Personality and Mental Health

8: 7984 (2014)
Published online 19 January 2014 in Wiley Online Library
(wileyonlinelibrary.com) DOI 10.1002/pmh.1253

Complex Case
Narcissistic biographiesthird age selftranscendence abilities

AUREL NIRESTEAN, EMESE LUKACS, DANA CIMPAN AND TUDOR NIRESTEAN, Psychiatric
Clinic II, Tirgu-Mures, UMF Tg. Mures, Targu Mures, Romania
ABSTRACT
Narcissistic traits interfere in the process of self-determination and the individual motivational strategies of
human beings. The grandiose and vulnerable narcissistic personality subtypes have difculties in their
education, interpersonal relationships and quality of life. The latter is also affected by ageing, whose attributes
inuence, above all, ones self-esteem, especially in women. Though very fearful of suffering and death,
narcissists have a powerful desire to overcome them by cultivating their grandiosity, especially through the
mystical and paranormal experiences they relate. The spiritual means of transcending ones self, including the
components of magical thinking, can prevent the destruction of self-esteem in narcissists in their third-age.
Copyright 2014 John Wiley & Sons, Ltd.
Narcissism is a term originated in ancient Greek
legends in which the Narcissus myth pleaded
simultaneously for human beings superiority
and vulnerability. Psychoanalysis reconrms
the signicance of this concept by describing
the primary and secondary narcissism of childhood, and the immaturity of the relationships
with the outer object in adulthood (Kohut,
1966, 1971).
Furthermore, the narcissistic state of balance in
which the selfs abilities correspond to the requirements of the super-self, represents an ideal of maturity for human beings. Thus, we may consider
that narcissistic traits always interfere in the
self-determination process and in the individual motivational strategies. As components of egocentrism,
they may have a signicant adaptive rolethe
healthy narcissism which means cohesion, strength

Copyright 2014 John Wiley & Sons, Ltd.

and a normal self-esteemor a maladaptive one that

dominates authoritatively the personalitys structure
interfering in 25% of cases with antisocial traits
(Gunderson & Ronningstam, 2001; Kernberg,
1989). The Defensive mechanisms of dissociation,
denial and impulsivity, are similar to those of antisocial personalities. (Perry & Perry, 2004).
The narcissistic grandiose self has been described
by Kohut whose contributionnext to Kernbergsfacilitates the diagnosis of the narcissistic personality disorder (Goldstein, 1985).
According to Gabbard (1989) and Gersten
(1991), the narcissistic personality has two subtypes
grandiose and vulnerable or hypersensitive
which both correspond to the borderline level of
organization of the self (Kernberg, 1984). The
vulnerable subtype is more conducive to psychotherapeutic intervention.

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Nirestean et al.

Even though the narcissistic style favours

activism and implication in existential roles, the
described defensive mechanisms are a disadvantage
for the education and the quality of life of the
narcissist. (Cramer, Torgersen, & Kringlen, 2004).
Narcissistic personalities go through life cultivating their self-esteem or trying to protect it from
the envy and/or indifference of those around them.
Independent of real personal qualities, talents and
accomplishments,ageing, with all its problems,
along with its vicissitudes becomes gradually becomes the subject dominating their conscience.
First case
Biographical data and personogenesis elements
Patient M, age 71 years, has been raised at an aristocratic family residence where her parents were
working during the rst part of her childhood.
She is the second child. Her elder brother died
at the age of 20, exactly 1 year before her birth.
The patient emphasizes this coincidence as well
as the advanced age of her parents at her birth
mother 43 years and father 45 years. She mentions
that older parents have smarter and more capable
children. Afrmatively, her father was the
noblemans illegitimate son, a plausible fact in
those times. Consequently, she declares herself
descendant of this family and relates her childhood memories: she was the most beautiful in
the castle, she received a special education, she
had access to the private library, she was dressed
as a countess, and so on. Subsequently, her
parents built a house on the most beautiful street
of the city. In addition to these self-valorizing
references, she identies herself with the angel
destined to change the world dreamt by her
mother before giving birth.
She writes poetry and paints since she was six.
Both parents lived into their late 80s. She
describes her fathers suicide by defenestration as
a refusal of the humiliation of living in suffering.
She studied for 12 years and completed a pedagogy course, considering herself the best student.

