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Personality and Mental Health 8 : 79 – 84 (2014) Published online 19 January 2014
Personality and Mental Health 8 : 79 – 84 (2014) Published online 19 January 2014

Personality and Mental Health 8: 7984 (2014) Published online 19 January 2014 in Wiley Online Library (wileyonlinelibrary.com) DOI 10.1002/pmh.1253

Complex Case Narcissistic biographies third age self- transcendence abilities

AUREL NIRESTEAN, EMESE LUKACS, DANA CIMPAN AND TUDOR NIRESTEAN, Psychiatric Clinic II, Tirgu-Mures, UMF Tg. Mures, Targu Mures, Romania

ABSTRACT Narcissistic traits interfere in the process of self-dete rmination and the individual motivational strategies of human beings. The grandiose and vulnerable narcissistic personality subtypes have dif culties in their education, interpersonal relationships and quality of lif e. The latter is also affected by ageing, whose attributes in uence, above all, one s self-esteem, especially in women. Though very fearful of suffering and death, narcissists have a powerful desire to overcome them by cultivating their grandiosity, especially through the mystical and paranormal experiences they relate. The spiritual means of transcending ones self, including the components of magical thinking, can prevent the destruction of self-esteem in narcissists in their third-age. Copyright © 2014 John Wiley & Sons, Ltd.

Narcissism is a term originated in ancient Greek legends in which the Narcissus myth pleaded simultaneously for human being s superiority and vulnerability. Psychoanalysis recon rms the signi cance of this concept by describing the primary and secondary narcissism of child- hood, and the immaturity of the relationships with the outer object in adulthood (Kohut, 1966, 1971). Furthermore, the narcissistic state of balance in which the selfs abilities correspond to the require- ments of the super-self, represents an ideal of matu- rity for human beings. Thus, we may consider that narcissistic traits always interfere in the self-determination process and in the individual mo- tivational strategies. As components of egocentrism, they may have a signicant adaptive rolethe healthy narcissism which means cohesion, strength

Copyright © 2014 John Wiley & Sons, Ltd.

and a normal self-esteemor a maladaptive one that dominates authoritatively the personalitys structure interfering in 25% of cases with antisocial traits (Gunderson & Ronningstam, 2001; Kernberg, 1989). The Defensive mechanisms of dissociation, denial and impulsivity, are similar to those of anti- social personalities. (Perry & Perry, 2004). The narcissistic grandiose self has been described by Kohut whose contributionnext to Kernbergs- facilitates the diagnosis of the narcissistic personal- ity disorder (Goldstein, 1985). According to Gabbard (1989) and Gersten (1991), the narcissistic personality has two subtypes grandiose and vulnerable or hypersensitivewhich both correspond to the borderline level of organization of the self (Kernberg, 1984). The vulnerable subtype is more conducive to psychother- apeutic intervention.

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Even though the narcissistic style favours activism and implication in existential roles, the described defensive mechanisms are a disadvantage for the education and the quality of life of the narcissist. (Cramer, Torgersen, & Kringlen, 2004). Narcissistic personalities go through life culti- vating their self-esteem or trying to protect it from the envy and/or indifference of those around them. Independent of real personal qualities, talents and accomplishments,ageing, with all its problems, along with its vicissitudes becomes gradually be- comes the subject dominating their conscience.

First case

Biographical data and personogenesis elements

Patient M, age 71 years, has been raised at an aris- tocratic family residence where her parents were working during the rst part of her childhood. She is the second child. Her elder brother died at the age of 20, exactly 1 year before her birth. The patient emphasizes this coincidence as well as the advanced age of her parents at her birth mother 43 years and father 45 years. She mentions that older parents have smarter and more capable children . Af rmatively, her father was the nobleman s illegitimate son, a plausible fact in those times. Consequently, she declares herself descendant of this family and relates her child- hood memories: she was the most beautiful in the castle, she received a special education, she had access to the private library, she was dressed as a countess, and so on. Subsequently, her parents built a house on the most beautiful street of the city. In addition to these self-valorizing references, she identi es herself with the angel destined to change the world dreamt by her mother before giving birth. She writes poetry and paints since she was six. Both parents lived into their late 80s. She describes her father s suicide by defenestration as a refusal of the humiliation of living in suffering. She studied for 12 years and completed a peda- gogy course, considering herself the best student.

