Transcription
The clinical literature on narcissism, you see a lot of, uh, commentary about how there are really two versions of it: the arrogant version and the kind of depressed, depleted version. We've called them different things. You know, I think Gabbard calls it the, uh, oblivious narcissist, who's the one who's, "I'm wonderful and everybody should worship me," and the hyper-vigilant narcissist, who's the one who's, "Where are my, my next self-esteem supplies coming from? I need affirmation that I'm okay."
There seems like there's something tautological about being like, some people can be described as, we'll say, grandiose, and then you say, "Oh, well, they are that," but it somehow doesn't get to the essence of what the thing is, right? That's why I really don't like the DSM descriptions of personality disorders. Starting in 1980, they tried to shift the DSM to having criteria that were able to look at external behaviors. You can get more agreement among experts that way than if you're trying to infer what's going on inside. But for a therapist, it's more important to know what's going on inside.
The DSM pretty much describes the more arrogant version, but that arrogant version is a defense against another self-state in which the person feels terrible about themselves. And so, their issue is all about self-esteem maintenance, and they use inflated self-esteem to defend against insufficient self-esteem. So, they're, they're easier to understand if you think of them as a person who came of age in such a way that they were always having to get narcissistic supplies, as we say in the trade. They need evidence of their being important and powerful and beautiful and well-known.
What would the DSM call the deflated narcissist? They don't really have a category of that, but somebody would show up, we'd probably diagnose them as having a depression. Not all depressions are alike, but the narcissistic version of depression is, "I'm empty. I don't know who I am. Help! I, I need somebody to make me popular and famous and powerful, and where am I going to get that? And I don't see where, so I'm depressed." That's very different from other kinds of depression, which, for example, involve the fear that I'm bad. It's more of a guilty depression. The narcissistic version of a depression is a shamed depression.
If you've, if you've got certain capacities and you have narcissistic psychological tendencies, then if you're successful, you tend to look very grandiose. But therapists see a lot of people who either were successful and lost it, and then they don't know who they are and they don't know what life is about, or who wish they had it and are very empty and come to us saying things like, "You got to make me popular. You got to make me, if only I were beautiful and rich and connected, then I'd be fine." And they don't have a concept of anything else that would make them okay.
About how you get this way is that somehow your truer qualities, your more authentic qualities, especially your feelings, were not fully accepted and recognized by your family of origin. And for whatever reason, that created in you the sense that you had to be false in some ways, or you had no value. Not one version of how to create a person with difficult, uh, narcissistic problems is to be super critical all the time. You know, "Why an A? Why not an A+?" And the child will always feel, "I'm not good enough," and get desperate to be good enough because that's the only way that the kid feels valuable.
But another way to do it is to say, "You're wonderful. You're terrific. If your teacher criticizes you, I'm going to go and tell her a thing or two." We're seeing a lot of that in Western cultures these days because we've tried to overcorrect for the previous version. But the kid can get the same message there because if a kid feels that the parent needs them to be perfect and is distorting them into a perfect being, they're not getting any message that their ordinary, you know, flawed, naughty, problematic qualities are part of them and acceptable because they're a human being. So, you can, you can create somebody with a big problem in their core sense of who they are by any kind of distortion to try to make them into the child that a parent needs to reflect well on the parent.
In the literature, again and again, we find that people, um, tell us histories that make it sound to us like they were treated as, the jargon, as narcissistic extensions. You know, the parent needs them to be an extension of the parent. That sheds a great light on the parent. Now, we all do this to some extent with our kids. We want our kids to make us look good as parents. But if that's the chronic, constant message, "You have to be perfect so that I, your parent, will look perfect," the kid gets to learn that you're fulfilling a function for your parent's self-esteem. But who are you, you know? So, there's, there's an emptiness about it.
And the most painful thing about the emptiness is the inability to really love other people as they are. People with narcissistic issues in relationships tend to be chronically critical in trying to improve their partner rather than deeply loving a person as he or she is. Very often, people with a lot of narcissistic problems can idealize other people, and that's the closest they get to real love. And in relationships, they fall in love, meaning that they go through that early phase of idealizing the other person that we all do when we fall in love. And then, you know, when they realize that the person they are in love with as a human being, they start getting critical. And it's because they really don't have the concept of having been loved for who they are, so they can't love others for who they are. But they use the term love, and they'll talk about somebody being the most wonderful this or the best that. So, idealization is sort of the closest that they can get.
So, they criticize other people for not taking care of them. In fact, a real problem in relationships with a narcissistic person is that people who are very narcissistic in their personalities tend to have this idea that if I'm in a relationship with you, you should simply divine my needs and meet them. I shouldn't have to ask because I feel shame about asking. Shame is really at the root of narcissistic problems. If I say to them, when they complain about somebody, "Well, did you make your needs explicit?" What I get back is, "What do you mean, needs?" You see the shame and the contempt for their being a person with needs. And in couple therapy, I'll try to get them to actually say, "Here's what I would need from you." But it's really, really hard for them. They would prefer to stay in the position of, "You did that wrong. You're, you're just a loser."
