 My name is Sam Vaknin and I am the author of Malignance of Love, Narcissism Revisited. Today we are back to normal, and we are going to discuss an obscure concept in the study of narcissism, narcissistic modification. It's a bit of a difficult concept to grasp, so you will have to enter the narcissist's bizarre landscape. This is surrealistic, nightmarish, Salvador Dali-like mind. Before we go there, we must understand that the narcissist is the first victim of narcissistic abuse. Narcissism is a post-traumatic condition. The narcissist has been traumatized and abused by a significant primary object, such as his mother. And the narcissist passes on the narcissistic abuse, he is like a conduit, like a channel. He channels his mother's narcissistic abuse, he does to others what mother did to him. So mother did not allow him to separate from her and to become an individual, she did not allow separation, individuation. She abused him, as I mentioned, she objectified him, in some cases she sexualized him, she parentified him, forced him to behave as a parent. She created dependency, a co-dependent relationship, emotional blackmail, fusion, merger, and she used the child to obtain narcissistic supply. And of course, if you go through this list, this is exactly what the narcissist does to his intimate partner. And most intimate partners collaborate in this charade, in this shared fantasy that I mentioned in the previous video, in this shared psychosis. Most of them agree to fit into the narcissist's narrative, his script, movie-like, Hollywood-like, stage set, his, the theater of his life. They agree to be actors on stage or, in some cases, props. But some potential and actual intimate partners refuse to be co-opted, refuse to be declined to collaborate. They confront the narcissists. They attack and challenge the shared psychosis and the shared fantasy. They exit brutally the shared space of surrealism, dream-like state. They wake up the narcissists, so to speak. It's exactly like waking up in the middle of a bedroom. So narcissistic modification is about fear. It is when the narcissist is confronted with reality, with reality about himself. When the narcissist is confronted with who he really is, and we'll come to it a bit later how this process unfolds, but the narcissist is faced with the narcissist when he finally sees himself in the mirror unfiltered, unembroidered. When he finally confronts his personality, his shortcomings, his limitations, his defects, his deformities, his deficiencies, his lacks, he can't cope with this. Anyhow, the narcissist is living in a state of fear, constant fear. Narcissism can easily be described as an anxiety disorder or even a depressive disorder. This is why the new therapy that I developed called therapy works well with major depression. So the narcissist has an intense fear, I'm quoting Sigmund Freud now, the narcissist has an intense fear associated with narcissistic injury and humiliation with a shocking reaction when individuals face the discrepancy between an endorsed or ideal view of the self in a drastically contrasting realization, is quoted in Ronningston, a paper from 2013. Another scholar of borderline personality disorder who dwelt upon the narcissistic face in the development of borderline, Rothstein, said that there is a fear of falling short of ideals, with a loss of perfection and accompanying humiliation. And this fear extends to intimacy in interpersonal relationships, as was observed by Fiskalini. It extends to unrealized or forbidden wishes and related defenses, always. Or as Kogut so aptly summarized it, it is fear associated with rejection, with isolation, loss of contact with reality, loss of admiration, equilibrium and important objects. Landberg augmented this list by adding fear of dependency and destroying the relationship with significant other, fear of retaliation, of one's own aggression and destructiveness and fear of death. So this is the background, the narcissist carries all these fears with him at all times. Now many of us have some of these fears, but none, no healthy or normal person has all these fears. And these fears are strongly and deeply associated with the narcissist's fantasies about himself. It's because he perceived himself as perfect, for example, that he is afraid to be discovered or uncovered or exposed as imperfect. He feels like a fraud at all times. He feels that had people only known him better, they would have shunned him and avoided him. And you know what? He's right. So narcissistic modification is the sudden, it has to be abrupt, it has to be a break, it's the sudden sense of defeat. The narcissist feels that all his efforts to sell himself, so to speak, all his fake it till you make it attempts, all his facade, the false self, it's crumbling, it's not working. There's a loss of control over both internal objects and external objects or realities. Now you remember that narcissists don't interact with real life, three dimensional people out there. What they do, they take snapshots of these people, they internalize or interject the snapshots and then they interact with these idealizations, with these internal objects, with these representations of people. Even an intimate partner doesn't exist for the narcissist in any true, real or meaningful sense of the word. Narcissist interacts with the representation of that intimate partner. So when suddenly an external object misbehaves, challenges the narcissist, disagrees, criticizes mocks the narcissist, mocks humiliates the narcissist publicly, does something that is unexpected in a shocking way, becomes aggressive. So when someone outside the narcissist does this thing, it's like waking up, it's like there is an enormous clash, a schism