Who Gets to Feel Ok? Disability, Healthy Narcissism and the Emotional Economy of Modernity

Introduction

‘Nature is only the raw material of culture, appropriated, preserved, enslaved, exalted, or otherwise made flexible for disposal by culture in the logic of capitalist colonialism’. (Haraway 2013)

Reflecting on her life with a severe physical disability, Nancy Mairs imagines what she calls a ‘habitable world’—that is, a world which shows in both its nature and its culture that it ‘wants me in it’ (Mairs 1996, 63). The point is that for her, as for the majority of people with disabilities globally, worlds remain less than habitable (Shakespeare 2014; Watermeyer, McKenzie and Swartz 2019; WHO 2011; 2022). In most societies, living with a disability means continually bumping up against reminders of a material and social environment which is misattuned to one’s embodied and emotional needs, limiting participation and access to resources and experiences which most take for granted (WHO 2011). In Donna Haraway’s (2013) terms, cited above, the ‘raw materials’ of nature are in this case the bodies of persons with disabilities, to be represented, appropriated, enslaved or disposed of in support of a modern capitalist order privileging the powerful. For those with material privileges and valued identities, the affirmation that the world does ‘want you in it’ may be so elemental as to go unnoticed. Yet, although taken for granted, such reassurances contribute to emotional well-being.

With this paper, I add to a growing literature attempting to conceptualise the emotional experience of living with disability in an ableist, excluding world, drawing on my own work as a psychoanalytic psychotherapist working with disabled people. There is little doubt that the contextual experience of disability is often hard, but conceptualising the emotional pressures and predicaments it presents remains a work in progress (Marks 1999; Reeve 2002; Thomas 1999; Watermeyer 2013). Colloquial as well as clinical assumptions typically reflect a pathologising and reductionist ‘medical model’ view binding disability to ableist tropes such as damage, misfortune and solipsistic grief, constructing disability as ‘individual tragedy’ while disregarding environmental factors. Besides demeaning the disability community, such perspectives support social injustice through ignoring the often-definitive role played by material and cultural barriers which systemically deny this group access to resources, services and rights that are essential to inclusion, meaningful participation and belonging (Barnes and Mercer 2005; Oliver 1996). Worse still, psychoanalysis has historically understood disabled people as prone to pathological narcissism, a view which presumes this group to be so intrinsically damaged as to have to manage internal feelings of low worth with brittle self-aggrandisement. More recently, however, critical psychoanalysis has presented a model of disability inequality which points to how disabled people have been positioned as reminders, or harbingers, of thorny aspects of the human condition which the dominant in society seek to repress, leading to a range of oppressive enactments that keep members of this community at the margins (Marks 1999; Watermeyer 2013). Central here is the projection into disabled people of unwanted knowledge and emotions to do with universal existential dilemmas such as the vulnerability and frailty of the body, the inevitability of dependency and the fact of mortality. These disavowals are part of something larger, comprising aspects of modernity’s narcissistic foundations, where affirmations of self-worth are rooted in commodities and status (Frosh 1991; Lasch 1978; 1984; MacDonald 2014). But not all narcissism is pathological; we all need adequate stores of healthy narcissism (Kohut 1966)—positive feelings regarding our identity and worth—in order to maintain psychic equilibrium and a degree of happiness. These resources are also fundamental to the development of a healthy self-concept and adequate self-esteem. This paper proposes that access to a sufficient supply of such narcissistic resources (McWilliams 1994) is subject to disparities in wealth, power and participation, which are reflected in the material and cultural oppression of disabled people. As we shall see, with regard to disability, the question of ‘who gets to feel OK’ relates to how material resources are distributed, who is compelled to carry a devalued identity and who is granted inclusion. Exploring this area reveals how this group may be positioned outside of not only the material but also the psychic luxuries of the narcissistic modern society and therefore have to endure sustained exposure to existential realities which others are able to avoid. Forced to carry the disavowed shames of the dominant, disabled people may be left processing wounds which are not their own while also driven to develop new perspectives on existential quandaries that narcissistic society simply ignores.

To enliven the argument, I draw on clinical material¹ from adults living with disability, which offers first-hand descriptions of the emotional labour required to maintain psychological equilibrium—to ‘feel OK’—in the face of both material and psychosocial adversity, not to mention the reality of impairment-based functional limitation. Since it is essential to reflect on and disclose one’s positionality in research work surrounding identity and inequality, I identify myself here as a white male professional in mid-life who has lived with disability since childhood.

