Pathological Narcissism: Does It Exist? (with Kelly Brogan, MD)

Uploaded 2/12/2024, approx. 22 minute read

And welcome back to Reclamation Radio. I am Dr. Kelly Brogan, and I am here today in conversation with Professor Sam Vaknin on the subject of narcissism and his body of work, which has spanned over decades in an effort to raise awareness around what has now become such a colloquial term that in social media and in the zeitgeist of relationship navigation, everyone seems to be able to diagnose the pathology of narcissism, have an opinion on it, feel victimized by it.

And I want to offer before we dive in a bit of a caveat, because as I mentioned before we started recording, I've spent the past 15 years challenging the concept of mental illness, psychiatric diagnoses through my published literature, through my clinical experience. And I do acknowledge that if psychiatry is good at something, and if psychiatrists are skilled in a particular way, it is around pattern recognition and so-called cluster B personality disorders are patterns and represent patterns, I think you would agree, that impact many of our lives and relationship experiences.

So I would love to explore what you have defined from your experience and your research. And I also want to frame that your perspective from my best understanding of it does align with my ethos on personal responsibility, because there is a very powerful field of victim consciousness around this concept of narcissism.

All you have to do is speak to 10 women and you'll find 10 stories of their experiences of narcissistic abuse. And I think that it's become a cover for a lot of victim stories, victim energy and disempowerment, I would say especially for women.

And a lot of what I've understood you have to share, I'd love to get into is that this is a dance, a dance of two matched individuals often in relationship.

And I want to talk about the role that you see, this mother projection, I would call it mother woundology, because that's very much in line with a lot of what I've been exploring.

So thank you for being here, Sam, I appreciate it.

And let's just start with the basics. Because there is such this sort of socialized understanding of what narcissism is and everybody has their own opinion, how would you define it? Like what actually is this entity?

And I know you would say probably it has many different shades and sort of fragments within it.

How would you define what you believe and have studied narcissism to be?

I think we tend to confuse the clinical entity of the logical narcissism. With narcissism is an organizing principle of postmodern society. Civilization is an explanatory principle, not dissimilar to religion. Whereby we make sense of our lives and we imbue our lives with meaning and direction and purpose using the percepts and tenets of narcissism.

So narcissism serves to organize modern life that includes politics, show business, inter gender relationships, I mean, you name it. Narcissism simply explains it all. And it is distinct and should be distinct from the clinical entity. It is because we conflate and confuse the two that we have this pandemic.

And the pandemic is not a pandemic of narcissism, but a pandemic of misattributing narcissism, mislabeling narcissism, misperceiving narcissism. And that tsunami of misinformation, disinformation, utter nonsense and ridiculous tropes that afflict us because we conflate and confuse it.

So first of all, many people have what is known as narcissistic style. That's Lance Perry's phrase, not mine. If someone was an a-hole or a jerk, many people have this, men and women, women increasingly more so because women are becoming more and more masculine, stereotypically masculine. That has nothing to do with pathological narcissism and definitely not nothing to do with narcissistic personality disorder.

The truth is that only a tiny percentage of the population suffer from narcissistic personality disorder anywhere between one and 2% of the general populations. Five to 6% of the clinical population suffer from narcissistic personality disorder.

So that's problem number one.

Problem number two, we are using an outdated text, which should have been trashed something like three decades ago. And that's a diagnostic and statistical manual in its latest iteration, which is the text revision of the fifth edition. It's as trashy as before. Nothing has changed. The only thing was a wink, a wink at state of the art knowledge by introducing what the DSM committee called the alternative models of personality disorders.

So now we have a, now we have two definitions of narcissism. One is the old, the copy-based job, the nine criteria in the DSM four, which migrated mysteriously into the DSM five text revision 25 years later or 30 years later, actually. And we have the alternative model of narcissistic personality disorder at the very end of the book, among the appendices, appendices, and it's a much better encapsulation of what narcissism is because it's dimensional.

Let me try to shed a different light on narcissism.

If I were asked to define narcissism, I could choose the DSM four path and describe behaviors, most of them antisocial behaviors, one way or another, lack of empathy, exploitativeness, destructive envy, and so on and so forth, so negative affectivity and so on.

So this is a descriptive way, a phenomenological way, which is very primitive because these behaviors are common in many, many other mental illnesses, alleged mental disorders and what have you.

