"I am my depression and my depression is me."
Depression in narcissistic pathology is associated with loss and occurs when the person is depleted of his or her narcissistic supplies from the external environment—those who offer admiration, adulation, appreciation. When these supplies are exhausted, the person sinks into a state of morbidity dominated by a powerfully critical and punitive superego, which is self-hatred turned inward. The depressed narcissist is the maestro of self-punishment, someone who functions almost like a reverse narcissist. One man was so depressed after the break-up of his marriage that he refused to go anywhere or see his friends, who begged him to go out with them. When they would call, he would retreat into Dostoevsky-like morbidity and darkness and moan how bleak and sad his life was.
According to Sam Vaknin (2007), this form of aggression directed against the self is the acknowledgment that something is so fundamentally wrong that there is no way the depressed person can win. This fatalistic outlook on life keeps the depressive spiralling downward. Vaknin eloquently detailed the depressed narcissist, abstracting ideas from many theoretical perspectives—including concepts from Sigmund Freud, Melanie Klein, Heinz Kohut, and the schools of object relations and self-psychology. Vaknin confirmed that the depressed narcissist has a prescripted punitive superego, sufficient in intensity to evoke a chain of guilt feelings, resulting in self-flagellation and self-punishment.
By extending Vaknin’s (2006) ideas, one might suggest that the imminent threat of self-punishment leaves little room for the narcissist to enjoy life or those around him or her. Vaknin described depression as the most difficult diagnosis to pinpoint because it enters into many other pathologies, including narcissistic pathologies. The narcissist reacts with depression when he or she is ignored or forced to face criticism, his or her own limitations, mortality, losses (e.g., fame, aging, career) and life crises. At this point, the narcissist’s omnipotent defenses are no longer accessible.
The same holds true for victimization, which most people do not realize is also a form of aggression, a subtle way of coercing others to feel pity and do things that they would not ordinarily do. One might ask how exactly the depressive narcissist is narcissistic. Although it appears that the grandiose self is intact and operative, the love of self is not. The depressive narcissist still maintains preoccupation with self, but it is now transformed into a lost or morbid self. The self becomes dominated by persecutory anxieties, which are triggered by being less than perfect and by the growing belief on the part of the narcissist that it is impossible to live up to his or her expectations.
Depressive narcissists feel a sense of entitlement not only to deprive themselves but to deprive and devalue the needs of others. offering little sympathy or empathy: “Sorry, can’t go to the wedding; we will have to cancel our plans. I am too depressed to do anything.” Although this form of aggression is not directed toward an external object but toward the self, depressive narcissists still tend to judge others as harshly as they do themselves. Because they are consumed with their faults, they have poor object relations.
Depression is not to be confused with Klein’s (1957) depressive position. The depressive position is a stage described by Klein as a healthy developmental phase moving away from the paranoid position. In the depressive position one feels sad, a sense of loss and mourning; however, this ultimately culminates in the desire to come to terms with guilt and to make reparation. In terms of communication, when patients come into a session feeling sad or with a terrible sense of guilt, they should be praised and acknowledged for their emotional progress. They should understand that feelings of sadness and remorse become the replacement for manic defenses and are part of replacing mania with reality: “I guess I was confusing mania with excitement!” It is a moving away from shame, blame and attack to that of wholeness and integration. One can then begin to see the other person as a whole object with needs and desire as opposed to a part object: “I see you only as a breast, someone who can provide for me.” Whole object functioning sounds more like, “I see that you also have needs.”
Unlike the antisocial narcissist, who shows little remorse or regret, the depressed narcissist may spend the rest of his or her life dwelling on all the wrongs and transgressions committed in life while simultaneously destroying all capacity for joy and pleasurable things. The issues and concerns of depressive narcissists are mainly over work, performance and responsibilities. People find them difficult to be with because they are always moody, complaining and pessimistic. A very wealthy man who was involved in the height of real estate and rising stock values kept crying and complaining that there was going to be depression, counseling everyone to sell their real estate and stocks. Meanwhile, everything skyrocketed. These are the children of parents who demanded perfection; they are totally self-absorbed and persecute themselves for even the slightest deviations from perfection. They are often withdrawn and isolated from others, and the least digression from their idealized image of perfection can throw them into a downhill spiral—a depressive episode.
