Narcissists believe that they are special and can be understood only by special people. Illustration by Simone Massoni

In Book III of Ovid’s Metamorphoses, from the first century B.C., we meet Narcissus, a young man so handsome that all the nymphs are in love with him. He doesn’t understand why; he wishes they would leave him alone. One day, in the woods, he comes upon a pool of water and leans over to take a drink. In the reflection, he sees his face for the first time, and falls in love. He swoons, he kisses his image, but he cannot have the thing he desires. In despair, he stops eating, stops sleeping. Finally, he lays his head down on the greensward and dies.

It is this ancient story that supplied us with the word “narcissism,” to mean excessive self-love. Thousands of years later, with the advent of modern psychiatry, the idea became more complicated. Freud, who considered narcissism primarily a female matter, used it as part of his question about what women want, and his answer: a penis. Women adorned their faces and figures—that is, became narcissistic—to compensate for the lack of the desired organ. This focus on their physical charms made them self-satisfied and, therefore, emotionally impoverished.

As time passed, many psychological professionals tried to become more scientific than Freud had been—to avoid interpretation and judgment and to focus instead on outward signs, as they would with a physical disorder. So it was with narcissism. The condition received a great deal of attention in the nineteen-seventies. In 1980, it won a place in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. In the most recent edition—DSM-V, published last year—the primary characteristic of narcissism is grandiosity. Narcissists exaggerate their achievements and what they are certain will be their future triumphs. They believe that they are special and can be understood only by special people, of high status. They feel entitled to extraordinary privileges. (They have the right to cut in line, to dominate the conversation, etc.) They show no empathy for other people. They envy them, and believe that they are envied in return. They cannot tolerate criticism. In life, we make moral judgments about such behavior. We say that the person in question is good or bad. But the DSM is a manual of disorders. In it, you aren’t good or bad but sick or well.

In the DSM, narcissism is one of the so-called “personality disorders,” a category different from neuroses. (The umbrella term “neurosis” is no longer included in the DSM’s catalogue, because it was based on Freud’s unverified theory of defenses, but it is still widely used by the public.) Neuroses are afflictions of the “worried well.” At a certain point in these people’s lives, things become hard for them. They wake up in the middle of the night; they’re swamped with dread; they don’t know why. A personality disorder, by contrast, doesn’t seem to start or to go away. The person’s family will often report that he’s always been like that. Furthermore, he thinks that he is perfectly all right. When neurotics go into treatment, it is because they are upset by their behavior. When people with personality disorders go for therapy, it is typically because their family is upset by their behavior. Likewise, people with personality disorders are often unpopular with therapists. While they are hungry for affection, they are often hostile, and resistant to therapy. They don’t know why they’re there.

Elizabeth Lunbeck, a professor of history at Vanderbilt University, has just written a book, “The Americanization of Narcissism” (Harvard), in defense of this condition. Her argument is an attack on the “cultural critics,” as she calls them, who wrote about the American society of the nineteen-fifties through the seventies. To her, that means, above all, Christopher Lasch, whose best-selling “The Culture of Narcissism: American Life in an Age of Diminishing Expectations” (1978) was a scorching denunciation of what seemed to him the moral emptiness of life in the postwar United States. Lunbeck finds Lasch’s complaints ridiculously exaggerated, but what annoys her most is that he tied his critique to the psychiatric definition of narcissism, with the whole range of disabilities that this entailed. A new kind of person was being born on our shores, Lasch proclaimed. Literally, he said, the “underlying structure of personality” was changing. Americans, formerly stoical and severe—Grant Wood types—had become addicted to instant gratification. They were mouths, sucking and whining. Lasch, needless to say, was not an admirer of the counterculture of the nineteen-sixties, but neither did he like the better-behaved bourgeois—the counterculturalists’ parents—with their insatiable consumerism. Modern technology, he claimed, had made Americans, especially women, dependent on commercial products, and thus deprived them of self-reliance. He disapproved of washing machines and birth control.

His argument fell on receptive ears. In the decades immediately following the Second World War, psychoanalysis enjoyed immense prestige in America, so that Lasch’s grounding of his critique in the psychiatric literature seemed to make sense. In 1979, two psychologists, Robert Raskin and Calvin Hall, came up with a test called the Narcissistic Personality Inventory. The subjects were given pairs of statements and asked to check off the statement in each pair which was more applicable to them—for example: “Compliments embarrass me” versus “I like to be complimented”; “I am more capable than other people” versus “There is a lot that I can learn from other people.” The N.P.I., like other measures of narcissism, has been strongly criticized. (Most mentally healthy people could easily check off both statements in the above pairs.) Nevertheless, psychologists used such tests to determine how prevalent the condition was. According to DSM-V, between zero and six per cent of the American populations surveyed suffered from narcissistic personality disorder—a nearly meaningless statistic. (Zero per cent?) The truth is that nobody knows how many people suffer from the disorder or whether, indeed, the supposedly diagnostic features listed in the DSM add up to a disorder, as opposed to just a loud, self-important personality that has been recognized for millennia. See the miles gloriosus (swaggering soldier) character in the comedies of Plautus and other ancient playwrights.

So narcissism is highly questionable as a psychiatric category. Lunbeck certainly thinks so, and she finds allies, some from long before the DSM and the N.P.I. The first is Sándor Ferenczi, who founded the Hungarian school of psychoanalysis. Ferenczi was a protégé of Freud’s, one of several men who Freud thought would disseminate his message and whom, instead—because they presumed to supplement his teachings with ideas of their own—he came to regard as traitors.

The showdown between Freud and Ferenczi had to do, in some measure, with narcissistic patients, those difficult people, so needy and, at the same time, so rebarbative. Freud seems to have thought that narcissists were untreatable, because of their resistance. Ferenczi felt that they should be treated, and that their resistance should be regarded as just another symptom to be analyzed. But the quarrel was larger than that. Freud claimed that an analyst’s position with regard to these patients—indeed, to all patients—should be one of “abstinence.” The analyst should say little, just listen. (In Philip Roth’s “Portnoy’s Complaint,” the hero’s analyst, apparently an orthodox Freudian, does not speak until the last two lines of the book, where he says, “So . . . Now vee may perhaps to begin. Yes?”) Ferenczi’s view was the opposite: what patients, especially narcissistic patients, needed was empathy and affection. They had not got this from their parents, and that was their problem. Ferenczi wrote that with difficult patients he wanted to be like “an affectionate mother.” Occasionally, he was more. He married one of his patients.

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But Lunbeck’s discussion of Ferenczi is only a lead-up to her portrait of Heinz Kohut, a Viennese doctor who, fleeing the Nazis, immigrated to the United States in 1940. It was partly because of Kohut that narcissistic personality disorder became a live issue in American psychiatry in the seventies. In that decade, Kohut was building a new theory of the disorder, based, in large part, on Ferenczi. Like Ferenczi, Kohut claimed that narcissism was due to low self-esteem, the product, in turn, of a mother’s failure to support her child’s natural sense of omnipotence, his conviction that his finger painting was the best finger painting in all the world. (Lunbeck says that Kohut blamed this maternal negligence, in part, on the women’s movement.) The child’s grandiosity, Kohut believed, would diminish in time, but it would still be there—in the bank, as it were—to protect him later, in the face of disappointment and failure.