From here, the paper progresses as follows: After outlining the central concern regarding disability and access to healthy narcissism, I briefly explore the history of the now-discredited views from psychoanalysis relating disability to narcissistic psychopathology. Thereafter, a discussion of the broad, self-adoring cultural pathologies of late modernity (MacDonald 2014) paves the way for the central argument, concerning the implications of disability oppression for access to healthy narcissism. Lastly, I reflect on the contradictions of how modern society holds disabled people’s feet to the fire of quandaries based in the human condition and the pitfalls associated with an emotional—and hence political—economy which is based on othering.

Emotional Life with Disability

In my role as a psychoanalytic psychotherapist working with adults who live with disability, the question of how socio-cultural mirroring, bodily difference, formative relationships, material resources and neurodevelopmental factors commingle to create psychological structures and emotional experiences is an ongoing one (Watermeyer 2012; 2024). Put simply, how does it feel to live with disability in an ableist, unwelcoming world?

In making sense of his emotional life, a man in his mid-30s living with a severe congenital physical disability (whom I will call Mr. C) told me the following:

‘But, I think, in terms of disability and managing being disabled, in society, there are very stark prices to be paid no matter which fork of any road you take. You make a choice, but it’s kind of …. between evils. Most of the time you’re on …. the losing side, and the choice is just, like…. what…. form of losing you’re going to be doing.’

Exploration of these remarks uncovered a psychological battle on two fronts. Mr. C faced an external onslaught of denigrating, ableist assumptions and material barriers to participation, alongside an inner struggle with internalised judgments and feelings that he was damaged and of low worth. These experiences were superimposed on the basic, corporeal demands of living with functional limitation, which were often laborious and exhausting. Facing this inundation, he described the substantial daily emotional labour required in order to simply ‘feel OK’ (Watermeyer and Swartz 2008). An ancient and hegemonic cultural logic ascribes personal, moral and intellectual shortcomings to the self of persons with disabilities, based on the ‘flaws’ of the body (Hughes 2019; Stiker 1982). The crux of this prejudice is the belief that a contented, fulfilling and happy life is not possible in the presence of disability. Disabled people must find a way to deflect, metabolise or reconstrue these projections for psychological survival (Murphy 1987), even in the face of an ‘uninhabitable world’.

It is important to note at this point that, for anyone, threats to the self exist in tension with the inner work of marshalling narcissism. In the cultural imagination, the idea of narcissism is normally associated with pathology, but here my emphasis is on healthy narcissism, an essential support to a secure sense of self (Horwitz 2000; Kohut 1966). This comprises positive feelings and cognitions about one’s qualities and worth, which only shade into pathology if excessively rigid, distorted and self-aggrandising (MacDonald 2014). These supports maintain the coherence and stability of the self (Winnicott 1960), as well as what psychoanalysts term ‘secure and cohesive internal objects’, with roots in early attachment relationships. Such ‘objects’ are inner resources arising from the internalisation of positive formative relationships. But while based on a template of early experience, these inner foundations are not constant realities, instead depending on positive experiences of social mirroring for their expression and maintenance (Winnicott 1967). Such mirroring experiences will tend to enliven healthier parts of the self, characterised by a capacity to justly appreciate one’s achievements and qualities, survive disappointments and feel entitled to comfort and support from others (Horwitz 2000; MacDonald 2014).

Conversely, experiences of rejection, exclusion and othering can galvanise parts of our inner worlds which attack the self, questioning our value and entitlement to belong. Due to the vicissitudes of psychological development, in combination with immediate environmental factors, we are all constantly engaged in an internal conflict between aspects of mental life which undermine our worth and healthy narcissistic cognitions and feelings which affirm the self. Put simply, we need to shore up enough of the latter to blunt the effects of the former, to not be overcome by self-deprecation and depression. Now, in the psychic economy of ableist othering, the question of how experiences which support healthy narcissism are distributed is central to understanding the struggle described above by Mr. C. The main proposition is this: access to what Nancy McWilliams (1994) terms ‘narcissistic supplies’ (affirming experiences, possessions, roles) is, by dint of societal arrangements, systemically skewed towards the dominant, privileged class, leaving those ascribed the identity of ‘disabled’ to get by on a far more spartan emotional diet. The troubling theoretical ideas in psychoanalysis positing a relationship between disability and pathological narcissism have a long history, but in a manner which, as we will see, contrasts diametrically to the current argument. These ideas also exist against the backdrop of a psychoanalytic view of disability which is broadly pathologising and denying the influence of social environments while ultimately blaming the victims of oppression for their purported ‘flaws’; I have provided a full critique of these problems elsewhere (Watermeyer 2013). Returning to the present narrative, however, let us briefly divert into a discussion of how psychoanalysis has historically connected disability with narcissistic pathology.