and a peace between the inner representation, the snapshot and the person whose snapshot exists inside the narcissist. It's exactly like as if a photograph would come to life and then attack you, imagine that your entire photo album comes to life and attacks you in a variety of ways, mocks you, humiliates you, etc. etc. So, modification is caused by an aggressing meaningful person or an aggressing person, someone who aggresses against the narcissist, attacks him, challenges him and so on. Even if this person is not significant or meaningful, but the context is significant or meaningful. Modification is also caused whenever the narcissist is forced to confront his real self, not his true self, but the reality about himself when he realizes that he has traits or behaviors which are to use a British understatement undesirable. So destructive, inferior, compulsive. And so when there's modification, when the narcissist is forced to look in the mirror and not to filter what he sees, but to really, really confront the monster in the mirror, the quasi-model that is staring back at him, the hunchback which is no longer in Notre Dame, but right here at home with me, with you. So when the narcissist is faced with this hideous, hideous representation, which is him, it produces disorientation. But even more so, it produces terror. Terror is not fear. You know, we mentioned fears. We started with fears. Fears are anticipatory. Fears predict that something will happen. Fears are forms of catastrophizing. But terror is reactive. It's because something really, really frightening has happened. And mortification, having to confront reality finally, especially about himself, leads the narcissist to a state of terror. Eidelberg, who in the 1950s was a prominent scholar on mortification, said that this, the reason is that there is a lot of energy pent up within the narcissist, narcissistic and ego energy known as libido, destrudo or multido, which is a kind of self-destructive energy. So all kinds of energy is a damning up inside the narcissist. And at some point, you cannot manage them any longer if he is not supported from the outside. And today we call it narcissistic supply. In the absence of narcissistic supply, when it is deficient or even much worse, when the supply is negative, the supply forces the narcissist, pushes him on a collision course with himself, forces the narcissist to become, in other words, self-aware. Mortification happens. The entire personality of the narcissist is overwhelmed by impotent ineluctability. It's like, narcissist sees the train coming head on, and there's nothing he can do about it, because he is chained to the rails of his own grandiosity and his own utterly deficient and fallacious self-perception and self-image, his cognitive deficits. And so he is there, the train is coming, head on, it's not going to stop, and he knows it. And he's impotent about it. The feeling of helplessness is utterly, utterly shocking and drowning and overwhelming. Narcissist's entire personality of self-perception is constructed upon omnipotence. He is all-powerful, he is godlike, and here he is, helpless. And there's a lack of alternatives, because he fails to force the objects around him, the people around him, to conform to his narrative, to conform to the confabulation or the piece of fiction that he had created, the false self. And he fails to convince people to support the false self, to buttress it, to provide it with supply. And he can no longer rely on the goodwill of people around him, because many of them had become hateful or aggressive or are very angry at him or very disappointed at him, and they're going to do bad things to him. They're going to humiliate him, they're going to hurt him, they're going to, and he knows it's going to happen. He knows it's about to happen. Motification sets in, and then there are infantile strategies, because the Narcissist, you remember, is a child, a small child, 9 to 11. An 11-year-old Narcissist is a mature adult Narcissist. So, infantile strategies of coping with frustration, with repression. So, the Narcissist tries, when he's modified, when he's confronted with himself via, via the gaze of others, he tries to reassert himself. He becomes overly grandiose, derisively grandiose. He becomes, he becomes buffoonish, he becomes funny. His hypervigilance is all over the place. And all kinds of defense mechanisms kick in, splitting, denial, magical thinking. Modification is when the Narcissist sees himself through other people's eyes. Now, this is not necessarily all bad. For example, that's precisely what I do in cold therapy. I re-traumatize the Narcissist and force him to see how small and insignificant he is. By re-traumatizing him, I take him back to early childhood, when he had been really helpless. And when he couldn't predict the capricious and arbitrary and vicious and cruel behavior of adults around him. And when he had been traumatized. So, that's not an entirely negative. Modification is not entirely negative because it gives the Narcissist a chance to free himself of the shackles of his task master, the false self. False self is like a slave, slaveholder. The Narcissist is a slave. I compare it Narcissism to a religion where the false self is Godhead, the Moloch. And the Narcissist has to sacrifice himself, human sacrifice, to the false self. So, it's a cruel, vicious God, dating. And so, modification is when the false self crumbles. The false self becomes very weak. It's a Narcissist's chance to escape. Narcissist is like a hostage. And here's the kidnapper. Kidnapper, and the kidnapper contracted COVID-19 modification. And there's a chance to escape. Narcissists would tend to surround themselves because they know