 Dear colleagues My name is Sam Wackney, and I'm the author of Malignan self-love Narcissism Revisited and other books about personality disorders I'm also a visiting professor of psychology in Southern Federal University, Wostov-on-Don, Russian Federation and a professor of finance and psychology in CS CS the Center for International Advanced and Professional Studies Welcome to the fourth world congress on neuro-psychiatry sleep disorders and medicine held in November 2019 Rome, Italy This is my video presentation and it will focus on psychosis delusions and personality disorders But first, let us try to understand the very concept of psychosis Psychosis is a chaotic form of thinking That is a result of a severely impaired reality test The patient cannot tell inner fantasy from outside reality and internal objects from external objects Some psychic states are short-lived and transient. They're called micro episodes These last from a few hours or three minutes even to a few days and sometimes there are reactions to stress Psychotic micro-episodes are common in certain personality disorders, most notably borderline and schizotypal personality disorders But even narcissists have psychotic micro-episodes if they are deprived of narcissistic supply Something I will discuss later Persistent psychosis are a Kind of fixture of the patient's mental life and manifests for months or years Psychotics are fully aware of events and people out there They cannot however separate data and Experiences originating in the outside world from information generated by internal mental processes It's like they have no boundary Like they kind of flow into reality and reality flows into them They confuse the external universe with their inner emotions Cognitions beliefs free conceptions fears expectations and representations Similarly patients suffering from narcissistic personality disorder and to a lesser extent antisocial and histrionic personality disorders These patients fail to grasp others as full-fledged entities They regard even their nearest and dearest as cardboard cutouts to dimensional Representations introjects or symbols they treat other people as instruments of gratification functional automata or extensions of themselves Consequently both psychotics and the personality disordered have a distorted view of reality They are not rational No amount of objective evidence can cause them to doubt or to reject their like their Hypothesis and convictions full-fledged psychosis Involves complex and ever more bizarre delusions and the unwillingness to confront and consider Contrary data and information a kind of confirmation bias gun or eye It's a preoccupation with subjective rather than objective Thought becomes utterly disorganized and fantastic There is a thin line separating most like the non-psychotic from the psychotic perception and ideation on This spectrum on this spectrum. We also find schizotypal and paranoid personality disorders the diagnostic and statistical manual defines psychosis as restricted to delusions or Prominent hallucinations with the hallucinations occurring in the absence of insight into their pathological nature But what are delusions and hallucinations and how do they differ a? Delusion is a false belief based on incorrect inference about external reality That is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and Obvious proof or evidence to the contrary A hallucination is a sensory perception that has the compelling sense of reality of a trope exception But that occurs without external stimulation of the relevant sensory organ Delusion is therefore a belief It's an idea or a conviction firmly held despite abundant information to the contrary The partial or complete loss of reality test is the first indication of a psychotic state or a psychotic episode Beliefs ideas or convictions shared by other people members of the same collective are not Strictly speaking delusions conspiracy theories for example are not delusions Although they may be hallmarks of a form of psychosis called shared psychotic disorder in cults for example There are many types of delusions Start with the paranoid delusion the belief that one is being controlled or persecuted by stealth powers and conspiracies This is common in the paranoid Antisocial narcissistic borderline avoidant and dependent personality disorders then there is the grandiose Magical kind of delusion it is a conviction that one is important omnipotent possessed of occult powers or a historic figure Narcissists invariably harbor such delusions Another form of delusion is the referential delusion also known as idea of reference or referential ideation The belief that external objective events carry hidden or quoted messages or that one is the subject of Discussion derision or opprobrium even by total status. This is common in avoidant schizoid Schizo-tipo narcissistic and borderline personality disorder Hallucinations are false perceptions Based on false sensor false sensory input not triggered by any external event or entity The patient is usually not psychotic. He's aware that What he sees smells feels or hears is not there Still some psychotic states are accompanied by hallucinations for example for mucation The feeling that bugs or hands are crawling over or under one's skin There are a few classes of hallucinations this auditory hallucinations the false perception of voices sounds such as buzzing humming radio transmissions whispering motor noises and so on There's gastatory hallucination the false percept perception