Craig, A. (2009) | References | Narcissus and the Child

What This Research Found

A. D. Craig's influential 2009 review synthesised decades of research to reveal how the anterior insula creates our moment-to-moment sense of being a feeling, embodied self. Published in Nature Reviews Neuroscience and cited over 6,000 times, it has become foundational for understanding the neural basis of emotion, self-awareness, and empathy.

The anterior insula as the body's translator. Craig demonstrated that this brain region, buried deep within the lateral sulcus, serves as the cortical integration centre for interoception—awareness of signals arising from within the body. Heartbeat, breathing, gut sensations, muscle tension, temperature, and pain all converge here. The posterior (rear) insula receives these raw physiological signals, and the anterior (front) insula weaves them into coherent feeling states. Racing heart plus tight chest plus shallow breath becomes "anxiety." Heavy limbs plus slow thoughts plus chest ache becomes "sadness." Without this translation, we would have bodily sensations without feelings.

The emergence of "the material me." Craig proposed that the anterior insula generates what he calls "the material me"—the subjective sense of a physical self that feels emotion in real time. This is not abstract self-concept but embodied self-awareness: the feeling of being a body, having sensations, experiencing emotions moment by moment. The anterior insula creates a neural representation of the body's physiological state at each instant, providing the foundation for subjective awareness. When someone asks "How do you feel—now?" the answer depends entirely on this structure.

The architecture of empathic feeling. The research reveals why the anterior insula is essential for emotional empathy. When you see someone in pain, your anterior insula activates as if you were experiencing that pain yourself—a process called embodied simulation. The structure contains Von Economo neurons (VENs), rare spindle-shaped cells found only in highly social species (humans, great apes, whales, dolphins, elephants). These cells enable rapid integration of social and emotional information, creating the gut feelings that guide compassionate response before conscious deliberation occurs.

The critical insight for understanding pathological empathy. Craig's framework explains why interoceptive deficits produce empathy deficits. To feel what another person feels, your brain must simulate their state in your own body-sensing regions. If the anterior insula cannot translate your own body signals into felt emotions, it certainly cannot translate simulated signals from observing others. This explains the dissociation between cognitive empathy (understanding that someone is suffering) and emotional empathy (feeling their suffering) that characterises narcissistic personality disorder and related conditions.

Why This Matters for Survivors

If you've experienced narcissistic abuse, Craig's research helps explain two phenomena that may have confused or distressed you: why your abuser seemed incapable of feeling your pain, and why you may now struggle to feel your own.

Your abuser's empathy void has a neurobiological explanation. When you cried, raged, or pleaded—when you showed them your suffering in ways that would move any normal person—and they remained unmoved, it wasn't that they chose not to care. The brain structure that would create the visceral experience of your distress in them was not functioning normally. Research on narcissistic individuals shows reduced grey matter volume and blunted activation in the anterior insula during empathy tasks. They could see you were upset. They could understand intellectually why. But the translation from observation to feeling never occurred. The information arrived ("she is crying") but the embodied response failed ("I feel her sadness"). This doesn't excuse their behaviour, but it explains why your attempts to make them understand were doomed to fail.

Your own emotional numbness may be protective adaptation, not damage. If you find yourself struggling to name your emotions, experiencing feelings as physical symptoms rather than emotional states, or feeling disconnected from your own inner experience, you may have developed alexithymia—difficulty identifying and describing emotions. Craig's research explains this: the interoceptive pathway requires practice and safety to develop and maintain. When your emotional states were chronically invalidated, punished, or weaponised against you, attending to body sensations and translating them into feelings became dangerous. Your brain learned to suppress this translation. This was survival. The pathway can be rebuilt, but it requires safety, support, and patient attention to the body.

The body holds what the mind blocks. Survivors often experience unexplained physical symptoms—headaches, digestive issues, chronic tension, fatigue—that seem disconnected from any identifiable emotion. Craig's framework explains this: when the anterior insula stops translating body signals into feelings, the physical arousal continues without the emotional overlay. Your body keeps generating stress responses, but you don't experience them as named emotions. The sensations become somatised—experienced as purely physical rather than emotional. Understanding this can reduce self-blame: you're not making up these symptoms, and you're not failing to "get over it." Your body is expressing what your brain learned not to feel.

Healing involves rebuilding the body-mind connection. The good news is that interoceptive capacity can be restored. Practices that direct attention to internal body states—somatic experiencing, mindfulness, yoga, breathwork—specifically target the pathway Craig describes. As you gradually rebuild awareness of body sensations and their emotional meanings, the translation process resumes. Initially, this may feel overwhelming as previously blocked feelings become accessible. But this is the path back to full emotional awareness—to knowing not just what you think, but what you feel.

