 mask it or cope with it. Okay, my name is Sam Vaknin. I'm a visiting professor of psychology in Southern Federal University or Stovon Don in Russia. And I'm a professor of finance and a professor of psychology in the outreach program of CIAPS, Center for International Advanced and Professional Studies. This self-promoting presentation aside, we can get to the point. And the point is narcissism and depression. This is what my presentation is about. The pandemic gave rise to narcissistic defenses and to mood disorders at the same time. And that is a very bad combination. People react with narcissistic defenses when they feel helpless, when they feel hopeless. They compensate for it by considering themselves and trying to convince others that they are Godlike. This is grandiosity. It's a grandiosity defense. And it distorts the perception of reality. It impairs reality testing. So people in this pandemic feel like playthings, like toys. They are attacked simultaneously by a faceless, impersonal force of nature, the virus, and by their own appointed authorities as they see it. So they feel squeezed and some of them react with narcissistic defenses. They become more grandiose, more defined. They lose impulse control. They become contumacious. They begin to hate authority. And all these are narcissistic, psychopathic traits and behaviors. At the same time, many develop mood disorders, mainly, mainly depression. Now, of course, depression is a whole family. It's not a single disorder. There's major depressive disorder, the cyclothermia, there is thisemia, and even experienced clinicians tend to confuse these disorders and conflict them, which doesn't help, I must say. We keep getting wrong diagnosis for people. Some people have a background of cyclothermia and dysthymia long before the pandemic. And this background is just exacerbated by the pandemic. And yet they are diagnosed with major depressive episode and are treated accordingly, which is wrong. Actually, medication in such a case can exacerbate the depressive symptoms. So there's a god-awful confusion in the profession, not only among patients, but in the profession itself. And I would like to start by one such confusion. Bipolar disorder. Bipolar disorder long before the pandemic has been often misdiagnosed and confused with borderline personality disorder. Recently, as narcissism becomes a keyword and a buzzword, bipolar disorder is misdiagnosed and confused with narcissistic personality disorder. The manic phase indeed has some resemblances to narcissistic defenses and a narcissistic disorder. Bipolar patients in the manic phase exhibit many of the signs and symptoms of pathologic and narcissism. Hyperactivity, self-centeredness, lack of empathy, control freakery. During this recurring chapter of the disease, the patient is euphoric. As grandiose fantasies, spins unrealistic schemes and has frequent rage attacks is irritable. If the wishes and plans of the bipolar patient are not met, if they are frustrated, they react with aggression. The manic phase of bipolar disorder, however, the manic phase is limited in time. Narcissistic personality disorder is not limited in time. Of course, it's a lifelong condition. Mania is followed by usually-protected depressive episodes in bipolar. So bipolar used to be called mania depression because there was a manic phase and then a depressive phase. The narcissist is also frequently dysphoric. That part is true. But whereas the bipolar sinks into deep self-deprecation, self-evaluation, unbounded pessimism, all-pervasive guilt, and hedonia. These are typical manifestations of the depressive phase of bipolar. The narcissist, even when he is depressed, never forgoes his narcissism, his grandiosity, his sense of entitlement, his haughtiness, his lack of empathy, and his alloplastic defenses, his tendency to blame others for his condition. Narcissistic dysphoria are much shorter than bipolar. They are reactive. They constitute a response to the gap between reality and inflated self-image, what I call the grandiosity gap. In plain words, the narcissist is dejected and despondent when confronted with the abyss, between his inflated self-image and grandiose fantasies, and the drab reality of his life. The narcissist's failures, lack of accomplishments, disintegrating interpersonal relationships, low status, they all grate on the narcissist and they create dysphoria. Yet a single dose of attention, a single dose of adulation and admiration, narcissistic supply, a single dose is enough to elevate the narcissist from the depth of misery to the heights of money-cubphoria. This does not happen in bipolar. Bipolar is not a reaction to anything external, it's entogenous, not exogenous. The psychogenesis has an internal etiology. The source of the mood swings of the bipolar is assumed to be brain biochemistry, we don't know enough. The bipolar is impervious to the availability of narcissistic supply, attention, adulation, admiration. Whereas the narcissist is in full control of his faculties, even when he is maximally agitated, the bipolar often feels that he or she has lost control over his or her brain, a flight of ideas as it's called. The bipolar doesn't control her speech, bipolar doesn't control his attention span, destructibility. And the bipolar very often loses control of motor functions even, can resemble a catatonic phase. The bipolar is prone