 Good day everyone. My name is Sam Vaknin, and I'm a visiting professor of psychology in Southern Federal University in Rostov-on-Don and a professor of finance and a professor of psychology in CIAPS. CIAPS, the Center for International Advanced and Professional Studies. I'm also the author of books about personality disorders, most notably Malignant Self-Love, Narcissism Revisited. I'm proud to be a presenter at the Psychosomatic Medicine 2018 conference. And my topic will be the narcissist relationship with this body. Narcissist in this presentation is someone properly diagnosed by qualified diagnostician as suffering from Narcissistic Personality Disorder according to the diagnostic criteria in the Diagnostic and Statistical Manual Edition 4 text revision and the Diagnostic and Statistical Manual Edition 5, both the alternate model and the old criteria borrowed from the DSM-4. With this presentation dispensed with, I will move directly to what I have to say. Possessing a distorted self-image is called, as you all know, a body dysmorphic disorder. One could say that all narcissists have a body dysmorphic disorder to some degree. Somatic narcissists, narcissists who derive narcissistic supply using their body and sexuality, Somatic narcissists are especially prone to misjudge their bodies, either positively or negatively. Somatic narcissists believe themselves to be physically irresistible, exuding sex, exuding energy, statuously shaped and in general stunning hunks. This grandiose self-image rarely corresponds with reality though. And so, aware of this discrepancy, the Somatic narcissist dedicates inordinate amounts of time and effort to reshaping, remoulding or even improving his body. I'm saying his, because about 75% of all people diagnosed with narcissistic personality disorder have either to been made. The statistic is changing and women are becoming more and more prevalent. Incidents among women is increasing. And so, probably at the end of this process, within 10 years or 15 years, there'll be an equal number. But right now, the majority of narcissists are men. So, the Somatic narcissist notices the discrepancy and tries to reshape his body via bodybuilding, exercising, mastering sexual advances and foreplay and the intricacies of the Coital Act itself. They become masters of sexuality and masters of muscularity and masculinity. To enhance his belief system, the Somatic narcissist co-ops other people by forcing them to compliment his build, his shape, his constitution, his health, his sexual prowess, his physical regime and his attractiveness. The Somatic narcissist is a compulsive consumer of body compliments or body extensions, objects that he thinks increase his attraction, increase his irresistibility, his appeal and the value of his propositions. Fancy cars, flashy clothing, sumptuous residences, first-class flights, luxury hotels, platinum credit cards, lavish parties, name-dropping, celebrity friends, high-tech gadgetry, all these serve to enhance the narcissist's self-image and to bolster his grandiose fantasies. Either to a focused on the Somatic narcissist. Again, Somatic narcissist is a narcissist who derives attention, garners attention by using his body and his sexuality. He uses this attention exactly like the other type of narcissists, the cerebral narcissists. Both of them use attention to regulate their labile sense, fluctuating sense of self-worth. And so this positive dysmorphic disorder serves to elicit narcissistic supply and serves to buttress a distorted, unreal self-image. We have said that. But it is also a control mechanism. It allows the narcissist's false self to manipulate both the narcissist and its human environment. To remind you, the false self is a piece of fiction invented by the narcissist in order to generate a gender narcissistic supply, elicit it from the environment. The false self is everything that the narcissist is not. The false self is brilliant, perfect, accomplished, omniscient, omnipotent. In other words, the false self is godlike. So the narcissist uses his body, at least the Somatic narcissist, uses his body to buttress, to support, to maintain and to sustain the false self. It is as though by morphing his body, the narcissist molds and designs his world, his nearest and dearest, his self, which is always in flux, his projected image and the reactions to this projected image. By lying about his body, about his health, about his sex appeal, about his longevity, about his possessions, his bodily extensions, by misrepresenting his sexual prowess, his attractiveness, his irresistibility, his friends, his lovers, adventures, affairs. In other words, by confabulating profusely, the narcissist transforms the real world into the fantastic realm in which he likes to