The Buddhism and Addiction Series (Part II of III)

Part II:

Narcissism, Addiction and Sexuality

The Narcissistic Personality

Like spirituality, the concept of “narcissism” is one that defies simple reduction.  Infused with different meanings by different theorists to explain both normal and pathological conditions, narcissism is one of the oldest and most enigmatic terms in all of psychology (Drescher, 2010; Brown & Bosson, 2001).  Origins of the word may be traced to the Greek myth of Narcissus, a young man who was cursed by the goddess Nemesis, fell in love with his own reflection, and ultimately transformed into the flower which bears his name (Beck, Freeman, & Davis, 2003).  As a psychological construct, the term first appeared in a footnote to a 1905 essay by Sigmund Freud entitled Three Essays on the Theory of Sexuality (Rubenstein, 2010).  Use of the term, however, did not gain prominence in psychoanalytic circles until the late 1960’s and 1970’s at which time it was more fully explicated by object relations theorists.  These theorists posited that primary narcissism arises from early childhood when all of the infant’s needs are met, and its self is undifferentiated from that of its caretaker (Beck et al., 2003; Epstein, 1986).  In the absence of childhood trauma, the infant transitions from this state to one of a mature, normal self (Van Schoor, 1992).  Psychological disturbances arise, however, when there is inadequate caregiving during childhood (Beck et al., 2003; Kernberg, 1982; Kohut, 1972).  During this phase of development, called “rapprochement”, there is alternation between exploring moves into the environment and returning to the safekeeping of the caregiver, [but] the child sometimes receives inadequate support in these alternating efforts because caregivers are inconsistent, unavailable, or place self-centered demands upon the child. (Beck et al., 2003, p. 243)

This deprivation leads to what Kohut (1972) referred to as selfobject failure and narcissistic injury (Beck et al., 2003; Burijon, 2001; Van Schoor, 1992).  To compensate, rage and entitlement are split off from the conscious mind and a false grandiose self emerges that seeks perpetual adoration and approval in a pathological state known as secondary narcissism (Beck et al., 2003; Van Schoor, 1992).  A grandiosity gap opens between the false self projected outward, and the inner true self which identifies with the narcissistic injury (Beck et al., 2003; Van Schoor, 1992).  The consequence is emotional pain arising from underlying feelings of inferiority, incompetence, and worthlessness (Beck et al., 2003).  The main motivational drive of the narcissist becomes bridging the gulf between the imperfect inner true self and the idyllic false self (Epstein, 1986; Greg & Sedikides, 2010).

The emergent narcissistic personality structure is defined by a limited capacity for object relations (Beard & Bakeman, 2000).  Narcissists are approval seekers who constantly strive to gain the admiration of others (Baumeister & Vohs, 2001).  Social interaction conceals what is actually a self-centered process where others are merely objects by which the narcissist attempts to regulate a dilapidated sense of self-esteem (Baumeister & Vohs, 2001; Beck at al., 2003; Falkenstrom, 2003).  Having thus objectified others, narcissists are rarely restrained by modesty, prudence, or realism; nor does consideration for others often interrupt their unrelenting pursuit for positive regard (Baumeister & Vohs, 2001).  One might think of the narcissist as living in a hall of mirrors, where object reflections are viewed as extensions of self (Beck et al., 2003).  Narcissists therefore perceive themselves as being constantly on display, and this prideful preoccupation with self-image leaves them feeling vulnerable to the fact that objective feedback cannot confirm a false sense of reality (Baumeister & Vohs, 2001; Beck et al., 2003).  The narcissist’s dichotomy of existence alternates between high and low self-esteem depending on social comparison information which the narcissist constantly monitors (Brown & Bosson, 2001; Bogart et al., 2005).  Though it appears that narcissists think highly of themselves, the truth is that they only desire to do so (Beck et al., 2003).

