The Imperious Urge

"The Imperious Urge"
by Richard R. Irons, M.D.

Addressing Narcissistic Defense in Treatment

One of the most daunting yet least understood challenges faced in the treatment of addictive disorders is the propensity for the addict to utilize narcissistic characterological defenses and features during the development and progression of their addiction. What is this “imperious urge,” mentioned by Bill Wilson in “The Big Book”? How does it manifest itself in the expression of addictive behavior and perception?

Characteristics of Narcissism

In Greek Mythology, Narcissus was a beautiful youth who was arrogant, cruel and insensitive to the feelings of others. Hearing the prayer of a maiden in distress, an avenging goddess [Aphrodite] granted that Narcissus would come to feel what it was like to love and experience no return of affection. One day, he came upon a clear fountain wherein he saw his own image reflected upon the water. Fascinated with the image, he fell in love and came to cherish that which he could not possess or control. He pined away for the departed apparition and died by drowning in it. In antiquity, water was associated with the “night states” of the soul: intoxication, dream, trance, unconsciousness and death.

The tragedy in this archetypal story is encapsulated succinctly by Alice Miller: “His passion for his false self not only makes object love impossible but also love towards the one person who is fully entrusted to his care — namely himself.”4 Stephen and Ondrea Levine offer this commentary on the myth: “Narcissus is that part of the mind which thinks about itself. He is always inventing someone to be. He is the overindulged architect of the ever-indulged self-image. Narcissus is a large part of small mind. Reaching out to possess himself where once his visage was reflected, Narcissus drowns in his own reflection.”5

There are many definitions of narcissism, but the one offered by Arnold Rothstein has particular value for the purposes of this article. He considers pathological narcissism to be an unrelenting, unrealistic pursuit of perfection. Yearnings for uniqueness, shame and humiliation over such yearnings, and the vulnerability which they engender (due to the danger of resistance or denial of fulfillment or a response of rejection or contempt from the object of desire) define an essential element in the narcissistic experience.2

In the Big Book of AA, there is an unambiguous statement that the greatest enemies of “us alcoholics” are resentment, jealousy, envy, frustration and fear. These are cornerstones of the narcissistic experience. They reinforce the psychopathology of denial. Heinz Kohut reminds us that shame arises when the ego is unable to provide a proper discharge for the exhibitionistic demands of the narcissistic self. In almost all clinically significant instances of a recurrent propensity to remain mired in shame, the personality is characterized by a defective idealization and by concentration on the narcissistic self. The ambitious, success-driven individual with a poorly integrated self concept and intense exhibitionistic narcissistic tensions is most prone to experience shame.

This yearning for uniqueness has significant affective implications, commonly referred to as mood swings in the addict. Morrison says it this way, “The need to share the stage with another may lead to an outpouring of aggression or retaliatory rage. Internally however such an experience leads to a sense of utter despair, profound depression, and reflects the paradoxical extremes of grandiose entitlement and vulnerability to mortification. Underlying both of these states are the common affects of shame and humiliation.”3 Narcissism is considered a continuum between adaptive character traits and defenses, through narcissistic personality, to the antisocial personality, which Kernberg sees as “an extreme form of pathological narcissism with a complete absence of an integrated superego.”

Narcissus may signal his presence, complicating addiction treatment when the following features appear:

Pressure of speech to present ones version of events or perceptions.
Difficulty providing simple and direct answers to questions.
Inability to accept blame or responsibility for harm or pain experienced by others.
Using profession or duty to defend behavior.
Preoccupation with feared or actual consequences that may come or have been experienced.
Identifying our selves as unique or bearing exceptional gifts.
Denouncing contrary opinion by discounting, verbally attacking or dismissing the individual.
Labeling those who think differently as wrong, evil or the enemy.
Recurrently searching to have our importance and perceptions acknowledged by others.

Practical Ways to Work with Narcissistic Defenses

Traumatic parental insensitivity or neglect, identification with parental grandiosity or narcissistic family systems, and constitutional aggressiveness may each play a part in the specific pattern of entitlement and exploitation of others developed by a particular individual, underscoring the need for careful assessment and strategic intervention on established defenses. Studies show that even one continuously sympathetic caregiver in childhood can make the difference between a seriously disturbed adult or someone who is nearly invincible. Childhood experiences do trigger, and sometimes garble or distort, the love relationships made later. But nothing is cast in stone. As the child grows, it forges new attachments and some of these may dilute bad childhood experiences. This is an important conclusion. It suggests that abused children may still be helped later in life.