exist. To him, the real world is how people perceive him to be. Everything is about appearances, not about substance. And by changing other people's perceptions by indoctrinating and brainwashing them, the narcissist secures what we call a pathological narcissistic space. A space, usually physical, in which the narcissist's false self can thrive, fully nourished by others, their admiration, adulation, attention. This phenomenon is not limited to the Somatic narcissist, of course. The cerebral narcissist also deforms the true image of his body in his mind. The cerebral narcissist may exaggerate the dimensions of his head to emphasize the volume of his brain, the height of his forehead, or the length of his sensitive fingers. The cerebral narcissist may attribute to himself ailments and syndromes typical of high-powered intellectuals. Consumption, tuberculosis, tendonitis, headaches. The cerebral narcissist derives attention in narcissistic supply by putting on display his intellect, his firework intelligence, the pyrotechnics of his mind. The cerebral narcissist almost always lies about his IQ, his mental capacities, or his skills. He tends to completely ignore and belittle the rest of his body, except his head. To him, the body is a burdensome and unnecessary appendage, a container. He may complain of the need to maintain the flesh and of the derided and decried dependence of his magnificent brain on his object-indicating carbon-container body. Cerebral narcissists typically say sentences like I would have willingly placed my brain in a laboratory jar to be artificially nourished there. I would have willingly and gladly given up my body. Cerebral narcissists rarely exercise their regard with disdain and contempt the activities, proclivities and predilections of the somatic narcissist. Physical pursuits, including sex, or maybe especially sex, up in sports and athletics, are perceived by them to be bestiary, demeaning, common, wasteful and meaningless. This is also a result of body dysmorphically disorder, of course. The cerebral narcissist underestimates the needs and requirements of his own body, misreads his body's signals, and ignores his body's processes. The body to the cerebral narcissist becomes abstract, a background noise, a nuisance. Cerebral narcissists sometimes go through somatic phases, of course. There is no type constancy. When cerebral narcissists hit rock bottom, they transform into somatic narcissists. And somatic narcissists, if capable, adopt cerebral behavior patterns. Their attitudes to the body change accordingly. The temporarily somatic narcissist suddenly begins to titivate, to exercise, to groom himself, to seduce, and to have creative and imaginative sex. The somatic narcissist, made cerebral, tries to read more, becomes contemplative and asocial, and consumes culture. But these are passing fans and phases, and the narcissist always reverts to true, and should I say, false, form. I would like to study two issues, kind of case studies. One is the narcissist's attitude to illness and accidents. And the other is the narcissist's attitude to his disabled and sick children. Both of them exemplify and demonstrate. The narcissist conflicted an ambivalent relationship with bodies, his body, and other people's bodies. When narcissists fall victim to chronic or acute diseases, or when they survive a traffic accident, for example, they react in either of four typical ways, depending on the type of the narcissist. The first way is the schizotypal reaction. The belief that a narcissist predicament is a part of a larger cosmic plan, or of a blueprint that governs the narcissist's life, and inexorably leads him to greatness and to the fulfillment of a mission. It's part and parcel of the grandiose cosmic blueprint for his life. The second way narcissists react is of cosmic rage, intended to allay feelings of helplessness, loss of control, and impotence. The narcissist's rage re-establishes his delusional omnipotence and his grandiose self. This is frequently followed by a schizoid phase, withdrawn from society, and then by a manic spirit of activity, seeking narcissistic supply, attention. It is very easy to confuse these phases with bipolar disorder. The third solution, the third reaction a narcissist has to any disability induced by an accident or by illness, is the paranoid reaction. The paranoid reaction is when the narcissist deludes himself that the accident was no accident. Someone is out to get him. The secretary delusions, etc. The narcissist casts himself in the role of a victim, usually in the framework of some grand design or conspiracy, or as, again, the outcome of merciless fate, a schizotypal element. And finally, there's a masochistic reaction. In the wake of the illness of the accident, the