Disability and Narcissism

The question of how narcissism might relate to disability is not new, and its history has relevance for our discussion. Although disability appears seldom in psychoanalytic theory, when it does, it is routinely associated with narcissistic pathology (Davis 2002; Harris and Wideman 1988). Disability has been regarded as a precursor to disorders of narcissism, which are understood to spring from a primary experience of damage to body or mind (Harris and Wideman 1988). In this essentialist, anachronistic view, disorders of the body/mind in terms of structure or function are somehow believed to be automatically reflected in a damaged sense of self. Pathological narcissistic defences—effectively distortions of reality—are then understood as a means of coping with the terrible knowledge of this ‘fundamental’ wound.

A host of psychoanalytic authors justify this assumption by reference to Freud, who—although ambiguous on the issue of disability—regarded a focus on patients with ‘organic disease’ as a valuable method for understanding pathological narcissism (Castelnuovo-Tedesco 1981; Freud 1914). Niederland (1965), for example, describes how physiological ‘defects’ serve as ‘nodal psychological factors’ in the ‘genesis and perseverance’ of disturbances to narcissism (Niederland 1965, 518). At play here is a view of the presumed psychological damage of disability being so profound, so primary, as to fundamentally shape psychic life while largely ignoring ideology and culture (Watermeyer 2013). This proposition is operationalised, within psychoanalysis at least, through Freud’s (1923) concept of the body ego. ‘Ego’ here refers to the conscious self, which relates to the world as personality. The ‘body ego’, in turn, is the earliest, foundational representation of the ego, formed as a reflection of the structures and sensations of the body (Lussier 1980; Orbach 1994). For Niederland (1965) and others (Jacobson 1959; Thomas and Siller 1999, to name only a few), the presence of a ‘damaged’ body manifests in distortions to the body ego and, by extension, the ego, which—through the self-aggrandising, narcissistic defences of denial and projection—creates a warped, pathological view of the world. In this prejudice-ridden view, which I have critiqued elsewhere (Watermeyer 2002; 2013), the individual’s experience of disability only ever appears as a negative part of self-image, which must be warded off with primitive, distorting defences, aimed at reformulating its ‘terrible’ reality (Davis 2002; Harris and Wideman 1988). While these sources may appear dated, their essential proposition remains embedded in clinical as well as common-sense accounts of disability, especially considering the relative silence of psychoanalysis and psychodynamic psychiatry on the issue of disability generally (Asch and Rousso 1985; Olkin 2012; Watermeyer 2013; 2017).

As should be clear, the key problem with this view is that very little, if any, attention is paid to the sociohistorical context in which disability is made meaningful, often through stark experiences of material deprivation, social exclusion and culturally engendered stigma (Watermeyer 2013; WHO 2011). To return to the prose of Nancy Mares, disabled people have, far more often than not, been denied a ‘habitable world’, which, unsurprisingly, leaves impressions on psychological well-being.

Over several decades, the discipline of disability studies has investigated the myriad ways in which disabled people worldwide are needlessly and unjustly excluded or discriminated against in most aspects of social life, including education, employment, health care, housing, transportation and recreation (Barnes and Mercer 2005; Oliver 1990; Shakespeare 2014; WHO 2011; 2022). In the words of Rosemarie Garland-Thomson (1997), modern society creates life-worlds which are exclusively habitable to the ‘normate’, an illusory nondisabled figure characterised by autonomy, self-determination and control (Garland-Thomson 1997). By contrast, living with a visible disability means confronting a societal gaze carrying imputations of damage and shame. Given the pervasive material exclusion and stigmatisation of disabled people, the labelling of this group by psychoanalysis as narcissistically damaged amounts to a victim-blaming ‘medical model’ view, reducing societal injustices to individual pathology. The authors I critique above take a simplistic, essentialist and prejudiced position that disabled people are, perhaps irrevocably, narcissistically wounded by the nature of their body-minds, a position which has been roundly rejected (Davis 2002; Watermeyer 2013). But how, then, do we conceptualise the lived emotional consequences of ableism and impairment? Previous theoretical contributions have sought to address various aspects of this question (Goodley and Lawthom 2006; Marks 1999; Reeve 2002; Thomas 1999; 2007; Watermeyer 2009; 2012; 2013; 2017; Watermeyer and Swartz 2008; 2016). This paper adds to this growing understanding by offering a reformulation of the place of narcissism in the psychological lives of disabled people.

