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Narcissism, Pathological
Narcissism is named after the ancient Greek myth of Narcissus, the handsome Greek youth who rejected the desperate advances of the nymph Echo.

In punishment of his cruelty, he was doomed to fall in love with his own reflection in a pool of water.

Unable to consummate his love, he pined away and changed into the flower that bears his name to this very day.

WHAT IS Pathological Narcissism or NPD Narcissistic Personality Disorder

A pattern of traits and behaviours which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition.

Most narcissists (50-75%, according to the DSM-IV-TR) are men.

The Narcissistic Personality Disorder (NPD) is one of a "family" of personality disorders (known as "Cluster B"). Other members of Cluster B are Borderline PD, Antisocial PD and Histrionic PD.

NPD is often diagnosed with other mental health disorders ("co-morbidity") ? or with substance abuse and impulsive and reckless behaviours ("dual diagnosis").

NPD is new (1980) mental health category in the Diagnostic and Statistics Manual (DSM).

There is only scant research regarding narcissism. But what there is has not demonstrated any ethnic, social, cultural, economic, genetic, or professional predilection to NPD.

It is estimated that 0.7-1% of the general population suffer from NPD.

Pathological narcissism was first described in detail by Freud. Other major contributors are: Klein, Horney, Kohut, Kernberg, Millon, Roningstam, Gunderson, Hare.

The onset of narcissism is in infancy, childhood and early adolescence. It is commonly attributed to childhood abuse and trauma inflicted by parents, authority figures, or even peers.

There is a whole range of narcissistic reactions ? from the mild, reactive and transient to the permanent personality disorder.

Narcissistic Supply is outside attention ? usually positive (adulation, affirmation, fame, celebrity) ? used by the narcissist to regulate his labile sense of self-worth.

Narcissists are either "cerebral" (derive their Narcissistic Supply from their intelligence or academic achievements) or "somatic" (derive their Narcissistic Supply from their physique, exercise, physical or sexual prowess and romantic or physical "conquests").

Narcissists are either "classic" [see definition below] or they are "compensatory", or "inverted" [see definitions here: "The Inverted Narcissist"].

The classic narcissist is self-confident, the compensatory narcissist covers up in his haughty behaviour for a deep-seated deficit in self-esteem, and the inverted type is a co-dependent who caters to the emotional needs of a classic narcissist.

NPD is treated in talk therapy (psychodynamic or cognitive-behavioural). The prognosis for an adult narcissist is poor, though his adaptation to life and to others can improve with treatment. Medication is applied to side-effects and behaviours (such as mood or affect disorders and obsession-compulsion) ? usually with some success.

The ICD-10, the International Classification of Mental and Behavioural Disorders, published by the World Health Organisation in Geneva [1992] regards Narcissistic Personality Disorder (NPD) as "a personality disorder that fits none of the specific rubrics". It relegates it to the category "Other Specific Personality Disorders" together with the eccentric, "haltlose", immature, passive-aggressive, and psychoneurotic personality disorders and types.

The American Psychiatric Association, based in Washington D.C., USA, publishes the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision (DSM-IV-TR) [2000] where it provides the diagnostic criteria for the Narcissistic Personality Disorder.

The DSM defines NPD as "an all-pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration or adulation and lack of empathy, usually beginning by early adulthood and present in various contexts."

The DSM specifies nine diagnostic criteria. For NPD to be diagnosed, five (or more) of these criteria must be met.

[In the text below, I have proposed modifications to the language of these criteria to incorporate current knowledge about this disorder. My modifications appear in bold italics.]

[My amendments do not constitute a part of the text of the DSM-IV-TR, nor is the American Psychiatric Association (APA) associated with them in any way.]

[Click here to download a bibliography of the studies and research regarding the Narcissistic Personality Disorder (NPD) on which I based my proposed revisions.]

Proposed Amended Criteria for the Narcissistic Personality Disorder

Feels grandiose and self-important (e.g., exaggerates accomplishments, talents, skills, contacts, and personality traits to the point of lying, demands to be recognised as superior without commensurate achievements);
Is obsessed with fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance (the cerebral narcissist), bodily beauty or sexual performance (the somatic narcissist), or ideal, everlasting, all-conquering love or passion;
Firmly convinced that he or she is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status people (or institutions);
Requires excessive admiration, adulation, attention and affirmation ? or, failing that, wishes to be feared and to be notorious (Narcissistic Supply);
Feels entitled. Demands automatic and full compliance with his or her unreasonable expectations for special and favourable priority treatment;
Is "interpersonally exploitative", i.e., uses others to achieve his or her own ends;
Devoid of empathy. Is unable or unwilling to identify with, acknowledge, or accept the feelings, needs, preferences, priorities, and choices of others;
Constantly envious of others and seeks to hurt or destroy the objects of his or her frustration. Suffers from persecutory (paranoid) delusions as he or she believes that they feel the same about him or her and are likely to act similarly;
Behaves arrogantly and haughtily. Feels superior, omnipotent, omniscient, invincible, immune, "above the law", and omnipresent (magical thinking). Rages when frustrated, contradicted, or confronted by people he or she considers inferior to him or her and unworthy.
I. PATHOLOGICAL NARCISSISM OVERVIEW

Whether narcissism and its pathology are the results of genetic programming (see Anthony Benis and others) or of dysfunctional families and faulty upbringing or of anomic societies and disruptive socialization processes - is still an unresolved debate. The scarcity of scientific research, the fuzziness of the diagnosic criteria and of the differential diagnoses make it unlikely that this will be settled soon one way or the other.

It is the psychoanalytic belief that we are all Narcissists at an early stage of our lives. As infants and toddlers we all feel that we are the center of the Universe, the most important, omnipotent and omniscient beings.

At that phase of our development, our parents are perceived by us to be mythical figures, immortal and awesomely powerful, there solely to cater to our needs, to protect and nourish us.

Both Self and others are viewed immaturely, as idealizations. This, in the psychodynamic models, is called the phase of "primary" narcissism.

Inevitably, the inexorable processes and conflicts of life erode these perceptions and reduce the ideal into the the real.

