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Question:

My husband is a Narcissist and constantly depressed. Is there any connection between these two facts?

Answer:

Assuming that these are clinically-established facts, there is no necessary connection between them. In other words, there is no proven high correlation between suffering from NPD (or even a milder form of narcissism) - and enduring bouts of depression.

Depression is a form of aggression. Transformed, this aggression is directed at the depressed person rather than at his human environment. This regime of repressed and mutated aggression is a characteristic of both narcissism and depression.

Originally, the Narcissist experiences "forbidden" thoughts and urges (sometimes to the point of an obsession). Examples: "dirty" words, curses, the remnants of magical thinking ("if I think or wish something it just might happen"), denigrating and malicious thoughts directed at authority figures (mostly at a parent) - all prohibited by the Superego. This is doubly true if the individual possesses a sadistic, capricious Superego (a result of the wrong kind of parenting). These thoughts and wishes do not fully surface. The individual is only aware of them in passing and vaguely. But they are sufficient to provoke intense guilt feelings and to set in motion a chain of self-flagellation and self-punishment.

Amplified by an abnormally strict and punitive Superego - this could result in a constant feeling of imminent threat. This is what we call anxiety. It has no discernible external reasons and, therefore, it is not (rational) fear. It is the echo of a battle between a part of the personality, which viciously wishes to destroy the individual through excessive punishment - and the instinct of self-preservation.

Anxiety is not - as some sholars have it - an irrational reaction to internal dynamics involving imaginary threats. To my mind, anxiety is more rational than many fears. The powers unleashed by the Superego are so enormous, its intentions so fatal, the self-loathing and self-degradation that it brings with it so intense - that the threat is real. Overly strict Superegos are usually coupled with weakness in all other personality structures. Thus, there is no structure able to fight back, to take the side of the depressed person. Small wonder that depressives have constant suicidal ideation (=they toy with ideas of self-mutilation and suicide, or worse, commit these acts). Confronted with a horrible internal enemy, lacking in defences, falling apart at the seams, dilapidated by previous attacks, devoid of the energy of life - the depressed wishes himself dead. Anxiety is about survival, the alternatives being, usually, self-torture or self-annihilation.

Depression is how these people experience their reservoirs of aggression. They are a volcano, which is about to explode and bury them under their own ashes. Anxiety is how they experience the war raging inside them. Sadness is the name that they give to the resulting wariness, to the knowledge that the battle is lost and personal doom is at hand. Depression is the acknowledgement by the individual that something is so fundamentally wrong and dangerous in him - that there is no way to gain the upper hand. The individual becomes depressed only when he becomes a fatalist. As long as he believes that there is a chance - however meagre - to better his position, he will move in and out of depressive episodes. True, anxiety disorders and depression (mood disorders) do not belong in the same category. But they very often go together. In many cases, the patient tries to exorcise his internal demons by adopting ever more bizarre rituals. These are the compulsions, which - by diverting energy and attention away from the "bad" content in more or less symbolic (though totally arbitrary) ways - bring temporary comfort and an easing of the anxiety. It is very common to meet all four: a mood disorder, an anxiety disorder, an obsessive-compulsive disorder and a personality disorder in one patient.

Depression is the most varied of all psychological disturbances. It wears a myriad of guises and disguises. Many people are chronically depressed without even knowing it and without corresponding cognitive or affective contents. Some depressions are part of a cycle of ups and downs (bipolar disorder and a milder form, the cyclothymic disorder). Other depressions are "built into" the characters and the personalities of the patients (the dysthymic disorder or what used to be known as depressive neurosis). One type of depression is even seasonal and can be cured by phototherapy (gradual exposure to carefully timed artificial lighting). We all experience "adjustment disorders with depressed mood" (used to be called reactive depression - which occurs after a stressful life event and as a direct and time-limited reaction to it).

But all these poisoned garden varieties are all-pervasive. Not a single aspect of the human condition escapes them, not one element of human behaviour avoids their grip. When this grip tightens we have melancholia - otherwise, we suffer from a mere depression. It is not wise (has no predictive or explanatory value) to differentiate "good" or "normal" depressions from "pathological" ones. There are no "good" depressions. Moreover, whether provoked by a sorry event or endogenously (from the inside), whether during childhood or later in life - it is all the same. A depression is a depression is a depression no matter what its precipitating causes are or in which stage it appears.

The only valid distinction seems to be phenomenological: some depressives slow down (psychomotor retardation), their appetite, sex life (libido) and sleep (known together as the vegetative) functions are notably perturbed. Behaviour patterns change or disappear altogether. These patients feel dead: they are anhedonic (find pleasure or excitement in nothing) and dysphoric (sad).

The other type of depressive is psychomotorically active (at times, hyperactive). These are the patients that I described above: they report overwhelming guilt feelings, anxiety, even to the point of having delusions (delusional thinking, not grounded in reality but in a thwarted logic of an outlandish world). The most severe cases (severity is also manifest physiologically, in the worsening of the above-mentioned symptoms) exhibit paranoia (delusions of systematic conspiracies to persecute them), seriously entertain ideas of self-destruction and the destruction of others (nihilistic delusions). They hallucinate. Their hallucinations let out the hidden contents: self-deprecation, the need to be (self) punished, humiliation, "bad" or "cruel" or "permissive" thoughts about authority figures. Depressives are almost never psychotic (psychotic depression does not belong to this family, in my view - though, this by no means is everyone's view). The misleading thing is that depression does not entail a change in mood. "Masked depression" is, therefore, difficult to diagnose (if we stick to the worn out definition of a "mood" disorder).

Parent Category: Disorders