WEBVTT 00:00:00.000 --> 00:00:02.080 I want to take you back a bit, way back. We're 00:00:02.080 --> 00:00:03.980 in the year 8 AD. Okay. We're in the ancient 00:00:03.980 --> 00:00:07.240 Roman world. And the poet Ovid is sitting down 00:00:07.240 --> 00:00:10.419 to write what will become, you know, his masterpiece, 00:00:10.619 --> 00:00:13.759 the Metamorphoses. Right. And he decides to tell 00:00:13.759 --> 00:00:17.199 the story about a specific young man, a hunter. 00:00:17.559 --> 00:00:21.120 And this guy is just physically stunning. I mean, 00:00:21.140 --> 00:00:23.539 the kind of beauty that would stop traffic or 00:00:23.539 --> 00:00:26.679 I guess stop chariots back then. But he's also 00:00:26.679 --> 00:00:30.609 emotionally impenetrable. Just cold. He rejects 00:00:30.609 --> 00:00:32.829 everyone who claims to love him, leaving this 00:00:32.829 --> 00:00:36.509 trail of broken hearts and spurned lovers deep 00:00:36.509 --> 00:00:39.049 in the forest. It's really the classic setup 00:00:39.049 --> 00:00:41.530 for a tragedy, isn't it? You have this beautiful, 00:00:41.710 --> 00:00:45.210 completely unreachable figure who thinks he's 00:00:45.210 --> 00:00:47.469 above the whole human condition of love and connection. 00:00:47.710 --> 00:00:50.429 Totally. And in the myth, the gods, specifically 00:00:50.429 --> 00:00:52.789 Nemesis, the goddess of revenge, they decide 00:00:52.789 --> 00:00:54.570 that, you know, this arrogance has gone on for 00:00:54.570 --> 00:00:56.770 long enough. She curses him. The curse is so 00:00:56.770 --> 00:00:59.109 specific. It is. And it's so cruel when you really 00:00:59.109 --> 00:01:01.170 think about it. He's doomed to fall in love, 00:01:01.210 --> 00:01:03.729 but never, ever to have his love returned. So 00:01:03.729 --> 00:01:06.359 the trap is set. As the story goes, this young 00:01:06.359 --> 00:01:09.120 hunter, he comes upon a pristine pool of water. 00:01:09.459 --> 00:01:12.260 It's perfectly still like glass. He leans over 00:01:12.260 --> 00:01:14.659 to get a drink, sees a face in the water, and 00:01:14.659 --> 00:01:17.000 is just instantly, violently captivated. But 00:01:17.000 --> 00:01:18.819 he doesn't realize he's looking at himself. Not 00:01:18.819 --> 00:01:21.659 at all. He thinks it's a water spirit or some 00:01:21.659 --> 00:01:24.040 beautiful stranger. He tries to kiss the water, 00:01:24.140 --> 00:01:26.780 but the second he touches the surface, the image 00:01:26.780 --> 00:01:29.879 just shatters. He pulls back, it returns, and 00:01:29.879 --> 00:01:33.400 he reaches out again. The beloved vanishes. He 00:01:33.400 --> 00:01:36.260 just stays there. Day after day, pining away, 00:01:36.359 --> 00:01:38.840 can't eat, can't sleep, until he literally just 00:01:38.840 --> 00:01:41.519 wastes away into death. And that young man's 00:01:41.519 --> 00:01:43.760 name, of course, was Narcissus. And from that 00:01:43.760 --> 00:01:46.560 one 2 ,000 -year -old myth, we get one of the 00:01:46.560 --> 00:01:49.640 most loaded, overused, and frankly weaponized 00:01:49.640 --> 00:01:53.159 words in our entire modern vocabulary. Narcissist. 00:01:53.200 --> 00:01:55.200 That is exactly what I want to tackle today. 00:01:55.280 --> 00:01:57.420 Because if you open up TikTok or Twitter or just, 00:01:57.420 --> 00:01:59.260 you know, eavesdrop on a brunch conversation, 00:01:59.700 --> 00:02:01.760 narcissist has become this catch -all term. Oh, 00:02:01.780 --> 00:02:05.209 absolutely. It means my ex who is a jerk, or 00:02:05.209 --> 00:02:09.169 someone who takes way too many selfies, or that 00:02:09.169 --> 00:02:12.340 boss who didn't give me a raise. It's just become 00:02:12.340 --> 00:02:14.719 a synonym for vanity or just being unpleasant. 00:02:15.080 --> 00:02:17.759 It really has. It's the pop culture villain of 00:02:17.759 --> 00:02:20.280 the decade. We diagnose people from, you know, 00:02:20.280 --> 00:02:23.280 miles away based on a bad text message. But for 00:02:23.280 --> 00:02:26.000 this deep dive, we are stripping all of that 00:02:26.000 --> 00:02:27.919 away. Getting back to the source. We're going 00:02:27.919 --> 00:02:29.759 back to the source material, specifically the 00:02:29.759 --> 00:02:31.840 clinical and scientific literature around what 00:02:31.840 --> 00:02:34.099 is called narcissistic personality disorder or 00:02:34.099 --> 00:02:36.759 NPD. We're moving away from the colloquial insult 00:02:36.759 --> 00:02:40.419 and looking at the actual machinery of the disorder. 00:02:41.039 --> 00:02:43.259 When you look at that machinery, it's not just 00:02:43.259 --> 00:02:45.439 about a guy loving his own reflection, is it? 00:02:45.500 --> 00:02:47.879 Not at all. In fact, that reflection story is 00:02:47.879 --> 00:02:49.979 almost misleading because it implies self -love. 00:02:50.159 --> 00:02:52.639 The clinical reality is about a person who has 00:02:52.639 --> 00:02:55.860 a fractured, deeply unstable sense of self, who 00:02:55.860 --> 00:02:57.860 can't connect with others, and who, according 00:02:57.860 --> 00:03:00.400 to the data, is often suffering or causing immense 00:03:00.400 --> 00:03:03.099 suffering in ways that are so much more complex 00:03:03.099 --> 00:03:06.479 than just having a big ego. So our mission today 00:03:06.479 --> 00:03:09.439 is to really peel back that label. We're going 00:03:09.439 --> 00:03:11.759 to look at the brain structure. The genetics, 00:03:11.960 --> 00:03:13.840 which I think are going to surprise a lot of 00:03:13.840 --> 00:03:16.060 people. Definitely. The tragic paradoxes and 00:03:16.060 --> 00:03:19.240 even the diagnosis wars that almost tore the 00:03:19.240 --> 00:03:21.539 entire psychiatric community apart. And we're 00:03:21.539 --> 00:03:24.639 going to cover the shy narcissist, the so -called 00:03:24.639 --> 00:03:28.259 saintly narcissist, and the biological reality 00:03:28.259 --> 00:03:30.560 of why they do what they do. Okay, so let's define 00:03:30.560 --> 00:03:33.360 the scope for you, the listener. We are treating 00:03:33.360 --> 00:03:36.300 the source material, the comprehensive documentation 00:03:36.300 --> 00:03:40.520 on the disorder, as our roadmap. And if you think 00:03:40.520 --> 00:03:42.439 you know what a narcissist looks like, you know, 00:03:42.460 --> 00:03:45.219 loud, arrogant, braggadocious, you might be missing 00:03:45.219 --> 00:03:47.080 half the picture. Because sometimes the most 00:03:47.080 --> 00:03:49.960 dangerous narcissist is the quietest person in 00:03:49.960 --> 00:03:52.219 the room. That's a chilling thought. Okay, let's 00:03:52.219 --> 00:03:54.340 unpack this. If a clinician is sitting down with 00:03:54.340 --> 00:03:56.800 a patient, what are the actual boxes that need 00:03:56.800 --> 00:03:59.400 to be ticked? What is the clinical portrait of 00:03:59.400 --> 00:04:02.219 NPD? Well, historically and clinically, we look 00:04:02.219 --> 00:04:05.300 at what you could call the big four core characteristics. 