On our most recent episode of Got Therapy? I asked my co-host, Dan Rose, a question I have been sitting with for a while. The word narcissist entered the lexicon, became a diagnosis in the DSM, and now it is a label we hand out. If all of us need something to prop up the narcissistic side of ourselves, where exactly is the line? At what point does the average person become a disorder?
Dan did not give me a line. He gave me a continuum, and a theorist who spent a career insisting that the need behind narcissism is human. The longer we talked, the more convinced I became that the way the word is used today undoes the very insight it came from.
Everyone is on the continuum
Dan's starting point was Heinz Kohut. In Kohut's account, as Dan put it, all of us have to maintain a narcissistic equilibrium — a firm, boundaried self. His example is so ordinary it is almost embarrassing. You walk into the office feeling good, say hello to someone, and get nothing back. Something small gives way. That is a narcissistic injury, and all of us are sensitive to it. As Dan said, you walk through the day and you get some bruises.
What distinguishes people is not whether they need supply, but what they do when it is interrupted. One person thinks, maybe they're having a bad day. Another thinks, they suck. A third thinks, maybe I suck. Only the first is what Dan called a proper defense. The other two are the beginnings of the patterns we eventually give names to.
That is a continuum, not a category. And a continuum has a consequence we have mostly forgotten: every one of us is standing somewhere on it.
The label is doing something for us
Here is the part of the conversation I did not expect. Dan pointed out that, for Kohut, calling someone a monster can itself be a narcissistic act. It lets us avoid owning the parts of ourselves that, in the other person, became exaggerated.
I think that describes a good deal of how narcissist gets used now. It is rarely a formulation. It is a way of closing the file on someone — and, not incidentally, of reassuring ourselves that we are the healthy one in the story. The word lets us skip the unreturned hello, the small humiliation, the sting of being overlooked, and go straight to a verdict on somebody else.
That is not clinical thinking. It is the fork in the road, and it is the branch that says they suck.
Confrontation doesn't work — even in the room
The clinical case against the verdict is stronger still. Dan described Kohut as "the Mr. Rogers slash Carl Rogers of psychoanalytic thought," because for Kohut you cannot confront grandiosity and expect it to yield. Tell someone who says they're the greatest that it's a little much, and you will generate more of the very defense you are objecting to. Dan's image for that defense is a puffer fish: the swelling is protection.
I will admit my own instinct would be to challenge it. I told Dan I would probably be fired in the first session. What Kohut offers instead is mirroring — reflecting the feeling behind the boast, then what matters about it, one clarification at a time, until the conversation arrives somewhere real. Underneath, Dan said, is usually a fear of being erased — and when you get there, depression tends to show up. That takes a long time and a very safe room.
None of that is possible if the therapist, or the culture, has already decided what the person is.
Flattery is not the cure either
There is an opposite error, and the episode is honest about it. If confrontation fails, endless praise fails worse. Dan described the person who replaces a healthy matrix of relationships with a wall of people who only tell them how great they are. The nutrients they need can't get in — truth above all, which Dan called one of the most important vitamins we get. His own rule of thumb stayed with me: when somebody starts telling him how great he is, he can hear them sharpening knives.
So the answer is neither the verdict nor the applause. It is being seen — accurately, and safely — which is exactly what good therapy is supposed to provide.
What I am asking
Three things, of clinicians and of the rest of us.
Hold the word back. Reserve narcissist for formulation, not for argument. If you would not put it in a treatment plan, it probably doesn't belong in the conversation.
Remember the continuum. The need is universal. The question is always how a person keeps their equilibrium — and every one of us has a version of the answer.
Reach for reflection. Whether you are in the room or at the dinner table, the move that helps is rarely you're a narcissist or you're wonderful. It is it sounds like that mattered to you.
Dan closed our conversation with a picture of progress I keep returning to: a client who notices, on the way in, that his therapist is short on pencils, and brings some. Not insight, exactly. Just the discovery that the person across from you has a heartbeat.
That is what the theory was for. We should stop using its most famous word to make sure we never get there.
Michael Baltimore Ph.D. co-hosts Got Therapy? with Dan Rose Psy.D. This editorial draws on Episode 88. It is commentary, not clinical advice, and it diagnoses no one.