Narcissistic Aspects of Aging and Illness

Abstract

Although people can flourish as they get older, aging is difficult and requires us to manage a number of blows regarding the ways that the body changes and lets us down. Growing older presents a number of challenges and involves adjustments to changes in physical abilities, the time required to complete tasks and activities, alterations in appearance, and an awareness of the inevitability of death. Although some people manage the passing of time with only minor ailments, aging increases possibilities for the development of various illnesses, a reality that serves as a disquieting threat for those who allow themselves to become conscious of this fact. A further complication of aging is that aspects of self-care and adherence to medical treatment become increasingly important to ward off health problems or to manage existing illness. Regarding self-care, this can be an enormous challenge for people who struggle to refrain from behaviors that put them at risk. As an introduction to these issues, and the topic of narcissism in aging, consider the following case example:

Mary is a 63-year-old woman who had a stroke that left her with significant weakness on her left side. She left acute rehabilitation in a wheelchair and then came to me for psychotherapy for 2 years. Mary had been a beautiful woman who had worked in the entertainment industry, where her attractiveness worked in her favor, as she frequently had contact with actors and television professionals. Perhaps linked with the culture of the entertainment business, she had also been a heavy smoker and drinker, and frequently engaged in illegal drug use. Her stroke left her unable to partake in these activities, since she initially lived in an assisted living facility where she was under frequent care and supervision. Although Mary reported that she was aware of risk factors for a stroke (she had suffered a heart attack a few years earlier and had continued to smoke and drink heavily) she experienced her stroke and subsequent limitations as a “shock.” And though she came to see me for help, it was never really clear what she wanted from therapy, except to “feel better.” Mary informed me that she was most distressed about the changes in her appearance following her stroke, as her ability to care for herself had been drastically compromised. Though she previously had plastic surgery in an attempt to maintain a youthful appearance, she felt that she now looked “old and tired.” Mary maintained a focus on the external aspects of herself in our meetings together, as she felt that if she could regain a youthful appearance, then she would feel better about herself. Attempts to talk about internal aspects of her functioning proved difficult and Mary eventually moved out of her supervised setting, back into her home with a caretaker. She then began smoking, drinking and using drugs, and eventually stopped seeing me.

This chapter will address aspects of narcissistic injury in aging and illness. Mary illustrates an extreme example of someone whose focus on the external aspects of herself, denial of the impact of unhealthy behaviors and subsequent illness can lead to self-destructive behavior. In the face of illness and aging, Mary could no longer rely on her outer appearance and the relative ease and privilege it provided. Without these sources of self-esteem, her sense of self collapsed. Facing the reality of her health situation was devastating because Mary had invested her self-worth in these external qualities, rather than developing an intact inner life, which would sustain her and connect her to others in a more meaningful way. Changing her behavior to promote better health required a capacity to tolerate sadness, emptiness and loneliness. Instead, she denied her medical condition, focusing on external aspects of her life, in an effort to restore the only sense of self and internal structure she knew. Mary's denial put her at risk for further medical complications, as she continued to indulge in temporarily relieving, but long-term injurious substance abuse.

This chapter will address aspects of narcissistic injury in aging and illness. Mary illustrates an extreme example of someone whose focus on the external aspects of herself, denial of the impact of unhealthy behaviors and subsequent illness can lead to self-destructive behavior. In the face of illness and aging, Mary could no longer rely on her outer appearance and the relative ease and privilege it provided. Without these sources of self-esteem, her sense of self collapsed. Facing the reality of her health situation was devastating because Mary had invested her self-worth in these external qualities, rather than developing an intact inner life, which would sustain her and connect her to others in a more meaningful way. Changing her behavior to promote better health required a capacity to tolerate sadness, emptiness and loneliness. Instead, she denied her medical condition, focusing on external aspects of her life, in an effort to restore the only sense of self and internal structure she knew. Mary's denial put her at risk for further medical complications, as she continued to indulge in temporarily relieving, but long-term injurious substance abuse.