Shalom, Shoshanim. Like Freddy Krueger or a bad coin, I am back.
I am back and I am not going anywhere. I am going to stick right here and make very, very, very unnecessarily long videos. And you are going to watch them because you made the mistake of subscribing to my channel.
Today we are going to discuss something that will blow your mind, provoke your resistance, make you angry at me for a change. We are going to humanize the narcissist in at least one limited way.
The narcissist is a two-year-old, a traumatized two-year-old, a terrified two-year-old, trapped in the body of an adult. And being a two-year-old, the narcissist is very, very sad. He is melancholy. He is depressed. He is dysphoric. He mourns and grieves the loss of his life and life potentialities and opportunities.
He said because as a child he had not been seen. He mourns the fact that he had never received proper love, that he had never had safe base, somewhere to go back to and cling to and feel utterly secure.
The narcissist is profoundly sad. He is so sad that he is not aware of it.
Clinically one could say that narcissism is a post-traumatic condition coupled with what came to be known as complicated grief or prolonged grief disorder.
And this precisely is the topic of today's video.
But many of you will arise and say, what does any of this have to do with us? The hell with the narcissist? What about us?
Which is, coming to think of it, a very narcissistic statement. But I'm going to divide it in two parts.
Today I'm going to deal with the impact of prolonged, complicated grief or assistant grief on the narcissist.
And then next week I'm going to have a dialogue with the inimitable, the one and only Richard Grannon. And we're going to discuss the impact of prolonged grief on victims.
You put the two together, you get a complete picture.
My name for those of you who are not aware is Sam Vaknin. And I'm the only author, only I swear, of Malignant Self-Love: Narcissism Revisited. I'm also a professor of psychology in a variety of universities around this ever shrinking, polluted and diseased globe.
And with this optimistic message, we can venture forth and begin to analyze and discuss this new clinical entity, persistent or prolonged grief.
All of you are probably acquainted or most of you are probably acquainted with Elisabeth Kubler-Ross. Elisabeth Kubler-Ross was a Swiss-American psychologist, and she came up with what is known as the Five Stages of Grief. She was a pioneer of studies on dying people. She had, you know, to each his own. That was her hobby, it seems.
Kubler-Ross wrote a fantastic book called On Death and Dying. It was published in 1969. And she proposed a patient focus, just death adjustment treatment. And in this book, she described five stages of mourning, five stages of grief, and they are in order, denial, anger, bargaining, depression and acceptance.
I've dealt with this cycle in other videos, so I won't go into details right here. It's important to note that you can go back and forth between these stages. They're not linear. They're more cyclical.
David Kessler suggested to add a six stage of grief and he calls it meaning.
Okay. All this has to do with healthy grieving, functional grieving, kind of grieving and mourning that allows you to move on.
But what happens when you get stuck in one of these stages? What happens when you are unable to stop grieving, unable to stop mourning?
Well, then what happens is called persistent complex bereavement disorder, also known as complicated grief, also known as prolonged grief disorder.
And what I'm suggesting in this video is that pathological narcissism is exactly this. A post-traumatic condition coupled with an inability to stop grieving, to stop mourning, the life lost as a child.
The narcissist has been traumatized as a child, had been abused as a child, either by being idolized, instrumentalized and parentified, or by being classically abused, sexually, physically, verbally and psychologically. Either way, the child was not allowed to separate, had not been allowed to separate and to individuate. The child was not allowed to become his own person. The boundaries of the child were always breached and violated and the child felt raped and traumatized, terrorized, horrified and terrified, a constant state of hyper vigilance and then vigilance later in life, evolving into paranoid ideation, persecutory delusions and so on and so forth.
So the narcissist is this child turned adult. And when this child becomes an adult, the child is sad. The child mourns. The child mourns.
The fact that he had never had a childhood, not a proper one at any rate, had never been loved unconditionally, had never been accepted, had never been seen, had never been embraced, had never experienced warmth.
And so narcissists are in a constant state of bereavement.
