Narcissistic Personality DisorderConfer Psychopathology Course 16.1.20

Phil Mollon PhD

Psychoanalyst and Energy Psychotherapist

Themes

• Freud 1914 first noted the role of narcissism in human development

• Narcissism is associated with healthy self-esteem, but also with a hatred and rejection of reality, grandiosity, aggression and ‘death instinct’

• Unmodified narcissism is a source of shame and anxiety

• The narcissistic vs reality positions

• In the 1970s, Kohut and Kernberg each drew attention to contrasting aspects of narcissism

• Kohut postulated separate lines of development of narcissism – from more primitive to more mature

• Pathological narcissism can be very damaging to others – we are narcissistically wounded by the narcissism of other people

• Being trapped in the distorting mirror of the mother’s narcissism, whilst the paternal dimension is excluded, is a common constellation

• Parental narcissism fosters the development of false self

• Working constructively with narcissism and narcissistic vulnerability requires empathy, tact, and truth

DSM-5 criteria (summary) for

NPD

• Grandiosity with expectations of superior treatment from other people

• Continually demeaning, bullying and belittling others

• Exploiting others to achieve personal gain

• Lack of empathy for the negative impact they have on the feelings, wishes, and needs of other people

• Fixation on fantasies of power, success, intelligence, attractiveness, etc.

• Self-perception of being unique, superior, and associated with high-status people and institutions

• Need for continual admiration from others

• Sense of entitlement to special treatment and to obedience from others

• Intense envy of others, and the belief that others are equally envious of them

The two sides of narcissistic

disturbance

• A. Overt grandiosity and exhibitionist display –attitudes of superiority [Kernberg, and most writers on narcissism]

• B. Narcissistic vulnerability and a fragile sense of self [Kohut]

• But A may contain hidden elements of B

A narcissistic injury

• I had trained in clinical psychology – then in psychotherapy at the Tavistock Clinic – and had embarked on training in psychoanalysis –and had worked in a high status NHS role as psychotherapy supervisor

• I took a job in a general psychiatric service in Stevenage – and was asked to work with several patients who presented with recurrent long-term psychiatric problems.

• Many appeared to have suffered severe and repeated childhood trauma and abuse.

• I found that talking therapy was literally ‘worse than useless’ – made people worse! My psychoanalytic understanding of trauma was very limited

• This led to a continuing search for better ways of helping people

Thought processes of

the narcissist

• A key feature of the thought processes of the narcissistic person. Assertions and conclusions are made not on the basis of reality but on what serves either the person’s desires or their self-image

• In the narcissistic state of mind, perceptual and cognitive processes are distorted, through selective attention and inattention and slippage of logic, such that reality is subordinated to the privileged task of preserving a grandiose self-image.

A pervasive delusion!

• “this narcissism … is a psychotic trait so pervasive in our species that to possess it is commonly considered to be not merely ‘normal’ but essential to health … something the human race as a whole seems unable fully to outgrow”

• (Roger Money-Kyrle, 1963, p 376-377)

Coercing others to

buttress the grandiose self

• The aggressive Type A narcissist may coerce others to support the pathological grandiose self – and to function as a container of the disavowed ‘defective’ self-image

• This is a malign variant of the Kohut selfobject function

• It is found in processes of ‘coercive control’

Depression as a narcissistic disturbanceSandor Rado 1928 – ‘The problem of melancholia’• International Journal of Psycho-Analysis, 9: 420-438

• “intensely strong craving for narcissistic gratification” and “narcissistic intolerance”

• The melancholic has remained greatly dependent for self-esteem on external “narcissistic supplies”

• “most happy when living in an atmosphere permeated with libido”

• But once the melancholic has won a love-object, he/she treats them as a possession, domineeringly and autocratically

• Reacts to withdrawal of love with hostile bitterness – the rebellion

• If the rebellion fails, the depressive reacts with remorse and begs for forgiveness – “a great despairing cry for love”

• But the drama has moved to the inner psychic plane, where the struggle is with the superego

• The bad object is split off and incorporated into the ego/self representation – where it is then sadistically punished by the superego

• Eventually, the ego “now breathes a sigh of relief and with every sign of blissful transport unites itself with the ‘good object’ which has been raised to the position of the superego” –may result in mania

Type B: Disturbances in the sense of self

• Shame-prone clients

• Proneness to embarrassed self-consciousness

• Uncertain sense of self

• ‘False self’

• ‘as if’ personality

Taxonomy of disturbances of self

• Differentiation (of self and other)

• Subjective self (sense of agency)

• Objective self (pathology of self-esteem)

• Structure (sense of coherence/cohesion)

• Balance between objective and subjective self (false self)

• Illusions of self-sufficiency

• Sense of lineage

Heinz Kohut: Narcissistic

disturbances

• “The disturbances of narcissistic balance to which we refer as ‘narcissistic injury’ appear to offer a particularly promising access to the problems of narcissism, not only because of the frequency with which they occur in a broad spectrum of normal and abnormal psychological states, but also because they are usually easily recognised by the painful affect of embarrassment or shame that accompanies them and by their ideational elaboration –known as inferiority feelings or hurt pride.” [Kohut, 1966. Forms and transformations of narcissism]

Two dreams illustrating the

narcissistic transference

• The patient is in a rocket, circling the globe, faraway from the earth. He is nevertheless protected from an uncontrolled shooting off into space (psychosis) by the invisible pull of the earth

• The patient is on a swing, forward and backward, higher and higher – yet there is never a danger of the patient flying off.

