Treating narcissism?

I have read an article on the treatment of Narcissistic Personality Disorder today, and while it provided a lot of insights into what happened between me and my therapist a few years back (I don´t know for sure, but I suspect he diagnosed me with NPD. It´s like this: the ICD-10 code on my health insurance bill covered various personality disorders, but the most likely I found among them was NPD) – well, while that article was not entirely unhelpful, some parts of it also upset me.

The first part I would like to talk about deals with the possibility of brief therapy:

“Patients with narcissistic personality disorder who are troubled by limited neurotic symptoms and maintain apparent satisfactory adaptation in other areas of their lives are unlikely to be sufficiently motivated to tolerate the demands of psychoanalysis or psychoanalytic psychotherapy. Short-term psychotherapy is probably the best treatment in such cases. The goal of such treatment is generally to improve adaptation rather than to alter character. These patients, who are generally young and whose narcissism is often well compensated by their life circumstances, may return for treatment later in life as their narcissistic pathology makes further inroads into their interpersonal relationships, their professional endeavors, or their general sense of pleasure. At these later times, they may be capable of greater insight into their need for more intensive psychotherapy.

Okay, allow me to rant for a moment? Good. What I conclude from this paragraph is that it is a moral, medical or at least some kind of imperative that people with NPD must undergo character-altering intensive psychotherapy. Unfortunately, though, one cannot force them to do so, so one must wait until they are so deep in crisis that they are ready to hear it is all their own fault! Their moments of happiness and success are their greatest enemy! It would be good for them if they hit rock bottom as early as possible!

Wow. What a compassionate attitude, really. It is said that people with NPD have no real empathy, but I can empathize enough with people who are in crisis to feel ashamed for even thinking it might be their own fault.  I really see a problem here: A person might show up for therapy after the failure of an important relationship, or whatever. I did. The guy who evaluated me first diagnosed me with adjustment disorder. The therapist I worked with then (Dr. Stoneface) diagnosed me with some type of personality disorder which might or might not be NPD.  Now, if a person comes to me and seeks help because she is in crisis after a break-up, and I think: “Oh great, that´s a window of opportunity for treating her against being a flawed, horrible person!” – then I´m not exactly empathic, I´m not exactly compassionate, and I´m a pretty horrible person myself. It´s like a little boy falling down, crying, and his mum telling him: “See, that´s what you get for running so fast! Now I do hope you learn your lesson  this  time!” It´s not helpful. It´s just cruel.

Another thing that sickens me is the prognosis that the patients might return for treatment later in their life when their pathology has thoroughly fucked things up for them. I mean – is this really a prognosis? Or is it a threat? Isn´t it a way of saying: “Alright, maybe right now you believe that you are awesome and that your life is going great, but in a few years you will be in pieces if you don´t clean up the mess that is your inner world, I can promise you that much! But, of course, it is all your own choice! I might be wrong! I don´t pretend to be omniscient, after all!”

Okay. Next paragraph. This one deals with a patient who actually entered treatment when his life was in shambles, and made first successes:

“The treatment ended with the patient asking to be able to return at a future date to touch base with the therapist. Highlighting the masochistic side of the narcissistic coin, Oldham concluded that “the narcissistic patient whose pathology leads to dismantling his own success may be highly receptive to treatment at such a critical point.” “

To be honest, whatever Oldham says there doesn´t make much sense to me. What I am interested in is “the masochistic side of the narcissistic coin”. I fully believe that such a thing exists. What worries me, though, is that some people might believe it should be used as a motivation for treatment. First of all, it might lead therapists to encourage that masochism in order to keep patients in treatment, and second, whisper it quietly: It doesn´t work.

I entered my last attempt at therapy (Dr. Stoneface) with the most masochistic of intentions: I wanted to be made fully and pain-fully aware of  1) what a flawed, inadequate person I was, 2) how pathetically my rotten core contrasted with  my delusions of grandeur, and 3) how much I had hurt and damaged others upon trying to maintain these delusions and therefore deserved each and every break-up and rejection.

I believed that only this kind of pain could create enough motivation for change. Of course, this idea is highly narcissistic in itself: “If only you could feel with each fiber of your body what a failure you are; then you might at last get up and improve and become a great, wonderful, awesome person, the kind you always wanted to be!” Being a little more self-aware than the average therapist likes to assume, that thought occurred to me even back then. And it crushed my motivation. It crushed my hopes. It convinced me that true healing would be all about recognizing that I was shit – and accepting it and saying “that´s all there is to me”. Resisting the urge to improve and become great and admirable. Instead lead a humble life, not draw any attention to myself, rather watch others become famous and admired and successful and tell myself why I don´t deserve to be in their position: Because I am such a sick, emotionally deranged person. Fame or even praise might endanger my recovery. It might stop me from seeing how flawed and horrible I am. I must stay away from it like a sober ex-addict must stay away from his drug. Now – try to create motivation for that one! Who wants a life like that? Who wants to be healed just so he can spend the rest of his life in purgatory?

Another problem about using masochism for therapeutic purposes, of course,  is another one of my diagnoses. Sexual deviation. Writing down, and, of course, imagining the prospects above gives me a severe adrenaline rush.  It so rapes the wishful fantasies and ambitions I have, the image I tend to have of myself (proud, clever, unbreakable); and it triggers so much shame and outrage in me, that, when faced with such prospects I will either lash out against anybody who I believe suggests them (in this case: a therapist), or I will, in an act of inverted sadism, comply in the most perverted way possible. Bring it on! Hurt me, break me, make me feel as miserable as it gets! It is good for meThe entire therapeutic process gets an obscene touch if you allow masochism to enter into it. That, of course, just increases my overall shame, which, in turn, increases my defense mechanisms: 1. Rage. 2. Masochism.

I´m going to stop here, before this post gets too long and too out of hand. I´m pretty sure I will return to the subject of narcissism, though. It is something that affects and actually even triggers me in many ways. Whether or not I myself have NPD, the disorder seems to play some kind of role in my emotional life. 

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2 Responses to “Treating narcissism?”

  1. vicariousrising Says:

    I dunno – I’ve never heard about the masochistic side of narcissism before. It’s true that my mother contributes to her own failure by doing nothing, but I don’t think it’s masochistically motivated. I think she thinks things should be passed to her because she’s special and that is all the work she should ever be required to do.

    And she wouldn’t be caught dead in a therapist’s vicinity, even if she’s not the patient. She believes she doesn’t need to change and everything in her life that isn’t perfect is everyone else’s fault.

    • What you say here about your mother reminds me of a classmate of mine. Her mother pressured her to take singing lessons and to become a star (the girl had to practice for hours every day), apparently because she herself (the mother) hadn´t made it. The mother once went to a therapist, saying: “I don´t know why I should change. Why don´t the others change?” She told her daughter that the therapist had agreed with her…

      Regarding masochism and narcissism: I´m not sure what the guy who is quoted in this article means, either. He made that connection while giving the example of a man who eventually started to appreciate therapy, even though it was painful. It reminded me of my feeling that I absolutely had to change and that I deserved the pain it would imply. I don´t know if full-blown narcissists can experience the same thing. I´m not sure either if the psychoanalytical use of the word narcissism completely matches its use in the context of NPD. I once read somewhere that the word is being thrown around so inflationary that there is massive confusion about what narcissism really is.

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