Copyright 2014 John Wiley & Sons, Ltd.

She worked in the educational system, involving

herself in multiple roles apparently superior to
her preparation, always having success due to her
special qualities. She has been greatly affected
by her retirementa humiliating event, described
as if she had entered a hospital waiting to die.
She got married at the age of 29 years, but
after 2 years she divorced because her husband,
although very rich and handsome, wasnt
educated, intelligent enough and she got bored
with him. Because he was dark, she checked
before marriage whether or not he had any
gypsy blood. She describes herself as a beautiful
woman who could not stand her husband
liking women. After divorce, she had several
brief relations but she never met a man to
match her. She does not have children and
never wanted any, having had three induced abortions on demand.
She has always cultivated her demeanor and
the feeling of belonging to the upper class and
searched for personal relationships that would
recognize her value. She still writes poetry, paints
and continues to fantasize about success.
For many years, she was in a particular relationship with a man 20 years younger, a person interested in her inheritance, who is worthless,
submissive. She manipulates him for her personal
advantage and mentions that he is gay, thus making
it clear that they do not have an intimate relationship. On the other hand, she describes herself
disinterested in intimacy considering it inferior to
her existential priorities. She lives alone and
permanently looking for a life partner considering
herself a picky woman.
She afrms that if she does not meet an intelligent partner, she will leave all her fortunea
two room apartment, the books she wrote and
her paintingsto the church.
She did not attended church or lived by the
reformed doctrine in which she has been baptized,
but lately she has been preoccupied by the paranormalsuch as clairvoyance, and the gift of
healingthis way which explain past, sometimes
trivial events in her life. Retroactive events and

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Narcissistic biographiesthird age self-transcendence abilities

sometimes trivial she afrms that even before birth,

she was near to God being sent to earth on a special
mission. She describes many premonitory dreams,
superstitions and coincidences and seeks refuge in
an environment that can value her on the level of
her phantasms. Recently, she converted to the
Pentecostal religion, but continues to select interpersonal relationships, disdaining followers who do
not receive the Divine grace.
She explains healing of ordinary diseases
colds and infectionsas miracles or paranormal
interventions. Her somatic pathological personal
antecedents are less signicant, but she mentions
having always been dominated by claustrophobia,
misophobia, thanatophobia and fear of touching.
She does not use drugs or alcohol.
Referring to herself, she afrms that she is
exacting, educated, intelligent, very beautiful
and has not found inner peace. Exaggerated selfesteem, feeling of grandeur and desire to succeed
are obvious in all her life roles. As she grows older,
she lives intensely the changes related to her appearance and physical condition and processes anxiously the state of loneliness.
Disease history
Patient had no psychiatric antecedents, until she
was rst admitted in the fall of 2011 with symptoms of anxiety and depression of average intensity associated with phobias of disease and death.
The symptomatology appeared insidiously due to
existential frustrations related to interpersonal
relationships, to retirement and to changes in
physical appearance and health due to ageing
and living alone. She followed a treatment with
Venlafaxina, Alprazolam, Nicergolin and Zopiclone
and a psychiatric counselling. Her claims to be
looked at as special were obvious, and she collaborated exclusively with the upper medical staff and
with obvious preference for males. The therapeutic
alliance has functioned well only when the medical
staff met her expectations, her clinical evolution
being slowly positive. She came on a regular basis
for special check-ups and periodic admissions, on

Copyright 2014 John Wiley & Sons, Ltd.

