Letters to Sam Vaknin no 6

©Stephen McDonnell and Sam Vaknin 2004

All text is copyrighted and is published here with the permission of the authors.

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Tuesday, November 30, 2004, Sixth letter to Sam

Dear Sam,

I took some time to think about your question in the last letter and even rewrote my reply several times. Let me reproduce your question again. Sam asked me this:

"Do you feel that narcissism has cultural and social components and determinants - or is it the narcissist's way or shifting responsibility to others, of exercising his alloplastic defenses (narcissist: I am not to blame - it is the way I was brought up in this narcissistic culture)?"

Is there an organic cause?

In order to answer this question clearly and concisely, I will have to back up a bit and define what is "normal". Firstly, I would like to refer you to Dr. John J Ratey a psychiatrist at Harvard Medical School who has co-authored Shadow Syndromes (1997) with Catherine Johnson, Ph.D. In it he puts forth the idea that we all suffer from some sort of mental disorder, but in very slight degrees. In other words, all of us are mentally ill in slight degrees, but the 'normal' people can function without causing too much harm to others. I believe this to be true, in that all of us are capable of doing some crazy things and acting crazy but we 'normally' do not; whether this is because society and its laws keep us all from killing each other, or because we tend to be 'herd' animals, it all boils down to getting along with each other as best we can. (This theory of carrying around the potential for mental disorders parallels the germ theory in that we also have germs, viruses, parasites and fungi that inhabit our bodies - or are in the environment - and that usually do us no harm - but they have the potential to under the right circumstances.)

You and anyone else reading what I just wrote may doubt the veracity of my assertion of communal 'madness' or 'potential madness'. Yet there are many examples of this happening. Take the Spanish Influenza epidemic of 1918. I have just finished reading a book entitled, "The Great Influenza, The Epic Story of the Deadliest Plague in History" by John M. Barry. The title by itself is alarming, yet "The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351" ( http://www.stanford.edu/group/virus/uda/ )

Some estimates go as high as 100 million deaths. One side effect I discovered after reading John Barrys' book was that the disease sparked an invasion of the brain by white blood cells with resulting high fevers; both produced sequel that mimicked psychosis and in some cases it may have caused the patient to become schizophrenic. (Some studies that followed a more recent flu outbreak in Finland showed that women, who were pregnant and caught the flu, had a higher average of children who eventually became schizophrenic.)

I talked to a friend recently who told me the story of how his father started acting strangely, even crazy. People thought he was crazy - but luckily for him when the doctors examined him, they found he suffered from pernicious anemia and lacked enough vitamin B12. Certain mental disorders are linked to brain chemistry and can be treated with drugs, or at least the drugs can alleviate some of the symptoms.


You have no argument with me there. I doubt the very concept of "mental illness".

Someone is considered mentally "ill" if:

    1. His conduct rigidly and consistently deviates from the typical, average behavior of all other people in his culture and society that fit his profile (whether this conventional behavior is moral or rational is immaterial), or
    2. His judgment and grasp of objective, physical reality is impaired, and
    3. His conduct is not a matter of choice but is innate and irresistible, and
    4. His behavior causes him or others discomfort, and is
    5. Dysfunctional, self-defeating, and self-destructive even by his own yardsticks.

Descriptive criteria aside, what is the essence of mental disorders? Are they merely physiological disorders of the brain, or, more precisely of its chemistry? If so, can they be cured by restoring the balance of substances and secretions in that mysterious organ? And, once equilibrium is reinstated ñ is the illness "gone" or is it still lurking there, "under wraps", waiting to erupt? Are psychiatric problems inherited, rooted in faulty genes (though amplified by environmental factors) ñ or brought on by abusive or wrong nurturance?

These questions are the domain of the "medical" school of mental health.

Others cling to the spiritual view of the human psyche. They believe that mental ailments amount to the metaphysical discomposure of an unknown medium ñ the soul. Theirs is a holistic approach, taking in the patient in his or her entirety, as well as his milieu.

The members of the functional school regard mental health disorders as perturbations in the proper, statistically "normal", behaviors and manifestations of "healthy" individuals, or as dysfunctions. The "sick" individual ñ ill at ease with himself (ego-dystonic) or making others unhappy (deviant) ñ is "mended" when rendered functional again by the prevailing standards of his social and cultural frame of reference.

In a way, the three schools are akin to the trio of blind men who render disparate descriptions of the very same elephant. Still, they share not only their subject matter ñ but, to a counter intuitively large degree, a faulty methodology.

As the renowned anti-psychiatrist, Thomas Szasz, of the State University of New York, notes in his article "The Lying Truths of Psychiatry", mental health scholars, regardless of academic predilection, infer the etiology of mental disorders from the success or failure of treatment modalities.

This form of "reverse engineering" of scientific models is not unknown in other fields of science, nor is it unacceptable if the experiments meet the criteria of the scientific method. The theory must be all-inclusive (anamnetic), consistent, falsifiable, logically compatible, monovalent, and parsimonious. Psychological "theories" ñ even the "medical" ones (the role of serotonin and dopamine in mood disorders, for instance) ñ are usually none of these things.

The outcome is a bewildering array of ever-shifting mental health "diagnoses" expressly centred around Western civilisation and its standards (example: the ethical objection to suicide). Neurosis, a historically fundamental "condition" vanished after 1980. Homosexuality, according to the American Psychiatric Association, was a pathology prior to 1973. Seven years later, narcissism was declared a "personality disorder", almost seven decades after it was first described by Freud.

Indeed, personality disorders are an excellent example of the kaleidoscopic landscape of "objective" psychiatry.

The classification of Axis II personality disorders ñ deeply ingrained, maladaptive, lifelong behavior patterns ñ in the Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] ñ or the DSM-IV-TR for short ñ has come under sustained and serious criticism from its inception in 1952, in the first edition of the DSM.

The DSM IV-TR adopts a categorical approach, postulating that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). This is widely doubted. Even the distinction made between "normal" and "disordered" personalities is increasingly being rejected. The "diagnostic thresholds" between normal and abnormal are either absent or weakly supported.

The polythetic form of the DSM's Diagnostic Criteria ñ only a subset of the criteria is adequate grounds for a diagnosis ñ generates unacceptable diagnostic heterogeneity. In other words, people diagnosed with the same personality disorder may share only one criterion or none.

The DSM fails to clarify the exact relationship between Axis II and Axis I disorders and the way chronic childhood and developmental problems interact with personality disorders.

The differential diagnoses are vague and the personality disorders are insufficiently demarcated. The result is excessive co-morbidity (multiple Axis II diagnoses).

The DSM contains little discussion of what distinguishes normal character (personality), personality traits, or personality style (Millon) ñ from personality disorders.

A dearth of documented clinical experience regarding both the disorders themselves and the utility of various treatment modalities.

Numerous personality disorders are "not otherwise specified" ñ a catchall, basket "category".

Cultural bias is evident in certain disorders (such as the Antisocial and the Schizotypal).

The emergence of dimensional alternatives to the categorical approach is acknowledged in the DSM-IV-TR itself:

ìAn alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one anotherî (p.689)

The following issues ñ long neglected in the DSM ñ are likely to be tackled in future editions as well as in current research. But their omission from official discourse hitherto is both startling and telling:

    • The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
    • The genetic and biological underpinnings of personality disorder(s);
    • The development of personality psychopathology during childhood and its emergence in adolescence;
    • The interactions between physical health and disease and personality disorders;
    • The effectiveness of various treatments ñ talk therapies as well as psychopharmacology.

Certain mental health afflictions are either correlated with a statistically abnormal biochemical activity in the brain ñ or are ameliorated with medication. Yet the two facts are not ineludibly facets of the same underlying phenomenon. In other words, that a given medicine reduces or abolishes certain symptoms does not necessarily mean they were caused by the processes or substances affected by the drug administered. Causation is only one of many possible connections and chains of events.

To designate a pattern of behavior as a mental health disorder is a value judgment, or at best a statistical observation. Such designation is effected regardless of the facts of brain science. Moreover, correlation is not causation. Deviant brain or body biochemistry (once called "polluted animal spirits") do exist ñ but are they truly the roots of mental perversion? Nor is it clear which triggers what: do the aberrant neurochemistry or biochemistry cause mental illness ñ or the other way around?

That psychoactive medication alters behavior and mood is indisputable. So do illicit and legal drugs, certain foods, and all interpersonal interactions. That the changes brought about by prescription are desirable ñ is debatable and involves tautological thinking. If a certain pattern of behavior is described as (socially) "dysfunctional" or (psychologically) "sick" ñ clearly, every change would be welcomed as "healing" and every agent of transformation would be called a "cure".

The same applies to the alleged heredity of mental illness. Single genes or gene complexes are frequently "associated" with mental health diagnoses, personality traits, or behavior patterns. But too little is known to establish irrefutable sequences of causes-and-effects. Even less is proven about the interaction of nature and nurture, genotype and phenotype, the plasticity of the brain and the psychological impact of trauma, abuse, upbringing, role models, peers, and other environmental elements.

Nor is the distinction between psychotropic substances and talk therapy that clear-cut. Words and the interaction with the therapist also affect the brain, its processes and chemistry - albeit more slowly and, perhaps, more profoundly and irreversibly. Medicines ñ as David Kaiser reminds us in "Against Biologic Psychiatry" (Psychiatric Times, Volume XIII, Issue 12, December 1996) ñ treat symptoms, not the underlying processes that yield them.

If mental illnesses are bodily and empirical, they should be invariant both temporally and spatially, across cultures and societies. This, to some degree, is, indeed, the case. Psychological diseases are not context dependent ñ but the pathologizing of certain behaviors is. Suicide, substance abuse, narcissism, eating disorders, antisocial ways, schizotypal symptoms, depression, even psychosis are considered sick by some cultures ñ and utterly normative or advantageous in others.

This was to be expected. The human mind and its dysfunctions are alike around the world. But values differ from time to time and from one place to another. Hence, disagreements about the propriety and desirability of human actions and inaction are bound to arise in a symptom-based diagnostic system.

As long as the pseudo-medical definitions of mental health disorders continue to rely exclusively on signs and symptoms ñ i.e., mostly on observed or reported behaviors ñ they remain vulnerable to such discord and devoid of much-sought universality and rigor.

The mentally sick receive the same treatment as carriers of AIDS or SARS or the Ebola virus or smallpox. They are sometimes quarantined against their will and coerced into involuntary treatment by medication, psychosurgery, or electroconvulsive therapy. This is done in the name of the greater good, largely as a preventive policy.

Conspiracy theories notwithstanding, it is impossible to ignore the enormous interests vested in psychiatry and psychopharmacology. The multibillion dollar industries involving drug companies, hospitals, managed healthcare, private clinics, academic departments, and law enforcement agencies rely, for their continued and exponential growth, on the propagation of the concept of "mental illness" and its corollaries: treatment and research.

Abstract concepts form the core of all branches of human knowledge. No one has ever seen a quark, or untangled a chemical bond, or surfed an electromagnetic wave, or visited the unconscious. These are useful metaphors, theoretical entities with explanatory or descriptive power.

"Mental health disorders" are no different. They are shorthand for capturing the unsettling quiddity of "the Other". Useful as taxonomies, they are also tools of social coercion and conformity, as Michel Foucault and Louis Althusser observed. Relegating both the dangerous and the idiosyncratic to the collective fringes is a vital technique of social engineering.

The aim is progress through social cohesion and the regulation of innovation and creative destruction. Psychiatry, therefore, is reifies society's preference of evolution to revolution, or, worse still, to mayhem. As is often the case with human Endeavour, it is a noble cause, unscrupulously and dogmatically pursued.

"It is an ill thing to knock against a deaf-mute, an imbecile, or a minor. He that wounds them is culpable, but if they wound him they are not culpable." (Mishna, Babylonian Talmud)

If mental illness is culture-dependent and mostly serves as an organizing social principle - what should we make of the insanity defense (NGRI- Not Guilty by Reason of Insanity)?

A person is held not responsible for his criminal actions if s/he cannot tell right from wrong ("lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct" - diminished capacity), did not intend to act the way he did (absent "mens rea") and/or could not control his behavior ("irresistible impulse"). These handicaps are often associated with "mental disease or defect" or "mental retardation".

Mental health professionals prefer to talk about an impairment of a "person's perception or understanding of reality". They hold a "guilty but mentally ill" verdict to be contradiction in terms. All "mentally-ill" people operate within a (usually coherent) worldview, with consistent internal logic, and rules of right and wrong (ethics). Yet, these rarely conform to the way most people perceive the world. The mentally-ill, therefore, cannot be guilty because s/he has a tenuous grasp on reality.

