 I'm Sam Dagnin and I'm the author of Malignant Self-Love, Narcissism Revisited. I'm often asked, if the narcissist becomes self-aware if he accepts that he is a narcissist. Isn't this acceptance the first important step towards recovery and healing? The answer is that narcissism is all-pervasive. It defines the narcissist's waking moments. It infiltrates and permeates his dreams. Narcissism is everywhere. Everything the narcissist does, every which way he behaves, is motivated by narcissism. Everything he avoids is the result of narcissism. Every utterance, every decision is very body language. They are all manifestations of narcissism. Narcissism is rather like being abducted by an alien and ruthlessly indoctrinated ever since. The alien is the narcissist's false self. It is a defense mechanism constructed by the narcissist in early childhood in order to shield his true self from hurt and inevitable abandonment and disappointment. A cognitive understanding of the disorder does not constitute a transforming insight. In other words, understanding knowing that one has narcissistic personality disorder means nothing and has no effect unless it has some emotional correlate. The narcissist does not internalize what he understands and learns about his disorder. His new gained knowledge about narcissistic personality disorder does not become a motivating part of himself. It does not create what we call psychodynamics. It remains an inert and indifferent piece of information with minor influence on the narcissist's psyche. Sometimes when the narcissist first learns about narcissistic personality disorder, he really believes that he could change. This usually follows a period of violent rejection of the charges against him. And so once he has assimilated the knowledge, he fervently wants to change. This is especially true when his whole world is in shambles, when he has hit rock bottom, when he is in the throes of a life crisis. Time in prison, a divorce, a bankruptcy, a death of a major source of narcissistic supply, these are all transforming life crisis. The narcissist admits to a problem only when he is abandoned, destitute and devastated. He feels that he doesn't want any more of this. He wants to change, he wants things to get better. He doesn't want to go through this patch in his life again ever. And there often signs that the narcissist is changing. And then when things do get better, it all fades. The narcissist reverts to old form. He goes back. He regresses. The progress he has made evaporates virtually overnight. Many narcissists report the same process of progression followed by recidivist remission. Many therapists refuse to treat narcissists precisely because of the Sisyphian frustration involved. The results are never permanent. 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 a psychodynamic landscape. Narcissistic behaviors can and are being modified very frequently using a cocktail of talk therapy and pinpointed medication, conditioning. But I have never met a healed narcissist, a narcissist who is no longer a narcissist. The emphasis in therapy is thus more on accommodating the needs of those nearest and dearest to the narcissists, his spouse, his children, colleagues and friends, rather than on treating the narcissist. The narcissist's abrasiveness, rage, mood swings, reckless and impulsive behaviors are modified, those around him benefit the most. This, as far as I am concerned, is a form of social engineering, not a proper healing therapy. One last hope, narcissism or the orbit rarely does tend to ameliorate with age. Many forms of pathological narcissism are reactive and transient, same as with psychopaths. It's the best I can offer.