In the book describing the fabulous tales of the Baron Munchhausen, there is a story about how the legendary nobleman succeeded to pull himself out of a quicksand marsh – by his own hair. Such a miracle is not likely to recur. Narcissists cannot cure themselves any more than other mental patients do. It is not a question of determination or resilience. It is not a function of the time invested by the narcissist, the effort expended by him, the lengths to which he is willing to go, the depth of his commitment and his professional knowledge. All these are very important precursors and good predictors of the success of an eventual therapy. However, they are no substitute for one.

The best – really, the only way – a narcissist can help himself is by applying to a mental health professional. Even then, sadly, the prognosis and the healing prospects are dim. It seems that only time can bring on a limited remission (or, at times, aggravation of the condition). A therapy can tackle the more pernicious aspects of this disorder. It can help the patient to adapt to his condition, to accept it and to learn to conduct a more functional life with it. Learning to live with one’s disorder – is a great achievement and the narcissist should be happy that even this minor modicum of success is, in principle, possible.

But just to get the narcissist to meet a therapist is difficult. The therapeutic situation implies a superior-inferior relationship. The therapist is supposed to help him – and, to the narcissist, this means that he is not as omnipotent as he imagines himself to be. The therapist is supposed to know more (in his field) than the narcissist – which seems to attack the second pillar of narcissism, that of omniscience. Going to a therapy (of whatever nature) implies both imperfection (something is wrong) and need (read: weakness, inferiority). The therapeutic setting (the client visits the therapist, has to be punctual and to pay for the service) – implies subservience. The process itself is also threatening: it involves transformation, losing one’s identity (read: uniqueness), one’s long cultivated defences against the world. The narcissist must shed his False Self and face the world naked, defenceless, and (to him) pitiful. He is inadequately equipped to deal with his old hurts, traumas and unresolved conflicts. His True Self is infantile, mentally immature, frozen, incapable of fighting the almighty Superego (the inner voices). He knows this – and he recoils. Therapy forces him to finally put full, unmitigated, trust in another human being.

Moreover, the transaction implicitly offered to him is the most unappealing imaginable. He is to give up decades of emotional investment in an elaborate, adaptive and, mostly, functioning, mental hyper structure. In return, he will become “normal” – an anathema to a narcissist. Being normal, to him, means, being average, not unique, non-existent. Why should he commit himself to such a move when even happiness is not guaranteed (he sees many unhappy “normal” people around him)?

But is there anything the narcissist can do “in the meantime” “until a final decision is made”? (A typical narcissist question).

The first step involves self-awareness. The narcissist often notices that something is wrong with him and with his life – but he never admits it. He prefers to invent elaborate constructions why that which is wrong with him – is really right. This is called: “Cognitive Dissonance”. The narcissist consistently convinces himself that everyone else is wrong, deficient, lacking, and incapable. He may be exceptional and made to suffer for it – but this does not mean that he is in the wrong. On the contrary, history will surely prove him right as it has done so many other idiosyncratic figures.

This is the first and, by far, the most critical step: will the narcissist admit, be forced, or convinced to concede that he is absolutely and unconditionally wrong, that something is very amiss in his life, that he is in need of urgent, professional, help and that, in the absence of such help, things will only get worse? Having crossed this Rubicon, the narcissist will be more open and amenable to constructive suggestions and assistance.

The second important leap forward is when the narcissist begins to confront a REAL version of himself. A good friend, a spouse, a therapist, a parent, or a combination of these people can decide not to collaborate anymore, to stop fearing the narcissist and acquiescing in his folly. Then they come out with the truth. They demolish the grandiose image that “runs” the narcissist. They no longer succumb to his whims or accord him a special treatment. They reprimand him when needed. They disagree with him and show him why and where he is mistaken. In short: they deprive him of many of his Narcissistic Supply Sources. They refuse to take part in the elaborate game that is the narcissist’s soul. They rebel.

The third Do It Yourself element would involve the decision to go to therapy and to commit to it. This is a tough decision. The narcissist must not decide to embark on therapy only because he is (currently) feeling bad (mostly, following a life crisis), or because he is subjected to pressure, or because he wants to get rid of a few disturbing issues while preserving the awesome totality. His attitude to the therapist must not be judgmental, cynical, critical, disparaging, competitive, or superior. He must not view the therapy as a contest or a tournament. There are many winners in therapy – but only one loser if it fails. He must decide not to try to co-opt the therapist, or buy him out, or threaten him, or humiliate him. In short: he must adopt a humble frame of mind, open to the new experience of encountering one’s self. Finally, he must decide to be constructively and productively active in his own therapy, to assist the therapist without condescending, to provide information without distorting, to try to change without consciously resisting.

And the end of therapy is really only the beginning of a new, more exposed life. Maybe it is this, which terrifies the narcissist.

The narcissist can get better, but rarely does he get well (“heal”). The reason is the narcissist’s enormous life-long, irreplaceable and indispensable emotional investment in his disorder. It serves two critical functions, which together maintain the precariously balanced house of cards called the narcissist’s personality. His disorder endows the narcissist with a sense of uniqueness, of “being special” – and it provides him with a rational explanation of his behaviour (an “alibi”).

Most narcissists reject the notion or diagnosis that they are mentally disturbed. Absent powers of introspection and a total lack of self-awareness are part and parcel of the disorder. Pathological narcissism is founded on alloplastic defences – the firm conviction that the world or others are to blame for one’s behaviour. The narcissist firmly believes that people around him should be held responsible for his reactions or have triggered them. With such a state of mind so firmly entrenched, the narcissist is incapable of admitting that something is wrong with HIM.

But that is not to say that the narcissist does not experience his disorder.

He does. But he re-interprets this experience. He regards his dysfunctional behaviours – social, sexual, emotional, mental – as conclusive and irrefutable proof of his superiority, brilliance, distinction, prowess, might, or success. Rudeness to others is reinterpreted as efficiency. Abusive behaviours are cast as educational. Sexual absence as proof of preoccupation with higher functions. His rage is always justified and a reaction to injustice or to being misunderstood by intellectual dwarves.

Thus, paradoxically, the disorder becomes an integral and inseparable part of the narcissist’s inflated self-esteem and vacuous grandiose fantasies.

His False Self (the pivot of his pathological narcissism) is a self-reinforcing mechanism. The narcissist thinks that he is unique BECAUSE he has a False Self. His False Self IS the centre of his “specialness”. Any therapeutic “attack” on the integrity and functioning of the False Self constitutes a threat to the narcissist’s ability to regulate his wildly fluctuating sense of self-worth and an effort to “reduce” him to other people’s mundane and mediocre existence.

The few narcissists that are willing to admit that something is terribly wrong with them, displace their alloplastic defences. Instead of blaming the world, other people, or circumstances beyond their control – they now blame their “disease”. Their disorder become a catch-all, universal explanation for everything that is wrong in their lives and every derided, indefensible and inexcusable behaviour. Their narcissism becomes a “licence to kill”, a liberating force which sets them outside human rules and codes of conduct. Such freedom is so intoxicating and empowering that it is difficult to give up.

The narcissist is emotionally attached to only one thing: his disorder. The narcissist loves his disorder, desires it passionately, cultivates it tenderly, is proud of its “achievements” (and in my case, makes a living off it). His emotions are misdirected. Where normal people love others and empathize with them, the narcissist loves his False Self and identifies with it to the exclusion of all else – his True Self included.