to reckless behaviors and to substance abuse, only during the manic phase. The narcissist does drugs, drinks, gambles, shops on credit, indulges in unsafe sex, reckless and compulsive behaviors, both when he is elated and when he is deflated, is also very often an addict. As a rule, the bipolar's manic phase interferes with his or her social and occupational functioning. Many narcissists in contrast, reach the highest ranks of their community, church, firm or voluntary organization, they are the pillars of the community. Most of the time, narcissists function flawlessly, though the inevitable glow-ups and the grating extortion of narcissistic supply, usually put an end to the narcissist's career and social liaison sooner or later. But until such time, the narcissist is high-functioning, not so the bipolar. The manic phase of bipolar sometimes requires hospitalization and more frequently than admitted involves psychotic features. Narcissists are never hospitalized, as the risk of self-harm is very minimal. Moreover, psychotic micro-episodes in narcissism are decompensatory in nature. They appear only under unendurable stress, such as modification or intensive therapy. The bipolar's mania, the mania of the bipolar of bipolar disorder, the manic phase, provokes discomfort in both strangers and in the patients nearest and dearest. The constant cheer, the compulsive insistence on interpersonal, sexual, and occupational or professional interactions, all these engender unease in people, repulsion, revulsion. The liability of mood, rapid shifts between uncontrollable rage and unnatural good spirits is downright intimidating and a bit alien. The narcissist's gregariousness by comparison, his sociability, is calculated. It's cold, it's controlled, it's goal-oriented, it's intended to extract narcissistic supply, attention from other people. The cycles of mood and effect in the narcissist are far less pronounced and they're definitely less rapid. There's less rapid cycling. The bipolar's swollen self-esteem, overstated self-confidence, obvious grandiosity and delusional fantasies are similar to the narcissist and they are the source of the diagnostic confusion. Both types of patients purport to give advice, carry out an assignment, accomplish a mission or embark on an enterprise for which they are uniquely unqualified. They lack the talents, the skills, the knowledge, the experience, the expertise required, but they still go for it. Fake it till you make it. But the bipolar's bombast is far more delusional than the narcissist's. Ideas of reference and magical thinking are common in both. And in this sense, the bipolar is closer to the schizotypal than to the narcissist. There are other differentiating symptoms. Sleep disorders, notably acute insomnia, are common in the manic phase of bipolar and uncommon in narcissism. Manic speech, pressured, uninterruptible, loud, rapid, dramatic, including singing, humorous asides and so on. This manic speech sometimes is incomprehensible, incoherent, chaotic, and it could last for hours. It reflects the bipolar's inner chaos, inner turmoil, and his or her inability to control the racing and kaleidoscopic thoughts. As opposed to narcissists, bipolar in the manic phase are often distracted by the slightest stimuli. They are unable to focus on relevant data. They resemble ADHD, attention deficit, hyperactivity disorder. They are unable to maintain the thread of conversation. They're all over the place, simultaneously initiating numerous business ventures, joining myriad organizations, writing up-tenth letters, contacting hundreds of friends and perfect strangers, acting in a domineering, demanding, and intrusive manner, totally disregarding the needs and emotions of the unfortunate recipients of their unwanted attentions. They rarely follow up on their projects. It's none of this. None of this characterizes the narcissists. The transformation of a bipolar is so marked, so obvious and discernible, that he is often described by his closest as not himself or not herself. Indeed, sub-bipolars relocate, change name, change appearance, lose contact with their former life. It's a bit like fugue, like dissociative fugue. Anti-social or even criminal behavior is not uncommon in bipolar, and aggression is marked, directed at both others, assault, and at oneself, suicide. Sub-bipolars describe an acuteness of the senses akin to experiences recounted by drug users. Smells, sounds, sights are accentuated, amplified. They attain an unearthly quality. None of this happens in narcissism. As opposed to narcissists, bipolar's regret their misdeeds following the manic phase. They feel guilty, they feel ashamed, they try to atone for their actions. They realize and accept that something is wrong with them. They seek help. The narcissist does none of these things. During the depressive phase, the bipolar is ego-dystonic. Is ego-dystonic, he feels bad with himself. He's uncomfortable, and he has autoplastic defenses. He blames himself for his defeats, failures, and mishaps, exactly the opposite of narcissism. And finally, pathological narcissism is already discernible in early adolescence. The full-fledged bipolar patient, including the manic phase, rarely occurs before the age of 20. The narcissist is consistent in his pathology. The bipolar is not. The onset of the manic phase is fast, furious, and results in conspicuous