I love him. I cannot leave him like that. He is like a crippled small child. My heart goes out to him. Will he ever get better? Can he ever get better?

ANSWER

A Narcissistic Personality Disorder is a systemic, all-pervasive condition, very much like pregnancy: either you have it or you don't. Once you have it, you have it day and night, it is an inseparable part of the personality, a recurrent set of behaviour patterns.

Recent research shows that there is a condition which might be called "Transient or Temporary or Short Term Narcissism" as opposed to "The Real Thing � The Narcissistic Personality Disorder, (NPD)" (Roningstam, 1996). The phenomenon of "Reactive Narcissistic Regression" is well known: people regress to a transient narcissistic phase in reaction to a major life crisis which threatens their mental composure.

There are narcissistic touches in every personality and in this sense, all of us are narcissists to a certain extent. But this is a far cry from the NPD pathology.

One bit of good news: no one knows why, but, in certain, rare, cases, with age (in one's forties), the disorder seems to decay and, finally, stay on in the form of a subdued mutation of itself. This does not universally occur, though.

Should a partner stay on with a narcissist in the hope that his disorder will be ameliorated by ripe old age? This is a matter of value judgement, preferences, priorities, background, emotions and a host of other "non-scientific" matters. There could be no one "right" answer. It would seem that the only valid criterion is the partner's well being. If he or she feels bad in a relationship (and no amount of self-help or of professional help suffices) � then looking for the exit sounds like a viable and healthy strategy.

This raises the second part of the question: a relationship with a narcissist is sometimes a kind of co-dependence, even symbiosis. Read "The Inverted Narcissist". Moreover, the narcissist is a superb emotional manipulator and extortionist. In some cases, there is real threat to his mental stability. Even "demonstrative" (failed) suicide cannot be ruled out in the repertory of narcissistic reactions to abandonment. And even a modest amount of residual love harboured by the narcissist's partner makes the separation very difficult for him or her.

But there is a magic formula.

A narcissist is with his partner because he regards IT as a Source of Narcissistic Supply. He values the partner as such a source. Put differently: the minute that the partner ceases to supply him with what he needs � he loses all interest in IT. (I use IT judiciously � the narcissist objectifies his partners, treats them as he would inanimate objects.)

The transition from over-valuation (bestowed upon Sources of Narcissistic Supply) to devaluation (reserved for other mortals) is so swift that it is likely to inflict pain upon the narcissist's partner, even if he previously prayed for the narcissist to depart and leave him alone. The partner is the narcissist's pusher and the drug that he is selling to him is stronger than any other drug because it sustains the narcissist's very essence (his False Self).

Without Narcissistic Supply the narcissist disintegrates, crumbles and shrivels � very much as vampires do in horror movies when exposed to sunlight.

Here lies the partner's salvation. An advice to you: if you wish to sever your relationship with the Narcissist, stop providing him with what he needs. Do not adore, admire, approve, applaud, or confirm anything that he does or says. Disagree with his views, belittle him (or put him in perspective and proportion), compare him to others, tell him that he is not unique, criticise him, make suggestions, offer help. In short, deprive him of that illusion which holds his personality together.

The narcissist is a delicately attuned piece of equipment. At the first sign of danger to his inflated, fantastic and grandiose self � he will disappear on you.

So I repeat:

That pathological narcissism is very hard to treat successfully is the position of clinical psychologists (which I am NOT) who bothered to write about the subject. NPD has been recognised as a distinct mental disorder a little more than two decades ago. There is no one who can honestly claim expertise or even in-depth understanding of this complex condition. My writings are limited to its phenomenology. I deal very briefly (and unconvincingly) with its aetiology (and I follow in this the Object-Relations school of psychodynamics for want of a better "explanation"). So, no one knows whether therapy works. What IS known is that therapists find narcissists repulsive, overbearing and unnerving. It is also known that narcissists try to co-opt, play-down or even humiliate the therapist.

To a narcissist, I would recommend a more functional approach, perhaps along the following lines:

"Dear Narcissist,

1. Know and accept thyself. This is what you are. You are highly intelligent. You are very inquisitive. You are a narcissist. These are facts. Narcissism is an adaptive mechanism. It is dysfunctional � but it saves you from a LOT MORE dysfunction or even non-function. Make a list: what does it mean to be a narcissist in your specific case? What are your typical behaviour patterns? Which types of behaviour are counterproductive, irritating, self-defeating or self-destructive? Which are productive, constructive and should be enhanced DESPITE their pathological origin?

2. Decide to suppress the first and to promote the latter. Construct lists of self-punishments, negative feedback and negative reinforcements. Impose them upon yourself when you exhibit one of the behaviours in the first list. Make a list of prizes, little indulgences, positive feedbacks and positive reinforcements. Use them to reward yourself when you display a behaviour of the second kind.