And this creates a phenomenon known as comorbidity.

And another phenomenon, which is less known, which is known as polytheticproblem. Nevermind that. What it means simply is that when you stick to behaviors, when you make a list of behaviors and diagnose people because they are behaving in a certain way, you're bound to misdiagnose many people. And you're going to, you're bound to slap multiple labels on the same person, which is bad practice. It's absolutely bad practice.

So today there's another text. It's the 11th edition of the International Classification of Diseases, the ICD 11. It's published by the World Health Organization, but don't hold it against it. And it's actually an excellent text because it does reflect cutting edge thinking about personality disorders.

For example, in the ICD 11 there is no narcissistic personality disorder. Actually, there's no personality disorder of any kind. There's a single diagnosis of personality disorder with multiple facets, multiple manifestations and dimension.

So you are diagnosed with a personality disorder with a narcissistic overlay. You're, you're more prone to be a narcissist than anything else or with an antisocial outlay with a borderline or emotionally dysregulated outlay.

The thing is this, anyone who's ever worked with walking, talking human beings knows that people are sometimes narcissists and then the week after their borderlines and then if they get really pissed off at you, they become psychopaths and then, et cetera, et cetera.

These diagnosis are utterly artificial. People are not pawns, they're rivers, they flow. Everything is in flux.

These are simply different facets or different shimmering, shimmering facade that disguises a core problem.

And the core problem is probably social, not clinical, not mental. An inability to function within society in ways which society deems acceptable, sublimated.

So when you disobey the rules, when you hate authority, when you're confirmations, when you're defiant, when you're reckless, they call you a psychopath. When you think that you're better off or better than others, when you feel superior and naughty and you're entitled to exploit other people and so and so forth, they call you a narcissist.

But these have nothing to do with any mental reality. These have to do, these are modes of functioning. These are personality styles. These are ways that we interact with fellow beings.

So there's a serious philosophical problem here, serious philosophical problem. With the exception of borderline personality disorder among cluster B, I would very much hesitate to consider psychopathy and mental illness or antisocial personality disorder. And I think that narcissistic personality disorder is a post-traumatic condition.

And I think that even borderline is a strong element of complex trauma, which expresses itself via emotional dysregulation and host of other phenomena.

We are lost. We are lost because we insist to pigeonhole people and we insist on the pretension that psychology is a science. It's not. It's a pseudoscience. It's a form of literature.

The greatest psychologists were probably Dostoyevsky, Nietzsche, you know, Mussolini. And Freud, who was a literary genius, much more than a rigorous scientist.

So I would define narcissism coming back to you, circuitously coming back to your question. I would define narcissism as someone who is unable to perceive other people as external and separate.

So what he does, this kind of person, I'm saying he, but it's a she, I mean, 50% a women.

What a narcissist does, now they convert other people, what is known as external objects, they convert other people into internal objects. They create avatars, they create representations of other people in their mind. I call this process snapshotting.

Clinically it's known as interjection. So they create representations of other people in their minds and then they continue to interact with these representations.

That's a major hallmark of narcissism. And the second major hallmark of narcissism, narcissism, functional narcissism is a disruption in the process of forming a functioning self.

So ironically, narcissists are selfless. They don't have a self. They don't have what Freud used to call an ego. They're not egoists because they don't have an ego. Because they don't have a functional, constellated, integrated self. And because they don't have an ego, the ego is our way of interacting with reality. The ego is the mediator between us and reality, because they don't have this. They have impaired reality testing, they miss the reality. They live in fantasy. They use other people to regulate their internal landscape.

So they use other people to regulate their sense of self worth. For example, this is known as external regulation. It's also common in borderline. So these are the two core features. I don't think it's very important that they're exploitative. I don't even think it's very important that they lack empathy, honestly. That's not the core issue, really. The core issue is they cannot perceive you as separate and external.

And so you have no rights. And you have no, they don't allow you to be independent or agentic or autonomous. And because you don't exist, your independent existence threatens them. They feel threatened by you.

And similarly, at the same time, they need you in order to feel good or even more so in order to feel that they exist. That's it. That's how it is, in effect.

I remember when I was on the floors in the hospital, we would be encouraged to deride people who were diagnosed with cluster B personality disorders. And we would say, it's just another fuck you don't leave me patient, because of that energy you're describing that says it's like pushing and pulling.