Copyright © 2014 John Wiley & Sons, Ltd.

She worked in the educational system, involving herself in multiple roles apparently superior to her preparation, always having success due to her special qualities . She has been greatly affected by her retirement a humiliating event, described as if she had entered a hospital waiting to die. She got married at the age of 29 years, but after 2 years she divorced because her husband, although very rich and handsome, wasn t educated, intelligent enough and she got bored with him. Because he was dark, she checked before marriage whether or not he had any gypsy blood. She describes herself as a beautiful woman who could not stand her husband liking women . After divorce, she had several brief relations but she never met a man to match her . She does not have children and never wanted any, having had three induced abor- tions on demand. She has always cultivated her demeanor and the feeling of belonging to the upper class and searched for personal relationships that would recognize her value. She still writes poetry, paints and continues to fantasize about success. For many years, she was in a particular relation- ship with a man 20 years younger, a person inter- ested in her inheritance, whois worthless, submissive. She manipulates him for her personal advantage and mentions that he is gay, thus making it clear that they do not have an intimate relation- ship. On the other hand, she describes herself disinterested in intimacy considering it inferior to her existential priorities. She lives alone and permanently looking for a life partner considering herself a picky woman. She af rms that if she does not meet an intelli- gent partner, she will leave all her fortune ’—a two room apartment, the books she wrote and her paintings to the church. She did not attended church or lived by the reformed doctrine in which she has been baptized, but lately she has been preoccupied by the para- normal such as clairvoyance, and the gift of healing this way which explain past, sometimes trivial events in her life. Retroactive events and

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sometimes trivial she afrms that even before birth, she was near to God being sent to earth on a special mission. She describes many premonitory dreams, superstitions and coincidences and seeks refuge in an environment that can value her on the level of her phantasms. Recently, she converted to the Pentecostal religion, but continues to select inter- personal relationships, disdaining followers who do not receive the Divine grace. She explains healing of ordinary diseases colds and infections as miracles or paranormal interventions. Her somatic pathological personal antecedents are less signi cant, but she mentions having always been dominated by claustrophobia, misophobia, thanatophobia and fear of touching. She does not use drugs or alcohol. Referring to herself, she afrms that she is exacting, educated, intelligent, very beautiful and has not found inner peace. Exaggerated self- esteem, feeling of grandeur and desire to succeed are obvious in all her life roles. As she grows older, she lives intensely the changes related to her ap- pearance and physical condition and processes anx- iously the state of loneliness.

Disease history

Patient had no psychiatric antecedents, until she was rst admitted in the fall of 2011 with symp- toms of anxiety and depression of average inten- sity associated with phobias of disease and death. The symptomatology appeared insidiously due to existential frustrations related to interpersonal relationships, to retirement and to changes in physical appearance and health due to ageing and living alone. She followed a treatment with Venlafaxina, Alprazolam, Nicergolin and Zopiclone and a psychiatric counselling. Her claims to be looked at as special were obvious, and she collabo- rated exclusively with the upper medical staff and with obvious preference for males. The therapeutic alliance has functioned well only when the medical staff met her expectations, her clinical evolution being slowly positive. She came on a regular basis for special check-ups and periodic admissions, on

Copyright © 2014 John Wiley & Sons, Ltd.

Narcissistic biographies third age self-transcendence abilities

request, accusing an affective discomfort and self-esteem oscillations. These Admissions in terms of relating to the staff and other patients are for her ways of restoring her self-esteem and to reaf rm her artistic and literary qualities and spiritual abilities that make her special. Consid- ering her narcissistic traits, age and present social status, remissions are incomplete and the prognos- tic reserved.

