Of all the astonishing features of the medieval cathedrals, one feature must stand out as particularly surprising to the modern mind: We have no idea who designed and built them. In a fashion quite foreign to contemporary practice, the architects and builders did not bother to sign their names on the cornerstones. The anonymity of the great souls responsible surely seems strange to our age. Why build the cathedral of Notre-Dame de Chartres if you can’t take credit for it? No lasting fame? No immortalized human glory? We are, if not scandalized, at the very least perplexed by the humility of these forgotten artists who labored in obscurity. Do and disappear? This is not how we roll in the America of the twenty-first century.

The artistic and cultural norm of the anonymous artist or craftsman began to change during the so-called Enlightenment. Witness Jean-Jacques Rousseau’s Confessions , a book he dedicated “to me, with the admiration I owe myself.” The book opens with these lines: “I have entered upon a performance which is without example, whose accomplishment will have no imitator. I mean to present my fellow-mortals with a man in all the integrity of nature; and this man shall be myself.” Rousseau deliberately chose his title as a response to Augustine’s work by the same name. In contrast to Rousseau’s vain self-aggrandizement, Augustine gives all glory to God, as in his opening quotation from the Book of Psalms: “Great thou art, and greatly to be praised.” One has to add, however, that even if we admire Augustine’s humility, Rousseau’s language strikes us as more familiar. “To me, with the admiration I owe myself” is a dedication that would look right at home today on a Facebook or MySpace page.

In the eighteenth century, Rousseau’s narcissism, although fashionable among the philosophes, was still something of an anomaly in the wider culture. Indeed, if you believe the statistics in the book under review, such self-conscious narcissism remained an anomaly until roughly forty years ago. Not so today, argue authors Jean Twenge and Keith Campbell. The Narcissism Epidemic opens with this claim: “We didn’t have to look very hard to find it. It was everywhere.” Indeed. As the reader sifts through the evidence the authors have gathered, it becomes apparent that this is a book that could have written itself. And yet this is the first popular book on the topic since Christopher Lasch’s 1979 bestseller, The Culture of Narcissism (a book still very much worth reading, in spite of its somewhat anachronistic theoretical framework, which draws heavily on Freudian psychoanalysis). We should be grateful to Twenge and Campbell for bringing us up to date, carefully collecting and collating the evidence at hand.

The authors, psychologists by training, employ clinical language throughout. In the book’s four sections, the phenomenon of narcissism is understood in terms of “diagnosis,” “causes of the epidemic,” “symptoms,” and “prognosis and treatment.” But what is dealt with here is, in fact, more a cultural phenomenon than a clinical one. The book could be classified as sociology rather than as clinical psychology or medicine. One wonders whether the authors’ use of language derived from a medical model is the wrong approach to the sort of narcissism they describe. The individuals profiled in the book are not the wounded souls who typically visit a psychiatrist’s office in search of succor and healing. They are, instead, the student denizens of UCLA and Texas Tech and the parents who formed them”individuals supposedly healthy and well adjusted, even flourishing, by contemporary standards. And yet, when one looks beneath the surface, these are sick souls. Medicine, then, is perhaps the apt descriptive metaphor. (“Narcissism is a psychocultural affliction rather than a physical disease,” as the authors put it.)

Twenge and Campbell cite empirical research throughout the text, and the evidence is so ubiquitous that it sometimes borders on the tedious. These are psychologists, after all, but an editor might have trimmed the endless numbers, graphs, and repetitious anecdotal evidence that inflate their book’s middle chapters. The anecdotes sometimes amuse, shock, or disgust, but they also tend to wear thin after a while. These quibbles are minor, however; this is a book that needs to be read.

The research that undergirds the book’s central thesis consists of survey data from 37,000 college students. In this sample population, narcissistic personality traits rose dramatically from the 1980s to the present, and the shift was especially pronounced in women. The rise in narcissistic traits has accelerated with each decade since the data began to be collected. The authors assemble evidence to show that these trends are generalizable to other age groups, not simply confined to the sample’s college students. The symptoms of narcissism are vanity; materialism; an inflated sense of one’s own specialness or importance; antisocial behavior; little interest in emotionally close or unselfish relationships, along with a lack of empathy; exaggerated overconfidence; and a strong sense of entitlement. Sound like anyone you know?