of taste All factorial hallucinations the false perception of smell and scent burning flesh candles Somatic hallucinations the false perception of processes and events that are happening inside the body or to the body Example piercing objects electricity running through one's extremities and so on Usually somatic hallucinations are supported by an appropriate and relevant delusion of content tactile hallucination is the false sensation of being touched or Crawled upon or that events and processes are taking place under one skin Usually supported by appropriate and relevant delusional content Then there's visual hallucination the false perception of objects people or events in force in broad daylight or in an illuminated environment with eyes wide open There is hypnagogic and hypnagogic and hypnopompic hallucinations images and trains of events experience while falling asleep or when waking up Not hallucinations in the strict sense of the word so hallucinations are common in schizophrenia affected disorders and Mental health disorders with organic origins hallucinations are also common in drug and alcohol withdrawal and among substance abusers Pathological narcissism is a defense mechanism Intended to isolate the narcissists from his environment and to shield him from pain hurt injury both real and imagined hence the construct of false self and Or pervasive psychological concept which generally or gradually Displaces the narcissist true self. It is a work of fiction intended to elicit praise and reflect criticism The unintended consequence of his fictitious existence is a diminishing ability to grasp reality correctly and to cope with it effectively self-efficacy is affected and the sense of agency narcissistic supply replaces genuine veritable and tested feedback analysis Disagreement and uncomfortable facts are screened out layers of bias and prejudice distorts the narcissist experience Yet deep inside the narcissists is aware that his life is an artifact a confabulated sham a vulnerable cocoon The world is inexorably and repeatedly Intrusive intrudes upon these ramshackle battlements Reminding the narcissist of the fantastic and feeble nature ofiosity and this is a much-graded Grandiosity gap to avoid the agonizing realization of his failed Defeats true in biography the narcissist resorts to reality Substitutes the dynamics are simple as the narcissist grows older if sources of supply become scarcer and his grandiosity gap he owns wider mortified by the prospect of facing this Actuality the narcissist withdraws even deeper Into a dreamland of concocted accomplishments feigned omnipotence and omniscience and a kind of Brattish entitlement The narcissist reality substitutes fulfill two functions. They help him to rationally ignore pain from realities With impunity and they prefer an alternative universe a virtual reality in which the narcissist reigned supreme an emergence triumphant all the time The most common form of denial involved to secretary delusions and a per-secretary object. I Describe these in very in several of my videos on my YouTube channel The narcissist perceives Slides and insults when none were intended he is he is hyper vigilant He becomes subject to ideas of reference people are gossiping about him mocking him crying into his affairs I don't know cracking his email. He's convinced that he's the center of malign and malintentioned attention People are conspiring to humiliating to punish him to have scorned with his property to dilute him to impoverish him to Confine him physically or intellectually to censor him to impose on his time to force him to action or to inaction To frighten him coerce him surround and besiege him changes mind part with his values murder him I've scorned with this property and so on and so forth The narcissist paranoid narrative Serves as an organizing principle. It's structures He's here and now and gives meaning to his life. It aggrandizes him as worthy of being persecuted The mere battle with his demons is an achievement not to be sniggered it Like overcoming his so-called enemies the narcissist emerges vixx and powerful a happy ending a happy grandiose ending The narcissist self-inflicted paranoia projections of threatening internal objects and processes of the secretary option legitimizes Justifies and explains he's abrupt comprehensive and rude withdrawal from anomalous and unappreciative world Narcissist pronounce misanthropy Fortified by these oppressive thoughts renders him a schizoid of devoid of all social contact Except the most necessary and the in the lactable But even as a narcissist divorces his environment He remains aggressive or even violent the final phase of narcissism involves verbal psychological Situational and mercifully more rarely physical abuse Directed at his foes at his inferiors It is a combination of a creeping mode of psychosis the sad and unavoidable outcome of a choice made long ago To forego the real in favor of the surreal One of the most important symptoms of pathological narcissism Narcissistic personality disorder is grandiosity grandiose fantasies the developmental conclusions of grandeur permeate every aspect of the narcissist personality they are the reason that the narcissist feels entitled to special treatment Which is typically in commensurate with his real life accomplishments The grandiose at the gap is the abyss between the narcissist self-image as reified by the false self and reality When narcissistic supply is deficient the narcissist Decompensates and he acts out in a