Senility and the Narcissist
Narcissism is a complex condition. It’s characterized by an inflated sense of self importance, a need, a deep seated need for fuel which manifests through the emotional reaction of those around an individual, and a profound absence of emotional empathy. The individual is manipulative, haughty, dismissive, behaves in an entitled fashion, lacks accountability, is an individual that shows various aspects of the narcissistic dynamic. The fact is, the narcissist is sustained by the external validation of fuel. Senility commonly referring to age related cognitive decline such as dementia or Alzheimer’s disease, introduces a neurological layer that naturally does not create narcissism but dramatically amplifies its cause traits. Their combination creates what might be seen as a perfect storm whereby a pre existing pathological disorder becomes more extreme, unfiltered, and destructive. Now it’s important to point out that this worsening is not universal. Some individuals may actually show softening of certain traits with advanced decline, but for many, the early to middle stages of dementia actually intensify the symptoms of narcissism in profound ways. Families and caregivers of those affected often report behaviours that feel like the worst version of the person that they’ve always known. Thank you. Ways known. At its core, narcissism involves structural and functional differences in brain regions responsible for empathy, self regulation, and emotional processing, particularly the prefrontal cortex and areas linked to the brain’s reward and social circuits. Narcissism is a self defense mechanism, it is there to protect the narcissist against threats to control. To motivate the narcissist to seek the fuel that holds the construct together, it powers the narcissist to do so by way of character trait acquisition and the obtaining of residual benefits. These, as you are familiar with, are the prime aims. Now, the prefrontal cortex areas and those linked to the brain’s reward and social circuits suffer gradual shrinkage as a consequence of normal ageing. But when senility, when dementia comes along, this accelerates the process dramatically. Frontotemporal dementia in particular, targets, as the name suggests, the frontal and temporal lobes. These govern personality, impulse control, judgment, and emotional empathy. When someone who is a narcissist develops dementia, the disease damages the very circuits which are already under strain by virtue of their narcissism. The veneer of social appropriateness, or the facade, slips away because the executive function, the brain’s ability to inhibit impulses and consider others, completely erodes.
Cognitive decline reduces coping skills, making it nigh on impossible to maintain the elaborate false self that narcissists use to construct subconsciously to hide the vulnerable true self. Psychologically, aging strips away, in many instances, the fuel that once powered the construct. For instance, career success wanes, physical attractiveness is reduced, social status can become diminished, along with independence. Now, this isn’t applicable for all narcissists. As I’ve explained in Ageing and the Narcissist, certain narcissists are better suited to deal with these things. They retain their wealth, they retain status, they retain attractiveness. However, a narcissist who once commanded rooms, who now struggles as a consequence of this dementia with basic tasks, suffers a massive threat to control. The threat to control fuels a sense of desperation, whereby the narcissist is compelled to make all the more frantic demands for fuel, and there’s a greater Exhibition of heated, ignited fury when the admiration and the love and the adoration are withheld. It’s the case that devaluation correlates with higher Alzheimer’s risk, essentially because the chronic stress that arises from it, the emotional dysregulation and interpersonal conflict all amount to threats to control, which then impact upon the narcissist. This means that the narcissism knows only one way to respond, and that is to lash out, to try and gain more fuel, to try and nullify the threats to control. The increased dependency clashes violently with the narcissist’s core belief of their superiority. Suddenly needing help is a threat to control because it’s an unbearable humiliation to the narcissist, and therefore it prompts defensive behavior which ultimately alienate caregivers. The brain changes of senility also heighten paranoia, which is already fairly rampant with the narcissist to begin with, and increases irritability. Impaired memory leads to confabulation, whereby the narcissist already revises history. However, where there are actual memory gaps, then that amounts to a threat to control, and the narcissism’s response. Is to come up with self serving stories that reinforce the grandiosity. In effect the dementia doesn’t invent new flaws in the narcissist.