Adaptation is a process of disillusionment. If this process is abrupt, inconsistent, unpredictable, capricious, arbitrary and intense - the injuries sustained by the infant's tender, budding, self-esteem, are severe and, often, irreversible. Moreover, the empathic support of our caretakers (the Primary Objects, the parents) is crucial. In its absence, our sense of self-worth and self-esteem in adulthood tends to fluctuate, to alternate between over-valuation (idealization) and devaluation of both Self and others. Narcissistic adults are widely thought to be the result of bitter disappointment, of radical disillusionment in the significant others in their infancy. Healthy adults accept their self-limitations (the boundaries and limitations of their selves). They accept disappointments, setbacks, failures, criticism and disillusionment with grace and tolerance. Their self-esteem is constant and positive, not substantially affected by outside events, no matter how severe.

II. PATHOLOGICAL NARCISSISM - SCHOOLS OF THOUGHT

The common view is that we go through the stages of a linear development. We are propelled forward by forces. Various psychoanalytic and psychodynamic models incorporate the libido (force of life) and Thanatos (force of death) in Freud's thinking, Meaning in Frenkel's, socially mediated phenomena (Adler, Behaviourism), cultural context (Horney), interpersonal relations (Sullivan) and neurobiological and neurochemical forces, to mention but a few schools.

These thought systems differ on many issues. Some postulate the cessation of personal development during childhood, others - during adolescence. Yet others claim that development is a process which continues throughout a person's life. Common to all these schools of thought are the mechanics and dynamics of the psychic process. Forces - inner or external - facilitate the development of the individual. When an obstacle to development is encountered, development is stunted or arrested - but not for long. A distorted pattern of development, a bypass appears. Hence, psychopathological conditions are the outcomes of disturbed growth.

Humans can be compared to trees. When a tree encounters a physical obstacle to its growth - its branches or roots curl around it. Yet, deformed and ugly, they still reach their destination, however late and partially.

Psychopathologies are adaptive mechanisms. They allow the individual to continue to grow around the disturbing factor. The personality twists and turns, deforms itself, is transformed - until it reaches a functional equilibrium, which is not too ego-dystonic. There it settles down and continues its more or less linear pattern of growth. But the thrust is clear: onwards. Adaptation above all, growth at any price, straight or deformed. The forces of life (as expressed in the development of the personality) are stronger than any hindrance. The roots of trees crack mighty rocks, microbes live in the most poisonous surroundings - humans form the personality structure which is best suited to their needs and outside constraints. Such a personality structure may be abnormal - but it has triumphed in the delicate task of successful adaptation.

III. Narcissistic Regression and the Formation of Secondary Narcissism

Research shows that (Gunderson-Ronningstam, 1996) when an individual (at any age) encounters an obstacle to his orderly progression from one stage of development to another - he retreats to his infantile-Narcissistic phase rather than circumvent the hindrance. The process is three-stepped:

(1) The person encounters an obstacle, (2) The person regresses to the primary Narcissistic phase, and (3) The person recuperates and moves back from the primary Narcissistic phase to attack the obstacle again.

While in step (2), the person displays childish, immature behaviours.

He feels that he is omnipotent and misjudges his power and the power of his opponents and opposition. He underestimates challenges facing him and pretends to be "Mr. Know-All". His sensitivity to the needs and emotions of others and his ability to empathize with them deteriorates sharply. He becomes intolerably haughty and arrogant, with sadistic and paranoid tendencies. Above all, he then seeks unconditional admiration, even when he does not deserve it.

He is preoccupied with fantastic, magical, thinking and daydreams his life away.

He tends to exploit others, to envy them, to be edgy and explode with unexplained rage. A person undergoing a psychological development crisis brought on by an insurmountable obstacle - will, mostly, revert to excessive and compulsive behaviour patterns. To put it succinctly:

whenever we experience a major life crisis (which hinders our personal growth and threatens it) - we suffer from a mild and transient form of the Narcissistic Personality Disorder (see further in this article).

This fantasy world, full of falsity and feelings hurt, serves as a springboard. It is from there that the individual can resume his progress towards the next stage of personal growth. Faced with the same obstacle, he feels (falsely) sufficiently potent to ignore it or to attack it. In most cases, success is guaranteed by the very unrealistic assessment of the fortitude and magnitude of the obstacle. The main function of the episodic NPD is this: to encourage the individual to engage in magical thinking, to wish the problem away or to enchant it or to tackle and overcome it from a position of omnipotence.

A structural abnormality of personality arises only when recurrent attacks fail constantly and consistently to eliminate the obstacle, or to overcome the hindrance - especially if this failure happens during the formative years (0-4 years of age). The contrast between the fantastic world (temporarily) occupied by the individual and the real world in which he keeps being frustrated - is too acute to countenance for long. The dissonance gives rise to the unconscious "decision" to go on living in the world of fantasy, grandiosity and entitlement. It is better to feel special than to feel inadequate. It is better to be omnipotent than psychologically impotent. To (ab)use others is preferable to being (ab)used by them. In short: it is better to remain a pathological Narcissist than to face the harsh unyielding realities.

This phase of permanent narcissism is often called "secondary" narcissism.

IV. The Dynamics of Narcissism - The Mother-Child Bond

Narcissism and its pathologies are commonly tackled by the application of the various psychodynamic models.

According to these models, parents ("Primary Objects") and, more specifically, mothers are the first agents of socialization. It is through his mother that the child explores the most important questions, the answers to which will shape his entire life. How loved one is, how lovable, how independent can one become, how guilty one should feel for wanting to become autonomous, how predictable is the world, how much abuse should one expect in life and so on. The mother, to the infant, is not only an object of dependence (survival is at stake), love and adoration. It is a representation of the Universe itself. It is through her that the child first exercises his senses: the tactile, the olfactory, and the visual.

Later on, she is the subject of his nascent sexual cravings (if the child is a male) - a diffuse sense of wanting to merge, physically, as well as spiritually. This object of love is idealized and internalized and becomes part of our conscience ("superego" in the psychoanalytic model).