Self-centered to the extreme, narcissists often have difficulty relating to the needs of others, and only attempt to do so through a very carefully constructed and protected façade (Beard & Bakeman, 2000).  Narcissists often lack empathy for others due to affective splitting which leaves them emotionally shallow (Beard & Bakeman, 2000).  Individuals are rather coldly assessed as potential sources of narcissistic supply which comes in the form of approval, adoration, respect, or even fear from others.  Narcissists are often condescending to those they perceive to be lower in social status, and will quickly move on when supply is depleted or unavailable (Beck et al., 2003).  When denied narcissistic supply, the perceived slight is often met with an episode of narcissistic rage, the hostility of which is rarely commensurate to the circumstances (Baumeister & Vohs, 2001).  Due to ego fragility, narcissists react to criticism with more anger and aggression than others; and that they experience dramatic increases and decreases in self-esteem in response to messages of success and failure (Beck et al., 2003; Bogart, Benotsch, & Pavlovic, 2005; Gregg, & Sedikides, 2010).  The underlying core belief of inferiority is activated in the narcissist when the superiority or special status of the false self is not confirmed (Beck et al., 2003).

Though the etiology of narcissism is often traceable to selfobject failure as a result insecure attachment styles in the early developmental stages of childhood, narcissism may also be explained as a cultural phenomenon independent of the relationship to primary caretakers.  At the very least, cultural forces likely compound any pre-existing narcissistic personality structure.  Marceau (2011) argues that Western culture breeds narcissism with constant “not good enough” and “get better” messages.  The common good gives way to an individualism that demands unrealistic levels of success and personal achievement (Marceau, 2011).  While individual initiative, willful effort, and raw ambition are bountiful sources of pride, such drives are invariably linked to much human sorrow and suffering throughout history (Smith, 2010).  Unlike the Diagnostic and Statistical Manual of Mental Disorders which is primarily utilized in the United States, the International Classification of Diseases does not even reference narcissistic personality disorder – an omission which further suggests that narcissism is largely an American expression (Millon, Grossman, Millon, Meagher, & Ramnath, 2004).  This may be explained by the difference in the individualistic “I” culture of the West, and the “We” culture of collectivist societies which focus more on the common good and less on self (Millon et al., 2004).  Thus, any discussion of narcissism must take into account cultural forces which come to bear on the dynamics of personality development, particularly for those who live in highly individualistic cultures such as the United States.

It is worth noting that not all narcissistic traits are maladaptive (Bogart et al., 2005; Rubinstein, 2010).  For example, craving for approval and attention of others is, in certain contexts, an adaptive personality trait that promotes social survival (Baumeister & Vohs, 2001).  Marceau (2011) points out that some identity confusion and identity role play is a normal part of personality development.  In factor analysis, four of the seven principle components of narcissism can be construed as adaptive depending on the circumstances (Hart & Huggett, 2005).  Millon et al. (2004) describe “healthy narcissists” as having a self-confident personality style, strong leadership ability, and a normal capacity for relatedness (p. 335).  Unlike the adaptive traits in healthy narcissism, the pathological narcissist exhibits traits that swing from the extremes of the spectrum – on one end, feelings of inferiority and impotence; and at the other, feelings of omnipotence, arrogance, and superiority (Millon et al., 2004).

Narcissism and Addiction

The link between addiction and pathological personality subtypes has been consistently reported for more than 100 years (Brown, 1993).  Individuals who are treated for substance abuse often exhibit pathological personality structures; and more specifically, high levels of false pride and narcissism (Beck et al., 2003; Brown, 1993; Hart & Huggett, 2005; Millon et al., 2004).  The prevalence of personality disorders among substance abusers has been estimated to be as great as fifty percent (Brown, 1993).  Though narcissism often co-occurs with substance abuse, it is difficult to make a differential diagnosis due to the similarity of symptoms (Beck et al., 2003; Millon et al., 2004).  Additionally, the overt emphasis on grandiosity in the diagnostic criteria unduly minimizes the compensatory aspects of the narcissistic personality structure (Rubinstein, 2010).  Nevertheless, the patterns of maladjustment are often prevalent prior to the onset of the addictive disorder, and may even be detected in early childhood (Brown, 1993).  Van Schoor (1992) identifies four types of self-pathology associated with addiction that correlates to pathological narcissism: self-destruction, self-absorption, self-esteem deficits, and ego fragility/fragmentation.  Narcissism falls within a constellation of pathological personality traits known as “disorders of self”, all of which are characterized by the presentation of a false self (Brown, 1993).