What it does is it removes the filters that were in existence that would mask many of them and amplifies the existing flaws through a vicious cycle of neurological damage which threatens the need for control. How might the worsened symptoms manifest? Well, the sense of superiority becomes grotesquely exaggerated. The narcissist affected by senility or dementia will insist they are still the smartest person in the world, yet they will forget basic facts, or they’ll get lost in familiar places. For instance, a former executive with early Alzheimer’s refuses to relinquish car keys, boasting about their perfect driving record, despite the fact that they’ve multiple minor accidents. When confronted with the evidence, which is the threat to control, they will deny the reality that didn’t happen, or they’ll blame others. The roads are worse because other people can’t drive properly. This denial will also extend to medical care. The narcissist with senility will reject diagnoses, claiming the doctors are envious or they’re incompetent, which of course delays treatment and escalates family conflict. Entitlement increases. It morphs into relentless, unreasonable demands.
The narcissist will expect 24/7 attention whilst also criticising the caregiver’s efforts. An elderly parent. With, let’s say, vascular dementia and NPD behavior, demands their adult child visits daily and then berates them for not doing enough or arriving late because they’re seen to be threatening the narcissist’s need for control. The fact that the adult child has a full time job and a family is irrelevant. It might be the case that the narcissist refuses assistance with bathing or dressing. I don’t need your help, I’m not helpless. Yet, of course, show the hypocrisy of the narcissist when they scream and bellow when they’re left to struggle, which creates impossible double binds. Hoarding is something that emerges too. The pointless accumulation of items because I might need them someday, combined with accusations that caregivers are stealing possessions, is another manifestation of this and is linked to the need for control. The hoarding is as a consequence of maintaining that control. The absence of emotional empathy becomes all the more pronounced. The narcissist shows zero regard. For a caregiver’s exhaustion, pain, or personal life. For instance, a female narcissist progressing with Alzheimer’s might call a daughter at 3am and do so repeatedly for what are trivial reasons, yet to her they seem all important. When the daughter seeks to set a boundary or suggest respite care, that will threaten the narcissist’s control with the result that she’ll respond with rage. When the daughter explains her own burden response will often be dismissive or accusatory. You’re so selfish after everything I’ve done for you.
This naturally leaves caregivers emotionally drained, often triggering guilt, because the behaviours are mixed with a genuine ailment of Alzheimer’s. The manipulations will increase. Classic gaslighting, making others doubting their reality, becomes more frequent and convincing in the early stages. The narcissist forgets promising to sign legal documents and then accuses his children of forging the papers or trying to steal the inheritance. Naturally, the narcissist genuinely believes the alternate stories where he remains the heroes and the others are the villains because of the black and white thinking. The narcissist is likely to cancel doctor appointments or stop medications, claiming, I know better, while manipulating family members into enabling the behavior through guilt or the application of charm. The exhibition Of Heated and United Fury, once episodic, may well become daily and particularly explosive. Minor frustrations, like a delayed meal, is a perceived slight and they trigger disproportionate outbursts, often physical. Paranoia surges. Accusations that caregivers are poisoning food, plotting institutionalisation, or spying on the narcissist are common. There are instances where the narcissist might do such things as smearing feces on the walls as an act of control and defiance. As a result of feeling powerless. Anxiety and fear from the cognitive gaps are repeated threats to control, which results in a near constant state of hostility. It’s also the case that the frontal lobe damage removes social breaks, therefore, inappropriate comments, crude language, public tantrums emerge all the more. A once facade wielding and image conscious narcissist may now make racist or sexist remarks without filter, flirting appropriately at family events. Conversely, other narcissists withdraw completely to hide the decline, becoming repulsive and apathetic as a consequence also of diminished fuel provision, yet they still expect others to orbit their needs. There is also often a fixation on past glories, repeatedly bringing up the past, which replaces present engagement with endless repetition of old stories where the narcissist. Is the star. The fact is. The narcissist was already a problem, and when senility comes, it amplifies this considerably in the ways that I have described.