Especially acknowledging one's dependency on other people. It's, uh, seems to be quite terrifying for people who are brought up not being fully affirmed as who they are to feel dependent on somebody else. I'm talking about normal human dependency now, not people who are pathologically unable to take care of themselves. But normally, people, we're interdependent. We, we require the forgiveness of our friends and partners when we make mistakes. We feel gratitude when people meet our needs. If you're brought up that you have to be perfect and grandiose, whatever way you got that message, whether it was from the culture at large or from your parents, but where it's overlearned that you have to be a false self, a grandiose kind of a person, you can't genuinely apologize because that's admitting a flaw. You can't genuinely thank because that's acknowledging need. And so, the two things that are really the most important to repair and sustain relationships are out of your capacity.
So, you end up doing things like apology substitutes, which tend to leave other people cold. Like, you know, if I am nasty to my husband on Monday and I make him a really nice dinner on Tuesday, he's not going to warm up to me unless I also say, "I'm making you a really nice dinner tonight because I feel bad about how I treated you last night." If I just make him the dinner and then get pissed off that he doesn't realize that this is my way of undoing what I did, you can see that the relationship doesn't improve at all. And the same with, with thanks, you know. It's a different transaction. If I go to a teacher who's helped my kid and if, if I say, "Thank you so much for how you've helped my daughter," then if I go in and do a kind of thank you substitute like, "Nice job with my kid. Very well done," as if I'm in a position of superiority dispensing praise, you know. So, it's sort of painful to watch people with narcissistic psychologies try to sort of get along in a world in which they don't know how to apologize and they don't know how to thank because they can't acknowledge their interdependence on other people.
People that we later diagnose as narcissistic, they don't even know their feelings because they haven't had people name them. Their feelings are unformulated. So, they, they often can identify that they're in a rage or they're feeling envy, but some of the more nuanced feelings, they can't even find in themselves. What's an example of a nuanced feeling? Being sad, being regretful, finding oneself having mixed feelings about something, feeling tender. Uh, it's not like, you know, the older descriptions of like neurosis where you have unconscious sadness, for example. It's more like you don't even know what sadness is. You don't, nobody else helped you grieve. So, when you're feeling sort of a painful sense, you don't even know how to, how to deal with it, what to call it. Uh, you, you tend to be critical of yourself and then critical of anybody else who's sort of open about sadness or limitation or dependency. And you, you suffuse yourself with contempt because you know you're feeling this thing that you don't understand.
But we have learned over the past 100 years that there are some people who can't find their anger, even though they look angry to other people, because they literally don't feel it. And in fact, there's been some research done in Canada where, uh, they've used fMRIs on people who are so-called alexithymic, which is a fancy word for they don't know what they're feeling. They have no words for affect, is really what the Greek term means. And if you, if you take fMRIs of their brain, they really aren't feeling what everybody else will say they're feeling. They'll be in a group and everybody will say, "You're angry," and they'll be acting what all the rest of us would think of as angry, and they literally don't know that that's what's going on there. Something isn't hooking up in their brain. I think we'll learn a lot more about the neurology of this eventually, but that's very different from, "I'm, I can find my anger if I just am honest with myself."
Well, I can say a few things about treatment. There, there's always been controversy about how to work with people with narcissistic dynamics, and partly it's because of they, they can have such different presentations. They can be devaluing or they can be idealizing, or there's some other ways that they sometimes relate. All of these are their ways of trying to have a relationship, but, but they differ in what they require. They're basically a couple of ways of framing it. One important theorist, Heinz Kohut, basically said, "We all have this, and you know, if you have a good enough family, you can idealize a parent and then slowly realize that they're human," and that's a kind of natural trajectory. And where you run into narcissistic problems is if the parent isn't good enough to idealize in the first place, so you can't take in the sense of identification with a good enough person, or when they, um, later in the process, when they resist your seeing them as human, like in kindergarten when they come home and tell you that their teacher knows more about dinosaurs than you do, and you have to, you have to continue to be seen as the wonderful, perfect parent of the three-year-old. Um, if you can't take their de-idealization, then they'll get stuck. And that's a way of thinking of it as a normal developmental process that people get stuck in. And therapy involves just helping them along that, uh, get back on that developmental path.
And the, the other main approach to it construes it as more of a getting off the path at the, at the very beginning and, and using, um, radically, uh, maladaptive ways of dealing with development, especially devaluation of anything you might envy. And if you frame people like that, you kind of have to slowly take apart their tendency to devalue and show them the, the needs and the shame and the envy underneath that. And, um, you work with patients depends on, you know, whether you're going from one theory or the other, how you see the particular patient, because some patients are better candidates for one than the other. And also, to some extent, the therapist's own personality, because especially with this kind of difficulty, it's really important that the therapist be fully authentic. You have to integrate who you are with how you understand any particular patient. So, you can't do really good psychotherapy by applying a formula to anybody. Yay, good enough, good enough object.