3. Keep doing this with the express intent of conditioning yourself. Be objective, predictable and just in the administration of both punishments and awards, positive reinforcements and feedback and negative ones. Learn to trust your "inner court". Constrain the sadistic, immature and ideal parts of your personality (known as "Superego" in psychoanalytic parlance) by the application of a uniform codex, a set of immutable and invariably applied rules.

4. Once sufficiently conditioned, monitor yourself incessantly. Narcissism is sneaky and it possesses all your resources because it is you. Your disorder is intelligent because you are. Beware and never lose control. With time this onerous regime will become a second habit and supplant the narcissistic (pathological) superstructure.

You might have noticed that all the above can be amply summed by suggesting to you to become your own parent. This is what parents do and the process is called "education" or "socialisation". If your path to the adoption of this course is a particular therapy � go ahead. As a metaphor, a narrative, no therapeutic approach is better or worse than any other."

The heart of the beast is the inability of the narcissist to distinguish true from false, posing from being, Narcissistic Supply from genuine relationships and compulsive drives from true interests and avocations in his life. Narcissism is about deceit. It blurs the distinction between authentic actions, true motives, real desires, original emotions � and the malignant forms that are the attributes of narcissism. Narcissists are no longer capable of knowing themselves. Terrified by their internal apparitions, paralysed by their inauthenticity, suppressed by the weight of their repressed emotions � they occupy a hall of mirrors. Munch-like, their elongated figures stare at them, on the verge of THE scream, yet somehow, without sound. Their curious, vibrant, optimistic True Self is dead. How can a False Self be anything but false? How can anyone on a permanent diet of reflections ever see true objects? How can the narcissist � whose essence is the devouring of meaningful others and their transformation into meaningless and other � ever love?

The answer is: discipline, decisiveness, clear targets, conditioning, justice. The narcissist is the product of unjust, capricious and cruel treatment. He is the finished product of a production line of self-recrimination, guilt and fear. He needs to take the antidote to counter the narcissistic poison. Unfortunately, there is no drug I know of which can ameliorate pathological narcissism. Confronting one's parents and childhood is a good idea if the narcissist feels that he is ready for it. Can he take it? Can he cope with new truths, however painful? The narcissist must be careful. This is playing with fire. But if he feels confident that there is nothing that can be revealed to him in such a confrontation that he cannot withstand � it is a good and wise move in the right direction. My advice to the narcissist would then be: just dedicate a lot of time to rehearsing it and define well what is it exactly that you want to ask. Do not turn this into a monodrama, group dynamics or trial. Ask so that you shall be answered. Don't try to prove anything, to vindicate, to take revenge, to win, to exculpate. Talk as you would with yourself. Do not try to sound professional, mature, intelligent, knowledgeable and distanced. There is no "problem to solve" � just a condition to adjust yourself to. Think about it as diabetes.

At the risk of sounding heartless, I will make three concluding comments:

1. The narcissist should take life in general and himself, in particular, much less seriously. Being immersed in one's self and in one's condition is never the right recipe to functionality, let alone happiness. The world is a comic, absurd place. It is indeed a theatre to be enjoyed. It is full of colours and smells and sounds to be treasured and cherished. It is varied and it accommodates and tolerates everyone and everything, even narcissists.

2. The narcissist should regard his condition as an asset. I am a narcissist, so I write about it. My advice to the narcissist would be: ask yourself what can you do with it? In Chinese the ideogram for "crisis" and "opportunity" is one and the same. Why don't you transform the curse in your life � into a blessing in other people's lives? Why don't you tell them your story, warn them, teach them how to avoid the same pitfalls, how to cope with the damage? Why don't you do all this in a more institutionalised manner? For instance, you can start a discussion group on the internet. You can establish "Narcissists Anonymous" in some community shelter. You can open a correspondence network, a help centre for men in your condition, for women abused by narcissists ... the possibilities are endless. And it will instill in you a regained sense of self-worth, a purpose, self-confidence and reassurance. It is only by helping others that we can help ourselves.
   This is, of course, a suggestion � not a prescription. But it demonstrates the ways in which you can derive power from adversity.

3. It is easy for the narcissist to think about Pathological Narcissism as the source of all that is evil and wrong in his life. Narcissism is a catchall phrase, a conceptual scapegoat, an evil seed. It conveniently encapsulates the predicament of the narcissist. It introduces logic and causal relations into his baffled, tumultuous world. But this is a trap. The human psyche is too complex to be captured by a single, all-encompassing explanation, however convincing. The road to self-help and self-betterment passes through numerous junctions and stations. Narcissism is the first and the foremost. But there are many other elements in the complex dynamics that is the soul of the narcissist. The narcissist should take responsibility for his life and not relegate it to some hitherto rather obscure psychodynamic concept. This is the first and most important step to healing.