[Both illustrate the selfobject transference protection against uncontrolled grandiose exhibitionist excitement]

Symptoms of Disintegration Anxiety

Kohut wrote of disintegration anxiety – “the deepest anxiety man

can experience”.

The nuclear psychopathology of these individuals concerns the self. Being threatened in the maintenance of a cohesive self because in early life they were lacking in adequate confirming responses (‘mirroring’) from the environment, they turned to self-stimulation in order to retain the precarious cohesion of their experiencing and acting self. The oedipal phase, including its conflicts and anxieties, became, paradoxically, a remedial stimulant, its very intensity being used by the psyche to counteract the tendency toward the break-up of the self – just as a small child may attempt to use self-inflicted pain (head banging, for example) in order to retain a sense of aliveness and cohesion.” [1972 Thoughts on narcissism and narcissistic rage. Search for the Self, Vol 2. pp 626-627].

Disintegration AnxietyDisintegration anxiety is difficult to articulate and communicate,

compared with other more specific anxieties (such as the series

Freud described: loss of the object, loss of love, castration).

Kohut (1977) wrote:

“… the expression of the ill-defined yet intense and pervasive anxiety that accompanies a patient’s dawning awareness that his self is disintegrating (severe fragmentation, serious loss of initiative, profound drop in self-esteem, sense of utter meaninglessness) … may initially veiled; the analysand may attempt to express his awareness of the frightening alterations in the state of his self through the medium of verbalisations about circumscribed fears – and it is only gradually and against resistances that his associations will begin to communicate the central content of his anxiety, which, indeed, he can only describe with the aid of analogies and metaphors.” [p.103].

The dream of the disintegrating ship- a self-state dream (Kohut 1993)

• In the context of discussion of termination, a patient had a dream

• There was a ship – at sea – although the hull appeared held together, it was in great danger because all the nuts and bolts had gone – the ship might fall apart

• The dream expressed, in a visual metaphor, the state of the self

• The analyst interpreted that the dream represented the patient’s anxiety about the end of the analysis, when the safe shore of the treatment setting was no longer there

• Kohut argued that (although broadly correct) the dream was not actually portraying the loss of the supportive figure of the analyst or of the setting – it was focused on the fear of the fragmentation of the self

Disintegration anxiety – Mr U

• Mr U’s dream – an ice tunnel – a ‘stainless steel world” – intense anxiety

• The horror of the loss of the selfobject “without which the self cannot continue to exist”.

• Not fear of loss of love, or even of hatred

• “What leads to the human self’s destruction …is its exposure to the coldness, the indifference of the nonhuman, the nonempathically responding world” [How does analysis cure? 17-18]

How to create narcissistic disturbanceFour methods

• First method• Ignore or actively shame a child’s authentic initiatives. Do not mirror and display empathy for the

child’s ‘true self’ and his/her development as their own ‘centre of initiative’• Make love highly conditional• Reward behaviour that supports the mother’s image of the child she wants• Discourage contact with the father, thus keeping the child trapped in the dyad

• Second method• Encourage (or fail to engage in optimal discouragement) the child’s grandiosity, egocentricity, and

sense of entitlement – of being special. Parental narcissism extends to a view that their child must be subject to no limits

• Combine this with a lack of development-nurturing ‘tough love’

• Third method• Subject the child to rejection and abuse – creating a sense of grievance and entitlement to

recompense for past wrongs• The child has some area of talent around which the pathological grandiose self can form – e.g.

physical strength/capacity for violence; good looks and charm; high intelligence

• Fourth method• Produce a child with a temperament that impedes resolution of narcissism – such as ADHD

The core of narcissistic vulnerability

• Sensitivity to rejection, insults, slights

• Some will remain sensitive and ‘thin skinned’ – will be shy and withdrawn, fearful of social contact, fearful of shame

• Others will develop a pathological ‘false self’ – a (Kernbergian) ‘grandiose self’ – a pathological fusion of self, ideal self, and ideal object – a ‘thick skin’

• This false self protects the vulnerable core

Sexual fantasies organised around narcissistic injuries

• Sexual fantasies may be “sexualised statements about narcissistic disturbance” [Kohut 1971]

• They are analogous to the theoretical formulations of the analyst, except that they are in opposition to insight, being created in the service of pleasure and relief from narcissistic tensions

• Robert Stoller 1976: ‘Perversion: The Erotic form of Hatred’ – the sexual fantasy attempts to bind and deny the core injury to the self

The experience of efficacy –the foundation of the sense of self

• ‘I have an effect, therefore I am’

• The power to have an effect, on the material or social world

• The capacity to evoke an empathic response in the mind of the other (originally the mother)

• Dread of utter helplessness

• Shame as a result of failure of efficacy

Pathological attempts to createthe sense of efficacy

• Psychopathic and narcissistic personality disorders, whereby the pathological person continually manipulates and inflicts emotional wounds on others