this. Because they know the only chance at healing, the only chance of reintegrating with the true self, the only chance of escape, escaping the hostage situation. They know the only chance is when they are mortified. So, they surround themselves with people who have the potential to cause modification. So, for example, consider the Narcissist intimate partners. Some Narcissists would tend to surround themselves with promiscuous labile and dysregulated women. Why? Because these women guarantee mortification. And only mortification guarantees freedom from commitment and the possibility of the adventure of the next shared fantasy. But also because mortification guarantees a sense of even temporary sense of liberation from the onerous inexorable false self. So, these Narcissists would find homemakers, homely domestic women and so on, would find them unexciting. They would feel dead around such women. Only mortification makes these Narcissists feel alive and sexually aroused. This mortification involves sadism, masochism, and libido maximized. And the recreation of the primary unresolved conflict with mother. Because remember, mother was the first one to inflict mortification on the child. This is why the child created narcissism. It's a defense against mortification. So, these women that the Narcissist chooses, the labile, broken, damaged, mentally ill women and so on, they are pawns. The Narcissist selects them to fulfill roles in first in the shared fantasy and then in the liberating mortification anti-fantasy. These women first need to be integrated into a shared psychosis, into a shared fantasy. But then their role is to re-traumatize the Narcissist. The Narcissist uses these women to reenact the unresolved conflict with his mother. The V conflict, the mother of all conflicts, the conflict that created the mega-mortification that led to the creation of pathological narcissism, he keeps hoping that with this woman or that woman, labile, dysregulated, crazy, cheating, promiscuous and so on, so forth, these kind of women will traumatize him, re-traumatize him exactly as his mother did, and maybe there's a way out of the false self. Maybe he will be free. First of the false self for a few, I don't know, minutes, days, hours, and then free to move on to the next shared fantasy. And some women say we cheated on the Narcissist because we felt that this is what he wanted. We felt that this way we will please him, we will prove him right. The Narcissist doesn't push his intimate partners away. He pushes his intimate partners to push him away. And of course, to tie in all the recent videos, the COVID-19 pandemic is a form of collective modification. We have become a narcissistic, psychopathic civilization. And the pandemic is a wake-up call. You are small, you are insignificant, you don't know everything. You can't do everything. You're not omnipotent. You're not all-powerful. You're not all-knowing. You're not God-like. You're just specks of dust. You're nothing. So it's collective modification. And if the Narcissist is lucky and he goes through the notification phase, the re-traumatization phase, sometimes with the agency of a promiscuous woman or labor woman, and he goes through this phase and is able to integrate and internalize the insight that he is actually very sick, this may be the first step in a therapeutic process of healing. This is what I create artificially in cold therapy. I create an artificial process of re-traumatization and modification, which opens the door to the possibility of healing by integrating and accepting the insight, the understanding. Hey, I'm very sick. I'm a narcissist. Narcissist is mental illness. I'm mentally ill. I'm not the first to suggest this. Idleberg, Anna Freud, I mean, they all realized that the first step towards healing is the acceptance of the illness, but that it is very traumatic. When a person realizes it's like getting news that you have COVID-19 or getting news that you have cancer. It's shocking. It's disorienting. It's frightening. It's terror. Let's go back to early childhood. Early childhood events of modification are crucial in teaching the baby to distinguish between external and internal. Like when you're mortified, you suddenly realize someone mortified you. So it's like the baby suddenly gets it. There's the baby and there's mother, mortified mother. So the baby also begins to form defenses, to form ego boundaries here. And while doing this, the baby realizes his own limitations and he learns to delay gratification. And he learns to select among options and make decisions. So modification is universal. Everyone goes through modifications in early childhood because in early childhood, we are helpless. We are small, we are weak and stupid. And we're surrounded by Godlike adults. That's very, very traumatizing and mortifying. But in the vast majority of cases, with healthy and normal people, modification leads to good places, to the development of functional constructs, behaviors and traits. Of course, it is possible to be overtaken by multiple internal and external modifications. By multiple what we call today traumas. And it's possible to be so overwhelmed by modifications, multiple modifications, that we start to repress them. We start to kind of forcibly forget them. We start to dissociate, cut them off. And so repression and dissociation become indispensable when the number of modifications and the character, the nature of modifications is such that they can no longer be tolerated. They are intolerable, unbearable. And we then also develop compensatory cognitive deficits, omnipotent or omniscient grandiosity, entitlement, invincibility, paranoid projection, magical thinking and so on. Bergler and Maldolado remind us that pathological secondary narcissism is a reaction to the loss of infantile omnipotent delusions and the loss of a good and meaningful object, mother in this case. And in the child's mind, mother is associated with ideal. She's perfect, she's ideal. And he loses mother, he not only loses mother, but he loses the very concept of the ideal, of the perfect. It's a loss that threatens continuity, stability, coherence and well-being of the personality itself. Now all of us cope with this, healthy people cope with this, by transitioning from splitting to object relations to a more nuanced picture of the world. If you look at mother as ideal and you lose her, you have two options. It's okay, I lost mother as an ideal. I lost the very concept of the ideal, of the perfect. And so the alternative is all bad, total imperfection. And this is called splitting, good and bad, dichotomous thinking, black and white, right and wrong. But the vast majority of healthy normal people develop a nuanced picture. So okay, mother is not all bad, but not all good. Everyone has a mixture of bad and good, right and wrong. In adulthood, self-inflicted internal notification, the realization that one is less than perfect, the realization that you have shortcomings, limitations, failings, that you're bound to be defeated and fail. These self-inflicted internal notifications are usually founded on reality, in healthy people. But in the narcissist, internal notification is founded on distortions of reality. And the narcissist uses internal notification to compensate for an external notification, to disguise it, and vice versa. He uses an external notification to compensate for an internal notification. No, I know you didn't get it. I didn't get it at first. Let's try again. Narcissist is inexternally motivated. For example, he's humiliated in public by someone. His wife cheats on him. His, I mean, his something happened that motivated, that challenged his self-perception as grandiose, perfect, brilliant, irresistible, amazing, sui genugis, et cetera, et cetera. And so he's, for the first time, or for the hundredth time, forced to face the fact that his self-perception is wrong, that his grandiosity is ludicrous. Sometimes, such external notification is totally unacceptable. Narcissist feels overwhelmed by it. So what he does, he invents an internal notification. And he says, for example, it is all my fault. I made it happen. My wife cheated on me because I pushed her to cheat on me. I abused her. I rejected her, humiliated her. I will hell sex, so she cheated on me. In other words, I'm in control. I'm in control. I'm in control. It's all my doing. It's all my fault. This is called auto-plastic defense. Of course, if you say it's all my fault, it's all my doing, it restores a grandiose illusion of control over an external modification. It's a delusion, but it's still better than admitting that you have no control over other people and that they do exactly what they want to do, regardless of you. And very often, the things they do have nothing to do with you. They have to do with their internal needs and internal psychodynamics. It's better to say, I made it happen. Even if it's with a very bad thing that it happened, I made it happen. Then to admit, I am not the prime mover and shaker. I'm irrelevant. I'm irrelevant to these people's lives. They go on with their lives, with and without me. And take the opposite. When there is internal modification, when you did something really, really, very bad, you say, I'm evil. I have hateful thoughts towards people. I am corrupted and decadent. I am defective and deformed. So this is internal modification. When you admit that you, as a narcissist, you admit that your character is really, really rotten, it's very difficult to accept. It creates modification. So sometimes the narcissist creates an external modification, fictitious external modification, to replace the internal one. Instead of saying, I'm evil. I'm hateful. I am unworthy. I'm bad. He says, they are evil. They are unworthy. They are out to get me. They hate me. In other words, per secretary. Per secretary delusions, also known as paranoia, is an external modification which replaces an internal modification. Yes, I acted badly. I misbehaved. I was aggressive. I was offensive. But I did it because of them. They made me do it because they are evil. They are out to get me. They are out to hurt me. They are conspiring against me. Of course, the only true solution to a modification is the regaining of control. And even then, it is only partial, as control has clearly been lost at some point. And this can never be forgotten or forgiven or effectively dealt with. So narcissists bear grudges and they ruminate a lot. They keep revisiting the sin of the trauma. It becomes an obsession. You can regain control after a modification, but there's been a minute of modification in which you had lost control. Clearly. You can regain your grandiosity and your perfect composure and your brilliance and your omnipotence and omniscience in your mind at least. But there had been a moment where you were helpless. You were humiliated. You were mocked. The need to reframe narcissistic modification is because it is an extreme and intolerably painful form of shame-induced traumatic depressive anxiety. Modification threatens the integrity of the self. It's a sudden awareness of one's limitations and defects. I'm referring you to Lansky's work in 2000 and Libby's excellent presentation in 2006. When the narcissists are faced with their own hopeless unloved ability, badness and worthlessness, they are mortified by this and they experience shock, exposure and intense humiliation, and sometimes it's converted to somatic symptoms. Narcissists