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Narcissistic personality disorder derives its name from the Greek myth of Narcissus, of which there are several versions.

In Ovid’s version, which is the most commonly related, the nymph Echo falls in love with Narcissus, a youth of extraordinary beauty.

As a child, Narcissus had been prophesized by Teiresias, the blind prophet of Thebes, to ‘live to a ripe old age, as long as he never knows himself’.

One day, when Narcissus was out hunting for stags, the mountain nymph Echo followed him through the woods. She longed to speak to him but did not dare to utter the first word. Overhearing her footsteps, Narcissus cried out, ‘Who’s there?’ to which she replied, ‘Who’s there?’ When she finally showed herself, she rushed to embrace Narcissus, but he scorned her and pushed her away.

Echo spent the rest of her life grieving for Narcissus, until there was nothing left of her save for her voice.

Then, one day, Narcissus became thirsty and went to a lake. Seeing his reflection in the water, he fell in love with it, not realizing that he had fallen in love with his own reflection. However, each time he bent down to kiss it, it seemed to disappear.

Narcissus grew increasingly thirsty, but would not leave or touch the water for fear of losing sight of his reflection. Eventually he died of love and thirst, and on that very spot there appeared a narcissus flower.

Narcissus pseudonarcissus, or Daffodil

The myth of Narcissus has long evaded interpretation, and what could Ovid possibly have meant by it?

Like many blind figures in classical mythology, Teiresias could ‘see’ into himself and thus find self-knowledge. This self-knowledge enabled him not only to understand himself, but also to understand other people, and so to ‘see’ into their futures.

If asked to predict someone’s future, he sometimes, reluctantly, uttered a vague prophecy. But what did he mean when he prophesized that Narcissus would ‘live to a ripe old age, as long as he never knows himself’?

Perhaps he just meant that Narcissus would live for a long time so long as he did not fall in love with himself.

Or, more subtly, that once Narcissus ‘saw’ himself, that is, understood himself and others (including Echo’s love for him), he would be such a different person as to no longer count as his former self, and so resurrect as a flower (a plant that has flourished).

Echo too must have been looking for herself, which is why she was never anything more than an echo.

For both Echo and Narcissus, love of the world (of beauty, of the other, and, in particular, of the beautiful other) represented the means to self-knowledge, self-completion, and self-fulfilment – which is why Echo withered away after having had her love spurned by Narcissus.

By falling in love with his reflection, Narcissus not only received the punishment that he deserved for his lack of piety in the treatment of Echo, but also unwittingly exposed the love of the world as being nothing but, or the same as, self-love.

In his novel The Alchemist, Paolo Coehlo invents a continuation to the myth of Narcissus: after Narcissus died, the Goddesses of the Forest appeared and found the lake of fresh water transformed into a lake of salty tears.

‘Why do you weep?’ the Goddesses asked.
‘I weep for Narcissus,’ the lake replied.
‘Ah, it is no surprise that you weep for Narcissus,’ they said, ‘for though we always pursued him in the forest, you alone could contemplate his beauty close at hand.’
‘But… was Narcissus beautiful?’ the lake asked.
‘Who better than you to know that?’ the Goddesses said in wonder, ‘After all, it was by your banks that he knelt each day to contemplate himself!’
The lake was silent for some time. Finally it said: ‘I weep for Narcissus, but I never noticed that Narcissus was beautiful. I weep because, each time he knelt beside my banks, I could see in the depths of his eyes, my own beauty reflected.’

Notes:
1. Ovid, Metamorphoses, Book 3, Narcissus and Echo.
2. Paolo Coelho, The Alchemist, Prologue.

This blog post is adapted from my new book,
Hide and Seek, The Psychology of Self-Deception.

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Whilst personality disorders may lead to distress and impairment, they may also lead to extraordinary achievement. In 2005, Board and Fritzon at the University of Surrey found that, compared to mentally disordered criminal offenders at the high security Broadmoor Hospital, high-level executives were more likely to have one of three personality disorders: histrionic personality disorder, narcissistic personality disorder, and anankastic personality disorder.

Thus, it is possible to envisage that people may benefit from strongly ingrained and potentially maladaptive personality traits. For example, people with histrionic personality disorder may be adept at charming and manipulating others, and therefore at building and exercising business relationships; people with narcissistic personality disorder may be highly ambitious, confident, and self-focused, and able to exploit people and situations to their best advantage; and people with anankastic personality disorder may get quite far up the corporate and professional ladders simply by being so devoted to work and productivity. Even people with borderline personality disorder may at times be bright, witty, and the very life of the party.

