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1. 00:02 during my short trip in Vienna I received an avalanche of email messages
2. 00:08 direct messages and carrier pigeons all bearing the same tantalizing piece of
3. 00:16 news narcissistic personality disorder has been finally cured
4. 00:23 there is a medicine there's a panacea there's a way to reverse narcissistic
5. 00:30 personality disorder get rid of it cleanse the patient and render the
6. 00:37 patient wholesome happy functional so that's the end of the saga and we
7. 00:45 have to revise thousands of videos textbooks um case studies research notes and
8. 00:54 articles to say that NPD is now curable
9. 01:02 believe me kids and cadets there is no person on earth who wishes this to be
10. 01:08 true more than I do absolutely i want this to be true i want someone to develop a treatment modality which would
11. 01:20 convincingly rigorously and demonstrabably reverse the course of narcissistic personality disorder and get rid of it once and for all this cancer of the soul
12. 01:32 so I dropped everything I was doing and immediately rushed to download this
13. 01:39 newly published article which describes what is known as exploratory study
14. 01:47 and I delve deep into it as you're about to see and unfortunately
15. 01:53 I've been disabused of the good news this gospel is wrong
16. 02:00 no there is still no cure for narcissistic personality disorder and the study itself is highly flawed embarrassingly so it is a cringe-worthy
17. 02:15 pseudo study i'm going to eviscerate it now analyze it if you wish
18. 02:21 and I'm sorry to say but these kind of wannabe studies wouldbe studies quasi
19. 02:27 studies pseudo studies they are the evidence they are a testimony to the
20. 02:35 lamentable state of the pseudocience known as psychology and they are the reason why more than 80% of all studies
21. 02:44 in psychology cannot be replicated the standards and benchmarks
22. 02:52 including methodology are so low
23. 02:59 so compromised and so analyzing this study carries a double benefit first of all to refute completely the claim which is more than implied in the study
24. 03:12 refute completely the claim that narcissistic personality disorder is treatable not only curable forget about it not only you know narcissist cannot heal or but it's not even treatable and the second benefit is to demonstrate
25. 03:29 the state of the discipline the state of the profession nowadays when people
26. 03:35 pursue 15 minutes of fame at the expense of what appears to be a
27. 03:41 lack of professional integrity and so without further ado let's delve
28. 03:48 right in my name is Sam Baknin i'm the author of Malignant Self-Love Narcissism Revisited i teach psychology in
29. 03:55 Cambridge United Kingdom in the institute of advanced in the Commonwealth Institute of Advanced Professional Studies i teach psychology in other universities as well throughout the thriving continent of Europe and so let's have a look at this article
30. 04:14 which has steered so many people myself included the article is authored by Igor
31. 04:21 Weinberg Elsa Ronston uh Gunderson John Gunderson and others
32. 04:29 it is titled "Can patients with narcissistic personality disorder change a case serious?" It was published in the
33. 04:35 journal of nervous and mental disease um recently in July 2024
34. 04:44 now just to be clear Ronston and Gunderson are leading scholars on
35. 04:53 narcissism they are pioneers in more than one way but the study to which they have lent their name mysteriously and embarrassingly
36. 05:06 the study is flawed one thing the study does it flatters
37. 05:12 Roning Stam and Gunderson it falls on Roning Stam and Gunderson by
38. 05:18 constantly citing their work i have counted more than 20 citations of Roning
39. 05:25 Stam and an equal number almost equal number of Gunderson now they are both eminent scholars but
40. 05:31 they are human beings and evidently they are not immune to flattery and so
41. 05:37 they've lent their names to this study to to start with the study deals with
42. 05:45 eight patients yes you've heard me correctly eight like one two three four six seven eight
43. 05:52 patients eight patients is a joke it is
44. 05:58 impossible to establish any meaningful statistical significance with eight people it's impossible to normatively
45. 06:05 validate eight people in other words all the statistical
46. 06:11 facade and all the statistical instruments that allegedly were used in this study were actually abused
47. 06:20 because when you deal with eight data points oh with eight clusters of data
48. 06:28 it is meaningless to try to derive statistical significance or to say anything meaningful statistically and so we'd better anyone who is reading this article anyone who is perusing this
49. 06:44 study my advice is ignore all the statistical machinery
50. 06:50 it is no more than a facade and it doesn't bear even the remotest
51. 06:56 resemblance to a rigorous application of statistics to the study of the human
52. 07:03 mind aka psychology not only is the number small vanishingly
53. 07:11 small eight people four men four women but the method of selection of this
54. 07:19 sample is nothing short of shocking
55. 07:25 the clinicians who were working with these eight patients
56. 07:31 they were the ones who selected these patients they were the ones who evaluated these patients do you hear
57. 07:39 what I'm saying the study was intended to ascertain
58. 07:45 whether certain treatment modalities applied over a long period of time had a
59. 07:51 beneficial impact on a narcissistic personality disorder diagnosis and on the functioning of these patients but
60. 07:59 who was chosen who led the study who who chose the patient selected the patients and who