So you're depicting this pattern of defenses that develop from a traumatic response, where individuals become like infrastructural support for the so-called narcissists' self-concept.

So where do you think, what is a typical pattern of childhood experiences, maybe particularly with the mother, that could give rise to this if this is a socialized experience for these individuals?

Narcissism is a very early reaction. Autological narcissism is a very early reaction. And so, unfortunately, it's the mother, not the father.

The father assumes a very important role in development much later in life, usually after age three years old, coming from age three onwards.

And the father's role is limited generally to socialization. The father conveys how he should behave, social scripts, skills, the fact skill acquisition is the father is helpful with this.

And so, so father is much more instrumental. Father is the equivalent of a teacher, actually. The mother is the one who shapes the internal world of the child.

In contrast to the self-help scam industry and its claims, this internal world is almost cast in stone. Once you have transitioned beyond a certain age, some things can never be changed. They can never even be mitigated or remitigated. It's done. That's it. That's who you are.

It's quite bleak.

It is, but it happens to be factual.

For example, attachment styles, which form very early on, according to Boulby and others. And according to modern reasons, attachment styles are literally immutable.

There are many claims online that attachment styles can change and so on. These are claims by self-enriching, self-interested, self-styled experts.

But the truth is that the vast majority of attachment styles are lifelong.

Similarly, this empathy, a lack of ability to experience emotional empathy, because everyone has empathy. Narcissists and psychopaths have empathy. They have a special kind of empathy, which I labeled called empathy. It's a combination of cognitive and reflexive empathy. So they do have empathy. If they were devoid of empathy, they wouldn't have been able to achieve empathy.

To exploit and abuse people. To interact with people in any meaningful way, even negatively, you need to have empathy.

But the inability to experience emotional empathy is lifelong, casting stone, utterly unchangeable. Period. Anyone who claims otherwise is a con artist.

So the damage inflicted by dead mothers, what Andrei Green calls dead mothers, metaphorically dead mothers, mothers who are emotionally upset or depressive or selfish and narcissistic or insecure, mothers who instrumentalize the child, mothers who parentify the child. These kind of mothers, the damage they inflict is regrettably a lifespan damage. It goes well into adulthood and you cannot get rid of it. And so I think there are three developmental trajectories of narcissism.

One is if you are ignored as a child, if you're ignored, abandoned and rejected, frustrated on a regular basis. That's one trajectory.

The other one, if on the very contrary, you're idolized, pedestalized, spoiled, pampered. In other words, if you're not allowed to separate from the parent and confront reality, if the parent isolates you and firewalls and keeps telling you that you can do no wrong and all your, your perfect and your God like and so on. That's another trajectory because it denies the child the ability to grow up and to separate from the parent.

We grow up only via losses and failures. These are the sole engine of engines of growth. We learn nothing from success. We learn a lot from loss and failure.

And when the child is smothered and pampered and spoiled, the parent does not allow the child to experience loss and failure. So that's a form of abuse.

So there's a second trajectory.

And the third trajectory is known as in behaviorism as intermittent reinforcement. It's when the mother is sometimes bought and sometimes called sometimes loving and sometimes hateful, sometimes rejecting and sometimes embracing approach avoidance, repetition, compulsive, unpredictable, indeterminate and therefore not a secure base.

That also generates narcissism. Nasticism is a defense. It's an attempt to do two things. Transform oneself into a God like untouchable, invincible, invulnerable figure because a child experiences so much pain, so much frustration is so terrified and intimidated by the capriciousness and arbitrariness of the adults in his or her life. That at some point the child gives up on itself. The child says, as I am right now, I'm not going to survive. I need to become someone else's frontal. And the child becomes someone else. He becomes a false self. The child creates a God like figure, a divinity and becomes this divinity, merges and fuses with their divinity in a symbiotic kind of relationship.

So this is the first element of the defense and the second element of the defense.

The child creates a fantasy and migrates, migrates from reality to the fantasy. Reality in the case of such children is unbearable and intolerable and life threatening, very often life threatening.

So they need to avoid and withdraw and they create a paracosm, which is a kind of elaborate virtual reality.

And then they transition into this virtual reality.

And in order to not feel the arrows and slings of mother, they become God like.

Now, unfortunately, this defense survives into adulthood.

