February 15, 2016

Is Self-Love Real Love?

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EDITOR’S NOTE: The confluence of two national events last week inspired the following interview with H. Steven Moffic, MD, Talk Ten Tuesdays’ celebrated resident psychiatrist: Valentine's Day on Sunday, Feb. 14 and last Tuesday’s New Hampshire presidential primary, which resulted in a GOP victory for presidential hopeful Donald Trump. A number of comments about Trump’s alleged narcissism have been made in the media, but could there be a code to denote his behavior? That’s one thing we wanted to find out.

Valentine’s Day is a celebration of love. How does self-love relate to narcissism? Can we not love others if we don't love ourselves? 

Self-love is the essence of narcissism, but it is important to understand that self-love is on a spectrum ranging from too little to too much. It is a paradox, perhaps, that indeed we can love others if we don't love ourselves. How and why? For instance, we can love entertainers, athletes, and politicians for many reasons … one of them being that doing so makes up for our own lack of self-love. When we idolize them, identify with them, and they do better, we feel better, at least temporarily.

Mature interpersonal love generally means each party loves the self and (each) other at least equally, and that when push comes to shove, one will put the needs of the other first, even putting one's own life in the balance. As our high divorce rates indicate, this is not easy to accomplish. At its best, two people complement, enhance, and forgive one another over time, not mirror each other, which makes mutual growth unlikely.

Can the feeling of love or being in love have any documented mental health benefits? 

As so many have said over history, love is hard to define and explain, which makes your question hard to answer. There are a variety of kinds of love: acutely passionate love, longer-term warm feelings of love, compassionate love, and love of many things other than people. What is clear, though, is that being in some state of love makes you feel better and happier.

Can love stave off depression, and are the two inexplicably linked?

No, you can be in love and still receive a clinically, ICD-10-defined depression of one sort or another. The chemical and causative paths of love and depression seem to be different: oxytocin in the brain for love and serotonin in the brain for depression is a simplistic distinction. Though I love the Beatles song, "All You Need Is Love," if only that was true. That is a fantasy and wish fulfillment, for you need more than love for depression. Then again, one of the reasons for such messages in songs (that makes them) popular is that we want that to be true.

About the much-discussed New Hampshire primary last Tuesday, to what extent do you see narcissistic personality disorder (NPD) at play here?

NPD is on the extreme spectrum of narcissism and means that as a dominant personality characteristic, it can cause frequent problems in relationships. Clinically speaking, NPD translates into excessive needs for attention, little empathy, and over-sensitivity to criticism. The nature of all personality disorders is for the person with the disorder to not realize they have a problem, but others usually notice that indeed they do. That is why it takes so long for those with NPD and other personality disorders to get treatment. NPD is probably the hardest to get successfully treated, for the person takes it as an unacceptable blow to their self-regard to need help, and if they do come to psychotherapy, the therapist has to be very careful to not come across as critical. There is no medication that helps personality disorders.

I say all this to let our readership make their own conclusions about whether any of the candidates, or even pundits, have NPD because it is unethical to do so without evaluating someone and then getting their permission to reveal their diagnosis – and I can assure you, I've never examined any of these candidates! I would say, though, that you need to have an above-average amount of psychological narcissism to want to run for president in the first place – but NPD would likely be too extreme and lead to failure, at least in our open society in the USA.

Are there examples of NPD negatively impacting leadership? 

More than likely, though again, I wouldn't provide examples, but try to provide the readership with enough information to at least (allow them to) make educated estimations.  

I would add, though, that coupling NPD with some sociopathy and paranoia can be the most worrisome. Think Stalin, Hitler, and Mao. 

Since politics is the art of negotiation, can NPD hinder a leader's ability to work with others?

For NPD, for sure, but less extreme amounts of narcissism may help, as charisma and being personable often accompanies it. The problem occurs when such narcissism is threatened, which can produce undue anger and rage. Graciously accepting a second-place finish in a primary is not an indication of NPD.

Does NPD relate to bullyism? 

Yes, for one with NPD tries to get their way, one way or another!

How does charisma relate to NPD? 

Charisma often goes hand in hand with NPD, though when the narcissism is that extreme, the charisma may start to seem off-putting. 

How does self-esteem relate to NPD?

This is a paradox. Low self-esteem often correlates with high narcissism, as the stronger self-love tries to compensate for lower self-assessment, which may even be unconscious to the person. That explains the risk of narcissistic leaders telling their followers that they will make everything better, including themselves, and everybody believing that is true. 

About H. Steven Moffic, MD

H. Steven Moffic, MD has received numerous awards for his practice, writings, and administration. After an award-filled career focusing on the underserved, he retired from clinical work and his tenured professorship at the Medical College of Wisconsin on June 30, 2012. He is an editorial board member of and regular contributor to Psychiatric Times. Dr. Moffic’s book, “The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare” (Jossey-Bass, 1997), was the first on the subject. 

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.

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