when they come, because of the pressure of the family and the pressure of the friends, colleagues, and maybe job issues and conflicts, and most of the time they feel injured in an aggressive state.

Same in the West. Same in therapy.

Narcissists come to therapy because the court told them to go, because the prison told them to go, because the wife told them to go, or she will leave, or because of the family, or they are forced, they are forced to come to therapy. And they don't come to therapy, because they think they have any problems, they don't have any problems. They come to therapy because they have to, and sometimes they come to therapy because they hope that you will make them better narcissists.

They hope to learn from you all kinds of techniques, and how to be better at manipulating people, and so on and so on. So it's a collusion. And they try to corrupt you and contaminate you, they offer you money, they offer you to do business together, they offer to make you famous, make you famous on television, they contaminate the therapy process. They try to bribe you, corrupt you.

These are all narcissistic situations and techniques. And this is why it's very difficult to work with narcissists in therapeutic service. Very, very difficult.

Borderlines are not the same. Borderlines are very crazy and everything, but borderlines are, they have a soul, if you wish. They have emotions, they have empathy. They are dysregulated. They sometimes are very aggressive. So they can accuse you of misbehavior, for example, whatever. It's very common that borderlines accuse the therapist of sexual misbehavior, so they're a bit dangerous.

But at least you feel that you're working with a human being, full fledged human being, maybe disrupted human being, disordered human being, but still human being, recognisable human being. Human being in need, human being in distress, human being in, you know, when you work with borderlines.

But when you work with narcissists, I don't know, it's a bit of a feeling of an alien. I don't know, some human elements are really missing. Really. You're not supposed to say this in the profession. You're not supposed to say it. Everyone is human, everyone is okay.

But let me ask you this.

The narcissist has no empathy, emotional empathy. And the narcissist has no access to positive emotions. Narcissists cannot love, for example. If you take away emotions and empathy, what is left? What is left to be human?

Computers. Computers compute. Artificial intelligence writes poetry.

Only thing that separates us from the machines and from animals is consciousness, empathy and emotions.

If you take away consciousness, because the narcissist is not conscious, he denies reality, he is stuck in fantasy, he has no consciousness, he has no awareness.

If you take this away and you take empathy away and you take emotions away, what is left to define a human being?

What? Nothing much. That you have two legs and two arms.

Many robots today have two legs and two arms. That doesn't make you human beings. Nothing.

And this is why when you go online, the victims, they're going crazy. They're saying this was a demon, this was a satan, this was they can't convey.

You know, when I started my work, it was 1995. There was no language for narcissism. I invented most of a language that is used today. I invented narcissistic abuse, I invented somatic narcissism, ribbon knot, I mean, knock on tar, all this, no, flying monkeys, hoovering, all this I invented. Why did I invent? Why did I invent this language?

Because there was no language. There was no way to communicate the experience, you know.

And even today, after almost 30 years, there is still no language. The experience is still so outside human, typical life, that the victims cannot communicate what happened to them.

They're going crazy. They're using demons and satan, I don't know, not because they are religious, but because they lack the language. There's no language to describe this experience. It's really out of this world in many ways.

And you have narcissists today everywhere. Your narcissists in politics, your narcissists in show business. They're taking over, they're multiplying, they're proliferating, definitely. That's not some vaccine. There are studies by Twenge and Campbell and many others that show that the incidence and prevalence of narcissism is increasing dramatically among young people.

Women today are much more narcissistic than they were 40 years ago. 40 years ago, only 24% of diagnosed narcissists were women. Today, depending on the country, is 40 to 50%.

The prevalence and incidence of narcissism among women is double.

I would like to have a second conversation with you where I would interview you. I'm very curious to hear about the practice of psychoanalysis and generally therapy in Iran. I'm very curious to hear.

I believe many other people are curious.

So if you don't mind, we could have a second conversation where we would discuss psychology, therapy in Iran and how the profession in Iran deals with various patients and what schools are accepted, what schools are rejected, what schools are dominant, and so on and forth.

I'm very curious about this.

So next time I will shut up and you will do the talking if it's okay with you.

Welcome, welcome and thank you.

It is my pleasure to explain you about the current situation and psychotropic practicing.

