The Case for Revisioning Narcissism in Just a Few Pages
When a problem has been with us for a long time, it may be time to view it with a fresh set of eyes. For if it had been clearly or comprehensively seen, it would less likely remain so problematic.
For the above reason I've published a book entitled Re-Visioning Narcissism: Healing Heresies for Polarized Times. While the conventional understanding of narcissism is expressed by the American Psychiatric Association’s official diagnostic and statistical manual (the DSM). For laymen, the understanding could be distilled into three paragraphs.
First, that Narcissistic Personality Disorder (NPD) is one of the (ten) personality disorders. And that each personality disorder deviates markedly from cultural norms; is deeply hardwired into the personality structure; having become visible by adolescence or early adulthood.
Second, personality disorders are considered more pathological than “garden variety neurotics”--yet less delusional than psychotics. And that those suffering from a personality disorder rarely exhibit one personality disorder, and that disorder alone.
Third, to be considered valid, a diagnosis of NPD should reflect at least five of nine diagnostic criteria. Central criteria include: Grandiosity, the feelings of being “special,” wanting only to associate with other high status people, being entitled, while also requiring excessive admiration. It can also exhibit exploitive tendencies, while lacking empathy, and manifesting arrogant or haughty behaviors.
I’d find the above three paragraphs to be perfectly valid, if hardly comprehensive...
The notion of personality disorders deviating markedly from cultural norms seems understandable. Yet this has also been where conventional understanding can miss the mark, while impacting the estimated prevalence of narcissism in the population. Here’s what I mean...
According to the last two editions of the DSM, NPD is estimated to exist in only between 0 and 6.2 percent of the American population. Yet if zero percent (!) is the low part of its estimated range, is this saying there could be no appreciable percentage of Americans suffering from narcissism? Yet even the high part of this estimated range—6.2 percent of the population—seems dubiously low. Upon what research are these “estimates” based? For even a moderately observant layman might find them questionable.
A further critique of DSM-5 is that it doesn't recognize when narcissism has grown to be normative in a culture, it becomes harder to recognize. Hence the pathology is underreported—and perhaps why the DSM gives such a low estimate of American narcissism—an estimate that hasn’t reflected what many American psychotherapists have found showing up in their consulting rooms, and for decades now.
Another critique of DSM-5 is that it makes no mention of distinctively different narcissistic styles as they’ve been portrayed by some of the clinical tradition’s leading figures. And there’s really quite a huge difference between a relatively benign “closet narcissism” as portrayed by Dr. James Masterson, to the most pernicious of the styles--malignant narcissism--which Erich Fromm characterized as “the quintessence of evil (seemingly identical to psychopaths). And there’s even a difference between how Otto Kernberg and Fromm characterize this malignancy.
Those just named weren’t "minor league clinicians." Where in the DSM’s portrayal of NPD are the nuances of their clinical vision? Similarly, there’s also differing degrees of narcissism--say between someone having a few narcissistic “features,” to having a full-blown Narcissistic Personality Disorder.
It should also be noted that the DSM is a volume written by committees, and often staffed by academic psychologists and researchers, not necessarily experienced, practicing clinicians. (These committees have been subject to political infighting). A further critique of DSM-5 might reflect two related facts--that throughout its history, the DSM is almost completely devoid of guidance for how to treat the disorders it classifies. And that the committee entrusted to define personality disorders has had a long and troubled history. (To better understand this history, I’d refer readers to a little known, yet revealing article you can find online: “Psychopathy and the DSM,” authored by Christina Crego and Thomas A. Widiger).
Crego and Widiger trace the inception of the DSM, and how over its various editions it came to throw sociopaths and psychopaths out of the manual—as if they no longer exist--replacing them both with its own self-invented construct, the Antisocial Personality Disorder—yet basing their disorder largely on research done for psychopaths by Hervey M. Cleckley and Robert D. Hare. (In other words, they threw psychopaths and sociopaths off the boat, while granting passage to a construct based on psychopaths). And as if all three of these constructs are somewhat interchangeable, with two of them no longer needed, and hence banished. A result has been that you lose the differentiation between them. (Just as the manual lacks differentiation between the different narcissistic styles).
Today, most psychotherapists –if asked--wouldn’t be able to tell you the difference between a sociopath and a psychopath. (Try asking one, and see if this isn’t so). The clearest discernment came from Hare--who for decades has been recognized as the leading authority on psychopaths.
Hare found the DSM’s Antisocial Personality Disorder to be a valid diagnostic construct; in fact, he found both APD and sociopaths far more common than his own specialty—psychopaths. And that what differentiated sociopaths from psychopaths was that the former grew up in crime families or crime infested neighborhoods--rather than from a total lack of morality or any concern for the welfare of others, as is the case with psychopaths.
Television's Tony Soprano and Ray Donovan were sociopaths. Both had criminal fathers--yet also, concern for their families. Squat Clemenza of the Godfather trilogy, also a sociopath, was a devoted family man. Bur also a killer--that's what you just do if you're in that family. Hence, as Clemenza oversees Paulie's murder from the back of his black sedan, he shows allegiance to both families as he famously says: Leave the gun, take the cannoli. While Ray Donovan’s dad, as portrayed by Jon Voight, was a sociopath, a psychopath, and a narcissist. For driven by his own chaotic needs he exploited even family members—and why Ray Donovan was constantly trying to protect the rest of his family from his father.