What I investigate here are the ways in which living with disability in an ableist society brings a barrage of assaults on healthy narcissism from the ‘world out there’, borne not of damaged bodies but of the social world’s unequal, jaundiced response to disability difference (Watermeyer and Swartz 2016). This response, according to a more recent critical psychoanalytic perspective (Marks 1999; Watermeyer 2013), is based on how the disabled figure tends to evoke projections from the broader community, involving the disavowal of discomforting but universal human dilemmas, such as the vulnerability of the body, the inevitability of dependency and the fact of mortality (Hevey 1992). The need to disown these universal conflicts is then systemically enacted upon disabled people themselves, through exclusions incorporating phenomena such as segregation (Hahn 2002), institutionalisation (Stiker 1982), enforced normalisation (Davis 1997; Wendell 2013) and other actions aimed at distancing, subduing or erasing the menace which disability represents. Attacks on the healthy narcissism of disabled people occur against the backdrop of a global turn towards self-aggrandising narcissistic culture, providing an unforgiving, even vengeful context for the awkward difference that disability brings. To locate disability in this cultural world, we must begin by reflecting on the rise of late modernity’s narcissism as a means of dealing with inner existential conflicts.

Narcissism and Modernity

Christopher Lasch’s scathing critique of the narcissism and rampant materialism of modern society, although decades old, seems ever more relevant in our 21st century world (Frosh 1991; Lasch 1978; 1984; MacDonald 2014; Twenge and Campbell 2010; Watermeyer 2013). In what Twenge and Campbell (2010) have termed ‘the age of entitlement’, we live surrounded by media appeals to our vanity and greed amid shallow online relationships devoid of intimacy, while everywhere the oracle of the market and drive to accumulate is supreme. Celebrity culture prizes wealth and fame, which is valued for itself, not for any genuine achievement (MacDonald 2014), while modelling an addiction to shallow narcissistic supplies.

In making sense of this, it is important to begin by recognising that narcissistic culture is shaped by prior experiences of loss. The narcissistic manoeuvring we do to recreate, adorn and augment our personas is an attempt to manage the insult of what we cannot have or cannot be—the more helpless and bereft we feel in the face of our shared condition, the more we need to self-aggrandise. Freud (1923) described how the ego—our personality—as expressed in the dominant culture contains a history of its prior attachments and losses, hopes and griefs; in other words, our human contours are a function of our disappointments. In shaping contemporary narcissistic culture, Lasch (1978) points to intolerable existential griefs based in our shared human condition, which we desperately seek to avoid (Frosh 1991). MacDonald (2014) highlights the power of terrors associated with old age and death, with physical beauty being the only way to define oneself as distinct from these ills. In response to these unspeakable realities, a defiant myth of control underpins the idealisation of bodies and lifestyles which seduce us with promises of not only pleasure and self-aggrandisement but also of immortality itself. The neoliberal charge towards commodification mirrors an internal piling up of narcissistic fantasies, bringing ever-deepening splits between not only rich and poor but also between the illuminated and the abject, the super-human and the sub-human. The recent global surge in imperialist capitalism, driven by authoritarian governments steeped in a myth of control through accumulation, bears alarming testimony here. To these narcissistic ideals, disability is perhaps the ultimate, impudent nuisance, bent on ‘spoiling the party’. In its inescapable carnality (Paterson and Hughes 1999), disability is the counterpoint to modernity’s strivings, putting all that it abhors about our vulnerable human condition frankly on display. Lasch (1984) writes:

‘It is misleading to characterise the culture of consumption as a culture dominated by things. The consumer lives surrounded not so much by things as by fantasies. He [sic.] lives in a world that has no objective or independent existence and seems to exist only to gratify or thwart his desires’. (Lasch 1984, 30)

What Lasch (1984) emphasises is how it is the narcissistic affirmations afforded by things, rather than the things themselves, which require our attention. Commodities’ only meaningful existence lies in the capacity of possession to fulfil fantasies of omnipotence while re-inscribing the otherness of outgroups amid dreams of immortality. The palpable corporeality, frailty and dependence of the human condition, which we are reminded of by disability, from this vantage point, can only be hated. But while it is hated, disability is—awkwardly—also the needed other, providing a convenient container for the projection of damage, vulnerability and its associated shames, which are to be found somewhere in all of us. This projection, along with the narcissistic ego’s consumerist props, protects the self against what Lacan regards as its—that is, our—fragmented core, presenting an illusion of integrity (Lacan 1977). De Zavala’s (2011) description of collective narcissism (as cited in MacDonald 2014) is useful here. They describe a shared investment in an emotionally laden, yet unrealistic belief about the status, importance and desirability of their in-group—in this case, that of self-identified ‘normals’ in denial of their human frailty. Correspondingly, in Slavoj Zizek’s (2004) terms, disability represents the quintessential threat to the ‘enjoyment’ of the dominant community—that is, to their self-idealising fantasy of ‘vivacity and plenitude’, which in this case is undone by fantasies of failing and decaying bodies. The fact that so much is at stake at the psychic level, and the pervasiveness of defences based on the shiny surfaces of things, means that personal insight which allows dialogue with one’s vulnerability appears ever harder to come by (Hoggett 1992). As vulnerability is disowned, so is the possibility of authentic experiences of human commonality, as well as the compassion that is their corollary, to everyone’s detriment.

