In this second part of my conversation with Mark Ruffalo, we move into the deeper internal structure of narcissistic personality—specifically the role of grandiose fantasy and why it is not just an accessory to narcissism, but something that can organize and sustain the self from within. We explore what these fantasies are actually doing psychologically, what kinds of emotional states they protect the person from, and what tends to emerge when that internal structure starts to break down. The conversation opens into the clinical tension between grandiosity and reality testing, including how narcissistic “deflation” can be misread as depression, and why that distinction matters. Finally, we talk about treatment and contrast Kernberg and Kohut—not as abstract theory, but as fundamentally different ways of entering into and working within this fragile internal world.

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Dr. Anthony Mazzella is a psychoanalyst and psychodynamic psychotherapist specializing in narcissism, personality disorders, and relational dynamics.