61. 08:06 evaluated the patient the very people who have administered the treatment
62. 08:12 it's like there's a medical doctor and the medical doctor administers
63. 08:18 medication or perform surgery and then we ask the very same doctor to evaluate
64. 08:26 the efficacy of the treatment this is never done period
65. 08:32 this is never done it's a major mortal sin
66. 08:38 it's it's it's a study design 101
67. 08:44 when you're trying to evaluate someone's performance you don't ask that very same
68. 08:50 part person to evaluate their performance it's exactly what this study does this
69. 08:56 study asked the clinicians to evaluate the efficacy of their own
70. 09:03 treatments with patients they have selected for the study
71. 09:10 this is mindboggling i don't have words to describe this flawed methodology and by using the word
72. 09:17 flawed I'm being uncharacteristically charitable and and restrained of course these clinicians these therapists these social workers these psychiatrists the psychologist of course
73. 09:29 they would say that the treatments have been an astounding success of course because if the treatment is a success it reflects well on their own miraculous
74. 09:41 professionalism what do you expect these people to say the treatment has been a failure i'm a failure as a professional
75. 09:48 this is a joke this study is a joke absolute joke i am shocked that people
76. 09:55 of the caliber of Waring Stam and Gunderson have lent their names to this this is shocking and a testament to the
77. 10:03 deterioration of the field to the to the decadence and decay decay of the field if you want to evaluate the efficacy of
78. 10:14 treatment modalities or the application of multimodel treatments on patients
79. 10:21 you ask from s for someone from the outside to make this evaluation you don't ask
80. 10:28 the very people who administer the treatment to evaluate the treatment and you definitely don't allow them to
81. 10:34 choose the patients who would participate in the treatment because they would select only the patients with
82. 10:40 whom they've had a modicum of success the authors admit that the clinicians
83. 10:48 selected only patients who have improved this is written in the study the
84. 10:55 researchers the authors of the study say "Yeah it's true that these clinicians have chosen only patients who have
85. 11:02 improved never patients who haven't improved."
86. 11:08 So it was what we call sampling or selection bias
87. 11:14 the clinicians who actually formed the backbone of this study they were highly
88. 11:20 motivated and incentivized to falsify the clinical picture falsify the the
89. 11:28 data in the study not directly but indirectly by choosing only patients
90. 11:34 whose treatment has been judged to be a success and ignoring all the patients
91. 11:40 whose treatment was an abysmal failure now we have no idea
92. 11:46 what are the ratios we have no idea whether for every patient who has been a success there are a thousand patients who have not been a success we have no idea whether the ratio is one one or one
93. 11:59 on thousand we don't have this data so we can't tell it means that the results cannot be generalized to the to the general uh NPD
94. 12:11 population if we were given the full set of data in the study which we are not deliberately so but if we were given the full set of
95. 12:22 data for example if if the authors told us there was a group of a thousand patients with narcissistic personality
96. 12:28 disorder and of these eight patients have improved then we would be able to use statistical methods to generalize this to project this on a bigger population or on the total population of people with narcissistic personality disorder but we
97. 12:45 are not given this information and I don't think it's an omission i think it's deliberate actually
98. 12:52 and that's not okay and again I'm being charitable that is absolutely not okay
99. 12:59 and I'm using an understatement and so the researchers say the authors of the study say don't worry yeah we ask the clinicians to choose the patients which is a no no and then we ask them to
100. 13:12 evaluate the efficacy of the treatment which is beyond shocking but don't worry about it because we were there the authors say we also diagnose these patients administer
101. 13:24 to them various tests and so on so we diagnosed them as well not only the clinicians and we followed up on the
102. 13:30 treatment so we were there but but
103. 13:36 the researchers the authors of the study are even more biased
104. 13:42 than the clinicians in this case because they came they started with a hypothesis
105. 13:48 they started with a with with a kind of theory and the whole study is intended
106. 13:54 to to to justify this theory this hypothesis to find it um to to find it
107. 14:00 valid to validate it so both the researchers and the clinicians
108. 14:06 are interested parties they have an axe to grind they're biased
109. 14:14 there this study is totally skewed off the rails completely biased unreliable
110. 14:22 and should be utterly ignored it has not only contributed nothing but it has
111. 14:28 polluted the discourse in my view and so mysteriously of course the
112. 14:35 diagnosis and observations of the researchers tally closely
113. 14:41 with this catastrophically skewed non-representative sample of course this is the case because both the clinicians
114. 14:48 and the researchers want want to substantiate the same outcome
115. 14:55 they want to be able to say our treatments are efficacious
116. 15:01 also there's a bit of self-enrichment here self-interest you know if the treatment is efficacious therapists and
117. 15:08 psychiatrists make a lot of money so there's a money motive here these
118. 15:15 people have every incentive in the world to present their treatments as efficient