Growing up (attaining maturity and adulthood) entails the gradual detachment from the mother. At first, the child begins to shape a more realistic view of her and incorporates the mother's shortcomings and disadvantages in this modified version. The more ideal, less realistic and earlier picture of the mother is stored and becomes part of the child's psyche. The later, less cheerful, more realistic view enables the infant to define his own identity and gender identity and to "go out to the world". Partly abandoning mother is the key to an independent exploration of the world, to personal autonomy and to a strong sense of self. Resolving the sexual complex and the resulting conflict of being attracted to a forbidden figure - is the second, determining, step. The (male) child must realize that his mother is "off limits" to him sexually (and emotionally, or psychosexually) and that she "belongs" to his father. He must thereafter choose to imitate his father in order to win, in the future, someone like his mother. This is an oversimplified description of the very intricate psychodynamic processes involved - but this, still, is the gist of it all. The third (and final) stage of letting go of the mother should be reached during the delicate period of adolescence. The person then seriously ventures out and, finally, builds and secures his own universe, replete and complete with a new "mother-lover". If any of these phases is thwarted - the process of differentiation is not successfully completed, no autonomy or coherent self is achieved and dependence and "infantilism" characterize the person.

What determines the success or failure of these developments in one's personal history? Mostly, the mother herself. If she does not "let go" - the child will not go. If the mother herself is the dependent, Narcissistic type - the growth prospects of the child are, indeed, dim.

There are numerous mechanisms, which mothers use to ensure the continued presence and emotional dependence of their offspring (of both sexes).

The mother can cast herself in the role of the eternal victim, a sacrificial figure, who dedicated her life to the child (with the implicit or explicit proviso of reciprocity: that the child will dedicate his life to her).

Another strategy is to treat the child as an extension of the mother or, conversely, to treat herself as an extension of the child. Yet another tactic is to create a situation of "follies a deux" (the mother and child united against external threats), or an atmosphere suffused with sexual and erotic insinuations, leading to an illicit psychosexual bonding between mother and child. In the latter case, the adult's ability to interact with members of the opposite sex is gravely impaired and the mother is perceived as envious of any feminine influence other than hers. The mother will criticize the women in her offspring's life pretending to do so in order to protect him from dangerous liaisons or from ones which are "beneath him" ("you deserve more"). Other mothers exaggerate their neediness: they emphasize their financial dependence and lack of resources, their health problems, their emotional barrenness without the soothing presence of the child, their need to be protected against this or that (mostly imaginary) enemy. The latter tactic is a pernicious variant of the guilt-related species. Guilt is a prime mover in the perverted relationships of such mothers and their children.

V. The Dynamics of Narcissism - Primitive Defence Mechanisms

"When the habitual narcissistic gratifications that come from being adored, given special treatment, and admiring the self are threatened, the results may be depression, hypochondriasis, anxiety, shame, self destructiveness, or rage directed toward any other person who can be blamed for the troubled situation. The child can learn to avoid these painful emotional states by acquiring a narcissistic mode of information processing. Such learning may be by trial-and-error methods, or it may be internalized by identification with parental modes of dealing with stressful information."

(Jon Mardi Horowitz - "Stress Response Syndromes: PTSD, Grief, and Adjustment Disorders", Third Edition)

Narcissism is fundamentally an advanced version of the splitting defense mechanism. The Narcissist cannot regard humans, situations, entities (political parties, countries, races, his workplace) as a compound of good and bad elements. He is an "all or nothing" primitive "machine" (a common self metaphor among narcissists). He either idealizes his object - or devalues it. The object is either all good or all bad. The bad attributes are always projected, displaced, or otherwise externalized. The good ones are internalized in order to support the inflated ("grandiose") self-concepts of the narcissist and his grandiose fantasies - and to avoid the pain of deflation and disillusionment. The Narcissist's earnestness and his (apparent) sincerity make people wonder whether he is simply detached from reality, unable to appraise it properly - or willingly and knowingly distorts reality and reinterprets it, subjecting it to his self-imposed censorship. It would seem that the Narcissist is dimly aware of the implausibility of his own constructions. He has not lost touch with reality.

He is just less scrupulous in reshaping it, remolding its curvatures and ignoring the uncomfortable angles.

"The disguises are accomplished by shifting meanings and using exaggeration and minimization of bits of reality as a nidus for fantasy elaboration.

The narcissistic personality is especially vulnerable to regression to damaged or defective self-concepts on the occasions of loss of those who have functioned as self-objects. When the individual is faced with such stress events as criticism, withdrawal of praise, or humiliation, the information involved may be denied, disavowed, negated, or shifted in meaning to prevent a reactive state of rage, depression, or shame."

(Jon Mardi Horowitz - ibid)

The second mechanism which the narcissist employes is the active pursuit of "Narcisstic Supply". The Narcissist actively seeks to furnish himself with an endless supply of admiration, adulation, affirmation and attention.As opposed to common opinion (which infiltrated literature) - the narcissist is content to have ANY kind of attention. If fame cannot be had - infamy and notoriety will do. The narcissist is obsessed with the obtaining of narcissistic supply, he is addicted to it. His behavior in its pursuit is impulsive.

"The hazard is not simply guilt because ideals have not been met. Rather, any loss of a good and coherent self-feeling is associated with intensely experienced emotions such as shame and depression, plus an anguished sense of helplessness and disorientation. To prevent this state, the narcissistic personality slides the meanings of events in order to place the self in a better light. What is good is labeled as being of the self (internalized) Those qualities that are undesirable are excluded from the self by denial of their existence, disavowal of related attitudes, externalization, and negation of recent self-expressions. Persons who function as accessories to the self may also be idealized by exaggeration of their attributes. Those who counter the self are depreciated; ambiguous attributions of blame and a tendency to self-righteous rage states are a conspicuous aspect of this pattern.

Such fluid shifts in meanings permit the narcissistic personality to maintain apparent logical consistency while minimizing evil or weakness and exaggerating innocence or control. As part of these maneuvers, the narcissistic personality may assume attitudes of contemptuous superiority toward others, emotional coldness, or even desperately charming approaches to idealized figures."

