 Esteemed colleagues, thank you for inviting me to this webinar and I would like to present myself. My name is Sam Vaknin. I'm a professor of psychology in Southern Federal University in Dostov-on-Don, in the Russian Federation. I'm also a professor of finance and a professor of psychology in the Global Outreach Program of SEAPS, Center for International Advanced Professional Studies. Today I would like to discuss with you a much neglected topic in psychology and more specifically in psychopathology and even more specifically in psychopathology of personality. And that is a topic of twins. Now it's very surprising that there's such a dearth that there are so few studies of twins in this particular niche of psychology. Twins share the same ovum, identical twins share the same appearance, they have the same age, they have the same set of parents, they experience the same upbringing. They, by definition, ipsofactor, they constitute the perfect case study. If we want to distinguish and discern individual effects upon the etiology and pathogenesis of personality disorders, nothing comes more natural than sets of twins. And yet you would be hard pressed to find such studies. Is it a question of political correctness? Is it a question of logistical difficulties, like finding a large population of twins to work on and to work with over an extended period of time? I'm not quite sure what the reason is. Twins are not that rare, as we might imagine. And there have been numerous other studies on groups of people and populations which are much more rare than twins. Why not twins is one of the unresolved mysteries of clinical psychology? At any rate, twins present a very interesting conundrum when it comes to narcissism, especially primary narcissism, the type of narcissism that is nascent and incipient in early childhood, the type of narcissism that allows the child to gradually separate from the parent, more specifically from mother, the primary object, the type of narcissism that allows individuation, the type of narcissism that endows the child with sufficient grandiosity and fantastic capacity to take on the world. The world is hostile, the world is unknown, the world is frightening. And so to take on the world, to assume risks, to seek novelty, to explore, to satisfy curiosity, this requires a lot of grandiosity. Mother, a good enough mother, provides a safe base, but that's not enough. It's only one of the conditions. She encourages the child to be grandiose. Actually a good enough mother colludes with the child's primary narcissism. And so there is a very clear narcissistic universe in the good sense. This is healthy narcissism, that's the kind of narcissism that later on underlies the regulation of self-esteem, self-confidence, and the sense of self-worth, it's a kind of narcissism that allows us to take on new tasks, new missions, new assignments, new jobs, to embark on undertakings such as having a relationship, siring children, these all require a modicum, a modicum of suspension of disbelief and a lot of grandiosity. So these are the roots of healthy primary narcissism and this process, which Jung called the constellation of the self via introversion and Freud called by other names, never mind all that right now, this process of primary narcissism, constructing one's individual, constructing one's self, becoming a person. This process is heavily disrupted in twins and it's disrupted in twins because there is triple or double mirroring. In a typical relationship between a newborn and a primary object, a mother or caregiver, in a typical relationship there is a narcissistic union between the child and the mother. At a very, very early stage, it starts with the kind of omnipotence, omniscience, and omnipresence that are essentially divine. The child experiences a unitary universe, the child is the world, the world is the child, there are no boundaries, there are no separations, there are no distinctions. The child does not realize that there is something external, external and internal are one. It's what Freud called an oceanic feeling and it also manifests in mental health disorders in adults such as psychotic disorders with hyperreflection. So the child creates initially a narcissistic union with a mother, a good enough mother, with Bayes mother, a mother which is not a dead mother to borrow a phrase from André Green. Such a mother would encourage a child to break apart this universe. This chism is the first major psychological trauma in life. Break apart this universe and realize that there is external and internal. The formation of the boundary between these two worlds is, starts us on the way to maturation, personal growth, personal development and ultimately adulthood via another phase, another narcissistic phase which is adolescence. But what happens if this unified universe doesn't include only one person, mother, but includes yet another person, the twin. And that other person is a mirror, a spitting image, a mirror image of the child. So the child has to confront two extensions of himself. One extension is the mother from which he has to separate and individuate on the way to becoming an adult, an individual adult. And the other person is a copy, a clone of oneself. Twinship being a twin requires a double