119. 15:22 to present the treatments as a cure because then people will give them a lot of money i can't begin to to tell you how how shocking this setup is to to someone who
120. 15:34 is versed in scientific methodology
121. 15:41 onto the next problem when you study a mental health condition
122. 15:47 you need to study only people who have been diagnosed with this mental
123. 15:55 health condition and only with this mental health condition so if you're studying people with narcissistic
124. 16:01 personality disorder you need to study people who have been diagnosed with narcissistic personality disorder in in other words they are not subclinical but they're clinical and you need to study
125. 16:14 people who do not have coorbidities do not have other mental health issues
126. 16:21 because if you're studying someone with narcissistic personality disorder who is also a borderline who also has a
127. 16:29 mood disorder his depress is depressive for example he has substance abuse
128. 16:35 disorder and so on then the picture is mudded the picture is fuzzy the picture is not clear you can never isolate any any event or any development you can
129. 16:48 never isolate them and attribute them with any any safety to a specific diagnosis imagine someone with narcissistic personality disorder and borderline
130. 16:59 personality disorder this kind of person responds well to therapy which part is responding well is it the borderline personality disorder or is it the narcissistic personality disorder we
131. 17:11 have no way of telling we know that people with borderline personality disorder are much more responsive to treatment we have dialectic dialectic behavioral therapy which is very powerful treatment modality in borderline personality disorder and
132. 17:27 equally we know that people with narcissistic personality disorder almost almost are nonresponsive to treatment
133. 17:34 but when you have a mixture in the same individual of borderline and
134. 17:40 narcissistic personality disorders when this person is reacting well to treatment there is there are good grounds to suspect that it is the
135. 17:51 borderline component that is reacting well to treatment not the narcissism and that's why we need when you conduct this kind of study exploratory or not
136. 18:02 exploratory by saying that the study is exploratory you do not exonerate yourself as as a
137. 18:09 researcher you do not you're not exempt even exploratory studies need to adhere
138. 18:15 to rigorous to standards of rigor rigorousness and so on so
139. 18:22 when you study narcissistic personality disorder you need to study people whose only diagnosis is narcissistic
140. 18:29 personality disorder however in this particular study eight patients mind you the patients had
141. 18:39 two to three other co-orbidities the average was two and a half
142. 18:45 five of these patients had mood disorder including the extreme bipolar 2 disorder
143. 18:54 now the manic phase of bipolar 2 disorder is indistinguishable from narcissistic personality disorder here
144. 19:01 the contamination and adulteration of the data is profound
145. 19:08 you should never study a patient who is conccommittently where there is a co-occurrence of narcissistic personality disorder and bipolar disorder because it's very
146. 19:20 difficult to tell whether the changes in behavior are attributable to the manic phase of
147. 19:27 bipolar or to the underlying narcissistic personality disorder and yet some of these patients some of these
148. 19:35 eight patients had bipolar disorder one of them actually had bipolar disorder
149. 19:41 three of them were abusing substances and we know that certain substances
150. 19:49 change the mind for example when you consume alcohol there's a phase known as alcohol myopia which is indistinguishable from pathological narcissism
151. 20:02 so three of these patients were consuming alcohol and drugs three of these patients had eating disorders one of them had obsessive compulsive disorder four of them were diagnosed
152. 20:14 with borderline personality disorder and one of them was a psychopath diagnosed with antisocial personality disorder and
153. 20:21 we know that psychopathy shares many clinical features and
154. 20:27 attributes with narcissistic personality disorder for example grandiosity
155. 20:33 so we have a tiny sample nar statistically insignificant sample
156. 20:41 of eight patients and none of these patients is a pure
157. 20:47 narcissist they are all afflicted by two to three
158. 20:53 other diagnosis all of which masquerade as narcissism bipolar disorder substance
159. 21:01 abuse disorder mood disorder antisocial personality disorder borderline personality disorder this is shocking what on earth did these people study
160. 21:12 what is this study all about this has nothing to do with narcissism they
161. 21:18 didn't study people with narcissistic personality disorder they studied people with coorbidities
162. 21:25 and they applied when they diagnosed people they used the diagnostic interview for narcissism DIN and the
163. 21:34 diagnostic statistical and statistical manual for psychiatric disorders mental health disorders they use the fifth edition they use section two however in the fifth edition section two in the fifth edition of the DSM is copy paste from the text from the DSM
164. 21:55 edition 4 so in the DSM5 they copy pasted text which was written
165. 22:03 25 years ago and appeared in the fourth edition of the DSM no one is using this anymore
166. 22:12 this is outdated this reflects totally obsolete clinical knowledge
167. 22:19 it's a categorical approach whereas today we use trait domain approach for example in the international classification of diseases or we use a dimensional approach for example in the
168. 22:30 alternative model in the DSM5 no one would would construct a study