(Jon Mardi Horwitz, ibid)

VI. Narcissism - Freud versus Jung

Sigmund Freud (1856-1939) is credited with the promulgation and presentation of a first coherent theory of narcissism. He described transitions from subject-directed libido to object-directed libido through the intermediation and agency of the parents. To be healthy and functional, the transitions must be smooth and unperturbed. Neuroses are the results of such perturbations.

Freud conceived of each stage as the default (or fallback) of the next one.

Thus, if a child reaches out to his objects of desire and fails to attract their love and attention - the child will regress to the previous phase, to the narcissistic phase. The first occurrence of narcissism is adaptive.

It "trains" the child to love an object. It ensures gratification through availability, predictability and permanence. But regressing to "secondary narcissism" is mal-adaptive. It is an indication of failure to direct the libido to the "right" targets (to objects, such as the child's parents).

If this pattern of regression persists and prevails, a "narcissistic neurosis" is formed. The narcissist stimulates his self habitually in order to derive pleasure and gratification. He prefers this mode of deriving gratification to others. He is "lazy" because he takes the "easy" route of resorting to his self and reinvesting his libidinal resources "in-house" rather than making an effort (and risking failure) to seek out libidinal objects other than his self. The narcissist prefers fantasyland to reality, grandiose self-conception to realistic appraisal, masturbation and sexual fantasies to mature adult sex and daydreaming to real life achievements.

Carl Gustav Jung (1875-1961) had a mental picture of the psyche as a giant warehouse of archetypes (the conscious representations of adaptive behaviors).

Fantasies to him were just a way of accessing these archetypes and releasing them.

Almost ex definitio, regression cannot be entertained by Jungian psychology.

Any reversion to earlier phases of mental life, to earlier coping strategies, to earlier choices - in other words, any default - is interpreted as simply the psyche's way of using yet another, hitherto untapped, adaptation strategy.

Regressions are compensatory processes intended to enhance adaptation and not methods of obtaining or securing a steady flow of gratification.

Actually, there is little difference between Freud and his disciple turned-heretic, Jung. They seem to be sparring in a linguistic field.

In other words, it is a matter of semantics. When libido investment in objects (esp. the Primary Object) fails to produce gratification, maladaptation results. This is dangerous. A default option is activated: secondary narcissism. This default enhances adaptation, it is functional and adaptive and triggers adaptive behaviors. As a by-product, it secures gratification.

We are gratified when we are at peace with our model of our environment.

We are at such peace when we exert reasonable control over our environment, i.e., when our behaviors are adaptive. The compensatory process has TWO results: enhanced adaptation and inevitable gratification.

Perhaps the more serious division between them is with regards to introversion. Freud regards introversion as an instrument in the service of a pathology (introversion is indispensable to narcissism, as opposed to extroversion which is a necessary condition for libidinal object-orientation).

As opposed to Freud, Jung regards introversion as a useful tool in the service of the endless psychic quest for adaptation strategies (narcissism being one such strategy). The Jungian adaptation repertoire does not discriminate against narcissism. To Jung it is as legitimate a choice as any. But even Jung acknowledged that the very need to look for a new adaptation strategy means that adaptation has failed. In other words, the search itself is indicative of a pathological state of affairs. It does seem that introversion per se IS NOT pathological (because no psychological mechanism is pathological PER SE). Only the use made of it CAN be pathological.

One would tend to agree with Freud, though, that when introversion becomes a permanent feature of the psychic landscape of a person - it facilitates pathological narcissism.

Jung distinguished introverts (those who habitually concentrate on their selves rather than on outside objects) from extroverts (the convese preference). Not only was introversion a totally normal and natural function in childhood, it remains normal and natural even if it predominates the mental life.

Yet, the habitual and predominant focussing of attention upon one's self, to the exclusion of others is THE definition of pathological narcissism.

What differentiates the pathological from the normal is degree.

Pathological narcissism is ex-clusive and all-pervasive.

Other forms of narcissism are not. So, although there is no healthy state of habitual, predominant introversion, it remains a question of form and degree of introversion. Often a healthy, adaptive mechanism goes awry. When it does, as Jung himself recognized, neuroses form.

Freud regards Narcissism as a POINT while Jung regards it as a CONTINUUM (from health to sickness).

VII. Narcissism - Kohut's Approach

In a way, Heinz Kohut took Jung a step further. He said that pathological narcissism is not the result of excessive narcissism, libido or aggression.

It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named: the Grandiose Exhibitionistic Self and the Idealized Parent Imago (see below). Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. These elements and the child's feelings regarding its parents (which are also painted by it with a brush of omnipotence and grandiosity) - coagulate and form these constructs.

The child's feelings towards its parents are reactions to their responses (affirmation, buffering, modulation or disapproval, punisment, even abuse).

These responses help maintain the self-structures. Without the appropriate responses, grandiosity, for instance, cannot be transformed into adult ambitions and ideals.

To Kohut, grandiosity and idealization were positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression.

In his "Chicago Lectures 1972-1976" he says:

"You see, the actual issue is really a simple one . . . a simple change in classical Freudian theory, which states that auto-eroticism develops into narcissism and that narcissism develops into object love ... there is a contrast and opposition between narcissism and object love. The forward movement toward maturation was toward object love.

The movement from object love toward narcissism is a backward regressive movement toward a fixation point. To my mind this viewpoint is a theory built into a nonscientific value judgment ... that has nothing to do with developmental psychology [pp.277-278].

Kohut's contention is nothing less than revolutionary. He says that narcissism (subject-love) and object-love coexist and interact throughout life. True, they wear different guises with age and maturation - but they always cohabitate.

Kohut: "It is not that the self-experiences are given up and replaced by... a more mature or developmentally more advanced experience of objects."

This dichotomy inevitably led to to a dichotomy of disorders. Kohut agreed with Freud that neuroses are conglomerates of defence mechanisms, formations, symptoms, and unconscious conflicts. He even did not object to identifying unresolved Oedipal conflicts (ungratified unconscious wishes and their objects) as the root of neuroses. But he identified a whole new class of disorders: the self-disorders. These were the result of the perturbed development of narcissism.

