CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

NARCISSISM: CAUSES, TYPES, TREATMENT FOR THE

NOVICE THERAPIST

A thesis submitted in partial satisfaction of the requirements for the degree of Master of Arts in

Educational Psychology

by

Donna Gardner Essert

May 1985

The Thesis of Donna Gardner Essert is approved:

Dr. Loren Grey

Dr. Luis Rubal ava

-----

California State University, Northridge

; ;

DEDICATION

The whole purpose of therapy is to help the

individual face the truth about himself because the

truth will make him free to love himself and others in

more wholesome ways. This thesis is dedicated to Truth,

Love, and Freedom.

iii

ACKNOWLEDGEMENTS

The members of my thesis committee turned my life

around. They gave me the theoretical knowledge in the

class room that I had sought si nee I was twelve. Under

the influence of their wisdom, patience, and kindness, I

was able to grow, not only academically, but personally.

To Dr. Stanley Charnof sky, Chair of my thesis

committee, Dr. Loren Grey, leader of my practicum, and

Dr. Luis Rubalcava, my committee members and the

professors of my most significant courses, I wish to

express my most grateful appreciation and thanks.

I also wish to thank my husband, Ray, for his love,

for sending me back to school, and for supporting me for

all those years while I finished my edu cation. I owe so

much to my two daughters for their contributions to the

final form of this thesis: I wish to thank Diane for

her constructive, firm, and knowledgeable editing, and

for her support whenever I faltered. Lynne deserves

many kudos for her patience in typing, retyping, and

editing this thesis, and for all her ideas and

assistance in writing and rewriting it. I wish to thank

my son, Kirk, for his understanding and support while I

suffered through the strain and tension of completing

this task.

iv

TABLE OF CONTENTS

DEDICATION iii

ACKNOWLEDGEMENTS iv

TABLE OF CONTENTS v

ABSTRACT vii

INTRODUCTION 1 Objective 4 Limitations to the Study 6 Definition of Terms 7 Brief History of Narcissism 11

REVIEW OF THE LITERATURE 14

DEFINITION OF NARCISSISM AS A CHARACTER DISORDER 29 Narcissistic Injury 33 Etiology of Narcissism 34 Instincts 34 Structure of the Personality According to

Freud 35 Function and Purpose of the Id 36 Splitting Process 37 Function and Purpose of the Ego 40 Function and Purpose of the Superego 42 Freud's Oral Stage 45 Freud's Anal Stage 48 Rapprochement Phase 50 Phallic Stage 52 Oedipal Complex 52 Introduction to Defense Mechanisms 57 Repression as a Freudian Defense Mechanism 64 Projection as a Freudian Defense Mechanism 65 Reaction Formation as a Freudian Defense

Mechanism 65 Regression as a Freudian Defense Mechanism 66 Additional Defense Mechanisms 67 Splitting 68 Narcissistic Rage 70 Entitlement and Grandiosity as Defense

Mechanisms 75 Abandonment Depression 79 Depression 80 Abandonment and Engulfment 81 Oral Addictions of the Narcissist 83

v

TYPES OF NARCISSISM 86 Definition of "Positive" or "Healthy"

Narcissism 86 Range of Narcissistic Character Disorders 90 Neurotic Narcissistic Personality 90 Phallic Narcissistic Personality 92 Narcissistic Character 97 Narcissistic Investment in Thinking 99 Borderline Personality 99 Normal Suppliant Personality Disorder 102 Schizophrenic Personality 105 Psychopathic Personality 106 The Paranoid Personality 109

THERAPEUTIC PROCESS AND TECHNIQUES 111 Goals of Therapy 111 Pragmatic Delineation of Therapeutic

Process 112 Establishing the Therapeutic Alliance 113 Being Prepared for the Use of Defense

Mechanisms 113 Self-Control Critical to Therapist 114 Narcissist's Manipulation of Therapist 115 Counter-Transference 115 Tracking Affect: Gentle Confrontation 116 Re-Parenting 117 Role-Reversal 118 Gestalt Therapy 119 Bioenergics 120 Constructive Release of Rage 121 Group Therapy 122 Other Techniques 123 Narcissism and Child Therapy 125 Therapeutic Discrimination 126 The Final Step: Concluding Therapy 126 Conclusion 128

BIBLIOGRAPHY FOR NARCISSISM 130

vi

ABSTRACT

NARCISSISM: CAUSES, TYPES, TREATMENT

FOR THE

NOVICE THERAPIST

by

Donna Gardner Essert

Master of Arts in Educational Psychology

An emotional trauma that happens to the young child

at any age from birth to four or five years causes

Narcissistic injury if other factors in the

mother-infant relationship are detrimental to the

welfare of the infant. Of the factors which can cause

such a Narcissistic injury to the infant, the most

significant is the presence of an unhealthy form of the

Narcissistic character disorder in the mother. Should

such an injury occur, the infant or child becomes

fixated at the developmental stage during which the

injury occurred. The etiology of Narcissism, then, must

be understood within the context of Freudian

vii

developmental stages, both becau~e Narcissism can

develop during any stage and because the later

expression of the child's Narcissism will reflect the

stage at which the injury occurred.

