Screen Shot 2017-07-14 at 9.07.51 PMThe legend is that Narcissus was a handsome Greek youth who rejected the desperate advances of the nymph Echo. As a punishment, he was doomed to fall in love with his own reflection in a pool of water. Unable to consummate his love Narcissus was said to stare at his image in the pool hour after hour and finally pined away and changed into a flower that bears his name Narcissus.Screen Shot 2017-07-14 at 9.12.22 PM

Screen Shot 2017-07-14 at 9.10.21 PMIn 1911, Otto Rank, a prominent psychiatrist, spoke of narcissism as being related to vanity and self-admiration. A few years later, Sigmund Freud thought narcissism was not necessarily abnormal. He distinguished between primary narcissism with self-love which is linked to self-preservation and secondary narcissism where there becomes limited ability to love others and the problematic development of megalomania.

In the 1970’s, Otto Kernberg wrote extensively on this subject and felt that there was a group of people who have an unusual degree of self-reverence in their interactions with other people. He noted that Screen Shot 2017-07-14 at 9.16.57 PMin these individuals, there was a great need to be loved and admired by others and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others. He believed that their emotional life is usually shallow and that they tend to experience little empathy for the feelings of others. Such people obtain very little enjoyment from life other than from the tributes they received from other people or from their own grandiose fantasies and they feel restless and bored when external glory wears off. Dr. Kernberg wrote about techniques for approaching such patients in psychotherapy.


Screen Shot 2017-07-15 at 10.54.33 AMThe latest version of the Diagnostic Criteria Manual (DSM-5) from the American Psychiatric Association stated that a Narcissistic Personality Disorder is a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and a lack of empathy beginning by early adulthood and present in a variety of contexts as indicated by five or more of the following.

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognize as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that he or she is “special” and unique and can only be understood by, or should associated with, other special or high status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
  6. Is interpersonally exploitative (i.e. takes advantage of others to achieve his or her own ends).
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  8. Is often envious of others or believes that others are envious of him or her.
  9. Shows arrogant, haughty behaviors or attitudes.

It is possible and in fact is often the case that other mental health conditions may be simultaneously occurring along with a narcissistic personality. This might be depression or other mood conditions, or variations of psychosis, et cetera. The criteria stated above are provided for mental health professionals to make a psychiatric diagnosis. Different professionals may disagree whether an individual meets a particular criteria. Also, it should be obvious that only five criteria are necessary to make the diagnosis. Therefore, people with the same diagnosis might be quite different from each other. For example, an individual theoretically could be quite empathic and not be arrogant or have haughty behavior and still meet the criteria.

Any diagnosis should not be a derogatory value judgment of an individual. It is true that some of the above-criteria deal with being self-centered and not relating well to others which usually makes a person unlikeable. This is not always the case, sometimes a person with these characteristics may be quite charming and liked by others, as well as having other positive and endearing characteristics.

From my experience, it is true that people with narcissistic personality do not seek therapy as much as others do. But certainly that is not always the case. In fact, such a person may be particularly susceptible and even devastated by a “narcissistic injury” which would be circumstances which gives the person insight into their weakness, faults and vulnerabilities. Such a person may very well feel that he or she need help in dealing with these overwhelming feelings. Nevertheless, it still requires a set of specific circumstances for a person with narcissistic personality to decide to seek psychotherapy. Treatment of such of individual is often difficult and requires special techniques.



Review of Newly Released DVD: Robert Wallerstein: 65 Years at The Heart of Psychoanalysis

Robert Wallerstein: 65 Years at the Heart of Psychoanalysis – Interviewed and Produced  by Shelley Nathans (Available in DVD and streaming from

Screen Shot 2015-12-03 at 12.37.20 PMIf you are a psychoanalyst, a psychoanalytically oriented psychiatrist, mental health professional or a student of psychoanalysis, you will appreciate this interview with Dr. Robert Wallerstein by Dr. Shelley Nathans. It presents Dr. Wallerstein as a warm, knowledgeable man who understands the legacy of his profession.

Dr. Wallerstein was born in Germany in 1921 and came to New York City with his mother at age two, to join his father, a physician who had come the previous year.  He grew up in the depression and recalled apples being sold by grown men for five cents apiece in order to make a living. He graduated from high school at the age of 15 and was sent to live with his uncle in Mexico City and then returned to Columbia University, graduating in 1941 at the age of 20. After medical school, he joined the army as the war was ending. He then took his psychiatric and psychoanalytic training at Menninger Clinic. His years at the Menninger Clinic, of course, are quite intriguing. I never realized that the program there had at one time 100 residents, which was one-eighth of the total number of psychiatric residents in the United States. He notes that during his psychiatric residency, the main tools to treat severe mental illness were Chloral Hydrate, ECT and lobotomies.

Although his training was in the United States, he was a witness and then a participant in the growth of psychoanalysis in this country. In the interview, Dr. Wallerstein was able to trace the plight of Jewish psychoanalysts in Germany and then in Austria, who during the pre-World War II years were not able to take Arian patients and then ultimately had to leave their native country. American psychoanalysts set up funds to bring these psychoanalysts to the United States, mostly to New York. Dr. Wallerstein described the fascinating details of this situation and also spoke of the German, probably Nazi oriented psychoanalysts, who came to Brazil and the unusual circumstances that happened in that country in the post-war years. He had occasion to conduct an investigation into the details of this situation in the 1980s.

As a faculty member at the Menninger Clinic he proudly described hiring a young psychiatrist from Chile by the name of Otto Kernberg. He also discussed his two personal analyses and candidly admits that he felt that they could have gone further than they did. He tells about meeting his wife Judith and her career as a well-known researcher who studied and wrote about the impact of divorce on children.

Dr. Wallerstein was barely at his mid-career when he moved to San Francisco in 1966 and became established at Mt. Zion Hospital. Perhaps, his greatest insights into the psychoanalytic world came during his front row seat as President of the American Psychoanalytic Association and then President of the International Psychoanalytic Association. He describes the famous “lawsuit” which, of course, was a turning point in allowing non-psychiatrist to join the American Psychoanalytic Association and take an equal role in psychoanalysis in the United States. From his unique perspective, Dr. Wallerstein was able to reflect on the roles of different schools of psychoanalysis and their influence in the United States and even labeled Anna Freud’s recognition as the “crown princess.”

Dr. Shelley Nathans showed excellent technique in her interview as she stayed out of the way of Dr. Wallerstein and gently led him to new topics. This interview was done in July 2013 one and half years before  Wallerstein died. While this DVD was only 1 hour and 22 minutes, there are a total of over five hours of the interview with him available in the archives. We are very appreciative of the efforts of the team led by Dr. Nathans  that captured this interview and most of all, to Dr. Robert Wallerstein for his many contribution to our profession.

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