request, accusing an affective discomfort and

self-esteem oscillations. These Admissionsin
terms of relating to the staff and other patients
are for her ways of restoring her self-esteem and
to reafrm her artistic and literary qualities and
spiritual abilities that make her special. Considering her narcissistic traits, age and present social
status, remissions are incomplete and the prognostic reserved.
Second case
Biographical data and personogenesis elements
Patient H, age 72 years, is the fourth in a family
with ve siblings. She describes her childhood as
happy, above average, the only child in the
family who was spared the agricultural and household chores and the only one schooled. She
describes harmonious family relations with her
mothera central gure, full of life, sociable and
dominantwhom she admired and thought she
resembled. Father is described as an introvert, submissive, indecisive, less present in family life, whom
she took advantage of, just like her mother. Both
parents lived over the age of 85.
The patient studied for 12 years, and she is a
school teacher with accounting studies. She loved
her profession and tends to exaggerate her accomplishments. She describes herself as the most
beautiful and elegant teacher. Currently she is
retired, a status she associates with the loss of
her qualities.
At the age of 17 years, she married an agronomist engineer, a director of wide reading and of
healthy breeding, a socially very appreciated
man, a ladies man, but an abusive alcoholic. In social life, the patient was highly notable being a
very elegant woman who wore fur. In the couple
relationship, she was domineering, possessive and
fastidious, obtained everything she wanted and
cannot imagine any other kind of relations in a
marriage or with the opposite sex. Although
she made efforts to get pregnant, she has no
children. This represents an existential frustration

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that she always evokes and tries to transcend it

sometimes in a fatalist manner. For example,
when she hears that a baby died she believes that
this way it will not suffer any longer since she
associates suffering with ageing and the inevitable
ending of life.
She has been a widow for 7 years, lives alone
and can hardly standing it. She lives alternatively in two different cities according to the
favourable attitude of those around her and
the access to special social and cultural events.
She seeks the company of important persons
and looks down on people without education
or lacking respect.
She describes herself as a religious person in her
youth but now she does not pray and can not
stand priests. Nevertheless, she narrates many
unusual experiences and premonitory dreams
through which she gains her self-worth since
they grant her the status of a person with special
spiritual abilities. She afrms that due to clairvoyance, intuition and personal symbology, she
foresaw important life events and deaths of
certain known persons.
She emphasizes her physical qualities having
indeed a pleasant physical appearancenobody
can tell how old I am. She nds it difcult to
adapt to ageing and lives anxiously the loneliness
and physical changesI feel old, ugly and I
dont like old people, I cant stand them. She
states being afraid of death; on the other hand,
she would die to get rid of old age. She has been
also preoccupied of the end of the world idea
associated to 2012, death in this context being
easier to accept becausenot only herbut
well all die.
She describes herself as a tidy, neat, sensible,
melancholic, educated person and of course very
beautiful. She is intolerant to criticism, intransigent and selective in social relationships, demanding preferential treatment and respect. She
can not stand gypsies nor weak men in her
entourage. She does not have particular somatic
pathological personal antecedents and does not
use drugs or alcohol.

Copyright 2014 John Wiley & Sons, Ltd.