describe the feeling as being annihilated, as disintegrating into molecules and to thin air. Harbage in 1989 described it as a virtually intolerable experience of terror, fright or dread, related to a sense of overwhelmed helplessness, reminiscent of the overwhelmed helplessness of infancy, a myelotary anxiety, fear of the disintegration of the self, or of identity, as Libby quotes him. Libby, apropos, postulates that narcissistic modification is a sudden loss of the psychic sense of self, which occurs simultaneously with a perception that the tie to a self-object is threatened. Self-object is an object that embodies the self and is very significant. Coghud, whom she quotes, added in 1971, if the grandiosity of the narcissistic self has been insufficiently modified, then the adult ego will tend to vacillate between an irrational overestimation of the self and feelings of inferiority and will react with narcissistic modification to the thwarting of its ambitions. And actually it's one of the very few topics in psychology where there's no disagreement between all the schools of psychology, because for example if you take object relation theories, like Bayonne or Winnicott, they agree, Bayonne has something called nameless dread. Winnicott has original agonies of the collapse of childish consciousness as it evolves and matures into another and these dreads and agonies are simply different names to modification and they all agree it's rooted in childhood. One possibility is that it may have to do with a lack of what we call evocative constancy. Evocative constancy is the capacity to maintain positively toned images of self and others with which to dispel feelings of self doubt. And it was first described by Adler and Bouyer in 1979. It is intimately linked to something called self reflexivity, the ability to oscillate easily among varying perspectives of the self and it crucially relies on the smooth operation of evocative constancy. So reflexivity and constancy go together. In the case of psychosis for example, there is hyper reflexivity. So there's a big problem to differentiate the self and various self states from external reality. Libby describes two strategies that narcissists use to restore a modicum of cohesiveness to the self. What she calls the deflated narcissists debases the self and inflates or idealizes the object in order to reacquire the object. And so for example, such a narcissist would atone or aggrandize the object or self-panish or self-flagellate and it's designed to appease and all done to self-objects. Libby was not the first to suggest this unafroid, pre-saged this with her concept of altruistic surrender, self-sacrificial and therefore self-disparaging, not to say self-destructive altruism. In other words, when the narcissist is modified, exposed to the reality of his self or to the fact that his false self is false. When he's modified, one option is to say, well, the person who aggressed against me, the person who modified me, she was right. She was right because I did something wrong. I abused her, I mocked her, I rejected her, I withheld, I misbehaved. She was right to do this and let me repent, let me display remorse, let me atone for my sins, let me require her, let me bring her back to my life. Another strategy of what Libby calls inflated narcissists and revenge seekers involves debasing of the object, attacking the other in order to aggrandize and re-stabilize the self. There's always a winner and a loser. Such narcissists fight fire with fire or take an eye for an eye, are writing the scales of justice. The only winners and losers and these narcissists must be the winners. Shamers are also adept at short-circuiting the plunge into modification altogether, preemptively expelling impending feeling of shame and defectiveness by humiliating the other. Whichever route is taken, the individual cannot recover from modification, until a tolerable, familiar self-state is re-acquired, either by re-establishing the other as an approving object or by destroying the other temporarily or permanently. Narcissistic conceit designed to project defective self-experiences onto self-objects is the second option. So what do we do in treatment? In treatment we try to focus on converting modification to shame. Shame is different to modification because it includes the capacity to tolerate it. You can tolerate shame and you can use it as a signal. Both defensive styles, deflated and inflated, require continued dependence on self-objects. Even if you say the self-object was right and misbehaved, you're still dependent on the self-object. And it must be mounted again and again. Tolerating bearable shame can make self-appraisal and self-tolerance possible, ultimately leading to a psychic separation and self-reliance. I want to describe two cases. There's a patient who craves love and intimacy, also sex, because sex rafies intimacy, so craves love, intimacy and sex. But he hates himself for this life-threatening vulnerability as it is easy. To crave something is to be weak, to be vulnerable. So he uses, the patient uses, projective identification and projective interjection, coupled with persecutory paranoia. Wow, these are big words. I love big words. So let me use small words now. The patient egregiously misbehaves, and so he forces others to hate him. When they hate him, they act against him. So then he perceives them as hateful with some justification. And this way, he prevents the formation of love and intimacy of course, as well as sexual relations. So here's a sequence. He wants love, he wants sex, he wants intimacy, but then he misbehaves, forcing people to hate him, forcing for example women to hate him, to be disappointed, to be angry at him. And then