An Interview with Psychologist Joshua Miller
Dr. Joshua Miller is a Professor of Psychology and Director of Clinical Training at the University of Georgia. His research focuses on the connection between personality and personality disorders, with specific interest in narcissism and psychopathy.
Amelia Worley: Thanks for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Amelia Worley, a research intern at Seattle Anxiety Specialists. I'd like to welcome Dr. Joshua Miller. Dr. Miller is a professor of Psychology and director of Clinical Training at the University of Georgia. His research focuses on the connection between personality and personality disorders, with specific interest in narcissism and psychopathy. He has numerous publications on narcissism, including one of his most recent publications on the topic, “Narcissism Today: What We Know and What We Need to Learn.” Before we get started, Dr. Miller, can you please let us know a little more about yourself and what made you interested in studying narcissism?
Joshua Miller: Sure. I've been a professor at UGA since 2005. I did my graduate work at University of Kentucky and then an internship in post-doctoral scholarship at Western Psychiatric Institute at Department of Psychiatry at University of Pittsburgh. In terms of studying narcissism, it was really sort of just happenstance to some degree. I was studying psychopathy, which is sort of like a fraternal twin of narcissism in a lot of ways, coming out of grad school, and then doing cluster B personalities sort of in general in my post-doctoral fellowship. And then, when I moved to the University of Kentucky, we had one of the foremost experts in narcissism from a social psychology perspective, Keith Campbell, and we just sort of hit it off and just started collaborating and talking about the differences in how I, as a clinical psychologist, thought of narcissism and how he, as a social psychologist, and it just sort of led to a fruitful collaboration and sort of kickstarted this whole line of research I've pursued really for the last almost 20 years.
Amelia Worley: So to begin, can you define what narcissism is?
Joshua Miller: Yeah, I mean, I just think of it as a suite of traits organized around an individual who values sort of a sense of superiority, status, recognition over almost anything else in their lives. That means even the willingness to denigrate, devalue those around them so as to maintain themselves in a higher position. So, narcissistic people tend to be grandiose, entitled, require others admire them, feel upset and angry when they don't receive those from others, while simultaneously being sort of callous and non-empathetic towards others. They expect particularly good treatment from others while providing very little of the same to those around them.
Amelia Worley: What are the different types of narcissism?
Joshua Miller: Yeah. And I think of the sort of two main dimensions we talk about, and they're not really types as in a narcissistic person has to be one or the other. Rather, they're modestly related dimensions. So, you could be mostly one, mostly the other, or you could have features of both. We talk about grandiose narcissism, and that's the one that most people will think of. The person that is explicitly outgoing, assertive, domineering, grandiose, entitled. And then, the vulnerable one is sort of sometimes harder to recognize because the person tends to actually have lower self-esteem. It's sort of this weird paradox of oftentimes these individuals dislike themselves, can have intense self-loathing, while also feeling quite entitled and having sort of grandiose fantasies, believing that others should treat them better, should recognize within them their special talents to some degree. These are the ones that sometimes in the literature they were called covert narcissists. The idea that it was more hidden, it would take longer to recognize some of those traits.
Amelia Worley: That's really interesting. I know you briefly covered this, but what are some of the most common signs that someone may be a narcissist?
Joshua Miller: For what we think about, the most defining features to me are things like grandiosity, a strong sense of entitlement that you deserve better things than others, that the rules shouldn't apply to you, that you shouldn't be treated like the average Joe. When we see those things, those are probably the clearest signs that someone is narcissistic. Tend to be egocentric, self-absorbed. Even the more vulnerable individuals who don't always have as much grandiosity, they tend to be quite self-absorbed. They believe the world should focus on them, should revolve around them. And even that self-absorption can sometimes revolve around their sense of sort of fallibility, and distress even. It's not like, "I deserve better things because I'm the best." It can be, "I deserve special treatment because of how wounded, how fragile I am." This is the sort of dimension we may see more in outpatients oftentimes.
The grandiose individuals may not be coming in to therapy very often. In fact, they're not likely to come in. And if they do, it may be later in life when they sort of have failed, they're starting to recognize that they can't maintain this grandiose sort of belief system. But, we're going to see lots of sort of more vulnerably narcissistic individuals who believe the world, their significant others, their clinician should accord them special treatment in part because of maybe past trauma, past difficulties, the amount of distress they're experiencing.
Amelia Worley: Is there such a thing as a healthy amount of narcissism?