It was not a cosmetic or superficial distinction. Self disorders were the results of childhood traumas very much different to Freud's Oedipal, castration and other conflicts and fears. These are the traumas of the child either not being "seen" (an existence, a presence which are not affirmed by objects, especially the Primary Objects, the parents) - or being regarded as an object for gratification or abuse. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they are worth anything (lack of self-worth, or self-esteem). They suffer depressions, as neurotics do.

But the source of these depressions is existential (a gnawing sensation of emptiness) as opposed to the "guilty-conscious" depressions of neurotics.

Such depressions: "... are interrupted by rages because things are not going their way, because responses are not forthcoming in the way they expected and needed. Some of them may even search for conflict to relieve the pain and intense suffering of the poorly established self, the pain of the discontinuous, fragmenting, undercathected self of the child not seen or responded to as a unit of its own, not recognized as an independent self who wants to feel like somebody, who wants to go its own way (see Lecture 22).

They are individuals whose disorders can be understood and treated only by taking into consideration the formative experiences in childhood of the total body-mind-self and its self-object environment - for instance, the experiences of joy of the total self feeling confirmed, which leads to pride, self-esteem, zest, and initiative; or the experiences of shame,loss of vitality, deadness, and depression of the self who does not have the feeling of being included, welcomed, and enjoyed."

(From: The Preface to the "Chicago Lectures 1972-1976 of H. Kohut, by: Paul and Marian Tolpin)

One note: "Constructs" or "Structures" are permanent psychological patterns.

This is not to say that they do not change - rather, that they are capable only of slow change. Kohut and his Self-psychology disciples believed that the only viable constructs are comprised of self-selfobject experiences and that these structures are lifelong ones.

Melanie Klein belived more in archaic drives, splitting defenses and archaic internal objects and part objects. Winnicott (and Balint and other, mainly British researchers) as well as other ego-psychologists thought that only infantile drive wishes and hallucinated oneness with archaic objects qualify as structures.

VIII. Narcissism - Karen Horney's Contributions

Horney is one of the precursors of the "Object Relations" school of psychodynamics. She said that personality was shaped mostly by environmental issues, social or cultural. She believed that relationships with other humans in one's childhood determine both the shape and functioning of one's personality. She expanded the psychoanalytic repertoire. She added needs to drives. Where Freud believed in the exclusivity of the sex drive as an agent of transformation (later he added other drives) - Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on. She believed that the satisfaction of these needs or their frustration early in chlildhood were as important a determinant as any drive. Society was introduced through the parental door. Biology converged with social injunction to yield human values such the nurturance of children.

Horney's great contribution was the concept of anxiety. Freudian anxiety was a rather primitive mechanism, a reaction to imaginary threats arising from early childhood sexual conflicts. Horney argued convincingly that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance) - so they become anxious.

Defenses are developed to compensate for the intolerable and gradual realization that adults are human: capricious, arbitrary, unpredictable, non-dependable. Defenses provide both satisfaction and a sense of security. The problem still exists, even as the anxiety does, but they are "one stage removed". When the defenses are attacked or perceived to be attacked (such as in therapy) - anxiety is reawakened.

Karen B. Wallant in "Treating Addictions and the Alienated Self":

"The capacity to be alone develops out of the baby's ability to hold onto the internalization of his mother, even during her absences. It is not just an image of mother that he retains but also her loving devotion to him.

Thus, when alone, he can feel confident and secure as he continues to infuse himself with her love. The addict has had so few loving attachments in his life that when alone he is returned to his detached, alienated self.

This feeling-state can be compared to a young child's fear of monsters
So, the child learns to sacrifice a part of his autonomy, of WHO is is, in order to feel secure. Horney identified three NEUROTIC strategies:

submission, aggression and detachment. The choice of strategy determines the type of personality, or rather of NEUROTIC personality.

The submissive (or compliant) type is fake. He hides aggression beneath the facade of friendliness. The aggressive type is fake as well: at heart he is submissive. The detached neurotic withdraws from people.

This cannot be considered an adaptive strategy.

Horney's is an optimistic outlook.Because she believes biology is only ONE of the forces shaping our adulthood - culture and society being the predominant ones - she believes in reversibility and in the power of insight to heal. She believes that if an adult were to understand his problem (his anxiety) - he would be able to eliminate it altogether.

Other theoreticians are much more pessimistic and deteriministic.

They think that childhood trauma and abuse are pretty much impossible to reprogramm, let alone erase. Modern brain research tends both to support this sad view - and to offer some hope. The brain seems to be plastic. It is physically impressed with abuse and trauma. But no one knows when this "window of plasticity"

shuts. It is conceivable that this plasticity continues well into adulthood and that later "reprogramming" (by loving, caring, compassionate and empathic experiences) can remold the brain permanently. Yet others believe that the patient has to accept his disorder as a given and work AROUND it rather than attack it directly.

Our disorders were adaptive and helped us to function. Their removal may not always be wise or necessary to attain a full and satisfactory life. additionally, we should not all conform to a mold and experience life the same. Idiosyncracies are a good thing, both on the individual level and on the level of the species.

IX. The Issue of Separation and Individuation

It is by no means universally accepted that children go through a phase of separation from their parents and through the consequent individuation.

Most psychodynamic theories (especially Klein, Mahler) are virtually constructed upon this foundation. The child is considered to be merged with his parents until it differentiates itself (through object-relations). But researchers like Daniel Stern dispute this hypothesis. Based on many studies it appears that what seems intuitively right is not necessarily right. In "The Interpersonal World of the Infant" (1985) Stern seems to, inadvertently, support Kohut by concluding that children possess selves and are separated from their caregivers from the very start. In effect, he says that the picture of the child, as depicted by psychodynamic theories, is influenced by the way adults see children and childhood in retrospect. Adult disorders (for instance, the pathological need to merge) are attributed to children and to childhood.

This view is in stark contrast to the belief that children will accept any kind of parents (even abusive) because they depend on them for their self-definition.

