Transcription
The key, in my mind, to treating malignant narcissism is the ability of the therapist to empathize with the sadistic pleasure that the person can take in triumphing over others, including you, the therapist. You have to go into it expecting that your efforts will be challenged in perhaps very aggressive ways, and then, as calmly as you can, you can try to engage the person, observing and acknowledging the pleasure in their attacks on you. It's a little hard because therapists, on the whole, go into the field because they're nice people who want to help others, and they have a hard time empathizing with an individual who gets pleasure from hurting. But if you can empathize with that, you can help somebody be more aware of that, and you can help them see there are alternative ways to connect.
There was one case I wasn't directly involved with, but I knew quite a bit about over a period of time. His patient, in her twenties, had serially just cut off one finger after another. I don't remember how many fingers, if any, she had left at the time of the interview that I saw. Everybody was concerned about the depression and the self-destructiveness, treating the patient as kind of a victim, which, of course, in a way she was. But I thought the genius of the interviewer was to move beyond the surface and get in touch with what I was talking about before: her almost glee in her actions. It was a glee in showing that however hard others tried, she was stronger. She could triumph. Nobody could overwhelm her. Nobody could be stronger. Nobody could control. It was a defiance. It's like, "You know, you're all trying to help me? Oh, isn't that cute? Look what I can do! You're not so big, are you, you big guy? No, I can still chop off another finger!" So it's this terrible underlying drama, and what looked like just the worst situation you'd ever want to be in seemed actually, on the deepest level, to be a source of pleasure and satisfaction and triumph.
If you're open to absorbing, containing, and helping the person come to terms with their sadistic pleasure, and then perhaps deciding there might be other ways to channel their aggression, then you have hope of success, as I have seen in some cases.
Is there a line where something should not be empathized with and should instead be pointed out as destructive? Or, by empathizing, I don't mean not pointing out as destructive. Empathizing includes tactfully naming what seems present, but that the patient is acting out or putting into action rather than describing as an emotion, and accepting it as human. So there's a containment and an acceptance. But I think acceptance is different from approval. So to accept the emotion is not to accept the action that follows the emotion. So, you know, I can deal with hate. I can deal with sadism. Maybe that says something about me. I just think those are part of the human experience. It's when they get channeled into destructive actions that say, "Well, you know, maybe we have to look at that and wonder if that's the way you want to go on living your life."
But, you know, think about Stephen King. Think about Carrie, the rage at the end. You know, people need to be able to empathize with that. That exists in a lot of our patients. Think about Misery, the mild-mannered woman who turns into the, uh, assaultive, controlling tyrant. You know, those fantasies connect with raw emotions. Civilization teaches us to channel those things, but it doesn't work for everybody. So I think the key to helping people is not to condemn the emotion, but to help people find better outlets for it and ways to manage it.