Integrating Faith and Psychiatry, Part 3: Narcissism

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Narcissism post

It goes without saying that narcissists have an inflated view of themselves, one that frequently masks a hidden sense of emptiness and inferiority. What’s not so obvious, according to Laity Leadership Senior Fellow Allan Josephson, M.D., is that those who are in relationship with a narcissist “by definition become depleted or depressed, because life always has to reflect the grandeur, the beauty, the intelligence of the narcissist.”

Lack of Empathy

The key hallmark of narcissism is a lack of empathy, Josephson said. Empathy is when you put yourself in someone else’s shoes as much as is humanly possible and try to understand what their world is like. Good parents empathize with their children, and spouses in healthy marriages empathize with each other.

“Narcissists can’t do it. It’s like they have a mirror in front of their face. At this extreme, the narcissist’s view is all that matters. ‘It’s all about them,’” he said.

Predictably, relationships for narcissists, both personal and professional, tend to be short lived.

Pathology or the Sin of Pride?

Ours is an increasingly narcissistic culture, Josephson said, but there is a difference between the clinical problem of narcissism and the sin of pride that plagues us all.

A psychologically healthy musician, for example, may become jealous of a fellow musician’s accomplishment, but in working to keep her jealousy in check, she is aware and somewhat ashamed of her feelings. Ideally, she asks for forgiveness. On the other hand, a narcissistic parent does not share the joy of their child doing something well, but sees their children as objects of their own success. A narcissistic leader takes credit for the work of his or her subordinates.

“That’s a type of theft. It induces anger, and it’s not right. One could call it a sin too, but when it gets like that, it’s beyond the normal nature that we all share,” Josephson explained.

Failure to Listen or Take Responsibility

Narcissists also don’t listen. “When I see a narcissistic leader in the workplace, employees often complain that he or she doesn’t listen and that they don’t feel understood. It’s a one-way exercise,” he said.

They don’t take responsibility for their failures and can’t stand criticism. A spouse, for example, will do something awful in a marriage and describe it as a mistake rather than a destructive wrong.

“A lot of us in the therapy business say that work with narcissistic patients is kind of like you pin prick a bubble,” Josephson said. “You can’t bluntly challenge them; you gently have to introduce the idea that maybe they’re not the greatest person in the world. Maybe other people have needs too.”

Narcissistic Parents and Children

Children who have an abundance of material goods or whose abilities or achievements are trumpeted by a narcissistic parent will often not feel a sense of the parent’s true love, but will instead feel used. “That’s a subtle feeling, but a very real one,” he said.

Children become narcissistic either through indulgence or neglect, Josephson said.


An indulged child will feel entitled or feel that he’s special because that’s how he’s been treated. For example, a child comes home from school with a note from her teacher about a behavior problem. Instead of correcting the child, the parent will say, “The teacher can’t criticize my kid.”

“The experience of the child is then that she is really supported in whatever she does,” Josephson said. This kind of excuse making or removal of distress eventually creates an emotionally crippled child, he explained, because life never offers unequivocal support in all endeavors.

Sometimes parents who’ve been through trauma themselves will overcompensate and indulge their children. A single mom, for example, may feel bad and indulge her son because he doesn’t have a father around and other kids have fathers.

“The way we look at it clinically is that this child is getting something more than he or she needs and it is developmentally a little inappropriate.” You have to let them fall down and skin their knees and learn how to deal with it. "There’s a certain amount of mastery and confidence gained in being knocked down and getting back up again,” he added.

Emotional Neglect

The second and more common cause of narcissism is emotional neglect or deprivation. Josephson compares this developmental experience to five hungry children sitting around a table at which only three hamburgers are served for dinner.

“What happens is they all grab for them because there’s not enough to go around,” he said. “There are other variables that might determine how they behave, but the child thinks, ‘I’ll take care of myself because no one else is going to take care of me.’ ”

This kind of neglect produces an aggressive self-centeredness, Josephson said, and can result in stealing and lying, even if the child has been taught not to steal or lie.

Curing Narcissism in Children

From a clinical standpoint then, parents must simply try to decrease the indulgence or increase the nurturance, he said. “If you’re too available to your kids, you’ve got to back off. If you are unavailable, you need to engage them in a relationship."

Like adding material to a garment rather than trimming excess; it is much more difficult to become more engaged or to be more available than to back off, he said.

Evaluating Yourself

In marriage, if your spouse says, “You interrupt people” or, “You don’t listen,” you may have a problem with narcissism. So listen to those around you, Josephson advises.

He suggests that the individual – parent, spouse, leader - who has a problem with narcissism should ask the following questions of himself or herself, to enable self understanding. Such self understanding is essential in forming enduring relationships.

Personal Vulnerability/Narcissism

  • Are you threatened by the achievements of others – those who report to you and those “above” you in the organizational hierarchy? Do they seem to get credit you believe is your due? What happens to you emotionally when others get compliments?
  • Do you ever wonder why people don’t seem to like you?
  • Is your anger easily triggered by negative comments about your performance? Is it easy for you to look for “kernels of truth” in the comments?
  • Have you been able to sustain long term relationships/friendships, or do people seem to come and go in your life?
  • How competitive are you? What happens to you emotionally when someone else seems to “win” at your expense?
  • To whom are you closest in an emotional sense? Personally and professionally? Could you articulate what is most important to them in their life?
  • Do people ever comment on your leadership: “He/she doesn’t listen! He/she doesn’t hear me.”
  • Have you ever been accused of bending, or breaking, “the rules”?

The Road to Psychological and Spiritual Health

In a culture that increasingly celebrates narcissism, followers of Christ are called to resist this temptation. Doing so is both psychologically and spiritually healthy. Not only that, but to love our neighbors as ourselves is to walk in the way of Christ.

Allan Josephson, M.D. is Vice Chairman for Adolescent Psychiatric Services at the University of Louisville School of Medicine and author of three books, including the Handbook of Spirituality and Worldview in Clinical Practice, a text he edited and contributed to that is used in psychiatric residency programs to help psychiatrists understand the diagnostic and therapeutic implications of their own and their patients' worldviews.