Transcription
Well, I think there's two issues. One is do they seek treatment, and the other is can they get better?
First of all, I think narcissists do those who, and I prefer to think of narcissistic personalities or those who have pathological narcissism. They do seek treatment, but they seek treatment at certain points in the life cycle: early adulthood. That's the first period in which we see a fair number of individuals who seek treatment. And that's because they often, you know, parents have grandiose expectations for their kids. Now, let's face it. I mean, that's unfortunately part of the norm, especially in urban centers and so on. They might have gotten through college with helicopter parents, you know, helping them write papers and that kind of thing, tons of tutors, but if they're not getting the job that they're expecting to get, or they're not getting the affirmation from the work world, or they just can't get out of the house and get a job, they often break down. A lot of kids who seem to be failure to thrive, I think really have pathological narcissism and simply aren't hearty enough to withstand the challenges, you know, the injuries that people go through when they make the transition from school to to the real world.
But let me give you an example. A young adult woman diagnosed with narcissistic personality disorder began to have difficulties in the last couple of years of high school. Her ambitions and her parents' ambitions for her were outstripping what she was able to do in her elite school. And, um, she wound up not getting into one of the top colleges that she expected to get into. Went to a college that she deemed a secondary school and was secondary, you know, in her view, and was very disappointed, and the parents were disappointed. It wasn't a lot of drugs and alcohol or the typical acting out scenario, um, promiscuity, any of those things that you might see in a more borderline situation. But she was lying to her parents. She was underachieving. She was not going to classes. She was saying she was turning in papers when she wasn't. There was some cheating going on. And she really began to break down in her first year of college. Um, and wound up leaving and then got evaluated by several people. They basically said, "Oh, well, you know, she has such severe personality pathology, she can't go back to school. Intensive treatment for at least a year, maybe day hospital."
So then I saw her in my office. Are you telling them they have this pathology? And what are you doing? Well, said to be untreatable, treatable. Well, interesting enough, because this person had already been evaluated and told that she had narcissistic personality disorder, she came in telling me that diagnosis. She didn't have a clue what it meant. I asked her what it meant, and she said, "Well, I don't know, something about being grandiose and vulnerable." I mean, that's about as much as she could come up with. So, I talked to her about it in different terms. I said, "Well, you know, those who have narcissistic pathology have extreme perfectionism. So much so that they torture themselves and, you know, if they don't absolutely perform according to the highest standard that they have, they feel like an utter failure and then they collapse and they can't do anything." I think that's kind of what happened to you when you went to college. Then we talked about having aspirations that are so unrealistic they kind of outstrip what that person can realistically do. If one is a singer, wants to be an opera singer. If one is a, you know, uh, has published a short story, they want to write a best-selling novel. Unless they do that, they feel like a failure. So, we talked about having goals that were perhaps unrealistic for where she was in her life and trying to set more realistic goals. And she was extremely rigid, weary, guarded. I could tell that she would talk and talk and talk, but she wasn't really revealing much about herself. And I think a real point of connection came when I said that to her and I said, you know, I think you're very guarded and very wary and really afraid to talk to me about what's really going on for fear that somehow I'm going to say what the other clinicians have said. You shouldn't go back to school. You really are very, very disturbed, etc., etc. And basically what I said to her is, we don't know what you can do. What do you want to do? Well, she did want to go back to school. So she did, and I advised the parents to let her do that, to pay her tuition, and we worked very intensively on her perfectionism, how difficult it was for her to, you know, not always get the top grades, to not always turn in the best paper, to sometimes say things in class where she felt like, you know, she wasn't making sense or she wasn't like, um, you know, getting the approbation she needed. We just worked on these day-to-day experiences. Her need to hide herself and fearfulness, her extreme vulnerability and sense of shame about having had to leave school. You see, this is the other side of narcissistic pathology. A year and a half later, she's actually doing very well. She's ready to graduate. She's had several summer jobs, has already been offered a job. Um, so this is a pretty quick turnaround time.
So that's one period. The second period is midlife. And that's because in early adulthood, if you make it through that transition and you're high achieving and you're, you know, reasonably intelligent and so on and have good opportunities, often there's a lot of narcissistic gratification. People may more or less arrange their lives to have admiration, to have their narcissistic needs met. And so that will go along until midlife when, because they've exploited people to a certain extent or their entitled attitudes will get them into trouble. Partners will begin to complain. Children will rebel and sometimes stop speaking to parents or make emotional demands on them to be heard and understood in a way that's beyond the capacities of a narcissistic parent, or even their, you know, secretaries or, you know, assistants will up and quit, will get fed up, and then they can begin to break down and feel, you know, have a loss of meaning about their life. Also, those narcissistic gratifications begin to wear thin. So midlife is often a time when people come for treatment. In fact, I have a fair number of patients now who are between the ages of 40 and 65. Some of them in treatment for the first time. And it's often really a revelation for them. They don't come in telling you they have narcissistic pathology, but that's clearly what's bringing them to treatment.