Disease history
The Patient, has no psychiatric antecedents, and
has been admitted for the rst time at the beginning of 2011 after an extended period of weight
loss, lack of appetite, sleeplessness and nightmares
in the contxt of an anxious-depressive episode.
The symptomatology appeared insidiously due to
existential frustrations related mainly to ageing.
Besides, changes in health and physical appearance,
the patient has been suffering from loneliness,
rinactivity and tensions derived from her interpersonal relationships. During admission, she has
been treated with Escitalopram, Alprazolam and
Nicergolina, supportive psychotherapy, therapeutic alliance being good only when the teams
attitude was permissive and compliant with her
various demands. She is envious of persons with
certain qualities or more important roles,
projecting on them her own feelings by repeatedly
evoking an inevitable and fatal ending. Evolution
has been favourable with partial remission due to
the persistence of onset factors and narcissistic
personality traits.
Comparative observations. We consider relevant
the description of these two patients with narcissistic traits and several similarities in their biographical
data. In both cases, there is no emphasis of clinical
phenomena of cognitive decline.
Their Narcissistic destiny was pregured since
childhood, each patient being more valued than
other children and/or spared from daily chores.
The father gure is described as passive or less
signicant, especially at patient H. Starting
from these patterns, in both cases, we observe
exaggerated demands on the opposite sex and
at the same time the conviction of their own
superiority in relation to the latter.
Egocentrism and affective superciality explain
the attitude towards children. Neither had
children but both worked with them in the educational system. In the professional role, all their
accomplishments and successes are related to their
own image and evolution in the professional

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Narcissistic biographiesthird age self-transcendence abilities

hierarchy without any reference to relationships

with children, or to their needs and successes.
Currently, because of loneliness, the subject
of children is frequently evoked by both
patients, as they regret lacking the support and
attention of their descendants and being deprived of the possibility of gaining self-worth
through them. The professional role and status
of both patients are described as very special
and much oversignied.
Both patients have difculties accepting
changes in physical appearance that are due to
aging, and constantly comment about them. Even
now, they try to display their physical qualities and
irt with the opposite sex in a natural manner.
In patient M, who has bohemian nature and
displays artistic and literary talents, the feeling of
grandeur is more unstable, maintaining currently
an obvious affective and attitudinal instability.
Patient H has a more stable self-esteem. She is
more calculated, tidy and meticulous, and her
perfectionism extends outward. Her emotional
strength is due to the experience of a longer and
more stable marital relationship and social relationships which gave her a better affective and
attitudinal balance.
Both patients speech conrms the fear of suffering and death, which, by the same token, they
have the desire to defeat by cultivating grandiosity, but also faith and magical thinking.
We noticed in both patients, several relatively recent mystical/religious preoccupations or concerning
the supernatural, that amplied concurrently with
the frustrating experience of ageing. They look for
meaning, for self-valuing coincidences, narrate paranormal experiences that confer them a particular status in a subjective reality and which only they can
verify or understand. These abilities and grandiose
fantasies become dominant when they are more intensely aware of the current reality which make their
existential values look ephemeral and obsolete. By
claiming to be closer to the divinity or to have intuitions and premonitory abilities, the two patients
may take refuge in the shadow of an idealized and
self-attributed object. This is how they give the

Copyright 2014 John Wiley & Sons, Ltd.

appearance of self-contentment and self-control

narcissistic transferthat may still draw the others
admiration.
The biographies described above conrm that
narcissists cannot deprive themselves of the feeling of uniqueness, grandeur or and the need to
be admired. They conrm that the manners of
self-transcendence derived from the spiritual dimensions of the human being are equally similar
and peculiar to both.
Questions
(1) Taking into account, the fact that throughout
their lives neither patient practiced a religion
or had paranormal convictions could the rise
of these preoccupations at an older age be just
a way of salvaging their narcissistic self-esteem?
(2) Could the two narcissistic biographies
described be considered two biographies of
persons with schizotypal features?
(3) Could we conclude that the grandiose narcissism in both patients became a vulnerable one
with ageing and because they are single women?
(4) Can loneliness, the lack of a familyespecially
childrenand the self-fullment which comes
from it, inuence the patients orientation
towards mysticism and the imaginary?
(5) Could there be a connection between the
contemporary social orientation towards
spirituality and the patients paranormal preoccupations and magical thinking?
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Address correspondence to: Prof Aurel Nirestean,

MD, PhD, Psychiatric Clinic No.2, Department
of Psychiatry, University of Medicine and
Pharmacy, Gheorghe Marinescu str, No.38, Tirgu
Mures, Romania. Email: aurelnirestean@yahoo.com

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