Attachment to and dependence on significant others is the result of the non-separateness of the child, go the classical psychodynamic/object-relations theories. The Self is a construct (within a social context, some add), an assimilation of the oft-imitated and idealized parents plus the internalization of the way others perceive the child within social interactions. The self is, therefore, an internalized reflection, an immitation, a series of internalized idealizations. This sounds close to pathological narcissism. Perhaps pathological narcissism is really a matter of quantity rather than of quality.

X. Childhood Traumas and the Development of the Narcissistic Personality

Traumas are inevitable. They are an inseparable part of life. But in early childhood - especially in the formative years of infancy (ages 0 to 4 years) they acquire an ominous aura, an evil, irreversible meaning.

No matter how innocuous the event and the surrounding circumstances the child's vivid imagination is likely to embed it in the framework of a highly idiosyncratic horror story.

Parents sometimes have to go away due to medical or economic conditions.

They may be too preoocupied to stay attuned at all times to the child's emotional needs. The family unit itself may be disintegrating with looming divorce or separation. The values of the parent may stand in radical contrast to those of society.

To adults, such traumas are very different to abuse. Verbal and psychological-emotional abuse or neglect are judged by us to be more serious "offenses". But this distinction is lost on the child. To him, all traumas are of equal standing, though their severity may differ together with the permanence of their emotional outcomes. Moreover, such abuse and neglect could well be the result of circumstances beyond the abusive or negligent parent's control. A parent can be physically or mentally handicapped, for instance. But the child cannot see this as a mitigating circumstance because he cannot appreciate it or even plainly understand the causal linkage.

Where even the child itself can tell the difference is with physical and sexual abuse. Here is a cooperative effort at concealment, strong emotions of shame and guilt, repressed to the point of producing anxiety and "neurosis". Sometimes the child perceives even the injustice of the situation, though it rarely dares to express its views, lest it be abandoned by its abusers. This type of trauma which involves the child actively or passively is qualitatively different and is bound to yield long term effects such as dissociation or severe personality disorders.

These are violent, active traumas, not traumas by default and the reaction is bound to be violent and active. The child becomes a reflection of its dysfunctional family - it represses emotions, denies reality, resorts to violence and escapism, disintegrates.

One of the coping strategies is to withdraw inwards, to seek gratification from a secure, reliable and permanently-available source: from the Self.

The child, fearful of further rejection and abuse, refrains from further interaction. Instead, it builds its own kingdom of grandiose fantasies wherein it is always loved and self-sufficient. This is the narcissistic strategy which leads to the development of a narcissistic personality.

XI. The Dyfunctional Family

The family is the mainspring of support of every kind. It mobilizes psychological resources and alleviates emotional burdens. It allows for the sharing of tasks, provides material supplies coupled with cognitive training. It is the prime socialization agent and encourages the absorption of information, most of it useful and adaptive.

This division of labour between parents and children is vital both to development and to proper adaptation. The child must feel, in a functional family, that he can share his experiences without being defensive and that the feedback that he is likely to get will be open and unbiased. The only "bias" acceptable (because it is consistent with constant outside feedback) is the set of beliefs, values and goals that will finally be internalized via imitation and unconscious identification. So, the family is the first and the most important source of identity and of emotional support. It is a greenhouse wherein a child feels loved, accepted and secured - the prerequisites for the development of personal resources. On the material level, the family should provide the basic necessities (and, preferably, beyond), physical care and protection and refuge and shelter during crises.

The role of the mother (the Primary Object) has been often discussed and dissected. The father's part is mostly neglected, even in professional literature. However, recent research demonstrates his importance to the orderly and healthy development of the child.

He participates in the day to day care, is an intellectual catalyst, who encourages the child to develop his interests and to satisfy his curiosity through the manipulation of various instruments and games. He is a source of authority and discipline, a boundary setter, enforcing and encouraging positive behaviours and eliminating negative ones. He also provides emotional support and economic security, thus stabilizing the family unit.

Finally, he is the prime source of masculine orientation and identification to the male child - and gives warmth and love as a male to his daughter, without exceeding the socially permissible limits.

We can safely say that the Narcissist's family is as severely disturbed as he is. He is nothing but a reflection of its dysfunction. One or more (usually, many more) of the functions aforementioned are improperly carried out. The narcissist is the "emergent" pathology of his family, he embodies this pathology.

In a dysfunctional family, two important mechanisms operate:

First, the mechanism of self-deception: "I do have a relationship with my parents. It is my fault - the fault of my emotions, sensations, aggressions and passions - that this relationship is not working. It is, therefore, my responsibility to make amends. I will write a play in which I am both loved and punished. In this play, I will allocate roles to myself and to my parents. This way, everything will be fine and we will all be happy."

Second is the mechanism of over-valuation and devaluation. The dual roles of sadist and punished masochist (Superego and Ego in the psychoanalytic model), parent and child - permeate, then invade and then pervade all the interactions that a Narcissist has with his fellow humans.

He experiences a reversal of roles as his relationships progress.

At the beginning of every relationship he is the child in need of attention, approval and admiration. He becomes dependent.

Then, at the first sign of disapproval (real or imaginary), he is revealed as an avowed sadist, punishing and inflicting pain.

XII. Narcissism - Otto Kernberg

Another school of psychology is represented by Otto Kernberg (1975, 1984, 1987).

Kernberg is a senior member of the "Object Relations" school in Psychology (Kohut, Kernberg, Klein, Winnicott).

Kernberg disagrees with Freud. He regards the division between an Object Libido (=energy directed at Objects, people in the immediate vicinity of the infant and who are meaningful to him) and a Narcissistic Libido (=energy directed at the Self as the most immediate and satisfying Object), which precedes it - as artificial.

Whether a Child develops a normal or a pathological form of Narcissism depends on the relations between the representations of the Self (=roughly, the image of the Self that he forms in his mind) and the representations of Objects (=roughly, the images of the Objects that he forms in his mind, based on all the information available to him, including emotional data). It is also dependent on the relationship between the representations of the Self and real, external, "objective"

Objects. Add to this instinctual conflicts related both to the Libido and to aggression (these very strong emotions give rise to strong conflicts in the child) and a comprehensive explanation concerning the formation of pathological Narcissism emerges.