Healthy Narcissism, Afforded and Denied

While the dominant in society find refuge, albeit precarious, in this often-crude narcissism, as corollary people with disabilities are required to publicly carry the mantle of the vulnerable, damaged and mortal while simultaneously being denied access to the narcissistic supports which others rely on. As alluded to earlier, narcissistic defences exist on a continuum of degrees of reality distortion, as well as rigidity, which stretches from the crude and psychotic to the healthy and essential. Also already noted, much attention has been paid to the purported tendency of disabled people towards pathological narcissism, which is viewed as an intrinsic, pre-social phenomenon. But this position elides the question of the extent to which disabled people do, or do not, have access to social mirroring, including experiences of participation and belonging, which support healthy narcissism. For anyone, such mirroring is needed to sustain the coherence and stability of self-identity, fostering secure internal foundations and a healthy entitlement to inclusion, belonging and love. Narcissistic support allows the internalisation of positive formative relationships—affirming figures in our worlds which coalesce internally into resources we can lean on as we manage and resist both inner and external attacks on our worth. My central thesis is that disabled people, at the group level, are systemically afforded less of such narcissistic resources while simultaneously being subjected to a unique, continuous stream of relational and material signals which denigrate the self, creating exposure to universal existential quandaries from which most in society are (at least temporarily) protected. Our psychic stability depends, far more than we think, on a continual flow of affirmations to our narcissism. Evidence from my work in psychotherapy with disabled people suggests that for persons living with a range of impairments, life in a disablist world can all but turn this tap right off, for reasons typically far more to do with discrimination and avoidable exclusion than the nature of bodies which are structurally or functionally different. Experiences of inclusion, participation, mastery, personal power, easy and affirming human contact, self-determination and control of the physical world may be so taken for granted by members of a more dominant social group (white, monied, nondisabled) that their importance to secure selfhood goes unnoticed. Some of these affirmations depend on economic resources and are diminished by poverty in both disabled and nondisabled people, but some do not; simply being able to move around as one wishes, to satisfy one’s urges for engagement, to be in control of one’s physical space and to enjoy unquestioned belonging in one’s community is a narcissistic affirmation. Inaccessible amenities, services and technologies; barriers to participation in community life; exclusion from the world of work; discrimination at the interpersonal level; and much else can extinguish a host of everyday experiences of ‘normal’ narcissistic support. In tandem with this may come excoriating mirroring experiences which actually devalue identity, including dehumanising projections to do with damage and invalidity (Murphy 1987), ableist micro-aggressions from strangers (Lourens 2021), prejudiced beliefs about low potential (Watermeyer & Swartz 2008), myths of divine punishment (Hughes 2019), denigrating media representations (Mitchell and Snyder 2001), and the ongoing experience of moving through a physical environment which was clearly created with only the needs of others in mind (Barnes and Mercer 2005).

But despite this, and with disregard to the hopeful fantasies of the ‘modern man’, the essential vulnerability exposed by these predicaments is not at all peculiar to disabled people. On the contrary, the insecurity and contingency of human life are elemental to all; what is of note is how, as per Lasch’s (1984) analysis, middle-class ‘normal’ lives are (temporarily) shielded from its realities, while it is thrust into view for the disability community. For many, living with disability means being drawn back, again and again, to the universal reality of human frailty and mortality, the laboriousness and unreliable physicality of the body and the contingency of life in every moment. A 37-year-old man living with quadriplegia, whom I shall call Mr. G, described an experience which, as a psychotherapist working in disability, has become familiar to me. He acquired his disability through an accident and very soon was shocked and amazed at how differently the world responded to him, as a man, a friend and an employee; he described the experience as ‘a crash course in social inequality’. Notwithstanding his middle-class status, an inaccessible built environment and unwelcoming culture in his city had drastically curtailed his participation in most aspects of community life. Mr. G reflected on his new existential vantage point as follows:

‘You know, you really are stripped back to an infantile state, and so your… so everything that gives you value in society is stripped away in … kind of in a moment. And so I think it had a lot to do with that as well… because of that relationship it has to do with society, but I think it also speaks to a very deep fear we have. You know that we’ve… failed in a very profound way… that we’ve failed full stop. You lose out on the ability to recognise yourself as valuable, as worthy’.

