Minor differences of narcissism: narcissistic personality in Germanophone Europe and North America

Abstract

How can the same object become split when viewed by different groups of observers? What is the relationship between conflict and consensus, and the ritual and the rational? I interrogate these questions through the case of narcissistic personality disorder (NPD) in Germanophone Europe and North America.

I interviewed forty-five practitioners from Germany, Austria, Switzerland, the US and Canada. These conversations were semi-structured and ethnographically inflected. I attempted to take the informant’s perspective earnestly and to read any available works by that author in advance of the interview. To gain a sense of how science differed when not immediately concerned with the treatment of patients, I included an assessment specialist and a social-personality psychologist. Non-expert practitioners, who had not published any books or articles on pathological narcissism, were included to test whether theory is solely alluring to the academician or if it holds sway over the psychotherapist on the street. These respondent pools were matched as closely as possible across the two contexts to facilitate comparison. Approximately six psychotherapeutic schools emerged as important amongst my respondents.

After a brief introduction to the different psychotherapies, I begin with the native understandings of NPD or pathological narcissism. These definitions and the wide range of narcissistic patients seen pose the puzzle: How can these definitions be so disparate, and all ostensibly be concerned with NPD as a clinical or scientific object? My concern is less oratorical and more earthy: What precisely do practitioners do? Opening with assessment (Ch. 5), we find some common signs. Diagnostic procedures may employ different technological mixes, but ultimately all follow a single pattern. Chapter 6 addresses empathy and the therapeutic alliance. The notion of a minimal medical model underlying all treatment types I encountered was unearthed despite many methods’ active denial of the ‘medical model.’ The patient-practitioner boundary is, however, far from the final frontier. Conceptualisation helps to guide the ways in which clinicians interact with one another, and ultimately the broader science of psychopathology. Chapter 8 addresses the ways in which different classificatory schemes relate to one another, and how this helps to shape the science of narcissism.

What ultimately emerges is a story of (1) the minor differences of narcissism and (2) the narcissism of minor differences. The narcissism (2) can be said to obscure the (1) minor differences. Competition is inherent in the process at multiple levels: between models for both students and patients (attention-space), and through scientific exchange and the effort to gain evidence for one’s theory. I suggest that science serves less to find the best description or explanation for pathological narcissism, and more to legitimate one’s conceptualisation. Evidence of this sort gives a theoretical school means to command more financial and attentional resources. Psychotherapeutic technology is, however, path dependent, limiting the distance between any two methods.