Harry Tiebout (1896-1966)

Dr. Harry Tiebout was one of the first to observe that alcoholics commonly present with a narcissistic personality structure (Morgan, 2002).  Sometimes referred to as “AA’s psychiatrist”, Tiebout was influential in lending credibility to Wilson’s early recovery movement by linking it to psychiatry (Morgan, 2002).  Tiebout viewed AA as a spiritual solution for a sickness characterized by a narcissistic grandiosity gap (Morgan, 2002).  According to Tiebout (1944), the typical alcoholic has an egocentric, narcissistic core dominated by feelings of omnipotence – intent on maintaining its integrity at all costs.  Tiebout (1944) recognized that many alcoholics are unaware that others exist except in relation to self, a condition which he referred to as “His Majesty, The Baby” (Cunningham, 1986).  In order to recover, the alcoholic must become aware of this basic egocentricity, give up defiant individuality, and penetrate the façade of rationalizations and defense reactions (Tiebout, 1944).  Tiebout (1944) saw the program of AA as a process whereby the narcissistic character structure which blocks help is dissolved and replaced by one which allows recovery to take place.

Given this, it appears that addiction could be described as a spiritual malady which arises from and then exacerbates a narcissistic personality structure.  Addiction involves pre-occupation with self and the distorted perception that the individual is the center of the universe – “a state of psychological narcissism bordering on solipsism” (Buxton, Smith, & Seymour, 1987, p. 280; McCrady, 1994).  Morjaria & Orford (2002) assert that in order to recover, the addicted person must undergo profound mystical experiences that result in ego death.  William James referred to this experience as an “ego collapse at depth” (Hanna, 1992).  Chen (2010) describes drug addiction as a spiritual disorder of self that is manifest by self-centeredness and existential frustration.  The primary purpose of recovery is, therefore, to bring about radical self-change (Chen, 2010).  The ego must ultimately be transcended in order to escape narcissism and addiction (Hanna, 1992).  Morjaria & Orford (2002) assert that a natural internal conflict exists between the ego, which fights to maintain its fixed identity, and the instinctual desire for spiritual transcendence and ultimate wholeness.  To mediate this conflict, the addicted person substitutes the euphoric effects of drugs and alcohol for ego transcendence.  What seems like genuine peak experiences are actually appeals to the lower levels of consciousness where survival and passion reign supreme (Morjaria & Orford, 2002).  In this respect, Morjaria & Orford (2002) compare addiction to a form of idolatry.

Given the considerable influence that the likes of Carl Jung, Williams James, and Harry Tiebout exerted in Wilson’s early recovery movement, it is not surprising that AA arose as a program that is uniquely positioned to address both the symptoms of addiction and the narcissistic personality structure that often feeds it.  “Selfishness – self-centeredness!  That we think is the root of our troubles.  Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity . . . the alcoholic is an extreme example of self will run riot” (Alcoholics Anonymous, 2001, p. 62).  The fundamental message from Wilson to alcoholics is that they are not God (Hart & Huggett, 2005; Kurtz, 1982).  Adherents to the AA program of recovery undertake a thorough self-appraisal wherein selfishness and self-seeking behaviors are inventoried (Alcoholics Anonymous, 2001).  As a major component of ongoing recovery, the individual must remain ever mindful of selfishness and, when it arises, promptly take corrective action (Alcoholics Anonymous, 2001).  The 12 Traditions of AA likewise work against preoccupation with self by emphasizing common welfare, lack of individual authority, personal anonymity, and proscription against endorsements (Alcoholics Anonymous, 2001; Griffin, 2010; McCrady, 1994).  The personality change brought about by the AA program is most profoundly seen in the constructive modification of self-other attitudes and perceptions – what might be described as a “spiritual transformation of personal identity” (Kurtz, 1982; Magura, 2007, p. 352).