they misbehave, as I said you see, they misbehave. I can't have love and intimacy and sex with these women, because they're misbehaving. So he kills two birds with one stone. He avoids acknowledging his own suicidal self-hatred, and he sidesteps being vulnerable to a dangerous level by being dependent on, for example, an intimate partner, which he also perceives as suicidal weakness. Another case study. The patient idealizes a potential partner, but rejects her, verbally abuses her, withholds sex, humiliates her. Let's reverse the genders. The patient idealizes a potential partner, but she rejects, verbally abuses, withholds and humiliates him. And he reacts by picking up another partner. Okay, triangulation. Very classic scenario. His behavior, or rather his misbehavior, challenges her omnipotence. She feels helpless, humiliated. Challenges her omniscience. She failed to spot his conspiracy to team up with another partner. She gallably trusted his lies about himself and about their interactions. He challenges her perfection. He rejected her. Challenges her superiority. He chose an inferior or a superior alternative over her. He challenges her brilliance. The incident proved that he regards her as a damaged fool. He challenges his self-perception as a loved and protected child. Because everyone involved, especially her former intimate partner, envied her, hated her, etc. So the internet partner's misbehavior by choosing another partner sort of demolished. It's like an explosive device, improvised explosive device of the caliber of a Hiroshima nuclear bomb. Everything is annihilated in a radius of 100 kilometers. Nothing is left of the false self. Not grandiosity, not superiority, not omnipotence, not omniscience. Nothing. All the defenses crumble. And it leads to a condition known as decompensation. And so in this state of modification, she repressed the intolerable external narcissistic modification. She repressed the public exposure of her glaring unfixable inadequacies, limitations, and defects. And what she did, she invented an internal one. So she couldn't face the external modification. I'm a zero. I'm a nobody. I'm irrelevant. I'm defective, deficient. She couldn't face this. So she invented an internal one. His miscontact is all my fault. I made him misbehave. I forced him to misbehave. And that's an attempt to restore her grandiosome nipotence. It doesn't always work, by the way. When it doesn't work, when it didn't work, she reverted to paranoia, replacing one external modification with another external modification. Yes, I had been humiliated. I had been exposed. But this was done to me by evil people who were out to hurt me. My ex-intimate partner, who picked up another partner, he was an evil person. And he was out to hurt me. And it's a failed attempt to not feel hopelessly damaged and evil. To restore egocintony and as wage her pain and desperation. I'm okay. They are evil. He is evil. I'm okay. He is evil. And very often, she will try to remain in touch with him in order to support with evidence both these alternative modifications. And she will let go. And this leads to stalking. This is the psychological foundation of stalking. And she will ghost him or go no contact with him, let go of him, only once she had succeeded to integrate the two alternative modifications, thereby fully accounting for all the events in a manner that is somehow realistic or at least satisfying. So she would, for example, convince herself by talking to him that my misbehavior did cause him to overreact, but his egregious, disproportional and unjustified misconduct, his reaction is because he is a psychopath and evil. So she combines the two narratives. I made him do it, but he shouldn't have done it. I made him do it. And the fact that he did it proves that he is an evil psychopathic person. And his new partner is an envious opportunist. And all the witnesses are malicious haters, et cetera, et cetera. So she restores grandiosity by vindictively punishing everyone involved, either metaphorically or symbolically, or sometimes in reality by taking actions. And of course, modifications is intimately connected to shame. Ironically, guilty people experience guilt because they have had the power to make a different choice. You can't feel guilty if you didn't have a choice. One cannot feel guilty when one is powerless or impotent and therefore not responsible for events, circumstances and decisions. So guilt goes with empowerment. You own your actions and the situation. Helpless people feel shame, not guilt. This is why pathological narcissism is associated with shame, not with guilt. The grandiosity gap is the difference between self-image, the way the narcissist perceives himself, the false self, and contravening cues from reality, the greater the disparity between grandiosity and reality, the bigger the gap, the greater the narcissist's feelings of shame. There are two varieties of shame, narcissistic shame, which is the narcissistic experience of the grandiosity gap and the affective correlate. Subjectively, narcissistic shame is experienced as a pervasive feeling of worthlessness. The dysfunctional regulation of self-worth is the crux of pathological narcissism, as you remember. So the narcissist feels, when he's ashamed, he feels worthless. He feels invisible, ridiculous. The patient feels pathetic, foolish, deserving of mockery and humiliation. Narcissists adopt all kinds of defenses to counter narcissistic shame. They develop addictive, reckless, or impulsive behaviors. They deny, they repress, they withdraw, they rage, they engage in a compulsive pursuit of some kind. Unattainable, of course. They try to be perfect. They display haughtiness and exhibitionism. All these defenses