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During my years as the psychologist on a rehabilitation medicine service, I have had a chance to observe narcissistic phenomena in some patients who were medically ill, chronically disabled, and brain injured. When we consider narcissistic phenomena, we are usually thinking about the problems that a physically healthy person is having with living and getting along with others. Of course, narcissistic people also become medically ill at times, and their various difficulties in living and being with others become as obvious in the sickroom or hospital as in their personal lives and their work.
Illness can also make nonnarcissistic people narcissistic. Freud noted that the sick person withdraws libido from objects and becomes narcissistic.1, p. 83 This is the same mechanism that Freud describes as the basic dynamic of schizophrenic psychosis as well—a condition that is more generally recognized as narcissistic per se.
Actually, narcissism is a collection of related phenomena that come and go throughout the life cycle and that have a different significance, depending on the circumstance. Narcissism during medical illness must be understood in the context of narcissism in general. Whenever a person's interests are being seriously threatened, attention, energy, and concern are withdrawn from their usual foci and directed back onto the self and its activities. For example, if a man's business is failing, we are not surprised to learn that he shows the following narcissistic phenomena: that he thinks of nothing else, neglects his family, loses his temper inappropriately, misinterprets the good wishes of others, and is often inconsiderate, demanding, even irrational.
Similarly, during adolescence and young adulthood, when the individual has to make career and personal decisions that will affect the rest of his life, while becoming more independent and assuming more personal responsibility, the individual is often self-involved, inconsiderate, impulsive, over-emotional, and host