One of the most important symptoms of pathological narcissism (the Narcissistic Personality Disorder) is grandiosity. Grandiose fantasies (megalomaniac delusions of grandeur) permeate every aspect of the narcissist's personality. They are the reason that the narcissist feels entitled to special treatment which is typically incommensurate with his real accomplishments. The grandiosity gap is the abyss between the narcissist's self-image (as reified by his False Self) and reality. When narcissistic supply is deficient, the narcissist decompensates and acts out in a variety of ways. Narcissists often experience psychotic micro-episodes during therapy and when they suffer narcissistic injuries in a life crisis. But can the narcissist "go over the edge"? Do narcissists ever become psychotic?
The narrowest definition of psychosis, according to the DSM-IV-TR, is "restricted to delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature."
And what are delusions and hallucinations?
A delusion is "a false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary."
A hallucination is a "sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ."
Granted, the narcissist's hold on reality is tenuous (narcissists sometimes fail the reality test). Admittedly, narcissists often seem to believe in their own confabulations. They are unaware of the pathological nature and origin of their self-delusions and are, thus, technically delusional (though they rarely suffer from hallucinations, disorganized speech, or disorganized or catatonic behaviour). In the strictest sense of the word, narcissists appear to be psychotic.
But, actually, they are not. There is a qualitative difference between benign (though well-entrenched) self-deception or even malignant con-artistry--and "losing it".
Pathological narcissism should not be construed as a form of psychosis because:
- The narcissist is usually fully aware of the difference between true and false, real and make-believe, the invented and the extant, right and wrong. The narcissist consciously chooses to adopt one version of the events, an aggrandizing narrative, a fairy-tale existence, a "what-if" counterfactual life. He is emotionally invested in his personal myth. The narcissist feels better as fiction than as fact--but he never loses sight of the fact that it is all just fiction.
- Throughout, the narcissist is in full control of his faculties, cognizant of his choices, and goal-oriented. His behaviour is intentional and directional. He is a manipulator and his delusions are in the service of his stratagems. Hence his chameleon-like ability to change guises, his conduct, and his convictions on a dime.
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