The following is the opening paragraph of “Transference Focused Psychotherapy for Narcissistic Personality” by Barry L. Stern, Frank Yeomans, Diana Diamond, and Otto F. Kernberg:
S. was a 23-year-old man who was referred to the lead author (BLS) for treatment pursuant to his withdrawing from his ﬁrst year at a prestigious law school. Overwhelmed by academic challenges that demanded great persistence, focus, and collaboration with peers, S. became severely depressed and withdrawn; disgusted with himself, he had feelings of inferiority and hopelessness and suicidal thoughts, all resulting in a late-semester withdrawal from school and an inpatient admission. S.’s inpatient treatment team noted his condescending attitude toward them and his fellow patients, his minimal engagement in the program, and his sarcastic, nonchalant attitude. Although he was aware that he was roundly disliked by the staff and fellow patients (a fact conﬁrmed by the staff), he also stated that he felt chronically misunderstood, unappreciated, and neglected.
I am reminded of my own experience as a first year law student. I too have chronic mental health issues (a personality disorder) — with prominent narcissistic traits — and was diagnosed by my former employer, a major law firm, as mentally ill and not suitable for employment. My difficulties in my first year of law school merit comparison with those of Dr. Stern’s patient.
I entered law school in August 1979 at age 25. Since graduation from college (1975) I had been profoundly dependent on my mother, both emotionally and financially. My mother took care of virtually all my needs. It was a co-dependent relationship. My mother was my whole world. I could barely function without her. The level of my dependency and lack of relationships (I had no friends) suggested narcissistic pathology of some magnitude. My one sibling — an older, married sister — was a high functioning individual. She, her husband, and daughter were an ideal family unaffected by the taint of mental illness. I was the one troubled individual in an otherwise healthy family.
Since graduating from college I lived with my mother in Philadelphia. I entered a law school three thousand miles away, located in Spokane, Washington. In Spokane I lived alone in an apartment I rented. I had no friends and established no relationships at school or elsewhere. In early January 1980, at the commencement of my second semester of law school, my mother — on whom I had been acutely dependent — died. I continued on with my studies and completed my first year of law school at the top 15 percent of my class. I had been the sole beneficiary of my mother’s life insurance in the amount of about $18,500. In May 1980 I gifted $10,000 to my sister and kept $8,500 for myself — despite severe narcissistic pathology that disposed me to experience intense envy and greed.
I was accepted as a transfer student at Temple University Law School in Philadelphia in August 1980 (a school that only accepts about two transfer students each year nationwide) and completed my law degree in May 1982.
Perhaps Drs. Stern and Kernberg would diagnose me with atypical narcissistic disorder–severe (Axis II). Asymptomatic paranoid schizophrenia (Axis I).