Already in 1942, Harvey Keckley hypothesized that psychopaths, as he called it, actually were describing narcissists, but he called them psychopaths.
So already then Keckley hypothesized that narcissists may actually be emotionally hyper sensitive and inordinately intelligent.
Keckley suggested that narcissism is a defensive attempt to wall off emotions that were so profound that they had threatened to overwhelm and dysregulate the narcissist.
So Keckley upended the common wisdom at the time and the common wisdom today.
He said, actually, narcissists are not devoid of emotion. They have too many and too much emotions. Their emotions are too powerful.
They cannot contain the emotions. He said that narcissism is a kind of post-traumatic state, but he didn't use the term.
And as I said, this post-traumatic state can be described as a form of complicated grief or prolonged grief reaction.
A later scholar, J.S. Grobstein, suggested in 1984 that borderline personality disorder was the outcome of a failed effort by the child to deploy pathological narcissism.
When the child fails to do so, the child becomes a borderline.
But why would the child try to become a narcissist in order to avert, in order to forestall, in order to prevent ominous emotional reactions to extreme abuse?
Well, it's high time to discuss the construct of prolonged grief disorder or complicated grief or persistent complex bereavement disorder.
First of all, it's important to know that it's going to make it into the diagnostic and statistical manual text revision. So there's going to be shortly a text revision of the diagnostic and statistical manual edition five. And in this text revision, they're going to include prolonged grief disorder. It's going to be in the newest edition of the manual.
Now, most of the information we have is based on the work of a single individual, Holly G. Priggerson. She's a professor of sociology in medicine at Weill Cornell Medicine in New York City. And she had written the book, or she co-authored the book actually, bereavement, studies of grief in adult life. She's been at it for three decades, as long as I've been at narcissism. And gradually she spawned a movement the same way I did with narcissism in the 90s. She spawned a movement and now there are quite a few scholars studying this condition in the United States, in the United Kingdom, in the Netherlands, and Australia, and so on and so forth.
And the outcome, the good outcome in my view, is the inclusion of prolonged grief disorder in the DSM.
Now, grief is a natural reaction. It should not be stigmatized. It should not be medicalized.
It's good to grieve. Grieving, mourning, is a form of processing adverse input, adverse experiences. It's a human reaction to loss, loss, absence, and death.
And grief is not linear, as I said. It's cyclical. It comes in waves because it's constantly triggered. It's triggered by internal triggers. It's triggered by external reminders. It's triggered by the environment. It's triggered by thoughts, passing thoughts, intrusive thoughts. It's triggered multiply all the time.
We have severe difficulty to accept loss. We are loss averse. We are also risk averse, and loss implies risk. Loss is vaguely ominous. Loss is vaguely menacing and threatening.
Each one of us processes loss differently. It's very difficult to generalize. It's very difficult to universalize.
Some people like to talk about their loss. They like to ruminate and contemplate and evoke and remember and reminisce on lost loved ones.
Others prefer actually to be silent. They withdraw to a corner. They don't want anyone to bother them.
So we process grief in very different ways.
But all of us, one way or another, in our own idiosyncratic manner, all of us have a hard time when we had lost something and more importantly when we had lost someone more significantly.
We have a hard time. It's tough. It's difficult.
Many people are unable to accept a loss. Many people lose meaning in life.
They say, well, life is meaningless with such a loss without a loved one, without a project, because we can grieve the loss of a project or the loss of a beloved enterprise.
Entrepreneurs mourn the loss of their startup ventures. People mourn the loss of loved ones. We mourn losses in general. It doesn't have to be losses of loved ones.
But in each and every case, some people find it more difficult to countenance loss. And the loss drains life of meaning. It makes it very difficult for these people to move on to reintegrate into society. They can't find new ways to love, new ways to work.
And so Catherine Shon, a professor of psychiatry at the School of Social Work and founding director of the Center for Complicated Grief at Columbia University, she says, but for a small but significant group of people, grief does not resolve. It is ongoing, pervasive, intense and debilitating. And this is what we call prolonged grief disorder.