variety of ways Narcissist of an experienced psychotic micro-episodes in therapy for example, or when they suffer narcissistic injuries in life prices But can the narcissists go over the edge do narcissists ever become truly and fully psychotic? Let's start with some terminology as we said the nearest definition of psychosis is Respected to delusions of prominent hallucinations with the hallucinations occurring the absence of insight into the pathological nature And we have defined delusions and hallucinations before Granted the narcissist hold on reality is tenuous Narcissist sometimes failed the reality test They have an impaired reality test admittedly narcissists often seem to believe in their own confabulations They are unaware of the pathological nature and origin of their self-illusions and are therefore Technically delusional though they rarely suffer from hallucinations disorganized speech or disorganized or catatonic behavior in the strictest sense of the world narcissists do appear to be psychotic though But actually in my view they are not There is a quantitative and qualitative difference between the nine though well-entrenched self-deception Malignant colon artistry and losing it Pathological narcissism should be construed as a form of Psychosis only because the narcissist is usually fully aware of the difference between true and false Real and make-believe they invented in the extant right and wrong the narcissists Consciously chooses to adopt one version of the events and aggrandizing narrative fairy tale evidence What if counterfactual life is emotionally invested in this person of myth the narcissist feels better at as fiction Than as fact, but he never was a side of the fact that it is all just fiction So the pathological narcissism should not be construed as a form of psychosis And throughout the narcissists is in full control of his faculties Cognizant of his choices and goal oriented his behavior is intentional Directional is Manipulating and his delusions are in the service of these strategists Hence his chameleon like ability to change geysers is called up and his convictions on a dime again not typical of psychotics Narcissistic delusions rarely persist in the face of blanket opposition and reams of evidence to the contrary The narcissist usually tries to convert his social milieu to his point of view He attempts to condition his nearest and nearest to positively reinforced its illusion of false self But if he thinks he modifies his profile on the fly he plays it by ear His false self is extemporaneous the perpetual work of art permanently reconstructed in a reiterative process Designed around intricate and complex feedback loops again utterly and atypical when when we deal with psychotics So I would say that narcissism is not psychosis Through the narcissistic personality though the narcissistic personality is rigid its content is always in flux Narcissists forever reinvent themselves adopt their consumption of narcissistic supply to the marketplace Narcissists are attuned to the needs of their suppliers like the performance that they are They resonate with their audience. They give the audience what it expects and wants They are efficient instruments for the extraction and consumption of human reactions As a result of this interlunable process of fine-tuning Narcissists have no loyalties no values no doctrines no affiliations no beliefs and no convictions The only constraint is their addiction to human attention positive or negative Psychotics by comparison are fixated on a certain view of the world and their place in it They ignore any known in all information that might challenge their delusions Gradually psychotics retreat into the inner resources of their tormented minds and they become dysfunction Narcissists cannot afford to shut out the world because they so heavily depend on the world for their regulation of their They buy the sense of self-worth Owing to this dependence narcissists are hypersensitive hyper-vigilant Alert to every bit of new data They are continuously busy rearranging their self delusions to incorporate new information in an egocintonic manner And this is why narcissistic personality disorder is insufficient grounds for claiming diminished capacity in an insanity defense Narcissists are never divorced from reality the way psychotics are They crave reality. They need it to consume it in order to maintain the precarious balance of their disorganized borderline psychotic personality All narcissists even the freakiest ones can tell right from wrong Act with intent and are in full control of their faculties and actions Ferensia and such undo wrote in notes and fragments international journal of psychoanalysis for you 30 1949 page 234 I Quote a surprising fact in the process of self-splitting is the sudden change of the object relation that has become intolerable into narcissism The man abandoned by all gods escapes completely from reality and creates for himself another world in which he can achieve everything that he wants has Been unloved even tormented He now splits off from himself a part of which is the form of a helpful loving often motherly mind Commiserates with the tormented remainder of the self Nurses him besides for him and this with the deepest wisdom the most penetrating intelligence He is a guardian angel that is the suffering or murder child from the outside He wanders through the whole universe seeking help invents fantasies for the child that cannot be saved in any other way But in the moment of a very