• Pathological liars, who play with truth and reality

• All forms of emotional manipulation of others

• Mass shootings and other forms of mass murder

• Abuse and pathological control of children

• Sado-masochistic sexual play with power and efficacy (if not consensual and playful)

• All forms of self-harm, where the body is taken as the object to be abused or caused pain

• Adolescent acts of delinquency

• Warfare, revolution, crowd violence

• Becoming or supporting a dictator

• Surrender to a powerful group or movement

The repetition compulsion – turning passive into active• Freud 1920 Beyond the Pleasure Principle

• Anna Freud 1936: Identification with the aggressor

• George Klein 1976:Turning passive into active

• We do to ourselves, and to others, what we originally suffered passively – a key principle in personality development and behaviour

The ‘totalitarian ego’

• Greenwald 1980: The totalitarian ego: fabrication and revision of personal history. American Psychology 35, 603-608

• The totalitarian ego will distort, selectively attend, selectively remember, and rewrite history, in order to support assumptions, beliefs, self-image and self-esteem – and will then believe it

• We all do this – so some extent. We are all mad!

Shame – the core dread in narcissistic disturbance - is about feeling inadequate as a human being

• Feeling weak and pathetic and worthless

• And having these qualities exposed

• Social identity torn away

• Physically or psychologically naked

Thanatogenic experience

• Eros – reaching out to make contact and connection – is met with:

• Rebuff

• Hostility

• Indifference

• Nothing – No-one is there

• The expansive flow is reversed –becoming an aversion of gaze – a wish not to see and not to be seen – to dis-appear – not to be alive

Reversal of life energy

• The expansive reaching out and connecting to mother …

• Encounters the ‘black hole’ of the ‘reversed breast’ – the terrifying vortex

• Years later … in the psychotherapist’s consulting room, the hidden question: “is it safe to be alive here?”

• Shame is psychological murder!

Shame and the look

It begins with a smile.

The blank face experiments.

Self-consciousness – being an object for the other.

The sudden shift from subject to object.

The visual emphasis in shame – the wish to hide.

Freud 1914: On narcissism

• Narcissism “might claim a place in the regular course of human sexual development” – and, in neurotics “one of the limits to their susceptibility to influence”

• In neurosis (as well as psychosis) there is a partial turning away from reality and external people – and a turning towards the imaginary

• Children, beautiful women, and ‘primitive people’ are viewed as narcissistic

• “it seems very evident that another person’s narcissism has a great attraction for those who have renounced part of their own narcissism and are in search of object love. The charm of a child lies to a great extent in his narcissism, his self-contentment and inaccessibility”

• Parents bestow their relinquished narcissism upon the child, who “shall have a better time than his parents … Illness, death, renunciation of enjoyment, restrictions on his own will, shall not touch him; the laws of nature and of society shall be abrogated in his favour; he shall once more really be the centre and core of creation – ‘His Majesty the Baby’, as we once fancied ourselves” [p 91]

Exposure of our narcissism evokes shame

• To varying extents we all retain vestiges of our infantile narcissism

• If this narcissistic remnants remain unmodified by reality and highly charged, they constitute a severe threat to our mental equilibrium

• Exposure of our narcissism (including to our own awareness) evokes shame

• We feel revealed to be foolish, deluded, and childlike

Gregory Rochlin: Narcissistic injury as the root of aggression [Man’s Aggression:The Defence of the Self. 1973]

• “The rapid development of the sense of the ‘self’ … appears …early in infant life … when our existence is closest to our physiology. … Its intensely egocentric nature … has no given limits. The curbs which a young child experiences give him no sense of security, but, instead tend to heighten his anxiety, cause him to increase his demands, and, in short, to warrant aggression. The sense of the ‘self’ manifest in egocentricity is thus promoted. Its needs will not be denied. … Without animal precedent or prototype of pattern, man’s unique psychological nature is his narcissism. … For relief, called to the service of narcissism, aggression responds. Man’s narcissism, therefore, not his aggression, is the great menace” [82-83]

Rochlin: The tyranny of narcissism

• “Narcissism begins its rule in our earliest period and continues its reign to our end. The tyranny of narcissism is the human condition.” [284]

• A secretly narcissistic patient:

• “I have the idea that if I accommodate to the world, it’s a deficiency in me. Kindness, gratitude, affection are all dangerous … If I liked someone they’d have free access to me. If someone gets pleasure from me, it feels like I have less. I hate to give gifts, I refuse to adapt or to civilise … I want only to watch myself and have no humans about… I should be able to do as I please, and no one to get angry while I do it. All this I have to keep secret. .. I want to be so aggressive. … I lie awake at night and think for hours how to escape the law. It all comes from hating and not giving…. I want to go and defy the laws. The hell with all! “ [232]

Narcissism hates reality

• Reality impinges on the illusory nirvana of experiencing no need, feeling only pleasure, and being the omnipotent centre of one’s world

• Reality is a narcissistic assault – an insult !• The care and empathic ministrations of our parents (or other

caregivers) help to mitigate and titrate this assault, to manageable dosages [Winnicott; Kohut]

• Gradually we relinquish much of our primitive raw narcissism – transforming grandiosity into realistic goals, and inner ideals [Kohut]

