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WHAT IS NARCISSISM, ANYWAY?

There's a lot of talk about narcissism and its effects on individuals and those over whom they have power, particularly in the Age of Trump. Typically, psychologists are ethically constrained from diagnosing those they have not personally assessed. However, 27 mental health experts have now weighed in on Trump's fitness for office in The Dangerous Case of Donald Trump. They argue their duty to warn overrides the Goldwater "Rule."

Because there is so much incorrect information in the media now about narcissism in using it to explain the behavior of people in the public eye (i.e., "he's just doing this to get attention"), I thought I'd clarify what narcissism is and isn't, and why and when it is considered a mental illness, so that readers can come to their own, more informed conclusions.

Primary narcissism is healthy; it's the basis of self-esteem. It allows us to get back up when things go wrong, when we make mistakes or do things we regret. It originates in early life, when caregivers support us, even when we fail while learning to do things like stand up, walk, or eat with utensils. Over time, we internalize this supportive inner voice, an aspect of the self that comforts us throughout life. Primary narcissism reveals itself in the positive narrator we hear when talking to ourselves: "It's okay, I did my best." "I'll figure it out." "Yeah, I did that, it's not good. I've got to watch for it next time and apologize now." "This is going to be challenging, but I'll do my best and I'll probably succeed in the end." If we had no healthy narcissism, we'd be unable to initiate any action, move toward goals, form relationships, or stand up for ourselves when in conflict with another.

In our early years, most of us had a caregiver who responded to us most of the time when we expressed a basic, survival need (to be fed, warm, sheltered, clean, touched). We were frustrated when our caregiver didn't respond right away, or couldn't figure out what we needed, or if we had an illness or injury they couldn't resolve right away. Those moments helped us learn to tolerate frustration, to wait for gratification of our wants and needs. We began to contain our impulses: we didn't grab the cookie dad told us we couldn't have, we waited for him to be out of the room! Most of the time, we came to associate our caregiver with getting our needs met. We learned the world contained what we wanted and needed, that sometimes there are delays, and sometimes, although you can't always get what you want, you can still survive. We took that basic understanding with us as we moved into adulthood. We can all be "narcissistic" sometimes. When we are stressed or ill, we become more self-focused and unempathic than usual. The key is the word "usual." True (or, "secondary") narcissists aren't narcissistic sometimes, they are narcissistic all the time. Secondary narcissism is a distorted frame, or template, for how we see the world, ourselves, and others. It's not an attitude, and it doesn't change without long, hard, directed, focused work--something narcissists don't tend to sign up for. (There are two kinds of secondary narcissism; here, I'll describe the one most of us are most familiar with.)

Secondary narcissism is pathological. It's also an epidemic in the United States, having grown from about 10% of the population (1980s) to over 30% in 2010 (Soergel, US News & World Report). It interferes with our ability to understand and respond to reality, especially about our limitations. It's not, however, due to the economy or to normative trends, but to a disruption in early childhood development in which the child was not exposed to normal frustrations, didn't learn to tolerate them or to delay gratification of desires, and didn't learn that others are not inferior but do have different feelings and needs than the self. In short, narcissistic personalities do not really understand that others have different emotions, thoughts, desires, plans, motivations, and goals than themselves, and that lack of understanding is demonstrated through their behavior. For example, such a personality might say, "that person who doesn't agree with me isn't human." What they mean is, "I can't understand what thing that person is. People echo what I believe and think. Otherwise, they are not me, and therefore, not human."

How does this happen? Imagine a mother (the mother is the one who feeds and attends to the child’s needs), Anne, and her infant son, Jack. Anne hovered over Jack, giving him what Anne actually needed or wanted at the moment, convinced that her own wants and needs were identical to her child's all the time. She didn't respond to him, she intruded upon him with her own needs. For example, she fed him when she was hungry, put a blanket on him when she was cold. In her mind, the two of them were the same. This kept him from learning who he really was, because Anne essentially told Jack who he was through her actions. Anne used him to fulfill her own narcissistic need for perfection ("No one has a better child than me!"), unable to see what her son might actually need or want. No action of Jack's was unacceptable. All actions reassured Anne that she was special because she produced such a special, perfect child.

Struggling with a narcissistic disorder herself, Anne needed to believe that Jack was exceptional in order to feel okay about herself. In that way, Anne was divorced from reality, in which children do acceptable, wondrous, and unacceptable things, and some behaviors need limits. Limits help children learn to adapt to the world in which they will spend their lives. But because Anne was unable to perceive any of her son's unacceptable behaviors (justifying them to make him sound exceptional rather than inappropriate, violent, or dangerous), she placed no limits on his outrageous actions. Note that Jack rarely felt much real frustration, because Anne was constantly meeting needs he didn't even know he had, so he never learned to tolerate frustration, to wait, or to control his impulses. There was no need.

