Narcissism
"Whoever loves becomes humble. Those who love have, so to speak, pawned a part of their narcissism." Sigmund Freud
Narcissism is the pursuit of gratification from vanity or egotistic admiration of one's idealized self image and attributes. This includes self-flattery, perfectionism, and arrogance. The term originated from Greek mythology, where the young Narcissus fell in love with his own image reflected in a pool of water.
Narcissism is a concept in psychoanalytic theory, which was popularly introduced in Sigmund Freud's essay On Narcissism (1914). The American Psychiatric Association has listed the classification 'Narcissistic Personality Disorder' (NPD) in its Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1968, drawing on the historical concept of megalomania.
Narcissism is also considered a social or cultural problem. It is a factor in trait theory used in various self-report inventories of personality such as the Millon Clinical Multiaxial Inventory. It is one of the three dark triadic personality traits (the others being psychopathy and Machiavellianism). Except in the sense of primary narcissism or healthy self-love, narcissism is usually considered a problem in a person's or group's relationships with self and others.
Narcissism is not the same as egoism or egocentrism. Egoism is an ethical theory that treats self-interest as the foundation of morality; whereas, egocentrism is the inability to differentiate between self and other; more specifically, it is the inability to untangle subjective schemas from objective reality and an inability to accurately assume or understand any perspective other than one's own.
Although egocentrism and narcissism appear similar, they are not the same. A person who is egocentric believes they are the center of attention, like a narcissist, but does not receive gratification by one's own admiration. Both egotists and narcissists are people whose egos are greatly influenced by the approval of others, while for egocentrists this may or may not be true.
Narcissistic Personality Disorder or NPD is a personality disorder characterized by a long-term pattern of exaggerated feelings of self-importance, an excessive need for admiration, and a lack of empathy toward other people.
People with NPD often spend much time thinking about achieving power and success, or on their appearance. Typically, they also take advantage of the people around them. Such narcissistic behavior typically begins by early adulthood, and occurs across a broad range of situations.
The causes of NPD are unknown. The condition is included in the cluster B personality disorders in the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM). A diagnosis of NPD is made by a healthcare professional interviewing the person in question and should be differentiated from mania and substance use disorder.
Treatments for NPD have not been well studied. Therapy is difficult, because people with it usually do not consider themselves to have a mental health problem.
According to a Mayo Clinic diagnosis, NPD is one of several types of personality disorders is a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others. But behind this mask of extreme confidence lies a fragile self-esteem that's vulnerable to the slightest criticism.
NPD causes problems in many areas of life, such as relationships, work, school or financial affairs. People with it may be generally unhappy and disappointed when they're not given the special favors or admiration they believe they deserve. They may find their relationships unfulfilling, and others may not enjoy being around them. With treatment for NPD cantering around talk therapy (psychotherapy).
For the sake of example, among others, Donald Trump’s grandiosity and impulsivity have made him a constant subject of speculation among those concerned with his mental health. But after more than a year of talking to doctors and researchers about whether and how the cognitive sciences could offer a lens to explain Trump’s behavior, I’ve come to believe there should be a role for professional evaluation beyond speculating from afar.
Viewers of Trump’s recent speeches have begun noticing minor abnormalities in his movements. Though these moments could be inconsequential, they call attention to the alarming absence of a system to evaluate elected officials’ fitness for office, to reassure concerned citizens that the “leader of the free world” is not cognitively impaired, and on a path of continuous decline.
A president could be actively hallucinating, and the medical community could be relegated to speculation from afar. The lack of a system to evaluate presidential fitness only stands to become more consequential as the average age of leaders increases. The Constitution sets finite lower limits on age but gives no hint of an upper limit. At the time of its writing, septuagenarians were relatively rare, and having survived so long was a sign of hardiness and cautiousness. Now it is the norm. In 2016, the top three presidential candidates turned 69, 70, and 75. By the time of a 2021 inauguration, a President like Joe Biden would be 78.