Yet, experience teaches us that a criminal maybe mentally ill even as s/he maintains a perfect reality test and thus is held criminally responsible (Jeffrey Dahmer comes to mind). The "perception and understanding of reality", in other words, can and does co-exist even with the severest forms of mental illness.

This makes it even more difficult to comprehend what is meant by "mental disease". If some mentally ill maintain a grasp on reality, know right from wrong, can anticipate the outcomes of their actions, are not subject to irresistible impulses (the official position of the American Psychiatric Association) - in what way do they differ from us, "normal" folks?

This is why the insanity defense often sits ill with mental health pathologies deemed socially "acceptable" and "normal"  - such as religion or love.

Consider the following case:

A mother bashes the skulls of her three sons. Two of them die. She claims to have acted on instructions she had received from God. She is found not guilty by reason of insanity. The jury determined that she "did not know right from wrong during the killings."

But why exactly was she judged insane?

Her belief in the existence of God - a being with inordinate and inhuman attributes - may be irrational.

But it does not constitute insanity in the strictest sense because it conforms to social and cultural creeds and codes of conduct in her milieu. Billions of people faithfully subscribe to the same ideas, adhere to the same transcendental rules, observe the same mystical rituals, and claim to go through the same experiences. This shared psychosis is so widespread that it can no longer be deemed pathological, statistically speaking.

She claimed that God has spoken to her.

As do numerous other people. Behavior that is considered psychotic (paranoid-schizophrenic) in other contexts is lauded and admired in religious circles. Hearing voices and seeing visions - auditory and visual delusions - are considered rank manifestations of righteousness and sanctity.

Perhaps it was the content of her hallucinations that proved her insane?

She claimed that God had instructed her to kill her boys. Surely, God would not ordain such evil?

Alas, the Old and New Testaments both contain examples of God's appetite for human sacrifice. Abraham was ordered by God to sacrifice Isaac, his beloved son (though this savage command was rescinded at the last moment). Jesus, the son of God himself, was crucified to atone for the sins of humanity.

A divine injunction to slay one's offspring would sit well with the Holy Scriptures and the Apocrypha as well as with millennia-old Judeo-Christian traditions of martyrdom and sacrifice.

Her actions were wrong and incommensurate with both human and divine (or natural) laws.

Yes, but they were perfectly in accord with a literal interpretation of certain divinely-inspired texts, millennial scriptures, apocalyptic thought systems, and fundamentalist religious ideologies (such as the ones espousing the imminence of "rupture"). Unless one declares these doctrines and writings insane, her actions are not.

we are forced to the conclusion that the murderous mother is perfectly sane. Her frame of reference is different to ours. Hence, her definitions of right and wrong are idiosyncratic. To her, killing her babies was the right thing to do and in conformity with valued teachings and her own epiphany. Her grasp of reality - the immediate and later consequences of her actions - was never impaired.

It would seem that sanity and insanity are relative terms, dependent on frames of cultural and social reference, and statistically defined. There isn't - and, in principle, can never emerge - an "objective", medical, scientific test to determine mental health or disease unequivocally.

"Normal" people adapt to their environment - both human and natural.

"Abnormal" ones try to adapt their environment - both human and natural - to their idiosyncratic needs/profile.

If they succeed, their environment, both human (society) and natural is pathologized.


My own research on the Internet and in books has produced no evidence of an organic or genetic cause for Narcissistic Personality Disorder. It may yet be found. Schizophrenic was once considered caused by 'bad mothering' - as postulated by the early Freudians. Even now there is no definite definition of the disease according to the psychiatrists I work with. The discovery of a possible gene linked to schizophrenic in the genome pool of Iceland and a mouse model d with the same gene may shed more light onto this mental disease. Perhaps further research will show that there is a true genetic link.

NPD may also have a genetic marker, yet I am skeptical. I am skeptical because NPD involves the 'personality' of someone, and I believe 'personality' is something that is constructed over the years.


Being a narcissist, I often think:

Is pathological narcissism the outcome of inherited traits - or the sad result of abusive and traumatizing upbringing? Or, maybe it is the confluence of both? It is a common occurrence, after all, that, in the same family, with the same set of parents and an identical emotional environment - some siblings grow to be malignant narcissists, while others are perfectly "normal". Surely, this indicates a predisposition of some people to developing narcissism, a part of one's genetic heritage.