169. 22:36 around diagnostic criteria of narcissistic personality disorder which
170. 22:42 were written in the year in in the 1990s and for example do not acknowledge the existence of vulnerable narcissism this is ridiculous this beginning to be
171. 22:53 funny so here the study transitions from flawed to comic
172. 23:01 similarly the diagnostic interview for narcissism which of course was was authored by Gunderson and that's why
173. 23:08 probably he lend his name to the study because of self agrandisement I assume
174. 23:14 but the diagnostic interview for narcissism was first compiled in the late 80s was published in 1990 I'm sorry
175. 23:22 to say I wouldn't use it if I were you as a clinician is good advice do not use it i will dedicate a video to analyze
176. 23:35 several tests um which I use in the diagnosis of narcissistic personality disorder and I would I definitely do not recommend using the DIN it's completely
177. 23:46 outdated it does not sit well with the DSM5 text revision it absolutely has no
178. 23:53 correspondence whatsoever with the ICD edition 11 it's old outdated and
179. 23:59 completely obsolete it reflects knowledge that has been debunked it is focused on overt grandio narcissism much
180. 24:07 more than vulnerable actually there's no hint of vulnerable narcissism it was good for its time it was progress for its time it contained you know many
181. 24:19 elements and so on but we are you know 1990 we are 35 years later
182. 24:28 so the authors used a 25y old text of diagnostic criteria
183. 24:34 and a 35 year old diagnostic test seriously
184. 24:40 you couldn't have used something a little more advanced a little more accurate a little more current something
185. 24:46 that reflects um contemporary clinical knowledge
186. 24:52 why did you default to these because of Gunderson they wanted him on the on the paper this is all politics
187. 24:59 academic politics which frequently contaminate and adulterate studies
188. 25:07 the authors claim that most of these patients seven of them
189. 25:15 have altered their behaviors they they began to relate to other people in a in a different way they've
190. 25:21 changed their lives in other words they claim that there have been massive improvements in psychosocial functioning
191. 25:30 absolutely nothing new about this we everyone in the field knows that
192. 25:36 therapy leads to behavior modification in narcissist that we can modify the
193. 25:44 behaviors of narcissists abrasive behaviors antisocial behaviors we can also modify the way narcissists relate
194. 25:50 relate to other people how pleasant they are to be with and so on so forth there's absolutely nothing new in this
195. 25:57 and so yes psychosocial functioning behaviors can be affected impacted
196. 26:05 by a variety of therapies and treatment modalities the problem is the remission
197. 26:12 or the remittance rate the once um time passes the narcissist tends to
198. 26:20 relapse and all the benefits of a therapy evaporate
199. 26:26 we'll we'll discuss this a bit later one major problem with the with the
200. 26:33 fourth edition of the diagnostic and statistical manual the text of which has been copied verbatim into the DSM5 one
201. 26:41 major problem is known as the polythetic problem the polythetic problem is the
202. 26:47 following there are nine criteria and if you meet five of these criteria
203. 26:54 you can be diagnosed should be diagnosed with narcissistic personality disorder
204. 27:01 but there are nine so if you meet criteria 1 2 3 4 5 and if you meet
205. 27:07 criteria 5 6 7 8 9 both in both cases you will be diagnosed
206. 27:14 with narcissistic personality disorder but there's only one common criterion in
207. 27:20 other words imagine two patients two patients come to the same clinician one of them satisfies criteria 1 2 3 4 5 the other one satisfies criteria 5 6 7 8 9
208. 27:31 they're both diagnosed with narcissistic personality disorder although they have almost nothing in common the only thing
209. 27:37 they have in common is criterion 5 this is known as the polythetic problem in
210. 27:43 the DSM4 and the copypasted DSM5 there is no differentiation
211. 27:50 between critical clinical functions without which narcissistic personality
212. 27:56 disorder should not be diagnosed critical diag clinical features such as
213. 28:02 lack of empathy or lack of effective empathy grandiosity narcissistic supply
214. 28:09 regulatory self-enhancement these are critical features without which one should never diagnose narcissistic personality disorder however that is not the way that the text of the DSM is worded the text of the DSM allows the clinician to diagnose someone with narcissistic
215. 28:31 personality disorder based on non-essential criteria such as exploitativeness
216. 28:39 envy entitlement so this is a major flaw in the
217. 28:46 methodology of the diagnostic and statistical manual because there are clinical features
218. 28:52 there attributes their traits trait domains without which one should never
219. 28:58 ever be diagnosed with narcissism and there are other clinical features
220. 29:04 other behaviors ways of relating to people and so on which are typical of
221. 29:11 narcissists but are insufficient they don't meet the threshold they're subclinical they don't allow us to
222. 29:17 diagnose with narcissistic personality so the polythetic problem is one of the
223. 29:23 reasons that the text of the DSM incorporated in the DSM5 should never be
224. 29:30 used in research never at least not section two this list of
225. 29:36 nine bullet list of nine diagnostic criteria should never be used in research because it does not make a
226. 29:42 distinction between threshold conditions sufficient and necessary conditions
