And by the way, they also lost their depression. Many of them had mood disorders, attendant mood disorders, reactive mood disorders, and so on. And these disappeared as well.

So 43 is a tiny sample, nonrepresentative, and clinically insignificant. But anecdotally it’s very telling because the record is 43 to zero. I don’t know a single narcissist who has been treated successfully with any other treatment modality anywhere in the world, and I have by far the largest database of narcissists in the world.

So 43 to zero.

Anecdotally, it’s impressive.

Yeah, that practically makes, I don’t know if you’re going to get this reference, but that practically makes you the Floyd Mayweather or the Rocky Marciano of treating narcissists.

That’s very impressive.

If I can ask, and I don’t know if you can answer this, what demographic or population generally are we talking about?

Well, I choose my patients. On a typical day I get 5 to 10 applications, on a typical day. And I reject on a typical day 100% of them. I choose one, no, I used to choose about 10 patients a year. And now I’m down to one or two patients a year because I have to do a lot of follow-up on the previous patients and because I’m beginning to certify therapists all over the world. Just came back from Brazil, before that in Vienna, next year in Prague, this year in Prague. So I’m certifying therapists and so on. So my time is differently allocated.

So now I’m dealing with one or two patients a year out of a typical application load of about 2,000.

I’m telling you this to tell you that this is not a random sample of population, but it’s a chosen sample.

Because of that, it’s probably also nonrepresentative.

Half women, half men, all age groups, except from 18 and above, 23 was the youngest. So all age groups and half men, half women and several types of cultures.

So I had Egyptians, Russians, Israelis, people from the Balkans, Africa, and of course the United States and Canada and so on. So a balance of cultures and societies because we need to eliminate the effects of culture and society on people.

The only thing common to all of them, which might be a theoretical hindrance, is that all of them are rich because the treatment is extremely expensive. So all of them are very well-off.

That may present an obstacle in trying to generalize the outcomes of the therapy because maybe, we don’t know, maybe rich people share a common psychological profile. Or maybe narcissists are successful simply and they make money. I don’t know.

Of course, this is not, as I keep saying and I keep warning, this is not a rigorously conducted clinical trial. These are a positively arranged individual therapies.

The thing is that no one has ever succeeded to cure narcissistic personality disorder, ever, period. No treatment modality, no decade, no country, no nothing.

And even 43 badly selected non-representative sample members represent anecdotally some startling, it’s a startling outcome, even anecdotally.

So it seems that cold therapy should work in much bigger things under rigorous clinical conditions. It seems, remains to be seen.

It is working with carefully selected individuals. That’s all I can say at this stage.

Very interesting. How long has the course of therapy been on average for some of these individuals?

About six months, about six months. The average is six, the shortest was three months, the longest was a year, a bit less than a year.

And well, that’s again, this is all very promising because a typical course of psychotherapy can last much longer than a few months. And oftentimes, no, it depends.

I wouldn’t generalize, it depends.

For example, CBT is equally short. There’s brief therapy, some brief therapies, two, three meetings. And there’s of course psychoanalysis, which could last a lifetime.

Right.

Yeah, that was more of what I was thinking. I’m curious, did you happen to watch Donald Trump’s State of the Union address?

No, I didn’t have a chance. I’ve been busy yesterday and today.

Do you see any change in him psychologically? I noticed that you run a page, Donald Trump, malignant narcissist. I wonder if you could tease that out. What would indicate malignant narcissism?

It doesn’t seem, I think, as you said, he’s adapted and he’s been a television star and real estate president. And generally speaking, I mean, as opposed to someone who’s engaging in obviously antisocial behavior, how does that, the concept of malignancy factor into this?

Malignancy has nothing to do with outcomes, of course. Consider Adolf Hitler. He was definitely malignant. Few would argue with him. He was first remotely diagnosed by Eric From, which was one of the five most important psychologists of his time. So no one would argue with the fact that he was a psychopathic narcissist.

And his outcomes were outstanding, weren’t they? He became counselor of Germany, Fuhrer, this, that, conquered half the known world. I mean, he can’t argue with that. Can’t argue with success.

Malignancy has nothing to do with outcomes. And the fact that Donald Trump is successful at a variety of careers represents, probably has to do with his versatile form of raw intelligence, more than with his narcissism.

Malignant narcissism has two crucial aspects, which differentiates it, separate it from classic overt narcissism, from covert narcissism, and from other forms of narcissism.