Jack grabbed things when he wanted to and hit and kicked whenever he felt afraid or angry, with no restraints. He couldn't imagine any other way of behaving. Because Anne imagined him as part of her own perfect self, she was unable to see his behavior as anything but desirable or justified or explained only by blaming others' "outrageous" behavior. Throughout childhood, Jack had tantrums, kicked, hit, screamed, insulted, demeaned, degraded, denied, boasted, rationalized, accused others of his own unacceptable behavior, or attempted to control them with his negative moods. After all, he got his basic physical needs gratified this way, and Anne (rather than disciplining him) rewarded him, labeling his violence and diminishment of others as strength, his tantrums as evidence of sensitivity, his denials and rationalizations as representing high intelligence. This allowed her to believe she was the special mother of an exceptional child, which was the point of having a child in the first place. She used Jack to gratify her own grandiosity (the belief that one is special and powerful, one to whom the normal rules don't apply, superior to others without consummate achievement). Anne held an image in her mind of Jack before he was born, and she couldn't see her real son through that image. He became that image for her, and in so doing, he never developed a real self of his own. He grew up to be charismatic, to appear powerful and desirable, because he believed so strongly that he was the best, and created an aura of desirability that pulled people to him who didn't know this would be a one-way relationship, oriented around Jack's needs and desires.

As an adult, Jack's opinions change based on who's adoring him. Inside, he has little imagination, expresses little genuine curiousity, feels different from others. He avoids being alone, for that's when the distracting noise stops, and he has no sense of who he is separate from the perfect son Anne needed him to be. He describes this feeling as emptiness or a void. It comes when he is either deprived of “supplies” (adoration, compliments, success) that allow him to continue to feel he is Anne's perfect child, or when his perfect image is attacked (by criticism, by reality not turning out to reflect the exceptional image he holds of himself—i.e., when he's questioned, fails, is fired, isn't universally adored).

The adult Jack is unable to recognize how people differ from his own, shifting images of them. This isn’t a preference or trait as much as an actual inability. Jack will consider another as incredible/wonderful/the best if they continue to perfectly support his perfect, powerful image of himself, but they will be bad, worthless, evil if/when they do not. That is the only criterion on which he judges others. He always needs to have his grandiosity reflected back to him, as it prevents him from feeling the terrifying void. If Jack is deprived of this, he will quickly find replacements. He can quickly cut off a person, even someone to whom he's appeared loyal, and never look back. That's because he's loyal only to the perfect image of himself the other person reinforced, not the actual other person. He wants to look in the mirror of another and see his perfect (if fake) self shining back. (On 7/19/17, James Poniewozik of the The New York Times wrote an excellent article illustrating this concept.)

That means that others are really only vending machines. For Jack, people are interchangeable as long as they consistently praise and adore, and the more high status or powerful, the better. The way to get along with Jack, then, is to constantly tell and show him that his judgment, feelings, beliefs, intuitions, decisions are the best, most perfect of all time, that only a genius could do what he does, to convince him that your fine ideas are his, and to never, ever humiliate him. A group could only effectively limit his destructive behavior uniformly, isolating him and creating and enforcing rules, while explaining that his own specialness actually requires this ("You're a genius, and a genius thinks so much; outside distractions will keep us from experiencing your brilliance"), and blaming something else (preferably an object) for any "mistake" others (not you, never you) believe he's made. Crucially, he doesn't make decisions based on caring for others' needs, and he's not responsive to arguments about others' needs at all. Instead, his eye is on feeding his perfect image of himself. If an action will do that, he'll take it. If not, he won't.

Narcissists are quite easy to feed with adoration and keep happy. Unfortunately, though, Jack is likely to be able to find others who want to bask in his charismatic glow and will continue to feed him just the way he is, and that is partly why people rarely heal from secondary narcissism. Narcissistic personalities are unwilling to stay in a "relationship" when confronted with the reality of themselves and the accompanying feelings of emptiness, void, and falling apart. Remember, they have no experience in coping with the kind of minor frustrations most of us take for granted. To most of us, a minor inconvenience, feedback, or delay is just that. To the narcissist, it’s a catastrophe worthy of a "nuclear" response.

Being around such a person is demoralizing. They fear their emptiness so much that, as charismatic as they are, they also create a subtle atmosphere of emptiness, dread, and void. One never quite feels connected to them, as there's nothing there to hang on to. Talking to Jack, others have a sense he hears them only when they talk about him and discuss topics of interest to him. When they begin to talk about anything else, he looks away, becomes restless, may grimace or look bored. His curiosity is motivated by seeking ways to think highly of himself. In reality, he's only listening for the adulation. He'll take in the words, focus on those that feed his grandiosity, and ignore the rest. If another says anything that isn't in keeping with his fake perfection, he will behave as always: he'll tantrum, get into a dark mood, plot revenge, unable to move on until he's destroyed the nonhuman who glimpsed his wounded real self that never got a chance to develop, and remains an infant. Then he'll destroy that person: personally, professionally, romantically ("you are dead to me!" "you are a thing!"). If that doesn't work, he can move into a paranoid stance, where others are perceived as hateful, vindictive objects who are trying to destroy him.

He cannot be any other way. In order to do so, he'd have to be able to see people as something other than mirrors and vending machines: as having feelings, thoughts, and attitudes that are different from his. Because he sees people as things, he is incapable of empathy. He cannot put himself in another's shoes: his perspective is the only valid one in the world. Expecting him to exhibit genuine empathy is like approaching a person in a wheelchair, expecting them to walk, and then taking it personally when they don't. He is not going to change. He simply can't. The world is his snow globe, and he alone winds it up and puts it away.

He is not "seeking attention." He's seeking emotional survival. Survival for him means avoiding "falling apart" in the void of having no real self, being able to continue to act as perfect fake son while hiding his incapable, undeveloped real self. He needs help to do that: the mirrors that are others. He lives in a house of mirrors, and he demands that everyone he sees reflect back to him the same shining image Anne obliterated him with so long ago. Otherwise, he'll shatter and replace them, and move on to the next.

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