Without the luxury of the trappings and sensations of the narcissistic modern society, people living with disability may be held, to a greater or lesser extent, existentially off-balance, repeatedly humbled by both a ‘non-habitable’ world (Mairs 1996) and a sustained encounter with our shared corporeal fragility. On this terrain, feelings of security may be out of reach, and one is reminded daily of the ultimate unreliability of modern material reassurances. Here, the modernist myth of the ‘good life’ comes into bold relief as just that, a myth, a fantasy of an ideal existence in which the vulnerability at the heart of the human condition is defeated.

Expanding on the granular nature of experiences promoting healthy narcissism, consider another example from my psychoanalytic work with disabled clients. For Mr. M, a middle-aged professional living with severe visual impairment, daily experience is peppered with a combination of exclusions from participation resulting from the social and material organisation of society and a more impairment-based lack of access to the world of visual exchange. Think of many moments composing a day—the mastery, control and self-determination of freedom of movement; a sense of belonging borne of taken-for-granted mutual participation; the command afforded by technologies designed specifically to interface with one’s body and emotional life (cars, electronic devices, built environments); as well as a kind look from a stranger or loved one, or the wordless appreciation of beauty—and so the list continues. With each experience comes a small surge of dopamine, of oxytocin, restoring a foundation of security and self-regard which we need in order to negotiate the next sling or arrow that fortune brings. But for Mr. M, these strokes became scarcer through the progression of a degenerative illness which worsened his visual impairment while heightening the impact of systemic barriers to participation. In such circumstances, a person living with disability must adjust to getting on with less narcissistic nourishment, perhaps through seeking new, secure foundations of self at some deeper, more integrated level or, alternatively, unconsciously turning to more distorting defences. This divergence reflects possible psychic responses to trauma of any kind. Choices may become narrowed, needs must be deferred (Watermeyer and Swartz 2008), essential care relationships may be unequal and silencing (Kittay 2011) and personal power is blunted by a world which is unwilling or unable, in the case of those with body-minds that are different, to create the conditions in which intention may be transformed into action, into participation. Note, too, that I write here of members of the global disability community for whom a degree of participation, of agency, of citizenship has been afforded by their society. For innumerable others, persistent prejudice and gross social injustice support lives of wholesale exclusion from education, employment, community life and citizenship rights. In such worlds, the challenge of finding a route to an integrated, secure and self-compassionate sense of self is herculean. My point is not to imply that this does not occur; not at all. Instead, I underscore the stamina required for such an inner journey.

Reading the foregoing, it might be easy to revert to a familiar but problematic attitude of what I might call the pity of medicalisation. What this means is the evocation of a denigrating disablist stereotype which affixes tragedy to the lives of disabled people while reductively attributing struggle to a medical view which denies the massive role of social injustice in sustaining exclusion and inequality. Instead, my intention is to describe a comingling of both societal and embodied factors which stifle the normative flow of narcissistic supports. Limited availability of experiences promoting healthy narcissism occurs amid a persistent stream of projections from a crudely narcissistic modern world, intent on ridding itself of the shame, frailty and fearfulness at its core. At the root of the modernist narcissistic machine is a disavowed abjection (Kristeva 1982) or fragmentation (Lacan 1977), with which, arguably, disabled people are systemically scapegoated (Watermeyer 2013). Ableist projections are supported by, inter alia, cultural and religious myths about disability (Hughes 2019), the demeaning implications of charity discourse (Longmore 1997), pity-inducing representations in media and the hegemony of ideals of achievement, accumulation, competition, vigour and stereotypical physical beauty (Wendell 2013). In this way, the ‘narcissistic labour’ of not avoiding but working with the vulnerable unconscious counterpoints of the ego of the ‘modern man’ is, to some degree at least, left to those culturally designated as damaged. Without the refuge of this projection—that is, the psychic payoff of scapegoating—tears would appear in the narcissistic armour of those at the forefront of reproducing collective narcissistic culture, in other words, those temporarily clothed in wealth, stereotypical beauty and status. Perhaps the attribution of narcissistic pathology to disabled people by Freud, Niederland and others reflects instances in which the psychic load of such projections is too much to hold for members of the disability community, leading to the fear of psychological breakdown. In such circumstances, through having to get by without everyday affirmations of healthy narcissism which I have described, the blanket of ego in the lives of people living with disability can become perforated, leaving gaps and exposures in identity which may have to be filled in defensive ways.