• But a residue may always remain – and some of us never fully come to terms with reality

Narcissism hates others – and may hate the despised self

• We hate others, because they impinge on our narcissism

• Our narcissism leads us to hate others who appear different from us – whom we cannot embrace within our narcissism

• We may love family, friends, country, those of our own culture – all these can be embraced by our narcissism, as part of the extended self

• But the despised, needy, imperfect, defective self may be hated

• Destructive strength – and the promise of eliminating the source of narcissistic injury – may be idealised [Hitler, Nazis, and contemporary developments]

Narcissism and the ‘anal’ phase

• The small child discovers it is possible to control bowel movements and body sensations

• This (secret) pleasure in control (of the body and its contents) is extended to pleasure in controlling the world

• In the narcissistic position, other people are treated as analogous to faecal objects to be controlled.

• The sadism of the anal phase is similarly extended to pleasure in controlling, depriving, and lying to others.

The narcissistic pain of other’s narcissism

• Displays of narcissism by others evoke our indignation and rage

• We are narcissistically wounded by the narcissism of others• Deeply narcissistic people may be experienced as repellent,

although they may have superficial charm• Apparent relating may actually be narcissistic use of others• We applaud those who manage to overcome their own

narcissism sufficiently to put others, or society in general, first – the soldier who saves others – the passer-by who takes on a criminal

• No child welcomes rivals for love – so the child part of us feels the world is full of 7.3 billion rivals – i.e. 7.3 billion centres of narcissism!

Introverted and extroverted narcissism

• Introverted narcissists try to avoid the intrusions of the external world by withdrawing and screening out others

• Extroverted narcissists relate to other people as objects to be controlled and manipulated

• Both types are (at times) non-relating

• We are all narcissistic and relating – from the beginning

• We all find other people’s narcissism unpleasant!

• Spot the narcissist – look in the mirror!

The narcissistic vs reality positions(analogous to the paranoid-schizoid and depressive positions)

Narcissistic position• Attempts to preserve grandiose self-

image

• Intolerance of narcissistic pain and shame

• Manic denial of reality that is at odds with grandiose image

• Egocentricity

• Lack of empathy

• Entitlement

• Lies, confabulation and self-delusion

• Manipulative and exploitative stance

Reality principle position• Accepts the impingement of reality upon

the ‘grandiose self’

• Suffers narcissistic injuries – feels the narcissistic pain – accepts shame

• Capacity for empathy – recognises ‘there are others who have the same needs and emotions as me’ – recognises the other as autonomous other

• Appreciates that we have a responsibility to care for others as well as ourselves

• Treat others with respect and truthfulness

• Refrains from deluding self or others

Relationship of the narcissistic and reality positions

• The narcissistic position is primary – Freud’s “His majesty the baby”

• Egocentricity, grandiosity, absence of empathy, disregard of reality, and an imperious attitude towards others are normal features of early childhood

• The shift from the ‘primary process’, pleasure-based, narcissistic position to a relative dominance of the ‘reality principle’ is gradual and uncertain

• Excessive indulgence, deference, and inappropriate praise may entrench a reality-avoidant narcissistic position

• Under stress there is always a potential to slip back into the narcissistic position

• Under extreme conditions, the narcissistic position becomes psychotic.

Otto Kernberg’s (1975) account of the Narcissistic Personality

• “an unusual degree of self-reference in their interactions with other people, a great need to be loved and admired by others, and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others.” [p 227]

• Their emotional life is shallow

• Little empathy for others

• Exploitative or parasitic relationships

• Feel entitled to control or possess others

• Lack of sadness or remorse – more resentment and rage

• The core structure is a pathological fusion of the images of the ideal self, ideal object, and actual self – denial of need and imperfection

Kernberg – fear of dependence

• “The greatest fear of these patients is to be dependent on anyone else, because to depend means to hate, envy, and expose themselves to the danger of being exploited, mistreated, and frustrated” [p 235]

• May idealise the analyst – may have the fantasy they are the analyst’s only patient

• May ‘forget’ the analyst during weekend breaks or holidays

• The idealised analyst is felt to be an extension of the self – or the patient is an extension of the idealised analyst

Kernberg’s view of the aetiology of narcissistic pathology

• Hidden feelings of emptiness, rage, and fears of being attacked –images of “a worthless, poverty-stricken, empty person who feels always left ‘outside’, devoured by envy of those who have food, happiness, and fame” [p 234]

• Chronically cold parental figures, with covert but intense aggression are a frequent feature of the background

• A parental figure, usually the mother, who functions well on the surface but with a degree of callousness, indifference, and nonverbalised spiteful aggression

• The patient possesses some inherent quality that could arouse the envy or admiration of others – physical attractiveness, intelligence, or special talent – a refuge against feelings of being unloved

• Sometimes the mother’s narcissistic use of her child made him/her feel special and triggered the search for compensatory admiration and greatness, and spiteful devaluation of others

Herbert Rosenfeld – on destructive narcissism

• “It is typical of all the phenomena connected with the death instinct that they create something mysterious, hidden, unspeakable, and yet incredibly powerful and dangerous, against which it is impossible to fight …. Eventually what happens is that the murderous force appears in a patient’s dreams. Once exposed, it can be seen that this murderous force is mainly directed against the patient … “ [p 267-8]