The malignant narcissist is psychopathic, so he would tend to cut corners, ignore rules, impose his will ruthlessly, recklessly, and relentlessly. And generally it would be antisocial.

But what Donald Trump has done, he has elevated antisocial behavior to an ideology. And then he leveraged, he rode the wave of this ideology all the way to the White House.

Now we have an antisocial establishment, so to speak. We, antisocial mores, antisocial behaviors, antisocial conduct, antisocial everything, has become embedded in the fabric of the administration and in decision making processes. And people around him represent an escalation in antisocial features.

So if to start with you had a certain type of chief of staff, then now you have another chief of staff who is a bit more open to antisocial conduct. Before that you had someone else, now you have Bolton. Bolton is definitely aggressive, violent, antisocial, and so on.

So simply it’s exactly like, for example, if we take people like Duterte or like Erdogan or like Bolsonaro in Brazil, or much earlier in history like Adolf Hitler, Benito Mussolini, and so on, these people elevated the rebellion against the establishment, the rebellion against society and its elites into an organizing principle, an ideology, and a guiding beacon, a guideline.

So that’s what Donald Trump has done.

And so this is the first distinguishing feature.

The second distinguishing feature is that malignant narcissists tend to end up in total devastation and destruction. The devastation and destruction could be invisible. For example, they can inflict lasting damage on institutions and precedents. Or it could be visible. For instance, they can destroy the entire continent of Europe, like Adolf Hitler. But at any rate, they leave behind a legacy of ruination, disintegration, dysfunction, and decomposition. And very often they are also self-destructive.

Although in the case of Donald Trump, I think his sense of self-preservation and survival will prevent him from that. But they also leave behind, many of them end up with self-destruction. So Benito Mussolini ended up being hung, and Hitler ended up committing suicide. And Donald Trump may end up in prison. I mean, we don’t know. But it’s common to have this combination of self-destruction and other destruction.

Even if self-destruction is absent, the legacy of the malignant narcissist is always deleterious and long-lasting. The effects are long-lasting, and they lead to decay, decay and later severe dysfunction.

These are, I think, the two distinguishing hallmarks.

Malignant narcissists also are very goal-oriented and purpose-oriented and capable of organizing teams in a cult-like setting to further their overt narcissist, because of their grandiosity, are very bad team players.

Overt narcissists are very bad team players.

The psychopathic narcissist, the psychopathic element in his narcissism allows him to organize people, leverage networks to further his own self-interest. That’s because psychopaths do that well, actually.

Psychopaths are good managers and good leaders. So it’s the worst of both worlds. It’s the capacity to use society against itself, elevate antisocial values, mores and behavior patterns, and enshrine them in an ideology or in a set of institutions, and then lead to a wasteland, a devastation, which is very long-lasting.

In the case of Donald Trump, more specifically, I’m not of the camp that compares him to Adolf Hitler. He’s no Adolf Hitler. And the United States is not the Weimar Republic. It has checks, balances, and very robust institutions.

So I doubt very much whether we will have Adolf Hitler redux or Adolf Hitler replayed, revisited.

I think these exaggerations are way over the top.

But what I think Donald Trump will do or will have done is to inflict irreparable damage on American institutions, foremost of which is the compact of trust between citizen and state, citizen and the elites, citizen and institutions, citizen and transmission mechanisms, citizens, citizens and everything. He will reduce the United States. He will atomize the United States. He will reduce the United States into a set of competing interest groups, into bubbles with confirmation bias, into silos of like-minded people.

So this is what you call partisanship. It’s not partisanship only. It’s a question only of Republicans against Democrats. Everyone is against everyone. That is the modus operandi of Donald Trump. He sets people against each other, divide and rule. It’s Roman. It’s not Trump. It’s a very old principle, works well. He divides and rules.

But because he’s president, this division is amplified and penetrates every, is ubiquitous, penetrates every corner of society. Every possible division erupts.

So you have blacks against whites, Republicans, I mean, reds against blues, women against men, conservatives against so-called liberals or progressives. I mean, everyone against everyone. It’s an all-out long, slow-motion, simmering civil war.

This civil war is not violent because you have a tradition of channeling dissent and discontent. But you can’t rule out the possibility of violence because you did have a precedent in your history of a violent civil war, a proper war.

So I don’t know. I just don’t know.

But it doesn’t look good.

Well, so one of the themes, it seems, in this conversation has been reducing assumptions, addressing assumptions. And there are some assumptions here, I think, that are worth addressing.

But before we do that, if you wouldn’t mind taking a few questions from the audience?

