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Narcissism has endured a strange fate in the history of mental health disorders, and consequently in our psychological understanding of its treatment. It has been by turns discovered, ignored, misunderstood, and rediscovered for over a century, seemingly in a never-ending cycle. Both clinically and culturally we have been at a loss to identify and effectively contain the long-term destructive aspects of the disorder.

One measure of our inability to contain narcissism is the barrage of newscasts where the exposure of fallen politicians, athletes, priests, and celebrities is brought into the light of day. Almost as a predictable, collective reflex, the label “narcissist” or “flawed character” easily falls from our lips. But, do we really hold a shared understanding of the meaning of the term? Is there a part of this psychological construction that remains beyond our grasp? As those in our public trust disappoint us with their missteps, many of us are left wondering, “What is happening to the American psyche?”

The term narcissist is bandied about in vague reference to any and all self-centered behaviors. Indeed, the word itself has become an in-vogue, finger-pointing weapon of scorn. Yet we seem to reward, reinforce, and revere those very same characteristics in individuals if they manage to achieve fame and fortune. This apparent (and hidden) inconsistency in our own behaviors and personal beliefs may be part of an important key to what is at the heart of the epidemic.

Idol worship, putting people on a pedestal, is as old as time. Haven’t we all over-idealized someone at some point in our lives? However, if and when that idealization usurps healthier trends and is not accompanied by core standards valuing basic honesty and fair treatment, we then enter the slippery slope of narcissistic expansiveness that condones fame and fortune at any price.

The slope gets even more slippery when we witness the reverse – taking pleasure in seeing people tumble off the pedestals we have created for them. We can scorn people taken down once they get publicly exposed. One need only look at the plethora of reality TV shows such as Bridezilla, Real Housewives, The Apprentice, Survivor, and Keeping Up with the Kardashians to see the roller coaster ride of living out the fantasy of extreme success or entitlement. And we also wait, as if in a trance of hypnotic fascination, for to utter the shattering words, “You’re fired”.

Are we unknowingly drawn to these undeniably humiliating and repeating cycles of narcissistic idealization and deidealization? What are vicariously being played out on a grand scale in all of us? It may be time to wonder whether the narcissistic displays we witness in prominent others are emboldened by our fascinated/silent consent. Unwittingly, may we be reinforcing a cultural condition of narcissistic grandiosity ubiquitous in many sectors of our human interaction?

As we attempt to track the intersection between the clinical and the cultural, an especially worrisome development has become recently visible. We seem to be facing a paradoxical split in which public communication in print, radio, TV, and electronic media is rife with explicit references to narcissism, while the professional of our mental health disciplines pays less and less to the disorder. Eerily, is the lay-professional split paralleling the internal dissociative splitting we see in narcissistic mechanisms.

The issue has extended into the drafting of 5, with protracted discussion of whether narcissism should be included in the Manual at all and whether it can really be called a pathological phenomenon. Yet by some measures, the rate of increase in narcissism among college students has been rising steadily since 1989 (Twenge, Konrath, Campbell and Bushman, 2008).

Some maintain that in this violent age of Columbine and Sandy Hook, it is difficult to determine which party lives in greater , the lay public or the mental health professions. But, as we have noted, dissociative reactions to our acknowledgment and understanding of narcissism have been a longstanding occurrence in our field. Inevitably, this has led to remarkably spotty, fitful, and discontinuous progress in both our understanding and our treatment of this disorder. Given the increase in violence and , the polarizing split and tension between personal liberties and public safety, one must wonder what is driving the ever-increasing extremes in ideology and violence.

This raises a larger clinical question. What is consciously or unconsciously being avoided or kept hidden?

In our recently published book Listening with Purpose: Entry Points into Shame and Narcissistic Vulnerability (2012), we respond to this question by drawing attention to the topic of shame. Shame is the hidden elephant in the room, both culturally and clinically. By connecting feelings of shame (or secret fears of inadequacy) to one’s underlying sense of self, it allows us a window into understanding our collective blind spot -- one that is being played out through enactments of grandiose posturing as well as increasing acts of violent retaliation. When we deny the existence of shame or minimize its importance, we create a breeding ground for excess -- the need to “prove” one’s value in ever more extreme and larger than life ways.

Once this connection is made, we can then ask, “What happens when young individuals think they can’t compete and judge they are falling short of the mark? How do they handle disappointment when attempting to fit in a culture that devalues those who don’t live up to presumed standards of perfection? What happens when we come closer and closer to this cultural blind spot – when we continually fail to examine the pitfalls of our feverish pitch to meet extreme and unrealistic standards?

If we stay with these questions, however, suddenly, it is as if the pieces of the puzzle begin to fall into place. The emotional equation identifies how extreme standards breed extreme reactions. When people fall short of the mark, it becomes easier to understand how , frustration, ideation, , even violence may be inevitable outcomes. A case example illustrates this point.

Vignette

A parent enters due to difficulties with her 12 year old son. She states that she had been brought into the school because the teacher and principal had observed her son ridiculing and threatening a girl in his class to the point that he brought her to tears. When the mother asked her son if he had threatened the girl, he responded, “No, she’s exaggerating. She’s a whining, complaining, stuck-up brat. I asked her if she wanted to be my girlfriend, and she rejected me.” The mother immediately came to her son’s defense and complained to the principal that the girl had humiliated her boy by rejecting him. She explained to the therapist that his behavior was understandable because he was just trying to recover his . She refused to ask her son to because she thought it would be a further to him. It appeared that she had entered therapy in hopes that the therapist would align with her and intervene with the school on her son’s behavior.

This is an all too familiar scenario for both therapists and educators alike. A narcissistically driven, angry parent in an attempt to protect her child fails to provide healthy ways of expressing disappointment. Logical consequences for destructive behavior fall by the wayside. Entitlement and grandiose expectations are sanctioned. One can imagine the scenario as this individual enters adulthood and the workforce.

In the past decade psychotherapists have been faced with an increasing number of cases that mirror the above vignette. It is no wonder that shame has moved to the clinical forefront as an issue in treating problems originating in . Pressures to perform, coupled with neglect of a child’s authentic self, have created a pressure cooker of shame and discontent. Unchecked bullying and violence are snapshots of evidence. It is not a reductionist statement to say that today a child’s principal concern growing up is to avoid being shamed. School at all ages has been called an “incubator” of shame. “Am I clever or smart enough, do I look good enough, am I popular enough, will I be left out?”

When the constellation of external pressures to perform is met with intensified shame (if a child is unable to “perform”), the stage is set for further descent into narcissistic self-destructive acts or suicidal ideation. When the rage is externalized, the mutually reinforcing denial of child, parent and society can lead to unexplained and seemingly random acts of violence (“I messed up her face because she refused to go out with me”; “he ‘dissed’ my friend so I threw him out of my car, I was only going 30 miles an hour”). In fact, the psychiatrist Michael Stone (2013) documents that most mass murders are committed by young males who have been “humiliated” and who show notable symptoms of narcissism.

With a culture that seems to be spinning out of control with grandiosity, postures of entitlement, and ever increasing shame-related violence, can we begin to break the spell? Can we confront a culture of denial and grandiose entitlement, when that entitlement justifies and elevates all-or-nothing thinking? In our book Listening with Purpose we offer a psychological contribution to the field around this compelling and sometimes overwhelming issue of our time.