General Discussion

When someone is dying they are, for better or worse, their authentic self. The mask, if they ever had one, comes off completely.
So -- what do those big personality types look like when they're dying? the narcissists and sociopaths? Well, it's complicated.

When A Narcissist Dies...

The word narcissist gets thrown around all too freely these days. Just because someone thinks highly of themselves doesn't mean
they're a narcissist. Just because someone is a tad arrogant doesn't mean they're a narcissist. Like a lot of things, clinical narcissism
[narcissistic personality disorder (NPD)] is a spectrum.

We've explained before how someone's arrogance often stems from insecurity which is true, but your general arrogant coworker is like
Primary School sports carnival level compared to someone with diagnosable NPD which is like Olympic level arrogance and insecurity.
Only when these traits are inflexible, maladaptive, persisting, and cause significant functional impairments or subjective distress do
they constitute narcissistic personality disorder.

So, NPD involves a pervasive pattern of grandiosity in fantasy or behavior need for admiration and lack of empathy. Those with narcissistic
personality disorder may have a grand inflated, unrealistic sense of self-importance. They often exaggerate their achievements or talents or
will outright lie about them, be preoccupied with fantasies of unlimited success, power, brilliance, beauty, and ideal love. They believe that they
are special and can only be understood by others that are special or high status. They require excessive admiration. They crave it, and they need
it like a drug. They have a huge sense of entitlement and have unreasonable expectations of and expectations of favorable treatment. They take
advantage of others to achieve their own wants and needs. They lack empathy and are unwilling to recognize or identify with the feelings and
needs of others. They are often envious of others and believe others are envious of them. They show arrogant, conceited behaviors and attitudes.

On the flip side of this, most individuals with NPD are extremely insecure in themselves and often feel ashamed, sometimes to the point of feeling
completely empty (not that they will ever show that or ever admit that), but that's what's running underneath.

Naturally they do not do well with the slightest criticism or what they believe to be criticism which could be anything. As you can imagine, people
with NPD have massive relationship difficulties because of problems related to self-preoccupation, self-admiration and insensitivity to others. In the
DSM {which codes and defines mental illnesses), NPD is a cluster B personality disorder meaning a personality disorder with dramatic emotional or
erratic features. Other disorders in this category include antisocial personality disorder, commonly referred to as Psychopaths or sociopaths, borderline
personality disorder, and histrionic personality disorder. Cluster B personality disorders are notoriously hard to treat because in order to seek treatment
you need to be aware that you have an issue and be motivated to dealing with it which is extremely unlikely. This means many people with these
disorders aren't diagnosed

Thankfully, true narcissists only make up about 1% to 2% of the population, and it does affect men more than women but not by a massive margin.
So, with all that said, try imagining having a parent with NPD or being married to someone with NPD, and, as a side note -- yes, a lot of domestic
violent perpetrators do show classic NPD traits

What is someone self-centered and arrogant, think they are better than everyone, have no empathy, like when they're dying in hospice experience. In Hospice Experience, my work is as a Psych in a hospice facility. I've dealt with two patients who were actually diagnosed with NPD, though, of course they denied it, but it was as damn clear as day. It's never a good sign where, after a few days, you are silently hoping that they drop dead sooner rather than later, but we're all human.

Let me tell you how it went. One was a bloke in his early 40s with cancer. He really reminded me of one of those sleazy, up themselves CEOs you see in movies. He was married with two sons. We never saw his two sons. His wife would spend at least 2 hours in the hallway and reception before going into his room each day, clearly not wanting to be there. I don't blame her because when she did go into the room, he would berate her, tell her that this was her fault (like she's the one that caused his cancer) and how much of a loser she was. The list just went on and on. He was in hospice for 2 weeks. After the first week, I, as a Psych, had spoken to her privately a few different times saying I know you feel loyal to him but you don't need to be here if you don't want to. She was insistent that she was going to be there when he died though I sensed it was more about making sure he was actually dead than anything else. I should also say that he had two living parents and two siblings living locally, and only his dad dropped by twice for a couple of minutes. The patient had obviously burnt those bridges.

Now, while he was in hospice, he yelled at the staff, threw stuff at the staff and was generally abusive. He was one of those patients that would ring the bell constantly for the smallest things and complained that he could hear other patients and their families. Now, nurses are used to dealing with a lot of crap and abuse unfortunately, but this guy made many of our seasoned staff tap out. We had to have two very large security blokes stationed at his door
because he was combative. Like I said before, NPD traits stem from deep insecurity of self, so they resort to manipulation and violence to have some sense of control, but you know that they don't give a **** about your insecurity and death. When you're in hospice and it's coming for you, well -- They will fight anyone like they are fighting death itself. He died alone, unsurprisingly.