00:04:05.620 --> 00:04:07.900 These are really the pillars. If you don't have 00:04:07.900 --> 00:04:10.360 these, you don't have the disorder. The first 00:04:10.360 --> 00:04:13.960 and the one everyone knows is grandiosity. Grandiosity. 00:04:14.439 --> 00:04:17.980 So I am the greatest. It's more than just confidence. 00:04:18.060 --> 00:04:20.560 It's a distortion of reality. It's an exaggerated 00:04:20.560 --> 00:04:23.180 sense of self -importance where the person believes 00:04:23.180 --> 00:04:27.420 they are inherently superior, unique, or... you 00:04:27.420 --> 00:04:29.800 know destined for greatness that others just 00:04:29.800 --> 00:04:31.980 can't comprehend so it's not i'm good at math 00:04:31.980 --> 00:04:35.800 no it's i am a mathematical genius and regular 00:04:35.800 --> 00:04:38.740 teachers can't possibly understand my gift Got 00:04:38.740 --> 00:04:40.959 it. It separates them from the common people. 00:04:41.060 --> 00:04:43.060 Correct. And that leads directly to the second 00:04:43.060 --> 00:04:45.959 pillar, entitlement. This is the belief that 00:04:45.959 --> 00:04:48.040 the world owes you something. It's this unreasonable 00:04:48.040 --> 00:04:50.800 expectation of especially favorable treatment. 00:04:51.060 --> 00:04:53.399 The rules apply to you, but they don't apply 00:04:53.399 --> 00:04:55.540 to me because I'm special. So this is the person 00:04:55.540 --> 00:04:57.220 who cuts the line at the airport, not because 00:04:57.220 --> 00:04:59.160 they're in a rush, but because they genuinely 00:04:59.160 --> 00:05:02.769 believe that standing in line is just... Beneath 00:05:02.769 --> 00:05:04.870 them. Precisely. And they're baffled if you call 00:05:04.870 --> 00:05:06.730 them out on it. They give you that, don't you 00:05:06.730 --> 00:05:08.870 know who I am? Like, even if nobody knows who 00:05:08.870 --> 00:05:10.569 they are. Right. Then we have the third pillar, 00:05:10.689 --> 00:05:12.730 which is, I would argue, the most destructive. 00:05:13.550 --> 00:05:16.490 Low empathy. This is the big one. Right. But 00:05:16.490 --> 00:05:18.899 does low empathy mean they're robots? That they 00:05:18.899 --> 00:05:21.379 feel nothing. No, and we'll get into the nuance 00:05:21.379 --> 00:05:23.620 of this later because it is absolutely fascinating. 00:05:24.100 --> 00:05:27.379 But diagnostically, it's defined as an unwillingness 00:05:27.379 --> 00:05:30.579 or an inability to recognize or identify with 00:05:30.579 --> 00:05:33.060 the feelings and needs of others. It's like being 00:05:33.060 --> 00:05:35.699 colorblind human emotion. So you tell them your 00:05:35.699 --> 00:05:38.139 dog died. And they look at you and say, okay, 00:05:38.240 --> 00:05:40.560 but are we still going to dinner? It's just a 00:05:40.560 --> 00:05:44.199 missing circuit. Wow. And the fourth? Interpersonal 00:05:44.199 --> 00:05:47.139 difficulties. Which is just the natural result 00:05:47.139 --> 00:05:49.279 of the first three. If you're grandiose, you're 00:05:49.279 --> 00:05:51.600 entitled and you lack empathy, your relationships 00:05:51.600 --> 00:05:53.319 are going to hit a wall. They're usually superficial 00:05:53.319 --> 00:05:56.199 or exploitative or just incredibly turbulent. 00:05:56.339 --> 00:06:00.279 They can't maintain long term healthy bonds because 00:06:00.279 --> 00:06:04.160 a bond requires mutuality and NPD is inherently 00:06:04.160 --> 00:06:06.740 one sided. Now, where does this sit in the grand 00:06:06.740 --> 00:06:09.930 scheme of mental health? I hear the term cluster 00:06:09.930 --> 00:06:12.110 B thrown around all the time on social media. 00:06:12.250 --> 00:06:14.750 Stay away from cluster Bs. What neighborhood 00:06:14.750 --> 00:06:18.310 are we actually in here? So the DSM, the Diagnostic 00:06:18.310 --> 00:06:20.490 and Statistical Manual of Mental Disorders, it 00:06:20.490 --> 00:06:23.050 groups personality disorders into clusters based 00:06:23.050 --> 00:06:26.899 on shared traits. NPD falls into cluster B. And 00:06:26.899 --> 00:06:29.120 this is the cluster that's described as the dramatic, 00:06:29.319 --> 00:06:32.839 emotional or erratic disorders. So NPD shares 00:06:32.839 --> 00:06:34.819 the space with borderline personality disorder, 00:06:35.220 --> 00:06:38.139 antisocial personality disorder and histrionic 00:06:38.139 --> 00:06:40.100 personality disorder. So it's a high conflict 00:06:40.100 --> 00:06:42.540 neighborhood. Extremely high conflict. The whole 00:06:42.540 --> 00:06:44.980 vibe of cluster B is emotional dysregulation 00:06:44.980 --> 00:06:48.600 and real difficulty with impulse control. But 00:06:48.600 --> 00:06:50.120 I want to pause here for a second because there's 00:06:50.120 --> 00:06:52.000 a crucial distinction we have to make. Okay. 00:06:52.120 --> 00:06:54.199 A lot of successful, highly functional people 00:06:54.199 --> 00:06:57.040 have these traits. You can be grandiose and entitled 00:06:57.040 --> 00:07:01.720 and be a Fortune 500 CEO or a huge movie star. 00:07:02.000 --> 00:07:04.100 Right. We almost expect our rock stars to be 00:07:04.100 --> 00:07:06.720 narcissists. We kind of reward it. We do. We 00:07:06.720 --> 00:07:09.399 reward it. But the DSM has a very strict rule. 00:07:09.800 --> 00:07:13.019 It's only a disorder when these traits are inflexible, 00:07:13.220 --> 00:07:16.560 maladaptive, persisting, and cause significant 00:07:16.560 --> 00:07:18.980 functional impairment or subjective distress. 00:07:19.480 --> 00:07:22.000 That's the threshold. That's the normalcy versus 00:07:22.000 --> 00:07:25.240 disorder threshold. If you're arrogant, but you 00:07:25.240 --> 00:07:27.459 have a happy marriage, you hold down a job, and 00:07:27.459 --> 00:07:29.800 you generally get along with people, you might 00:07:29.800 --> 00:07:32.980 be a jerk, but you don't have NPD. NPD requires 00:07:32.980 --> 00:07:35.319 that your life is messy because of your personality. 00:07:36.079 --> 00:07:38.139 There's an interesting paradox mentioned in the 00:07:38.139 --> 00:07:41.139 sources regarding ambition. You'd think, with 00:07:41.139 --> 00:07:43.720 all this grandiosity, I am destined for greatness, 00:07:43.860 --> 00:07:47.019 that narcissists would always be high achievers. 00:07:47.100 --> 00:07:49.060 They'd be the ones taking the biggest risks. 00:07:49.120 --> 00:07:51.100 Right, you'd expect that. But the sources say 00:07:51.100 --> 00:07:52.899 that's not always the case. No, it's the paradox 00:07:52.899 --> 00:07:55.480 of ambition. While that overconfidence often 00:07:55.480 --> 00:07:58.660 does fuel ambition, people with NPD are often 00:07:58.660 --> 00:08:01.379 terrified of failure or... More specifically, 00:08:01.600 --> 00:08:03.540 they're terrified of the appearance of failure. 00:08:03.680 --> 00:08:05.899 Because failure would shatter the grandiosity. 