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News for 11-Jan-25 Source: MedicineNet Senior Health General Source: MedicineNet Senior Health General Source: MedicineNet Prevention and Wellness General Source: MedicineNet Prevention and Wellness General
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Pathological narcissism is an addiction to Narcissistic Supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours – workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving – piggyback on this primary dependence. The narcissist – like other types of addicts – derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the centre of attention – but also place him in "splendid isolation" from the madding and inferior crowd. Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist – the adrenaline junkie – feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction, that he can quit at will and on short notice. The narcissist denies his cravings for fear of "losing face" and subverting the flawless, perfect, immaculate, and omnipotent image he projects. When caught red handed, the narcissist underestimates, rationalises, or intellectualises his addictive and reckless behaviours – converting them into an integral part of his grandiose and fantastic False Self. Thus, a drug abusing narcissist may claim to be conducting first hand research for the benefit of humanity – or that his substance abuse results in enhanced creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind. The narcissist's addictive behaviours take his mind off his inherent limitations, inevitable failures, painful and much-feared rejections, and the Grandiosity Gap – the abyss between the image he projects (the False Self) and the injurious truth. They relieve his anxiety and resolve the tension between his unrealistic expectations and inflated self-image – and his incommensurate achievements, position, status, recognition, intelligence, wealth, and physique. Thus, there is no point in treating the dependence and recklessness of the narcissist without first treating the underlying personality disorder. The narcissist's addictions serve deeply ingrained emotional needs. They intermesh seamlessly with the pathological structure of his disorganised personality, with his character faults, and primitive defence mechanisms. Techniques such as "12 steps" may prove more efficacious in treating the narcissist's grandiosity, rigidity, sense of entitlement, exploitativeness, and lack of empathy. This is because – as opposed to traditional treatment modalities – the emphasis is on tackling the narcissist's psychological makeup, rather than on behaviour modification. The narcissist's overwhelming need to feel omnipotent and superior can be co-opted in the therapeutic process. Overcoming an addictive behaviour can be – truthfully – presented by the therapist as a rare and impressive feat, worthy of the narcissist's unique mettle. Narcissists fall for these transparent pitches surprisingly often. But this approach can backfire. Should the narcissist relapse – an almost certain occurrence – he will feel ashamed to admit his fallibility, need for emotional sustenance, and impotence. He is likely to avoid treatment altogether and convince himself that now, having succeeded once to get rid of his addiction, he is self-sufficient and omniscient. First published in my
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