How can fostering the development of healthy narcissism help prevent interpersonal trauma?




Vol 10 #3

Caroline Giroux, MD, FRCPC

Author information:

Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, UC Davis Health System, Sacramento, CA, [email protected]

More than ever, we seem to be living in an era of damaging narcissism. Countless children have suffered at the hands of parents with destructive narcissistic defenses, turning into victimized adults or grownups who identified with the aggressor, hence perpetuating a cycle of trauma: personal, familial, transgenerational, societal. And now global. How can we ignore the malignant narcissism of certain leaders of our nations, their so-called leadership tested as we go from global crisis to large-scale disaster? There doesn’t even seem to be any tension between their egotistical principles and the common good. Decisions seem to be guided by the former. As therapists, we are solicited too late in the game, when we must deal with the repercussions of oppression, violence, further narcissistic hemorrhage. But there’s got to be another way than putting out fires.


As a field that often discusses a form of what Winnicott referred to as “objective hatred” experienced towards narcissistic patients, we must use our collective vulnerabilities to such transferential triggers as a source of enlightening momentum. What we feel by interacting with an abrasive patient would be experienced by most of humankind, hence the “objective” quality. In order to be able to think clearly, maintain a decent level of compassion, while at the same time dealing with an overwhelming mixture of emotions, we must create a healthy distance between the attacks from these patients on our core. I remember vividly a patient I saw as a fifth-year psychiatry resident with my mentor. Saying his presentation was arrogant would be an understatement. His attitude was full of contempt towards me, as he persisted on calling me “student”, and even made a destabilizing remark about my outfit, saying the style was out of fashion. Whiplashed by such judgment of my attire, without being quite able to name or articulate this micro-aggression directed at me, I nonetheless sensed an intentionality that was meant to intimidate me. In other words, he was challenging to interview and he had the exhausting tendency to return our questions like a boomerang. A trivial intervention on my part towards the end of this painful, ego-bruising session was sufficient to change the tide and create an interesting dénouement: he thanked me and had even some level of respect in his attitude, while refusing with contempt to shake hands with my supervisor. From then on, I knew that splitting wasn’t a myth, and that reality could surpass caricature.


Social Determinants


Our rapidly changing societies, shifting our social landscape, and shaping complex family configurations, invite major adaptations to our primate brain that cannot evolve that quickly. The declining effectiveness of stabilizing aspects of institutions (schools, churches, communities etc) that used to buffer stressors does shape individual development; it almost makes sense that human nature cannot go beyond the scaffolding phase of personality development, or so-called ego, to be able to survive and respond to fast changing demands by shifting personas like a chameleon.


Think about how social media have affected our lives and self-image. Suddenly, we can all declare ourselves journalists, reporters, photographers, bloggers, etc through instantaneous “publications” or “posts”. Some become addicted to “likes” as if it were candy. The number of Facebook friends has become another metric of our own sense of personal value, popularity or desirability. Frédéric Lenoir described the function of the ego very well during a TV show: “ego is a structure and eventually we must go beyond it.” It is also an agency in our being that is generating defenses, and not always mature ones. It tends to identify with thoughts or cling onto them. It gets fooled by images, roles, external and shifting attributes from the world of form. As opposed to the essence, or the self, the ego is considered an illusion, yet a source of great torment and pain. It is the ego that crushes us when we don’t attain success, when we experience a loss labeled as failure. It is a black hole that is never satisfied, and the more it gets (fame, wealth, power, material possessions…), the more it wants. On the other hand, our essence is always there and not touched by external circumstances, roles or rewards. It is content with the now and allows us to experience fullness with little, eternity with the present, and an infinite space within the stillness of a silent spirit. Accessing it requires the mindful appraisal of emotions, pleasant or unpleasant, even the tormenting ones. The ego doesn’t allow the person to experience the difficult affects and rather creates an artillery of defenses meant to repress the internal experience because such affects can be perceived as an obstacle to success or a stain on the impeccable image the narcissist tried to maintain in the eyes of the world and his/her own. Rather than growing with the acknowledgment of one’s own vulnerability, rather than learning from the universal plague called shame, the ego refuses to see it and creates fortifications that end up aggravating the issue, generating more trauma, impoverishing psychic life, stunting spiritual growth.


The unhealthy development of narcissism can come from various mechanisms, but usually it is mainly lack of fulfillment (or pseudo- over fulfillment) of basic emotional safety needs by lack of attunement (wounding attachment) or resources (poverty, under-stimulation). Beyond the impact of the parent-child dyad, there are generational or cohort effects that may shape the development of the ego. Certain generations have greatly suffered (deprivation through war etc) and try to live vicariously through their children by giving them everything they didn’t have (over-fulfillment). Both situations end up being damaging and can create a sense of entitlement, a salient characteristic in those beset with narcissism in our world.