narcissist's constant anxiety is alleviated and he is relieved, having been punished properly for his inherent evilness and decadence. The accidents of the illness are perceived as just rewards for the narcissist's inherent badness. The narcissist as a worthless object is worthy of such mishaps. Narcissists hate weak and sick people and they hate it even more when their source of narcissistic supply ceases to function properly. Most of them just move on. The sick spouse, they abandon the sick spouse, they find another, healthier one. Some of them play the role of martyrs, victims, selfless saints, and thus garner narcissistic supply as they treat their bedridden spouse. The permanently disabled narcissist adopts one or more of three strategies. One, exaggerated healthlessness, which justifies emotional blackmail and the kind of insidious dependence that cripples his caregivers. Two, control freakery in a frenzied attempt to reassert his grandiose sense of omnipotence, now gravely challenged by his invalidity. And three, sadism, which renders his victims as helpless as he is and as frustrated as he feels and thus levels the playing field and normalizes his disability. The sadistic narcissist tortures everyone around him, especially his caregivers, and he says to himself, everyone is helpless, everyone is frustrated, so there is nothing really wrong with me. I am, after all, still perfect. This is how the narcissist reacts to his own body. But how does he react to other people's bodies, especially his nearest and dearest? And let's take a case of his children. How does the narcissist react to disabled and challenged and sick children? The narcissist regards his disabled or challenged child as an insult, a direct challenge to his self-perceived perfection and omnipotence, a constant nagging source of negative narcissistic supply and the reification and embodiment of a malevolent and hostile world which tirelessly conspires to render the narcissist a victim through his fortune in catastrophe. The precarious foundations of the narcissist force self and therefore his ability to function. They are undermined by this miscegenation, relentlessly challenged by his defective offspring's very existence. Narcissus is always with his offspring, but he sees the offspring. He sees the offspring's disability or sickness. So he is relentlessly and constantly challenged by the offspring's very existence and by the persistence of its attendant painful reminders. And so the narcissist lashes out. He seeks to persecute and penalize the sources of his excruciating frustration, the child and his mother. The narcissist holds the mother responsible for this failure, not himself. She brought this shame and perturbation into his otherwise fantastic life. It was she who gave issue to this new fount of torment, this permanent reminder of fallibility, imperfection, mortality, impotence, guilt, disgrace, and fear. And to rectify this wrong, to restore the interrupted balance and to firmly regain an assured sense of his grandiosity, the narcissist results to devaluation. He humiliates, belittles, and demeans both the unfortunate child and his suffering mother. He compares their failings unfavorably to his own wholeness. He berates and mocks the mother and child for their combined disability, frailty, weakness, weakness, and resortlessness. The narcissist transforms them into, transforms both the mother and the child into the captive baths of his unrivaled sadism and the cowed adherents of a cult-like shared psychosis. He says to himself, it serves them well for having ruined my life. Casting himself as a compassionate proponent of tough love, the narcissist eggs his charges on mercilessly. He contrasts their slowness with his self-imputed delicacy, their limitations with his infinite grasp, their mediocrity with his genius and acuity, and their defeats with his triumphant life, whether real or imagined. The narcissist harps on and leverages his child's insecurities. He displays his hateful contempt for this mother-child diet with a fiery vengeance whenever he is confronted, criticised, or resisted. The narcissist may even turn violent in order to enforce the discipline of his distorted worldview and delusional exegesis of reality. By reducing the mother-in-sik or disabled child, the narcissist feels elevated by comparison, yet again. Bonding and attachment in infancy have critical determinants and predictors of well-being in adulthood. A small minority of children are born with dysfunctions, such as attention deficit hyperactivity disorder or autism disorders. These dysfunctions prevent them from properly bonding with the primary caregiver, mother in most cases. Environmental factors, such as an unstable home, parental absenteeism, or disintegrating family