Narcissistic Culture, Grief and Resistance

With Cheng (2000), I argue that the only way in which the ego can be restored for members of oppressed groups is through the inner work of grief. This can allow for a re-narrating of experience and identity, in turn providing new ways of valuing the self in that particular, susceptible psychic location. The question of what the material content of this grief might be—that is, what, exactly, is being grieved—is crucial. I have elsewhere critiqued the stereotyped, oppressive attribution of pre-social, impairment-related grief to disabled people—another manifestation of the medicalising discourse of personal tragedy (Watermeyer 2009; 2014). While grief for the loss of a sense, the ability for movement or any other acquired impairment is not at all discounted, grief felt by disabled people is more likely to be complex and contextual, relating to lives of socially engendered disadvantage, denigration and exclusion (Watermeyer and McKinney 2022). And, as should be clear, mingling with this quandary is a good deal of existential struggle not stemming from the embodied lives of disabled people but instead resulting from the projections and disavowals of dominant groups steeped in narcissistic culture. Importantly though, while grieving is always hard, for members of subordinated groups it may be more so.

Elsewhere (Watermeyer 2017), I have outlined how Ann Anlyn Cheng’s (2000) model of melancholic suspension, which she developed to understand the persistence of race-based inequality in the US, could be applied to the psychosocial predicaments of disabled people. ‘Melancholic suspension’ here can be understood as a kind of emotional stasis, where feelings of grief must be deferred due to social prohibitions, rendering disempowerment and alienation. In the case of both race and disability, we see how the dominant group in society is, unconsciously yet systemically, at pains to silence the emotional lives of those it subordinates. This is for at least two reasons. First, the dominant group would clearly not want exposure to the emotional harms caused by its inhumane actions of materially and psychologically oppressing persons with devalued identities, as this might provoke guilt and insecurity. Second, and perhaps more tellingly, part of what the subordinated carry and are forced to metabolise is not their own suffering, but the projected abjection of the dominant, disavowed through the presence of narcissism, which is so hegemonic as to be invisible. The marginal (in this case, people with disabilities) are thus left ‘holding the baby—a baby replete with the dread and disorganised, unbearable emotional struggles of the human condition, who will never grow up. The existential task set before those carrying this identity is therefore enormous; that is, to hold and withstand the hardest emotional realities of the human condition while simultaneously having one’s experience not only denied but also openly pathologised and demeaned. In this regime, there is no place for compassion.

Returning to the oppressive, pathologising psychoanalytic work on disability I referred to earlier, Jacobson (1959) describes a familiar trope of ableist stereotyping—the idea that people with disabilities may carry a narcissistic investment in being ‘chosen’ to suffer, which is associated with unconscious self-hatred. While Jacobson’s stereotype of some sort of existential persecution complex is a hateful prejudice which is, quite possibly, her own projection, it is nevertheless interestingly resonant with our discussion. In some sense, perhaps there is an unconscious wisdom at work, recognising that in some way disabled people have, in fact, been ‘chosen’ (i.e., recruited) to suffer in the stead of others; in other words, required to publicly carry a mantle of vulnerability and shame which others have the luxury of disavowing.

Disability Stereotyping, Narcissism and Projection

Familiar, denigrating stereotypes of disabled people reflect ideas of frailty, damage and emotional vulnerability, which, as we have seen, are viewed as the ‘natural’ (i.e., ideologically sterile) consequences of impairment. Alternatively, the present discussion paints a picture of a (largely) socially engendered struggle on two fronts—being required to hold and metabolise existential anxieties disavowed by the dominant while, by virtue of society’s organisation, being systemically deprived of the narcissistic supplies to do so. The result is a crucible, a forced and sustained encounter with the otherwise imponderable reality of human vulnerability. As noted, this is hard and comes at great cost, as one withstands and makes sense of being held in the glare of unwanted shame. Several authors identify how difficult mass political mobilisation of the global disability community has proven to be, showing the depth and stubbornness of internalised oppression (Scotch 1988; Watermeyer 2017). What this may reflect is how difficult it is, in the face of the psychosocial predicament sketched above, to find emotional foundations to build a secure sense of self, able to advocate for one’s rights with clarity and authority. As I have noted (Watermeyer 2013), the building blocks of a secure self-identity are experiences of being known, understood and accepted by others, conceptualised in Bion’s (1962) notion of containment. It is such experiences which, by dint of the daily reality of worlds which are not habitable, tend to be more scarcely available in the lives of the global disability community.