break, a double schism and a double trauma which non-twins don't go through. First, the child has to separate from mother and then the child has to separate from himself. Twins self as reflected in the other twin. The separation from the other twin is perceived unconsciously and intuitively as a divorce from oneself, as divorcing oneself. That is even much more traumatic than the experience with mother. Theoretically, such a cataclysmic break will be perceived as internal, not external indeed. Twins form a narcissistic union. They consider themselves one organism with two heads, one organism with two souls and two psyches. Throughout life, twins maintain this pseudo or quasi-telepathic capacity where they actually share a life. It reminds me that in quantum physics we have a phenomenon called entanglement where two particles share the same molecules and then they're broken apart, they're separated. One of them is cast away light years into the universe. But when the first one changes on Earth, this particle changes somehow, for example, changes his spin, changes one of its characteristics, the particle at the very end of the galaxy will change instantaneously. This is called entanglement. It has been demonstrated in laboratory experiments. It's not speculation. This is an entanglement among twins. Twins are like these two particles. Never mind how further away the second twin is going to go. They maintain this union, this narcissistic union. And breaking it apart somehow is an apocalyptic, super traumatic event which no twins don't go through, don't have to endure. Now, if this is the case, we should expect to see a much higher level of secondary pathological narcissism among twins. If twins have to endure a trauma in order to individuate, many of them theoretically would opt not to go through this process, to remain entangled with their twin. Twins may decide to not become individuals, but to become a colony, a colony of two, to become a hive, a hive mind, to become an organism with two heads. In other words, many twins, we can speculate that many twins would get stuck somehow in the transition from primary narcissism to individuation. And when this happens, this is what Freud called secondary narcissism, and today we call this pathological narcissism. When the child who is not a twin cannot separate from the parent and individuate, we have on our hands a narcissist. When the twin cannot separate from his or her twin and individuate, when the twin remains engulfed and meshed, merged, fused and entangled with another person who is a replica of him, a copy, a clone, we should definitely anticipate much higher rates of secondary narcissism because of the failure of separation and individuation in this case from oneself. Because exactly as Jung had observed very early on, and today, many other scholars in object relations theory, in the object relations school and so on, it's not enough to separate individuate from the parent. At some stage, one needs to separate and individuate from the self. Jung called it the constellation of the self. The self becomes like an alien object, a separate object, an autonomous entity. Freud described it as the ego. He said that the ego has an interface with reality, the ego helps us to maintain reality testing. And he made it very clear that the ego and the person are not coterminous. Jung went even further. He said the ego is not the self and the self is not the ego. There are structures and constructs inside us, like introjects, like the self. And many people say that the self is an introject, like what Freud called the superego, the inner critic or whatever you want to call it. There are structures and constructs inside our psyche, which are essentially alien to us. And this is why many of us experience estrangement. We feel that we are not ourselves in certain situations under extreme duress or stress or anxiety. If the twin, if one twin cannot separate from the other twin, ever mentally, psychologically, they may have a problem in maturation, a problem in becoming an adult. Is this true? And here is the agony, in a way, of the theoretical psychologies, because the experimentalists failed him or her. I work in theoretical psychology. I'm not an experimentalist. And when I try to go to the literature to see studies which will substantiate or falsify some of my ideas, I can't find any. So I would like to propose a mini review of the literature somehow. Let's start with a general statement. It's taken from an article titled, Beyond the Diet, How Thinking About Twins Expands Psychoanalytic Theory. It was written by Dr. Ruth Simon, it was published not long ago, in Fort Da. Fort Da is a psychoanalytic newsletter and it's published in volume 26. So she starts by asking the question, who is older? You know, this is a classic question, everyone asks twins, who is older? And the answer is, we are both older. She asks, why think about twins? Why at all? And here is her answer, concisely. She says, psychoanalytic theory and practice have conceptualized psychology and identity in highly individualistic ways. We have, I take a break here just to elucidate. Our modern psychology is founded on the principle of individualism, a psychology which would have reflected a more collectivist approach, would