Joshua Miller: It's hard to say, right? I mean, I think within some reason, some degree of believing that you're good at things, that kind of stuff, believing that you're entitled to fair treatments, right? The higher you are, the more impairment we're going to see. The more difficulty you're going to cause in other people's lives, the more difficulty you're probably going to cause in your own life, the more impairment. So, any degree further like lower we can help someone get is probably better. I think when people say healthy narcissism, they're really just thinking about self-esteem really. Self-esteem is almost entirely healthy. It's actually not that correlated with grandiose narcissism. It's negatively correlated with vulnerable narcissism. It's positively correlated with grandiose narcissism, but at a correlation about 0.3. That's pretty small. The reality is that most people who have high self-esteem aren't that narcissistic, and many people that are narcissistic don't actually have that much high self-esteem.
This one study we did in my lab that really compared them over about 5000 individuals, and multiple studies, they're similar in that high self-esteemed people and grandiosely narcissistic individuals are outgoing, they're approach-oriented. They sort of go out and attack the world. They go for what they want. They believe in themselves. They're assertive. They take on leadership roles. The difference is that high self-esteemed people are more communal. They're more other people-oriented than narcissistic individuals. The way I would describe it is if I'm a high self-esteemed person, I can feel good about myself without having to denigrate you.
Let's say we're both clinicians. We both could be good clinicians. We both could be good parents. We both could be good spouses. Whereas, the grandiose narcissistic person views the world more hierarchically. There isn't room for both of us to be good. If I'm going to say I'm the best clinician, that means I need to denigrate you. They view the world almost like a ladder. You can either be above someone or below someone. Not equal. And I think high self-esteemed individuals can allow the space for others to feel good about themselves without being threatened by that. Does that make sense?
Amelia Worley: Yeah, definitely. And digging into that further then, where do you draw the line between someone who is just highly confident versus someone who's a narcissist?
Joshua Miller: Again, it comes down to these more disagreeable traits. Is the person callous? Do they have a sense of entitlement that they expect treatment that other people wouldn't get? Are they constantly talking about themselves as being better than others? I think people who are just high self-esteem have a quiet self-confidence about themselves. They don't need to trumpet it everywhere. They don't need that kind of persistent, nonstop validation from others. They don't need that admiration because within themselves, there is just a general sense that, "I'm a good person." And self-esteem is usually built on a sort of a broader base. If you think about it, good self-esteem is built like a house with multiple sort of parts of the foundation.
I might think, "I'm a good researcher, but I also value that I'm a good husband and a good parent and a good friend. So even if my work isn't going well, let's say I get multiple papers rejected, I don't feel terrible about myself because I still know my kids love me and my spouse loves me. And that I have friends and a supportive social network." But, a narcissistic person builds themselves up, their foundation, on a much smaller, narrower set of things. They tend to be agentic things. Narcissistic individuals don't tend to think they're better than others in all things. They tend to think they're better in agentic things, like smarter, better-looking, more athletic, better leader.
They don't tend to actually report that they're better people. They know that they're not necessarily as nice as other people, as kind. And they don't value that as much. These interpersonal things. So, for a narcissistic individual, if my whole sense of who I am is built on being a great researcher, well, if I start getting negative feedback on my papers, that's going to be really threatening to me because I have nothing else to build my sense of self on. That's one of the differences that makes self-esteem largely quite a healthy, psychological construct. And narcissism, a more mixed bag in some ways, for sure, with more maladaptivity.
Amelia Worley: Can narcissistic personality disorder be treated? Can a narcissist ever change?
Joshua Miller: It's a great question. There's been remarkably little funding from NIMH about treatments on narcissism. I don't know if there's ever actually been like an RCT on narcissistic personality disorder specifically. There has been some work from more like sort of psychodynamic perspective, looking if short term psychodynamic therapy can make changes in these individuals. And I think they've shown some positive results. I certainly don't know that there's a panacea or an easy cure for someone with really persistent, longstanding narcissism. I believe with kind of constant, consistent feedback in a supportive way of the ways in which a person's narcissism is negatively affecting others, even the clinician, the clinician giving that in the moment feedback, that you know, "Hey John, when you say that, it makes me feel devalued," like that kind of consistent feedback, but you'd have to have a patient that's really motivated to get treatment, to improve, to recognize that their narcissism is standing in the way of a fuller, healthier sort of life.