The Narcissistic character traits range from the

heal thy and normal to the severely incapacitating and

pathological; these traits are referred to in the

following fashion in this thesis: Healthy, Neurotic,

Phallic, Narcissistic, Narcissistic Character,

Narcissistic Investment in Thinking, the Borderline

·Personality, the Normal Suppliant Personality,

Schizophrenic Personality, Pathological Personality, and

Paranoid Personality.

Narcissism can be treated with an eclectic modality

including psychoanalysis, Rogerian Humanism,

Transactional Analysis, Behavior Modification, Family

Systems, Gestalt, and others. Successful treatment

relies upon the flexibility, skill, and alertness of the

clinician. The use and combination of this wide range

of techniques is essential if the clinician is to help

resolve the problems of the Narcissist and to help the

patient to become an autonomous, differentiated,

functioning individual.

viii

__ .-"'--

CHAPTER I

INTRODUCTION

This thesis offers a brief introduction to

Narcissism as a character disorder and to the range of

its attendant symptoms for the graduating therapist.

Since Narcissism is becoming more prevalent in this

society, it is gaining attention as another classic

disorder. Consequently, it is important that the

therapist just starting his practice be alerted to its

symptoms in order to be able to diagnose Narcissism

accurately and to plan an effective course of treatment

for the clients who manifest its symptoms. Although

Freud was one of the first psychiatrists to recognize

and define Narcissism, many other psychiatrists have

broadened our knowledge of it in recent years and their

views will be included in this paper.

To explain both the development and nature of

Narcissism as a personality disorder and its nature, it

will be necessary to review Freud's definitions of the

parts of the personality, their development, their

interactions, and the defense mechanisms which are

generated when these interactions are imbalanced.

According to Freud, one of the causes of Narcissism as a

character disorder is the lack of an integrated

development of all three parts of the personality--i.e.,

1

the id, the ego, and the superego. Integration of these

three elements is critical to a healthy state of mind in

the development of the child. If a trauma, or traumas,

interrupts the synthesis of the id, ego, and superego

before they are well-integrated, the resultant fixation

created during that developmental stage will generate

many character disorders, including Narcissism. The

characteristics of Narcissistic behavior are also

present in other character disorders and are so similar

that they are often cl caked by them. Freud himself

said:

Now those engaged in psycho-analytic

observation were struck by the fact that isolated

features of the Narcissistic attitude are found in

many people who are characterized by other

aberrations--for instance, as Sadger states, in

homosexuals.... (Freud 191 4, 1 04)

Freud included among these aberrations hypochondria,

homosexuality, sado-masochism, sch izoph reni a, neurosis,

and paranoia. He also found these traits in such

healthy people as those in love or in parents' attitudes

toward their children.

Since this configuration of Narcissism with other

character disorders can confuse the therapist, it may

cause him to make multiple diagnoses and possibly to

prescribe the wrong therapy. It is, therefore,

necessary to be aware of the symptoms of Narcissism.

2

Consequently, I will discuss causes, specific traits,

and some of the behavior patterns relating to Narcissism

in this paper so that the beginning therapist will be

able to identify its symptoms. I will also describe the

range of types of Narcissists to facilitate recognition

of them. Finally, a few suggestions for treatment will

be made.

NOTE: For the sake of ease in reading and writing

this paper, "women's lib" acknowledged, but

notwithstanding, I will use the generic term for all

mankind, "he," not "s/he," throughout this paper.

3

Objective

Busy clinicians in active practice usually do not

have the extra time to research Narcissism, or any other

character disorder, as thoroughly as I have. This

thesis delineates my research into Narcissism and

provides easily accessible information on the

background, causes, symptoms, and treatment of

Narcissism based upon the Freudian psychoanalytic point

of view. It also describes pertinent treatment

modalities that would be useful to the practicing novice

therapist in his first encounter with the Narcissistic

personality. It provides a knowledgeable foundation of

the ramifications of this disorder, not only in the life

of the Narcissist and in his relationships, but also as

he presents his problems to the clinician in therapy.

This selective knowledge would provide the clinician

with more confidence and discrimination in treating a

Narcissist for this disorder. Although many books are

written exploiting each theoretician's point of view,

not all are relevant to practical appl ica ti on in the

therapeutical setting, nor do they delineate any

techniques for treatment. I have extracted the most

important major considerations of theoretical models of

the etiology of Narcissism and its range of behavioral

characteristics in an effort to save the clinician

research time. I offer the clinician ways of

4

identifying as well as methods of treating the

Narcissistic components of the client's disorder. The

therapist who is in urgent need of finding methods with

which to deal with disturbed clients will find the

information in this thesis to be succinct, helpful, and

valuable.