One year of grieving and one year of mourning is standard, is common, and is healthy. If it goes beyond that, something's wrong.
So prolonged grief disorder cannot be diagnosed before one year had elapsed from the loss. And prolonged grief disorder is not just this vague feeling that something is missing, this amputated absence, this yearning and longing and and twitching of the hard cords. It's not just an ambient thing. It's a daily, intense feeling, pining for the disease, deceased, a preoccupation with thoughts and memories to the point of rumination and obsessive obsession or intrusive thinking.
There are other things there are other symptoms, identity, confusion, disbelief, avoidance of reminders of the loss, intense emotional pain, difficulty to engage with other people and with life, emotional numbness, the feeling that life is meaningless and intense loneliness.
And yes, if this reminds you of complex post-traumatic stress disorder, and even if this reminds you of major depression, you're not entirely wrong. CPTSD and depression are allied with prolonged grief disorder. They are kind of symptoms of this disorder. They take a high, they hitchhike on the disorder.
Complicated grief had been described for many, many decades, as I said, about 10% of people who had lost a loved one, for example, struggle with this problem.
So prolonged grief disorder is not depression. It's not post-traumatic stress disorder.
Prickerson says that it's neurobiologically and epidemiologically different. It has distinct patterns of symptoms and different treatments, but it's still closely allied with.
Some people are at much higher risk for prolonged grief disorder. We'll talk about it a bit later.
And prolonged grief disorder tends to produce medical problems and conditions, even cancer, high blood pressure, heart or cardiovascular or immunological issues. Other than that, disorders, disability, hospitalization, and in the ultimate cases, suicide.
Now, there's quite a lot of research on this disorder. We identified several factors that complicate the process of grieving.
For example, if you were very dependent on the deceased person, on the law, on the loved one who had just died, or if you were very dependent on a workplace and a work environment, or a group, a collective, a church, a nation, a football club, whatever, dependence for practical or emotional needs predisposes you to a much longer grieving period.
If your world revolved around these things, the loss can be impossible to process because it threatens you. It's a threat.
And then the classic panoply of reactions takes hold and takes place. Freeze, fight, respond, and phone, etc.
These four Fs, they are typical reactions to extreme loss because extreme loss is perceived as a threat.
And some people have difficulty to remember positive traits or positive aspects of the loss. And so they develop negative affectivity because they can't remember the positive things. They tend to overemphasize the negative things, negative traits, negative behaviors, injustices, discriminatory behaviors, failures, defeats.
And so when they dwell on this, they develop anger, they develop envy, they develop rage. So this enhances, this negative affectivity creates a toxic environment within which the grief cannot be properly processed.
A scholar by the name of Kritzkaya says, sudden and traumatic deaths and deaths by suicide are more likely to lead to complicated grief.
If the grieving person is dealing with multiple losses, poor social support has a lot of stress in their lives or a history of psychological disorders or prior trauma, those are risk factors too.
And you're beginning to see the interface with narcissism because this is a very good description of the childhood of the narcissist, multiple losses, poor social support, a lot of stress, a history of trauma. These are risk factors.
Grief is also exacerbated by chronically avoiding thinking about the loss, denying it somehow, refusing to think of it, getting stuck in a ruminative cycle, asking why has this happened to me? Wondering could I have done something different?
Judging oneself, the inner critic, the sadistic superego takes over and renders the grieving person a victim of internal processes.
The grieving person, the person in mourning experiences negative emotions related to themselves. They kind of assume responsibility and feel guilty and ashamed for the loss, which is of course form of extreme auto-plastic but pathological defense.
There are quite a few treatments for complicated grief, at least in the last 30 years or 20 years, I would say. So we don't treat complicated grief with anti-depressants and depression-focused therapy is pretty useless.
And so there are specialised treatments for complicated grief. There's shears, integrative treatment, and many of these treatments are described in a book called Grief and Bereavement in Contemporary Society.