unit. They also play a role, and they can lead to the emergence of a reactive attachment disorder. Toddlers adapt to this sterile and hostile emotional landscape by regressing to an earlier phase of unbridled, self-sufficient and solipsistic primary narcissists. Disabled and challenged children of narcissistic parents may well end up being narcissists themselves, a said but inescapable irony. Narcissistic parents of seriously ill children derive narcissistic supply, sometimes, from onlookers, friends, family, colleagues, and community. And they do that by attracting attention to their role as saintly caretakers. They broadcast to their social milieu, to their environment, look at me. Although I have a disabled and sick child which is quite an onerous burden, look at my behavior. Look how impeccably I treat this child. They are demonstratively and ostentatiously patient, compassionate, suffering heroically and dedicated to the child, it's welfare and ultimate healing. They flaunt the child's sickness as a kind of hard-worn but well-deserved meadow, down in the trenches with their tortured offspring doing desperate battle with a pitiless enemy, the disease or the disability. It is an intoxicating part in the unfolding film that is the narcissist's life is moving. But this irresistible craving for attention should be demarcated from the sinister affliction colloquially known as Minhausen Biproxy Syndrome. Patients afflicted with a fictitious disorder colloquially known as Minhausen Syndrome, these patients with Minhausen Syndrome seek to attract the attention of medical personnel by feigning or by self-inflicting serious illness or injury. Minhausen Biproxy Syndrome, fictitious illness or disorder Biproxy or imposed by another or fabricated or induced illness by carers, these are all the names. So Minhausen Biproxy involves the patient inducing illness in or causing injury to a dependent a child, an old parent, a spouse in order to gain his capacity as a caretaker or her capacity as a caretaker the attention, the praise the sympathy of medical care providers. Both syndromes Minhausen and Minhausen Biproxy are forms of shared psychosis, foliadeu or foliaprisio. They are forms of crazy making with hospital staff as unwilling and unwitting participants in the drama. Superficially this overwhelming need for consideration by figures of authority and role models, doctors, nurses, clergy, social workers this overwhelming need resembles the narcissist's relentless and compulsive pursuit of narcissistic supply. To remind you narcissistic supply is consist of attention, adulation, admiration being feared, being noted. The narcissist uses fake illnesses feigned injuries and diseases in himself or in others in order to obtain supply from medical staff and other authority figures. But there are some important differences. To start with, the narcissist especially the somatic narcissist worships his body and cherishes his health. If anything, narcissists tend to be hypochondriacs they have anxiety disorders associated with the body. They are loaded to self harm and self mutilate or fake laboratories and consume potentially deleterious substances and medications. That's not what the narcissists would do. They are also unlikely to seriously damage their social supply for example their children or their spouses as long as they are compliant and aggravating of course. As opposed to narcissists, people with both greenhouse and syndromes desire acceptance, love caring relationships and nurturing, not merely attention. Theirs is an emotional need that amounts to more than the mere regulation of their sense of self-worth. Narcissists require attention in order to regulate their sense of self-worth. People with Miehausen syndrome or Miehausen syndrome by proxy ask for much more than attention. They ask for love. They don't have a full-fledged force only a clinging, insecure or traumatized, deceitful and needy true sense. Miehausen syndrome may be comorbid, can be diagnosed with personality disorders including narcissism. Patients can be pathological lives, history, paranoia, hyper vigilant and aggressive especially when they are confronted. But while narcissists are indiscriminate and promiscuous when it comes to their sources of narcissistic supply anyone could be a source of supply as far as a narcissist is concerned. Patients with Miehausen syndrome derive emotional nurturance and sustenance mainly or usually exclusively from healthcare providers and practitioners. This has been a presentation about a narcissist, unusual relationship with his body and the body of others. I hope you found it useful and edifying. I wish you a very successful conference with numerous things to learn thought-provoking presentations and a great time in Japan. Bye.