In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis state, as a matter of fact, that pathological narcissism was preserve of "the royal and wealthy" and that it "seems to have gained prominence only in late twentieth century". Narcissism, according to them, may be associated with "higher levels of Maslow's hierarchy of needs ... Individuals in less advantaged nations .. are too busy trying (to survive) ... to be arrogant and grandiose".
They - like Lasch before them - attribute pathological narcissism to "a society that stresses individualism and self-gratification at expense of community, namely United States." They assert that disorder is more prevalent among certain professions with "star power" or respect. "In an individualistic culture, narcissist is 'God's gift to world'. In a collectivist society, narcissist is 'God's gift to collective'".
Millon quotes Warren and Caponi's "The Role of Culture in Development of Narcissistic Personality Disorders in America, Japan and Denmark":
"Individualistic narcissistic structures of self-regard (in individualistic societies) ... are rather self-contained and independent ... (In collectivist cultures) narcissistic configurations of we-self ... denote self-esteem derived from strong identification with reputation and honor of family, groups, and others in hierarchical relationships."
Having lived in last 20 years 12 countries in 4 continents - from impoverished to affluent, with individualistic and collectivist societies - I know that Millon and Davis are wrong. Theirs is, indeed, quintessential American point of view which lacks an intimate knowledge of other parts of world. Millon even wrongly claims that DSM's international equivalent, ICD, does not include narcissistic personality disorder (it does).
Pathological narcissism is a ubiquitous phenomenon because every human being - regardless of nature of his society and culture - develops healthy narcissism early in life. Healthy narcissism is rendered pathological by abuse - and abuse, alas, is a universal human behavior. By "abuse" we mean any refusal to acknowledge emerging boundaries of individual - smothering, doting, and excessive expectations - are as abusive as beating and incest.
There are malignant narcissists among subsistence farmers in Africa, nomads in Sinai desert, day laborers in east Europe, and intellectuals and socialites in Manhattan. Malignant narcissism is all-pervasive and independent of culture and society.
It is true, though, that WAY pathological narcissism manifests and is experienced is dependent on particulars of societies and cultures. In some cultures, it is encouraged, in others suppressed. In some societies it is channeled against minorities - in others it is tainted with paranoia. In collectivist societies, it may be projected onto collective, in individualistic societies, it is an individual's trait.
Yet, can families, organizations, ethnic groups, churches, and even whole nations be safely described as "narcissistic" or "pathologically self-absorbed"? Wouldn't such generalizations be a trifle racist and more than a trifle wrong? The answer is: it depends.
Human collectives - states, firms, households, institutions, political parties, cliques, bands - acquire a life and a character all their own. The longer association or affiliation of members, more cohesive and conformist inner dynamics of group, more persecutory or numerous its enemies, more intensive physical and emotional experiences of individuals it is comprised of, stronger bonds of locale, language, and history - more rigorous might an assertion of a common pathology be.
Such an all-pervasive and extensive pathology manifests itself in behavior of each and every member. It is a defining - though often implicit or underlying - mental structure. It has explanatory and predictive powers. It is recurrent and invariable - a pattern of conduct melded with distorted cognition and stunted emotions. And it is often vehemently denied.