Clinical Implications

For psychiatrists, psychologists, and trauma-informed therapists, Craig's interoception framework has direct implications for assessment and treatment of both perpetrators and survivors of narcissistic abuse.

Assess interoceptive capacity directly. Traditional psychiatric assessment focuses on named emotions and cognitive content, assuming patients can identify their feeling states. Craig's research suggests this assumption may be invalid for many patients, including those with personality disorders, dissociative symptoms, or complex trauma. Consider using validated interoceptive measures such as the Multidimensional Assessment of Interoceptive Awareness (MAIA). Recognise that patients with poor interoception may struggle to answer "How does that make you feel?" not from resistance but from genuine inability. Their body is speaking a language their mind has forgotten.

Reframe alexithymia as interoceptive disconnection. When patients describe emotions in purely physical terms ("my chest is tight" rather than "I'm anxious"), recognise this as a predictable consequence of anterior insula dysfunction. Rather than interpreting this as avoidance or low emotional intelligence, understand it as a translation failure that requires specific intervention. The treatment goal is not to bypass the body but to rebuild the body-mind connection that trauma disrupted.

Incorporate body-based interventions for trauma survivors. Craig's framework supports the growing evidence for somatic approaches to trauma treatment. If the anterior insula translates body sensations into feelings, and if trauma disrupts this translation, then treatment must address the interoceptive pathway directly. Somatic Experiencing, sensorimotor psychotherapy, trauma-sensitive yoga, and mindfulness practices that direct attention to internal states are not merely adjunctive—they may be prerequisite to accessing emotional content. Patients cannot process emotions they cannot feel.

Expect increased emotional intensity during recovery. As interoceptive capacity improves, previously blocked emotions may surface with unexpected force. Prepare patients for this: healing doesn't mean emotions stay manageable. It often means feeling them fully for the first time. Build window-of-tolerance work into treatment so patients can expand their capacity to contain the feelings that emerge as the translation process resumes.

Consider interoceptive foundations for treating narcissistic patients. For the rare narcissistic patient who genuinely seeks change, Craig's research suggests that developing emotional empathy may require first developing emotional self-awareness. They cannot feel what others feel if they cannot feel their own internal states. Interventions that improve interoception—mindfulness, body awareness practices, even compassion-focused imagery—may be prerequisite to empathy development. However, clinicians should maintain realistic expectations: narcissistic patients frequently abandon treatment when these approaches generate uncomfortable self-awareness.

Broader Implications

Craig's research on interoception and the anterior insula extends far beyond the therapy room. Understanding how the brain creates embodied emotional awareness illuminates patterns across families, institutions, and societies.

The Intergenerational Transmission of Emotional Disconnection

The capacity for interoception develops through early relational experience. Infants learn to recognise and name their internal states through thousands of interactions in which caregivers attune to their body-based signals and reflect them back: "You're tired," "You're hungry," "You're upset." When caregivers lack this capacity themselves—perhaps because their own anterior insula function is compromised—they cannot teach what they do not possess. The child of a narcissistic parent may never develop robust interoceptive awareness because no one ever translated their body signals into named feelings. They grow up to become parents who cannot attune to their own children's internal states, propagating intergenerational trauma through impaired interoceptive development.

The Dissociation Epidemic

Craig's framework helps explain the prevalence of dissociation in trauma survivors. Dissociation—feeling disconnected from one's body, emotions, or sense of self—represents a shutdown of the interoceptive pathway. When body awareness becomes associated with danger (because bodily sensations signalled abuse was coming, or because attending to internal states made the unbearable conscious), the brain learns to suppress interoceptive input. The anterior insula stops translating. The dissociated person exists, but doesn't fully feel that they exist. Treatment approaches that work "bottom-up"—from body sensation to feeling to meaning—may be more effective than purely cognitive approaches for this population.

Institutional Settings and Emotional Awareness

Schools, hospitals, prisons, and workplaces often operate in ways that suppress interoceptive awareness. Children are told to sit still and ignore body signals. Patients' subjective experiences of illness are subordinated to objective measures. Workers are expected to perform regardless of internal state. Craig's research suggests this carries costs: interoceptive suppression impairs emotion regulation, empathy, and decision-making. Institutions that want emotionally intelligent members might consider practices that support rather than suppress body awareness.

