My name is Sam Vaknin, I am the author of Malignant Self-Love, Narcissism Revisited.
Can pathological narcissism be cured? Other narcissists can rarely be cured or healed, although some scholars still maintain otherwise.
The earlier the therapeutic intervention, the better the prognosis.
A correct diagnosis and a proper mix of treatment modalities in early adolescence guarantees success without relapse in anywhere between one third and one half of the cases.
Additionally, aging tends to moderate or even vanquish some antisocial behaviors associated with pathological narcissism.
In their seminal tome, titled Personality Disorders in Modern Life and published in New York in the year 2000, Theodore Millon and Roger Davis write on page 308.
Most narcissists strongly resist psychotherapy.
For those who choose to remain in therapy, there are several pitfalls that are difficult to avoid. Interpretation and even general assessment are often difficult to accomplish.
In the third edition of the Oxford Textbook of Psychiatry, published in Oxford in the year 2000, on page 128, the author cautions.
People cannot change their natures, but can only change their situations.
There has been some progress in finding ways of effecting small changes in disorders of personality, but management still consists largely of helping the person to find a way of life that conflicts less with his character. Whatever treatment is used, aims should be modest and considerable time should be allowed to achieve these goals.
The fourth edition of the authoritative Review of General Psychiatry, published in London in 1995, says on page 309, people with personality disorders cause resentment and possibly even alienation and burnout in the health care professionals who treat them. On page 318, the author continues, long-term psychoanalytic psychotherapy and psychoanalysis have been attempted with narcissists, though their use has been controversial.
The reason narcissism is under-reported and healing overstated is that therapists are being fooled by smart narcissists. Most narcissists are expert manipulators and consummate actors, and they learn how to deceive their therapies.
Here are some hard facts.
There are gradations and shades of narcissism. The differences between two narcissists can be great.
The existence of radiosity and empathy, or lack of empathy actually, are not minor variations. They are serious predictors of future psychodynamics.
The prognosis is much better if they do exist.
There are cases of spontaneous healing. A quiet situation of narcissism and short-term narcissistic personality disorder have been observed. They are kind of reactive patterns to life stresses, and they tend to vanish.
The prognosis for a classical narcissist with grandiosity, lack of empathy, and all is decidedly not good as far as long-term, lasting and complete healing.
Moreover, narcissists are intensely disliked by their own therapies.
But having said that, not everything is gloom and doom.
Side effects, comorbid disorders such as obsessive compulsive behaviors, and some aspects of narcissistic personality disorder, for instance, the dysphoria, the depression, the persecutory delusions, sense of entitlement, pathological lying, all these behaviors can be modified using talk therapy. And depending on the problem, medication.
These are not long-term or complete solutions. Therefore, they don’t amount to healing or curing. But some of them do have long-term effects on the narcissist environment.
The Diagnostic and Statistical Manual is a billing and administration oriented diagnostic tool. It is intended to tidy up the psychiatrist’s desk.
The access to personality disorders are ill-demarcated. The differential diagnosis between various disorders are vaguely defined.
There are some cultural biases and judgments. There is some gender bias. The result is sizable confusion and multiple diagnoses, a phenomenon known as comorbidity.
Narcissistic personality disorder was first introduced into the Diagnostic and Statistical Manual only in 1980. It is now about to be struck off. There isn’t enough research to substantiate any view or hypothesis about narcissism.
Future diagnostic and statistical manual editions may abolish, as we just said, narcissistic personality disorder altogether within the framework of a cluster or a single personality disorder category.
So when we ask can narcissistic personality disorder be healed, we need to realize that we don’t know for sure what is narcissistic personality disorder. And additionally, what constitutes long-term healing in the case of narcissism.
There are those who seriously claim that narcissism, narcissistic personality disorder, is a culture-bound disorder or disease with a societal determinant. In other words, a piece of fiction which fits well into our cultural and social narratives.