Kernberg's concept of Self is closely related to Freud's concept of Ego.

The Self is dependent upon the unconscious, which exerts a constant influence on all mental functions. Pathological Narcissism, therefore, reflects a libidinal investment in a pathologically structured Self and not in a normal, integrative structure of the Self. The Narcissist suffers from a Self, which is devalued or fixated on aggression.

All object relations of such a Self are distorted: it detaches these relations from the real Objects (because they often hurt), it dissociates, represses, or projects them unto other objects. Narcissism is not merely a fixation on an early developmental stage. It is not confined to the failure to develop intra-psychic structures. It is an active, libidinal investment in a deformed structure of the Self.

XIII. The Narcissist and his Family - An Integrative Framework

"For very young children, self-esteem is probably best thought to consist of deep feelings of being loved, accepted, and valued by significant others rather than of feelings derived from evaluating oneself against some external criteria, as in the case of older children. Indeed, the only criterion appropriate for accepting and loving a newborn or infant is that he or she has been born. The unconditional love and acceptance experienced in the first year or two of life lay the foundation for later self-esteem, and probably make it possible for the preschooler and older child to withstand occasional criticism and negative evaluations that usually accompany socialization into the larger community.

As children grow beyond the preschool years, the larger society imposes criteria and conditions upon love and acceptance. If the very early feelings of love and acceptance are deep enough, the child can most likely weather the rebuffs and scoldings of the later years without undue debilitation.

With increasing age, however, children begin to internalize criteria of self-worth and a sense of the standards to be attained on the criteria from the larger community they observe and in which they are beginning to participate. The issue of criteria of self-esteem is examined more closely below.

Cassidy's (1988) study of the relationship between self-esteem at age five and six years and the quality of early mother-child attachment supports Bowlby's theory that construction of the self is derived from early daily experience with attachment figures. The results of the study support Bowlby's conception of the process through which continuity in development occurs, and of the way early child-mother attachment continues to influence the child's conception and estimation of the self across many years. The working models of the self derived from early mother-child inter-action organize and help mold the child's environment "by seeking particular kinds of people and by eliciting particular behavior from them" (Cassidy, 1988, p.133). Cassidy points out that very young children have few means of learning about themselves other than through experience with attachment figures.

She suggests that if infants are valued and given comfort when required, they come to feel valuable; conversely, if they are neglected or rejected, they come to feel worthless and of little value.

In an examination of developmental considerations, Bednar, Wells, and Peterson (1989) suggest that feelings of competence and the self-esteem associated with them are enhanced in children when their parents provide an optimum mixture of acceptance, affection, rational limits and controls, and high expectations. In a similar way, teachers are likely to engender positive feelings when they provide such a combination of acceptance, limits, and meaningful and realistic expectations concerning behavior and effort (Lamborn et al., 1991). Similarly, teachers can provide contexts for such an optimum mixture of acceptance, limits, and meaningful effort in the course of project work as described by Katz and Chard (1989)."

(Distinctions between Self-Esteem and Narcissism: Implications for Practice - ERIC database)

Kohut, as we said, regarded Narcissism as the final product of the failing efforts of parents to cope with the needs of the child to idealize and to be grandiose (for instance, to be omnipotent).

Idealization is an important developmental path leading to Narcissism.

The child merges the idealized aspects of the images of the parent (Imago in Kohut's terminology) with those parts of the image of the parent which are cathected (infused) with object libido (=in which the child invests the energy that he reserves to Objects). This exerts a great and important influence on the re-internalization processes (=the processes in which the child re-introduced the Objects and their images into his mind) which are right for each of the successive phases.

Through these processes, two permanent nuclei of the personality are constructed:

a. The basic, neutralizing texture of the psyche and b. The ideal Superego

Both of them are characterized by an invested instinctual Narcissistic cathexis (=invested energy of self-love which is instinctual in its nature).

At first, the child idealizes his parents. As he grows, he begins to notice their shortcomings and vices. He withdraws part of the idealizing libido from the images of the parents, which is conducive to the natural development of the Superego. The Narcissistic sector in the child's psyche remains vulnerable throughout its development. This is largely true until the Child re-internalizes the ideal parent image.

Also, the very construction of the mental apparatus can be tampered with by traumatic deficiencies and by object losses right through the Oedipal period (and even in latency and in adolescence).

The same effect can be attributed to traumatic disappointment by objects.

Disturbances leading to the formation of NPD can be thus grouped thus:

1. Very early disturbances in the relationship with an ideal object.

These lead to structural weakness of the personality which develops a deficient and/or dysfunctional stimuli filtering mechanism. The ability of the individual to maintain a basic Narcissistic homeostasis of the personality is damaged.

Such a person will suffer from diffusive Narcissistic vulnerability.

2. A disturbance occurring later in life - but still pre-Oedipally -

will effect the pre-Oedipal formation of the basic fabric of the control, channeling and neutralizing of drives and urges. The nature of the disturbance has to be a traumatic encounter with the ideal object (such as a major disappointment). The symptomatic manifestation of this structural defect is the propensity to re - sexualize drive derivatives and internal and external conflicts either in the form of fantasies or in the form of deviant acts.

3. A disturbance formed in the Oedipal or even in the early latent phases - inhibits the completion of the Superego idealization. This is especially true of a disappointment related to an ideal object of the late Pre-Oedipal and the Oedipal stages, where the partly idealized external parallel of the newly internalized object is traumatically destroyed.

Such a person will possess a set of values and standards - but he will forever look for ideal external figures from whom he will aspire to derive the affirmation and the leadership that his insufficiently idealized Superego cannot supply.

Everyone agrees that a loss (real or perceived) at a critical junction in the psychological development of the Child - forces him to refer to himself for nurturing and for gratification. The Child ceases to trust others and his ability to develop object love or to idealize is hampered. He is constantly shadowed by the feeling that only he can satisfy his emotional needs and he regards.

