Is pathological narcissism the outcome of inherited traits - or the sad result of abusive and traumatizing upbringing? Or, maybe it is the confluence of both? It is a common occurrence, after all, that, in the same family, with the same set of parents and an identical emotional environment - some siblings grow to be malignant narcissists, while others are perfectly "normal". Surely, this indicates a predisposition of some people to developing narcissism, a part of one's genetic heritage.
This vigorous debate may be the offshoot of obfuscating semantics.
When we are born, we are not much more than the sum of our genes and their manifestations. Our brain - a physical object - is the residence of mental health and its disorders. Mental illness cannot be explained without resorting to the body and, especially, to the brain. And our brain cannot be contemplated without considering our genes. Thus, any explanation of our mental life that leaves out our hereditary makeup and our neurophysiology is lacking. Such lacking theories are nothing but literary narratives. Psychoanalysis, for instance, is often accused of being divorced from corporeal reality.
Our genetic baggage makes us resemble a personal computer. We are an all-purpose, universal, machine. Subject to the right programming (conditioning, socialization, education, upbringing) - we can turn out to be anything and everything. A computer can imitate any other kind of discrete machine, given the right software. It can play music, screen movies, calculate, print, paint. Compare this to a television set - it is constructed and expected to do one, and only one, thing. It has a single purpose and a unitary function. We, humans, are more like computers than like television sets.
True, single genes rarely account for any behaviour or trait. An array of coordinated genes is required to explain even the minutest human phenomenon. "Discoveries" of a "gambling gene" here and an "aggression gene" there are derided by the more serious and less publicity-prone scholars. Yet, it would seem that even complex behaviours such as risk taking, reckless driving, and compulsive shopping have genetic underpinnings.
What about the Narcissistic Personality Disorder?
It would seem reasonable to assume - though, at this stage, there is not a shred of proof - that the narcissist is born with a propensity to develop narcissistic defences. These are triggered by abuse or trauma during the formative years in infancy or during early adolescence. By "abuse" I am referring to a spectrum of behaviours which objectifies the child and treats it as an extension of the caregiver (parent) or an instrument. Dotting and smothering are as much abuse as beating and starving. And abuse can be dished out by peers as well as by adult role models.
Still, I would have to attribute the development of NPD mostly to nurture. The Narcissistic Personality Disorder is an extremely complex battery of phenomena: behaviour patterns, cognitions, emotions, conditioning, and so on. NPD is a PERSONALITY disordered and even the most ardent proponents of the school of genetics do not attribute the development of the whole personality to genes.
From "The Interrupted Self":
"Organic" and "mental" disorders (a dubious distinction at best) have many characteristics in common (confabulation, antisocial behaviour, emotional absence or flatness, indifference, psychotic episodes and so on)."
From "On Dis-ease":
"Moreover, the distinction between the psychic and the physical is hotly disputed, philosophically. The psychophysical problem is as intractable today as it ever was (if not more so). It is beyond doubt that the physical affects the mental and the other way around. This is what disciplines like psychiatry are all about. The ability to control "autonomous" bodily functions (such as heartbeat) and mental reactions to pathogens of the brain are proof of the artificialness of this distinction.
It is a result of the reductionist view of nature as divisible and summable. The sum of the parts, alas, is not always the whole and there is no such thing as an infinite set of the rules of nature, only an asymptotic approximation of it. The distinction between the patient and the outside world is superfluous and wrong. The patient AND his environment are ONE and the same. Disease is a perturbation in the operation and management of the complex ecosystem known as patient-world. Humans absorb their environment and feed it in equal measures. This on-going interaction IS the patient. We cannot exist without the intake of water, air, visual stimuli and food. Our environment is defined by our actions and output, physical and mental.
Thus, one must question the classical differentiation between "internal" and "external". Some illnesses are considered "endogenic" (=generated from the inside). Natural, "internal", causes - a heart defect, a biochemical imbalance, a genetic mutation, a metabolic process gone awry - cause disease. Aging and deformities also belong in this category.
In contrast, problems of nurturance and environment - early childhood abuse, for instance, or malnutrition - are "external" and so are the "classical" pathogens (germs and viruses) and accidents.