5

Limitations to the Study

This thesis derives from the unavailability of

subjects for experimental research. However, it

provides a valuable synopsis of the pertinent knowledge

the therapist will need in encountering Narcissistic

clients in his practice. It summarizes the etiology of

the disorder itself, ~numerates the character types seen

in the therapeutical situation, and offers suggestions

for treatment.

The data and information compiled in this thesis

are basically gleaned from library resources. It is,

therefore, a 1 i br ary study rather than experimental or

experiential.

6

Definition of Terms

The definitions below are arranged in the order in

which the terms appear in the body of this thesis. This

arrangement is intended to facilitate the reader's

understanding of the material •

Narcissism

Object

• • . love of, or sexual desire for, one's

own body; can be described "as an

interest in (or focus on) the self.

Narcissistic personalities have a very

intense interest in their 'selves' --so

much that they often can see others only

as extensions of themselves, or as

existing for the purpose of serving

themselves. They cannot take themselves

for granted; they constantly need to

confirm their 'selves'. 11 (Nelson 1977,

17)

••• in psychoanalytic theory, or

object-relations theory: the

nomenclature for any person, place, or

thing that is not the individual •

• • . one of the three divisions of the

psyche in psychoanalytic theory that is

completely unconscious and is the source

7

Superego

Instinct

Cathexis

Anticathexis

Narcissistic

Injury

of psychic energy derived from

instinctual needs and drives •

••. one of the three divisions of the

psyche in psychoanalytic theory which is

the conscious self that one calls "I", as

di sti ngu i shed from another -self or the

world.

••• one of the three divisions of the

psyche in psychoanalytic theory that is

only partly conscious, represents

internalization of parental conscience

and the rules of society. It functions

to reward and punish through a system of

moral attitudes, conscience, and a sense

of guilt .

••• a quantum of psychic energy.

••. the investment of libidinal energy in

a person, object, idea, or activity

(bonding) .

• . • the release of libidinal energy, or

the breaking of the bond between the

individual and another per son, object,

idea, or activity, usually accompanied by

a negative emotional reaction .

••• trauma to the idealized self, or a

trauma that is phase-inappropriate at

certain developmental stages.

8

Alienation

Splitting

Autonomy

Defense

Mechanisms

Projection

Repression

Reaction

Formation

••• lack of recognition of the parts of

the self.

•.• the separation of the whole self into

parts, some of which become repressed

into unconsciousness •

••. independence, self rule.

••. psychological traits and responses to

feeling attacked or anxious.

••• a defense mechanism by which internal

neurotic or moral anxieties are

transformed into reality anxiety •

• • • occurs when an object-choice that

arouses undue alarm is forced out of

consciousness by an anticathexis .

••• replacement in consciousness of an

anxiety-producing impulse or feeling by

its opposite.

Withdrawal •.. retreat into the self, removing

oneself from relationships.

Engulfment ••• fear of being completely dominated by

another individual.

Rapprochement ••• stage of development when the toddler

between the ages of 2 to 5 years becomes

aware of his separateness from his

mother, with a resultant sense of loss to

the child in which conflict is generated

between child and mother.

9

Entitlement

Grandiosity

••• exaggerated sense that what is due to

one should be automatically granted to

one.

••• characterized by affectation of

grandeur or splendor or by absurd

exaggeration.

1 0

Brief History of Narcissism

The classical tale of Narcissus will show how the

name of the character disorder derived from the

symbolism of the myth.

According to the Greek myth, Narcissus was a

handsome youth with whom the nymph Echo fell in

love. Echo had been deprived of speech by the wife

of Zeus and could only repeat the last syllables of

words she heard. Unable to express her love for

Narcissus, she was spurned by him and died of a

broken heart. The gods then punished him for his

callous treatment of Echo, making him fall in love

with his own image. It had been predicted by the

seer Tiresias that Narcissus would live until he

saw himself. To save his 1 ife, his mother removed

all mirrors from his presence. One day, Narcissus

saw his reflection in a pool of water. He became

passionately enamored of his image and refused to

leave the spot. He was thought to have taken root

there (became fixated) and died of starvation. The

beautiful flower, narcissus, sprang up at the spot

and even now likes to grow near springs.

It is significant that Narcissus fell in love

with his image only after he rejected the love of

Echo. Falling ·in love with one's image--that is,

becoming Narcissistic--is seen in the myth as a

11

form of punishment for being incapable of loving,

but let's take the legend one step further. Who is

Echo? She could be our own voice coming back to

ourselves. Thus, if Narcissus could say 11 I love

you", Echo would repeat these words and Narcissus

would feel loved. The inability to say those words

identifies the Narcissist. Having withdrawn their

libido from people in the world, Narcissists are

condemned to fall in love with their image--that

is, direct their libido to their ego.

possible interpretation is Another

interesting. In rejecting Echo, Narcissus also

rejected his own voice. Now, the voice is the

expression of one's inner being, one's bodily self

as opposed to one's surface appearance. The

quality of the voice is determined by the resonance

of the air in the inner passages and chambers. The

word "personality" reflects this idea. Persona

means that by his sound you can know the person,

and according to this interpretation, Narcissus

denied his inner being in favor of his appearance.

