Shirah Vollmer MD

The Musings of Dr. Vollmer

Medical Issues As A Narcissitic Injury

Posted by Dr. Vollmer on July 13, 2012

Xavier, sixty-four, has a sister with Multiple Sclerosis, another sister with Scleroderma, but he has always considered himself the “healthy one”. “Out of the blue, I started having pains in my chest, and now I discovered I have cardiovascular disease. I had no idea. How can this happen? What did I do?” Xavier communicates with a deep sense of wonder and shock about his newly discovered medical issues. I am aware how abruptly he must change the way he thinks of himself, yet I am also aware that cardiovascular issues are common medical problems, so I am a bit taken by his sense of immunity to the medical issues of aging. “This diagnosis has really gotten to your core,” I say, highlighting that  the meaning of these medical problems for him, run deep. “I know they do,” Xavier says with good humor, acknowledging that there are narcissistic issues at play. His sense of being “better” than his sisters because he was healthy is a longstanding mantra for him, which his family supported. Now, that he has joined the ranks of those with chronic medical illnesses, he is no longer special. “I have to say that this diagnosis is really making me look at myself and how I see the world. I really did not know how important it was to me, psychologically speaking, to know that I was healthy. Now, I feel that my core sense of myself has been shattered, but of course, I know that makes no sense. I am still Xavier, and yet, now I feel like a different person.” Xavier says with an openness and curiosity that begins to explain his powerful shock over this news. “That makes sense, given that your identity was built on your health, so now that your health is in question, your identity is too.” I say, reviewing our understanding of his mental state. As Jon said in his comment to the previous post, it is a universal truth that people both want to fit in and feel special. Xavier felt special because he did not have medical problems, and hence this fragile basis for his uniqueness was likely to shatter as he aged. Fortunately, his curiosity about this shift in his mental state, allows us to explore the inner workings of his mind, allowing for a more solid reconfiguration of how he both fits in to his world and how he is special.

4 Responses to “Medical Issues As A Narcissitic Injury”

  1. Jon said

    Xavier is sadly coming to understand that good health is part good luck and part good choices. From my understanding, neither Multiple Sclerosis nor Scleroderma are the result of poor life choices, but are part of “the luck of the draw.” It is a little less clear about cardiovascular disease.
    Xavier’s sense of self is in need of self-examination. Fortunately, others may be able to help on this difficult road. From Hollywood, Bette Davis when diagnosed with cancer and then suffering a stroke nine days later said, “Growing old is not for sissies.” From the realm of politics, LBJ’s daughter, Luci Baines Johnson, said of her mother, “Getting old is not for the faint of heart. It takes an extraordinary stamina to do it with exceptional grace, and mother is doing just exactly that.”

    • Shirah said

      Thank you, Jon. This post was trying to illustrate that for some folks, Xavier in this example, getting a diagnosis becomes an “insult” to his character. It is not just that he has to cope with his possible premature mortality, but that he has to take another look at how he framed himself in this world. In that way, the diagnosis hit at his narcissism. Thanks, as always. Thanks also for adding in both history and cinema to this discussion.

  2. Shelly said

    Very interesting post and comments. I like to think what makes us special is not what we are or are not but what we contribute. Being healthy (or not) is a combination of luck, environment, and how we take care of ourselves. It is interesting to me to see how others consider themselves unique and their inner worlds, and what their fantasies are based on.

    • Shelly, I think you articulate an extremely important point. There is a tension between existing, and thereby contributing because we participate in the world, versus making a conscious effort to “help” others. Clearly, there is altruism in the world, but at the same time, it would be nice if each person felt that their existence was a contribution since they are living by example. The balance, as usual, is the key issue between taking care of ourselves and caring for others. What makes us special is how we balance that tension. Yes, knowing one’s fantasies, or one’s internal dialogue is the key to understanding human motivation and responsiveness. As we love and care about others we get a good sense of their internal narrative and this guides how we treat them. Psychotherapy makes that internal narrative more explicit so the individual can change that narrative and thereby change how others treat them.

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