This vigorous debate may be the offshoot of obfuscating semantics.

When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.

Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.

True, single genes rarely account for any behavior or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviors such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings.

What about the Narcissistic Personality Disorder?

It would seem reasonable to assume - though, at this stage, there is not a shred of proof - that the narcissist is born with a propensity to develop narcissistic defenses. These are triggered by abuse or trauma during the formative years in infancy or during early adolescence (see http://samvak.tripod.com/faq64.html). By "abuse" I am referring to a spectrum of behaviors which objectifies the child and treats it as an extension of the caregiver (parent) or an instrument. Dotting and smothering are as much abuse as beating and starving. And abuse can be dished out by peers as well as by adult role models.

Still, I would have to attribute the development of NPD mostly to nurture. The Narcissistic Personality Disorder is an extremely complex battery of phenomena: behavior patterns, cognitions, emotions, conditioning, and so on. NPD is a PERSONALITY disordered and even the most ardent proponents of the school of genetics do not attribute the development of the whole personality to genes.

Narcissists often quote themselves, so allow me to conform to form.

From "The Interrupted Self" (http://samvak.tripod.com/sacks.html):

"'Organic' and 'mental' disorders (a dubious distinction at best) have many characteristics in common (confabulation, antisocial behavior, emotional absence or flatness, indifference, psychotic episodes and so on)."

From "On Dis-ease" (http://samvak.tripod.com/disease.html):

"Moreover, the distinction between the psychic and the physical is hotly disputed, philosophically. The psychophysical problem is as intractable today as it ever was (if not more so). It is beyond doubt that the physical affects the mental and the other way around. This is what disciplines like psychiatry are all about. The ability to control "autonomous" bodily functions (such as heartbeat) and mental reactions to pathogens of the brain are proof of the artificialness of this distinction.

It is a result of the reductionist view of nature as divisible and summable. The sum of the parts, alas, is not always the whole and there is no such thing as an infinite set of the rules of nature, only an asymptotic approximation of it. The distinction between the patient and the outside world is superfluous and wrong. The patient AND his environment are ONE and the same. Disease is a perturbation in the operation and management of the complex ecosystem known as patient-world. Humans absorb their environment and feed it in equal measures. This on-going interaction IS the patient. We cannot exist without the intake of water, air, visual stimuli and food. Our environment is defined by our actions and output, physical and mental.

Thus, one must question the classical differentiation between "internal" and "external". Some illnesses are considered "endogenic" (=generated from the inside). Natural, "internal", causes - a heart defect, a biochemical imbalance, a genetic mutation, a metabolic process gone awry - cause disease. Aging and deformities also belong in this category.

In contrast, problems of nurturance and environment - early childhood abuse, for instance, or malnutrition - are "external" and so are the "classical" pathogens (germs and viruses) and accidents.

But this, again, is a counter-productive approach. Exogenic and Endogenic pathogenesis is inseparable. Mental states increase or decrease the susceptibility to externally induced disease. Talk therapy or abuse (external events) alter the biochemical balance of the brain. The inside constantly interacts with the outside and is so intertwined with it that all distinctions between them are artificial and misleading. The best example is, of course, medication: it is an external agent, it influences internal processes and it has a very strong mental correlate (=its efficacy is influenced by mental factors as in the placebo effect).

The very nature of dysfunction and sickness is highly culture-dependent. Societal parameters dictate right and wrong in health (especially mental health). It is all a matter of statistics. Certain diseases are accepted in certain parts of the world as a fact of life or even a sign of distinction (e.g., the paranoid schizophrenic as chosen by the gods). If there is no dis-ease there is no disease. That the physical or mental state of a person CAN be different - does not imply that it MUST be different or even that it is desirable that it should be different. In an over-populated world, sterility might be the desirable thing - or even the occasional epidemic. There is no such thing as ABSOLUTE dysfunction. The body and the mind ALWAYS function. They adapt themselves to their environment and if the latter changes - they change. Personality disorders are the best possible responses to abuse. Cancer may be the best possible response to carcinogens. Aging and death are definitely the best possible response to over-population. Perhaps the point of view of the single patient is incommensurate with the point of view of his species - but this should not serve to obscure the issues and derail rational debate.

