Narcissistic Personality Disorder: Self-Awareness and Healing
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By: Dr. Sam Vaknin
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If the narcissist becomes self-aware, if he accepts that he is a narcissist, isn't this the first, important step, towards healing?
Narcissism defines the narcissist's waking moments and his nocturnal dreams. It is all-pervasive. Everything the narcissist does is motivated by it. Everything he avoids is its result. Every utterance, decision, his very body language - are all manifestations of narcissism. It is rather like being abducted by an alien and ruthlessly indoctrinated ever since. The alien is the narcissist's False Self - a defence mechanism constructed in order to shield his True Self from hurt and inevitable abandonment.
Cognitive understanding of the disorder does not constitute a transforming INSIGHT. In other words, it has no emotional correlate. The narcissist does not INTERNALIZE what he understands and learns about his disorder. This new gained knowledge does not become a motivating part of the narcissist. It remains an inert and indifferent piece of knowledge, with minor influence on the narcissist's psyche.
Moreover: the narcissist may grow aware of certain behaviors of his that are pathological, dysfunctional, or self-defeating. He may even label them as such. But he never grasps the psychodynamic significance of his conduct, the deeper layers of motivation, and the relentless and inexorable engine at the convoluted and tormented core of his being. So he may say: “I really like attention” or even, disparagingly or self-deprecatingly: “I am an attention whore”. But, he won’t be able to fully account for WHY it is that he is addicted to narcissistic supply and what role it plays in his psychology, interpersonal relationships, and life. The narcissist may realize, belatedly, that he is ticking – but never what makes him tick.
Sometimes, when the narcissist first learns about Narcissistic Personality Disorder (NPD), he really believes he could change (usually, following a period of violent rejection of the "charges" against him). He fervently wants to. This is especially true when his whole world is in shambles. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply - are all transforming life crises. The narcissist admits to a problem only when abandoned, destitute, and devastated. He feels that he doesn't want any more of this. He wants to change. And there often are signs that he IS changing. And then it fades. He reverts to old form. The "progress" he had made evaporates virtually overnight. Many narcissists report the same process of progression followed by recidivist remission and many therapists refuse to treat narcissists because of the Sisyphean frustration involved.
This article appears in my book "Malignant Self-love: Narcissism Revisited"
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I never said that narcissists cannot CHANGE - only that they cannot HEAL. There is a huge difference between behavior modification and a permanent alteration of the psychodynamic landscape. Narcissistic behavior CAN be modified using a cocktail of talk therapy, conditioning, and medication. I have yet to encounter a healed narcissist.
The emphasis in therapy is thus more on accommodating the needs of those nearest and dearest to the narcissist - spouse, children, colleagues, friends - than on "treating" the narcissist. If the narcissist's abrasiveness, rage, mood swings, reckless and impulsive behaviors are modified - those around him benefit most. This, as far as I am concerned, is a form of social engineering.
One last hope:
Narcissism (though rarely) does tend to ameliorate with age and many forms of pathological narcissism are reactive and transient (Ronningstam and Gunderson, 1996).
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