Women Who Choose to Stay With the Depressive Narcissist
Depressive narcissists usually hook up with types ranging from the caretaker to borderline to the histrionic. A depressed narcissist says of his estranged histrionic wife, “Without her I cannot live. She cannot be replaced, and there is no life after her. As crazy as she was she gave me life and excitement.”
It might be noteworthy to mention at this point that not all women who stay with the various narcissists described in this book are mentally disturbed or have a pathological disorder (Lachkar, 1997, 2004). Many women stay for such primary reasons as the desire to have a home, to avoid the destruction that divorce brings and to maintain a marriage, a social life and an intact family. Many consider divorce to be far more damaging than staying in an abusive relationship. These women frequently are what I have referred to as high-functioning women—those who have not abused and have not had traumatic childhoods. They stay because of a greater cause: not wanting to destroy the lives of their children. These women do not identify with the abuse or the mistreatment or take in negativity and emotions of mass destruction. They understand clearly how they are being mistreated but do not take it as a personal attack: “My husband claims I am too demanding and too needy, but this is not my problem. I know my needs are healthy.”
In contrast, the lower-functioning woman (Lachkar, 1998) presents a more severe pathology in that she does take in the negative projections, does identify and personalizes them: “He makes me feel terrible; whenever I ask him for something he tells me I’m too demanding. I guess I am too demanding and not deserving of getting my needs met.” These women are hard to pinpoint because they represent a mixed bag of disorders—including narcissistic, borderline, dependent, histrionic, and caretaker- or rescue-type disorders. These are the women who have had abusive, traumatic childhoods and do tend to identify with the negative projections of the depressive narcissist. Many of these women grow up to feel they are deserving of the abuse, morbidity and misery that the depressive provides. In other instances they have some unconscious need to stay bonded to the pain: “He is just like my father, always complaining and unhappy. But as bad as the pain and agony is, at least it is familiar.” Others are caretakers—the little adults, children who grew up much too early and much too soon: “I am programmed this way; I had to be a mother to younger siblings and now to my depressed, narcissistic, morbid husband.”
Communication with the depressed narcissist requires a more confrontational approach than with other types of narcissists. Although empathy is important, the depressed narcissist may misrepresent empathy as collusion with his or her apathy and victimization: “Now there are two of us feeling sorry for me.” The therapist might respond, “So you have a crystal ball, and you already know what your future brings you as if you have a roadmap a blueprint of your life ahead. That is rather omnipotent on your part. I would prefer that we open up our therapeutic space together, but if you clutter it with darkness and morbidity, we’ll both go down together.”
In discussing the most effective way to communicate with the depressive narcissist, there are two points I would like to make. The first has to do with identity and the loss thereof. Even though depressive narcissists cannot perform or function as they once did, they are still the same person. The cases later in this chapter illustrate this point, showing how imperative it is to stay in contact and never to lose one’s identity. As an aside, the subject of identity has applicability to all personality structures, but it becomes a more pervasive theme within the context of depression. Artists and musicians, like the great violinist Isaac Stern, have inspired this concept. At the age of 80, even after developing debilitating arthritis, Stern never lost his identity as a musician. The same holds true for others such as Arthur Rubinstein, Jascha Heifetz, Maria Callas and countless other artists who could no longer function the way they once had. I remember how acclaimed ballet master Carmelita Maracci, who at the age of 75 was suffering from severe spinal injury, would sit at the edge of her chair, banging her stick in time to a Bach partita with contrapuntal timing, offering images of sharpness and skill as if she were still a brilliant performer.
The second point has to do with the psychotic aspect of depression. Although depressed patients are not psychotic, it is revealing how they take on certain psychotic elements. The psychotic has the tendency to confuse a mental state by becoming it instead of feeling it. There is a difference between feeling sad, feeling lost, feeling depressed and becoming the depression. This is true with agoraphobics; it is not that they fear the outdoors, but because they become the fear they are paralyzed. Depression is often seen in the elderly, who have lost both their identity and the narcissistic supplies that used to gratify and feed their emotional needs.
Carolyn came into treatment after being referred by her caretaker physician. She began by stating how depressed she was and how there was nothing she could do about it. In the following vignette the therapist meticulously attempted to help Carolyn identify her feelings by extending beyond depression to a real and genuine affective experience. It is like Noah naming the animals.
Therapist (Th): Hi, Carolyn. Nice to meet you (shake hands).
Carolyn (C): Hi.
Th: So tell me why are you here.