• Idealisation of omnipotent destructive parts of the self – who may pose as friends

• Idealisation of death as a solution to all problems

• When the patient makes progress he/she may dream of being attacked by a gang, the Mafia, or adolescent delinquents –intent on retaining the power of the destructive organisation and on keeping the person away from internal or external figures who might help

Herbert Rosenfeld – on ‘thin skinned’ narcissists

• Some narcissistic patients have a ‘thick skin’ – impervious to deeper feelings – need to be treated in analysis very firmly, and to be confronted with their narcissistic attitude and their envy

• By contrast, some are ‘thin skinned’ – hypersensitive – easily hurt

• They have been repeatedly severely traumatised in their feelings of self-regard

• “… one has to be particularly on guard not to add to these traumas by making mistakes in our analytic approach which humiliate such people and put then down. These mistakes are very difficult to remedy afterwards” [p 275]

• “The analysis and the patient may be brought near to collapse … if the destructive aspects of a patient’s behaviour are constantly repeated in the analyst’s interpretations. Such patients can end the analysis very much worse off than before” [p 274]

• Impasse and Interpretation. London. Tavistock. 1987

Patients who fit the Kohut paradigm.

• Narcissistic vulnerability

• Narcissistic rage

• Seeking mirroring

• Idealising

• Twinship

• Respond positively to interpretations informed by the Kohut perspective.

The Analysis of the Self. 1971

• “…the study of certain transference or transference-like phenomena in the psychoanalysis of narcissistic personalities, and of the analyst’s reaction to them”

• Distinguish from psychotic and ‘borderline’ cases

• Can show temporary regressive swings – to hypochondriacal or seemingly psychotic states – precipitated by a narcissistic injury, such as feeling rebuffed by the analyst.

Kohut 1966Forms and transformations of narcissism

• Disagreed that narcissism per se is essentially unhealthy and an interference with love for others.

• Postulated that narcissism (like object love) follows its own line of development

• Lower and higher forms of narcissism

• Therapeutic goal of helping to transform primitive forms of narcissism to higher forms

Grandiosity and idealisation

• The two developmental lines of narcissism

• Transformation of primitive feelings of omnipotence into mature and persisting ambitions

• Transformation of the sense of perfection and power of the idealised parent into mature and persisting ideals

• “Man is led by his ideals but pushed by his ambitions”

Kohut’s concept of the ‘selfobject’

• The caregiver’s empathic response to the infant’s state of being forms part of the infant’s regulatory system – thus the maternal ‘object’ functions as an aspect of the infant’s ‘self’ – hence ‘selfobject’

• The selfobject does not denote a fusion of the images of self and other, but designates the way the psychological functions of the other play a role in the regulation of the self

• The dyadic regulation of affect

• Somewhat like Bion’s account of the mother’s thoughtful response, her ‘alpha function’

• Also similar to some of Winnicott’s perspectives

Kohut did not advocate mirroring

• Common misunderstanding that Kohut advocated the therapist should ‘mirror’ the patient.

• What he did advocate was that the therapist track the mirroring and idealising transferences –and interpret the client’s reactions to empathic failures.

“You don’t have to mirror the patient”

• “… you don’t have to mirror the patient to be effective as his analyst. That really is a total mistake. The meaning of mirroring… is not that you have to play act with your patient and praise him and respond to him and say that he is wonderful. No such nonsense. But you do have to show the patient over and over again how he defensively retreats because he expects he will not get what he wants and that he doesn’t dare to let himself know what he wants.” [Chicago lectures p 373]

Ego achievements from transformations of narcissism

• Creativity: “..creative people tend to alternate …between phases when they think extremely highly of their work and phases when they are convinced that it has no value …a sure indication that the work is cathected with a form of narcissistic libido.”

• Empathy – a transformation of primitive states of including the other as part of the self

• Religious feeling – ‘cosmic narcissism’

• Wisdom – overcoming unmodified narcissism – “acceptance of the limitations of his physical, intellectual, and emotional powers”.

Malign selfobject processes

• The malign narcissist coercively recruits others to serve as selfobjectsto support the pathological grandiose self

• Taking over the other’s mind

• React with fury and contempt when the target fails to comply

• A feature of coercive and controlling relationships

• Can be a feature of ADHD

The effects of being in a relationship(as child or adult) with a malign narcissist

• Consistent invalidation

• Discouragement of independent thought, feeling, or perception

• Feeling loved if subservient, abandoned if independent

• Idealisation of the other and denigration of the self

• Confusion – loss of independent perception of reality

• Self-blame

• Toxic corrosion of self-esteem

The child has no escape

• When subject to the reality distorting effects of a narcissistic parent, a child has no escape – unless he or she can turn to a non-narcissistic caregiver

• The child is dependent on the mother –and dreads abandonment or loss of love

• Learns to distort his/her own feelings, thoughts, and perceptions to accommodate the mother

• This was the personal experience of Heinz Kohut

Non-mirroring motherand the missing paternal dimension

• The child is not mirrored for who he or she truly is – but is captured by an image in the mother’s mind

• The paternal function – of helping to separate mother and child – is missing.