00:08:06.060 --> 00:08:07.839 Exactly. It's a house of cards. So they play 00:08:07.839 --> 00:08:11.220 it safe. They often avoid risks. They won't apply 00:08:11.220 --> 00:08:13.680 for the big promotion if there is even a 10 percent 00:08:13.680 --> 00:08:15.920 chance they won't get it because not getting 00:08:15.920 --> 00:08:18.519 it would be a narcissistic injury they just can't 00:08:18.519 --> 00:08:21.000 handle. So you see a lot of people with NPD who 00:08:21.000 --> 00:08:24.000 underachieve. They talk a huge game. You know, 00:08:24.019 --> 00:08:26.379 I could have run this company, but they never 00:08:26.379 --> 00:08:29.399 actually put themselves in the arena. They want 00:08:29.399 --> 00:08:32.059 the accolades without the risk. It's a fragility 00:08:32.059 --> 00:08:35.230 hidden behind all that armor. Yeah. And that 00:08:35.230 --> 00:08:37.750 leads us perfectly into the next segment, because 00:08:37.750 --> 00:08:40.269 I think the biggest misconception, and the one 00:08:40.269 --> 00:08:42.370 I've certainly had before reading this source 00:08:42.370 --> 00:08:45.210 material, is that all narcissists act the same 00:08:45.210 --> 00:08:48.870 way. We think of the loud bragger, but the sources 00:08:48.870 --> 00:08:51.590 describe two very distinct faces of this disorder. 00:08:51.809 --> 00:08:53.769 This is absolutely critical for the listener 00:08:53.769 --> 00:08:55.730 to understand. If you are only looking for the 00:08:55.730 --> 00:08:57.850 loud narcissist, you are going to miss the quiet 00:08:57.850 --> 00:09:00.419 one who might be just as destructive. We tend 00:09:00.419 --> 00:09:03.179 to think of the thick -skinned, grandiose narcissist. 00:09:03.519 --> 00:09:05.899 This is the archetype. The Tony Stark type, or 00:09:05.899 --> 00:09:08.159 maybe that's too generous because Tony has a 00:09:08.159 --> 00:09:10.320 heart deep down. Maybe think more of the corporate 00:09:10.320 --> 00:09:13.259 raider or the reality TV star who thrives on 00:09:13.259 --> 00:09:17.120 conflict. This type is arrogant, socially dominant, 00:09:17.360 --> 00:09:19.679 exhibitionistic. They believe they're unique. 00:09:19.840 --> 00:09:22.460 They believe others are envious of them. And 00:09:22.460 --> 00:09:25.639 here's the kicker. Psychologically, these thick 00:09:25.639 --> 00:09:28.850 -skinned types often report feeling good. Wait, 00:09:28.870 --> 00:09:30.850 they don't suffer? They report higher levels 00:09:30.850 --> 00:09:32.990 of psychological well -being. They don't have 00:09:32.990 --> 00:09:35.250 anxiety. They don't have depression. They walk 00:09:35.250 --> 00:09:37.990 into a room and they own it because their delusion 00:09:37.990 --> 00:09:40.929 is working. They truly, genuinely believe they 00:09:40.929 --> 00:09:42.970 are better than everyone else. So the disorder 00:09:42.970 --> 00:09:45.549 isn't painful for them? Exactly. The suffering 00:09:45.549 --> 00:09:47.710 is all externalized. They don't suffer. Their 00:09:47.710 --> 00:09:49.789 spouses, their employees, their children suffer. 00:09:50.049 --> 00:09:52.110 They're the hurricane and everyone else is just 00:09:52.110 --> 00:09:55.279 getting wet. That is terrifying. But then there's 00:09:55.279 --> 00:09:57.600 the other side. And this was the real aha moment 00:09:57.600 --> 00:10:01.620 for me. The thin skinned or vulnerable narcissist. 00:10:02.000 --> 00:10:05.240 Yes. This is the type that flies completely under 00:10:05.240 --> 00:10:08.799 the radar. Vulnerable narcissism looks very, 00:10:08.879 --> 00:10:11.299 very different on the surface. These individuals 00:10:11.299 --> 00:10:13.840 are often shy. They can be introverted. They 00:10:13.840 --> 00:10:16.360 are hypersensitive to criticism. They struggle 00:10:16.360 --> 00:10:19.320 with these deep feelings of shame and inferiority. 00:10:19.419 --> 00:10:22.419 But hold on. If they're shy and they feel inferior. 00:10:22.960 --> 00:10:24.960 How are they narcissists? Doesn't that contradict 00:10:24.960 --> 00:10:27.720 the whole grandiosity rule? That's the paradox. 00:10:28.350 --> 00:10:30.750 The core machinery is identical. They still have 00:10:30.750 --> 00:10:32.710 extremely high entitlement. They still have that 00:10:32.710 --> 00:10:35.250 intense self -focus. But instead of saying, I 00:10:35.250 --> 00:10:37.730 am the king, look at me, the internal monologue 00:10:37.730 --> 00:10:40.549 is, I am the misunderstood genius. I am special, 00:10:40.750 --> 00:10:43.149 but the world just refuses to recognize it. Ah, 00:10:43.190 --> 00:10:45.409 so it's a victim narrative, but it's a superior 00:10:45.409 --> 00:10:48.129 victim narrative. Precisely. I am suffering more 00:10:48.129 --> 00:10:50.429 than anyone else because I am so deep, so unique, 00:10:50.529 --> 00:10:53.049 so sensitive. It's still all about them. And 00:10:53.049 --> 00:10:55.110 unlike the thick skin type, the vulnerable narcissist 00:10:55.110 --> 00:10:58.350 is chemically extremely volatile. They're prone 00:10:58.350 --> 00:11:00.509 to what's called narcissistic rage when they 00:11:00.509 --> 00:11:02.809 feel rejected. The sources mention that this 00:11:02.809 --> 00:11:06.210 vulnerable type is highly correlated with neuroticism, 00:11:06.289 --> 00:11:09.470 whereas the grandiose type is linked to agentic 00:11:09.470 --> 00:11:12.399 extroversion. Can you break those terms down 00:11:12.399 --> 00:11:15.440 for us? Sure. So neuroticism is essentially a 00:11:15.440 --> 00:11:18.840 tendency toward negative emotion, anxiety, worry, 00:11:19.139 --> 00:11:22.860 anger, moodiness. The vulnerable narcissist is 00:11:22.860 --> 00:11:25.220 miserable. They are constantly scanning the room 00:11:25.220 --> 00:11:27.600 for slights. Did that person look at me the wrong 00:11:27.600 --> 00:11:30.519 way? Why didn't they laugh at my joke? They interpret 00:11:30.519 --> 00:11:33.639 totally neutral events as personal attacks. And 00:11:33.639 --> 00:11:36.360 agentic extroversion. That's the drive for reward, 00:11:36.659 --> 00:11:39.299 dominance, and achievement. The grandiose narcissist 00:11:39.299 --> 00:11:41.360 assumes everyone loves them, or if they don't, 00:11:41.360 --> 00:11:43.419 they're just jealous haters. They have this buffer 00:11:43.419 --> 00:11:45.620 against the world. The vulnerable narcissist 00:11:45.620 --> 00:11:48.840 has no buffer. They're an exposed nerve. Is it 00:11:48.840 --> 00:11:51.500 possible to be both? Or are you sort of locked 00:11:51.500 --> 00:11:53.679 into one lane? This is a subject of debate called 00:11:53.679 --> 00:11:56.179 fluctuation theory. The evidence suggests that 00:11:56.179 --> 00:11:58.460 people with the vulnerable profile often oscillate 00:11:58.460 --> 00:12:00.279 up into grandiosity. They might have a moment 00:12:00.279 --> 00:12:01.879 where they feel on top of the world. Maybe they 00:12:01.879 --> 00:12:04.700 get a big compliment. And for an hour, they're 00:12:04.700 --> 00:12:07.059 the grandiose king. And then they crash. Then 00:12:07.059 --> 00:12:09.279 something happens, a perceived slight, and they 00:12:09.279 --> 00:12:12.179 crash right back down into shame. What about 00:12:12.179 --> 00:12:15.940 the grandiose types? Do they ever crash? Rarely. 