Now I know many of you will be thinking, Well, you sound so unempathetic. You're horrible. You can't be a Psych. Let's put this another way. We have 14 beds in our hospice. That one patient was abusing staff physically and verbally abusing his wife and father, breaking thousands and thousands of dollars worth of medical equipment and scaring the hell out of 13 other dying patients and their families. If you think empathy will help calm him down, you have never crossed the lines of someone with NPD, and unfortunately you can't just sedate a patient indefinitely although some were definitely arguing for it. So, that was one patient.

The other patient was a woman in her 60s, also with cancer. Now her paperwork stated that she was divorced, and she had three adult kids. When she came to the hospice, she started asking us to call them and ask them to come in and see her. Now, this isn't uncommon at all. We do it all the time, and her eldest son was written down as her next of kin. So. I do the calling around and find out that they all live locally. Okay -- bit weird. Mother's been put into hospice, and the next of kin isn't around, but okay. I first get hold of her youngest who politely but in no uncertain terms tells me that he's definitely not coming in and to only call back when she has been declared dead. That would be the second red flag of the situation. I then get a hold of of
the middle child, the daughter, who probably hands the phone to her husband and tells him to deal with it. After asking how long we reckon she's going to be alive, he says they will think about it and they might come in to visit, maybe. Not going well here. Finally, I get hold of the oldest son who says... and says he'll be right over. It's only when he arrives and we chat privately does he explain that he effectively raised his two siblings because their mother wasn't interested and simply used them as props in her life.His father stayed as long as he could, drinking to deal with it, but eventually left and. When he tried to get custody of the kids, she lied to the court. Obviously verbal and emotional abuse by their mother was all too prevalent in this family as well.

Sure enough, the moment he steps into her room, she's screaming, What took you so long. Your siblings are useless and don't love their mother, and how could they betray me. A lot of overdramatic gestures and fake tears. It was a real performance, one that our other patients did not appreciate having to hear. Anyway..

The next day, the daughter comes in with her husband. After about 20 minutes of being in the patient's room, the husband comes out looking frustrated. Now, I've been keeping an eye on this room for obvious reasons, so I ask him how's it going and what's going on. He says his wife wants an apology from her mother for everything which did surprise me, but we all know how that's going to go and it's not going to go the way she wants it to. Narcissists don't apologize because nothing is their fault, according to them. Cue a lot of screaming, security running, and no apology forthcoming. She also died alone, and her family had her body sent for direct cremation.I wouldn't be surprised if they didn't go back to pick up her cremains either, and all this is not to mention the hell that she put staff through as well the dying.

The Dying Narcissist

I did a lot of asking around at other hospices in the country, both in-patient and home care, to hear their experiences. It would appear that a
narcissist is much more likely to die at home. Now this isn't in a good death kind of a way. It's more a "I can control everything around me
if I'm at home" kind of a way, and they will manipulate and control those around them like they have always done. In order to care for them in
their dying days and because they are so fearful of the inevitable, they will be even more arrogant, more entitled, and more demanding -- if
that's even possible. They will belittle you more than ever, show no regret, and they will not apologize for anything that they have ever done
unless they can use it to manipulate you, but that's only if their intimidation isn't enough. The irony in all of this is that this kind of person's
biggest fear is dying alone, and a lot of them do. They have pushed away everyone. No one wants to be near them. So many of them have
beaten down, manipulated, and crushed the self-esteem and self-worth of those around them --usually their kids. They are able to manipulate
them, usually through guilt, to care for them during this time. All that is to say dying is not going to soften someone with NPD, so don't get
your hopes up.

The Aftermath

A narcissist's ways don't tend to stop after they're dead. They will not show any regret or guilt forwhat they have done, and when they die
you should not expect to get anything from them in their will. It will be left to the grown child, to their enablers. It will be left to people who
validated the delusions of their false self -- people who were susceptible to their manipulation, people who didn't try to oppose their false
narrative, people who kept a Code of Silence, or, more likely -- they will leave everything to their dog or to some random charity because
they know it will make them look good after death. It's all about the facade. So, don't be thinking, Thank God, they're finally dead. At least
I'll get part of the estate, because it's unlikely. Also. we touched a bit on this in our video about when someone you despise dies -- but when
someone like this eventually dies that's not going to make the pain go away. Many victims of these people expect that they will feel a massive
weight lift off their shoulders when their abuser finally dies, but that is rarely the case.

So -- don't wait for that seek help for yourself long before that moment happens. Seek out a mental health professional, preferably one who
specializes in personality disorders, because that means they also specialize in the damage that they cause. There are also many support
groups out there. Some are very specific, like for kids of those with personality disorders, and some more general, like survivors of abuse.
Also -- surround yourself with positive, respectful people that will help build up your self-worth again.

As bad as it sounds, a dying narcissist is simultaneously the saddest, most pathetic but infuriating thing you'll ever see. Our hospice has cared
for dying patients with antisocial personality disorder, and they were much easier to deal with than those with NPD They weren't great by any
means, but they were easier to deal with. The traits of a narcissist will only become worse as they become more aware of their inevitable death
and there is no shame. You should feel no guilt at all in walking away from these people, even when they are dying.