• A failure of the Lacanian ‘Law of the Father’

Lacan – we can never be our selves

• “In Lacan’s view … the degree to which human beings are convinced that they possess a strong identity is more indicative of psychosis than anything else”. [D. Nobus 2000. Why I am never myself p 196].

• “… behind all these identifications there is no essential core, no anchored true identity. The me does not operate as part of a larger ‘self’, nor does it shield a hidden self. It is but a surface or wall behind which there is nothing to be found.”[Nobus2000 p 197]

• Nobus, D. 2000. Why I am never myself. In B. Seu (Ed) Who am I? The Ego and the Self in Psychoanalysis. London. Rebus Press. pp 181-198

Lacan’s ‘Primordial Discord’

• The primordial discord – the fragmented body image resulting from the prematurity of birth.

• This infantile hell is displaced by illusions of coherence offered by identification with an external image.

• The threat of fragmentation is ever present – leading to a “narcissistic passion” – the “passionate desire peculiar to man to impress his image in reality”.

Human selves are based on signifiers

• Human culture and identity is based on signifiers – just as our financial currency is based on signifiers – paper notes that can only be exchanged for other paper notes (other signifiers). These signifiers have become severed from the signified (gold).

• If enough people challenged the illusion, the banking system would collapse.

• Similarly if the illusory identification with social role/image signifiers is challenged, then one’s identity threatens to unravel.

• This leads to profound inchoate anxiety.

We identify with words and images

• We identify with words – the name that is uttered when we are born – or the name of the organisation that qualifies us in psychotherapy.

• We identify with the images in our parent’s minds.

• We believe these images and words are what we are.

The image that has social value

• We seek to identify with the image that is perceived as having social value (repudiating that within ourselves that does not fit this image).

• Identification with negative images if the positive identification is blocked.

• The essential search for a viable identity – even, as a last resort, as ‘psychiatric patient’.

• The crucial identification with the image in mother’s mind

The word/image imprisons us

• Once we identify with a word/image/role, it becomes a prison.

• We defend our prison.

• We repudiate whatever does not fit that prison.

• The ‘totalitarian ego’ fabricates and revises personal history.

Illusion is inherent in the human psyche

• All human selves are ‘false selves’ – based on identification with images and roles available within the particular family and culture that the child is born into.

Trapped in a deceitful image

• Assumed identities

• Some people may project an intentionally deceptive image –evoke the other’s belief in it – and then become imprisoned by their own deception.

The false self’s attempt to rule.

• The false self is opposed to the child’s unknown evolving Self.

• The false self is frightened – and may assume a posture of arrogance and omnipotence.

The true self is an unknown self –continually evolving

• Although it is relatively easy to refer to a ‘false self’, there is no comparable ‘true self’.

• The ‘true self’ is a deeper unknown source that is continually evolving and emerging.

Is there a design fault?

• The latent fury of humankind – our helplessness in the face of the cultural invasion of our bodies.

• The ‘language of the Other’ is like a viral software that hijacks our experience, takes over our mind and body, falsifies our experience, and leaves us trapped in our alienation.

Organic, assumed, and imposed identities• An organic identity is one that

follows naturally from one’s origins, prolonged strivings and achievements (linking to Kohut’s ‘nuclear self’).

• An assumed identity is one that is rapidly and mimetically acquired, unsupported by a developmental process.

• An imposed identity is one that another person insists that you have regardless of your inner experience and perception of self.

The healthy relationship with the deeper unknown Self

• The conscious ‘self’ (ego) is a child of the deeper source Self.

• The healthy attitude is one of dependence and trust in relation to the deeper Self.

• People with entrenched narcissistic problems may be particularly fearful or hostile towards the deeper Self.

The shame of the true self

• The ‘true self’ is associated with shame.

• Tentative emergence of delicate shoots of the authentic creative self.

• The threat of overwhelming shame blocks this emergence.

Transmission of narcissistic disturbance (and the ‘false self’) down the generations• The child is subject to the parents’ narcissistic

distortions

• Identifies with and repeats the narcissistic distortions

• Attempts to maintain a ‘grandiose self’ image based on the parents’ desire – a prisoner of the image

• The ‘true self’ is feared – as a threat to the totalitarian ego

• Constant dread of being ‘found out’ and revealed to be an ‘imposter’

Transmission down the psychoanalytic generations – a hypothetical process

• The analyst adheres to a ‘strong’ theory – rigidly held, all-encompassing, perceived as ‘deep’

• The analysand’s own perceptions, beliefs, and emotions are consistently invalidated

• Perspectives based on the analyst’s ‘strong theory’ are substituted for the analysand’s original view

• The analysand may leave

• If the analysand does not leave, he or she will identify with the aggressor, learn the theory, and impose it on self and others

• May result in a perverse and cultish variant

• Contrast with the alternative view of the analysand as ‘an unknown Other’

Addiction to psychoanalytic beliefs

• “ .. in the largest number of instances, a future analyst’s training commits him … to a particular set of theoretical beliefs. With very rare exceptions … the analyst does not stray from these beliefs, which he comes to make his own. Rather, he defends them loyally, displaying hostility and contempt toward those who do not share them. … I do not believe that groups whose members display such deep and unswerving loyalty to specific sets of theories are encountered with equal frequency in other sciences.” [How does analysis cure? 163]

Psychic Murder Syndrome

• The ‘Stepford Child’

• The mother wishes to replace her actual child with a replica more congruent with her own desire.