As the American psychologist and philosopher William James (1842–1910) put it more than a hundred years ago, ‘When a superior intellect and a psychopathic temperament coalesce … in the same individual, we have the best possible condition for the kind of effective genius that gets into the biographical dictionaries.’

Update 27/12/11:
Most recently, in 2010, Mullins-Sweatt and her colleagues carried out a study to uncover exactly how successful psychopaths differ from unsuccessful ones. They asked a number of members of Division 41 (psychology and law) of the American Psychological Association, professors of clinical psychology, and criminal attorneys to first identify and then to rate and describe one of their acquaintances (if any) who was not only successful but also conformed to Robert Hare’s definition of a psychopath,

…social predators who charm, manipulate and ruthlessly plow their way through life … Completely lacking in conscience and feeling for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.

From the responses that they collated, Mullins-Sweatt and her colleagues found that the successful psychopath matched the unsuccessful one in all respects but one, namely, conscientiousness. Thus, it appears that the key difference between unsuccessful and successful psychopaths is that the one behaves impulsively and irresponsibly, whereas the other is able to inhibit or restrain those destructive tendencies to build for the future.

Adapted from The Meaning of Madness.

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Doctors often tell people starting on an SSRI such as fluoxetine or paroxetine that they have a 55-70% chance of responding to their medication. However, a recent paper by Turner et al in the New England Journal of Medicine (358(3), 252-260) suggested that the effectiveness of SSRIs is greatly exaggerated as a result of a bias in the publication of research studies. Of 74 studies registered with the United States Food and Drug Administration (FDA), 37 of 38 studies with positive results were published in academic journals. In contrast, only 14 of 36 studies with negative results were published in academic journals, and 11 of these were published in such a way as to convey a positive outcome. Thus, whilst 94% of published studies conveyed a positive outcome, only 51% of all studies (published and unpublished) actually demonstrated one.

Another paper by Kirsch et al in Public Library of Science Medicine combined 35 studies submitted to the FDA before the licensing of four antidepressants, including the SSRIs fluoxetine and paroxetine. The authors of the study found that, whilst the antidepressants performed better than a placebo, the effect size was very small for all but very severe cases of depression. Furthermore, the authors attributed this increased effect size in very severe cases of depression not to an increase in the effect of the antidepressants, but to a decrease in their placebo effect.

If, as these studies suggest, the efficacy of SSRIs has been greatly exaggerated, their cost-benefit urgently needs to be re-evaluated. In any case, there can be little doubt that at least some of the benefit of an antidepressant is attributable to its placebo effect.

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Whilst personality disorders may lead to distress and impairment, they may also lead to extraordinary achievement. In 2005, Board and Fritzon at the University of Surrey found that, compared to mentally disordered criminal offenders at the high security Broadmoor Hospital, high-level executives were more likely to have one of three personality disorders: histrionic personality disorder, narcissistic personality disorder, and anankastic personality disorder.

Thus, it is possible to envisage that people may benefit from strongly ingrained and potentially maladaptive personality traits. For example, people with histrionic personality disorder may be adept at charming and manipulating others, and therefore at building and exercising business relationships; people with narcissistic personality disorder may be highly ambitious, confident, and self-focused, and able to exploit people and situations to their best advantage; and people with anankastic personality disorder may get quite far up the corporate and professional ladders simply by being so devoted to work and productivity. Even people with borderline personality disorder may at times be bright, witty, and the very life of the party.

As the American psychologist and philosopher William James (1842–1910) put it more than a hundred years ago, ‘When a superior intellect and a psychopathic temperament coalesce … in the same individual, we have the best possible condition for the kind of effective genius that gets into the biographical dictionaries.’

Update 27/12/11:
Most recently, in 2010, Mullins-Sweatt and her colleagues carried out a study to uncover exactly how successful psychopaths differ from unsuccessful ones. They asked a number of members of Division 41 (psychology and law) of the American Psychological Association, professors of clinical psychology, and criminal attorneys to first identify and then to rate and describe one of their acquaintances (if any) who was not only successful but also conformed to Robert Hare’s definition of a psychopath,

…social predators who charm, manipulate and ruthlessly plow their way through life … Completely lacking in conscience and feeling for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret.

From the responses that they collated, Mullins-Sweatt and her colleagues found that the successful psychopath matched the unsuccessful one in all respects but one, namely, conscientiousness. Thus, it appears that the key difference between unsuccessful and successful psychopaths is that the one behaves impulsively and irresponsibly, whereas the other is able to inhibit or restrain those destructive tendencies and build for the future.

Adapted from The Meaning of Madness.