"It is always possible to bind together a considerable number of people in love, so long as there are other people left over to receive the manifestations of their aggressiveness"

(Sigmund Freud, Civilization and Its Discontents)

In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis state, as a matter of fact, that pathological narcissism was the preserve of "the royal and the wealthy" and that it "seems to have gained prominence only in the late twentieth century". Narcissism, according to them, may be associated with "higher levels of Maslow's hierarchy of needs ... Individuals in less advantaged nations .. are too busy trying (to survive) ... to be arrogant and grandiose".

They - like Lasch before them - attribute pathological narcissism to "a society that stresses individualism and self-gratification at the expense of community, namely the United States." They assert that the disorder is more prevalent among certain professions with "star power" or respect. "In an individualistic culture, the narcissist is 'God's gift to the world'. In a collectivist society, the narcissist is 'God's gift to the collective'".

Millon quotes Warren and Caponi's "The Role of Culture in the Development of Narcissistic Personality Disorders in America, Japan and Denmark":

"Individualistic narcissistic structures of self-regard (in individualistic societies) ... are rather self-contained and independent ... (In collectivist cultures) narcissistic configurations of the we-self ... denote self-esteem derived from strong identification with the reputation and honor of the family, groups, and others in hierarchical relationships."

Having lived in the last 20 years 12 countries in 4 continents - from the impoverished to the affluent, with individualistic and collectivist societies - I know that Millon and Davis are wrong. Theirs is, indeed, the quintessential American point of view which lacks an intimate knowledge of other parts of the world. Millon even wrongly claims that the DSM's international equivalent, the ICD, does not include the narcissistic personality disorder (it does).

Pathological narcissism is a ubiquitous phenomenon because every human being - regardless of the nature of his society and culture - develops healthy narcissism early in life. Healthy narcissism is rendered pathological by abuse - and abuse, alas, is a universal human behavior. By "abuse" we mean any refusal to acknowledge the emerging boundaries of the individual - smothering, doting, and excessive expectations - are as abusive as beating and incest.

There are malignant narcissists among subsistence farmers in Africa, nomads in the Sinai desert, day laborers in east Europe, and intellectuals and socialites in Manhattan. Malignant narcissism is all-pervasive and independent of culture and society.

It is true , though, that the WAY pathological narcissism manifests and is experienced is dependent on the particulars of societies and cultures. In some cultures, it is encouraged, in others suppressed. In some societies it is channeled against minorities - in others it is tainted with paranoia. In collectivist societies, it may be projected onto the collective, in individualistic societies, it is an individual's trait.

Yet, can families, organizations, ethnic groups, churches, and even whole nations be safely described as "narcissistic" or "pathologically self-absorbed"? Wouldn't such generalizations be a trifle racist and more than a trifle wrong? The answer is: it depends.

Human collectives - states, firms, households, institutions, political parties, cliques, bands - acquire a life and a character all their own. The longer the association or affiliation of the members, the more cohesive and conformist the inner dynamics of the group, the more persecutory or numerous its enemies, the more intensive the physical and emotional experiences of the individuals it is comprised of, the stronger the bonds of locale, language, and history - the more rigorous might an assertion of a common pathology be.

Such an all-pervasive and extensive pathology manifests itself in the behavior of each and every member. It is a defining - though often implicit or underlying - mental structure. It has explanatory and predictive powers. It is recurrent and invariable - a pattern of conduct melded with distorted cognition and stunted emotions. And it is often vehemently denied.

A possible DSM-like list of criteria for narcissistic organizations or groups:

An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning at the group's early history and present in various contexts. Persecution and abuse are often the causes - or at least the antecedents - of the pathology.

Five (or more) of the following criteria must be met:

1. The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - feel grandiose and self-important (e.g., they exaggerate the group's achievements and talents to the point of lying, demand to be recognized as superior - simply for belonging to the group and without commensurate achievement).

The Narcissism of Differences Big and Small