After age 40, the brain decreases in volume by about 5 percent every decade. The most noticeable loss is in the frontal lobes. These lobes also control much more important processes, from language to judgment to impulsiveness. Everyone experiences at least some degree of cognitive and motor decline over time, and some 8.8 percent of Americans over 65 now have dementia. An annual presidential physical exam at Walter Reed National Military Medical Center is customary, and Trump’s is set for January 12. But the utility of a standard physical exam—knowing a president’s blood pressure and weight and the like, is meager compared with the value of comprehensive neurological, psychological, and psychiatric evaluations. These are not part of a standard physical.
Even if they were voluntarily undertaken, there would be no requirement to disclose the results. Even if the country’s psychiatrists were to make a unanimous statement regarding the president’s mental health, their words might be written off as partisan in today’s political environment.
The downplaying of a president’s compromised neurological status would not be without precedent. Franklin Delano Roosevelt (FDR) famously disguised his paralysis from polio to avoid appearing “weak or helpless.” He staged public appearances to give the impression that he could walk, leaning on aides and concealing a crutch. Instead of a traditional wheelchair, he used an inconspicuous dining chair with wheels attached. According to the FDR Presidential Library, “The Secret Service was assigned to purposely interfere with anyone who tried to snap a photo of FDR in a ‘disabled or weak’ state.
Trump has exhibited a “clear reduction in linguistic sophistication over time.” The phrasing was so peculiar for a medical record that some suggested that he had written or dictated the letter himself. Indeed, as a key indicator of neurological status, Trump’s distinctive diction has not gone without scrutiny. He was once a more articulate person who sometimes told stories that had beginnings, middles, and ends, whereas he now leaps from thought to thought. He has come to rely on a small stable of adjectives, often involving superlatives. An improbably high proportion of what he describes is either the greatest or the worst he’s ever seen; absolutely terrible or the best; tiny or huge. The frontal lobes also control speech, and over the years, Trump’s fluency has regressed, and his vocabulary contracted.
If Trump’s limited and hyperbolic speech were simply a calculated political move, he repeated the phrase “no collusion” 16 times in the Times interview, which some pundits deemed an advertising technique, then we would also expect an occasional glimpse behind the curtain. In addition to repeating simplistic phrases to inundate the collective subconscious with narratives like “no collusion,” Trump would give at least a few interviews in which he strung together complex sentences, for example, to make a case for why Americans should rest assured that there was no collusion.
Though it is not possible to diagnose a person with dementia based on speech patterns alone, these are the sorts of changes that appear in early stages of Alzheimer’s. Trump has likened himself to Ronald Reagan, and the changes in Trump’s speech evoke those seen in the late president. Reagan announced his Alzheimer’s diagnosis in 1994, but there was evidence of linguistic change over the course of his presidency that experts have argued was indicative of early decline. His grammar worsened, and his sentences were more often incomplete. He came to rely ever more on vague and simple words: indefinite nouns and “low imageability” verbs such as have, go, and get.
After Reagan’s diagnosis, former President Jimmy Carter sounded an alarm over the lack of a system to detect this sort of cognitive impairment earlier on. “Many people have called to my attention the continuing danger to our nation from the possibility of a U.S. president becoming disabled, particularly by a neurological illness,” Carter wrote in 1994 in the Journal of the American Medical Association. “The great weakness of the Twenty-Fifth Amendment is its provision for determining disability in the event that the president is unable or unwilling to certify to impairment or disability.”
Indeed, the 1967 amendment laid out a process for transferring power to the vice president in the event that the president is unable to carry out the duties of the office because of illness. But it generally assumed that the president would be willing to undergo diagnostic testing and be forthcoming about any limitations.
This might not happen with a person who has come to be known for denying any hint of weakness or inability. Nor would it happen if a president had a psychiatric disorder that impaired judgment, especially if it was one defined by grandiosity, obsession with status, and intense aversion to being perceived as weak.
Nor would it happen if the only person to examine the president was someone like Harold Bornstein, whose sense of objective reality is one in which Donald Trump is healthier than the 42-year-old Theodore Roosevelt (who took office after commanding a volunteer cavalry division called the Rough Riders, and who invited people to the White House for sparring sessions, and who, after his presidency, would sometimes spend months traversing the Brazilian wilderness).