Freud was the first to observe this. He said the primary narcissism becomes secondary. And it survives into adulthood.

And then as an adult, you prefer fantasy to reality and you defend yourself against the pain and loss of reality by pretending to be a God. Simply your divinity.

And if your divinity is challenged, you externalize aggression. You become violent verbally or physically or whatever.

This is in a nutshell, this is narcissism. It's a child.

And one of the major mistakes we make in therapy is that we try to treat narcissists as if they were adults. We try to strike the therapeutic alliance with the narcissist, negotiate with the narcissist, treatment goals in a treatment plan.

That's utterly ridiculous. A typical narcissist is anywhere between two and four years old.

We need to treat narcissism using tools from child psychology and of course, trauma therapies.

The child is heavily traumatized.

The way that this adaptation to early stressors manifests in adulthood seems to have different nuances and you've talked about different types.

Is it important to know about these sort of subtle patterns within the category of narcissism or do they all stem from such a similar place that the behaviors are all really related?

We used to think that there are two types of narcissists. We used to think that there are overt grandiose narcissists and covert vulnerable shy fragile.

We no longer believe this. Definitely not in the practitioners community. There's a gap. There's an abyss between the practitioners community and academe. Academe is light years behind the practitioners community actually.

But even in academe, more progressive voices begin to understand that all narcissists are both overt and covert. That the choice of style, whether to be overt or covert depends crucially on the availability and regularity of narcissistic supply.

When the narcissist experiences something called collapse, when the narcissist becomes less self efficacious or less efficacious in obtaining supply, when he fails to obtain supply, but on a regular basis, then most narcissists become covert for a while, become covert. They build up sources of narcissistic supply and they become overt again.

So there's no type of constancy. We also have somatic versus cerebral narcissist. It's something I was the first to describe. Somatic narcissist derive narcissistic supply using their bodies, their sexuality, their musculature, their attire, their sartorial choices, their looks. While cerebral narcissists use their intellect or leverage their intellect, intelligence incisiveness to obtain supply. And again, there's no type constancy. A cerebral narcissist who fails to obtain supply, who undergoes a phase of collapse would become somatic. Somatic narcissist would attempt to become cerebral, which is a pretty pathetic site, but it does happen. So it's not that constancy. I think at the core of all this is the following equation.

Narcissists have learned as children that they can elicit positive emotions from the environment, especially love only when they perform.

So everything is founded on performance. Narcissists are thespian, they're actors, but not in the sense that they're deceiving people. In the sense that they believe they have to act all the time in order to obtain supply.

And the false self is a kind of a mega, mega theater production, a Broadway production. And so because they believe that everything depends on performance, the minute they for some reason don't perform well or don't perform according to expectations, their own expectation, their perfectionist, perfectionistic.

So when they don't perform well, they collapse, they simply fall apart. It's a process known in some schools of psychology as decompensation. The defenses shut down and they fall apart, they disintegrate. And then the only solution is to become not you.

Again, it's a typical feature of narcissism. Narcissism is founded on performance. And if you fail to perform, the solution is to give up on yourself, to deny yourself and to become someone else.

The child becomes the false self. The cerebral becomes somatic, the somatic becomes cerebral. The covert becomes overt, the overt becomes covert. We call this identity disturbance.

Exactly, exactly like in borderline personality.

So there is no core identity. Narcissist, there's nothing there. It's what used to be called in the 90s, an empty schizoid core. There's a void, there's a black hole where a human being or person should have been.

And so this shapeshifting kaleidoscopic metamorphosis, they're compensatory. They're intended to compensate for deep set sense of inferiority and fragility and vulnerability.

And this is an automatic process. This is a lifelong automatic process that is a major determinant of narcissism, defines narcissism.

Narcissism is absence masquerading as presence. Narcissists are about the art of not being.

That's narcissism. And it is, people can't wrap their heads around. They just can't. They're trying to explain narcissism in terms of objects. Other people as objects, objects, physical objects as objects, I don't know, goals.

So they attribute to narcissism malice and premeditation. And that's not the case. There's simply nobody there.

As Kernberg had observed about borderlines, there's emptiness there. And yet there is the need to feel that you belong to the human species, that you're normal somehow. There's compulsive normalcy. There's the wish to appear, to function, to fit into a peer group, if you wish.

