 My name is Sam Vaknin and I am the author of Malignant Self-Love, Narcissism Revisited. A woman wrote to me to ask, My husband is a narcissist and is constantly depressed. Is there any connection between these two problems, narcissism and depression? Well, the answer is that there is no necessary connection. There is no proven high correlation between narcissism and enduring bouts of depression. But depression is a form of aggression. It is transformed. This aggression is directed at the depressed person rather than at his environment. And this regime of repressed and mutated aggression is a characteristic of both narcissism and depression. Indeed, narcissism is sometimes described as a form of low-intensity depression. Back off a little. Originally, the narcissist experiences forbidden thoughts, forbidden urges, sometimes to the point of obsession. The narcissist's mind is full of dirty words, curses, the remnants of magical thinking. Narcissist says to himself, If I think or wish something to happen, it just might. As well as denigrating and malicious celebrations concerned with authority figures. When he was a child with his parents, later with his teachers, later with his bosses. So, all these, this seething cauldron of resentment, of anger, of hatred, of maliciousness, they are all proscribed, they are all prohibited by the superego, what we call conscience. This is doubly true if the individual possesses a sadistic, capricious superego, the result of the wrong kind of parenting. These thoughts and wishes do not fully surface. The individual is only aware of them in passing and vaguely. But they are sufficient to provoke intense guilt feelings, and set in motion a chain of self-flagellation and self-punishment. So, prohibited thoughts or hidden thoughts, punishing superego or conscience, and then self-punishment. Amplified by an abnormally strict, sadistic and punitive superego, these prohibited thoughts result in a constant feeling of imminent threat. And this is what we call anxiety. It has no discernable external triggers, therefore it is not fear. It is, but it is, an echo of a battle between one part of the personality, which viciously wishes to destroy the individual through excessive punishment, and his or her instinct for self-preservation. Anxiety is not, as some scholars have it, an irrational reaction to internal dynamics involving imaginary threats. Actually, anxiety is more rational than many types of fear. The powers unleashed by the superego, by the conscience, are so enormous, the superego's intentions are so fatal, the self-loathing and self-degradation that it brings with it are so intense, that the threat is absolutely real. Overly strict superegos are usually coupled with weaknesses and vulnerabilities in all other dimensions of the personality. Thus, there is no psychological structure, which is capable of fighting back, of taking the side of the depressed person against the superego. It is small wonder that depressives, people with depression, have constant suicidal ideation. They toy with ideas of self-mutilation and suicide. Or worse, they commit them. Confronted with such a horrible internal enemy, lacking in defenses, falling apart at the seams, depleted by previous attacks, devoid of the energy of life, depressed people wish to die. Their anxiety is about survival, the alternatives being usually self-formant or self-annihilation. Depression is how this kind of patient experiences his overflowing reservoir of aggression. The depressed patient is a volcano, which is about to erupt and bury him under his own ashes. Anxiety is how the patient experiences the war, raging and waged inside him. He is in a coffin. Sadness is the name that he assigns to the resulting weariness. To the knowledge that the battle is lost, and personal doom may well be at hand. Depression is the acknowledgement by the depressed individual that something is so fundamentally wrong that there is no way he can win. The individual is depressed because he is fatalistic. As long as he believes that there is a chance, or a slim, to better his position, the patient moves in and out of depressive episodes. But when he gives up, it's only depression. It's true that anxiety disorders and depression do not belong in the same diagnostic category, but they are very often comorbid. In many cases, the patient tries to exercise his depressive demons by adopting ever more bizarre rituals. These are the compulsions which, by diverting energy and attention away from the bed cotton in more or less symbolic or totally arbitrary ways, these compulsions bring temporary relief and an easing of the anxiety. It is very common to meet all four. A mood disorder, an anxiety disorder, an obsessive-compulsive disorder, and a personality disorder in one patient. Depression is the most varied of all psychological illnesses. It assumes a myriad of guises and disguises. Many people are chronically depressed without even knowing it, and without discernible corresponding cognitive or affective content. Some depressive episodes are part of cycles or acycle of ups and downs. The bipolar disorder, the milder form, the cyclothymic disorder. Other forms of depression are built into the characters and personalities of the patients, for instance, this themic disorder or what used to be known as depressive neurosis. One type of depression is even seasonal and can be cured by phototherapy, gradual exposure to carefully timed, artificial lighting. We all experience adjustment disorders with depressed mood. These used to be called reactive depression. They occur after a stressful life event and is a direct and timely reaction to it. These poisoned garden varieties are all pervasive. Not a single aspect of the human condition escapes them. Not one element of human behavior avoids their grip. It is not wise, as no predictive or explanatory value, to differentiate good or normal classes of depression from pathological ones. There are no good depressions, whether provoked by this fortune or endogenously from the inside, whether during childhood or later in life, they are all one and the same. Depression is a depression, is a depression, no matter what its precipitating causes are or which stage in life it occurs. The only valid distinction seems to be phenomenological. Some depressive patients slow down, psychomotor retardation sets in. Their appetite, sex life, libido and sleep known together as the vegetative functions. They all are notably perturbed. They all slow down. Behavior patterns change or disappear altogether. These patients feel dead. They are anhedonic, they find pleasure or excitement in nothing and they are dysphoric, they are sad. The other type of depressive is psychomotorically active or at times hyperactive. These are the patients that I described above. They report overwhelming guilt feelings, anxiety, even to the point of having delusions, delusional thinking not grounded in reality but in a thwarted logic of an outlandish world. The most severe cases, severity is also manifested physiologically in the worsening of the above mentioned symptoms. So the most severe cases exhibit paranoia, the secretary delusions involving them in systematic conspiracies and seriously entertained ideas of self-destruction or the destruction of others, nihilistic delusions. These people hallucinate. Their hallucinations