Sam Vaknin (part 2)

I asked Sam Vaknin about self-aware narcissism. He corrected me that he has never been diagnosed a psychopath, that he scored a 13 on the PCL-R when he would need an 18 to be diagnosed a psychopath in Europe and a 30 in the U.S.

He linked me to the following about self-aware narcissism, in which he makes some very interesting points about the difference between "changing" and "healing" that I think apply equally well to sociopaths:

Narcissism defines the narcissist's waking moments and his nocturnal dreams. It is all-pervasive. Everything the narcissist does is motivated by it. Everything he avoids is its result. Every utterance, decision, his very body language - are all manifestations of narcissism. It is rather like being abducted by an alien and ruthlessly indoctrinated ever since. The alien is the narcissist's False Self - a defense mechanism constructed in order to shield his True Self from hurt and inevitable abandonment.

Cognitive understanding of the disorder does not constitute a transforming INSIGHT. In other words, it has no emotional correlate. The narcissist does not INTERNALIZE what he understands and learns about his disorder. This new gained knowledge does not become a motivating part of the narcissist. It remains an inert and indifferent piece of knowledge, with minor influence on the narcissist's psyche.

Sometimes, when the narcissist first learns about the Narcissistic Personality Disorder (NPD), he really believes he could change (usually, following a period of violent rejection of the "charges" against him). He fervently wants to. This is especially true when his whole world is in shambles. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply - are all transforming life crises. The narcissist admits to a problem only when abandoned, destitute, and devastated. He feels that he doesn't want any more of this. He wants to change. And there often are signs that he IS changing. And then it fades. He reverts to old form. The "progress" he had made evaporates virtually overnight. Many narcissists report the same process of progression followed by recidivist remission and many therapists refuse to treat narcissists because of the Sisyphean frustration involved.

I never said that narcissists cannot CHANGE - only that they cannot HEAL. There is a huge difference between behavior modification and a permanent alteration of the psychodynamic landscape. Narcissistic behavior CAN be modified using a cocktail of talk therapy, conditioning, and medication. I have yet to encounter a healed narcissist.

The emphasis in therapy is thus more on accommodating the needs of those nearest and dearest to the narcissist - spouse, children, colleagues, friends - than on "treating" the narcissist. If the narcissist's abrasiveness, rage, mood swings, reckless and impulsive behaviors are modified - those around him benefit most. This, as far as I am concerned, is a form of social engineering.