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Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

Authors Thomas Hyphantis, Augustina Almyroudi, Vassiliki Paika, et al

Published 9 August 2009 Volume 2009:3 Pages 239—250

DOI https://doi.org/10.2147/PPA.S5499

Review by Single-blind

Peer reviewer comments 2

Thomas Hyphantis1, Augustina Almyroudi1, Vassiliki Paika1, Panagiota Goulia1, Konstantinos Arvanitakis2,3

1Department of Psychiatry, Medical School, University of Ioannina, Ioannina, Greece; 2Canadian Institute of Psychoanalysis, Mcgill University, Montreal, Canada; 3Departments of Philosophy and Psychiatry, Mcgill University Health Centre, Montreal, Canada

Abstract: Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications.

Keywords: consultation-liaison psychiatry, psychosomatics, narcissism, physical illness, quality of life, psychological distress, personality

General overview

Based on a psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles' heel” has come to mean a person's principal weakness), the present study of 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease and glaucoma showed that narcissistic rage is associated with a number of psychosocial parameters. In patients with disease duration less than one year, narcissistic rage had a minor impact on patients’ psychosocial life, but in those patients with longer disease duration in whom the narcissistic rage insists, the interpersonal relationships and quality of life are impaired and psychological distress symptoms are elevated, indicating that narcissistic rage could actually be regarded as an “Achilles' Heel” for patients with long-term chronic physical illness.

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