Second case

Biographical data and personogenesis elements

Patient H, age 72 years, is the fourth in a family with ve siblings. She describes her childhood as happy, above average , the only child in the family who was spared the agricultural and house- hold chores and the only one schooled. She describes harmonious family relations with her mothera central gure, full of life, sociable and dominantwhom she admired and thought she resembled. Father is described as an introvert, sub- missive, indecisive, less present in family life, whom she took advantage of, just like her mother. Both parents lived over the age of 85. The patient studied for 12 years, and she is a school teacher with accounting studies. She loved her profession and tends to exaggerate her accom- plishments. She describes herself as the most beautiful and elegant teacher . Currently she is retired, a status she associates with the loss of her qualities. At the age of 17 years, she married an agrono- mist engineer, a director of wide reading and of healthy breeding, a socially very appreciated man, a ladiesman, but an abusive alcoholic. In so- cial life, the patient was highly notablebeing a very elegant woman who wore fur. In the couple relationship, she was domineering, possessive and fastidious , obtained everything she wanted and cannot imagine any other kind of relations in a marriage or with the opposite sex. Although she made efforts to get pregnant, she has no children. This represents an existential frustration

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that she always evokes and tries to transcend it sometimes in a fatalist manner. For example, when she hears that a baby died she believes that this way it will not suffer any longer since she associates suffering with ageing and the inevitable ending of life. She has been a widow for 7 years, lives alone and can hardly standing it. She lives alterna- tively in two different cities according to the favourable attitude of those around her and the access to special social and cultural events. She seeks the company of important persons and looks down on people without education or lacking respect . She describes herself as a religious person in her youth but now she does not pray and can not stand priests . Nevertheless, she narrates many unusual experiences and premonitory dreams through which she gains her self-worth since they grant her the status of a person with special spiritual abilities. She afrms that due to clair- voyance, intuition and personal symbology, she foresaw important life events and deaths of certain known persons. She emphasizes her physical qualities having indeed a pleasant physical appearance —‘ nobody can tell how old I am . She nds it dif cult to adapt to ageing and lives anxiously the loneliness and physical changes —‘ I feel old, ugly and I don t like old people, I can t stand them . She states being afraid of death; on the other hand, she would die to get rid of old age . She has been also preoccupied of the end of the world idea associated to 2012, death in this context being easier to accept because not only her but we ll all die . She describes herself as a tidy, neat, sensible, melancholic, educated person and of course very beautiful . She is intolerant to criticism, intransi- gent and selective in social relationships, de- manding preferential treatment and respect. She can not stand gypsies nor weak men in her entourage. She does not have particular somatic pathological personal antecedents and does not use drugs or alcohol.

Copyright © 2014 John Wiley & Sons, Ltd.

Disease history

The Patient, has no psychiatric antecedents, and has been admitted for the rst time at the begin- ning of 2011 after an extended period of weight loss, lack of appetite, sleeplessness and nightmares in the contxt of an anxious-depressive episode. The symptomatology appeared insidiously due to existential frustrations related mainly to ageing. Besides, changes in health and physical appearance, the patient has been suffering from loneliness, rinactivity and tensions derived from her interper- sonal relationships. During admission, she has been treated with Escitalopram, Alprazolam and Nicergolina, supportive psychotherapy, therapeu- tic alliance being good only when the team s attitude was permissive and compliant with her various demands. She is envious of persons with certain qualities or more important roles, projecting on them her own feelings by repeatedly evoking an inevitable and fatal ending. Evolution has been favourable with partial remission due to the persistence of onset factors and narcissistic personality traits.

Comparative observations. We consider relevant the description of these two patients with narcissis- tic traits and several similarities in their biographical data. In both cases, there is no emphasis of clinical phenomena of cognitive decline. Their Narcissistic destiny was pre gured since childhood, each patient being more valued than other children and/or spared from daily chores. The father gure is described as passive or less signi cant, especially at patient H. Starting from these patterns, in both cases, we observe exaggerated demands on the opposite sex and at the same time the conviction of their own superiority in relation to the latter. Egocentrism and affective super ciality explain the attitude towards children. Neither had children but both worked with them in the educa- tional system. In the professional role, all their accomplishments and successes are related to their own image and evolution in the professional