reveal their hidden content, self-deprecation, the need to be self-punished, humiliation, bad or cruel or permissive thoughts about authority figures and so on. Depressives, people with depression, are almost never psychotic. Psychotic depression does not belong to this family, in my view. Depression does not necessarily entail a marked changing mood, though. Masked depression is therefore difficult to diagnose if we stick to the strict definitions of depression as a mood disorder. There are depressions in which the mood does not change. Depression can happen at any age, to anyone, whether without a preceding stressor, stressful event. Its onset can be gradual or dramatic. The earlier in life it occurs, the more likely it is to recur. And this apparently arbitrary and shifting nature of depression only enhances the guilt feelings of a patient. The patient refuses to accept that the source of his problems is beyond his control, at least as much as his aggression is concerned. And that it could be biochemical or genetic. The depressive patient blames herself or events in her immediate past or her environment. And this is a vicious and self-fulfilling prophetic cycle. The depressive feels worthless, doubts his future and her abilities and feels guilty. And this constant brooding alienates his nearest and nearest, her interpersonal relationships become dysfunctional and this in turn exacerbates her depression. It's a cycle. The patient finally finds it more convenient and rewarding to avoid social interactions altogether. He resigns from his job, tries away from social occasions, sexually abstains and shuts out his few remaining friends and family members. Hostility, avoidance, histrionics all emerge and the existence of personality disorders only makes matters worse. Freud said that the depressive person has lost a love object, was deprived of a properly functioning parent. A psychic trauma suffered early on can be alleviated only by inflicting self-punishment, thus explicitly penalizing, devaluing the internalized version of the disappointing love object. In other words, the patient internalizes the parent in his childhood and then seeks to punish the parent by punishing this internalized object and in other words by punishing himself. The development of the ego is conditioned upon a successful resolution of the loss of these love objects, a phase we all have to go through. When the love object fails a child, the child becomes furious, revengeful and aggressive, unable to direct these negative emotions at the frustrating parent. The child directs them at himself instead. And so become full circle to narcissism. Narcissistic identification means that the child prefers to love himself, direct his libido at himself, rather than loving, rather than to love an unpredictable, abandoning parent, mother in most cases. When the child is confronted with a capricious arbitrary or even malicious parent, the child prefers to love himself rather than the parent. From that moment on, this learned self-love becomes malignant. The child becomes his own parent and directs his aggression at himself. And the parent that he had become. Throughout this wrenching process, the ego feels helpless and this is another major source of depression. When depressed, the patient becomes an artist of sorts. He tires his life, people around him, his experiences, places and memories with a thick brush of schmaltzy, sentimental and nostalgic longing. The depressive endures everything with sadness. A musical tune, a sight, a color, another person, a situation, or a memory. In this sense, the depressive is cognitively distorted. He interprets his experiences, evaluates his self and assesses the future totally negatively. He behaves as though constantly disenchanted, disillusioned and hurting according to the dysphoric effect. And this helps him to sustain these distorted perceptions. No success, no accomplishment or support can break through this cycle because this cycle is so self-contained, so romantic, so self-enhancing. Dysphoric effect supports distorted perceptions which enhance dysphoria, which encourages self-defeating behaviors which bring about failure, which justify depression. Again, this vicious, self-enclosed cycle. And this is a cozy little circle, charm and emotionally protected because it is unfailingly unpredictable. Depression is addictive because it is a strong love substitute. Much like drugs, it has its own rituals, its own language and worldview. Depression imposes a rigid order and behavior patterns of the depressive. And this becomes learned helplessness. The depressive prefers to avoid even situations which hold the promise of improvement in his heroin condition. The depressive patient has been conditioned by repeated, aversive stimuli to freeze in his tracks. He doesn't even possess the requisite energy to end his world predicament by committing suicide. The depressive is devoid of the positive reinforcements which are the building blocks of our self-esteem. He is filled with negative thinking about himself. His lack of goals, his lack of achievements, his emptiness, his loneliness and so on. And because his cognition and perceptions are deformed, no cognitive or rational input can alter the situation. Everything is immediately reinterpreted to fit the paradigm of depression. People around the depressed patients and especially around the narcissist often mistake depression for emotion, they say about the narcissist. But he says, and what they mean to say is, but he is human. But he has emotions, and this of course is wrong. It's true that depression is a big component in the narcissist's emotional makeup. But it mostly has to do with the absence of narcissistic supply. It mostly has to do with nostalgia for more plentiful days, full of adoration and attention and applause. It mostly occurs after the narcissist has depleted his secondary sources of narcissistic supply. His spouse is made, girlfriend, colleagues. After he is, he wore them off, after he drove them away with his constant demands for reenactment of his days of glory. Some narcissists even cry. They cry exclusively for themselves and for their lost paradise. And they do so conspicuously, ostentatiously and publicly in order to attract attention. The narcissist is a human pendulum hanging by the thread of the void that is his forced self. The narcissist swings from brutal and vicious abrasiveness to malicious modeling and saccharine sentimentality. It is all a simulacrum, a very similitude and a facsimile. It's enough to fool the casual observer, enough to extract the narcissist's drug from passers-by. Other people's attention and their reflection that somehow sustain his house of cards can all be derived safely. But the stronger and more rigid the defense is and nothing is more resilient than pathological narcissism, what the stronger these defenses are, the greater and deeper the hurt the narcissist aims to compensate for. Once narcissism stands in direct relation to the seething of ease and the devouring vacuum that one harbors in one's true self. Perhaps narcissism is indeed, as many say, a reversible choice, but it is also a rational choice, guaranteeing self-preservation and survival. The paradox is that being a self-loathing narcissist may be the only act of true self-love that the narcissist ever commits.