As a result, it is logical to introduce the notion of "positive aberration". Certain hyper- or hypo- functioning can yield positive results and prove to be adaptive. The difference between positive and negative aberrations can never be "objective". Nature is morally-neutral and embodies no "values" or "preferences". It simply exists. WE, humans, introduce our value systems, prejudices and priorities into our activities, science included. It is better to be healthy, we say, because we feel better when we are healthy. Circularity aside - this is the only criterion that we can reasonably employ. If the patient feels good - it is not a disease, even if we all think it is. If the patient feels bad, ego-dystonic, unable to function - it is a disease, even when we all think it isn't. Needless to say that I am referring to that mythical creature, the fully informed patient. If someone is sick and knows no better (has never been healthy) - then his decision should be respected only after he is given the chance to experience health.

All the attempts to introduce "objective" yardsticks of health are plagued and philosophically contaminated by the insertion of values, preferences and priorities into the formula - or by subjecting the formula to them altogether. One such attempt is to define health as "an increase in order or efficiency of processes" as contrasted with illness which is "a decrease in order (=increase of entropy) and in the efficiency of processes". While being factually disputable, this dyad also suffers from a series of implicit value-judgements. For instance, why should we prefer life over death? Order to entropy? Efficiency to inefficiency?"

I strongly recommend this paper, by the way:

Liveslye, W.J., Jank, K.L., Jackson, B.N., Vernon, P.A.. 1993. Genetic and environmental contributions to dimensions of personality disorders. Am. J. Psychiatry. 150(O12):1826-31.


Are there Social causes?

I believe personality is independent of intelligence and of genetics. I agree with Freudians and post Freudians that personality is a part of our natural development. The 'self' that we call ourselves is based on this thing we call our personality. Heinz Kohut did some amazing work on self and narcissism. As I understand Kohut theories, our mothers (and to some degree our fathers) give us 'selves' by mirroring back to us when we are babies. In my natural understanding of babies, I see them as pure narcissists much like aliens who see themselves as the center of the universe and who consider everything outside themselves as part of themselves.

As a parent I have seen narcissistic babies grow and explore till they reach the terrible twos, the age where they seem to wake up and discover, to their great discomfort, that they are not the center of the universe. I remember going to the local park where a mother asked me if my son would bite her if she took away the toy my son had 'borrowed' from her own child. Only then did I realize that this behavior was common till a certain age. Children go from a stage of thinking everything belongs to them to suddenly realizing that no, certain toys belong to others; this is a rude shock. Witness the huge rages two and three year olds go through! This awareness of boundaries is the beginning of 'humanity', I believe. In other words, the child suddenly realizes he or she is separate from others, and that other children and adults are separate from them; in other words the child no longer sees the world as his or her oyster. No doubt Piaget has much to say on this, as he categorized the stages of child learning. Somewhere and at some time in our natural development arises the notion of 'empathy' or awareness of the other. I believe this has also called 'theory of mind' in that the child, and in some cases animals, understand what other people are feeling and even thinking.

In a recent article in Psychological Science by David R. Forman and collaborators, entitled 'Toddler's Responsive Imitation Predicts Preschool-Age Conscience, he posits an interesting theory based on research that babies who mimic their care givers have a higher sense of moral values when tested at a more advanced age. It seems that monkey see monkey do holds true for humans in that the mirroring that naturally occurs between mother and baby (and fathers) can predict how they will behave later; the babies who failed to mimic or who were more self absorbed were noted as being less empathetic and more prone to 'cheat' on the simple tests they were given. No data was given as to how these children faired later but my guess is that the more empathetic children stayed that way and vice versa. If we view this study under the filter of narcissism, we might conclude that narcissistic parents may raise narcissistic babies, or that self-centered babies may stay self-centered as they grow up. As most babies are narcissistic (according to my own theory) then the process of weaning them from this mind set to a more empathetic personality may very be the result of 'good' parenting.

Again the slippery slope of blaming our parents for our 'personality' and thus mental disorders may lead us to believe that narcissism is learned at our mother's breast. Our parents' ills and failings sometimes bypass us, despite all the bad habits they have, and children do grow up 'normal'. I believe Ann Landers 12 rules of raising children are still as valid now as when she first published them in her nationally syndicated column (they can be found on the internet, I am sure).

