A Country Doctor Writes:

The Swedish psychologist Erik Erikson’s 1950s theory on the stages of human development still informs mental health providers and physicians around the world. He distanced himself from Freud’s sexually focused theory and instead framed his development theory from a psychosocial viewpoint.

This month I have read about two Swedish psychiatrists in my morning paper, Dagens Nyheter: Stefan Krakowski and Peder Björling. Both work in clinics and both are pioneers in their own way.

Krakowski, is a researcher, columnist, author and senior psychiatrist with a background in general practice, occupational medicine and terrorism studies. He has deepened and championed our understanding of incels, involuntarily celibate young men who are sometimes linked to violence and hate crimes. He has applied his psychiatric expertise to in-depth interviews he conducted as an author and columnist. In his new book, INCEL, first published in Swedish and soon also available in English, he describes their tragic lives with tenderness and understanding.

Dagens Nyheter writes: Looking at right wing extremists or violent Islamists, they see themselves as a clear-sighted elite with an often grandiose view of themselves. This is not the case with incels. They see themselves as disadvantaged. The uniting factor is their rigid views of how women should be and behave.

The book is a description of what is called the male surplus, where men fall behind in education and in society; men who never had a partner, and who sometimes also don’t have any other natural social contact points. In the incel vernacular this is called NEET: Not in Education, Employment or Training. In a survey on an incel site, close to 70% say they view their being incels as permanent – that their loneliness will persist their entire lives.

Björling explains to Dagens Nyheter that narcissists are not simply selfish and evil, like sociopaths, but capable of empathy and emotions many people don’t give them credit for.

Like people who suffer from borderline personality disorder, the narcissist has difficulty managing relationships:

– But unlike people with borderline, who are preoccupied with the relationship to others, narcissists are more preoccupied with power and respect, with gaining recognition and praise, who is superior and inferior, respectively. They constantly have a need to emphasize and re-establish themselves, to be admired and respected, which gets in the way of their relationships. If the constant question for people with borderline is “are you still there for me?”, then the corresponding question for the narcissist is “do you respect me?”.

Narcissism is partly brought on by childhood experiences:

– If you throughout your upbringing suffered from a lack of trusting relationships, lack of feedback on yourself, if adults could not handle how you felt inside; for example, became stressed if you cried, it is not so strange that you have difficulty managing relationships as an adult. You find it difficult to understand and regulate your own feelings, you find it difficult to ask for help, get support from someone else or show yourself [as] weak.

Narcissists often seek power within a relationship but ultimately often strive to be viewed as good, loved or likable:

– If they feel at a disadvantage, are questioned, receive criticism from someone they feel dependent on and the self-image ends up in a state of shock, the narcissistic reaction is triggered. The closer the relationship is, the stronger the stress. The defense is then often to go to a powerful attack…

– At the same time, they may feel deep anxiety about being in a conflict, because the need to feel that “I am a good person” is so strong. The nightmare is that that bubble will burst. It can also be that they blame the other person for “You made me behave badly!”

It is estimated that 1% of the population suffers from narcissistic personality disorder, but many more have narcissistic features. Very few seek help for their narcissism but often present with depression, anxiety or psychosomatic problems like chronic pain.

Treatment trials at Björling’s clinic include work on self image, emotion regulation and impulsivity.