That is a typical maneuver of Narcissists. Of what

importance was the prediction by the seer? Being a

wise person, seers understand the dangers of too

much self-love at the expense of others, and that

beauty can be a curse instead of a blessing.

(Lowen 1983, 26, 27)

12

In other words, the more Narcissistic one becomes,

the more self-centered one is and the less one is able

to love others.

13

CHAPTER II

REVIEW OF THE LITERATURE

Since this is a library research project, Chapter

III, which is the body of this work, contains the most

important information selected from the pertinent

literature as it related to the topic of Narcissism as a

character disorder. I incorporated the work of most of

the major clinicians there. In general, practically all

of the theorists that I read agree with the foundation

Freud perceived as to etiology, behavioral

characteristics, personality types, method and mode of

treatment (psychoanalysis) of Narcissism. However, only

Masterson and one or two other psychiatrists offered

realistic practical instructions on how to handle the

Narcissist in treatment. This would be imperative

information to know when one is just beginning a career

as a therapist. Even though it is assumed that the

novice therapist will learn techniques from his

supervisors and from experience, I believe it is helpful

to be aware of the difficulties that will be encountered

in treating a Narcissistic patient and to have some

outline of how to start therapy with such a client.

Having discovered these ideas in my research, I am

sharing them with others through this thesis.

1.4

Since everyone is unique, with his own original

contribution to make to society, every theorist I

researched had something different to add to the

existing knowledge of the structure of the Narcissistic

character disorder. I have added a brief summary of

their general viewpoints, with a sample of their greatly

valued contributions. If I did not include them in the

body of my work, it was because they did not fit the

structure of my presentation. They are offered here to

give the reader a wider perspective on the apparently

unending ramifications and innuendo that are involved in

this personality problem. I hope the reader will have

time to pursue the research on this fascinating topic

with the aid of the additional literature.

In Narcissus and Oedipus, Y.i.9t_()__r_~? __ HamJJ_to_n offers

her own theoretical views, some new ideas, and her

critique of other well-known theorists in the field:

I draw a fundamental distinction between those

theories of development which proceed from a

primary state of isolation or union, in which

autonomy is non-existent (let us name these "unity"

theorists) , and, on the other hand, those which

postulate an original diversity or duality.

Among the u_l'lJty ___ theories, I inc! ude Freud 1 s

theory of pr ime3ry Narcissism, Mahler 1 s concept of

normal primary autism, and other Freudian and

object-relations theories which postulate a

15

primitive state of fusion or merger between mother

and infant. Kohut's work on Narcissism and his

-66ricept of the "self-object" fall in this category.

When development originates out of a state of

oneness, the notions of autism and of fusion meet,

as they did in Freud's theory. In either the

autistic or the fused state, there is no awareness

of distinction. Nevertheless, there is an

important difference in that fusion entails

relationship of some kind, and autism does not.

On the diversity side, I place attachment

theorists, some object-relations theorists, such as

Balint, Klein and (at times) Winnicott, and all

interactional theorists. Some attachment and

object-relations theorists conceptualize the early

relationship in both active and passive modes.

Winnicott, for instance, sometimes talks of the

mother-infant unit as if the infant were incapable

of initiative and, at other times, particularly in

his later works, he describes the "overlap" of two

"play" areas between mother and infant in

interactional terms.

The interactionalists view the neonate as

distinct ·from the mother and capable of activating

and contributing to the quality of the relationship

which develops between them. Ainsworth, Bell,

Bruner, Bower, Brazelton, Klaus, Rosenblum, et al.,

16

seek to redress the imbalance in the psychological

literature in which the infant is viewed as a

passive organism, which responds to maternal and

environmental factors and is subject to internal

pressures. In a recent volume, The Effect of the

Infant on the Caregiver, Lewis and Rosenblum focus

attention " ••• on the impact of the infant as a

source of the information, refutation and indeed

even the malevolent distortion of the caregiver's

behavior" (Lewis and Rosenblum 1974, ix). To

describe these reciprocities, the interactionalist

invokes one of the central tenets of systems or

information theory: elements of behavior only

convey information or have meaning insofar as they

occur in a context. Without context, there is no

communication •••. Crying, as every mother knows, has

a variety of meanings. The context helps to

designate the cry as an initiator or as a response

in the ongoing exchange between the mother and the

infant which, at this stage of infancy, never

ceases, even when the mother is absent.