It was for these reasons that in 1994, Carter called for a system that could independently evaluate a president’s health and capacity to serve. At many companies, even where no missiles are involved, entry-level jobs require a physical exam. A president, it would follow, should be more rigorously cleared. Carter called on “the medical community” to take leadership in creating an objective, minimally biased process, to “awaken the public and political leaders of our nation to the importance of this problem.”
To attribute Trump’s behavior to mental illness risks devaluing mental illness. In the public sphere, however, they’re easily dismissed as value judgments motivated by politics. The Harvard law professor Noah Feldman recently accused mental-health professionals who attempt to comment on Trump’s cognition of “leveraging their professional knowledge and status to ‘assess’ his mental health for purposes of political criticism.”
Indeed, thousands of mental-health professionals have mobilized and signed petitions attesting to Trump’s unfitness to hold office. Some believe Trump should carry a label of narcissistic personality disorder, antisocial personality disorder, or both. The largest such petition has more than 68,000 signatures, though there is no vetting of the signatories’ credentials. Its author, the psychologist John Gartner, said last year that in his 35 years of practicing and teaching, “this is absolutely the worst case of malignant narcissism I’ve ever seen.”
Many other mental-health professionals are insistent that Trump not be diagnosed from afar by anyone, ever, that the goal of mental-health care is to help people who are suffering themselves from disabling and debilitating illnesses. A personality disorder is “only a disorder when it causes extreme distress, suffering, and impairment,” argues Allen Frances, the Duke University psychiatrist who was a leading author of the third edition of the Diagnostic and Statistical Manual, which was the first to include personality disorders.
This is consistent with the long-standing, widely misunderstood rule in the profession that no one should ever be diagnosed outside the confines of a one-on-one patient-doctor relationship. The mandate is based on a legal dispute that gave rise to the American Psychiatric Association’s “Goldwater Rule,” which was implemented after the politician Barry Goldwater sued Fact magazine for libel because a group of mental-health professionals had speculated about Goldwater's thought processes in its pages.
The rule has protected psychiatrists both from lawsuits and from claims of subjectivity that threaten trust in the entire enterprise. After more than a year of considering Trump’s behavior through the lens of the cognitive sciences, I don’t think that labeling him with a mental illness from afar is wise. A diagnosis like narcissistic personality disorder is too easily played off as a value judgment by an administration that is pushing the narrative that scientists are enemies of the state. Labeling is also counterproductive to the field in that it presents risks to all the people who deal with the stigma of psychiatric diagnoses. To attribute Trump’s behavior to mental illness risks devaluing mental illness.
Unavoidably, bias will color any assessment to some degree, but it needn’t render science useless. The idea that the president should not be diagnosed from afar only underscores the point that the president needs to be evaluated up close.
A presidential-fitness committee, of the sort that Carter and others propose, consisting of nonpartisan medical and psychological experts, could exist in a capacity similar to the Congressional Budget Office. It could regularly assess the president’s neurological status and give a battery of cognitive tests to assess judgment, recall, decision making, attention, the sorts of tests that might help a school system assess whether a child is suited to a particular grade level or classroom, and make the results available.
Such a panel need not have the power to unseat a president, to undo a democratic election, no matter the severity of illness. Even if every member deemed a president so impaired as to be unfit to execute the duties of the office, the role of the committee would end with the issuing of that statement. Acting on that information, or ignoring or disparaging it, would be up to the people and their elected officials.
Of course, the calculations of the Congressional Budget Office (CBO) can be politicized and ignored, and they recently have been. Almost every Republican legislator voted for health-care bills this year that would have increased the number of uninsured Americans by 20-some million, and they passed a tax bill that will add $1.4 trillion to the federal deficit. A majority of Americans did not support the bill, in part because a nonpartisan source of information like the CBO exists to conduct such analyses.
That math and polling can be ignored or disputed, or the CBO can be attacked as a secretly subversive entity, but at least some attempt at a transparent analysis is made. The same cannot be said of the president’s cognitive processes. We are left only with the shouts of experts from the sidelines, demeaning the profession and the presidency...
"The desire for self-development stems from “narcissistic” desires, a tendency to self-aggrandizement and superiority over others." Sigmund Freud
Food for thought!