Ingredients of Healthy Narcissism


What does it take for the development of healthy narcissism, with an ego that “knows” when its “job” is done and exits or sheds like the molt of an arthropod? Winnicott summarized it: a good enough mother, holding and mirroring. The good-enough mother (or father) validates her child, accepts him or her as such, while being imperfect herself and not pretending to be the opposite, by remaining flexible, allowing mistakes that leads to healthy doses of frustrations.


Failures of attunement are bound to happen, but the good enough parent is able to acknowledge these lapses that hurt the child, take responsibility and initiate repair by apologizing (from the heart, not from the highly scripted ego), making room for the child’s emotional experience and doing everything possible to prevent other such wounds.


Adequate parenting also consists of holding (flexible containment), attentiveness (attunement), and structure. Holding is essential to mood regulation and general safety. By noticing, naming, containing the child’s overwhelming archaic affects, we can better guide him or her in their metabolization of them and by giving them meaning. Attunement means the parents are attentive to the child’s emotional responses, inclinations and struggles and respond to them accordingly. They will foster growth by reinforcing the mature aspects while encouraging the development of other skills without shaming the child. Such parents see their child not as “perfect” or “the best” but whole, unique and full of potential. They are able to effectively provide accurate and realistic feedback to the child to promote his or her development.


Winnicott introduced the concept of “mirroring”. Of course, parents who have their own unresolved narcissistic struggles will be unable to view their children without a distorted lens, hence the competitive, aggressive father forcing a nonathletic child (who’d rather play music) in playing sports. Or the perfectionistic, shame-averse mother who does all her child’s school projects to ensure a perfect score.


In other words, seeing a child as one’s own narcissistic extension by idealizing is subtle abuse and gross neglect. Excessive criticism is the other side of the same coin. Regardless of the mechanism, the child is not affirmed or valued as he or she is. Poor attunement is about the ego of the parent and leads to further frustration in the parent and a sense in the child that he/she has to conform to an image the parent has of him/her, that he/she is not enough.


In order to survive and ensure he will be loved, the child ends up suppressing the real self and creates a false self, or fake persona, or overidentifies with an ego defined by external expectations. Finally, a firm yet flexible structure is essential to give the child a sense of emotional security. Parents who never say “no” don’t train their children to learn to tolerate frustration (the “king child” wants everything, and not now, but yesterday), or parents who don’t institute routine and healthy rules like curfew might make the child feel like the parent doesn’t care about what happens to them, that they don’t matter. In summary, pathological narcissism is a form of developmental arrest due to deprivation at a phase when the child needed specific environmental feedback to maintain cohesion of the self and secure attachement.


The Core Emotion in Pathological Narcissism: Shame


Shame is a universal emotion. It is essential for our survival and indicates that the integrity of our emerging self or self-concept is threatened. Most people would agree that it is very unpleasant to experience, and is a core emotion in trauma. Symptoms (addictions, dissociation, fight or flight etc) evolve as attempts to cope with shame of having been abused for instance. To overcome it, one must admit its presence and deal with it, or laser-beam it. But we live in a world where even shame itself is shameful. Meta-shame, or shame of being ashamed… This leads to toxic shame.


The Narcissistic personality configuration is the outcome of such toxic shame that occurred during the formative years. Shame can lead to fear, and the helplessness experienced during a frightening event can lead to shame. The presence of unprocessed shame might be due to our universal intolerance of being powerless. Knowing we cannot always defend ourselves when confronted with danger or a predator must have been even more unbearable than a fear of not being enough in the eyes of the world. It paralyzes the ego with a distorted image from internalized badness after abuse or humiliation. Sometimes, when there is a trauma legacy, subsequent generations run the risk of being the recipient of parents’ or ancestors’ own unprocessed shame.


When children are young and developing, they do not have the necessary vocabulary to articulate or process shame. If parents are inducing it, they are no longer seen as safe or potential protectors to buffer such stress. Because they at times must still turn to those abusive figures for protection, they end up splitting the image of their parents, to preserve the good aspects. That creates attachment issues and problems in subsequent relationships modeled after such templates.


To survive psychically, those wounded children become teenagers and eventually adults who learn to bury this unnamable under layer after layer of defenses, like sediments that crystallize in rigidity. Shame cannot be contained and is therefore partially transformed in or buried under envy. Instead of looking at one’s own perceived defects, one prefers to look at other people’s positive attributes that we desire. But envy is also intolerable. It means someone has something we don’t have. It exacerbates the very thing one tried to eliminate: shame!


Envy, also paralyzing and destructive, is not sustainable and can then lead to anger or rage. The perceived self-value difference is experienced like an injustice, and therefore generates a fight mode, or aggression. But overt manifestations of anger will trigger responses or disapproval from society. Therefore, it must be disavowed via a primitive defense mechanism called projection, such as paranoia (“it’s the other that wants to destroy me!”) and then, because it is energy- (if not life) consumingtoned down arrogance emerges, as a combination of grandiosity and contempt. On an individual or interpersonal scale, such defenses can be damaging. On a national or global level, people can suffer in disastrous proportions at the hands of narcissistic leaders. These extremely envious people who have a thirst for power (that is unquenchable) combined with a lack of empathy may commit horrific acts, or have others do so on their behalf.