Nevertheless, as Brazelton, et al., observe, there

remains a problem for the interactionalist to

account for the evolution of the individual and to

di sti ngu ish the relative contributions of each

member of the dyad (Brazelton, et al., 1974, 75)

17 9 •

In the field of psychoanalysis, the Kleinian

school has been instrumental in bringing attention

to the infant 1 s contribution to the earliest

obj ect-rel a ti onshi p. In terms of the tricky issue

of the evolution of the individual, the Kleinians

would seem to hold a considerable theoretical

advantage. From the Kl ei ni an point of view, the

infant is an individual at birth, with complex

mental structures. "Splitting" is the dominant

mental operation which follows the intra-uterine

state of complete union be tween mother and fetus.

Splitting is the beginning of the long-term process

of separation which is precipitated by birth. It

seems to me that Melanie Klein, like the

interactional psychologists of today, set out to

redress an imbalance in the psychoanalytic

1 i terature on infant development in which the

infant was perceived as a passive, mindless

creature, unrelated to the world about him. The

Kl ei ni an group cite recent psy chol ogi cal research

as confirmatory of their views on the infant 1 s

contributions to his relationships and his complex

mentation. However, they can be cri ti ci sed for

their belief in primitive mental structures which

are not confirmed by the findings of research on

infant cognition, for their underestimation of the

maternal contribution and for the predominantly

18

negative quality with which the earliest

object-relationship is described. To build her

picture of the infant as a unique individual

capable of thinking and of constructing his

relationship with his mother, Klein ignored the

child's interactional context and his powers of

cognition, perception and problem-solving outside

the realm of "phantasy."

Thus the diversity of theories of infant

development fall into two groups depending upon the

emphasis they place on the positive or negative

aspects of mother-infant relations. In the

interactional view, not only does the mother seek

to sy nch roni se with her infant, the infant also

wishes to link harmoniously with his care-giver.

In the Kleinian view, the young infant's tie to the

mother is suffused with anxiety, pain, envy, greed

and destructiveness. Linking is secondary and is

associated with reparative wishes towards the

mother for damage done to her. (Hamil ton 1982,

30-31)

.in looking at Klein's work, although she agrees

with Freud's theory of primary Narcissism, she prefers

to emphasize his theory of the life and death instinct

as it relates to the whole field of Narcissism because

she believes that this factor has been overlooked in the

field. For Klein, the neonate is born with its own

19

conflicts because the death instinct is activated at the

moment of birth, and the rest of the human being's

lifespan is spent in overcoming the internal frustration

caused by the opposing pulls of each of these

contrasting instincts. The frustration engendered by

this internal clash causes the child to become

aggressive. In the struggle to develop an equilibrium

between the antithetical drives, Klein states,

••. the successful outcome of such devices

(aggressive tactics) brings a state of harmony and

oneness, and these states are threatened by

endogenous and exogenous factors. And si nee the

instincts are inborn, we have to conclude that some

form of conflict exists from the beginning of life.

We claim that the orientation towards

psychological problems which follows from the

acceptance fo the primary instincts of life and

death is of inestimable value in our work. Our

evaluation of the conflicts in social relations is

notably influenced when we approach them against

the dynamic background of a perpetual intrapsychic

struggle between life and death. We hear a great

deal in our work about wrongs done to our patients

by their parents, wives, husbands, partners in

work, and so on, and their complaints often seem

truthful and in line with general observations.

Yet analysis shows how many unhappy experiences are

20

actively provoked or exploited by the sufferer. On

account of the need to deflect hatred and

destructiveness, ultimately the death instinct,

from the self onto object, "bad" objects are needed

and will be created, if not found to hand.

To this idea, Klein addresses many pages discussing

the ways in which one breast becomes the "good" breast

and one becomes the "bad" breast. The "good" breast

provides comfort and nourishment to the infant, whereas

the infant will attack the "bad" breast by nibbling and

biting it.

Closely linked with this problem is that of

frustration (of bodily needs or of libidinal

desires) which also appears in a different 1 igh t

when considered in relation to the operation of the

life and death instincts. Since frustration acts

as a lever for the deflection of hate and

destructiveness from the self, it is sought after

because an object which inflicts the pain of

frustration may be more justifiably hated and

annihilated. Thus frustration has its appointed

place in the design of primitive defenses. But

precisely for this reason, a frustrating

environment, lack of understanding and love are so

dangerous for the child. When the environment

meets his primitive needs for the deflection of his

destructive impulses half-way by coldness,

21

rejection and hostility, a vicious circle is

created. The child grows up in the expectation of

badness and when he finds his fears confirmed in

the world outside, his own cruel and negativistic

impulses are perpetuated and increased.