00:12:16.379 --> 00:12:19.019 The data shows grandiose types very rarely show 00:12:19.019 --> 00:12:21.200 vulnerability. They seem to have a much more 00:12:21.200 --> 00:12:24.440 stable, albeit diluted, self -image. So you're 00:12:24.440 --> 00:12:26.860 right. The vulnerable ones are riding this emotional 00:12:26.860 --> 00:12:29.820 roller coaster. And the grandiose ones are driving 00:12:29.820 --> 00:12:31.860 the roller coaster off the tracks while smiling 00:12:31.860 --> 00:12:34.379 for the camera. I want to circle back to the 00:12:34.379 --> 00:12:36.879 empathy piece. Because low empathy feels like 00:12:36.879 --> 00:12:39.340 such a damning label. And I think a lot of listeners 00:12:39.340 --> 00:12:41.919 might worry, do I have low empathy? Does it mean 00:12:41.919 --> 00:12:45.730 they literally cannot feel? Or is it that they 00:12:45.730 --> 00:12:48.309 choose not to? This is where we have to be really 00:12:48.309 --> 00:12:50.690 clinically precise because the popular understanding 00:12:50.690 --> 00:12:52.710 is just wrong. We have to distinguish between 00:12:52.710 --> 00:12:55.070 emotional empathy and cognitive empathy. Okay, 00:12:55.129 --> 00:12:57.370 break that down for us. Emotional empathy is 00:12:57.370 --> 00:13:00.429 feeling what you feel. If I see you crying and 00:13:00.429 --> 00:13:02.730 I feel a physical pang of sadness in my own chest, 00:13:02.970 --> 00:13:05.190 that's emotional empathy. It's a visceral, you 00:13:05.190 --> 00:13:07.730 know, contagion of emotion. It happens automatically 00:13:07.730 --> 00:13:10.190 for most of us. And cognitive empathy? Cognitive 00:13:10.190 --> 00:13:13.169 empathy is knowing what you feel. It's intellectual. 00:13:13.309 --> 00:13:15.750 It's looking at you and computing. Oh, he's crying. 00:13:15.870 --> 00:13:17.750 Water is coming out of his eyes. His face is 00:13:17.750 --> 00:13:20.809 contorted. Therefore, he is sad. It's just data 00:13:20.809 --> 00:13:24.289 processing. So where's the deficit in NPD? The 00:13:24.289 --> 00:13:27.129 evidence shows that people with NPD have significant 00:13:27.129 --> 00:13:29.629 deficits in emotional empathy. They don't catch 00:13:29.629 --> 00:13:32.049 the feeling. If you're crying, they don't feel 00:13:32.049 --> 00:13:34.070 sad. They might even feel annoyed or impatient. 00:13:34.610 --> 00:13:37.429 However, their cognitive empathy is often preserved. 00:13:38.029 --> 00:13:40.090 They know you're sad. They just don't feel it. 00:13:40.169 --> 00:13:42.029 Which actually makes them effective manipulators, 00:13:42.110 --> 00:13:44.570 right? Because if I know what buttons to push 00:13:44.570 --> 00:13:47.429 to make you react, but I don't feel bad about 00:13:47.429 --> 00:13:49.289 hurting you. That is the dangerous combination. 00:13:49.370 --> 00:13:51.210 If you have zero empathy at all, you're just 00:13:51.210 --> 00:13:53.309 confused by people. If you have cognitive empathy 00:13:53.309 --> 00:13:55.309 but no emotional empathy, you can be a predator. 00:13:55.509 --> 00:13:58.210 You can feign concern perfectly because you know 00:13:58.210 --> 00:14:00.370 what concern is supposed to look like. There's 00:14:00.370 --> 00:14:03.090 a fascinating study mentioned in the source material, 00:14:03.190 --> 00:14:06.149 the instruction study. This really blew my mind 00:14:06.149 --> 00:14:08.409 regarding that ability versus choice debate. 00:14:08.730 --> 00:14:11.309 This is a crucial piece of research. Researchers 00:14:11.309 --> 00:14:13.629 hooked participants up to brain scanners and 00:14:13.629 --> 00:14:16.429 showed them images of people in distress. For 00:14:16.429 --> 00:14:19.250 the MPD group, initially, the empathy centers 00:14:19.250 --> 00:14:22.669 of the brain were just quiet, a flat line. So 00:14:22.669 --> 00:14:25.450 no automatic response. Right. But then the researchers 00:14:25.450 --> 00:14:27.950 gave a specific instruction. They said, I want 00:14:27.950 --> 00:14:31.009 you to imagine this is you or try to take this 00:14:31.009 --> 00:14:33.110 person's perspective. And suddenly the brain 00:14:33.110 --> 00:14:36.379 lit up. The hardware fired. So the hardware works. 00:14:36.379 --> 00:14:38.799 It's not actually broken. The hardware is there. 00:14:38.980 --> 00:14:42.360 Right. But the software isn't auto running. The 00:14:42.360 --> 00:14:45.460 deficit seems to be motivational. They can empathize. 00:14:45.460 --> 00:14:47.720 They just don't care to unless there's a specific 00:14:47.720 --> 00:14:50.980 reason to do so. In a neurotypical brain, empathy 00:14:50.980 --> 00:14:54.039 is a reflex. In a narcissistic brain, it's a 00:14:54.039 --> 00:14:56.559 manual overriding switch that they rarely, if 00:14:56.559 --> 00:14:58.799 ever, bother to flip. That brings up the selfish 00:14:58.799 --> 00:15:02.080 altruist concept. They can do good things. But 00:15:02.080 --> 00:15:04.039 the engine driving the behavior is completely 00:15:04.039 --> 00:15:06.580 different. Completely different. They are much 00:15:06.580 --> 00:15:09.139 less likely to be pro -social, meaning helpful 00:15:09.139 --> 00:15:13.120 or kind, unless it improves their status. If 00:15:13.120 --> 00:15:15.679 a narcissist donates a million dollars to charity, 00:15:15.840 --> 00:15:19.509 they want the giant check, the gala. And the 00:15:19.509 --> 00:15:21.669 building named after them. They're not donating 00:15:21.669 --> 00:15:24.889 anonymously. Very rarely. The act of giving isn't 00:15:24.889 --> 00:15:27.830 about the recipient at all. It's about the donor's 00:15:27.830 --> 00:15:31.330 public image. Is there a brain explanation for 00:15:31.330 --> 00:15:34.179 this self -obsession? Or is it just personality? 00:15:34.519 --> 00:15:37.019 Oh, there's a neurological underpinning. Neuroscientists 00:15:37.019 --> 00:15:39.059 have looked at the salience network in the brain. 00:15:39.220 --> 00:15:41.120 You can think of this as the brain's traffic 00:15:41.120 --> 00:15:43.100 controller. It decides what's important enough 00:15:43.100 --> 00:15:45.220 to pay attention to. Okay, so it filters the 00:15:45.220 --> 00:15:47.419 world. In a neurotypical brain, when you interact 00:15:47.419 --> 00:15:50.320 with someone, your default mode network, which 00:15:50.320 --> 00:15:52.279 is the part of the brain responsible for daydreaming 00:15:52.279 --> 00:15:54.820 and self -reflection, it switches off. The salience 00:15:54.820 --> 00:15:56.980 network says, hey, stop thinking about yourself. 