have been totally different. A psychology, a psychology started in China or in Japan and not in Germany and the United States. Had it started in Asia, it would have looked completely different, it would have emphasized social relationships, interactions, interpersonal dynamics rather than the individual. But it's a fact that psychology started in countries where the individual was the organizing and explanatory principle. So all our psychology, modern psychology revolves around the concept of personality or individual. It's a construct, there's no veracity to it. It's not something that is essentially testable or falsifiable. It's simply a convenient way to organize knowledge, but one should not mistake a convenient way to organize knowledge a classificatory system, a taxonomic system with the truth or with reality. No one had ever captured an ego or spoken to a super ego. We use the tri-lateral, Freud's tri-lateral model, those of us who do, to talk about the world. It's a language element. It is not pretensions to reality or truth. Well, at least if you are not seriously primitive in your approach to psychology. So I continue from Simon's article. The limitations of these conceptualizations, individualism, become particularly apparent when we try to apply them to patients who are twins. It used to be fairly rare to encounter twins in a therapy practice, but that is becoming less and less true as the birth rate of twins has risen dramatically over the past several decades. Interrogating the ways in which current psychoanalytic theory falls short of addressing the unique psychological needs of twins and other multiples elucidates a fundamental individualistic bias in the field. In lieu of understanding the unique psychology of people who were born as twins, those who were born as singletons, parents, friends, partners, teachers and therapists, singletons tend to impose and interpolate our own majority cultural, political and psychological biases on the minority twin population. By the way, she's not the first to say this, Louis Althusser, the famous post-Marxist social theorist and psychologist, I think he was psychologist, I'm not sure, but he made contributions to psychology. Althusser in 1971 made the same observation that actually singletons, people who are born as single newborns, they are the majority and twins are a repressed minority, akin for example to black people or Native Americans or women in many cultures. They are a repressed minority and the value system and the language and the constructs and the assumptions and the theories that pertain to single people, people who had never grown up in a dyadic cell with another twin, these are imposed on twins. It's like twins at a certain stage should become singletons. This can never happen, because twinship is not a state of birth, it's a state of mind. There is a, we should establish a separate psychology for multiples, which is divorced from the psychology of individuals. Simon continues, contemporary American neoliberal ideologies, psychoanalytic theories and our own familial experiences have led us to think in individualistic and binary terms that do not readily apply to healthy twin psychology and have led twins to feel misunderstood by those who care for and try to help them. The relational identities and psychologies of twins fundamentally challenge our understanding of psychic health, with significant implications for twins and non-twins alike. One recent study of twins was conducted by Vernon, Vilani and Vickers together with Harris, it was published in 2008 and the title was a behavioral genetic investigation of the dark triad and the big five, big five is a personality factor, personality factor theory. It was published in personality and individual differences, volume 44. So Philip Vernon and Vanessa Vilani in 2008, they examined the behavioral hereditary aspect of three dark triad factors. Today we have dark tetrads, the concept has evolved a little, but in those early days the dark triad was comprised of narcissism, Machiavellianism and psychopathy. It was an open question whether these are acquired, whether these were acquired or learned behavioral trait complexes or whether they reflect brain abnormalities. What is a genetic contribution or template? So there was a lot of, there were a lot of open questions about heredity and their relationship between heredity, brain functioning and behavior. And this was one of the first studies to examine dark triad elements. And what they did, they used the big five factor analysis theory of personality to sort of map the characteristics and then they tried to correlate them with genetics. And of course the easiest way to do this was to study twins. So they selected 278 adult grown-up twins and they subjected them to surveys and to structured interviews and tests and so on and so forth and then they took the results and they grouped them together in terms of the dark triad, Machiavellianism, narcissism, psychopathy and in terms of the big five factors of personality. What they discovered is that there was a very strong relationship. They even used the word huge, huge relationships among a few dark triad factors and each of the dark triad factors and the big five. In other words, there was internal correlation