Our under standing of the individual becomes

more poignant through our awareness of the deep

biological sources from which his destructiveness,

his defensive need for unhappiness and his

anxieties spring, and our capacity to deal with

such baffling technical problems as sado-masochism,

delusions of persecution or negative therapeutic

reactions will be greater through the light gained

in our work from Freud's concept of the life and

death instincts. (Klein 1970, 328)

Zweig says that society has gone thr·ough various

stages from the earlier forms of nuclear family to the

communal forms of living in the 60's, to what is today

called the "me" generation in which the previous social

bonds seem to have lost their significance. These

stages represent the development of a collective

personality (society) which develops in the same fashion

as does that of the individual. At the same time,

psychiatrists see a decline in former personality

problems such as the neuroses, and an increase in

feelings of loneliness, emptiness, and a generalized

feeling of low-key misery. This condition seems to come

22

from people expressing an inability to love " ••• and is

ultimately a form of loneliness which Heinz Kohut calls

a Narcissistic personality disorder." (Zweig 1980, ix)

Zweig proposes that the members of present-day

society are generally and collectively rebelling, as

does the adolescent child, against the old established

values of patriotisim, honor, national and family

loyalty, authoritarian religion, morality, and, lastly,

against helping each other. The rejection of these

values means that present-day society has become

Narcissistic. The remedy for this ailing attitude is to

learn to forget the "self" by giving service to others.

The highest service that could be given would be for

everyone to learn to love themselves in the proper

manner, selflessly loving others, and by teaching others

how to love. His observations are identical to

Spotnitz.

Zweig believes that during this present form of a

renaissance-like transition period, many people tend to

become unbalanced because of larger social forces at

work on their psyche, and they fall into a trap from

which· they cannot remove themselves. This causes the

development of the serious personal·i ty disorder of

Narcissism in its various degrees of severity because

the pressure of the times is much greater now than it

was in past ages. Therefore, he recommends that more

people consider entering therapy for help in learning to

23

love themselves and others and to . overcome their own

Narcissism.

Zweig also investigates the history of Narcissism

as it is expressed in literary tales about heroes

through the ages, from the Gnostics, King Arthur, and

even Melville's Moby Dick to Faulkner. Since this book

derived its sources and opinions from literature, it did

not pertain to my theme. However, it was a very

interesting concept. (Zweig 1980)

Stern agrees with Zweig's point of view and also

believes that "Narcissism and the capacity to love

others are directly related to each other, as the one

increases, the other must decrease." (Stern 1979, 12)

He states that marital love is the prototype for all

other forms of loving. Thus, we should marry only as a

commitment to 1 ov ing one another. In the rebellion

against traditional unwritten laws, free sex as a form

of narcissistic pleasure and as a form of one's

dominance over sex became the rule of the day in the

60's and 70's. A loving commitment to another for a

whole lifetime was replaced by transitory relationships

as people "collected" conquests. Short-term

"relationships" became another euphemism for

old-fashioned Narcissistic adultery. Without the legal

papers and emotional commitments of marriage, "breaking

up" was much easier than divorcing, people thought.

However, with the passage of time, we are beginning to

24 0 '

see protests in the media about the emotional costs

these people have paid for following this life-style.

Rather than the expected freedom and joy, this

sel r-eentered attitude toward sexual commitments only

brought on more traumas and the former level of low-key

misery developed into acute emotional problems for the

practitioners. The ensuing contrast from the expected

joy to that of loneliness and depression from being

rejected so often had one good aspect for many of the

sufferers, but not all of them: it drove some of them

into therapy.

Stern feels that we all must learn to balance our

needs for Narcissistic fulfillment, suppress its

overwhelming urges in order to attain a balanced life of

commitment and loving others, whether one complies with

is society's marital mores, or not. It is interesting

to note that the "relationships" of the 80's are

becoming more durable, lasting longer, and now are

showing all the signs of loving concern that

old-fashioned marriages exhibited. Children who are

born to many of these "un-wed" couples are being cared

for as in the former nuclear families. Couples are even

committing themselves to a longer-term association by

buying houses together. As an estimate, probably

one-fourth of the couples buying homes these days in

"partnership" rather than as "community property" which

would require marriage in California.

25

Stern feels it is imperative that we each make the

conscious choice to love others more than we love

ourselves for the sakes of ourselves, our children, and

our society as a whole. Since Narcissists seem to be on

the rise in our population, he feels we must learn to

overcome the dangers of Narcissism by learning about it,

developing our sense of self-control over its selfish

pleasure-seeking, and learn to love others as many of

the great teachers have declared to mankind down through

the ages. If we fail to learn to love others and fail

to teach others to 1 ov e, society cannot and will not

survive. Anarchy and chaos will probably ensue. We

must begin this change by helping each other. (Stern

197 9)

Spotnitz agreed with Stern that people, and

especially clients in therapy, be taught to love one

another as part of therapy--a concept wherein both go

beyond Freud's therapeutic point of view.

Disputing the prevalent belief that Narcissism

represents love withdrawn or withheld from

disappointing objects and invested in the self,

Spotnitz holds that Narcissism preserves the object

and turns hatred--often murderous--on the self.

