We all know that movie stars, professional athletes, rich people and politicians often act like complete jackasses, but Robert B. Millman, professor of psychiatry at Cornell Medical School and the medical adviser to Major League Baseball, thinks he knows why. The cause, he says, is acquired situational narcissism, a psychological dysfunction that Millman was the first to identify and that he treats in his celebrity patients.

Classical narcissism, a personality disorder whose symptoms include lack of empathy, grandiose fantasies, excessive need for approval, rage, social isolation and depression, has been well mapped by the psychoanalytical community. It begins, conventional theory has it, because of an uneven transition between infancy, when we're all natural narcissists, and age 4, when a more realistic view of the world should be developing.

People who aspire to stardom tend to be more narcissistic than others, but they don't develop a true narcissistic personality disorder until they begin to achieve success: the first platinum album, the first appearance in Vanity Fair's ''Young Hollywood'' issue, the first public fling with Winona Ryder. 

Because the onset occurs well after childhood, celebrity narcissism isn't covered by the textbook definition of the condition. ''Psychoanalytic literature is filled with jargon about how narcissism happens really early,'' says Millman, ''but I realized that given the right situation, it could happen much later.'' That's the Acquisition.

The Situation is fame, money and, even more, the pheromone-like power of fame and money. ''When a billionaire or a celebrity walks into a room,'' says Millman, ''everyone looks at him. He's a prince. He has the power to change your life, and everyone is very conscious of that. So they're drawn to this person. What happens is that he gets so used to everyone looking at him that he stops looking back at them.''

Before the celebrity knows it, he's having grandiose fantasies, he can't feel empathy, he's full of rage, she's starring in ''Glitter.'' The celebrity has begun to share all the symptoms of severe narcissists. 

But there are a few important differences. Both groups suffer from a distorted view of their place in the world, but the tension in the early-developing narcissist is more self-contained. In the acquired situational narcissist, it is also fed by people who surround him.

Even worse, the view of the world the acquired situational narcissist is getting is, when you think about it, quite reasonable. ''They are different,'' says Millman. ''They're not normal. And why would they feel normal when every person in the world who deals with them treats them as if they're not?''

This includes the celebrity's usual planetary system of assistants, publicists, agents, lawyers and groupies. But it also includes us, the public. We're all complicit in acquired situational narcissism. ''We've created it,'' says Millman. ''They're just responding to us.''

We're drawn to stars because they're stars, but we also want to be assured that something in them is still ''normal,'' that, really, they're just like you and me. This leads to magazine scoops like, ''On Saturday nights, Julia Roberts loves to just stay at home and churn her own butter.''

But there's also a thrill when they mess up, as they inevitably do. Who doesn't enjoy reading in The National Enquirer about someone ''buying $5,000 chips and downing house drinks. . . . He was down about $70,000 and he got louder, picking on the poor dealer, saying, 'Would it kill ya to deal a [expletive] blackjack once in a while?''' That was Ben Affleck, God bless him. 

So why is acquired situational narcissism a problem? It's not, for us or for E! or for the tabloids or for VH1's ''Behind the Music.''

It is, however, for the acquired situational narcissists. Their marriages fall apart, they make lousy parents, they take copious quantities of drugs, they get into trouble with the law. ''Because they truly don't believe the world is real,'' Millman says, ''they begin to think they're invulnerable. Some even risk their lives, since the world can't hurt them if it's not real.''

The goal of treating acquired situational narcissists can't be to convince them that they're normal. They're not, and people are never going to treat them as if they are. Also, narcissists don't seek treatment for narcissism. They seek treatments for the symptoms their narcissism causes, like depression, anxiety and substance abuse. 

''What I do is talk about the depression,'' says Millman, who has treated actors, politicians and athletes (as well as regular, nonfamous people), ''because that's what's really bothering them. And then, in passing, you gently and nicely and with love tell them how they have this narcissistic problem.''

Sometimes the narcissists are O.K. with that, and sometimes they're not. ''A number of people never come back,'' Millman says.

The term doesn't appear yet in the psychiatric literature, but it will be included in the next edition of ''Substance Abuse: A Comprehensive Textbook,'' which Millman co-edits and which is the definitive guide to the field of substance abuse.

And there's always word of mouth. ''Last night I had dinner with this old friend of mine'' - a celebrity - ''who was actually one of the inspirations for the idea,'' says Millman. ''He thought it was so remarkable, because it explained his behavior. He said, 'I have high-class problems!' He just couldn't stop talking about it.''

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New York Times, Dec. 9, 2001
Copyright 2001 The New York Times Company

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