Is pathological narcissism the outcome of inherited traits - or the sad result of abusive and traumatizing upbringing? Or, maybe it is the confluence of both? It is a common occurrence, after all, that, in the same family, with the same set of parents and an identical emotional environment - some siblings grow to be malignant narcissists, while others are perfectly "normal". Surely, this indicates a predisposition of some people to developing narcissism, a part of one's genetic heritage.
This vigorous debate may be the offshoot of obfuscating semantics.
When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.
Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.
True, single genes rarely account for any behaviour or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviours such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings.
What about the Narcissistic Personality Disorder?
It would seem reasonable to assume - though, at this stage, there is not a shred of proof - that the narcissist is born with a propensity to develop narcissistic defences. These are triggered by abuse or trauma during the formative years in infancy or during early adolescence (see http://samvak.tripod.com/faq64.html
). By "abuse" I am referring to a spectrum of behaviours which objectifies the child and treats it as an extension of the caregiver (parent) or an instrument. Dotting and smothering are as much abuse as beating and starving. And abuse can be dished out by peers as well as by adult role models.
Still, I would have to attribute the development of NPD mostly to nurture. The Narcissistic Personality Disorder is an extremely complex battery of phenomena: behaviour patterns, cognitions, emotions, conditioning, and so on. NPD is a PERSONALITY disorder and even the most ardent proponents of the school of genetics do not attribute the development of the whole personality to genes.
From "The Interrupted Self" (http://samvak.tripod.com/sacks.html
"'Organic' and 'mental' disorders (a dubious distinction at best) have many characteristics in common (confabulation, antisocial behaviour, emotional absence or flatness, indifference, psychotic episodes and so on)."
From "On Dis-ease" (http://samvak.tripod.com/disease.html
"Moreover, the distinction between the psychic and the physical is hotly disputed, philosophically. The psychophysical problem is as intractable today as it ever was (if not more so). It is beyond doubt that the physical affects the mental and the other way around. This is what disciplines like psychiatry are all about. The ability to control 'autonomous' bodily functions (such as heartbeat) and mental reactions to pathogens of the brain are proof of the artificialness of this distinction.
It is a result of the reductionist view of nature as divisible and summable. The sum of the parts, alas, is not always the whole and there is no such thing as an infinite set of the rules of nature, only an asymptotic approximation of it. The distinction between the patient and the outside world is superfluous and wrong. The patient AND his environment are ONE and the same. Disease is a perturbation in the operation and management of the complex ecosystem known as patient-world. Humans absorb their environment and feed it in equal measures. This on-going interaction IS the patient. We cannot exist without the intake of water, air, visual stimuli and food. Our environment is defined by our actions and output, physical and mental.
Thus, one must question the classical differentiation between 'internal' and 'external'. Some illnesses are considered 'endogenic' (generated from the inside). Natural, 'internal', causes - a heart defect, a biochemical imbalance, a genetic mutation, a metabolic process gone awry - cause disease. Aging and deformities also belong in this category.
In contrast, problems of nurturance and environment - early childhood abuse, for instance, or malnutrition - are 'external' and so are the 'classical' pathogens (germs and viruses) and accidents.
But this, again, is a counter-productive approach. Exogenic and endogenic pathogenesis is inseparable. Mental states increase or decrease the susceptibility to externally induced disease. Talk therapy or abuse (external events) alter the biochemical balance of the brain.
The inside constantly interacts with the outside and is so intertwined with it that all distinctions between them are artificial and misleading. The best example is, of course, medication: it is an external agent, it influences internal processes and it has a very strong mental correlate (its efficacy is influenced by mental factors as in the placebo effect).
The very nature of dysfunction and sickness is highly culture-dependent.
Societal parameters dictate right and wrong in health (especially mental health). It is all a matter of statistics. Certain diseases are accepted in certain parts of the world as a fact of life or even a sign of distinction (e.g., the paranoid schizophrenic as chosen by the gods). If there is no dis-ease there is no disease. That the physical or mental state of a person CAN be different - does not imply that it MUST be different or even that it is desirable that it should be different. In an over- populated world, sterility might be the desirable thing - or even the occasional epidemic. There is no such thing as ABSOLUTE dysfunction. The body and the mind ALWAYS function. They adapt themselves to their environment and if the latter changes - they change.
Personality disorders are the best possible responses to abuse. Cancer may be the best possible response to carcinogens. Aging and death are definitely the best possible response to over-population. Perhaps the point of view of the single patient is incommensurate with the point of view of his species - but this should not serve to obscure the issues and derail rational debate.
As a result, it is logical to introduce the notion of 'positive aberration'. Certain hyper- or hypo- functioning can yield positive results and prove to be adaptive. The difference between positive and negative aberrations can never be "objective". Nature is morally-neutral and embodies no 'values' or 'preferences'. It simply exists. WE, humans, introduce our value systems, prejudices and priorities into our activities, science included. It is better to be healthy, we say, because we feel better when we are healthy. Circularity aside - this is the only criterion that we can reasonably employ. If the patient feels good - it is not a disease, even if we all think it is. If the patient feels bad, ego-dystonic, unable to function - it is a disease, even when we all think it isn't. Needless to say that I am referring to that mythical creature, the fully informed patient. If someone is sick and knows no better (has never been healthy) - then his decision should be respected only after he is given the chance to experience health.
All the attempts to introduce 'objective' yardsticks of health are plagued and philosophically contaminated by the insertion of values, preferences and priorities into the formula - or by subjecting the formula to them altogether. One such attempt is to define health as 'an increase in order or efficiency of processes' as contrasted with illness which is 'a decrease in order (increase of entropy) and in the efficiency of processes'. While being factually disputable, this dyad also suffers from a series of implicit value-judgements. For instance, why should we prefer life over death? Order to entropy? Efficiency to inefficiency?"
Liveslye, W.J., Jank, K.L., Jackson, B.N., Vernon, P.A.. 1993. Genetic and environmental contributions to dimensions of personality disorders. Am. J. Psychiatry. 150(O12):1826-31.
The Genetic Roots of Personality Disorders - click on the link: