ShrinkWrapped

Happy Birthday America

Full Text and list of signers below the break:

When Columnists' Brains Short-Circuit

Once upon a time, MSM reporters, columnists, and editors mediated our information environment.  Authoritative newspapers, such as the New York Times, and newsreaders, like Walter Cronkite, not only determined what the news of the day was but also established the acceptable parameters for discussing the news.  The advent of the blogosphere introduced a complication to this structure.  Suddenly, true experts in their fields could discuss what they considered to be the news in an unmediated fashion with their readers.  One of the more interesting outcomes of such "contamination" of the once pristine MSM narrative was the spreading awareness that reporters, much of the time, are out of their depth talking about most technical subjects and that their biases blind them all too frequently to a full understanding of their subjects.  This would be embarrassing and deflating to our MSM sages if they but noticed.  Unfortunately, to a large extent, the MSM still determines what qualifies as "news" and continue to exercise their role as information gatekeepers in ways which damage our society.

Yesterday I remarked on the "sublime ignorance" of Tom Friedman's comments about the urgent  necessity of passing Cap-and-Trade.  I also linked to  John F. Opie's Tuesday post discussing the first half of the bill. 

John, obviously a masochistic glutton for punishment, has done us all a favor and read through the second half of the bill.  It is not pretty.  (While John was kind enough to thank me for the impetus to finishing the job, I suspect he really blames me for all the pain he has put himself through.)  A few lowlights:

Further Follies...

The real hoot starts on page 890: the government wants detailed swap information on:

the number of positions and total notional value of index funds and other passive, long-only and short-only positions (as defined by the Commission) in all markets to the extent such information is available; and data on speculative positions relative to bona fide physical hedgers in those markets to the extent such information is available.

Okay, there are the weasel words "to the extent such information is available" that let most folks off the hook: otherwise, it's a real funny. And it's supposed to happen within 60 days of this Commission setting up the rules.

This would be, in a perfect world, fabulous. And yes, I want a pony. No, a unicorn!

Oh, and the regulator for this? The Fed.

A brief recap can't do John's post justice so please read the whole thing and pay special attention to his concluding section:

Subtitle E: Adapting to Climate Change

This is basically the "Environmental Wacko Employment Act", aka "There Shall Be No Dissent Act", since it requires cooperation and subservience to the Settled Science of Anthropogenic Global Warming.

Oh, and there'll be workshops galore. And advisory committees! Lots and lots of advisory committees!

And lots of subsidies for "education", aka The Truth.

But Indian Tribes shall be exempt. Except they get money.

There's a huge section on land use and the like...and from page 1180 onwards it talks about how everyone, worldwide, needs to be indoctrinated.

Ye Gods.

I wish that some lawmakers had actually read this before the House had passed it.

Aside from the protectionism and higher energy prices, with all kinds of exceptions that are designed to elicit votes from wayward Representatives, there is an entire section devoted to further attempts to silence Global Warming "Skeptics", attempts that have been underway for quite some time. 

Be Careful What You Wish For

I don't often agree with Dick Morris, but he makes some excellent points in his article on RealClearPolitics today:

GOP: Stand Your Ground

Only the Senate and House Republicans can save Obama now by compromising and lending his extremist legislation the veneer of bipartisanship in order to remove it as a political issue.

If the likes of GOP Sens. Olympia Snowe (Maine), Susan Collins (Maine), Chuck Grassley (Iowa), Orrin Hatch (Utah) and others refuse to go along with Obama on healthcare and on cap-and-trade, they will force him to pass both programs as one-party bills. Not only is it possible that as public support runs out on these measures he will fail even to get 50 votes to pass them, but it is likely that even if they go through, they doom his administration to perpetual unpopularity.

With a filibuster proof majority in the Senate, thanks to the people of Minnesota who in their wisdom have given us Senator Franken, and a large majority in the House, the Democrats will be able to enact all of the legislation of their dreams.  Impediments to Social justice and saving the planet from Anthropogenic Global warming will soon give way before the wisdom of the Democrats.  They will have full responsibility for the outcomes.

We can anticipate more such arguments for legislation as conveyed by the eminent Tom Friedman today in support of the tax and Trade abomination recently passed by the House:

There is much in the House cap-and-trade energy bill that just passed that I absolutely hate. It is too weak in key areas and way too complicated in others. A simple, straightforward carbon tax would have made much more sense than this Rube Goldberg contraption. It is pathetic that we couldn’t do better. It is appalling that so much had to be given away to polluters. It stinks. It’s a mess. I detest it.

Now let’s get it passed in the Senate and make it law.

Why? Because, for all its flaws, this bill is the first comprehensive attempt by America to mitigate climate change by putting a price on carbon emissions. Rejecting this bill would have been read in the world as America voting against the reality and urgency of climate change and would have undermined clean energy initiatives everywhere.

More important, my gut tells me that if the U.S. government puts a price on carbon, even a weak one, it will usher in a new mind-set among consumers, investors, farmers, innovators and entrepreneurs that in time will make a big difference — much like the first warnings that cigarettes could cause cancer. The morning after that warning no one ever looked at smoking the same again.

Ditto if this bill passes. Henceforth, every investment decision made in America — about how homes are built, products manufactured or electricity generated — will look for the least-cost low-carbon option. And weaving carbon emissions into every business decision will drive innovation and deployment of clean technologies to a whole new level and make energy efficiency much more affordable. That ain’t beanbag.

When your ends are so important, all means are acceptable.  What sublime ignorance!  We are going to take this Rube Goldberg bill and toss monkey wrenches, most of them unknown with unknowable results, into the world's most sophisticated, vibrant, and complex economy; we are going to introduce significant energy taxes in the middle of a deep and pervasive recession; and we already know that in the best case scenario we will only decrease the projected (by inadequate computer models that have repeatedly been shown to be inaccurate, even for  predicting the past climate history) AGW increase by ~0.5 degrees. 

The hubris is breath taking.  Yesterday I described this as being a result of "absolute good intentions."  By this I meant that even if their goals are complicated by venality, their goal of saving the planet is so important that it enables any and all means for its achievement.  Al Gore may become wealthy beyond measure, Henry Waxman may achieve heights of power rarely seen by a mere subcommittee chairman, Nancy Pelsoi can achieve both power and wealth, but all is allowed, even demanded, by the morally absolute goal they desire.

The combination of absolute certainty and near absolute power that the Democrats have will lead us to disaster (just as the control of the government by the Republicans led to many unintended and untoward outcomes.)  Since the MSM is fully on board with the Democratic party, there are almost no effective checks available on the use of power by the Democrats.  They now have what they have always wished for...

King Canute was a Piker

One of my favorite econobloggers has done the near impossible; he has read more than half of the "'American Clean Energy and Security Act of 2009'' and finds it is not only 1201 pages long but filled with impossibilities, fantasies, and nonsense masquerading as legislative wisdom. 

Read Congress' Folly...; you will be enlightened.  A brief excerpt to whet your appetite:

Further down the road: Peak Demand Reduction Programs using a "Smart Grid", which I read as basically saying that rather than providing energy for peak demand use, the grid will react to peak demands by ... reducing peak demand. Sorry, I really did try to figure that one out, but all that is talked about is reducing peak demand. Not how, except by inference by cutting power to users.

In other words, what are now called brownouts.

Read it all and savor the madness of our legislators, a body of men and women who strive to prove King Canute wrong...

Environmental Luddites

There is a predictable arc of environmental progress that should be evident to all who pay attention with an open mind.  Advances in Medicine, Sanitation, and Nutrition lead to burgeoning populations.  When those people are poor they do not care about the environment but care about their own survival needs.  As a result, people in developing countries tend to ignore the environment.  However, once they have attained a level of existence which obviates the need to worry quite so much about subsistence, they invariably begin to pay attention to the environment in which they and their children reside.  As the society becomes wealthier, there is more and more marginal income available to direct toward the repair and preservation of the environment.  This is the stage that the West has already reached and which the new Core states are approaching. 

The Climate Change alarmists not only appear to not understand this developmental progression but insist upon statist interventions that will not only halt the progression but will actually cause the environmental progress to regress while impoverishing millions, perhaps billions, in our deeply connected world.

Consider Cap and Trade, an enormous energy tax which will make everything from food to transportation more expensive for everyone while, at it proponent's most optimistic best case scenario, will mitigate the presumed AGW by ~0.5 degrees. 

Michael Anissimov, in an effort to address the misguided demands of the environmentalists, makes the argument:

Dismiss Gaianism

One of the many useful terms that George has popularized is "Gainism" -- "reverential desperatism and misanthropism that is now the all too familiar opium promoted by the deep ecologists." I love the environment, but I think that the insipid SWPL, New York Times-inspired environmentalism held so dear by the farmers market crowd is the wrong way to go about helping our planet.

The reason why is that individual conservation is ultimately a losing game and improving our industrial manufacturing, energy, and agricultural processes are the only ways to avoid spewing garbage all over our pristine verdant globe. The global population is doubling about every 40 years, and any conservation efforts undertaken by the First World (less than a third of humanity) are ultimately dwarfed by exponential population increase worldwide....

The way to be a good environmentalist is to talk about and invest in strategies that impact the environment less whatever people believe -- I'd rather have a planet of people who don't explicitly care about the environment but have little impact on it due to the structure of their society than people who profess care but still drive cars and take airplanes everywhere. For manufacturing, that means investing in molecular manufacturing, synthetic biology, renewable building materials, new materials in general, and other potential routes to cheap, low-waste manufacturing, not buying endless trendy electronic gadgets that deposit heavy metals into our landfills.

Our modern, technological civilization is like the shark in Annie Hall, it must keep moving or it will die. 

The "Diversity" Delusion

One of my first Supervisors in Psychiatry training was a world renowned expert on Schizophrenia.  When he interviewed a Paranoid Schizophrenic, not only was he adept at elucidating the details of their delusional system but even more impressively, he was able to show how the delusion contaminated the patient's thinking and impaired multiple aspects of their relationship to reality, often in ways that were not immediately obvious.  The Paranoid Schizophrenic could often seem quite rational.  The brightest among them would arrive in the office with reams of paper, filled with their writings which purported to document the extent of the conspiracy that was afoot.  At times it could be quite difficult to differentiate a plausible conspiracy from a paranoid delusion.  It often required finding those areas in which their preoccupation overtly damaged their sense of reality before we could ascertain with any confidence that the patient was delusional.

The salient point that my Professor made over and over again was the way in which the delusion and the thought disorder of the Schizophrenic affected all areas of functioning, especially, but not limited to, their cognitive functioning.

In the past I have described Political Correctness as a societal thought disorder, in which we mouth statements and profess beliefs that are overtly disconnected from reality.  The concept of "diversity" is a piece of PC-thought that cannot be reality tested because any questioning of the belief is proof of racism and bigotry and therefore beyond the pale of polite conversation.  The infection of "diversity" is damaging to every institution which becomes contaminated by it:

Diversity Guidance I Can Believe In...

I was reading the June 26th edition of Rhumb Lines about diversity and really liked the key messages contained. Lets think critically about what this says one key message at a time.

1.    Leaders who embrace diversity and differing viewpoints and seek talent that embodies a broad range of life experiences ensure naval readiness today and tomorrow.

2.    The Navy must reflect the face of the nation. Further, we want an officer corps that is reflective of the enlisted force it leads.

3.    Obtaining talent from diverse populations across the U.S. strengthens the force and ensures forward progress.

The first key message doesn't match the last two, and the last two are exactly how the CNO describes diversity. I think the first key message should be the only key message, but sadly it is rhetoric that does not reflect reality, while the Navy is completely guilty of failing on the last two primarily because the promotion system that deals with an abundance of talented officers really only sucks the same soda through a thin straw.

I would love to see the Navy "embrace diversity and differing viewpoints" but sadly, that isn't reality. The reality is, the way the Navy expects to call itself a diverse officer corps is to align minorities and women into the the right jobs that insure promotions. That is exactly what ADM Roughead told the Current Strategy Forum, nearly verbatim.

Galhran mistakenly believes that diversity means diversity of thinking and mind; in America today diversity merely describes the most superficial aspects of our being, our appearance.  In fact, because "diversity" is in conflict with reality (you cannot have an effective quota based on diversity of identity groups and maintain merit as the primary metric) the effects of the Navy search for diversity is to homogenize thinking and develop a corps differentiated only by race (artificial and real), gender, (and eventually, sexual orientation) rather than by thinking.  This is how an irrational idea contaminates thinking.

Today the Supreme Court is issuing their ruling on the Ricci case, one of the more blatant examples of the mischief that "diversity" insists upon. 

[Apparently, reality has begun to reassert itself.]

Consider Steve Sailor's comments on the case:

A Dangerous Health Care Misunderstanding

In his health care infomercial, Barack Obama repeated a comment that has become part of the accepted, underlying assumptions of the health care debate, that as much as 30% of health care spending is worthless and wasteful.  If we could save that 30%, universal health care would pay for itself.  Michael Kinsley, in the process of highlighting the key flaw in the discussion, repeats the meme:

Health Care Faces the 'R' Word

The Obama administration believes that health care can be made cheaper without any reduction in quality. It has evidence to back this up. According to the famous Dartmouth studies, health care costs two or three times as much per person in some places in America as it does in others, with no measurable difference in results. Atul Gawande's deservedly admired recent essay in the New Yorker makes a similar point. So in theory it's easy: Just figure out how the cheap places do it and apply this knowledge to bring down the cost in the pricier places.

But that doesn't mean rationing will be easy to avoid. Statistics on life expectancy or infant mortality are averages. The easiest way to raise your averages -- maybe even the best way, if we're being honest -- is to concentrate on the general level of care and not to squander a lot on long-odds cases. But if the long-odds case is you or a family member, you may well feel differently. [Emphasis mine-SW]

...

Less care doesn't necessarily mean worse care. The administration is investing great hopes (and $1.1 billion of stimulus money) in "comparative effectiveness research." Because we don't collect and compare in any systematic way the vast piles of data we have about individual patients and their treatment, we know astonishingly little about which treatments work and which are a waste of money. [Emphasis mine-SW]  The administration is touting the figure of 30 percent of all health-care costs as spending that may accomplish nothing.

I suspect that what a billion-plus dollars' worth of research will find is that perhaps 30 percent of what we spend on health care is almost entirely worthless, or just barely better than a much cheaper alternative. Or it might be better and no one knows for sure. Denying someone these treatments or tests is rationing.

Micheal Kinsley does an excellent job illuminating the meaning of rationing in health care but, as with so many commentators, misses an essential point about how Medical knowledge increases and care evolves.

When a new drug or procedure is approved for use in humans it has typically spent many years being tested in the laboratory, on animals, and finally on a select group of patients for short term trials.  Only at that point, and after $1.4 billion dollars (in the case of new drugs) is the medication approved for use by an uncontrolled population of patients of varying degrees of illness, varying degrees of associated conditions, and varied genetic and constitutional endowments.  It is only at that point that a true naturalistic, long term study begins.  Generally, the first patients who receive such treatments are those who are long odds cases, for whom the usual treatments are likely to be ineffective.  Later, as the procedure is found to be reasonably safe, the individual calculation of risks versus benefits are made by thousands, then millions, of patient-family-Doctor triads and the experiment expands.  Only after millions of doses of the medication (or thousands to hundreds of thousands of iterations of the treatment) do the results begin to arrive, as the signal is teased out from the noise.

For example, not too many years ago, after something on the order of a million Cardiac Artery Bypass Graft Surgeries, did the data become clear enough to enable Cardiologists to begin to construct a rubric by which to determine which patients would best be treated by the surgery versus those who would do just as well with diet, exercise, and various combinations of medications.  Today, there are many fewer CABG surgeries than there were ten years ago.  Or consider Breast Cancer.  Our best understanding of breast Cancer twenty years ago suggested that it could be cured if caught early by a radical mastectomy in which the woman's breast, lymph nodes, and underlying muscle tissue were sacrificed.  This was a horrendous surgery that had long term implications for the woman's psychological health and only after many, many years, and millions of cases, did we learn that for a great many Breast Cancers, a more limited procedure, often without the need for any mutilation, followed by radiation and/or chemotherapy, offered the same or better survival rates.  Now we understand Breast Cancer as a systemic disease with contributions from the immune system, genetics, etc.

The point is that at any given moment, our knowledge of best treatments for any individual is limited and constantly evolving.  The "best practices" today may well be superseded or even contradicted by new "best practices" as our knowledge grows.

Further, Medicine is at a revolutionary moment:

 We are in the earliest stages of Individualized Medicine.  We can already identify specific tumor markers and genes that indicate specific treatments.  One day this will be true for every tumor; today it is true for a small fraction of cancers.  Before we arrive at a time where an individual's cancer treatment sis inexpensive and routine, we must first pass through a time when an individual's cancer treatment is extraordinarily time intensive, expensive, and anything but routine.

Government run health care will destroy, or at best indefinitely delay, the advent of Individualized medicine.  If the guiding principle behind the cost savings of Government Health care is "to concentrate on the general level of care and not to squander a lot on long-odds cases" and "comparative effectiveness research"  we will be effectively enshrining the status quo as the gold standard of affordable medical care. How could we expect an insurance plan that has an overriding interest in minimizing costs to pay for a new treatment that is unproven and much more expensive than the current "best practice"?  Even if there are some patients who will benefit, it usually (as above) takes a long time, and millions of cases, before significant outcome improvements can be conclusively shown to exist.  This is a prescription for stagnation in Medicine.

Barack Obama (and the Congress) are certainly hypocritical; none of them would agree to accept the kinds of plebeian health care insurance they would foist upon the rest of us.  Their gold plated health insurance allows them to receive state of the art health care,  However, even they will suffer when potentially like extending and life saving treatments are simply never developed because the expense of development can never recoup the investment.

Unfortunately such "opportunity costs" are hard to describe in brief commercials and op-ed pieces.  Health Care as a Right is so much simpler and easier to support.  Sacrificing the future for present votes and power has never been a dififcult calculation for politicians, in any event.

Politicians, Affairs, and Narcissism

Politicians are self-selected for narcissistic traits.  Anyone who runs for election and is willing to put him or herself under the kinds of scrutiny to which we favor our politicians, can be assumed to have more than the usual need for approval and power.   Successful politicians find their narcissistic traits reinforced by the kinds of celebrity that their success engenders.  Suddenly finding that others genuflect before them because of their position (and because of the favors they wish to receive) as opposed to any particular inherent value of the person, tends to create an expectation, and reinforce the desire for, approval in all situations.  This can put rather intense stress on a marriage.

In a marriage, even one that starts off with more than the usual idealization, there is a tendency over time to see more and more of one's spouse.  As time goes on their genuine humanity, which includes all of their shortcomings and flaws, become more and more evident.  In a mature relationship, one recognizes that the same process of de-idealization is taking place within the spouse and the original, intense infatuation ("falling in love") slowly becomes replaced by a shared history and a deeper, more intimate loving relationship.  Unfortunately, when one party to a relationship achieves great success and has their narcissistic traits reinforced, the pressure on the marriage can become impossible to bear.  A Governor, for example, is unlikely to receive worshipful adoration from his wife of 20 years.  At the same time he will have many opportunities to be showered with the adoration of a new, idealized woman. 

Many years ago, an analytic patient entered treatment because of conflicts over an affair.  He did not want to break up his family but complained bitterly about his wife's disinterest after her first pregnancy.  His girlfriend, perhaps not as beautiful as his wife, nonetheless treated him like an Adonis.  She would do anything for him.  Any fantasy he could imagine she was willing to indulge.  That was proof that she loved him more than his wife did.  The affair came to a bad end when she had the temerity to become pregnant by her husband; this was a profound betrayal of him!

There are two important additional aspects of this that are worth noting.

First, those who exhibit narcissistic traits, whether due to a Narcissistic Character structure or the kinds of Acquired Narcissistic Character of celebrity, tend to disconnect cause and effect.  Because their unconscious grandiosity is being reinforced and gratified at so many turns, they do not recognize how harmful their behavior is to themselves and others.  Their lack of empathy (or inhibited empathy) makes it impossible for them to consider how their behavior effects their family.  As well, their grandiosity blinds them to the possibility (likelihood for politicians) that their behavior will lead to their ruin.

Second, there is a kind of acquired Psychology of the Exception that occurs by which the person justifies his behavior.  For my patient, he felt that he was less favored in his family growing up.  Although he had achieved the most success, financially and academically, of any of this siblings, he was convinced that his mother found him unattractive and lacking.  He buried these feelings and thoughts deeply but his resulting sense of defectiveness gave him a ready rationalization for his untoward behaviors.  He transferred his maternal feelings toward his wife (ie, he convinced himself that his wife no longer cared for him) and in response, rationalized his affair as an acceptable response to her indifference. 

(In reality, as occurs with many young mothers, the partial transfer of her affections to the newborn who needs her in reality, often is experienced as a betrayal by the young husband who feels estranged from his wife's affections.  Understanding that her exhaustion and relative decrease in libido are expectable reactions to a newborn and not signs of alienated affection, can be helpful for the young couple.  Many less mature marriages and relationships run into trouble during and after a first pregnany.  Many men have affairs at that time and among that segment of the population most notable for their lack of stability, many relationships fail when the baby-daddy confuses his baby-mama's investment in her infant's infantile needs with an abandonment of his infantile needs.)

In his treatment we learned a great deal about this construct.  He was the second of six children, all born within an 8 year span.  His mother's indifference was certainly more related to her being overwhelmed by the needs of six young children (and a demanding husband) rather than any disaffection with her second born son, yet he harbored deep resentments and hurt from his early life.  His disappointment in his mother and ungratified neediness led to bitter feelings and anger toward women in his life.  His affair, among other things, was an attack on his wife and his behavior with his girlfriend often included sexual behavior that conveyed his unconscious disdain and hostility. 

Luckily my patient was neither famous nor extremely wealthy, which limited his opportunities for unrealistic narcissistic supplies from the environment.  Too many of our politicians do not have such advantages.  As a result, many will continue to be unsatisfied with real (ie, flawed) relationships, and will continue looking for adoration from beautiful young prostitutes (who offer their faux adoration for a hefty price), adoring young interns, and exotic foreign beauties.  The price they pay for their successes varies but can be exorbitant.  They risk losing their families, their self-respect, and their legacies.  If it weren't so tawdry it would be the stuff of Greek Tragedy.

Sacrificing for One's Religion

[Update: Could Australia Blow Apart the Great Global Warming Scare?, by Robert Tracinski and Tom Minchin, discusses an excellent example of what happens when religious belief meets scientific data that disproves its pseudo-scientific premises; read the whole thing and keep in mind that what is happening in Australia could happen here, too.]

We all have blind spots, parts of reality that we simply do not allow ourselves to see.  Very often our blind spots are obvious to other people who do not have the emotional investment in our blindness that we do.  Tom Friedman today writes an article of such penetrating insight that his blind spot, roughly the size of Texas, is all the more remarkable for how obvious it is.  He starts his argument with an excellent, though banal, observation:

The Green Revolution(s)

There has been a lot of worthless chatter about what President Barack Obama should say about Iran’s incipient “Green Revolution.” Sorry, but Iranian reformers don’t need our praise. They need the one thing we could do, without firing a shot, that would truly weaken the Iranian theocrats and force them to unshackle their people. What’s that? End our addiction to the oil that funds Iran’s Islamic dictatorship. Launching a real Green Revolution in America would be the best way to support the “Green Revolution” in Iran. 

Oil is the magic potion that enables Iran’s turbaned shahs — “Shah Khamenei” and “Shah Ahmadinejad” — to snub their noses at the world and at many of their own people as well. President Mahmoud Ahmadinejad behaves like someone who was born on third base and thinks he hit a triple. By coincidence, he’s been president of Iran during a period of record high oil prices. So, although he presides over an economy that makes nothing the world wants, he can lecture us about how the West is in decline and the Holocaust was a “myth.” Trust me, at $25 a barrel, he won’t be declaring that the Holocaust was a myth anymore.

He goes on to show how the beginning of the end for the Soviet Union occured when the Saudis used their control of the oil spigot to drive the price of oil down to levels so low that the Soviets could no longer afford their inefficiencies.  Clearly, Tom Friedman understands the relationship between drilling for oil and price.  Yet, nowhere in the article does he mention the possibility of drilling for more oil and gas in the United States!  Instead, he proposes we magically find solutions to our energy needs in technologies that either do not yet exist or have already been to shown to be incapable of scaling up to the size necessary to replace more than a small fraction of our energy needs.  (eg, wind) 

Narcissism and Paranoia: Part I

Narcissism and paranoia occur on different developmental axes yet they are intimately related to each other.  Narcissistic pathology can, and often does, exist without paranoia while paranoia usually includes narcissistic pathology as part of its substrate.  Cultures that reflect an overabundance of narcissistic pathology or paranoia are quite problematic and understanding the relationship between the two pathologies can be very helpful.

The posts in this series were originally published in 2005; I am repeating them now with some alterations.  The original of this post can be found here.

Narcissism, as defined at Dictionary.com:

1.Excessive love or admiration of oneself. See Synonyms at conceit.
2.A psychological condition characterized by self-preoccupation, lack of empathy, and unconscious deficits in self-esteem.
3.Erotic pleasure derived from contemplation or admiration of one's own body or self, especially as a fixation on or a regression to an infantile stage of development.
4.The attribute of the human psyche characterized by admiration of oneself but within normal limits.

Narcissism, a greatly overused word,  is typically understood to include excessive self-regard, inflated self esteem, and lack of empathy for others.  The first three definitions all refer to pathological narcissism.  The last definition is vague and fairly banal; in reality, healthy narcissism is a prerequisite for healthy relationships and functioning in the world.   I would like to more carefully craft a description of narcissism, and show how pathological narcissism can merge into sociopathy and paranoia.  This has significant importance in our politics because, as I have pointed out elsewhere in slightly different language, Democratic systems are the best ways we have found to manage conflicting narcissistic needs. 

Closely related to narcissism is self esteem, another concept which is often invoked and even more often, poorly understood.  In general when one has a healthy narcissistic investment in one's self, one also usually has decent self esteem, and the ability to weather various injuries to one's image of oneself.  When you read the following, you should try to keep in mind that only part of what I am describing is conscious to the person; much of what makes us who we are is out of our awareness most of the time (and some of it can never be accessed.)