Digital Technology and Interoceptive Development

Craig's research has concerning implications for a generation raised on screens. Interoceptive capacity develops through embodied experience—attending to the body's signals in real time. Digital interactions are disembodied by nature; they engage visual and auditory processing but not the internal body sensing that underlies emotional awareness. Mounting evidence suggests heavy digital media use during development correlates with reduced anterior insula grey matter—the same pattern seen in narcissistic personality disorder. We may be inadvertently producing a population with impaired interoception and, consequently, impaired emotional empathy.

Legal and Forensic Considerations

When interoceptive deficits are implicated in empathy failure, legal questions arise. Can someone who cannot feel others' suffering be held fully responsible for causing it? Craig's research doesn't provide simple answers, but it complicates assumptions about mens rea and moral culpability. At the same time, preserved cognitive empathy in narcissistic individuals suggests they retain the capacity to know they're causing harm even if they don't feel it—which may be sufficient for legal responsibility. The research informs but doesn't determine these judgments.

Public Health and Prevention

If interoceptive capacity develops through early relational experience, then supporting attentive caregiving becomes a public health priority. Programmes that help parents attune to infants' internal states, recognise and name children's emotions, and respond sensitively to body-based cues may prevent the interoceptive deficits that underlie later psychopathology. Investment in early childhood intervention may be investment in the neural substrate of emotional awareness itself.

Limitations and Considerations

No research is without limitations, and responsible engagement with Craig's paper requires acknowledging several:

Integration rather than empirical study. This paper is a theoretical review synthesising existing evidence rather than reporting new empirical findings. While Craig marshals impressive support for his framework, alternative interpretations of the same data are possible. The "material me" concept, while compelling, remains a theoretical construct rather than a directly observed entity.

Individual variation in anterior insula function. Not everyone with reduced anterior insula volume or activity develops empathy deficits or personality pathology. Considerable individual variation exists, and the brain contains redundant systems. Craig's framework identifies an important component but not the complete picture.

Correlation versus causation. Much of the research Craig cites is correlational. When narcissistic individuals show reduced anterior insula activity during empathy tasks, we cannot determine whether this reflects a cause of narcissism, a consequence of it, or a shared underlying factor. Developmental and longitudinal studies are needed to establish causal relationships.

Treatment implications remain speculative. While Craig's framework suggests that interoception-focused interventions might help, rigorous clinical trials specifically testing this hypothesis are limited. The translation from neurobiological theory to clinical practice involves assumptions that require empirical validation.

How This Research Is Used in the Book

Craig's work on the anterior insula appears throughout Narcissus and the Child as foundational neuroscience for understanding both narcissistic empathy deficits and survivor symptomatology. In Chapter 7: Inside the Brain, the research explains how the "Translator" creates emotional awareness:

"The anterior insula generates what the neuroscientist A. D. Craig calls 'the material me'—that subjective sense of a physical self that feels emotion in real time. This translation occurs through accessing our 'inner space' (interoception): the awareness of signals arising from within the body itself."

The book uses Craig's framework to explain why narcissists can witness suffering without being moved—the translation from observation to feeling never occurs—and why survivors often develop alexithymia as a protective adaptation to chronic invalidation.

In Chapter 9: Brain Chemistry of Misery, Craig's research situates the anterior insula within the brain's salience network:

"A key part of the Gatekeeper is the brain's feeling centre, the anterior insula, which creates our moment-to-moment sense of empathy, bodily self, and emotional awareness. This region shows reduced volume in NPD. When this region is compromised, narcissistic individuals often experience alexithymia—Greek for 'no words for emotions'—and struggle to identify their own feelings."

This explains the paradox of narcissistic emotional life: intense reactions without the ability to name or regulate the underlying feelings.

Historical Context

The anterior insula was identified as an anatomical structure in the 19th century, but its functions remained mysterious for over a hundred years. Early lesion studies suggested involvement in disgust and visceral sensation, but no unified theory emerged. The advent of functional neuroimaging in the 1990s revealed the insula activating across an impossibly diverse range of tasks—emotion, cognition, social interaction, pain, decision-making—creating more confusion than clarity.

Craig's 2009 review provided the synthesis the field needed. By proposing that the anterior insula's fundamental function is creating a neural representation of the body's internal state at each moment, he unified the disparate findings: all of those seemingly different tasks involve interoceptive processing as a foundation for subjective experience. The "material me" concept offered a neurobiological account of how physical embodiment generates felt awareness.

The paper has been cited over 6,000 times and continues to shape research into consciousness, emotion, and disorders characterised by disrupted self-awareness. Craig's interoception framework has influenced clinical approaches to trauma, eating disorders, anxiety, depression, and personality disorders. His work forms part of the growing "embodied cognition" paradigm that locates the mind in the body rather than solely in the brain.

How do you feel—now? The anterior insula and human awareness

APA Citation