If the DSM still recognized sociopaths and psychopaths, Trump likewise could be diagnosed as both a psychopath, a sociopath, as well as an NPD, and an APD. (Remember, if you suffer a personality disorder, it’s unlikely you’ll suffer from that one alone). And a person suffering several may be especially chaotic in their personality organization, and its toxic impact upon others.
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Part Two
Let’s summon our historical vision, and direct it to the year 2010... As the DSM was readying to release its 5th edition, its personality disorder committee next attempted to banish Narcissistic Personality Disorder (NPD). But this was met by so much flak from clinicians, that the personality disorder committee reversed their stance, and when the 5th edition was finally published in May of 2013, it simply retained the estimate of NPD’s prevalence given in the previous edition. There was no further research—if any in the previous edition.
In contrast, the longest running study of narcissism (conducted by a group of social psychologists with college students over several decades) gives a radically different picture of American narcissism: Namely that its prevalence may extend to approximately two thirds of the population--not 0 to 6.2 percent. And that students scoring highly on a narcissism index actually increased by 30 percent over the duration of the study. Which suggests that American narcissism is an underreported epidemic that’s only spreading further. And for this reason alone, narcissism has been badly in need of a re-visioning.
And to heal the epidemic, our revisioning of narcissism would be aided by an augmented perspective that unfolds from the intersection of four avenues of vision--the historical, mythic, spiritual, as well as the psychological. (Rather than the latter alone). This would include how other cultures and historical epochs have viewed narcissism, and the practices that the world’s spiritual traditions have used to reduce or transmute it. For narcissism has been with us forever. (It was arguably the first personality disorder to have been recognized—by the Greek and Roman poets of antiquity who gave us several different versions of the myth of Narcissus—the most profound of which was the version of the Roman poet Ovid).
Lacking this wider vision, the conventional view of narcissism has become like “blind people attempting to account an elephant.” For the last hundred years have taught us that a narrowly psychological vision--one based on psychopathology, rather than optimal mental health, has lacked the skillful means to treat this personality disorder.
In fact, many psychologists still suffer from an unrecognized narcissism, as does much of the population. (If two groups of psychologists have estimated the prevalence of American narcissism to be as varied as 0 to 6.2 percent, or two thirds of the population, a clear-eyed Zen master might recognize it to be more pervasive still). In fact, an argument could be made that in order to fully understand what narcissism truly is, you'd need to understand what its complete opposite looks like--the highest standard of all.
Yet a psychological vision informed by history would also show that, a century ago, as modern psychology was first attempting to establish itself as a legitimate medical and scientific discipline, it divorced itself from its close cousins--the world’s religious and spiritual traditions.
We’d also see that most of the early psychoanalysts had been trained as medical doctors. For this reason, pathology becomes the lens through which to look at the psyches of human patients. The early psychoanalysts also considered narcissism untreatable. And once you’ve disowned the historical treasury of skillful means possessed by the spiritual traditions, narcissism may be untreatable. (Here, allow me to put in a plug for transpersonal psychology--a bit of a hodgepodge--yet in its most capable practitioners, expresses the marriage between conventional clinical psychology and the skillful means employed by the world's spiritual traditions).
From both a more spiritual and developmental perspective, narcissism isn’t just a problem of “those people.” It’s an issue of awareness—whereby awareness has become stunted—and fixated within a narrow, self-referential bubble, where “it’s all about me.” Developmentally, this can be a healthy and necessary stage—for young children (characterized as the grandiose stage of the “King Baby”). People who’ve largely failed to develop beyond this stage—those deemed to be narcissistic—are thus a case of arrested development. Emotionally stunted, they remain entitled “adult children”—who don’t play well with others. (See "On Narcissism, Tribalism and Developmental Arrest".)
And perhaps even the healthiest of us might pass through (or remain stuck in) a narcissistic stage multiple times within a single day or hour. But just as when an enlightened person has a foolish thought he’s no longer an enlightened person but a fool, there’s no inherent permanence in either our enlightened or narcissistic states.
For those committed to their further development, this lack of permanence can work in their favor. For it also means that there’s hope for deconstructing the narcissism which all of us share, if to varying degrees. Should we fail to recognize this, discussions of narcissism could continue to be a case of “the pot calling the kettle black.” So again, narcissism is not just a problem of those people. (This consideration could be humbling—and not a bad thing; while thinking that narcissism only applies to other people can be a diagnostic indicator of narcissism itself).
Today narcissism seems as rampant—and as inadequately understood and treated--as when it was first recognized over two millennia ago by the Greek and Roman poets who gave us versions of the myth from which narcissism was first named, the myth of Narcissus and Echo. It thus remains...still badly in need of a revisioning.
Yet what distinguishes our epoch from the ancient Greeks and Romans is that we and out children no longer have the lazy ease of generations and centuries to evolve further than we have. The urgencies of global warming alone, and the threats by narcissistic, psychopathic leaders with access to advanced weaponry and their own propaganda channels, should be the greatest of wake-up calls. Not only for America, but for the wider world we all share.
Whether enough of us wake up in time—well, that remains to be seen. What’s more sobering is that the preservation of the world’s democracies--and our species--now hangs in the balance.