between the dark triad factors which shows that the dark triad is a valid construct. It has internal validity, internal consistency and there was a high correlation between the dark triad and the big five factors of personality. So it seems that personality somehow interacted with dark triad elements. So in terms of genetics, this is phenotype. It's not genotype. So these factors were somehow connected to the phenotypic level. These relationships probably had to do with heredity because the correlation was consistent across the sets of twins, across the various twin couplets, it was consistent. It was predictable if you knew, if you created a picture, created an analysis, analyzed the big five factors, you were able to predict dark triad and vice versa. And so the strong indication was that there was a hereditary kind of variable, series of hereditary variables, which together constituted a template upon which two phenotypes emerged. One phenotype was the big five factor analysis of personality, but it was closely correlated with dark triad factors which were correlated among themselves. In other words, dark triad factors in twins were derived from their personality, which was clearly strongly correlated with their genes, with the fact that they shared the same genes. This was an astounding discovery because if dark triad, if dark triad properties and traits and behaviors are correlated in twins with their phenotype, which by definition is correlated with their heredity, with a genetic baggage or material, why not make the same reasonable assumption when it comes to non-twins? Can we learn from this about non-twins or is there something in twins that predisposes them to manifest or to express certain clusters of traits and behaviors? It's very unlikely. It's very likely. Twins simply provide a crystal lens. Twins are laser. It's like studying laser rather than a diffused light from a bulb. We can see things much more clearly, but these things are valid. A light is light. Whether it's a laser beam or a bulb, it's still light. It's still photons. It's still these personality traits and characteristics and phenotypes and factors that appear in twins in a very discernible and emergent way that is very easy to observe and to analyze, but this means in all probability that it's the same with non-twins. The same Vernon collaborated with Petrides and Schermer and Wesselka three years later, 2011. They published an article called Trade Emotional Intelligence and the Dark Trier Trades of Personality, and it was published in a journal that is dedicated to the study of twins, Twin Research and Human Genetics, Volume 14. They wrote, and this time I would quote because there are many technical terms, so they wrote, for instance, in one way to deal with twin investigations, scientists analyze the identity scores of monozygotic or indistinguishable twins raised together to disygotic or friendly twins raised together. Since the two sorts of twins, so we have monozygotic twins, they're identical, they share the same ovum, they grow, they come out of the same egg, maternal egg, essentially they are one person, one person divided in two. In many cases, by the way, one of the twins dies in uterus in the womb and the other twin survives and when he's born he carries parts of his, of his, of the other twin, the dead twin carries them with him. So the surviving twin would have two sets of some organs, which are actually inherited from the dead twin, but some monozygotic twins, of course, we have identical twins. So Petritis and Vernon studied indistinguishable twins, monozygotic twins, and studied dizygotic twins. These are twins that develop at the same time, two fertilized eggs in the womb develop at the same time, they're born at the same time, but they're not identical. Yet they are raised together. These are two, these are two perfect, perfect study conditions, pure unadulterated situations. And they continue to write, since the two sorts of twins in this plan are raised together, all twin sets are viewed as having shared a 100% regular condition. Conversely, the monozygotic twins share 100% of their qualities, while the dizygotic twins just offer around half of their qualities. So the monozygotic twins have 100% identity. The dizygotic twins are 50-50. Yet both sets of twins, both types of twins, were raised in the same environment that was critical, critical for the experiment, for the study. In this way, the authors continue, in this way, for any given identity attribute, it is conceivable to divide impacts by first getting the monozygotic connection, reflecting 100% normal condition and 100% shared qualities. And then subtracting the dizygotic relationship, reflecting 100% regular condition, but only half the shared qualities. And this distinction speaks to half of the hereditary impact. Multiplied, this number is said to represent 100% of the hereditary impact, and is one approach to infer a file of heritability. Now and then, called the heritability coefficient, we designate it by each two. So you see that if we study simultaneously, twins who are 100% the same raised in the same environment, and twins who are only 50% the same and raised in the same environment, we can clearly eliminate the environment and remain only with a