are primitive. They involve splitting, projection, projective identification, intellectualization, all kinds of psychological defenses. The second type of shame is self-related. It is a result of the gap between the narcissist's grandiose ego ideal and his self, or his ego, which is very minimal in dysfunction. This is a well-known concept of shame and it has been explored widely in the works of Freud in 1914, Reich, 1960, Jacobson in 1964, Kogut in 1967, Kingston in 1983, Sparrow in 1984 and Morrison in 1989. But one must draw a clear distinction between guilt or control and guilt-related shame and conformity-related shame. Again, guilt is an objectively, so to speak, determinable philosophical entity. Given a relevant knowledge regarding society and culture in question, you can anticipate or predict when guilt will arise. It is context-dependent. It is the derivative of an underlying assumption by others that a moral agent exerts control over certain aspects of the world. This assumed control by the agent imputes guilt to the agent. If the agent acts in a manner in commensurate with prevailing morays, morals, conventions, or if the agent refrains from acting in a manner commensurate with these. So there's always an agent, someone with will and control, who could have made a different choice. Choice is crucial, crucial component of guilt. Shame in this case is the outcome of the actual occurrence of avoidable outcomes, events which impute guilt to a moral agent who acted wrongly or refrained from acting. So this is a specific type of shame, shame connected to guilt. And again, it's the outcome of actual avoidable outcomes which impute guilt to the moral agent because he acted wrongly or refrained from acting, which is in itself wrong very often. And we must distinguish guilt from guilt feelings as well. Guilt follows events. Guilt feelings can precede events. Guilt feelings in the attaching shame, guilt related shame, can be anticipatory. Moral agents assume that they control certain aspects of the world. This makes them able to predict the outcomes of their intentions and to feel guilt and shame as a result, even if nothing had happened. Guilt feelings are composed of a component of fear and a component of anxiety. Fear is related to the external, objective, observable consequences of actions or inaction by the moral agent. Anxiety has to do with inner consequences. It is ego dystonic. It threatens the identity of the moral agent because being moral is an important part of the identity of a moral agent. The internalization of guilt feelings leads to a shame reaction. This is the connection, the subterranean connection between guilt and guilt related shame. But remember, guilt related shame is not the same as narcissistic shame or self-related shame. Thus shame has to do with guilty feelings, not with guilt. And so let me remind you, guilt is determined by the reactions and anticipated reactions of others to external outcomes, such as avoidable waste or preventable failure. So there's a fear component here. Guilty feelings are the reactions and anticipated reactions of the moral agent himself to internal outcomes, to helplessness, loss of presumed control, narcissistic injuries, anxieties and so on. And so far, and so we now establish that there are three types of shame, narcissistic, self-related, guilt related. This is the fourth type, conformity related shame. It has to do with the narcissistic feeling of otherness. Narcissist feels alien, freakish, an outlier, an outcast. This kind of shame involves a component of fear, of the reactions of others to one's otherness, and a component of anxiety, of the reactions of oneself to one's otherness. Guilt related shame is connected to self-related shame, perhaps through a psychic construct akin to the superego. Conformity related shame is more akin to narcissistic shame. Lydia Rangelovska suggested, made a few observations about shame. She advanced the idea that some children subjected to abuse in dysfunctional families, these children are objectified, dehumanized, the boundaries abridged, the growth is stunted. So Rangelovska suggested, these kind of children develop intense feelings of shame. They turn out to be codependence on narcissists owing to their genetic make-up and innate character. But according to Rangelovska, children who turned out to be codependence as adults are resilient, while the more fragile narcissists seek to evade shame by co-cocting and then deploying the false self. So Rangelovska says there's a universal setting abusing these one-true families. And then the resilient ones become codependence, and the more fragile and vulnerable ones become narcissists, and they are trying to evade shame by not being, by denying their own existence, by disappearing into or away from a false self. As she observes, shame motivates normal people, and those suffering from plus to b personality disorders differently. Shame constitutes a threat to normal people, to the true self of normal people, but it constitutes a threat to the false self of narcissists borderlines and so on. Owing to the disparate functionality and psychodynamics of the true self and false self, the ways shame affects behavior and manifests in both populations different. Additionally, pervasive constant shame forces anxiety and even fears or phobias. These can have either an inhibitory effect or, on the contrary, a disinhibitory function. In other words, shame creates anxiety, fear and phobia and these can either inhibit you, paralyze you, or they can actually push you to action, motivate you to action. Both narcissists and co-dependence compensate for their shame. The former narcissists by developing a need to be needed, and the latter by developing