strong repeated trauma Even this guardian angel must confess his own helplessness and well-meaning deceptive swings and then nothing else remains, but Suicide Study of narcissism is a century old and the two scholarly debates central to its conception are still undecided Is there such a thing as healthy adult narcissism as cohort says or are all the manifestations of narcissism in otherhood? Pathological as Freud and Cranberg postulate promulgated Moreover is pathological narcissism the outcome of verbal sexual physical of psychological abuse overwhelming View or on the contrary the set result of spoiling the child and idolizing it as Milan and the late Freud said The second debate is easier to resolve if one agrees to adopt a more comprehensive definition of abuse over winning Smothering spoiling over valuing and idolizing the child putting him on the pedestal. They are all forms of a rental abuse Actually, this is because as her Karen Borne pointed out The child is dehumanized and instrumentalized when the child is spoiled and put on a pedestal His parents loved the child not for what he really is But for what they wish and imagine him to be the fulfillment of their dreams and frustrated wishes The child becomes the vessel of his parents discontented lives a tool Magic brush with which they can transform their failures into successes the humiliation To victory their frustrations into happiness the child is taught to ignore reality and to occupy the parental fantastic space Such an unfortunate child feels only but an omniscient perfect and brilliant worthy Evaluation and entitled to special treatment true the faculties that are home by constantly brushing against bruising reality empathy compassion realistic assessment of one's abilities and limitations realistic expectations of oneself and of others Personal boundaries teamwork social skills perseverance and goal orientation Not to mention the ability to postpone gratification and to work hard to achieve it via impulse control These are all lacking or missing altogether The child turned adult sees no reason to invest in his skills and education Convinced that is inherent genius with shy through and should suffice The child turned adult feels entitled for merely being rather than for actually doing Rather than rather as the mobility in days gone by felt entitled by virtue of its merit But as the inevitable for ordained outcome of its birthright in other words In other words, the child turns adult is not meritocratic, but aristocratic Narcissist is born But such a mental structure evidently is brittle susceptible to criticism to disagreement vulnerable to the incents in sense incessant encroachment and encounter with harsh and intolerant world deep inside Narcissist of both kinds those wrought by classic abuse and those yielded by being idolized Both of them feeling adequate phoning fake inferior the imposter syndrome and deserving of punishment This is Millan's mistake. He makes a distinction between several types of narcissists He wrongly assumes that the classic narcissists is the outcome of overvaluation Idealization idolization and spoiling and thus is possessed of swim and chance of confidence and is devoid of self doubt According to Millan It is a compensatory Narcissist that falls prey to nagging set outs feelings of superiority and a masochistic desire for self-puncture Yet this distinction is both wrong and unnecessary There's only one type of narcissists, but there are two developmental paths to it And all narcissists are besieged by deeply ingrained though at times not conscious feelings of inadequacy fears of failure Masochistic desires to be penalized fluctuating sense of self-worth Regulated by narcissistic supply and an overwhelming sensation of fakeness The grandiosity gap between a fantastically grandiose and unlimited self-image and an actual limited The actual limited accomplishments and achievements of life The grandiosity gap because between the ego ideal and the false self is grating Its recurrence threatens a precariously balanced house of cards that is a narcissistic personality The narcissists finds to his chagrin that people out there are much less admiring accommodating an esteem of him than his parents were As he grows old the narcissists often become the target of constant derision and mockery a sorry sighting heat His claims for superiority appear less plausible and substantial the more and longer he makes them A theological narcissism originally a defense mechanism intended to shield the narcissist from an injurious world Becomes a liability the main source of hurt the generator of injuries counterproductive and dangerous Overwhelmed by negative or absent narcissistic supply The narcissist to his force to let go of his grandiosity the narcissist then resorts to self-delusion Unable to completely ignore Contrarian opinion data and reality the narcissist transmutes them Unable to face the dismal failure that he is the collapsed narcissists Partially withdraws from reality to soothe and solve the pain of disillusionment The narcissists administers to his aching soul and mixture of lies Distortions half-truths confobulations and outlandish interpretations of events around him These solutions can be classified this way the delusional narrative solution The narcissist constructs a narrative in which he figures as the hero Brilliant perfect saintly irresistibly handsome Destined for great things entitled powerful wealthy the center of attention etc The bigger the strain of this delusional charade