However, the predicament of being forced to live close to basic human dilemmas, close to the ground in existential terms, may also present the opportunity, fearsome though it is, to develop firmer, more integrated psychological foundations. The familiar yet troubling stereotype of the disabled seer or saint (Hughes 2019) may be a distorted echo of this reality, gesturing towards how disabled people may perform daily existential work in the stead of others. What this discussion also suggests is how engaging with the life-worlds of people with disabilities brings the potential for emotional integration—in other words, an escape from not only the personal but also the collective denials supported by narcissistic culture. Building on Davis (2002), in the lives of members of the disability community who find the wherewithal to grieve and, to some extent at least, internally transcend the psychic quandary of ableism, there are cultural resources to be found which surpass the brittleness of modern, collective narcissism. Those who have been forced to survive without the distracting addictions of modernity’s trappings and pretences may also find themselves yoked to the project of building ways of being founded on how vulnerability unites, rather than divides us. Where this leads is towards compassion based on human commonality and the recognition that, underneath our narcissistic garb, there is strength to be found in the embracing of shared vulnerability. Along these lines, Wendell (2013) reflects as follows:

‘Not only do physically disabled people have experiences which are not available to the able-bodied, they are in a better position to transcend cultural mythologies about the body, because they cannot do things the able-bodied feel they must do in order to be happy, “normal” and sane…If disabled people were truly heard, an explosion of knowledge of the human body and psyche would take place’. (Wendell 2013, 274)

Conclusion

I began by asking ‘who gets to feel OK’, querying how we might imagine the psychological predicament of living with disability in an ableist world. Since the strategy for managing threats to the security of the self in late modern society leans ever more heavily on chasing bodily perfection and accumulation, the ‘real’ work of processing the realities of this life must be handled elsewhere. In societies designed to invite, deify and drive consumption, the constant message to the ‘chosen people’ is that the world belongs to you, that the shame of human troubles is far away, and only the province of those who have failed at the most important game, the one to do with wealth, status and power. These chosen ones, the society declares both overtly and symbolically, have won the right to ‘feel OK’, but it is a well-being with precarious foundations, based on twin defences of projection and denial (McWilliams 1994). Of course, it is not only disabled people who are positioned as custodians of unwanted aspects of our shared human experience—othering targets subordinated groups of many kinds. Yet disability brings, and hence evokes, something particular to do with the narcissist’s race against time to hang onto a dream of bodily beauty and vigour that will not wane, let alone suffer the ignominies of a return to infantile dependency.

As noted, to live with disability is to wage both internal and external battles. Internally, one may be confronted with the remnants of formative relationships which constructed disability as something which does intrinsic, immutable damage to one’s human value, acceptability and entitlements—an experience which may intermingle with the visceral, daily reminders of the impermanence of the body associated with functional limitation, pain and fatigue. On the external plane, one may be faced with harmful, emotionally corrosive experiences of mirroring (material, cultural, relational), combining into a stream of projections able to enliven one’s most malignant, mutinous parts of self. The grinding work of trying to ‘feel OK’, which challenges us all daily, is compounded for disabled people for all of these reasons. Yet, being positioned outside of the narcissistic emotional indulgences of modern society offers the possibility—albeit a colossally challenging one—for integration of splits which have become cemented into social organisation, with the potential for both personal and collective benefits. Disability offers an urgently needed, humbling corrective to the hubris of late modernity.

None of this is to say that the lives of disabled people are confined to endless existential trials devoid of the possibility of freedom. Around the world, disability culture is also replete with creativity, verve and subversion, displaying flashes of what might be possible in a human world which recognises that we all arrive and leave the same way, naked. The simple truth that inside bodies of endless diversity in shape and functioning dwell human selves no different to any other, at once obvious and unthinkable, can help to create societies in which everyone, at least some of the time, gets to feel OK.

In closing, I reflect on how the ideas described in this paper may suggest new directions in critical disability studies. Amid the growth of theorising on psycho-emotional aspects of life with disability in an ableist society, there remains relatively little conceptual knowledge which directly addresses the emotional economy and inner reality of inhabiting a world which continually attacks emotional well-being. The notion of ableism is especially useful here, as it relates not only to the lives of disabled people but also to an ideological substrate that imposes emotional harms upon all that it touches, with particularly violent implications for the disability community. As an example of the small but growing store of psychoanalytic ideas on disability oppression, the concepts outlined in this paper seek to describe currents created in the psychic worlds of disabled people confronted with ableism, rather than speaking simply in more general and contextual terms. Returning to Nancy Mairs, I believe that her conception of a habitable world implies not only that it ‘wants me in it’ but also that it is interested in what things are like for me. This question of ‘what it is like’ to live with racism, sexism, religious or cultural bigotry should be one which compels us; the reality of how seldom it is asked is a reflection of the stubborn silences which still prevail around socially engendered suffering. It is a deceptively simple question with complex and far-reaching answers. As a qualitative researcher in disability studies, it has often been observed to me by a disabled interviewee that ‘no one, even in my own family, has ever asked me what it is like, how it feels’. To some this may seem whimsical. But for members of an oppressed minority, as, indeed, for anyone, it is hard to see how anything could be more important.