C: I am depressed and can’t get myself out of it. I am on medication but don’t like it and want to learn to handle my depression.
Th: Sounds like a good idea, but you first need to know I don’t really relate well to the term depression and doesn’t help us describe what you are really experiencing.
C: I am experiencing depression.
C: Well, like today, I tried to get things done, and I just couldn’t get myself going.
Th: So you were resisting.
C: Then I went to call my friend and she didn’t call me back.
Th: So you felt frustrated.
C: Then I made plans to go to a movie with my other friend. But she cancelled at the last minute, and I had no one to be with.
Th: So you felt betrayed, disappointed and abandoned.
C: This is interesting.
Th: Yes, but if you prematurely or precipitously classify everything as depression then you are out of control and there is nowhere to go but down.
C: Is this why I always feel down in the dumps?
Th: Yes, because all of your feelings that need to be dealt with and sorted out get dumped and lumped into the classification of depression.
Ogden (1980) described psychosis as a dichotomy between a wish to maintain a certain psychological state in which meaning can exist and a wish to attack and destroy all meaning. He made the point that in neurosis the patient remains linked to the object world and maintains a libidinal connection with it. Ogden (1980) stated that the schizophrenic relinquishes all object relations, turns inward and fails in attempts to regain connection with these lost objects. In psychosis, object relations deteriorate, and thinking and reality testing are lost to the delusional inner world, with only a fragment of reality remaining to attempt to restore meaning out of the meaninglessness: “When I become the sadness at least there is meaning to my life, as opposed to nothingness.” This is the way the depressed narcissist thinks:
Loss or abandonment: I feel depressed; therefore I become the depression.
Emptiness: I feel like a nothing; therefore I become the nothingness.
Paralysis: I feel scared; therefore I become the fear.
Isolation: I feel alone; therefore I become the aloneness.
Food, alcohol, drugs: I feel empty; therefore I become the consumption.
A patient called to tell me that he was hospitalized. He had removed himself from his car in an uncontrollable outburst of rage. Passersby thought he was crazy and called the police, who put him on a 72-hour hold. Upon his release, he told me how he could not control these bouts of rage. I let him know that he was doing more than just feeling the anger: “You become it.” He responded positively, much to my surprise: “You mean like a volcanic explosion?” I told him, “You don’t just feel it; you become the explosion.” He had never thought of it that way before.
A colleague and good friend treating a group of senior citizens expressed concern for the aging participants, who were grappling with many losses (e.g., loss of career, friends, health). She mentioned how depressed the people in the group were and how she was trying to help them cope with their losses by acknowledging that they were no longer able to function as before. I told my colleague that my view of depression in the elderly differs from hers. I do not sympathize or join with them in mourning their losses. In this way, I allow them to hold on to their identity and not to lose sight of who they are and were.
Although my colleague and friend was very empathic with the changes senior life brings to the group, I felt she was colluding with and dismissing them because they were elderly instead of helping them hold on to their primary identity. My friend and I held disparate views on the subject, but this all changed when we went to see the movie Ballet Russe de Monte Carlo, produced by David Geller and Dayna Goldfine. The film depicted aging pioneer ballet dancers who immigrated to the United States as refugees. These dancers, teachers and performers were shown in wheelchairs and walkers, still humming and moving in their chairs to parts of Swan Lake and other ballets. They never lost their spirit, their humor and, most of all, their identity. I know because some of them were my teachers. At the very end of the film, my colleague and I looked at each other, and at that moment we both knew that throughout life one never loses one’s identity, and therapists must do everything they can to keep aging patients in contact with the core of who they are.
Al: “I Am the Disability”
A colleague referred Al, a middle-aged attorney, to me for depression. His primary concern centered on conflicts within his marital relationship. His secondary concern was being placed on disability because he was no longer able to work at his full capacity. He asserted that his wife had destroyed him both emotionally and financially. He referred to her as the shopaholic terrorist. He claimed that she had bankrupted him with her insatiable needs for materialist possessions, including luxurious vacations, and offered no emotional support during his downfall. Al loved his work and received much pleasure, gratification, esteem and recognition from his colleagues and business associates: “My referrals came mostly from doctors, who acknowledge and recognize me to be the best personal injury attorney. There is no one like me who can close a deal.” Al was constantly praised not only for the expert legal and technical aspects of his work but also for his interpersonal skills and extreme care for his patients and colleagues.
