Monday, April 30, 2007

Beneath Narcissism Lie Fear and Self-loathing

Some seemingly overconfident people are actually in considerable psychological trouble, suffering what psychiatrists call narcissistic personality disorder, one of the most self- destructive and difficult-to-treat conditions in the lexicon of mental illness.

For contrary to Narcissus of Greek legend, who was enthralled by his own reflection in a pool of water, researchers say that roughly 1 million Americans with this personality disorder act not from self-love but from a kind of self-loathing, a dread of failure and an inability to endure its emotional fallout: shame. Millions more are thought to suffer from narcissistic tendencies, based on similar but less extreme fears. Recent research suggests that this anguish develops in early childhood, and that therapists can help put it to rest. New treatments combine advice on handling everyday situations -- so-called cognitive therapy -- with emotional forays into the unconscious more typical of psychoanalysis.


This integration of biology and psychology amounts to a "paradigm shift" in the way that therapists understand conditions such as narcissism, said Allan Schore, a UCLA behavioral specialist and expert on the origins of personality disorders. "The essential thing seems to be that the patient not only see their narcissism, and talk about it," he said, "but also that they have a physical experience of the emotion that underlies it -- rage, shame, sadness, whatever it is."

The word "narcissist" is so commonly thrown around that it's in danger of becoming an all-purpose label for any difficult character, in the same way that "chauvinist" or "fascist" was used a generation ago. When psychiatrists diagnose the disorder, however, they do so on the basis of several specific traits. These include a grandiose sense of self-importance, in which talents and personal achievements are vastly exaggerated; a desperate need for admiration; an almost absolute blindness to the needs and feelings of others; and continual fantasies of power, ideal love and success that far outstrip the ordinariness of many narcissists' lives.


To be sure, when deployed in a business that feeds on self-promotion and star power, such as entertainment or music, these qualities often produce just that: a star, a sensation, the sort of executive or performer who lands in a Beverly Hills estate with a chef and a fleet of German sports cars. But add to this carefully cantilevered life some imperfect elements -- a demanding spouse,young kids, sluggish box office or sales -- and you can almost hear the joists creaking. When deprived of across-the-board success in the outside world, narcissists' need for attention may turn inward, causing depression, mood swings, even exacerbating physical pain, said Marc Schoen, a UCLA School of Medicine psychologist. "And of course their pain is always much, much worse than anyone else's," he said.

Marriages often wither under such selfish complaint. Alcohol and drug problems are commonplace. Usually it's only a matter of time, therapists say, before there's trouble in the arena that's often the most gratifying, work.

"That's when they come to see someone like me," said Dr. Robert Neborsky, a San Diego therapist who specializes in difficult-to-treat patients, some 40 percent of whom have narcissistic tendencies, if not the whole package, he estimates. "At some point they look around and realize that at home, and at work, everyone hates them." The narcissistic longing for admiration has brought loathing instead, and they don't know why.

As patients, they're no treat, either. Pompous one moment and solicitous the next, alternately contemptuous and then exuberantly affectionate, narcissists are among most difficult therapy candidates.

They may know something is wrong but resist treatment vigorously because the nature of the disorder is based on self-defense and deception of others -- even a therapist trying to help.

The hot flush of shame or anger; the heavy ache of sadness or loss: These physical sensations themselves, expressed in the presence of a capable therapist, appear to activate areas in the brain that did not develop normally in narcissists' second year of life, said Schore.

Researchers do not know exactly why the development goes awry. Some -- in a revival of what has become an out-of-fashion point of view -- attribute the problem to parents who can't or don't properly soothe their toddler's disappointments: teaching the child, in effect, to avoid failure at all costs, rather than learning to cope with it.

Other theorists are convinced that parents' indulgence of their child's moods and demands freezes the boy or girl in a state of childlike grandiosity.

Los Angeles Times
Sunday, October 20, 2002
©2002 San Francisco Chronicle.