No, I wouldn’t.

So are there masculine and feminine differences in the expressions of these narcissistic traits to male and female individuals expressed these dynamics you’re discussing differently?

Well, obviously, men and women are still different. Not as much as they used to be, but they’re still different. One should, of course, make a distinction between sex and gender. Sex is biological. Gender is social, socially imposed, socially inculcated. It’s part of the socialization and acculturation process.

There are societies, for example, northern Albania, where women function totally as men, dress as men, function as men, and have all the rights of men. So men and women, in the gender sense, are social conventions. As social conventions erode and gender roles become more and more fuzzy, the ways narcissism is expressed become more and more uniform.

So while 20 years ago, I would have told you, yes, women express narcissism differently. They emphasize their appearance, or they would play out the narcissism via the home and the children and so on.

Today, I think the distinction is fast eroding, and women become men-like in expressing their narcissism.

So for example, if you take a parameter like adultery or cheating, it’s now equal among men and women. If you take power trips or power plays, women and men are exactly the same in C-suites. So I think women are becoming more and more like men, even in the expression of their narcissism.

Still, there are some differences. Of course, women would tend to emphasize the somatic side. So women are more histrionic, shall we say. Men are more into materialistic goods, and so they would use objects much more than women. Women would use children to enhance their grandiosity, their children. They would use their homes. They would use power more surreptitiously and subterraneanly. They’ve been weak for 10,000 years, so they have the weapons of the weak. They’re more passive-aggressive, and so on.

But I think this is fast eroding.

I think in 20 years’ time, the question will be meaningless because the distinction between men and women will have disappeared completely.

Well, I certainly hope not.

Here’s another question that was asked. Is there a genetic component to narcissism? Hypothetically, could a narcissism gene be passed down intergenerationally?

Absolutely not. A complex of genes, maybe.

Narcissism is a very complex, complex or pervasive set of traits, character traits and behaviors and so on. So we can’t be talking about a single gene. It’s not being left-handed or having black hair. It’s a bit more complex than that.

So if at all complex of genes. I am extremely skeptical about the medicalization of psychology.

I think what happens is psychologists feel very inferior because they are not treated as medical doctors, or as physicists. So they try to be scientists to the best of their ability. They try to ground their discipline in physical facts, like genes, or like brain activity, or patterns of brain activity.

But it’s to a very large extent nonsensical. So nonsensical, first of all, because of our state of knowledge, we know extremely close to nothing about the brain and about genetics. We are just at the very beginning of these two disciplines.

In 400 years, ask me the question again. That’s one thing.

And second thing is, I very much doubt whether one could reduce behaviors and so on and traits to a single factor.

I think it tends to reason that if there is an underlying foundation or predisposition, genetically or otherwise, it would express itself via an interaction with the environment.

So it can’t be only nature. Maybe it’s not only nurture. Maybe it’s the interplay.

But to reduce it only to a gene or a complex of genes would be foolhardy, even 400 years from now.

Because we are machines, devices, or animals who are constantly influenced by input from the outside.

Very well said.

Another question that was sent in. Do you have any thoughts on the work of Oswald Spengler and declineism more broadly?

I suspect that you are aware that this work is well over 100 years old.

Yes.

And that all the, well, majority of the predictions and this prognosis and this work have been hitherto, at least, refuted.

I don’t think, I think the construct of the West is a relatively new construct. And it emerged more or less after the Second World War with people like Willie Brown and so on who tried to make a distinction between East and West.

So it’s a new, relatively new concept.

Spengler was a pioneer, but he remained a pioneer. There was no continuation to his work, actually, after his death and so on. And it was revived in the 1950s and 60s.

There was a distinction between South and West, South and the North and East and West. And so they invented the construct of the West.

Well into the end of the 19th century, and in Spengler’s time, the distinction was not between Westernists. The distinction was between white men and non-white men.

And there was, in the words of Rudyard Kipling, there was the white man’s burden. It was the white man’s missionary obligation to educate, enlighten and elevate the natives all over the world.

So it was skin color, actually.

Now it’s politically incorrect to talk about skin color. So we talk about culture and society. And I don’t know what else.

I have worked in well over 50 countries. I have lived in Africa. I was born in the Middle East. I spent two decades in the Balkans and Russia. I lived in most of the countries of Western Europe, in North America, United States, New York. So I am in a privileged position to compare cultures and societies. And I can tell you, in today’s world, everything is utterly homogenized.

The distinction between West and East is anachronistic, antiquated, and largely irrelevant.