After numerous neurological and psychopharmacological exams, it was determined that Al needed to go on full-time disability. His mental state was further exacerbated by a horrific divorce and a wife with no capacity for empathy or compassion. The following case illustrates not only how depressed Al was but also how I attempted to help him hold on to his identity as a family man, as an important person in his community and as an accomplished person and not to become the disability.
The Case of Al
Al: Just got a call from my best referral source, Dr. Goldman. He wants to refer me another personal injury case, but I just can’t do it. I have to refer it out because I am disabled.
Therapist (Th): How does this make you feel?
Al: What do you expect? Lousy. I just can’t function. I start to do the paperwork, and I just lose it. Don’t know what happened to me. I was never this way before.
Th: (This is one of the first times that I clearly get a sense of Al’s disability. In a most direct and cogent manner, he explains how he simply cannot function when trying to fill out the paperwork for his cases.)
Al: I start to sweat. I get anxious and confused. I know I am not myself. I can’t perform even the simplest tasks like adding up numbers. It took 20 minutes before I was able to even look at the document. I was sweating; my heart was pounding. I then started to cry. I felt terrible, and I feel terrible each time I have to face my disability. I wasn’t like this before. Before, I was driven; it was my drive that got me through. But I didn’t have these problems; I wasn’t disabled and could function. This is why I am crying now.
Th: Yet last week you mentioned you were praised for organizing your school reunion—that you played your trumpet with the band and that everyone had a great time.
Al: That’s not a problem. I know I have good social skills and am a good planner and organizer. My kids were blown away when I arranged a detailed trip around the world without a stone unturned. I took care of everything.
Th: Well, it is a problem, because those qualities don’t seem to matter to you. You are a father of three daughters, all going to Ivy League schools, all in fine relationships. You are a family man, a coach, and don’t forget you are man known throughout your community for your charity work, a man of integrity.
Al: That’s all true. I know I have good interpersonal skills, lots of friends—that everyone respects and love me. But I am still disabled.
Th: Al, you may be on disability, but you are not a disability.
Al: What do you mean?
Th: You are still an attorney; you still have performed and achieved at the highest level. Doctors from all over have acknowledged you and acclaimed you. You are still that person.
Al: That’s true. Everyone at the reunion was blown away with how I planned it.
Th: It’s one thing to come to terms with a loss. And it is a loss because you cannot perform in the same way as before. I can no longer do double pirouettes en point. But it is another thing to blame and persecute yourself for being less than perfect.
Al: I have always had high expectations and been very hard on myself. I was so happy at work. After closing a deal I would have a burst of excitement, jump for joy—feel almighty and powerful.
Th: That was not a feeling of accomplishment; it was mania. Right afterwards you would slump into a depression, feel empty and in despair because you don’t see the you that you are. Just as your wife is an insatiable shopper and feels entitled to have it all, you do not feel entitled to anything else except closing a deal. This can explain why you are so depressed. This is a far cry from feeling sad and dealing with a loss.
Al: In a way you’re right. For her it was never enough. She always needed more. More. And more.
Th: You are telling me you are never enough. Maybe you haven’t shopped enough. You have a limited shopping cart and only see yourself as a disability and never see or appreciate the other things you have to offer in reality—thus, an empty cart.
This case demonstrates how I tried to help Al come to terms with loss as described by Klein’s depressive position—not to see himself as merely a part object, a disability, but as a whole object, a real person who is still valued and appreciated. Because Al’s self-esteem was inextricably tied to his work, it was important for me to help Al hold on to that identity and never to lose it. Al’s identity crisis was further exacerbated by his fluctuating states between mania and depression, triggered by a traumatic childhood.
As treatment proceeded, we began to see that Al identified with a “defected” father, one whom he never respected or experienced as a “real man” but some-one weak and passive. Communicating with Al helped him to move away from his disabled self to an intrapsychic self, giving him more insights as to why he continually devalued himself. In addition, Al realized why he could not hold on to the good and whole aspects of his self—why instead he blamed himself when he was unable to live up to his expectations of normalcy.
Case of Sasha and Jim: Endless
Promises, “I Am the Paralysis”This is another example that illustrates how a patient who is continually waiting and on hold for her lover to finally commit not only feels paralyzed but also becomes the paralysis. This case also demonstrates how patients dominated by primitive defenses lose all capacity not only to see reality but also to deal with it—how these primitive defenses intoxicate and invade the ego, destroying all capacity to think and function (i.e., reality testing, perception, and judgment) to the extent that this patient actually believed her lover’s lies to be the “truth.”