And so there's an Australian study from 2014 and cognitive behavior therapy streamlined and custom designed for grief seems to help.
And the therapy focuses on thinking traps, negative automatic thoughts that keep us mired deeply and profoundly in grief and so on and so forth.
So these are the treatments available today. We sometimes provide anti-depressants as well, but that's only when depression is diagnosed separately from the complicated grief.
For those of you who want to learn more or know more, I recommend that you go to Columbia University's Centre for Complicated Grief and Cornell University's Centre for Research on End-of-Life Care. These are wonderful resources for this issue.
So before we move on to narcissism, let us just summarise what we had learned about persistent bereavement, complicated grief and prolonged grief disorder.
Some people, when they experience loss, they experience debilitation, they can't recover, they don't improve even when time passes. And so painful emotions are long lasting and they are severe and there's trouble to resume one's own life.
And of course, as I said before, different people have different paths in life and this applies to grieving and mourning as well. And so they cycle through the Kubler-Ross five stages in different ways.
Some of them accept the reality of the loss early on, others deny it. Some of them allow themselves to experience the pain of the loss. Others are terrified by any form of pain and agony and so they drown their sorrow sometimes with the aid of substances. Some people adjust to the new reality where the loss is present like an aching tooth and others can't accept it and they keep pretending that there had been no loss and pushed to the extreme, this could lead even to psychotic symptoms.
Some people self-medicate with rebound relationships or some other form of self-soothing, eating, sex, etc, etc. Others withdraw, they become totally avoidant and schizoid and never leave home. And these differences are totally normal if they last up to one year but if they last longer than a year something is wrong, something is wrong.
So during the first few months after the loss normal grief is indistinguishable from complicated grief but normal grief fades, it fades over time, time is the great iller and if the grief lingers or gets worse we're talking about complicated grief, it's a heightened state of mourning, it doesn't allow you to heal.
The Mayo Clinic lists these signs and symptoms of complicated grief, intense sorrow, pain and rumination over the loss, focus on little else but the loss, extreme focus on reminders of the loss or excessive avoidance of reminders of the loss, intense and persistent longing or pining, problems accepting the loss, numbness or detachment, bitterness about the loss, feeling that life holds no meaning or purpose, it's known as anhedonia, lack of trust in others, inability to enjoy life or to think back on positive experiences with the dead loved one or in the workplace and so on.
Complicated grief entails certain kinds of behaviors.
If you have trouble carrying out normal routines, if you isolate from other people and withdraw from social activities, if you experience depression, deep sadness, guilt or self-blame, if you believe that you did something wrong or could have prevented the loss, if you feel life isn't worth living without your loved one or workplace, if you wish you had died along with your loved one, these are signs of a pathology.
Now we don't know what causes complicated grief. It could be the environment, could be the personality, could be inherited traits, could be a natural chemical makeup of the body, we don't know, we simply don't know but we do know that complicated grief occurs more often among females and with older age
and there are risk factors.
An unexpected or violent death such as death from a car accident or the murder or a suicide of a loved one, the death of a child, close or dependent relationship to a deceased person, a workplace, an environment, a collective establishment and institution, social isolation or loss of support system, loss of friendships, past history of depression, separation anxiety or post-traumatic stress disorder, traumatic childhood experiences such as abuse and neglect where narcissism comes in, other major life stressors such as major financial hardships and complicated grief gets even more complicated.
The effects are physical, mental but also social.
Without appropriate treatment, complicated grief evolves and progresses into depression, suicidal ideation or suicidal behaviors, anxiety including CPTSD and PTSD, significant sleep disturbances, increased risk of physical illness as I mentioned, heart disease, cancer, high blood pressure, long-term difficulty with daily living, relationships, work activities, alcohol, nicotine use or substance misuse and abuse.
So if you experience all this you need to talk to someone, you need to talk to someone professional or not, you need to get support and you need to get bereavement counseling.