The Narcissist is born into a dysfunctional family. It is characterized by massive denials, both internal ("you do not have a real problem, you are only pretending") and external ("you must never tell the secrets of the family to anyone"). The whole family unit suffers from an affective dysfunction. It leads to affective and other personality disorders displayed by all the members of the family and ranging from obsessive - compulsive disorders to hypochondriasis and depression.

Such families are reclusive and autarkic. They actively reject and encourage the rejection of social contacts.

This inevitably leads to defective or partial socialization and differentiation and to problems with sexual identity.

This attitude is sometimes applied even to other members of the extended family. The nuclear family feels emotionally or financially deprived or threatened by them. It reacts with envy, rejection, self-isolation and rage.

Constant aggression and violence are permanent features of such families.

The violence can be from verbal (degradation, humiliation) and up to severe cases of psychological, physical and sexual abuse.

Trying to rationalize and intellectualize its unique position and to justify it, the family resorts to emphasizing logic, cost effectiveness, and calculations of feasibility. It is a transactional approach to life and it regards knowledge as an expression of superiority and as an advantage.

These families encourage excellence - mainly cerebral and academic - but only as means to an end. The end is usually highly Narcissistic ("to be famous/rich/to live well, etc.").

Some Narcissists react by creatively escaping into rich, imagined worlds in which they exercise total physical and emotional control over their environment. But all of them react by diverting libido, which should have been object-oriented to their own Self.

The source of all the Narcissist's problems is the foreboding sensation that human relationships invariably end in humiliation, betrayal and abandonment.

This belief is embedded in them during their very early childhood by their parents and by their experiences with peers.

But the Narcissist always generalizes. To him, any emotional interaction and any interaction with an emotional component is bound to end this way.

Getting attached to a place, a job, an asset, an idea, an initiative, a business, or a pleasure is bound to end as badly as getting attached to a human being. This is why the Narcissist avoids intimacy, real friendships, love, other emotions, commitment, attachment, dedication, perseverance, planning, emotional or other investment. Narcissists are unable to empathize and have little morale or conscience (which are only meaningful if there is a future to consider). They never develope a sense of security, or pleasure.

The Narcissist emotionally invests only in things which he feels that he is in full, unmitigated control of: himself and, at times, not even that.

XIV. Narcissism - Cultural Considerations

The ethnopsychologist George Devereux ("Basic Problems of Ethnopsychiatry", University of Chicago Press, 1980) suggested to divide the unconscious into the id (the part that was always instinctual and unconscious) and the "ethnic unconscious" (repressed material that was once conscious). The latter includes all our defence mechanisms and most of the superego.

Culture dictates what is to be repressed. Mental illness is either idiosyncratic (cultural directives are not followed and the individual is unique and schizophrenic) - or conformist, abiding by the cultural dictates of what is allowed and disallowed.

Our culture, according to Christopher Lasch teaches us to withdraw into ourselves when we are confronted with stressful situations. It is a vicious circle. One of the main stressors of modern society is alienation and a pervasive sense of isolation. The solution our culture offers us - to further withdraw - only exacerbates the problem.

Richard Sennett expounded on this theme in "The Fall of Public Man: On the Social Psychology of Capitalism" (Vintage Books, 1978). One of the chapters in Devereux's aforementioned tome is entitled "Schizophrenia: An Ethnic Psychosis, or Schizophrenia without Tears". To him, the whole USA is afflicted by what came later to be called a "schizoid disorder".

C. Fred Alford (in "Narcissism: Socrates, the Frankfurt School, and Psychoanalytic Theory", Yale University Press, 1988) enumerates the symptoms:

"...withdrawal, emotional aloofness, hyporeactivity (emotional flatness), sex without emotional involvement, segmentation and partial involvement (lack of interest and commitment to things outside oneself), fixation on oral-stage issues, regression, infantilism and depersonalization. These, of course, are many of the same designations that Lasch employs to describe the culture of narcissism. Thus, it appears, that it is not misleading to equate narcissism with schizoid disorder." (page 19).

XV. Narcissism and Schizoid Disorders - Melanie Klein

The first to seriously consider the similarity between Narcissistic and Schizoid pathologies was Melanie Klein. She broke with Freud in that she believed that we are born with a fragile, easily fragmentable, weak and unintegrated ego. The most primordial human fear is the fear of disintegration (death), according to Klein. Thus, the infant is forced to employ primitive defence mechanisms such as splitting, projection and introjection to cope with this fear (actually, with the result of aggression generated by the ego). The ego splits and projects this part (death, disintegration, aggression). It does the same with the life-related, constructive, integrative part of itself. The result of all these dynamics is to view the world as either "good" (satisfying, complying, responding, gratifying) - or bad (frustrating).

Klein called it the good and the bad "breasts". The child then proceeds to introject (internalize and assimilate) the good object while keeping out (=defending against) the bad objects. The good object becomes the nucleus of the forming ego. The bad object is felt as fragmented. But it is not gone, it is there.

This (the fact that the bad object is "out there", persecutory, threatening) - gives rise to the first schizoid defence mechanisms, foremost amongst them the mechanism of "projective identification" (so often employed by Narcissists). The infant projects parts of himself (his organs, his behaviours, his traits) unto the bad object. This is the Kleinian "paranoid-schizoid position". The ego is split. This is terrifying but it allows the baby to make a clear distinction between the "good object" (inside him) and the "bad object" (out there, split from him).

If this phase is not transcended the individual develops schizophrenia and a fragmentation of the self.

Around the third or fourth month of life, the infant realizes that the good and the bad objects are really facets of one and the same object.

He develops the depressive position. This depression (Klein believes that the two positions continue throughout life) is a reaction of fear and anxiety.

The infant feels guilty (at his own rage), anxious (lest his aggression harm the object and eliminate the source of good things). He experiences loss (of his own omnipotence since the object is outside his self). The infant wishes to erase the results of his own aggression by "making the object whole again". By recognizing the wholeness of other objects - the infant comes to realize and to experience his own wholeness. The ego re-integrates.

But the transition from the paranoid-schizoid position to the depressive one is by no means smooth and assured. Excess anxiety and envy can delay it or prevent it altogether. Envy seeks to destroy all good objects, so that others don'
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