00:15:57.159 --> 00:16:00.440 Listen to this person. And in NPD? In NPD, that 00:16:00.440 --> 00:16:04.019 switch is faulty. The salience network fails 00:16:04.019 --> 00:16:06.840 to deactivate the default mode network. So even 00:16:06.840 --> 00:16:08.159 when they're looking right at you, listening 00:16:08.159 --> 00:16:12.139 to your story of woe, they are literally neurologically 00:16:12.139 --> 00:16:14.779 still stuck in their own heads. Wow. They're 00:16:14.779 --> 00:16:18.559 processing self -related information. How do 00:16:18.559 --> 00:16:21.620 I look while listening to this? When is it my 00:16:21.620 --> 00:16:23.720 turn to speak? Is this person boring me? They 00:16:23.720 --> 00:16:25.659 are trapped in the echo chamber of the self. 00:16:26.190 --> 00:16:28.549 That explains that glazed over look you sometimes 00:16:28.549 --> 00:16:30.169 see when you're talking to someone who just wants 00:16:30.169 --> 00:16:31.590 you to finish so they can start talking. That 00:16:31.590 --> 00:16:33.690 is exactly what is happening biologically. Okay, 00:16:33.750 --> 00:16:35.789 so we've got the behavior and we've got the brain 00:16:35.789 --> 00:16:38.309 mechanism. But the big question, the one everyone 00:16:38.309 --> 00:16:41.169 always asks is, are they born this way? Yeah. 00:16:41.230 --> 00:16:43.350 Or did their parents make them this way? The 00:16:43.350 --> 00:16:46.149 classic nature versus nurture debate. This is 00:16:46.149 --> 00:16:48.970 where the data really flips the script on conventional 00:16:48.970 --> 00:16:51.990 wisdom. We have this deep -seated Freudian idea 00:16:51.990 --> 00:16:54.669 that narcissism comes from a mother who didn't 00:16:54.669 --> 00:16:57.169 hug you enough or a father who was too critical. 00:16:57.490 --> 00:17:00.149 We want to blame the parents' behavior. Right. 00:17:00.210 --> 00:17:02.110 It's the mother's fault. That's the old cliche. 00:17:02.370 --> 00:17:05.170 But modern science points very, very strongly 00:17:05.170 --> 00:17:08.710 to genetics and neurobiology. Really? So it's 00:17:08.710 --> 00:17:10.890 not just bad parenting? Well, let's look at the 00:17:10.890 --> 00:17:13.309 twin studies. These are the gold standard for 00:17:13.309 --> 00:17:15.990 separating genes from environment. Researchers 00:17:15.990 --> 00:17:18.849 look at identical twins who share 100 % of their 00:17:18.849 --> 00:17:22.170 DNA and fraternal twins who share about 50%. 00:17:22.170 --> 00:17:26.109 If identical twins are more alike in narcissism 00:17:26.109 --> 00:17:28.089 than fraternal twins, it points to genetics. 00:17:28.990 --> 00:17:31.670 And when you run the complex statistical analysis, 00:17:32.130 --> 00:17:35.130 the reviews show a major contribution of genes. 00:17:35.549 --> 00:17:38.730 But the environment must play some role. It does, 00:17:38.930 --> 00:17:41.289 but probably not the way you think. The non -shared 00:17:41.289 --> 00:17:43.480 environment matters a lot. These are the random 00:17:43.480 --> 00:17:45.319 things that happen to one twin, but not the other. 00:17:45.440 --> 00:17:47.140 Different teachers, different friends. Exactly. 00:17:47.200 --> 00:17:50.240 A random illness, a specific trauma, different 00:17:50.240 --> 00:17:52.759 friend groups. These random life events shape 00:17:52.759 --> 00:17:56.000 us. Okay. But here is the real shocker. The shared 00:17:56.000 --> 00:17:57.880 environment, which includes parenting style, 00:17:58.180 --> 00:18:01.259 the home life, socioeconomic status, all the 00:18:01.259 --> 00:18:03.720 things both twins experienced equally, showed 00:18:03.720 --> 00:18:06.920 little or no influence on developing NPD. Wait, 00:18:06.960 --> 00:18:09.980 pause there. You are saying that how you parent 00:18:09.980 --> 00:18:12.859 your child whether you're strict, lenient, warm, 00:18:13.099 --> 00:18:17.000 cold, has little or no influence on whether they 00:18:17.000 --> 00:18:22.220 become a narcissist. That feels wrong. That feels 00:18:22.220 --> 00:18:24.500 counterintuitive to everything we're told about 00:18:24.500 --> 00:18:26.940 child rearing. It feels very counterintuitive. 00:18:26.960 --> 00:18:28.880 And this is why we have to understand a concept 00:18:28.880 --> 00:18:30.859 called genetic confounding. This was highlighted 00:18:30.859 --> 00:18:34.220 by the psychologist Sven Torgersen. And it is 00:18:34.220 --> 00:18:36.759 a massive wrench in the gears of traditional 00:18:36.759 --> 00:18:39.339 psychology. Unpack that for us because I'm trying 00:18:39.339 --> 00:18:40.960 to wrap my head around it. OK, let's imagine 00:18:40.960 --> 00:18:44.940 a scenario. You have a father who is cold, distant 00:18:44.940 --> 00:18:48.029 and critical. He has a son who grows up to be 00:18:48.029 --> 00:18:50.430 a cold, distant, narcissistic adult. Right. The 00:18:50.430 --> 00:18:53.569 standard assumption is the cold father caused 00:18:53.569 --> 00:18:55.710 the son to be that way. Bad parenting caused 00:18:55.710 --> 00:18:58.769 a bad outcome. But Torgerson asks, who is the 00:18:58.769 --> 00:19:02.009 father? The father is a man with genes. If the 00:19:02.009 --> 00:19:04.470 father is cold and critical, he likely has narcissistic 00:19:04.470 --> 00:19:06.509 or depressive traits himself written right there 00:19:06.509 --> 00:19:08.890 in his DNA. And he passes those genes to his 00:19:08.890 --> 00:19:11.289 son. So the son inherited the coldness genes. 00:19:11.730 --> 00:19:14.269 Exactly. The father provided the environment, 00:19:14.369 --> 00:19:17.660 which was coldness. and the genes for coldness. 00:19:17.960 --> 00:19:20.519 The genetic confounding theory suggests that 00:19:20.519 --> 00:19:22.480 the parenting style didn't cause the disorder. 00:19:22.720 --> 00:19:25.039 The parenting style was just a symptom of the 00:19:25.039 --> 00:19:26.680 parent's own genetic makeup, which he passed 00:19:26.680 --> 00:19:29.039 on. Oh, wow. The child would have likely developed 00:19:29.039 --> 00:19:31.640 those traits, even if he were raised by a different, 00:19:31.799 --> 00:19:34.140 warmer parent, because the blueprint was already 00:19:34.140 --> 00:19:37.440 there. That is a mind -bending loop. So the bad 00:19:37.440 --> 00:19:40.740 parenting and the child's disorder are both just 00:19:40.740 --> 00:19:43.420 branches of the same genetic tree. It's not cause 00:19:43.420 --> 00:19:46.160 and effect. It's a shared origin. That's a perfect 00:19:46.160 --> 00:19:48.299 way to put it. And this absolves a lot of parents 00:19:48.299 --> 00:19:50.480 who carry a men's guilt. And it also complicates 00:19:50.480 --> 00:19:52.119 things for people who want to believe they can 00:19:52.119 --> 00:19:55.279 love the narcissism out of a child. If it's structural 00:19:55.279 --> 00:19:58.319 and genetic, it's much, much harder to shift. 00:19:58.480 --> 00:20:00.980 And biologically, we see these structural deviations 00:20:00.980 --> 00:20:03.619 you mentioned earlier. We do. We see that gray 00:20:03.619 --> 00:20:06.519 matter volume is consistently lower in the medial 00:20:06.519 --> 00:20:09.119 prefrontal cortex. You can think of the medial 00:20:09.119 --> 00:20:12.079 prefrontal cortex as the brain's mirror. It's 00:20:12.079 --> 00:20:14.720 where you look at yourself and reflect. In a 00:20:14.720 --> 00:20:17.319 narcissist, that mirror is physically smaller 00:20:17.319 --> 00:20:21.019 or maybe foggy. The hardware for self -reflection 00:20:21.019 --> 00:20:23.750 is literally atrophied. And for the vulnerable 00:20:23.750 --> 00:20:25.970 types, there was a mention of oxidative stress. 00:20:26.250 --> 00:20:28.750 Yes. Specifically for vulnerable narcissism, 00:20:28.849 --> 00:20:31.349 they show increased oxidative stress in the body. 00:20:31.609 --> 00:20:33.829 And this links right back to that high neuroticism. 