Okay this is prolonged grief disorder.
How does it apply to narcissists?
Let's go one step back.
Remember, narcissists are post-traumatized, abused children, even when they become adults. These are ossified, fossilized children, children trapped in a cocoon or a shell which is protective against external abuse, real, perceived or imaginary. These are children who had created a deity, a divinity, the false self and had sacrificed themselves to the false self. They sacrificed the true self to the false self. So these children no longer exist.
The essence of narcissism is absence, not presence and not existence.
And so recently there was a study published in this month actually, October 2021. The study was published in Child Abuse and Neglect, volume 121, November 2021. I mean the next issue. And it's titled A Tangled Start, the link between childhood maltreatment, psychopathology and relationships in adulthood.
The authors are Mona Shahab, Josiah Derrida, Philip Spinhoven, Brenda Penix and others.
And these are the highlights of the study.
Number one, childhood maltreatment and insecure attachment styles are linked to intimate relationships. The strongest pathway is through depression, severity and anxious attachment. Anxiety and alcohol dependence severity did not mediate the relationships in the final model.
Depression and severity, depression, severity and anxious avoidant attachment style fully mediated the relationship.
Now let me translate this into English.
Academics tend to write in an obscure language because it makes them feel self-important.
So what they're trying to say is that if someone had been mistreated as a child, if someone had been abused as a child, he's likely to develop an insecure attachment style.
Now I refer you to my video on insecure attachment styles for more.
And lo and behold, surprise, surprise, insecure attachment styles impact adversely future intimate relationships.
Point number one. Point number two.
It seems that the abuse translates into depression and depression translates into anxious attachment.
Now this is a critical insight. It's very important. This is the pathway we've all been looking for for decades.
And this study of 2000 people, a Dutch study, by the way, was done in the Netherlands. This study is the first to point the finger at the real culprit.
When the child is abused, he becomes sad, the child becomes depressed, the child is dysphoric, sadness is the mediating factor, the child reacts with extreme depression.
Now Melanie Klein, as early as the 50s, had theorized about this. She has something called the depressive schizoid phase, but she didn't go far enough.
No, not by a long shot.
This study closes the gaps. This study shows that narcissism, pathological narcissism, or at the very least, insecure attachment styles which render intimate relationships impossible or abusive, these are mediated. These come into being because of depression.
So the child who is abused, who is mistreated in a variety of ways, the child whose boundaries are not allowed to develop, the child who is constantly intruded upon and invaded, the child who is parentified and instrumentalized and idolized, the child who is sexually abused, the child who is physically abused, the child who is psychologically and verbally abused, this child, his initial reaction long before the development of pathological narcissism and maybe borderline if there's a failure, long before a personality disorder forms as a post-traumatic condition, long before all this, the initial overwhelming drowning reaction is immense depression.
If I have to put it in one sentence, the child wants to die. The child is not getting nourishment, emotional nourishment. He's not getting the nutrients needed to sustain and build up his soul, so to speak, as a metaphor. He's not getting love. He's not getting acceptance and warmth and safety. He lives in fear and terror. He's walking on eggshells. He's hypervigilant. He develops cold empathy in order to anticipate the crazy, arbitrary, capricious, threatening, unpredictable behavior of the selfish dead mother, the narcissistic or depressive or absent mother.
It is depression that mediates the outcomes of narcissism in adult life, especially when it comes to interpersonal relationships. This depression leads to the development of insecure attachment and anxious attachment.
Now, the scholars, the researchers who offered this study, they tested for other factors, except depression. They tried to see whether anxiety is the cause. No, it's not. They tried to see whether substance abuse, such as alcohol dependence, may be the reason. No, it's not.
Anxiety, substance abuse, other mental health disorders, they do not explain. They do not explain the relationship failure of people who had been abused as children.
Only depression, severity, and only anxious avoidant attachment styles explained the later outcomes, the abject and desolate and total defeat when it comes to maintaining long-term relationships.