227. 29:50 and merely sufficient conditions it doesn't make this distinction so the criteria are muddled and highly
228. 29:57 problematic and because there's no differentiation
229. 30:06 the eight patients are highly suspect maybe some of them are actually not narcissists people who should not have been diagnosed with narcissistic personality disorder but for example with a dark personality subclinical narcissism
230. 30:22 we don't know and the picture is f further obfuscated
231. 30:28 by the fact that all these people have had co-orbidities
232. 30:35 which are indistinguishable from narcissistic personality disorder other conditions other mental health conditions which are indistinguishable from narcissistic personality disorder
233. 30:46 this is the methodology of selection how you select a sample so
234. 30:52 here in this study there's extreme sampling bias and selection bias and the
235. 30:59 wrong people the wrong patients have been selected 100% all of them maybe with one exception all of them
236. 31:07 what about the design of the study it is equally flawed and problematic the study
237. 31:13 uses something called retro retroactive pre-est post- test it's a type of design
238. 31:20 of studies which is considered a seriously inferior vulnerable and
239. 31:26 problematic design because it makes it impossible to tell what is the ethology
240. 31:33 of any observed changes in the patient in other words this kind of study doesn't allow us to say this change is the result of this event or this change
241. 31:45 is the result of this crisis in the patient's life or this change is the
242. 31:51 result of therapy a treatment modality or the combination of treatment modalities multimodel therapy we can't
243. 31:58 say this when the study is designed when the design is retroactive pre-EST post
244. 32:06 test we're unable to trace the origin of
245. 32:12 changes in the patient's life and the claim that these changes have to do with
246. 32:18 treatment or therapy these claims are false and wrong end of story no
247. 32:26 mitigating statement no amilarating circumstances here these are simply fellacious claims
248. 32:33 and statements life circumstances events crisis relationships the passage
249. 32:41 of time known as maturation all of these
250. 32:47 have impacts on patients change them people change over time
251. 32:53 how can we tell that these changes have been brought on by these miraculous new
252. 32:59 fangled treatment modalities we can't not with this kind of design of the study and there is a foundational problem here pathological narcissism is about attempting to impress people attempting
253. 33:16 to manipulate people attempting to manage impressions in other words the patients who participated in the study and were diagnosed with narcissistic personality
254. 33:27 disorder definitely attempted to impress the researchers and the clinicians they
255. 33:34 definitely attempted to manipulate the clinicians and the researchers they definitely attempted to manage the
256. 33:41 impressions gained by the clinicians and the researchers this is what narcissists do you cannot rely on self-reporting by the narcissist
257. 33:53 everyone says that narcissism is about fantasy delusionality
258. 33:59 and confabulation so how can you trust a narcissist to provide you with accurate reporting regarding their own internal
259. 34:07 states which to which they have no access this is complete nonsense and
260. 34:14 unmmitigated nonsense crazy nonsense I would say you know and so the the this
261. 34:20 there are threats to the internal validity of the of the study
262. 34:26 the internal validity of the of study is is threatened in my view non-existent
263. 34:33 how do we know that the changes observed in the patients most of which by the way have to do with behavioral changes like getting a job or finding a girlfriend these kind of changes yeah how do we
264. 34:45 know that these changes are the outcomes of therapy and not other factors or confounding factors
265. 34:51 well you guessed it the answer in the study is the clinicians who have
266. 34:57 administered the therapies assure us that this is the case that these changes
267. 35:03 are the result of the therapy so the very doctors psychologist psychiatrists therapists and social
268. 35:10 worker in one case the very people who have been treating these patients they
269. 35:17 give us their word and their guarantee that all the changes in the patients
270. 35:23 have to do with the treatment and with the therapy and of course we should believe them they're not biased there's
271. 35:29 no incentive to lie for example or to fabricate or to exaggerate or to maybe deceive themselves they have no incentive to do any of these things they're objective unbiased observers of
272. 35:41 their own work they don't want they don't want to feel successful they don't want to self agrandise they don't want to exaggerate their accomplishments no way they're superhuman they're not human and so if they're telling us that all these changes have to do with therapy
273. 35:57 and treatments we should take their word for it because they are the one who have administered the therapy and treatment
274. 36:03 this is a mockery a mockery of how a study should be designed i am beyond shocked that people
275. 36:12 of the caliber of Gunderson and Ronstam have lent their names to this beyond short the very awareness
276. 36:25 of the very awareness of the people participating in this study that they are participating in a study this awareness this selfconsciousness
277. 36:37 that hey I am someone in a study I'm being observed i'm being analyzed and so
278. 36:44 on this affects the behaviors and responses of the narcissist
279. 36:51 because narcissists constantly respond to these cues they constantly manage