To better understand narcissism, you need to better understand  the development of self esteem and a related concept of the "ego ideal."  Early in life we take the various images we have developed of ourselves (our self representations, in Psychoanalytic terms) and merge them to form a relatively stable, and usually only moderately distorted, sense of who we are and how we fit into the world around us.  If we had the good fortune to be raised by a "good enough" mother (D.W. Winnicott, again) part of our core self representation will be of the adored child, the "apple of the mother's eye" as Kohut once so elegantly put it.  Many other self representations are added through the years, some positive, some negative, until we form a  relatively stable, relatively realistic, core sense of who we are and what kind of person we want to be.  One of Kohut's contributions was to show how the child's nascent sense of himself developed primarily in relation to the mother's sense of the child and how failures of attunement by the mother left the child at high risk for narcissistic disorders.  In other words, how a mother looks at her child, especially her unconscious wishes and fears, are the most important influences on the child's developing self concept.  A mother who experiences her two year old as demanding or defiant or a brat, rather than appreciating (not without some difficulty; 2 year olds have their reputation for a reason) her child's need for and push for independence, will one day discover they have a poorly behaved, impulse ridden, needy child on her hands.

[Please note, I am fully aware that I am generalizing here.  Many fathers, grandparents, siblings, and others, can have a salutary effect on the child's developing self esteem.  Many children, despite what we might think of as poor parenting, find a teacher, or an older sibling, or relative, who values something within them, and allows the child to flourish.  You might think of my use of "mother" as a shorthand to include other nurturing  objects, as well as the primary care taker.]

Clearly, there are a great many influences on the developing self representations, but for a start we are considering the impact of the mother.  From the various self representations the child develops his ego ideal.  The ego ideal is the collection of abilities, traits, strengths and weaknesses, that make up the person who the child wishes he could be.  This will include identifications with various important people in the child's world (including fantasies of people, but that takes us farther afield) and can include famous people as well.  Many adolescents and pre-adolescents long to be like their favorite athlete or movie star (though what they want to be like is their fantasy of the person based on the celebrity's carefully crafted persona.  Despite the celebrity culture in this country, most people give up their longing to be someone else well before they reach adulthood.) 

An example of an "ego ideal" and its vicissitudes would be someone who, as a child, wishes to be a heroic "White Knight." This "ego ideal" might include images of oneself being kind and loving, brave and steadfast, honest and chivalrous, a hero who fights injustice,  protects the meek, and rescues fair maidens.  A healthy outcome of such wishes and fantasies about oneself might be to become a fireman, or join the military, or become a Psychiatrist who helps people overcome their own difficulties (sorry about that; a little irony is useful at times).  A less healthy outcome could be a man who can only become involved with a woman who has a drug problem, because then he can "save" her and gratify his rescue fantasies.    When our hypothesized "White Knight" succeeds in ways which allow him to feel he is close to his "ego ideal", he feels that he has returned to his position as "the apple of his mother's eye", he is on top of the world.  When he finds himself distant from his "ego ideal", he loses the glow of his mother's love and approval (now internalized) and his self esteem plummets.

In the healthy person, by adulthood, the ego ideal has been tempered by reality and includes a realistic assessment of one's abilities and attributes.  (Many a "great" third grade athlete recognizes, by high school, that his two left feet render him a better bet for college than for pro sports, and is able to negotiate the metamorphosis, without too much emotional pain, of his ego ideal to more closely approximate reality.)  The healthy person sees himself as lovable, likable, able to like and love others, able to do good and useful work, and adding some benefit to the community.  It is worth noting that this definition of health is very much culturally determined.  There are cultures in which such traits as described are of relatively little significance.  In some cultures, selfless devotion to an ideology, the submerging of one's identity to the cause, is held up as a culturally acceptable ego ideal.  These are issues that will be further elucidated.