genetic hereditary difference between the two groups. Any quality they have, any trait, any behavior, any psychological construct can then clearly be attributed to a genetic predisposition or foundation. It's a brilliant approach, absolutely brilliant approach. So H2 is the heritability coefficient. The authors continue, essentially monozygotic H2 might be viewed as a gauge of the impact of the normal condition. At long last, since singular contrasts and the earth should represent the totality of conduct, it is said that subtracting the entirety of H2 and the normal condition impact from one is equivalent to the impact of extraordinary or non-shared situations. The year before, in the International Journal of Methods in Psychiatric Research, the July 2010 edition, an article was published titled Measurement Non-Variance of DSM-4 Non-Cecistic Personality Disorder Criteria Across Agents 6 in Population-Based Sample of Norwegian Twins. I don't know why everyone goes to Norway to get twins for psychological studies. Must be a secret there, which I am not a privy to. Anyhow, the authors in this case were Kubaric, Egen, Kendler, Torgersen, Reichborn, Kjernoud and Niel. Quite a few. And they wrote the following. We investigated measurement non-invariance of DSM-4 non-ecistic personality disorder criteria across age and sex in population-based cohort sample of 2,794 Norwegian twins. That's a very big study. And so they discovered amazing things. I would even say counter-intuitive things. First, age had a statistically significant effect on the factor mean for NPD. Sex had a statistically significant effect on the factor mean and variance. Sex was more important than age. Controlling for these factor-level effects, item-level analysis indicated that the criteria were functioning differently across age and sex. Now this defies the DSM. Defies even the alternate model in the DSM-5 published in 2013. Because the assumption is that narcissistic personality disorder is stable across the lifespan, all pervasive and stable across the lifespan. And this study shows it's not. The assumption also is that it is gender-neutral, sex indifferent. And this study clearly shows it's not. So they continue. After correcting for measurement differences at the item level, the latent factor mean effect for age was no longer statistically significant. So when they tweaked the measurement effect, they discovered that age is much less important than sex. The mean difference for sex remained statistically significant after correcting for item threshold effects. The results indicate that DSM-4 NPD criteria, which are still valid in DSM-5 by the way, perform differently in males and females and differently across age. Differences in diagnostic rates across groups may not be valid without correcting for measurement non-variance. But of course, in all this, there's another hidden conclusion, surprisingly not enunciated and promulgated in the study. These were twins. It seems that being a twin, the state of twinship, which intuitively and theoretically should have affected primary narcissism, should have encouraged pathological secondary narcissism, didn't. Being a twin is not a good predictor prognosticator of having NPD in later life. Being a twin seems to have zero impact or little impact on the development of secondary pathological narcissism. What matters is age. What matters is sex, not whether you're a twin or singletoe. That's a pretty conclusive study, the foundational study, I would say. The number of people studied was enormous. It seems that biological factors, because age and sex are totally genetic. They're totally biological. This is not gender, mind you. This is sex. Male, female. Yeah, male, female, not men, women. Men, women, these are gender constructs, gender roles which we acquire, learn, emulate via socialization and otherwise, imitating role models and figures. It's not men and women. It's male and female gametes. It's totally biological. It seems that whether you're male or female and your range determine your propensity for acquiring or developing NPD and then determines the progression and trajectory of the disease, not whether you're a twin or singletoe. It seems that the role of environment here is really seriously minimized, because if we were to rely on environment only, all twins should have ended up being narcissists. They have this narcissistic, self-contained universe which they cannot extricate themselves from. They are solipsistic. They are enclosed, self-sufficient, self-contained. Their communication patterns are very, very interesting. I think they have a private language, so they should have developed into rank narcissists with autistic features and if they didn't, being a twin has a biological foundation, but it's mostly an environmental thing. The way other people react, acquisition of language, parental changes, modifications in behavior. In a study published entitled Narcissism and Object Relations in Monozygotic Twins, studied by Haussier, Weiber, Aikis, Philippine, Prigent, Quistake and Ahdaba. It was published in Research in Psychoanalysis last year. They did discover that the mother of twins becomes a third-party symbiotic object. A twin goes through libidinal investment, investment in the self and later