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hierarchy without any reference to relationships with children, or to their needs and successes. Currently, because of loneliness, the subject of children is frequently evoked by both patients, as they regret lacking the support and attention of their descendants and being de- prived of the possibility of gaining self-worth through them. The professional role and status of both patients are described as very special and much oversigni ed. Both patients have dif culties accepting changes in physical appearance that are due to aging, and constantly comment about them. Even now, they try to display their physical qualities and irt with the opposite sex in a natural manner. In patient M, who has bohemian nature and displays artistic and literary talents, the feeling of grandeur is more unstable, maintaining currently an obvious affective and attitudinal instability. Patient H has a more stable self-esteem. She is more calculated, tidy and meticulous, and her perfectionism extends outward. Her emotional strength is due to the experience of a longer and more stable marital relationship and social rela- tionships which gave her a better affective and attitudinal balance. Both patients speech con rms the fear of suf- fering and death, which, by the same token, they have the desire to defeat by cultivating grandios- ity, but also faith and magical thinking. We noticed in both patients, several relatively re- cent mystical/religious preoccupations or concerning the supernatural, that amplied concurrently with the frustrating experience of ageing. They look for meaning, for self-valuing coincidences, narrate para- normal experiences that confer them a particular sta- tus in a subjective reality and which only they can verify or understand. These abilitiesand grandiose fantasies become dominant when they are more in- tensely aware of the current reality which make their existential values look ephemeral and obsolete. By claiming to be closer to the divinity or to have intu- itions and premonitory abilities, the two patients may take refuge in the shadow of an idealized and self-attributed object. This is how they give the

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Narcissistic biographies third age self-transcendence abilities

appearance of self-contentment and self-controlnarcissistic transferthat may still draw the others admiration. The biographies described above con rm that narcissists cannot deprive themselves of the feel- ing of uniqueness, grandeur or and the need to be admired. They con rm that the manners of self-transcendence derived from the spiritual di- mensions of the human being are equally similar and peculiar to both.

Questions

(1) Taking into account, the fact that throughout their lives neither patient practiced a religion

or had paranormal convictions could the rise of these preoccupations at an older age be just a way of salvaging their narcissistic self-esteem? (2) Could the two narcissistic biographies described be considered two biographies of persons with schizotypal features? (3) Could we conclude that the grandiose narcis- sism in both patients became a vulnerable one with ageing and because they are single women?

Can loneliness, the lack of a familyespecially

(4)

childrenand the self-fullment which comes from it, inuence the patientsorientation towards mysticism and the imaginary? (5) Could there be a connection between the contemporary social orientation towards spirituality and the patients paranormal pre- occupations and magical thinking?

References

Cramer, V., Torgersen, S., Kringlen, E. (2004). Quality of life in a city: The effect of population density. Social Indicator Research, 69 , 103116. Gabbard, G. O. (1989). Two subtypes of narcissistic personal- ity disorder. Bulletin of the Menninger Clinic , 53 , 527532. Gersten, S. P. (1991). Narcissistic personality disorder con- sists of two distinct subtypes. Psychiatric Times , 8 , 25 26. Goldstein, W. (1985) DSM III and the narcissistic personal- ity. American Journal of Psychotherapy 39, 4 16. Gunderson, J. G., Ronningstam, E. (2001). Differentiating narcissistic and antisocial personality disorders. Journal of Personality Disorders , 15 , 103109.

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Kernberg, O. F. (1984). Severe personality disorders. New Haven, CT, Yale University Press. Kernberg, O. F. (1989). The narcissistic personality disorder and the differential diagnosis of antisocial behavior. Psychiatric Clinic of North America, 12 , 553570. Kohut, H. (1966). Forms and transformations of narcissism. Journal of the American Psychoanalytic Association , 14 ,

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Kohut, H. (1971). The analysis of the self: a systematic psycho- analytic approach to the treatment of narcissistic personality disorders . New York: International Universities Press.

Copyright © 2014 John Wiley & Sons, Ltd.

Perry J. D., & Perry J. C. (2004). Con icts, defenses

and stability of narcissisti c personality features. Psychiatry: Interpersonal and Biological Processes , 67 ,

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Address correspondence to: Prof Aurel Nirestean, MD, PhD, Psychiatric Clinic No.2, Department of Psychiatry, University of Medicine and Pharmacy, Gheorghe Marinescu str, No.38, Tirgu Mures, Romania. Email: aurelnirestean@yahoo.com

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