a need to deny their neediness. So co-dependence have a need to be needed and narcissists have a need to deny their neediness. The true self involves an accurate reality test with minimal and marginal cognitive deficits, as well as the capacity to empathize on all levels, including especially the emotional level. People whose true self is intact, mature and operational are capable of relating to others deeply, for example, by loving them. The sense of self worth of these kind of people, healthy people is stable, it's grounded in a true and tested assessment of who they are, reality testing, maintaining a distinction between what we really are and what we dream of becoming, knowing our limits, our advantages and faults, and having a sense of realistic accomplishment in our life. All these are paramount importance in the establishment and maintenance of our self-esteem, sense of self-worth and self-confidence. Shame threatens a true self by challenging the affected person's ego-syntony, by forcing her to feel bad about something she had said or done. And the solution is usually facile and usually easy in at hand. Reverse the shameful situation by apologizing or by making amends, that's what we all do. We feel ashamed, we apologize. In contrast, the forced self leads to forced assumptions, to an impaired reality testing, to a contorted personal narrative, to a fantastic worldview, to a grandiose inflated sense of being. And this grandiosity is rarely grounded in real achievement or real merit. The narcissist's feeling of entitlement is all-pervasive, ubiquitous, demanding and aggressive. It easily deteriorates into open verbal, psychological, physical abuse of others. When the patient with a forced self feels shame, it is because his grandiosity, the fantastic narrative that underpins his false self, is challenged, usually, but not necessarily, in public. There is no easy solution to such a predicament, such modification. The situation cannot be reversed, the psychological damage is done, whatever happens, later. The patient urgently needs to reassert his grandiosity by devaluing or even destroying the frustrating, threatening object, the source of his misery. Another option is to reframe the situation by delusionally ignoring it or recasting it in new terms. It was all my fault. I controlled it. So while shame motivates normal people to conduct themselves pro-socially and realistically, shame pushes the disordered patient, the narcissist, and the borderline, the psychopath, in the exact opposite direction to antisocial or delusional reactions. Shame is founded on empathy. The normal person empathizes with others. The disordered patient empathizes with himself. But empathy and shame have little to do with a person with whom we empathize, the empathy. They may simply be the result of conditioning and socialization. In other words, when we hurt someone, we don't really experience his or her pain. We experience our pain. Hurting somebody hurts us. The reaction of pain is provoking us by our own actions. We have internalized other people's pain. We have been taught a learned response to feel pain when we hurt someone. So it's learned, it's like learned helplessness. We attribute feelings, sensations, and experiences to the object of our actions. It is the psychological defense mechanism, projection. Unable to conceive of inflicting pain upon ourselves, we displace the source. It is the other pain that we are feeling. We keep telling ourselves, not our own. In other words, when we hurt someone, we actually hurt ourselves. But because we cannot admit that we are hurting ourselves, we say we hurt someone. Hurting someone is a piece of fiction. You can hurt other people, of course, no question about it. But what you feel about it is when you hurt yourself. And because you cannot admit that by hurting others, you're actually hurting yourself, you stick to the fiction that you're hurting only others. Additionally, we have been taught to feel responsible for our fellow beings and to develop guilt and shame when we fail to do so. So we also experience pain whenever another person claims to be anguished or feel guilty or into his or her condition. We feel somehow, I don't know, responsible, accountable, even if we had nothing to do with the whole affair. We feel ashamed that we haven't been able to end another person's agony. And this agony is the key to healing narcissism. The key. The narcissist needs to go again through the original conflict with his primary object, usually mother. He needs to experience agony. He needs to be able to feel again. Only by being re-traumatized and modified can he regain a sense of his true self and understand and assimilate and integrate the insight that there is nothing about his false self that is real and everything that is false and that it is no longer functional in his adulthood, no longer adaptive in his adulthood as it had been in his childhood, in many cases leading him to dysfunction, humiliation and further modification. False self as a narcissist, biggest enemy, it made him disappear as a child and it does everything in its power to make sure that it never reappeared. The narcissist never reappears. Not as a child, not as an adult, not in any form. A false self is a parasitic psychological construct which had taken over the narcissist like a body snatcher and in therapy we should teach the narcissist to feel again but not to feel love in the first stage, to feel shame, to feel shame and then to feel guilt and then the rudiments of empathy and this can be done only if we shatter explosively the false self by forcing the narcissist to experience modification, traumatic modification and this is a very good summary of what we do in cold therapy.