Twenge and Campbell correctly lay much of the blame for the epidemic at the feet of the self-esteem movement, which has been enormously influential, not only in the spheres of popular psychology and education, but also as a central tenet of the “gospel of success” message heard in many evangelical megachurches. Indeed, the obsession with self-esteem has crept even into Catholic catechesis. This Trojan horse, the authors argue, has led not to health but to rampant self-centeredness. “Narcissism causes almost all of the things that Americans hoped high self-esteem would prevent, including aggression, materialism, lack of caring for others, and shallow values,” they write. “In trying to build a society that celebrates high self-esteem, self-expression, and ‘loving yourself,’ Americans have inadvertently created more narcissists”and a culture that brings out the narcissistic behavior in all of us.” The self-esteem fad apparently has backfired, but the folks at your local public or parochial grade school don’t seem to have noticed.

In an early chapter, Twenge and Campbell use recent psychological research to deflate five common myths about narcissism. These myths are as follows: that narcissism is “really high” self-esteem; that underneath the facade, narcissists are insecure; that narcissists really are better looking or smarter; that some degree of narcissism is healthy; and that narcissism is nothing more than a bit of physical vanity. All rubbish, says the research. As for the first claim, “narcissists think they are smarter, better looking, and more important than others, but not necessarily more moral, more caring, or more compassionate.” As for the second (that narcissism is a defense against unconscious insecurity), “it turns out that deep down inside, narcissists think they’re awesome .” (This is one area in which the cultural narcissists studied in this book may differ from people with some forms of clinical narcissistic personality disorder. The personality disorder is typically characterized by extreme anger that masks grief of deep emotional wounds and self-doubt. Perhaps further research on severe cases will reveal important differences between the cultural narcissist and the clinical narcissist.)

As for the claim that some narcissism is healthy in a competitive society, the authors argue that “it would be better for everyone not to concentrate on self-feelings”positive or negative”quite so much.” The book’s language here runs against the grain of much conventional wisdom in modern psychology. The authors put the case this way: “Think about the deepest joy you experience in life”it doesn’t typically come from thinking about how great you are. Instead, it comes from connecting with the world and getting away from yourself, as when you enjoy time with friends, family, and children, are engaged at work, or do all-absorbing tasks such as art, writing, crafts, athletics, or helping others.” Twenge and Campbell are drawing here on research from the so-called positive psychology movement, which recently has attempted to shift the focus of psychological research away from disease and disorder to a study of the character strengths that make for happiness and human flourishing. In the process, this research program seems to have rediscovered the list of classical (and even Christian) virtues. Yes, forgetting about myself and giving myself generously to others is a prescription for happiness.

The final misconception, that narcissism is just another word for vanity, is incomplete: “Narcissists are also materialistic, entitled, aggressive when insulted, and uninterested in emotional closeness.” A psychiatric study found that the biggest consequence of narcissism was suffering endured by people close to the narcissist.

The narcissism epidemic is the common denominator underneath many contemporary trends”from grade inflation, to the crass and aggressive tone of so much entertainment, to birthday gifts for high school girls that stupefy the imagination. A friend who teaches at a Catholic high school in Orange County, California, confirmed Twenge and Campbell’s claim that breast augmentation surgery has become a common graduation gift from parents to their teenage daughters.

The Narcissism Epidemic traces the root causes of narcissism to the triumph of the therapeutic mentality, beginning in the 1970s; to changes in parenting styles (parents wanting their kids’ approval rather than children striving for parental approval); to celebrities who are “famous for being famous” and the media that transmit their endless, self-absorbed chatter; to the MySpace/Facebook/YouTube phenomenon (dubbed Web 2.0); and to easy consumer credit (which recently came crashing down). One could add to the authors’ list, the capitulation of schools, churches, and other mediating institutions of society to these trends and fads.

“Vanity of vanities, all is vanity,” saith the preacher. “Hell, yeah, I’m hot!” saith the Facebook home page. This is vanity on steroids, and it is becoming the norm. From whence will we find the cure for this disease? As the authors argue, we need to implement reforms in parenting styles, the media, education, economic policy, and the tone of political and social life. No one who reads this book can reasonably disagree with these prescriptions. But we need more. The virtue of humility is the real antidote, and Twenge and Campbell endorse this. But even among the noblest pagans such as Aristotle, humility was not included among the list of virtues. Humility is a distinctively Christian virtue, grounded in the doctrine of Christ’s kenosis. It is not triumphalism, but simply a fact of history: Christianity was the leaven that shaped a more humble and humane culture; gave rise to America’s founding values; and, ultimately, prevented us from worshipping ourselves. The cure? Either we will become the salt and light that purge and dispel the insipid narcissism that surrounds us, or our culture will continue to descend deeper into the loud, crass, and aggressive cult of self-worship.

Aaron Kheriaty, M.D., is director of residency training and medical education and founding director of the Psychiatry and Spirituality Forum at the department of psychiatry at the University of California, Irvine.

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