Without that, I'd be much more sort of pessimistic that you would see much change. There's got to be some insight into the problem. There's got to be motivation to make those changes first. And then, it's probably going to take some substantial time with a supportive, trained therapist to make some gains, I think.
Amelia Worley: Is there a link between being around someone with narcissistic tendencies and anxiety and depression?
Joshua Miller: I don't know specifically of empirical study and looked at that exactly. We published a paper in 2007 where we did find that people who were rated as, these are community participants and patients, those who had more narcissistic personality disorder were rated by our research group as causing their significant others more distress. So, to the extent that we could think that people being distressed probably means having anxiety, depressive symptoms, marital instability, it probably is likely that really severe narcissistic individuals probably can cause those in close proximity, spouses, parents, children, friends, coworkers, some of those kind of symptoms, for sure, if they're not able to sort of remove themselves from the situation. Which, of course, if you have a narcissistic parent or a child, it's not so easy to remove yourself. If it's a coworker, you might be able to find ways to psychologically or even physically distance yourself from that person such that they can't do as much damage.
Amelia Worley: So, digging into that further, at what point should someone consider cutting ties with a narcissist? What can someone do if the narcissist is a coworker or superior at work?
Joshua Miller: Yeah, I wish I had really clear cut answer to, "Oh, at this point, you should do..." I think whenever a person recognizes that someone is really bad for their psychological wellbeing, then it's reasonable for them to start thinking about how they can take steps to mitigate that harm, whether that's ending a relationship, like if it's a friendship, but I don't like to be too glib about the idea of ending a relationship because of course that's not always that easy. It's not that easy to, say, cut off a parent or cut off a child, or decide to end a romantic relationship. With a coworker, I think, again, we can do whatever we can to mitigate the time we spend dealing with that individual. If it's a coworker, potentially talking to those higher up. If they're trusted about working less with that person, not being assigned to those same kind of teams, being asked to move off of a team.
If it's a narcissistic boss, it's hard to know what exactly are your mechanisms to exert change. If you have someone even higher up, you could consider talking with them. It could be that if it's bad enough, you look to move within your job or move to a different job. Again, I would never want to speak for someone without knowing the circumstances. Sometimes, working with someone narcissistic is mostly just annoying. You feel frustrated, you feel put down, but it may not be something that you're willing to, say, change a job or ruffle feathers. I trust someone's autonomy to make that decision. If it's much worse where you come home feeling beleaguered every day, put down, denigrated, dismissed, then I think we're talking about things where if it's starting to really adversely affect your mental health, then thinking about bigger changes is certainly worthwhile. And if the person is in therapy that's doing this, that's the perfect thing to talk to a therapist about.
One of the cool studies that this guy, Drew Westen at Emory did was look at countertransference with narcissistic patients. So, that is like, what are the feelings that a therapist has towards a narcissistic patient? They're really noteworthy like dreading those sessions, not feeling like they're going to make much change, feeling put down, feeling dismissed. If therapists who are trained to deal with patients and try to put their own feelings aside feel that way, then certainly it's reasonable for us to expect people with less psychological training to struggle even more to deal with people in their lives that show these kinds of traits.
Amelia Worley: That's fascinating. Lastly, do you have any advice or anything you would like to say to someone who may be involved with a narcissist?
Joshua Miller: Again, there's no easy glib answer to that. If it's, again, persistently, negatively impacting your wellbeing, their traits, their grandiosity, their need to put themselves before others, if they're showing a lack of concern, if the relationship doesn't feel bidirectional, if it's like, "Wait, I'm only here for this person as a sounding board. I'm here to support them and validate them. But when I need a chance to talk about this trouble I'm having, they're disinterested," then I think rethinking, again, the parameters of that relationship are reasonable.
But, again, relationships are really complicated, and I get that. If you're in a relationship with someone and have children with them, I don't want to say quickly, "Oh, well, just end that relationship." And it depends on the severity of the person's narcissism. If the person seems narcissistic but it is unaware of it and that they might be willing to seek treatment, then it might be something where the couple can have meaningful discussions about whether or not that's something that could be dealt with in couples counseling and individual therapy, things like that. Each case is so specific. It's really hard to give an overarching answer to that.
Amelia Worley: Yeah. That's great. Well, thank you so much, Dr. Miller. It was wonderful having you on our series today.
Joshua Miller: You're welcome. Yeah. Thanks for having me.
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Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.