Transcription
How do you differentiate between malignant narcissism and just sociopathy? What's the difference?
That's an excellent question, and that one I have thought about. The cutoff in my mind is that a sociopath, which I think is pretty synonymous with the psychopath, literally has no concern about any other person on the planet.
Interestingly, malignant narcissists, even though they are caught up in this defense of grandiosity, they usually can care about another person. Putting it differently, relations can matter. They do seem to have some urge, some desire for connection to others. That desire for connection is very fragile because since they don't think they have anything to offer, they don't expect that relations are going to work out very well. Therefore, they puff themselves up and seek admiration where one might better seek love.
But at least in the malignant narcissist, there's some internal conflict between that wish to connect and the opposing aggressive drives. That's why there's hope in therapy for the malignant narcissist. You have a conflict to deal with. In the sociopath, there's the aggression, there's the exploitativeness, but it doesn't seem to be combined with any desire to have any kind of emotional connection with anybody else. So you don't have a conflict. A person is totally fine exploiting, hurting, damaging others, perhaps getting pleasure out of it. So that's how I see the difference.
What would ever bring a malignant narcissist to therapy? Why would they ever go?
Well, in some cases, it's the family. Most of the people I've treated with this disorder have been young adults, and of course, we have concerned families, concerned about the suicide attempts, the self-harm. And I don't mean to imply that all self-harm has a sadistic component towards others. I'm talking about in this patient population. But some people themselves realize, let's put it this way, in the professional parlance, they have at least some ego-dystonicity about their condition. They're not totally happy with it. They realize it's impeding their effort to have any kind of a more successful life. So there is sometimes that urge within the person, if it's not the family sending them.
You mentioned a few minutes ago that the narcissist in a relationship may feel they have nothing to offer and therefore puff themselves up. Do they actually feel that they have nothing to offer, or is that the unconscious feeling that they're trying to fight with their narcissism?
That's what I'm always trying to figure out when I'm dealing with somebody with this condition. It's never clear to me, at least at the start with a patient, if their defensive system, their grandiose narrative, truly relieves them of the horror of the internal emptiness, or if it works some of the time. It's hard to enter into, like, total contact with the subjective experience of somebody like that. So we can only speculate.
Some of the times, the person gives the impression of having a sense of satisfaction, and that may be true. Most often, one suspects that underneath, they're plagued by doubt, insecurity, anxiety. But the interesting thing is, the more they escape from the anxiety and the sense of inadequacy, the less they're in touch with reality. Extreme narcissism borders on psychosis. So if the person is able to delude him or herself adequately, maybe their subjective experience is gratifying to them, but they're almost, or perhaps are, in a world of their own.
There's also a link with substance abuse because the person can't sustain their delusional grandiose narrative, and when the doubt enters in, sometimes the substance is needed to sort of wash away the doubt and the anxiety that goes with it. In contrast to somebody who manages to keep the grandiosity intact and doesn't have those fault lines that are threatening to the whole system. In a significant number of people with substance abuse, these personality disorder issues are not adequately addressed. And if we're to do better with our substance abuse population, we should include assessments for underlying personality disorders.
Is there really such a thing as family for someone who's in malignant narcissism?
Well, if the family is organized to worship and adore the militant narcissist, there can be some semblance of a family. But it's hard to imagine because the aggression that gets played out would so tear at the family fabric. The only cases I've seen, I would say, would fall into two categories. The people who've come to treatment sometimes come from marriages where the partner has a quite a masochistic streak, and so will tolerate the kind of things I've been describing. And the children may just have no choice but to stay in the family until they can leave. And I'm happy to say I've seen progress in patients like that and the achievement of relative harmony in the family.
The other kind of family is one where everybody is in it for mutual exploitation, where it just seems like the connections are based on exploitation and power grabbing, not anything we would say looked like love and concern and being one big happy family.