Narcissism and Sexuality

The incidence rate of substance misuse among LGBT persons is 30% as compared to 10-12% in the general population (Bliss, 2011).  Within that population, males are more than twice as likely as females to exhibit drinking problems (Suprina, 2006).  Stimulant abuse, particularly among gay men, has had a devastating effect on communities and leads directly to high-risk sexual behavior and the transmission of HIV (Avants & Margolin, 2004; Quittner, 2004).  These findings are significant and deserve the special attention of addiction professionals who carry the burden of identifying, intervening and treating populations at high risk for substance abuse.  In considering why gay men abuse substances at disproportionately high levels, it may be necessary to first investigate whether there is a common pathological personality structure contributing to the addiction.  Unidentified and untreated co-occurring disorders leave the individual at far greater risk of substance use relapse (Xie, McHugo, Fox, & Drake, 2005).  Within the population of gay men, treatment professionals will be well advised to investigate to what extent narcissistic personality structures are contributing to or even arising from the addictive disorder.  Men have consistently been found to be more narcissistic than females (Brown & Graham, 2008).  Gay men specifically score higher than their heterosexual counterparts in measures of narcissism, and lower in self-esteem (Rubinstein, 2010).  As will be discussed below in more detail, the fact that gay men are at high risk for addiction may be explained by the fact that this population is vulnerable to the development of narcissistic personality structures.  As such, this population is at very high risk not only for addictive disorders, but for a variety of negative health outcomes.

Narcissism has long been associated with male homosexuality both in psychoanalysis and popular culture, though not without considerable controversy (Beard & Bakeman, 2000; Drescher, 2010).  From the perspective of object relations theory, it seems that the link between narcissism and male homosexuality may best be explained by what Beard & Bakeman (2000) describe as boyhood gender non-conformity (BGNC).  Gender non-conforming behavior has been found to reliably predict adult sexual orientation with BGNC often pointing to adult male homosexuality (Beard & Bakeman, 2000).  Rather than accepting and affirming these children, many parents are quite disturbed by BGNC – a fact which does not often go unnoticed by the child (Beard & Bakeman, 2000).  Parents often seek to change the gender non-conformity in male children by various means with the goal of extinguishing the behavior and eliminating adult homosexual outcomes – a goal which is dubious at best and mentally and emotionally abusive at worst (Beard & Bakeman, 2000).  The rejection of the expressions, feelings, and experiences of the child by parents or primary caregivers results in narcissistic injury (Beard & Bakeman, 2000).  The pain of this rejection by those closest to the child leads to chronic devaluation of the self; an exaggerated need for admiration, validation, or reflection from others; and the creation of a defensive false self (Beard & Bakeman, 2000).  Thus is created Narcissus who, not surprisingly, will exhibit low self-esteem, high rates of depression and anxiety, suicidal ideations, poor family relations, and feelings of distance from parents/caregivers (Beard & Bakeman, 2000).

In addition to the often less than ideal circumstances of childhood, as gay children mature into adolescence and begin to explore the social environment, they are often greeted with hostility and bombarded with anti-homosexual rhetoric. (Allen & Oleson, 1999).  The resulting internalized homophobia occurs when the gay adolescent or young adult adopts these negative attitudes and beliefs about homosexuality as his own, a process which in turn results in further devaluation of self (Barnes & Meyer, 2012).  Once internalized, homophobic cognitions may become activated in a variety of contexts and may be directed internally towards the self, outwardly against other gay people, or towards homosexuality in general (Barnes & Meyer, 2012).  Internalized homophobia has been related to many negative health outcomes, including addiction, though its most noxious effect is that it leads to the emergence of a shame-based identity (Allen & Oleson, 1999; Barnes & Meyer, 2012).  Shame is related to the regulation of narcissism and it is the source of the primary dysphoric effect related to it (Allen & Oleson, 1999).  Kurtz (1982) describes the projection of the false self as the mechanism by which the alcoholic hides from the shame of failure of perfection.  This sort of self-hatred, alienation, and stigma lead to a crisis of the spirit – an existential pain often soothed by drugs and alcohol (Eliason et al., 2006).