Some elements in this study are not new. We knew for a long time now that childhood maltreatment is associated with lower quality relationships later in life.
There's been past research which had demonstrated conclusively that childhood abuse and childhood neglect can lead to insecure attachment styles and patterns in other adulthood.
But this study goes further because it found the missing link, and the missing link is severe depression.
Trauma in childhood, depression, insecure avoidant and anxious attachment, failure in maintaining intimacy, and long-term relationships.
And of course, if you keep failing at something all the time, you begin to dread it. So you develop a fear of intimacy and commitment phobia.
And so they tracked in this study, they tracked 2000 people for well over a decade, and they evaluated everything. It's a very thorough study and commendable for its rigorous methodology.
And three quarters of these people, it's a shocking number. It's reminiscent of the adverse childhood experiences study. Three quarters of this group reported a history of depression and anxiety. And the anxiety and depression were much more severe than among a comparable cohort who did not experience childhood abuse.
Childhood abuse predisposes you to extreme depression that then impacts your attachment style, ruins your relationships and renders you intimacy averse, frightened to try again. You begin to equate love with pain and hurt.
These individuals in the study reported lower quality relationships and higher level of insecure attachment, anxious attachment, extreme levels of intimacy sometimes coupled with low levels of autonomy, or high levels of autonomy and discomfort with intimacy.
So these were the two outcomes also known as codependence and narcissism.
Some of these groups were extremely intimate with their partners, but had zero agency and zero autonomy. They were totally dependent, dependent personality disorder. And some of these groups had exact opposite. They had an extremely high level of autonomy, bordering actually on defiance, but they were very uncomfortable with intimacy, avoidant and anxious, anxious and avoidant.
And so the study is seminal in the sense that it proved that poor relationship quality is fully mediated by insecure attachment and depression severity.
They tried six other alternatives and they found only two distinct pathways.
The strongest pathway connected childhood abuse to increase depression severity, anxious attachment and lower quality relationship as I mentioned.
And the authors write, this pathway indicates that some individuals who reported being maltreated during childhood may develop low mood and other depressive symptoms, become more dependent and unconfident, which may be perceived as clingier and experience more distress in the relationship, which might subsequently affect the relationship quality.
But there was a second pathway.
Maltreatment was linked again to depression, but this time the person developed avoidant attachment. And again, it resulted in lower quality relationship.
Partners with avoidant attachment reject intimacy. They don't trust anyone. They don't rely on others. They're self-sufficient. Their self-containment had become a rigid ideology.
And both of these pathways lead to the same outcome. And both of them are very common in narcissism.
The compensatory narcissist tends to be highly co-dependent.
And in some ways the covert narcissist is the same overt or fragile narcissist is also in many ways co-dependent.
The overt narcissist, who is manifestly grandiose and sanguineous supply, the overt narcissist is usually an avoidant type.
And so this is the study and the authors conclude by saying, informing parents, teachers, general practitioners, and the general public about the possible destructive impact of childhood maltreatment on mental wellbeing and intimate relations may lead to better recognition and earlier detection.
The study again was published in Childhood Abuse and Neglect in the next issue, November 2021.
As children, when narcissists are abused in a variety of ways, they become very sad. They develop extreme depression. They try to fend off the depression by developing narcissism, pathological narcissistic defenses. Some of them succeed. Many of them don't and they become border lines.
Those who succeed become narcissists, but the depression is still there. They're in a state of constant mourning and constant grief, known as prolonged grief disorder.
And so this is their landscape. A landscape imbued with extreme debilitating or permeating sadness on the one hand and extreme defenses against this sadness, because maybe exactly as Cleckley and Rothstein had suggested, narcissists are actually hypersensitive emotionally and sufficiently intelligent to realize their predicament. And so they try to deny it all. They try to cast themselves grandiosely as invulnerable, invincible. It's their way of trying to cope with the grieving process, a bereavement process, so profound that it threatens to overwhelm them and push them to suicide.
Thank you for listening.