The covert narcissist might deal with envy by belittling or denigrating, but a void will necessarily ensue (our joy is boosted in sharing with others… by being a kill-joy of others, we create a spiritual vacuum). The attempt to fill the void will take the form of idealization. But such pseudo-admiration or obsequiousness is aggression in disguise.


The figure aims to illustrate two variants of defense development based on two narcissistic phenotypes: the overt narcissist, or “thick-skinned” (inflated self-esteem, or “ego-esteem”) versus “thin-skinned” (expects rejection, prone to fragmentation; tends to associate with covert narcissists to boost their “ego-esteem”). But even if such defenses temporarily allow the narcissist to forget shame, rage and envy threaten the stability of an ego already fragile and end up being toxic forces for the targets of such experience.

Figure 1. Intolerable shame: the defense layers of a pathological narcissist



The Glamorous Versus the Mundane


Unhealthy narcissism is pervasive. In our day-to-day life, its manifestations can be very subtle and won’t necessarily present as with certain national leaders who parade even though they have a contagious illness. Many of us have to deal with people who have a disregard for our boundaries, who are rigid, who want to control all the variables. Others around them might feel exploited, or a set of functions, not seen as a whole (some men exploit women and split their representations based on primitive and egotistical need satisfaction, such as in the “Whore and Madonna complex”).


Such people think their way is the best and make others around them feel defective or incompetent. This can alternate with a shower of compliments, increasing further the likelihood of confusion through manipulation of the victim’s mind. They can be hypercritical, tyrannical, have razor-blade remarks and are experts at gaslighting. They don’t care about wasting resources, polluting the planet (the ego cannot think beyond self-centered outcomes that will be an advantage for the advancement of the individual; they see themselves as the sole tree, ignoring the forest).



In our clinical settings, there is a level of wounded narcissism in many psychiatric disorders. Think about the antisocial who is above rules and exploits others. Or the rigid principles of the obsessive personality that positions him or her above others and who maintains tyrannical expectations of others. Or the paranoid who thinks the police, or FBI, or a celebrity (the more grandiose the better) is after him or her. Or the omnipotence of the person in a manic phase.


Paying attention to our counter-transference can help provide red flags: boredom, a sense of void, irritability, coldness, oppression, feeling instrumentalized. The patient’s sarcasm or projective identification might instill doubt. We feel disqualified. Worst of all, the over-empathizer with a genuine desire to understand that disorienting individual might feel disconnected from herself or himself, even devitalized. Severe narcissists use the relationship to self-regulate: they project the emotions they are unable to metabolize on their own, and the victim, whiplashed by the experience, owns it or identifies with it (projective identification).



Recommendations and Conclusion


It is crucial to gain awareness about the intricacies of this personality structure. Through their rage, projection, contempt, entitlement, they risk causing relational damage through abuse or neglect. Therapists and others working with narcissists must learn to decode defenses, depersonalize (by not owning the emotions projected by the narcissist), and repair mis-attunements the best they can to end the cycle of trauma. The skilled therapist and good enough parent will accept being a model of fallibility, finding an optimal level of frustration as they navigate the needs of all parties. Narcissism is like muscular tone: it can’t be too soft (flaccid, ineffective in lifting a limb) or rigid (catatonia). Healthy narcissism will provide resilience to the self-concept, just like a flexible muscle will be able to set a body part into effective motion.


As we interact with our children, students and patients, we must strive to validate, contain, reflect. In therapeutic settings, we should carefully unmask fear, shame, envy and rage (by maybe starting with the most distal defense: reflect on arrogance and dig, and go as deep as the patient will let you, and a bit deeper every time). Establish trust with and reassure the paranoid. Defuse or distract the rage. Empower the envious. To elicit or access our own empathy and self-compassion (and in a way, model it to the patient), we must first be attuned to our own emotional experiences to know what belongs to us and what comes from them in order to avoid projective identification, and keep in mind that the unpleasant defenses are screaming loudly the unmet needs of the patient who desperately attempts to maintain self-cohesion. As we contain in a safe therapeutic space, our role is a) to help patients develop a new, more balanced self-representation through our attentive mirroring; b) to foster the development of a healthy self-concept by being a good enough “parent-therapist” that can look at past trauma with the patient; and c) remove shame by letting helplessness in, normalizing it, and reinforcing positively the shared humanness the newly discovered vulnerability.



This essay is dedicated to Dr Antoine Jilwan, an inspiring psychoanalyst, decades-long mentor, spiritual father figure and extraordinary friend who has been instrumental in my ever-evolving conceptualizations of narcissism and trauma.

Print Friendly, PDF & Email
Blog Attachment