The second time that narcissistic behavior develops in children is in adolescence when they pass into the penumbra of not children not adulthood. Hormones play a role in how girls and boys suddenly change both physically and mentally. Girls are known to suddenly want to either become veterinarians or models.

Boys try to choose between firemen and soldiers. Of course this is a gross over exaggeration, but parents who have teenagers may see my point. This indeterminate time in a person life can bring out narcissistic tendencies; girls who suddenly garner the attention of males may enjoy this new situation, and it may go to their heads. Boys who are respond to testosterone by testing themselves against their fellow males/rivals can also feel their egos inflated or deflated. Fortunately for most of us, but not all, the passage into adulthood finally ends and the habits that were once condoned, are forgotten and left behind.

But there are still adult men and women who never quite get over their adolescent years and try to prolong them till they die. Are they NPDs, these eternal adolescents?

Sibling rivalry also plays a role in how we develop as individuals as books on birth order try to justify.

Therefore I conclude that the development of humans includes narcissistic tendencies that are useful and natural. Only when the individual gets stuck into an endless feed back loop, where they no longer change or develop, do we see something that is called Narcissistic Personality Disorder.

Is Cultural to blame?

At the risk of offending many cultures, I would say that many different peoples often encourage narcissistic behavior. By this I mean the behaviors characterized by selfishness and self-centered behavior. No doubt there are good reasons for this behavior, historical, sexual or whatever, still it comes from the need to survive. Cover your own back is a good piece of advice. But as E. O.

Wilson has pointed out in such seminal works as Consilience, altruism is a survival technique as well. Charity and generosity are often seen as signs of weakness when they are really the domains of the truly powerful. By powerful, I do not mean the rich. On the contrary, I have seen more giving amongst the poor than amongst the rich. A rich man or woman counts every penny they give and receive, while the poor is happy to be alive. True, there are Bill Gates and other philanthropic millionaires but most do not become rich by sharing the wealth despite Reagonomic theory of the 'trickle down' effect.

Personal development dependency on culture is the basis for many theologies and political movements. Granted we are all part of our culture, or our human environment, but take someone from one culture and plop them into another and most people will adapt, if not thrive. To say we are encased or enslaved by what happens around us, how other people act, is an easy out of personal responsibility. Children usually follow the orders, spoken and unspoken, of their parents, but when they are cut loose from parental administration; they go their own way. If they have developed some good morals and decision making ability they will not be swayed by others, or by their culture. Of course this is impossible to do, as culture is an ever-present force, like gravity, and those who ignore it are bound to fall. To escape this gravity (an idea that I discovered in Dinosaur Brains; Dealing with All those impossible People at Work by Dr. Albert J. Bernstein and Sydney Craft) is difficult. It can be done.

To say that one has to drive badly because everyone on the highway drives badly is childish and nonsensical; even though it is tempting. On the other hand, to ignore how other drivers drive is also dangerous. We have to adapt to survive. Perhaps a narcissist will say he or she drives badly because everyone else is, although most judges will throw this defense out of a court of law. The blame other defense is an easy out, one that children often take because they know no better. Dr Stephen Covey's first habit of highly effective people says, "We are responsible for our own choices and have the freedom to choose, based on principles and values rather than moods and conditions. Proactive people choose not to be victims or to blame others." This could be applied to NPDs and their victims.

Alloplastic Defenses?

Is this why this disorder exists? Just because the world has dealt you a bad hand of cards, you have to play anyway, and we all loose in the end. If life gives you lemons, make lemonade. No doubt you will say my homespun humor and sayings are off the target, yet they contain a grain of the truth. Narcissist was a legend in his own time - in ancient Greece - because this disorder is probably as old as humankind. It is part of what makes us human. To say we 'suddenly' are living in a narcissistic culture is to belie all of human history that tells the stories of narcissists who have struggled to do and bad. Great leaders need a pinch of narcissism, but too much spoils the meal. In fact all of us need a little narcissism in our psyches to balance out our personality. But when we suddenly think we are the star of the show, the only one in the world, then we begin to show signs of NPD; as to the origin of this there are many as I have detailed in the above text.

So to answer your question, I would say yes to all of what you asked in your question.

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Last updated September 25, 2006