And this constant failure, because you cannot convert absence into presence. You cannot. It's doomed to failure.

Narcissist sets himself up for failure all the time. It's a process of grief. It's what we call today prolonged grief disorder.

The narcissist grieves the true self, grieves the child, grieves the lost potential. The narcissist grieves what he could have become and never will.

And so narcissists are heavily invested in becoming, in being, in existing, in which, as far as other people are concerned, it's a background thing. I mean, you don't sit around saying, "Okay, now I have to exist." Or you know, but narcissists do actually.

Narcissists do sit around and say, "No one is noticing me. I'm not being seen. Existential, right? Existential matter. "I'm not being seen so I don't exist. I need to be noticed. Otherwise I will not exist."

One of the many shadow elements of psychological pathology and psychiatric diagnosis that I have contended with is the way that these frameworks are used to other, right?

And to foster projection of our own disavowed shadow elements onto those sick people, onto those disordered people, I'm not like that, right?

And in your description just now, I was really reflecting on how many of my patients would say the same phrase to me as they emancipated from medications and diagnoses, at least identifying with that rubric. They would say, "I finally feel like myself."

And there's an element of what you're describing, even with what is referred to as like imposter syndrome, right? There's an element that I think is quite relatable.

This idea that we have been inculturated to perform in order to secure attention and approval and a sense of safety and that when that fails, we kind of like skitter off into another sense of self-identity, behavioral pattern.

And so there are elements of what you're describing that feel common enough. And it also seems like what you're saying is that the relational consequences in certain individuals that you would describe as narcissists are different than those of us who might otherwise have general insecurity or a sense of a diffused core.

So I'd love to dive into this because your depiction of the relational patterns, especially romantic, I think is one of the most clear that is out there.

And as much as you describe that there isn't an opportunity for a maturation or an integration or a so-called healing, there is an effort, it sounds like, in romantic relationships to individuate and to experience what was not experienced maturationally if you're saying that these individuals are walking around like two to four year olds.

So I wonder if you could take us through sort of the phases, what I've heard you describe as the phases of the kinds of, and I know you don't always use the term codependent, right? But colloquially, that's what a lot of people talk about, the narcissists and the codependent.

I don't mind using.

Okay. So a classical sort of romantic dyad, how that looks, what is the subconscious, perhaps, intention on the part of this individual who's in this pattern of narcissism? What happens? What are the stages? And how does it end up typically?

The reason you identify with so many elements of narcissism is because it's primordial. It's primordial. The baby needs to be seen. Babies who are not seen are also usually dead babies, end up as dead babies. The survival depends on being noticed and seen.

There are newborns who have embedded cues intended to elicit and solicit the mother's attention. Because by far the most important thing as far as survival goes is being seen. By the way, into adulthood, there are studies that demonstrated conclusively that if you're socially shunned, you pay a very high price in terms of health, physical health and so on and so forth. So it starts from there. It's a baby thing. Don't forget also that narcissism, at least in some schools of thought, narcissism is a healthy phase in development, in early development. It's known as primary narcissism.

And this is something that's been agreed on by adversaries such as Freud and Jung, for example. They both agreed that narcissism is a crucial phase in development, early childhood development and so on and so forth. And regardless of whether you believe in the jargon or lingo of narcissism or whether you think narcissism is a science, I don't. I still think narcissism does capture, sorry, psychology does capture truths, some truths. And I still believe that language is an important role in evoking or provoking insight and so on.

So I place a lot of emphasis on language. And I believe that when I say, for example, that there is such a thing as narcissism, I'm not just, it's not self-referential. I believe there is something like that.

And so both the need to be seen, which is relational, because you're seen by others. And narcissism, they're both real and they're both early childhood phenomena and therefore primordial, they're atavistic and you can't get rid of them. And they're lifelong.

That's why you identify with so many features of narcissism.

What is something goes awry in this process? When you as a baby need to be seen, you still don't make a distinction between yourself and the world. So this used to be known as a symbiotic phase. You still don't have this awareness. I am baby and then there's the rest of the world. It's all one big mishmash. It's all a huge mess. So you are actually observing yourself. When you need to be seen and then you're seen, you don't perceive it. You don't say to yourself, it's Mummy who is watching me. It's Mummy who is seeing me. You say to yourself, it's me. I am seeing me. I am watching me. And that's how primary narcissism evolves and develops.

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