metamorphosis of the patient. Many scholars consider pathological narcissism to be a form of depressive illness. This is the position of the authoritative magazine Psychology Today. The life of the typical narcissist is indeed punctuated with recurring bouts of dysphoria, ubiquitous sadness, and hopelessness. Unhedonia, loss of the ability to feel pleasure, and clinical forms of depression, cyclothermic, dystemic, or other. The picture is further obfuscated by the frequent presence of mood disorders, such as comorbidity with bipolar disorder. So it's very, very difficult to tell apart. You really need to be a good clinician with a huge amount of experience to tell narcissism apart from certain mood disorders. While the distinction between reactive, exogenous, and endogenous depression is obsolete, we don't make this distinction anymore. It is still, in my view, very useful in the context of narcissism, and it should be resurrected to be revived. Because narcissists react with depression, not only to life crises, but to fluctuations in narcissistic supply and to a circumstantial inability to express their dominant psychosexual type, cerebral somatic sadistic. The narcissist personality is disorganized. It's precariously balanced, very similar to the borderline. The narcissist regulates his sense of self-worth by consuming attention narcissistic supply from other people. Any threat to the uninterrupted flow of narcissistic supply compromises the narcissist's psychological integrity and his ability to function. It is perceived by the narcissist as life-threatening. Indeed, depression itself can be conceptualized as a reaction to the systemic failure of hitherto trustworthy and efficacious coping strategies. When coping strategies that you have developed all your life are not working anymore, one of the typical reactions is depression. And this is owing to some seismic change in circumstances or the environment or because of overwhelming new information. Now, narcissists experience four types of dysphoria, four types of depression in a way. One, loss-induced dysphoria. This is the narcissist's depressive reaction to the loss of one or more sources of narcissistic supply or to the disintegration of a pathological narcissistic space. Let me explain. Narcissistic supply is attention. Any type of attention, by the way, positive or negative. Narcissistic supply comes from people. These people who provide the supply, they are the sources of narcissistic supply. And they provide the supply within something called pathological narcissistic space. This is the narcissist's stalking or hunting grounds. The social unit whose members lavish the narcissist with attention. So when the narcissist loses his sources of supply, when for some reason he cannot access his pathological narcissistic space or he loses it, he reacts with depression. And this is loss-induced dysphoria. Another type of dysphoria, number two, is deficiency-induced dysphoria. This is a deep and acute depression, which follows the aforementioned losses of narcissistic sources and this narcissistic space. Having mourned, having grieved over these losses, having processed them, the narcissist now grieves the inevitable outcome, the absence or deficiency of narcissistic supply. Paradoxically, the deficiency-induced dysphoria energizes the narcissist, pushes him, moves him to find new sources of supply to replenish the dilapidated stalk. The narcissist, this dysphoria is the first stage in what I call the narcissistic cycle. The narcissist loses his sources, he has no supply, and so he is energized to find new sources and new supply, and this new cycle begins. The third type is the self-worth dysregulation dysphoria. The narcissist reacts with depression, to criticism, to disagreement, to mockery, to derision, to ostracism, to being shunned, especially from a trusted and long-term source of narcissistic supply. It could lead him even to narcissistic modification. Narcissistic modification is an extreme form of decompensation where all the narcissistic defenses and coping strategies are simultaneously inactivated and the narcissist is totally exposed, skinless, like a turtle without the shell, and this is a life-threatening condition. The narcissist fears the imminent loss of the source and the damage to his own fragile mental balance. The narcissist also resents his own vulnerability and his extreme dependence on feedback from other people. And this type of depressive reaction is therefore a mutation of self-directed aggression. And then there is the grandiosity gap dysphoria. The narcissist firmly, though counterfactually, perceives himself as omnipotent, omniscient, omnipresent, brilliant, accomplished, perfect, irresistible, immune, and invincible. In short, the narcissist's self-perception is that he is God. He is of the attributes of God. Any data to the contrary, any information to the contrary, anything that challenges his grandiose self-image, any of these attributes, is filtered out, altered, discarded altogether, this is called confirmation bias. And still, despite all these efforts, to deny, to suppress, to repress, to eliminate, to delete, to vitiate, challenging information, sometimes reality intrudes, and it creates a grandiosity gap, a gap between the narcissist's inflated grandiose self-image and reality, which is not so grandiose. The narcissist is forced to face his