Treatment and the Narcissist

In the process of treatment and rehabilitation from addictive disorders, patients are asked to complete an inventory of their strengths and shortcomings. The Big Book of AA encourages introspection regarding narcissistic behavior when it asks: “Where had we been selfish, dishonest, or inconsiderate? Whom had we hurt? Did we unjustly arouse jealousy, suspicion, or bitterness? Where were we at fault, what should we have done instead? We got this all down on paper and looked at it.”

The process of telling the life story in its entirety is an act of humility that erodes away narcissistic defenses and helps an individual to recognize their humanity. Whether that story is fully told in a fifth step, to a sponsor over time, a close friend, religious counselor or their therapist may not be as important as the sincerity, completeness and thoroughness with which it is undertaken. The same insight required to appreciate our own past provides a pathway to transform our attitudes and actions in the present. One may begin to solicit hones feedback from others on how they perceive us. Motives and desires that lie behind thoughts and actions may become more conscious, uncovering preoccupation with matters of power and prestige. One may also come to take oneself less seriously, to see humor in many situations and to take all courses of events less personally.

The Greeks had a fear of hubris. The term originally meant wanton violence or passion arising from pride. Hubris was seen as the human arrogance that appropriates to man what belongs to the gods. In this regard, it is manifestation of ego expansion. Encounters with reality frustrate inflated expectations and bring about an estrangement between ego and the future Self. This estrangement is symbolized by such images as a fall/exile/wound that cannot be healed, or ongoing despair and suffering. Joseph Campbell has eloquently described these developmental cycles as a heroic journey, wherein the essential function of the heroic struggle is to develop proper “ego-consciousness,” with progressively greater awareness of personal strengths and weaknesses. The hero’s symbolic death and rebirth becomes a marker of achievement of maturity.

The ego-expanded state, when acted out, leads to a fall and hence to alienation. This can evolve into healing and restitution. Psychological development and growth is a redemptive process. It is in mindfully experiencing the tension between living a provisional life in its superficial course [of addiction], and touching the archetypal patterns that stir our souls as they emerge form the unconscious [intoxicated] state, that we can feel a sense of authenticity and humility.

Paradoxically, at the very time when a person comes to realize how little he know about love, service, humility, authenticity, equanimity, and genuine spirituality, there is the opportunity to find deeper meaning and truer, clearer perceptions. This the ongoing rehabilitation [treatment] process. It is a deeply personal journey that leads us to love ourselves, and to embrace and transform the narcissistic elements within.

When narcissistic defenses are encountered in the treatment setting, it is important to recognize their presence and to work with the structure rather than against it. The initial aim is not so much to uncover unconscious drives or impulses, but to build structure in treatment that facilitates healthy boundaries and trust. Cognitive distortions need to be pointed out whenever feasible. Boundaries between the patient and others may become blurred through manipulation, and need to be clarified. Benignly confront narcissistic defenses at first, using minimally judgmental words and actions. Movement toward personal individuation and growth should be rewarded and re-enforced whenever possible. Remember to provide hope and inspiration for transformation and progressive change over time.

Thomas Moore does it through these words: “Narcissism heals itself away from loneliness into creation: in our narcissism we wound nature and make things that cannot be loved, but when our narcissism is transformed, the result is the love of self that engenders a sense of union with all of nature and things.”6

References 1. Morrison, Andrew P., MD, “Narcissism: An introduction by Sigmund Freud in Essential Papers on Narcissism”, Editor New York University Press, pg. 17. (1986). 2. Ibid, pg. 4 3. Morrison, Andrew F. MD, “Factors in the treatment of Narcissistic Personalities by Otto Kernberg in Essential Papers on Narcissism”, Editor New York University Press, pgs. 236-239, (1986). 4. Miller, Alice, “Drama of the Gifted Child”, New York: Harper Collins, pg.50, (1990). 5. Levine, Stephen, “Embracing the Beloved”, Bantam/Doubleday, pg. 99, (1995). 6. Moore, Thomas, “Care of the Soul” New York: Harper Collins, pg. 74, (1992).

Richard R. Irons is an addictionologist and Associate Program Director, Alcohol and Drug Abuse Recovery Program at the Menninger Clinic in Topeka, Kan. Dr. Irons is an international speaker and published author. (785/350-5742)

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