I as an Iranian psychoanalyst trying to visit and to try to have psychoanalysis sessions with the Iranian colleagues.

As you know, we do not have access to any IPA-approved psychoanalytic institute in my country, Iran. You cannot find a lot of internationally approved psychoanalyzed in my country, but you can find several and highly ranked experts psychoanalyzes who graduated from the Western Institute and the universities.

Do people generally go to therapy? Is it considered a...

Yes, these days because of the social medias and accessing the average people to the social media, they understood the importance of participating in any kind of psychotropic sessions in my country.

And as you know, our main problem is the same as the most of the psychoanalyzed psychotropics in Western countries is the tuitions and the payment fee for the psychotropic sessions because most of the local insurance organizations do not support for the psychotropic sessions and mental health.

But most of the Iranian psychologists trying to get governmental support for supporting our own people.

Is there a lot of couples there?

Their mental health.

But I do not practice couple entropy because it is very difficult in my country. I believe that I lose a lot of energy when I used to visit the couples in my clinics.

So I refuse to visit the couples because their problems are very complex, very difficult to resolve.

So it is a very hard situation and I always admire my colleagues.

I have many many questions for you, but I have to go now. And I would like to talk to you again about the situation of therapy and psychotherapy and so on in Iran.

I have many questions, definitely. So if you don't mind, we will have a second conversation.

I'm really happy if you...

Yes, it's my pleasure to explain about the current and the most recent psychotherapy and the most common problems that my people are facing these days. Amazing. And which schools also... It seems that the school manages super-tid. Yes, please. And also which schools are dominant in Iran? Which schools of psychology are still dominant and which therapy is dominant and so on? It's interesting. Good question.

Good question because the most dominant schools in my country is CBT.

Unfortunately, what happened... CBT, yes. And unfortunately, what happened these days, most of the Iranian clients tired of the CBT techniques, they visited by the several CBT therapists, they know all of the techniques, they can find the technique through the internet. So a kind of revolution, I think, is happening in the atmosphere of the psychology and psychotherapy in my country and most of the Iranian psychology students at the university are trying to touch and participate in the psychodynamic school, psychoanalysis school, and they know that most of the people are trying to know their unconscious and they are very tired of the techniques. They are very tired of the direct advices, tired of the charts, challenging with the automatic negative thought and so on.

I really do respect to my CBT, entropy colleagues, but I'm talking about the atmosphere of my city is one and all of my country in Iran. But we are challenging with the Iranian client and Iranian people who come to visit with this as psychoanalyzed.

The main problem as most of the Iranian psychoanalyzed believes that is the core problem for practicing psychoanalyzes and psychodynamic techniques. The Iranian client is free association.

According to our culture and to our literature, someone who wants to tell a sentence, he or she has to think before, think about the reaction and by considering all of these kinds of cultural and background of the Iranian culture, the free association does not happen purely in our sessions.

And this is our main problem.

Actually Freud experienced identical problem because the Viennese society, the society in Vienna, when he invented free association, he didn't invent it, actually he took it from someone else. Never mind. When he tried to implement free association, the Viennese society was very similar to what you described in Iran nowadays. Everyone was thinking before they were talking and what would be the social impact and how would be the reactions.

So he had very big difficulty with this and he was, I would like to talk to you further, I have to go unfortunately, but we definitely, if you agree, we will talk again about psychotherapy in Iran. Fascinating topic.

Okay. Sure. This is very fascinating topics for me too and it's my pleasure for a second meeting and thought about the atmosphere.

And I'm referring you to a very well-known book who is published and written by Dr. Gohar Homayun, who is a famous psychoanalyze, he's graduated from Boston Psychoanalyze Institute and his book name Psychoanalyzes in Tehran. And she very well explained about the atmosphere of the psychoanalyzes in Iran and she believes that the core conflict and the core problem for everyone who are trying to visit and to practice the psychoanalyzes with the Iranian people is that he or she has not expect a pure free associations and you are very well-referred to the Viennese atmosphere in the world history and it makes sense to me.

Psychoanalyzes was a revolution. Yes.


Thank you very much and we will talk again. Thank you very much.

Thank you. Have a nice day. So nice to meet you. Have a nice day. Bye.

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