• Murder of the ‘true self’, replacement with a replica.

• This ‘psychic murder’ is then continued within the child/adult’s own personality.

Richard Nixon

• Bob Woodward’s new book: The Last of the President’s Men

• In 1968 there was a breakthrough in the Paris peace talks in relation to the war in Vietnam – but peace would jeopardise Nixon’s election prospects – so he sabotaged the talks

• Later, as president, he wrote a note to Kissinger, saying 10 years of bombing had produced “zilch” – yet publically claimed the bombing had been “very very effective” – and he intensified the bombing. In 1971, election year, the US dropped 1.1 million tons of bombs in Vietnam

• On Christmas eve 1969, he noticed that some employees in the White House displayed photos of John Kennedy on their walls or desks – and was enraged. He ordered all the photos to be replaced with ones of him

• He had hidden microphones installed in every room at the White House: “There will be no whitewash in the White House”

The malign twins: narcissism and psychopathyThe Talented Mr Ripley

• The psychopath Tom Ripley – and the narcissist Dickie Greenleaf

• Dickie narcissistically wounds Tom

• Tom makes a narcissistic-psychopathic ‘choice’ – decides it is “better to be a fake somebody than a real nobody”

• Seeks to assume Greenleaf’s identity, through malign projective and introjective (entering and stealing) processes, in both fantasy and reality

• Ripley lacks a true identity – he is a malign false self that has consumed any vestige of inner core

• A story of deception, predation, and murder – Ripley murders anyone who suspects the truth – a continual murder of his ‘true self’

‘His Royal Highness Prince Masud Khan’ Malignant Narcissism

• Empathy and sensitive perception coexisted with:• Grandiose arrogance and exploitativeness – violating every boundary• Would turn up at patient’s homes drunk• Played poker with two of his patients (and cheated)• Wynne Godley’s account of how his analysis with Khan severely blemished

his life• Khan initially appeared interested in him – but this turned out to be to do

with Godley being married to the daughter of a well-known sculptor• Then Khan displayed antisemitism and tried to break up their marriage –

and tried to pair him with another of his patients• Invited himself to the home of Godley and his wife and told Godley he

lived like a pig• Khan’s characteristic response was “indignation and withering sarcasm”

1965 – new insights on narcissism

• Summer 1965 – age 52 – “bursting at the seams” in a state of “absolute abandon” – isolated in his study over the garage.

• “Essentially everything I’ve written since then I wrote in those weeks in that one summer”

• ‘Forms and transformations of narcissism’ presented as an extension of Freud’s 1914 paper.

Narcissism and the selfobject

• “One of the difficulties encountered as one approaches the theoretical problems of narcissism …is the frequently made assumption that the existence of object relations excludes narcissism. On the contrary …some of the most intense narcissistic experiences relate to objects; objects, that is, which are either used in the service of the self and of the maintenance of its instinctual investment, or objects which are themselves experienced as part of the self. I shall refer to the latter as self-objects” [Analysis of the Self p xiv]

Focus on the selfobject transferences

• “… since the essential driving force of the analytic process in the disturbances of the self is provided by the reactivation of the thwarted developmental needs of the self; since, in other words, the renewed search of the damaged self for the development-enhancing responses of an appropriately empathic selfobject always occupies center stage in the analysand’s experiences during the analysis, it follows that the analyst’s pivotal communications to the analysand are those that focus on the psychic configurations to which we refer as selfobject transferences.” [How does analysis cure? 192]

The interweaving of selfobject and historical transference

• The historical transference of repetition remains relevant:

• E.g. the calm before the storm:

• “What happens is nothing else but the transference clicking into place. Thus during the calm before the storm, the analyst and the patient have jointly explored the patient’s traumatic past, allied in the shared pursuit of a goal; once the storm breaks loose, however, the analytic situation has become the traumatic past and the analyst has become the traumatising selfobject of early life” [How does analysis.. 178]

‘Psychological structure’

• “Some addicts, for example, have not acquired the capacity to soothe themselves or to go to sleep; they have not been able to transform early experiences of being soothed or of being put to sleep into an endopsychic faculty (structure). These addicts therefore have to rely on drugs, not as a substitute for object relations, but as a substitute for psychological structure. If such patients are in psychotherapy, they may be said to become addicted to the psychotherapist or to the psychotherapeutic procedure. Their addiction must not, however, be confused with transference: the therapist is not a screen for the projection of existing psychological structure; he is a substitute for it.” [Introspection, Empathy, & Psychoanalysis 1959]

“essential therapeutic conclusion”

• “it is the defect in the self that brings about and maintains a patient’s selfobject transference, and it is the working through of this transference, via transmuting internalisation, that is, via a wholesome psychic activity that has been thwarted in childhood, lays down the structures needed to fill the defects in the self” [How does analysis cure? 4]

Depersonalisation of the selfobject

• “If an analysis has been successful … most memories concerning the analyst fade away and the functions that the analyst had assumed – his understanding and explaining – have become unnecessary and are discarded. … The ‘foreign protein’ of the selfobject and of the selfobject’s functions, whether in childhood or during analysis, becomes split up after being ingested; its constituents are then reasembled to form the self in accordance with those individual patterns that characterise the growing child’s (or analysand’s) specific psychic ‘protein’ “ [How does analysis cure? 160]

A patient’s reaction to being told of an analytic break

• Professional man in his 40s – heard Kohut lecture –had seen various therapists, critical of them all.