mortality, his failures, his defeats, his limitations, his ignorance, in short, actually, his relative inferiority, because the narcissist is a cripple, is a cripple, is an invalid, in many ways. The narcissist then confronted with his incontrovertible evidence of his own deficiency, his own inadequacy, his sulks, his sinks into an incapacitating, but short-lived dysphoria. There's another form of dysphoria that's the self-punishing dysphoria, number five out of four. Deep inside, the narcissist hates himself, loathes himself, doubts his own worth. He deplores his desperate addiction to narcissistic supply, and to the people who provide him with self-supply. He feels that he's inadequate. He judges his actions and intentions harshly, sadistically. There's an inner sadistic inner critic, what Freud used to call superego. The narcissist may be unaware of these dynamics, but they are at the heart of the narcissistic disorder. And the reason the narcissist has to resort to narcissism is a compensatory defense mechanism in the first place. It is because the narcissist feels inferior that he feigns superiority. It's compensatory. Now, some narcissists are not aware of this, and they are the overt, classic narcissists. They are egocintonic. Egocintonic, I'm sorry. They're happy with themselves. They're comfortable with themselves. And other narcissists are compensatory, and they get in touch from time to time with this nucleus or kernel of failure. The inexhaustible will of ill will, self-chastisement, self-doubt, self-directed aggression, these ill numerous, self-defeating, self-trashing, self-destructive behaviors. So narcissists engage in reckless driving, substance abuse, unsafe sex. They have suicidal ideation, constant background depression, dystemia. It is the narcissist's ability to confabulate, to lie to himself, to self-deceive that saves him from himself. His grandiose fantasies remove the narcissists from reality, impair his reality testing as a defense mechanism, as an adaptive strategy. This prevents recurrent narcissistic injuries and modifications. So many narcissists end up being delusional, schizoid, paranoid. To avoid agonizing and knowing depression, they give up on life itself. They develop something we call a constricted life. One therapeutic technique would be anchoring, reorienting the narcissist towards self-supply, anchoring the narcissist, anchored like in a ship. Rather than resort to fickle and ephemeral external sources of narcissistic supply, the narcissist is taught and encouraged to resort to himself for narcissistic supply, to look forward with excited anticipation to the structured pursuit of hobbies, vocation, traits, skills, and reward eliciting behaviors. Anchoring leverages the narcissist's grandiose solipsism and fantasies of godlike omnipotence and omniscience. The anchoring leverages these to render the narcissist emotionally self-sufficient. There is no necessary connection between these two clinical conditions, depressiveness and pathological narcissism. They may be comorbid, but there's no necessary connection. There is no proven high correlation between narcissistic personality disorder and any form of depression. We don't have studies corroborating this. Narcissism is ego congruent, ego incongruent, I'm sorry. Narcissism is a state of things where there's an inner fight between lacking ego and other structures, but this doesn't necessarily lead to depression. Depression is a form of aggression. Transformed, this aggression is directed to the depressed person rather than at his environment. This regime of repressed and mutated aggression is characteristic of both narcissism and depression. Indeed, narcissism is sometimes described as a form of low-intensity depression. Originally, the narcissist experiences forbidden thoughts, forbidden urges, sometimes to the point of an obsession like intrusive thoughts. His mind is full of dirty, prohibited words, curses, the remnants of magical thinking. If I wish or if I think something, it just might happen. There are denigrating and malicious cerebrations concerning authority figures, mostly parents, mostly teachers. Narcissism's mind is a vortex. These are all, all these things that are happening in the narcissist's mind are proscribed by his so-called inner critic. And this is doubly true if the individual possesses a sadistic, capricious super ego, a result of the wrong kind of parenting or a dead mother. 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 to set in motion a chain of self-flagellation and self-punishment. What about anxiety? Anxiety is not, as some scholars have it, any rational reaction to internal dynamics involving imaginary threats. Actually, anxiety is more rational than many fears and phobias. The powers unleashed by the inner critic are so enormous. It's intentions, so fatal. The self-loathing and self-degradation that it brings with it, so intense, that the threat is real. The narcissist's worst enemy is himself. We have seen the enemy and it is us, like the comic, the famous comic strip. Anxiety disorders and depression, mood disorders, don't 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 compulsions, which by diverting energy and attention away from the bad content in more or less symbolic, ritualistic, arbitrary ways bring temporary relief and an easing of anxiety. It is very common to meet all four in clinical setting. A