investment in other people. Always accompanied by two people, not one. A singleton newborn has to contend with the mother figure, with the representation of the mother figure, with the introjects which the mother had become in his mind. He had all the time the dialogue is with the mother figure or the main caregiver and this dialogue never stops, of course, but at some stage, via various stages of individuation and separation, the mother becomes totally internalized, she becomes an introject, the voice, not so with twins. Twins have to contend with mother but also with another copy of themselves. This is a highly unusual situation and none of the psychological theories we have. Not one of them has any tools to describe this or to cope with this. Is it symbiosis? Is this second twin a reflection, a mirror, and if so, what are the dynamics that are created, for example, in the constellation of the self? Does every twin create a twin self, a twin ego? Is everything doubled? Is it a state of constant resonance, vibration, life-long vibration, lifespan vibration? And what's the role of the mother, who is more dominant at any stage? Is the separation and individuation mainly from the mother or mainly from the twin? And if a separation and individuation with the mother succeed but fails with the twin, what happens? If it succeeds with the twin but fails with the mother, what happens? What is the meaning of Nazism in a twin set, among a couple of twins, especially identical twins? Imagine two identical twins, one of them is a narcissist. Nazism is a confusion of external objects with internal objects. The narcissist mistakes external objects and treats them and relates to them as internal objects. The other twin is internalized up initial from the very beginning. So what happens then when there is essentially no external object? Don't forget the child at the beginning, the mother is not an external object. And then he has two internal objects. And of course, the other twin is a personality of her own and this personality diverges from the inner representation. How does the first twin cope with the divergences and idiosyncrasies and emerging personality of the other twin? We don't have any information about this or little information about Nazism in twins. In an article published in February this year titled the behavioral genetics of the dark triad core versus unique trait components pilot study was published in personality and individual differences volume 154 was written by offered by eight consumer and Jones. So they wrote recently there has been the suggestion that the dark triad traits Machiavellianism Nazism and subclinical psychopathy share a common overlapping core in this exploratory investigation. A secondary data analysis were conducted to extract common dark triad core which they call the dark factor. So they try to find a dark factor that underlies all three manifestations of the dark triad, Nazism, Machiavellianism, subclinical psychopathy. And so they continue. We found that Machiavellianism and psychopathy had higher factor loadings of the dark factor than Nazism. The dark factor was best explained by genetic and unique environmental factors when sex and age effects were removed. Genetic and unique environment models best fit the residuals for Machiavellianism and psychopathy. And Nazism, but only when sex and age were removed. Again we see the critical importance of sex and age. You have to remove them which I find to be totally unacceptable. I mean removing sex and age from the equation is like removing the individual. I would have never done this had I designed a study but okay they did. And even then they discovered that the dark factor actually creates Machiavellianism and psychopathy, not so much Nazism. Nazism had much more to do with sex and age. These results suggested that further behavioural genetic studies should be conducted on the common and unique variances of dark triad. And finally I would like to quote from Caliguria's article the influence of childhood rearing of the separation and individuation process of tweens Pace University. It's a doctoral dissertation published last year. A critical sentence, a single sentence to round up the presentation. Similar to the intrauterine environment the infant is in a state of absolute primary Nazism and is contained within kind of a bubble. With the mother, as Hoel suggests, they have a shared sense of self. They have a self-contained narcissistic system in which both tweens feel incomplete. So he sustains, he believes that there is a trilateral system with twins. Mother and the other tween fulfill an identical psychodynamic role. I think this is pretty indisputable. The importance, crucial importance of tweens in each other's lives has been documented numerous times and amply. What we fail to study is how is this connected intimately and inexorably to the emergence of primary Nazism, which is a precondition for separation and individuation, and to the emergence of secondary Nazism, which is the pathological kind that we find in narcissistic personality disorder. These questions, regrettably and egregiously, we don't have an answer. Here's something for you to do. A research agenda. Thank you for listening. And now, if you have any questions, I will pick.