Sasha (S): We have been in a relationship for five years. He promised me marriage, a home and children. I am 39 years old, and my biological clock is running out, and nothing is happening.
Therapist (Th): But you are also saying he doesn’t follow through on holidays or just taking you out on dates?
S: He makes all these promises. He gets me all excited, and then suddenly he disappears, vanishes, and I don’t hear from him.
Th: This is when you panic?
S: Panic isn’t the word. I get so desperate; I call and call, but he doesn’t return my calls. All I get is the voicemail. Then I sit and wait and wait and wait. He promises me it will all work out.
Th: Isn’t this what your mother used to do? Keep you waiting and waiting?
S: I remember when I was in the fourth grade; school got out at 3, and my mother didn’t show up until 6 that night.
Th: Well, what your mother did and her inappropriate behavior in keeping her child waiting is unacceptable. And now the same dynamic is being reenacted in your relationship.
S: That’s true. That’s all I do is wait. I guess he’s unpredictable, like my mother. Suddenly, he will call around 8 or 9 o’clock on a Saturday night and say, “Okay, are you ready to go out now?”
Th: (Silent, listening)
S: I am reeling inside, but I am so desperate after waiting so long.
Th: This reminds me of your birthday—how he planned to take you out and then didn’t show up because he said he was so tired he fell asleep.
S: I guess you are tired of listening to this. [patient projecting her own frustration onto the therapist]
Th: I think you are telling me how tired you are [therapist not taking in the patient’s projection]. In fact, I think that you are exhausted.
S: Then when I call him and do reach him, he offers me no sympathy. He says things like, “What do you want from me? Whatever I give you is never enough? I just took you out last week, now you want more? Come on,” he says, “Sasha, you know I love you.”
Th: Ah, now I can understand the confusion. Jim is not only abusive and cruel, but he can also be seductive and knows just how to hook into your vulnerability. [V-spot]
S: Yes, this is the hook. If he were just plain mean it would be easier to leave.
Th: And thus the dance starts all over again.
S: Yes, it is a dance. We go round and round … endless promises as he keeps me on hold.
Th: And then?
S: I wait and wait, but no call.
Th: As a little girl, you felt helpless. You were dependent on your mother. You didn’t have a car, you didn’t have your own phone, and there was not much you could do. But now you are a grown-up woman, and you are still projecting into your current relationship this little helpless, victimized girl.
S: Okay. What should I do about that? I am still hooked.
Th: Of course, there can always be an external abuser like your boy-friend, and we cannot control his behavior. But we can control the internal abuser.
S: What internal abuser are you talking about?
Th: The part of you that abuses your psyche by not facing his mistreatment of you and keeps waiting and waiting.
S: What kind of a therapist are you to say I am abusing myself? [This will become a deeper therapeutic issue as we go into in later sessions.]
Th: I am not sure what we can do much about that now; it will take more time to sort out. But what I can tell you is that when your V-spot gets stirred up by this abusive mommy/Jim, it’s hard to know what to do. Because when you become the paralysis it is hard to think clearly, especially when you keep on believing his lies are the truth.
S: What do you mean I become the paralysis?
Th: Sasha, you are not just dealing with loss and feelings of sadness; you become the loss, you become the sadness, you become the waiting. Then you are not able to see the reality, that you are being mistreated and emotionally violated and are not deserving of this mistreatment.
S: You are right. I keep losing things, I don’t remember things, I get into accidents, and my mind is all blurred. You mean it is okay for me to feel sad, to feel depressed, lost, etc., but not become it!
Th: Exactly. Now you are moving and thinking. See you next week.
S: Bye and thanks.
Although Sasha’s case is quite different from the case of Al, both Sasha and Al enacted their depression by becoming the very thing they felt. Al became the disability and Sasha the paralysis. Depression can be so debilitating and paralyzing that it can deprive the patient of actually experiencing the state of mourning. However, this changes as the patient moves to the depressive position outlined by Klein. I employed a form of communication devised specifically to help Sasha face her depression. In a later session, I helped Sasha face her internal abuser, how she kept herself on hold by believing in dreams and false hopes. As painful as the loss may be, it is not nearly as painful as the loss of ability to face reality and come to terms with her own abandonment issues.