280. 36:57 impressions they constantly manipulate they are constantly trying to alter the consciousness of everyone around them to drag them into a fantasy in this case the shared fantasy is treatment works
281. 37:09 npd can be cured that's a shared fantasy of the researchers the clinicians and
282. 37:15 the narcissists who have in my opinion manipulated all of them
283. 37:21 the awareness that you're part of a study the awareness of the expectations of the
284. 37:27 researchers and the clinicians would motivate the participating narcissists to alter their behaviors to present a
285. 37:34 facade of change to to to claim that they're undergoing
286. 37:40 transformative processes and events so as to gratify
287. 37:46 the researchers and the clinicians and garner narcissistic supply it's as simple as that these people the re researchers and clinicians have been manipulated by the narcissists in the study i don't have the slightest doubt whatsoever
288. 38:04 and they should look seriously into this
289. 38:10 when the patients have been evaluated in the study and again to remind you we're talking about eight patients not 8,000
290. 38:16 patients but eight patients all of which have been selected by the clinicians as the patients who have made it ignoring
291. 38:23 completely the population of patients who failed abysmally and miserably so
292. 38:29 that's a self- selecting biased sample how has these people been evaluated
293. 38:36 the the authors or the researchers use what is known as retrospective assessment they they evaluated the existence or the incidence actually
294. 38:49 of narcissistic personality disorder at baseline when the study started and they evaluated the existence of narcissistic personality disorder post treatment on the face of it this is a great way to determine whether there's been any kind
295. 39:06 of remission in the in the crit in the diag in the diagnostic criteria of narcissistic personality disorder in other words in other words if you evaluate someone at the beginning of a study and then you evaluate the same
296. 39:17 person at the end of a study after years of treatment and this person has changed
297. 39:23 in the sense that this person no longer meets certain diagnostic criteria we can
298. 39:29 say that the diagnosis is gone and healing and cure a cure has been
299. 39:35 affected however when you use retrospective assessment to accomplish this
300. 39:42 uh the results are null and void retrospective assessment is a useless
301. 39:48 tool because it involves recall bias selection bias difficulty in
302. 39:55 establishing causation missing information inability to generalize a generalizability problem confounding variables undergeneration of hypothesis temporal relationships statistical limitations for example you cannot use incidence rate in this kind
303. 40:13 of of uh retrospective assessment so again the tool chosen and I admit that
304. 40:20 the researchers didn't have much choice the tool chosen in this particular case gave gives no meaningful information
305. 40:28 about the diagnosis of these patients about
306. 40:34 the longitudinal evolution of the of the disorder and about any changes and
307. 40:40 definitely we cannot attribute any changes to the therapy so even the diagnosis of these patients is highly suspect the use of antiquated obsolete text and antiquated obsolete diagnostic test
308. 40:58 and the use of retrospective assessment at baseline and post treatment put together mean that these people
309. 41:07 these patients may have actually been misdiagnosed or that the narcissistic personality disorder diagnosis is in the conjunction of a powerful
310. 41:20 overpowering overwhelming coorbidity in other words it's an adulterated contaminated diagnosis which can never ever be used in research
311. 41:31 the study authors authors of the study claim that the study is longitudinal
312. 41:37 because it has followed it has followed the the patients for an average period
313. 41:43 of two and a half to to five years by the way the study didn't follow the patients the clinicians follow the
314. 41:49 patients so the authors of the study rely on the biased self-serving
315. 41:56 self-interested and may I add self-enriching reports of the clinicians
316. 42:02 and then they call the study longitudinal because they have reports submitted by these clinicians and which
317. 42:10 cover a period of two and a half to five years i don't know how these this the the the
318. 42:16 authors got their PhDs i find this equally shocking anyhow
319. 42:23 the study is of course not longitudinal a longitudinal study is a study that
320. 42:29 follows the patient does not rely on reports by third
321. 42:35 parties follows actually the patient for several years sometimes decades the authors of this study have not done this they dived
322. 42:47 into a heap of documents compiled by people who have had every reason in the world to falsify the results knowingly
323. 42:55 or unconsciously so the patients have not been followed up not during the treatment and not
324. 43:02 after the termination of therapy why is this important because we don't know what happens to these alleged changes after the therapy is terminated
325. 43:14 for example imagine that the treatment modality the therapy has induced some
326. 43:22 changes in a patient and then the therapy is over terminated and the patient goes his own merry way he he now has a girlfriend he has a job he treats
327. 43:33 people nicely and so on how do we know how long these effects
328. 43:41 these changes last how do we know that the patient does not completely relapse after 6 months how do we know that these
329. 43:49 narcissists who are allegedly ostensibly altered changed transformed
330. 43:56 transsubstantiated almost by the treatment miraculous treatment modalities administered by these