00:20:34.049 --> 00:20:36.170 If you're in a constant state of fight or flight, 00:20:36.289 --> 00:20:38.529 constantly scanning for insults, constantly jealous, 00:20:38.730 --> 00:20:42.089 your body is just flooded with cortisol. It physically 00:20:42.089 --> 00:20:45.069 wears down the cells. It's tragic, really. It's 00:20:45.069 --> 00:20:47.269 written in the code and the cells. I want to 00:20:47.269 --> 00:20:48.990 broaden the picture a bit because we talked about 00:20:48.990 --> 00:20:51.509 the two main faces, grandiose and vulnerable. 00:20:52.089 --> 00:20:54.809 But the source material lists some other subtypes 00:20:54.809 --> 00:20:56.630 that are really specific and really fascinating, 00:20:56.930 --> 00:20:59.890 specifically the communal narcissist. Ah, the 00:20:59.890 --> 00:21:01.990 saintly narcissist. This is the one that tricks 00:21:01.990 --> 00:21:04.269 everyone. How do you spot them? This is the person 00:21:04.269 --> 00:21:07.190 who is always volunteering, always leaving the 00:21:07.190 --> 00:21:09.410 charity drive, always the mom of the friend group. 00:21:09.490 --> 00:21:12.890 They are ostentatiously self -sacrificing. But 00:21:12.890 --> 00:21:15.569 isn't that a good thing? We want people to volunteer. 00:21:16.269 --> 00:21:19.190 The behavior is good. The motivation is the problem. 00:21:19.369 --> 00:21:21.529 Their motivation is the same as the guy buying 00:21:21.529 --> 00:21:24.769 the Ferrari. It's power and admiration. But instead 00:21:24.769 --> 00:21:27.470 of saying I'm the richest, they say I'm the most 00:21:27.470 --> 00:21:31.329 helpful. I'm the most moral. I am the best person 00:21:31.329 --> 00:21:34.049 here. So if you don't praise them for it. That's 00:21:34.049 --> 00:21:36.670 the tell. If you don't praise their helpfulness 00:21:36.670 --> 00:21:39.730 or worse, if you challenge their method of helping, 00:21:39.829 --> 00:21:42.029 hey, maybe we should do. Charity drive this way 00:21:42.029 --> 00:21:45.190 instead. The mask slips. You see the rage. You 00:21:45.190 --> 00:21:47.029 see the entitlement. After all I've done for 00:21:47.029 --> 00:21:49.630 you, they weaponize their kindness. Then we have 00:21:49.630 --> 00:21:52.150 the darkest corner of the spectrum, the malignant 00:21:52.150 --> 00:21:54.930 narcissist. This term was coined by Eric Firm. 00:21:55.029 --> 00:21:57.730 This is a cocktail. You take narcissistic personality 00:21:57.730 --> 00:22:00.410 disorder and you mix in antisocial personality 00:22:00.410 --> 00:22:03.289 disorder, which we used to call sociopathy, paranoia, 00:22:03.309 --> 00:22:06.049 and sadism. Sadism, meaning they actually enjoy 00:22:06.049 --> 00:22:09.859 inflicting pain. Yes. Unlike the standard narcissist 00:22:09.859 --> 00:22:11.940 who hurts you because they're indifferent to 00:22:11.940 --> 00:22:13.900 your feelings, you know, they step on you because 00:22:13.900 --> 00:22:16.279 you're in the way, the malignant narcissist might 00:22:16.279 --> 00:22:18.039 hurt you because it makes them feel powerful. 00:22:18.380 --> 00:22:21.400 They enjoy the control. And the sources note 00:22:21.400 --> 00:22:24.670 something very frightening about this type. As 00:22:24.670 --> 00:22:27.369 they achieve things, their disorder tends to 00:22:27.369 --> 00:22:29.970 worsen. Usually people mellow out with success. 00:22:30.329 --> 00:22:32.750 Yeah. If you get what you want, you kind of chill 00:22:32.750 --> 00:22:35.910 out. Not here, because the power feeds the paranoia. 00:22:35.930 --> 00:22:38.069 Now that I'm on top, everyone wants to take it 00:22:38.069 --> 00:22:40.849 from me. It feeds the entitlement. It just confirms 00:22:40.849 --> 00:22:43.430 their worldview that they are superior and everyone 00:22:43.430 --> 00:22:45.990 else is an enemy or a tool. This is the profile 00:22:45.990 --> 00:22:48.869 of the dictator. And then there's the high -functioning 00:22:48.869 --> 00:22:51.650 or exhibitionistic type theorized by Glenn Gabbard. 00:22:51.980 --> 00:22:54.180 This is that successful archetype we see in business. 00:22:54.660 --> 00:22:57.099 Competitive, sexually provocative, adaptive functioning. 00:22:57.400 --> 00:22:59.700 They use their narcissistic traits that drive, 00:23:00.000 --> 00:23:02.259 that need to win to succeed. They often have 00:23:02.259 --> 00:23:04.319 very few psychological issues. No depression, 00:23:04.579 --> 00:23:07.160 no anxiety, but they are rigid perfectionists. 00:23:07.180 --> 00:23:09.980 So they look perfect on paper. They do, but their 00:23:09.980 --> 00:23:11.940 interpersonal relationships are usually a complete 00:23:11.940 --> 00:23:14.359 disaster. They cycle through spouses, they're 00:23:14.359 --> 00:23:16.359 estranged from their kids, they have no real 00:23:16.359 --> 00:23:19.339 friends, just associates. It seems like interpersonal 00:23:19.339 --> 00:23:21.900 disaster is the common thread that runs across 00:23:21.900 --> 00:23:24.480 all these subtypes. This brings us to the diagnosis 00:23:24.480 --> 00:23:27.670 wars. Reading the history of this in the source 00:23:27.670 --> 00:23:30.069 material, it sounds like the psychiatrists were 00:23:30.069 --> 00:23:32.529 having a bit of a brawl over how to define this. 00:23:32.710 --> 00:23:35.289 It wasn't just some quiet academic meeting. Oh, 00:23:35.329 --> 00:23:37.430 it was a massive controversy. It was essentially 00:23:37.430 --> 00:23:40.130 a bar fight in the academic world. Leading up 00:23:40.130 --> 00:23:43.470 to the publication of the DSM -5 in 2013, the 00:23:43.470 --> 00:23:46.230 committee actually recommended removing NPD as 00:23:46.230 --> 00:23:48.250 a distinct diagnosis. Wait, they were going to 00:23:48.250 --> 00:23:50.529 delete narcissism, just erase it? They were. 00:23:51.019 --> 00:23:53.140 They argued that the definition was too messy, 00:23:53.240 --> 00:23:56.079 too focused on the external loud traits and missing 00:23:56.079 --> 00:23:58.640 the internal suffering. They wanted to fold it 00:23:58.640 --> 00:24:01.359 into a general personality trait model. But there 00:24:01.359 --> 00:24:03.839 was a massive backlash from clinicians like John 00:24:03.839 --> 00:24:06.000 Gunderson, who was the heavyweight of personality 00:24:06.000 --> 00:24:09.319 disorders. He basically said, you cannot remove 00:24:09.319 --> 00:24:12.180 this. It is a distinct clinical entity that ruins 00:24:12.180 --> 00:24:14.660 lives. So the old guard fought back. And they 00:24:14.660 --> 00:24:17.839 won for the most part. It stayed. But the debate 00:24:17.839 --> 00:24:20.859 highlighted this huge shift in. how we think 00:24:20.859 --> 00:24:24.019 about mental health. Categorical versus dimensional. 00:24:24.220 --> 00:24:26.000 Explain that distinction. Categorical meaning 00:24:26.000 --> 00:24:28.480 you either have it or you don't. Right. The DSM 00:24:28.480 --> 00:24:31.440 -5, the old guard, is categorical. It's a toggle 00:24:31.440 --> 00:24:33.859 switch. You need to meet five out of nine criteria. 00:24:34.279 --> 00:24:36.240 If you have four, you don't have the disorder. 