mood disorder, anxiety disorder, obsessive compulsive disorder and personality disorder in one patient. Freud said that the depressive person has lost the love object, was deprived of a properly functioning parent. The psychic trauma suffered early on can be alleviated only by inflicting self-punishment in this way, implicitly penalizing and devaluing the internalized version of the disappointing love object. The development of the ego according to Freud and early psychoanalyst is conditioned upon a successful resolution of the loss of the love objects. That's a phase we all have to go through. We all lose mother when we separate from her and individuate, set boundaries and become individuals. When the love object fails the child, when the love object is dead in the sense that she is emotionally unavailable or narcissistic, the child is furious, revengeful, aggressive and unable to direct these negative emotions that the frustrating parent, the child directs these emotions at himself instead. Narcissistic identification means that the child prefers to love himself, direct libido at himself than to love an unpredictable, abandoning parent, mother in most cases. So the child becomes his own parent. He parentifies himself and he directs his aggression at himself and the parent that he had become. Throughout this wrenching process, the ego and the child feel helpless and that's another major source of depression, helplessness. When depressed, the patient becomes an artist of source. He tires his life, people around him, his experiences, placements, his memories with a thick brush of schmaltzy, sentimental and nostalgic longing. There's a lot of catastrophizing going on. The depressive imbues everything with sadness, hopelessness, helplessness, anything, a tune, a sight, a color, another person, a situation, a memory. So depressive people are cognitively deficient, cognitively distorted. They interpret their experiences, they evaluate themselves and they assess the future totally negatively, they catastrophize. Depressive behaviors though constantly disenchanted, disillusioned and hurting the dysphoric effect. And this helps to sustain these distorted perceptions. No success, no accomplishment, no support can break through this cycle because it is so self-contained, so self-enhancing. Dysphoric effect supports distorted perceptions, distorted perceptions enhance dysphoria which encourages self-refeating behaviors which bring about failure and defeat which justifies the depression. That's a cozy, charmed little circle, emotionally protective and adaptive because it's unfailingly predictable. It's a comfort zone. Depression is addictive because it is a strong love substitute. Much like drugs, depression is its own rituals, its own language, its own worldview, it's an exoskeleton. It imposes rigid order and behavior patterns on the depressive. This is learned helplessness. The depressive prefers to avoid even situations which hold the promise of improvement in his harrowing 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 cruel predicament by committing suicide. The depressive is devoid of the positive reinforcements which are the building blocks of our self-esteem. The depressive is filled with negative thinking about his self, automatic thinking, his lack of goals, his lack of achievements, his emptiness, his loneliness and so on and so forth. And because his cognition and because his perceptions are so defective, so deformed, no cognitive or rational input can alter the situation. Everything is immediately refrained and reinterpreted to fit the depressive paradigm. People often mistake depression for emotion. They say, when they talk about the narcissist, they say, but he's sad or he's grieving what they need to say, he's human, he has emotions. But this is wrong. Depression is a big component in the narcissist's emotional makeup, but it mostly has to do with the absence of narcissistic supply. 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 supply, his spouse, his mate, his girlfriend, his colleagues, his business partners, with his constant demands for the reenactment of his days of glory with the evocation of early childhood conflicts with his need, neediness, clinging and wish to parentify everyone around him. Some narcissists even cry, but they cry exclusively for themselves and for the lost paradise. They do not cry because they feel anything recognizable. 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 false self. He swings from brutal and vicious abrasiveness to mellifluous, muddler and saccharine sentimentality. It is all a simulacrum, a very similitude, a facsimile. It can fool the casual observer and even many clinicians. It is enough to extract the narcissist's drug, other people's attention, the reflection that somehow sustains this house of cards. But the stronger and more rigid the defenses and nothing is more resilient than pathological narcissism. The stronger the defenses, the greater and deeper the hurt, the pain the narcissist aims to compensate for. One's narcissism stands in direct relation to the seething abyss 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 because it guarantees self-preservation and survival. It's a positive adaptation. The paradox is that being a self-loathing narcissist may be the only act of true self-love that the narcissist ever commits. Thank you for listening.