331. 44:02 impeccable highass professionals how do we know that these impacts of the treatment are not
332. 44:09 completely temporary and transient we don't know because there's been no
333. 44:15 follow-up of these patients after the the treatment after the therapies no
334. 44:21 followup it's not a longitudinal state uh study this claim in the study is completely fellacious completely false
335. 44:32 i said that I will dedicate a video to the DIN that was used and so on so forth so we'll let it go at this stage i want to read to you a segment from the study to give voice to the authors they
336. 44:50 say "Clinical reports indicated that patients experiencing pathological narcissism including NPD present with
337. 44:58 such interpersonal problems as intrusiveness dominance and vindictiveness." They're quoting studies
338. 45:04 by Keian Gnichuk more specifically say the authors
339. 45:10 studies show that grandio narcissism is associated with a triad of admiration seeking rivalry and retaliation whereas vulnerable narcissism is associated with patterns of intrusion coldness and social avoidance there's a mistake in the text by the way covert narcissists
340. 45:27 are also grandiose all narcissists are grandiose what they call grandio narcissism is overt narcissism okay
341. 45:36 I'm continuing to read from the from the article pathological narcissism was found to be negatively associated with
342. 45:42 attachment security that is grandio narcissism related to dismissive attachment and vulnerable
343. 45:49 narcissism to fearful and preoccupied attachment and they're quoting a variety of studies in addition to attachment
344. 45:56 patterns identity dysfunction and non-addaptive defense mechanisms also contribute to interpersonal problems in NPD patients various forms of psychotherapy were reported to improve
345. 46:09 interpersonal patterns that is accurate behavior modification definitely can be induced by therapy the authors continue to say such changes occur through a direct focus on
346. 46:21 interpersonal patterns or treatment relationships or through changes in general personality functioning
347. 46:28 including use of more adaptive defenses or a better consolidated sense of self they're quoting Wtel in fact studies confirmed that one of the mechanisms of change in interpersonal functioning relates to changes in attachment style as well as
348. 46:44 in mental representations of self and others such changes were reported in patients with borderline personality disorder although in NPD patients this
349. 46:55 question remains untested that's the understatement of the year this question is not untested it's actually quite
350. 47:02 settled in the present study continue the authors the results indicated a decrease in interpersonal problems during this study and this is based of course on reports by the clinicians who
351. 47:15 have administered the therapy and these reports are unreliable biased
352. 47:21 the authors continue to say unflinchingly individual cases demonstrated less
353. 47:27 interpersonal avoidance less dismissiveness in interactions less sensitivity to rejections and better
354. 47:33 regulation of anger and they're quoting inevitably running stuff although our sample was too small
355. 47:40 to permit analysis of these individual variables these changes were likely contributors to improved interpersonal functioning at the end of the study given the fact that these patterns were
356. 47:52 also addressed in the case reports filed by the aforementioned clinicians it is likely that these treatments at least in part have contributed to the improved interpersonal functioning observed in
357. 48:03 the study sample at the end of the treatment this is all by the way taking a break here it's all catastrophic disastrously methodologically flawed as
358. 48:15 I've explained before i continue to read from the article careful observations of
359. 48:21 the case reports highlighted the following putitive factors that were likely contributed to change observed in
360. 48:29 the study one openness and motivation for change two interest and capacity for
361. 48:35 work or study three ability to stay in close and committed relationships they're talking about narcissists by the
362. 48:42 way four multimodel nature of the treatment five motivation for change
363. 48:48 stemming from co-occurring disorders such as borderline personality disorder they're saying it they're admitting that the coorbidity taints contaminates the
364. 49:00 study and they say motivation for change stemming from co-occurring disorders such as borderline personality disorder or motivation to maintain sobriety
365. 49:11 treatment factors for example treatment alliance focus on emotions reflective processing and experiences as well as
366. 49:19 life events such as work losses achievements relationships synergistically contributed to change no
367. 49:26 doubt but what's the contribution of the treatments is it 5% is it 50% is it
368. 49:34 maybe 85% we have no way of knowing and so this invalidates the whole study it's a meaningless study treatment therapy is a life event
369. 49:45 exactly like divorce or falling in love or you know it's a life event so this study says life events affect change create change in in narcissists well
370. 49:58 we've known it of course they do and one of these life events is therapy say the authors no kidding but what's the
371. 50:05 contribution of therapy this is what you were supposed to answer you claim that
372. 50:11 therapy cures narcissism really you haven't substantiated this you
373. 50:18 haven't given us a single datum single you haven't given us data in nothing there's nothing in this study it's a totally vacuous study non-study vacuous
374. 50:29 non-study when a single tiny study flies in the face of decades of research decades of research by hundreds of