00:24:36.519 --> 00:24:39.170 You're healthy. If you have five, you do. You're 00:24:39.170 --> 00:24:41.490 sick. Which seems so arbitrary. If I have four 00:24:41.490 --> 00:24:43.509 severe symptoms, I'm probably still a problem. 00:24:43.670 --> 00:24:46.710 Exactly. That's the flaw. So the new way, which 00:24:46.710 --> 00:24:48.869 is represented by the ICD 11, that's the World 00:24:48.869 --> 00:24:51.170 Health Organization's manual, is dimensional. 00:24:51.450 --> 00:24:53.990 It's like a dimmer switch. They essentially got 00:24:53.990 --> 00:24:57.309 rid of the specific labels like narcissist. or 00:24:57.309 --> 00:25:00.490 borderline, now you just have personality disorder, 00:25:00.750 --> 00:25:03.869 and it's classified by severity, mild, moderate, 00:25:03.970 --> 00:25:06.109 or severe. So you don't get diagnosed with NPD 00:25:06.109 --> 00:25:08.950 and the ICD -11? Technically, no. You get diagnosed 00:25:08.950 --> 00:25:11.190 with a personality disorder with prominent traits 00:25:11.190 --> 00:25:13.849 of dissociality, which covers the grandiosity 00:25:13.849 --> 00:25:16.390 and attention -seeking and negative affectivity, 00:25:16.569 --> 00:25:19.509 which covers the vulnerable neurotic side. That 00:25:19.509 --> 00:25:23.619 feels less satisfying somehow. Yeah. Dissociality 00:25:23.619 --> 00:25:25.420 doesn't have the same ring as narcissists. It 00:25:25.420 --> 00:25:27.259 doesn't, but it's probably more scientifically 00:25:27.259 --> 00:25:30.200 accurate. It captures the nuance because people 00:25:30.200 --> 00:25:33.539 rarely fit perfectly into one box. The ICD -11 00:25:33.539 --> 00:25:36.140 recognizes that narcissism is a spectrum of traits, 00:25:36.380 --> 00:25:38.519 self -centeredness, lack of empathy that can 00:25:38.519 --> 00:25:40.599 exist at different intensities. There's also 00:25:40.599 --> 00:25:43.859 mention of the alternative model or AMPD in the 00:25:43.859 --> 00:25:46.500 back of the DSM -5. A hybrid. This is where the 00:25:46.500 --> 00:25:49.039 compromise landed. It sits in Section 3 of the 00:25:49.039 --> 00:25:51.720 manual, the Emerging Measures section. And it 00:25:51.720 --> 00:25:55.160 defines MPD by impairments in functioning, in 00:25:55.160 --> 00:25:58.160 identity, self -direction, empathy, and intimacy. 00:25:58.619 --> 00:26:01.599 It asks, can this person form an identity without 00:26:01.599 --> 00:26:04.400 constant external validation? Can they be intimate? 00:26:04.759 --> 00:26:06.779 It's a much more functional way of looking at 00:26:06.779 --> 00:26:08.779 the problem than just counting symptoms like 00:26:08.779 --> 00:26:11.359 has a sense of entitlement. Let's pivot to what 00:26:11.359 --> 00:26:13.930 it's actually like. To be this person, or maybe 00:26:13.930 --> 00:26:15.990 more importantly for many listeners, to be in 00:26:15.990 --> 00:26:17.950 a relationship with them. The lived experience. 00:26:18.069 --> 00:26:20.349 We talked about supply. Narcissistic supply. 00:26:20.509 --> 00:26:23.490 This is a concept by Otto Fenichel. Think of 00:26:23.490 --> 00:26:26.490 it as fuel. The narcissist has a leaking tank 00:26:26.490 --> 00:26:29.470 of self -esteem. They cannot generate self -worth 00:26:29.470 --> 00:26:32.369 internally. You and I, hopefully, can wake up 00:26:32.369 --> 00:26:35.230 and feel okay about ourselves just because they 00:26:35.230 --> 00:26:37.480 can't. So they need the gas station. they need 00:26:37.480 --> 00:26:40.619 a constant inflow of admiration attention or 00:26:40.619 --> 00:26:43.819 even fear from others to keep the tank full without 00:26:43.819 --> 00:26:47.259 supply they crash into depression or rage and 00:26:47.259 --> 00:26:50.410 when the tank is empty or threatened That's where 00:26:50.410 --> 00:26:52.829 we get narcissistic rage. Heinz Kohut's term. 00:26:53.009 --> 00:26:54.910 And this isn't just getting mad because you lost 00:26:54.910 --> 00:26:57.329 your keys. This is a reaction to a narcissistic 00:26:57.329 --> 00:27:00.029 injury. If you criticize them or even just ignore 00:27:00.029 --> 00:27:02.789 them, it cracks their reality. The rage is a 00:27:02.789 --> 00:27:05.549 defense mechanism. It can range from icy aloofness, 00:27:05.730 --> 00:27:07.690 the silent treatment, which is a form of punishment, 00:27:07.849 --> 00:27:10.609 to violent outbursts. The goal is to destroy 00:27:10.609 --> 00:27:12.910 the threat, which is you, and restore their sense 00:27:12.910 --> 00:27:15.230 of superiority. And in relationships, this plays 00:27:15.230 --> 00:27:17.970 out in a predictable cycle. The cycle of idealization 00:27:17.970 --> 00:27:20.740 and devaluation. This is classic. In the beginning, 00:27:20.839 --> 00:27:23.099 they idealize you. You are the perfect partner, 00:27:23.180 --> 00:27:25.680 the perfect employee. They love bomb you. Why 00:27:25.680 --> 00:27:28.140 do they do that? Is it just manipulative? It 00:27:28.140 --> 00:27:30.849 can be, but often they actually believe it. Because 00:27:30.849 --> 00:27:33.089 if you are perfect and they chose you, well, 00:27:33.130 --> 00:27:34.849 that proves they are perfect. You're a trophy. 00:27:35.029 --> 00:27:38.130 Look at this amazing person I acquired. But reality 00:27:38.130 --> 00:27:40.910 sets in. I can't be perfect forever. Right. You 00:27:40.910 --> 00:27:42.950 make a mistake. You have a bad day. You have 00:27:42.950 --> 00:27:46.150 a need of your own. And because they split, meaning 00:27:46.150 --> 00:27:48.950 they see people as all good or all bad, you are 00:27:48.950 --> 00:27:52.529 suddenly devalued. You go from being an angel 00:27:52.529 --> 00:27:55.089 to being worthless. There is no middle ground. 00:27:55.150 --> 00:27:57.130 They can't integrate the good and the bad. That 00:27:57.130 --> 00:28:00.349 splitting concept explains so much. Why you can't 00:28:00.349 --> 00:28:02.509 reason with them. You say, but I did 10 good 00:28:02.509 --> 00:28:04.230 things yesterday. And they look at you like, 00:28:04.289 --> 00:28:06.269 doesn't matter. You did one bad thing today. 00:28:06.349 --> 00:28:09.069 So you are entirely bad. Exactly. It's binary. 00:28:09.269 --> 00:28:12.029 And boundaries. They don't exist. To a narcissist, 00:28:12.289 --> 00:28:14.690 you are an extension of them. Why would my arm 00:28:14.690 --> 00:28:16.650 have a boundary against me? Why would my arm 00:28:16.650 --> 00:28:19.670 have a private diary? They view people as objects, 00:28:20.009 --> 00:28:22.190 self -objects to be used for their own regulation. 00:28:22.589 --> 00:28:24.769 The source material touches on mate selection. 00:28:25.559 --> 00:28:27.579 This is the part that might hit home for some 00:28:27.579 --> 00:28:29.640 of the single people listening. It says cluster 00:28:29.640 --> 00:28:32.980 B traits might actually increase short -term 00:28:32.980 --> 00:28:35.400 mating success. This is the evolutionary hook. 00:28:35.799 --> 00:28:38.220 Why hasn't this disorder been bred out of the 00:28:38.220 --> 00:28:40.920 population? Well, look at the traits. Confidence, 00:28:40.940 --> 00:28:43.740 boldness, risk -taking, surface -level charm. 