Many churches and religious organizations commonly perpetuate anti-homosexual rhetoric which significantly contributes to the epidemic of internalized homophobia in gay men.  Most American religious organizations exhibit hostility towards LGBT persons (Barnes & Meyer, 2012).  The official position of many churches is that homosexual conduct is sinful and that LGBT persons are morally corrupt (Barnes & Meyer, 2012).  All three of the major U.S. Christian denominations – the Roman Catholic Church, the Southern Baptist Convention, and the United Methodist Church – have taken proscriptive action against sexual minorities including barring them from leadership positions in the church and refusing to solemnize same-sex unions (Barnes & Meyer, 2012).  The position of these churches may be an accurate reflection of its members’ sentiments.  According to Suprina (2006), if hate crimes and violence are indicators, then gay men are “the most hated minority group in the United States” (p. 99).  “God as judge” is a factor of religiosity most often endorsed by American religious conservatives; and to them, God’s judgment against gay persons will rightfully be harsh (Kendler et al., 2003).  Social psychologists have repeatedly confirmed that high levels of religiosity are associated with negative views towards homosexuality (Kendler et al., 2003).  While denominations such as the Metropolitan Community Church and the Unitarian Universalist Church have taken affirming positions towards LGBT persons, these congregations are generally located in or around urban centers and are therefore inaccessible to many gay men who might otherwise benefit from them (Barnes & Meyer, 2012).

Not surprisingly, gay men view religion much more negatively than those in the general population (Suprina, 2006).  Ninety-three percent of gay men believe that churches perpetuate homophobia in society-at-large (Suprina, 2006).  The churches’ hostility and outright exclusion has made the task of integrating religion, spirituality, and sexual identity a difficult and painful one for LGBT persons (Halkitis et al., 2009).  As a result of these hostilities, many LGBT persons are less likely to engage in religious activity or attend religious services as adults (Barnes & Meyer, 2012; Eliason et al., 2006).   Exposure to non-affirming religious settings promotes internalized homophobia, creates internal conflict, and can result in the splitting or compartmentalizing of identities (Barnes & Meyer, 2012; Halkitis et al., 2009).  Notwithstanding the vitriol directed at them by mainstream religion, many LGBT individuals remain committed to cultivating a spiritual life (Halkitis et al., 2009).

Additionally, the visual standards of the gay sub-culture may also contribute to the development of narcissistic personality structures in gay men (Rubinstein, 2010).  Brown (2008) notes that body aesthetics is a principle factor involved in gay male dating and relationships.  Gay men know they will be evaluated by others who place a high premium on body shape and physique (Brown, 2008).  Narcissists tend to objectify persons of desire, and are usually attracted to those who can enhance their own self-image (Maskowitz, Rieger, & Seal, 2009).  Traditionally, models of perfect bodies have had the greatest impact on women, but appear to be increasingly influential on gay men who are frequently exposed to images of the perfect, lean, muscular male body (Brown, 2008).  However, regulation of self-esteem based on attainment of an ideal body image can lead to a number of negative health outcomes including eating disorders, depression, shame related to diminished sense of self, and drug use (Brown, 2008).

While theories which relate narcissism and homosexuality appear valid in many respects, care must be taken to avoid characterizing homosexuality itself as a pathological condition.  Homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973, and the concept of narcissism has gained status wholly independent of sexuality (Rubinstein, 2010).  Nevertheless, there remains an unfortunate legacy wherein homosexuality was pathologized as a means to discriminate against gay people (Beard & Bakeman, 2000).  In fact, until the early 1990’s, some orthodox analytic organizations held tight to the view that homosexuality is a pathological disorder and only relented in this stand when threatened by legal action (Drescher, 2010).  It is not necessary to conclude, as did many of the early psychoanalysts, that pathological narcissism is intrinsic to homosexuality.  Rather, it is likely that many gay men ultimately exhibit narcissistic traits as a result of experiencing traumas in childhood and during the process of socialization (Beard & Bakeman, 2000; Allen & Oleson, 1999; Rubinstein, 2010).  Absent these traumas, homosexuality is a non-pathological human difference (Beard & Bakeman, 2000).

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Part I: Spirituality, Addiction & Recovery
Part III:  Religious Dilemmas & Spiritual Solutions

 (Parts I, II and III of this series were originally written in the Spring Semester of 2013 by the Site Administrator in partial fulfillment of the requirements for the Bachelor of Integrated Studies Degree at Murray State University)

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