(Nelson 1977, 16)

Although agreeing with the general Freudian theory

of the causes of Narcissism, " ••. Spotni tz ultimately

came to the conclusion that the primary problem for

26

therapists working with schizophrenics, as known

Narcissists, was to work through their 'internalized

agression'." (Nelson 1977, 16)

Grunberger was very succinct in summarizing the

overall problems that analysts face. He stated:

••• we are confronted with an attempt to

rediscover in analysis, infantile omnipotence, and

there by repair a fundamental traumatic si tua ti on

(Narcissistic injury). (Grunberger 1971, 63)

He was concerned that the depression and

melancholia accompanying many cases of Narcissism had

the seed germ in the patient's "· .• nostalgia for a

perfect and happy primate state, destroyed through his

own fault." (Grunberger 1971, 247) He felt that the

universal self- accusations, unless treated, would 1 ead

to suicide, or at the very least, extreme incapacitating

states of depression for the Narcissist. ( Grunberger

1971)

Although I have drawn upon Forrest's theories of

the interaction of alcoholism and Narcissism in the body

of this thesis, I did not include Forrest's techniques

in my' chapter on treatment because they dealt more

specifically with the treatment of the alcoholic as a

Narcissist, whereas I chose to address the general

issues of Narcissism. Should the therapist be

confronted with a patient exhibiting this combination of

personality disorders, however, I would recommend he

27

consult Forrest's work for its excellent therapeutical

treatments.

Rothstein believes that striving for perfection is

the critical, underlying drive of the Narcissist. The

Narcissist has been taught from infancy that to be

perfect is to be a "1 oved object 11 • Not to be perfect,

to act, to think, or to feel in a perfect fashion is not

to be a loved object. This proscription includes his

secret thoughts and real feelings.

not being loved are castration or,

Because the Narcissist can't face

The consequences of

worse, death.

the awesome

consequences that await him if fails to be perfect, he

represses his true self into his unconscious, i.e.,

becomes split, and exerts all of his energy towards

trying to be perfect in order to please his Narcissistic

parent and, in so doing, to stay alive.

Rothstein is the only clinician who delineates the

major sty 1 es of Narcissism and the resultant behavior

one might expect from observing them. He creates his

examples by describing the types and how the

consequences of their behavior affects their lives and

those with whom they are involved by using the six

romantic pairs of Tolstoy's Anna Karenina (which shows

us what an excellent natural psychologist was Tolstoy).

28 1 •

CHAPTER III

DEFINITION OF NARCISSISM AS A CHARACTER DISORDER

Freud, in 1914, defined Narcissism in the following

fashion:

The word Narcissism is take-n from clinical

terminology and was chosen by P. Naecke in 1899 to

denote the attitude of a person who treats his own

body in the same way as otherwise the body of a

sexual object is treated; that is to say, he

experiences sexual pleasure in gazing at,

caressing, and fondling his body, till complete

gratification ensues upon these activities.

Developed to this degree, Narcissism has the

significance of a perversion, which has absorbed

the whole sexual life of the subject; consequently,

in dealing with it we may expect to meet with

phenomena similar to those for which we look in the

study of all perversions. (Freud 1914, 104)

Looking at the Narcissistic Personality Disorder,

as it' is cited in the Diagnostic and Statistical Manual

of Mental Disorders (3d edition), one can see how the

identifying traits, as we now classify them, were

derived from the myth.

The essential feature is a Personality

Disorder in which there are a grandiose sense of

self-importance or uniqueness; preoccupation with

fantasies of unlimited success; exhibitionistic

need for constant attention and admiration;

characteristic responses to threats to self-esteem;

and characteristic disturbances in interpersonal

rel ati onshi ps, such as feelings of entitlement,

interpersonal exploitativeness, relationships that

alternate between the extremes of overidealization

and devaluation, and lack of empathy. (DSM III

1980. 315)

From Freud's definition, Arnold Rothstein simply

defines Narcissism, a character disorder, as a " ••. felt

need for perfection." (p. 1)

Alexander Lowen defines Narcissism as a

.•• loss of self, ( 1983, 7) , characterized by

an exaggerated investment in one's image at the

expense of the self. Narcissists are more

concerned with how they appear to be than with what

they feel. Indeed, they deny feelings that

contradict the image they seek. (1983, xix).

The consequent rejection and unconscious repression

of part of the self begins the process of "splitting"

and becomes self-alienation of the whole self away from

its essential unity.

The degree to which the person identifies with

his or her feelings is inversely proportional to

the degree of Narcissism. The more Narcissistic

30

one is, the less one is identified with one's

feelings.

Also, in this case, one has a greater

identification with one's image [as opposed to

real-self] along with its compe nsa tingly higher

proportionate degree of grandiosity. In other

words, there is a correlation between the denial or

lack of feeling and the lack of a sense of the

whole self. Recall that I equate the self with

feelings, and with the sensing of the body. (Lowen

1983, 15)

Since the baby is born helpless and de pendent,

unable to differentiate itself from its environment and

the people around it, it depends upon its mother or

caretaker, not only for food, but also for cuddling and

protection from discomfort. The pleasure the baby

receives from this attention and the joy the infant

returns to its mother generates the bond between mother

and child and, ordinarily, develops into a healthy

1 ife- sustaining Narcissism. As the baby reflects and

responds to the way his mother or caretaker feels about

him and the way in which she handles him' his first

mirroring of his environment begins. Thus, the

foundation for the baby's mental health is laid at this

oral stage.