00:28:44.000 --> 00:28:46.259 These are attractive traits initially. I was 00:28:46.259 --> 00:28:48.420 playing that bad boy appeal. Absolutely. If you 00:28:48.420 --> 00:28:51.099 meet a grandiose narcissist at a bar, they are 00:28:51.099 --> 00:28:53.200 charming, they buy the drinks, they tell the 00:28:53.200 --> 00:28:55.279 best stories, they look like a high -value mate, 00:28:55.380 --> 00:28:57.240 they sweep you off your feet. But it's a trap. 00:28:57.420 --> 00:28:59.319 It's a short -term strategy. It works for the 00:28:59.319 --> 00:29:01.599 first date or the first month. It gets the genes 00:29:01.599 --> 00:29:04.500 passed on. But long -term, the lack of empathy 00:29:04.500 --> 00:29:08.339 and the... lead to relationship failure. But 00:29:08.339 --> 00:29:10.440 from a purely evolutionary standpoint, if they've 00:29:10.440 --> 00:29:13.079 already had the kid, the genes are past. So what's 00:29:13.079 --> 00:29:16.859 the prognosis? Can it be fixed? The sources mention 00:29:16.859 --> 00:29:19.880 a treatment gap. It's massive. People with NPD 00:29:19.880 --> 00:29:23.059 rarely walk into a clinic and say, Doc, I think 00:29:23.059 --> 00:29:26.200 I'm a narcissist. Why would they? In their mind, 00:29:26.240 --> 00:29:29.220 they are perfect. The world is the problem. My 00:29:29.220 --> 00:29:31.200 wife is the problem. My boss is the problem. 00:29:31.319 --> 00:29:33.230 So why do they end up in therapy at all? They 00:29:33.230 --> 00:29:35.730 go for the comorbidities. They go because they're 00:29:35.730 --> 00:29:37.869 depressed, which is usually the vulnerable types, 00:29:38.029 --> 00:29:41.029 or they have bipolar disorder, or, and this is 00:29:41.029 --> 00:29:44.089 specifically noted, substance abuse. Cocaine 00:29:44.089 --> 00:29:46.230 is specifically mentioned in the sources as a 00:29:46.230 --> 00:29:49.009 common comorbidity. That fits the grandiose profile. 00:29:49.599 --> 00:29:51.519 The drug of confidence for the person who's addicted 00:29:51.519 --> 00:29:53.960 to confidence. It really does. But when they 00:29:53.960 --> 00:29:55.980 get into therapy, it's incredibly difficult. 00:29:56.119 --> 00:29:58.079 They struggle to form a therapeutic alliance. 00:29:58.680 --> 00:30:01.240 They often devalue the therapist. What do you 00:30:01.240 --> 00:30:03.079 know? I'm smarter than you. Your degree is from 00:30:03.079 --> 00:30:05.900 a state school. Or they try to charm the therapist 00:30:05.900 --> 00:30:08.079 to validate them. Are there therapies that work? 00:30:08.599 --> 00:30:11.720 Or is it hopeless? It's not hopeless, but it 00:30:11.720 --> 00:30:14.890 is very hard. There are approaches. Psychoanalytic 00:30:14.890 --> 00:30:17.650 therapy, specifically transference -focused psychotherapy, 00:30:18.089 --> 00:30:20.609 tries to help them integrate those split parts 00:30:20.609 --> 00:30:22.670 of themselves to see that they can be flawed 00:30:22.670 --> 00:30:25.869 and still be lovable. Cognitive behavioral therapy 00:30:25.869 --> 00:30:29.369 or CBT and schema therapy are also used, but 00:30:29.369 --> 00:30:32.029 the outcome data is sparse. There's no cure. 00:30:32.289 --> 00:30:34.829 And the dropout rates are very high. Once the 00:30:34.829 --> 00:30:37.069 therapist really challenges them, they often 00:30:37.069 --> 00:30:39.990 just quit. What happens when a narcissist gets 00:30:39.990 --> 00:30:42.779 old? We always picture the young, hot -shot narcissist, 00:30:43.099 --> 00:30:45.059 but what about the 80 -year -old narcissist? 00:30:45.579 --> 00:30:48.500 It's a grim picture. Grandiosity is hard to maintain 00:30:48.500 --> 00:30:50.740 when you lose your looks, your job, your status. 00:30:51.220 --> 00:30:53.720 When you retire and nobody laughs at your jokes 00:30:53.720 --> 00:30:55.799 because you're not the boss anymore, the supply 00:30:55.799 --> 00:30:58.519 gets cut off. The tank runs dry. The source material 00:30:58.519 --> 00:31:00.779 suggests the grandiosity might fade, but the 00:31:00.779 --> 00:31:03.079 narcissistic scarring, that was Freud's concept, 00:31:03.180 --> 00:31:05.339 remains. They might become bitter, isolated, 00:31:05.700 --> 00:31:08.039 hypochondriacs, complaining constantly about 00:31:08.039 --> 00:31:10.220 their health to gain attention because they can 00:31:10.220 --> 00:31:12.339 no longer command admiration through achievement. 00:31:12.359 --> 00:31:14.779 It's a very lonely end. That is a heavy reality. 00:31:15.000 --> 00:31:18.680 It really reframes the whole villain narrative. 00:31:18.960 --> 00:31:21.039 It does. So synthesizing this whole deep duck, 00:31:21.180 --> 00:31:23.769 we've gone from Ovid's myth. all the way to brain 00:31:23.769 --> 00:31:26.470 scans. We've seen that MPD is a brain structure 00:31:26.470 --> 00:31:29.569 issue, a failure of the salience network. It's 00:31:29.569 --> 00:31:32.809 a genetic roll of the dice. And it is, at its 00:31:32.809 --> 00:31:35.670 core, a tragic inability to connect with the 00:31:35.670 --> 00:31:37.730 human experience of others. And it's not just 00:31:37.730 --> 00:31:39.930 the movie villain. It's the vulnerable narcissist, 00:31:40.250 --> 00:31:43.069 hiding in shyness and resentment, suffering from 00:31:43.069 --> 00:31:46.299 oxidative stress and neuroticism. Exactly. It's 00:31:46.299 --> 00:31:48.759 easy to demonize the behavior and we absolutely 00:31:48.759 --> 00:31:51.019 should protect ourselves from the abuse. But 00:31:51.019 --> 00:31:53.599 when you look at the mechanism, you see a person 00:31:53.599 --> 00:31:56.240 who is frantically, delusionally trying to prop 00:31:56.240 --> 00:31:59.200 up a fragile self that is constantly threatening 00:31:59.200 --> 00:32:01.180 to collapse. I want to leave the listener with 00:32:01.180 --> 00:32:03.180 a thought based on that evolutionary theory you 00:32:03.180 --> 00:32:05.920 mentioned. If narcissism leads to short -term 00:32:05.920 --> 00:32:08.799 mating success, if the charming, arrogant people 00:32:08.799 --> 00:32:10.579 are the ones getting the dates and passing on 00:32:10.579 --> 00:32:14.720 their genes, are we evolving to be more narcissistic? 00:32:15.119 --> 00:32:17.880 That is the provocative question. If our society 00:32:17.880 --> 00:32:21.079 values the superficial, the selfie, the self 00:32:21.079 --> 00:32:23.740 -promotion, the personal brand, and if those 00:32:23.740 --> 00:32:26.019 traits are rewarded with attention and reproductive 00:32:26.019 --> 00:32:29.880 success, are we selecting for these genes? Are 00:32:29.880 --> 00:32:31.579 we building a world that looks more and more 00:32:31.579 --> 00:32:34.180 like the medial prefrontal cortex of a narcissist? 00:32:34.680 --> 00:32:37.440 A chilling thought to end on. Look closer at 00:32:37.440 --> 00:32:39.440 the behaviors around you. Look at the motivations. 00:32:39.480 --> 00:32:42.000 And perhaps look in the mirror not to fall in 00:32:42.000 --> 00:32:44.440 love. like narcissists, but to understand what 00:32:44.440 --> 00:32:46.559 you see. Well said. That's our deep dive for 00:32:46.559 --> 00:32:47.519 today. We'll see you next time.