• Alarming deterioration after Kohut was away for several weeks – hypochondria, headaches, paranoid preoccupations

• “The patient, as I finally grasped, insisted – and had a right to insist – that I learn to see things exclusively in his way and not at all in my way” [How does analysis cure? 182]

Dream of the father’s return

• Mr Z’s dream of his father’s return – loaded with packages of gifts –the boy desperately tries to shut the door against his father

• Kohut’s ‘freudian’ analysis was of ambivalence towards the oedipal rival.

• His deeper ‘self psychological’ analysis was “of a boy who had been all-too-long without a father; of a boy deprived of the psychological substance from which, via innumerable observations of his father’s assets and defects, he would build up, little by little, the core of an independent masculine self”

Kohut’s Mr. Z: disintegration anxiety as he extricates from his mother’s image

of him

• As he moved from his archaic tie to his mother, he experienced “a number of frightening, quasi-psychotic experiences in which he felt himself disintegrating and was beset by intense hypochondriacal concerns”

• Dream: His mother appeared standing with her back to him. This was accompanied by “the deepest anxiety he had ever experienced”.

The ‘nuclear self’

• Experience of free will and autonomy of self.

• Some heroic individuals remain true to their ideals even when these are in conflict with social pressures and internal urges to preserve life and comfort

• Franz Jaggerstatter refused to serve in the German army – his dream of a beautiful train, hordes of people streaming towards it – a voice says “This train is going to hell”.

• Sophie Scholl’s dream prior to execution by the nazis – depositing a child on the far side of a crevice, then she falls into the depths.

The pivotal point in lifeGuilty man vs Tragic man

• “I believe that there is … a specific point in the life curve of the self at which a final crucial test determines whether the previous development had failed or succeeded… I am inclined to put the pivotal point … to late middle age when, nearing the ultimate decline, we ask ourselves whether we have been true to our innermost design. This is the time of utmost hopelessness for some, of utter lethargy, of that depression without guilt and self-directed aggression, which overtakes those who feel they have failed and cannot remedy the failure in time and with the energies still at their disposal. The suicides of this period are not the expression of a primitive superego, but a remedial act – the wish to wipe out the unbearable sense of mortification and nameless shame imposed by the ultimate recognition of a failure of all-encompassing magnitude” [Restoration 241]

The two developmental opportunities and ‘compensatory structures’

• If the childhood self succeeds in disentangling from a seriously pathogenic selfobject (mother) – and nearly succeeds in a new developmental route (via father) –it is this second route that will be remobilised in the transference.

• “… the transference, after briefly touching early depressions and rages, will spontaneously move on and settle at a different, later point in development”

• “…experience has taught me that it is an error to guide the patient to the analysis of archaic traumata”. [How does analysis cure? 6]

Countering unhealthy narcissism

• Emphasise the Freudian ‘reality principle’

• The primary human goals/instincts of survival – of self, family, and the group

• Contrast with an unhealthy focus on self-image

• Emphasise healthy pride in the results of work and effort – contrasting with unhealthy pride in natural beauty, intelligence, race, social class etc.

• Foster empathy by enquiry about the feelings and motivations of others

• The heathy stance of “I don’t know who I am – I am an unknown evolving self”

‘Maternal’ and ‘paternal’ functions of the psychotherapist

• Mirroring the true self – tuning in to authentic expressions and potential – capturing the developmental striving. Deeply empathic.

• Facilitating the client’s engagement with reality – countering his or her attempts to remain in states of illusion. Counter-empathic.

Narcissistic vs Client-Centred StanceNarcissistic Illusion of knowing and understanding the client

‘Shows’ the patient what he or she is doing

Holds firmly to a theory of mental life

Client-CentredViews the client as an Unknown Other – feels curious

Allows the client to reveal, in conscious and unconscious communication

Holds theories very tentatively –allows the client to be the unconscious supervisor

The ethics of listening

• The client is a sacred Other

• At their core, the Other is essentially unknown and unknowable

• If we listen, without judgement, and without a clamour to impose our ‘understanding’, this sacred Other may reveal something of him/herself

• The precise words used by the Other are important – we should not distort them by substituting our own words

• We should take care that our own words, in response, have coherence and clarity – and not to add confusion to the client’s discourse

• New understanding will emerge in the client’s free-associative discourse – not through the analyst’s ‘showing’ him or her what is ‘unconsciously’ going on

• To disregard what the client consciously means, and to transpose this as an unconscious narrative about the ‘here and now’ relationship, is a potentially harmful invalidation of the client’s subjectivity.

• To seek to understand the client without consideration of the historical childhood past is similarly invalidating of their formative experience which provides context for his or her current mental state, beliefs, and behaviour