375. 50:42 highly esteemed experts something is seriously wrong not with the decades of research but with this tiny ill-designed study
376. 50:56 i want to read to you again from the article studies documented significant challenges and I'm reading from the article now studies documented significant challenges in psychotherapies with NPD patients twothirds of NPD patients tend to leave
377. 51:13 treatment prematurely and elevated ratings of pathological narcissism are associated with treatment
378. 51:21 dropout patients with NPD tend to evoke strong negative feelings in their therapies specifically therapies of these patients report feeling disengaged hostile angry criticized devalued helpless inadequate unsatisfied negative
379. 51:36 or worried uninvolved there there's even a clinical term for it by the way it's called vicarious traumatization
380. 51:44 back to the article these reactions in the therapies are hard to bear and many
381. 51:50 times they lead to stalemates treatment undermining the interventions or precipitate treatment terminations
382. 51:58 dismissive attachment associated with NPD is also associated with weaker alliance less treatment commitment less self-disclosure less time spent in sessions discussing treatment relevant themes and longer pauses perfectionism
383. 52:13 another characteristic of NPD patients interferes with effective treatments shame yet another feature of NPD
384. 52:20 Morrison they're quoting Morrison is associated with a slower improvement in treatment worse attendance and lower
385. 52:28 treatment alliance devaluation of others was also reported to interfere with treatment progress anecdotally comorbid NPD was associated with slower improvement in improvements in psychotherapy although the statistical testing of these observations is lacking
386. 52:45 these studies confirm the notion that treatments of NPD patients are challenging i'm reading from the article
387. 52:53 several studies focusing on the stability or remission rate of the categorical diagnosis of personality
388. 53:00 disorders in DSM3 and DSM4 have pointed to the instability of narcissistic
389. 53:06 personalities disorder symptoms and remittance of the NPD diagnosis over
390. 53:12 time in other words even when the patient somehow improves this improve
391. 53:18 improvement is unstable temporary transient the authors are quoting these
392. 53:24 studies and then they say pretty arrogantly in my view everything that came before us should be ignored we're opening a new chapter a new period in
393. 53:36 history based on eight se patients selected by their own clinicians none of
394. 53:42 which is a pure narcissist all of which are diagnosed with coorbidities
395. 53:50 wow talk about grandiosity the authors continue to say that
396. 53:59 their approach is superior to everything that's been done before and they delineate a research agenda based on this approach
397. 54:10 i'm sorry I can't take this study seriously never mind who or the authors this is not a
398. 54:18 serious study it doesn't give the slightest indication that narcissistic personality disorder can be cured or healed or even treated
399. 54:30 it is hopelessly muddled obfuscated flawed
400. 54:36 its shortcomings are so profound that it should be completely discarded and
401. 54:42 ignored in the literature so regrettably no there's no
402. 54:49 breakthrough here there's nothing here but a group of self-interested clinicians maybe selfdeceiving clinicians who report about a group of manipulative people none of which none of whom is a pure narcissist by the way and these
403. 55:06 reports are taken as raw material when they should never be
404. 55:12 and then extreme conclusions are drawn with not the slightest hint of anything
405. 55:20 rigorous with a catastrophically wrong methodology and no longitudinal followup
406. 55:30 yet another disappointment i am looking for a stud the study which would convince me that NPD is treatable let alone curable that day I will
407. 55:41 celebrate we all learn we all evolve nothing stays the same knowledge
408. 55:49 knowledge especially in science or discipline thinking new knowledge always
409. 55:57 revises and revolutionizes what you thought you knew this is the fun this is
410. 56:03 the wonderful aspect of science that there's always something new there's
411. 56:09 always progress there's always evolution and revolution sometimes this this
412. 56:15 excitement this thrill of the new this is what drives academics
413. 56:21 forward this is what keeps them uh in their fields so I'm not committed to any position i'm not committed to any statement i'm not
414. 56:32 committed to anything i'm commitment to the facts i go where the evidence leads
415. 56:38 and if the evidence were to lead to the conclusion that NPD can be treated I would be the first one to issue a video
416. 56:44 saying NPD can be treated guys there are wonderful exciting news npd now can be
417. 56:50 treated there are new treatment modalities there are new ways to treat people maybe by combining therapies and
418. 56:56 so I'll be the first to say so and if psychedelics could affect the the cure I'll be the first to celebrate this it's
419. 57:03 not true simply at this stage NPD cannot be treated and no psychedelics don't
420. 57:10 cure NPD and no we don't have studies that show that NPD is genetic or hereditary
421. 57:17 although in my personal opinion it is but personal opinion is not science
422. 57:24 and so cool it science is slow it's an inexurable
423. 57:30 glacial process They're very rarely revolutions in
424. 57:36 science and and this is a major revolution to claim that NPD NPD is curable is a major revolution
425. 57:43 based on eight pseudo patients so-called patients give me a break this is a joke simply a joke
426. 57:51 and I'm not laughing