The greater the gap between fantasy and reality the more the delusion coalesces and solidifies Finally, if it is sufficiently protracted it replaces reality and the narcissist reality test deteriorates He withdraws his bridges may become schizotypical cathetonic or schizoid The other solution is the antisocial solution The narcissists renounce his reality to his mind those who pusing Pucillanimously failed to recognize his unbound talents The nature of priority overarching brilliance benevolent nature Entitlement cosmically important mission perfection and so on these people do not deserve consideration The narcissist natural affinity with the criminal is lack of empathy is compact in compassion His deficient social skills his defiance his disregard for social laws and morays and morals These criminal affinities now erupt and blossom. He becomes a full-fledged antisocial sociopath or psychopath He ignores the wishes and needs of others. He breaks the law. He violates all rights He causes pain Natural and legal laws and rules He discards he holds people in contempt and disdain He derives society in his cause and decrees them decries them He punishes the ignorant ingrates that to his mind drove him to this state by acting criminally and by jeopardizing their safety lives emotions and property Another solution would be the paranoid schizoid solution The narcissism fails as a defense mechanism. The narcissist develops paranoid narratives So directed confabulations which plays a narcissism at the center of others allegedly maligned intention and attention Narcissist becomes his own His own audience and self-sufficient as his own sometimes exclusive source of narcissistic supply Narcissist develops persecretary delusions. He perceives lights and injuries and insults when none were intended or exist He becomes subject to ideas of reference Mentioned before he is convinced that he is the center of my mind and my intention People are conspiring to humiliate him punish him and so on so forth Some narcissists withdraw completely from a world populated with such menacious and ominous objects These are really projections of internal objects and processes, of course These narcissists avoid all social contact except the most necessary They refrain from meeting people from falling in love from having sex from talking to others or even from corresponding with others In short, they become schizoids Not out of social slack shyness, but out of what they feel to be their choice This evil hopeless world does not deserve me goes the inner refrain and I shall waste none of my time and resources on it The paranoid aggressive or explosive solution is when Other narcissists who develop persecretary delusions when they resort to an aggressive stance a more violent resolution of their internal conflict They become verbally, psychologically, situationally, physically abusive They insult, castigate, chastise, berate, demean and deride and decry their nearest and dearest Often well-wishers, often loved ones They explode in unprovoked displays of recognition, righteousness, condemnation and blame Thus is an exegetic bedlam they interpret it in Even the most innocuous inadvertent and innocent comments as designed to provoking me later They so fear, revulsion, hate and malignant envy everyone They flail against the windmills of reality, a pathetic, forlorn sight But often they cause real and lasting damage Fortunately mainly to themselves There is a masochistic avoidance solution. The narcissist is angered by the lack of narcissistic supply He directs some of this fury inwards punishing himself for his failure becomes depressed This masochistic behavior has the added benefit of forcing the narcissist's closest To assume the roles of dismayed spectators or of persecutors and thus either way to pay him the attention that he craves Self-administered punishment often manifests as self-handicaping masochism a narcissistic co-op By undermining his work, his relationships and his efforts The increasingly fragile narcissist avoids additional criticism and censure negative supply Self-inflicted failure is a narcissist doing and thus proves that he is the master of his own fate Masochistic narcissists keep finding themselves in certainly fitting circumstances which render success impossible And they they maintain a kind of an objective assessment of their performance And make it improbable as Milan said They act carelessly that we draw in mid-effort the constantly fatigued bored or disaffected and thus passive aggressively support our lives The suffering is defined and by deciding to abort they reassert their omnipotence The narcissists pronounce and public misery and self-pity are compensatory and as Milan said they reinforce His self-esteem against overwhelming convictions of worthlessness They maintain again an objective as they again make an objective assessment of their performance improbable The narcissistic tribulations and anguish render the narcissist in his eyes unique certainly virtuous righteous resilient and significant These narcissists are in other words Generators of self-supply They are in other words All these all these tribulations and anguish or this pain or this hurt or these injuries They are a form of self-generating narcissistic supply As paradoxically the worst is anguish and unhappiness The more relieved and related such a narcissist fears. I refer you all to Theodomilans and Roger Davis's Seminole told personality disorders in modern life second edition Year 2000 Thank you for listening