If this nurturing balance is upset by an

overindulgent mother who is herself emotionally in need,

31

she will project the concept onto the baby that he is

"special," "unique," elite." "The felt need for

perfection" that the baby senses unconsciously at the

oral stage is created in him by the mother. As a

result, the child grows up to become self-centered,

defensively superior, and develops an arrogant sense of

grandiosity on the surface of his personality. This

exaggerated sense of self arises from a Narcissistic

injury received as a young child, which will be defined

1 ater. Actually, these traits mask deep- sea ted fears

that, should he make a mistake, he will lose the

exaggerated approval of his mother or any other

authority figure in his life, including that of the

therapist.

On the other hand, if the mother was so deprived of

love and approval from her mother that she is

emotionally incapable of giving these qualities to her

baby, she will demand, in turn, that missing love and

approval from her infant. This emotionally handicapped

mother reacts to her baby by neglecting to see to its

comfort, not being consistent with its feeding pattern,

or witholding warm, loving attention. Instead, she

treats the baby with coldness, harshness, rejection,

resentment, or anger because she is dependent upon him

for supplying 1 ove and nurturing to her, which he

obviously cannot supply because of the baby's helpless

condition at the oral stage. Her demand never abates as

32

the child grows older; he is forced to mirror her

negative form of Narcissism all his life.

Unless the individual is born with the Narcissistic

character disorder--a fact which no one can prove or

disprove yet--the causes are inextricably interwoven

with the developmental stages of early childhood

because, as mentioned, the baby experiences his

environment as himself at first: he and the world

around him are one. Additionally, he perceives that

world as perfect because he does not have the capacity,

experience, or the knowledge to be objective and know it

to be otherwise. These attributes would enable him to

perceive imperfection. Later when he is older, and the

Narcissistic child gains the capacity for objectivity,

he discovers that the world around him, the object, and

he, himself, are not perfect; he then compensates for

that imperfection by refusing, defensively, to forego

his own Narcissistic perfection if other factors or

fixations intervene in his growth pattern toward good

mental health.

Narcissistic Injury

This recognition of the loss of perceived

perfection of the child's world leads to one form of

Narcissistic injury, which is a trauma to his idealized

self. This imperfection consists of "the object's

unavailability to provide Narcissistic gratification."

33

(Rothstein 1980, 113) Another type of injury that is

Freudian in its definition is any trauma that happens to

the infant that is phase-inappropriate at certain

critical developmental stages that causes a child to

become fixated at that stage. It is also the child's,

or really the ego's, recognition that neither he nor the

o b j e c t are pe r f e c t : he has 1 o s t hi s N a r c i s s i s t i c

perfection. This is too much to bear and creates the

first splitting of the self away from the feelings.

Etiology of Narcissism

The concept of a phase-inappropriate Narcissistic

injury will become clearer if we first review, briefly,

Freud's theory of personality structure, which is the

basis for understanding the etiology of the character

disorder called Narcissism.

Instincts

Freud was one of the first psychiatrists to make

the use of the concept of "instincts" so popular that it

has become a lay term.

topic of this paper:

His definition leads into the

An instinct is a quantum of psychic energy: a

measure of the demand made upon the mind for work.

All the instincts taken together constitute the sum

total of psychic energy available to the

personality. The investment of energy in an action

34

or image that will gratify an instinct is called an

instinctual object-choice or object-cathexis. An

instinct has four characteristic features: a

source, (a bodily condition); an .9..i.m, (removal of

bodily excitation, or tension, or fulfillment of a

need); an object, referring to the particular

thing, person, or condition that will satisfy the

above need. It includes all the behavior that

takes place in securing the thing, person, or

condition; and the Impetus of an instinct is its

force or need, such as eating food when hungry,

drinking water when thirsty, or seeking love when

one is in need of self-fulfillment. (Freud 1905a,

16 8)

Structure of the Personality According to Freud

If there is no one else in the immediate

environment to love or to love him, the Narcissist has

learned to 1 ov e himself as the object. According to

Freud,

••. the structure of the personality is

composed of the id which is the matrix within which

the ego and the superego become differentiated.

This id consists of everything psychological that

is inherited and that is present at birth,

including the instincts. It is the reservoir of

psychic energy and furnishes all the power for the

35

operation of the other two sy~tems. It is in close

touch with the bodily processes from which it

derives its energy.

However, as we will see later, in Narcissism, the

id splits itself completely away from its awareness of

those bodily processes and becomes alienated from them

as well as from the ego and superego.

Function and Purpose of the Id

Freud further states the following:

The id is the true psychic reality because it

represents the inner world of subjective experience

and has no knowledge of object reality. The id

cannot tolerate increases of energy that are

experienced as uncomfortable states of tension, and

it attempts to discharge tension by forming an

image of an object that will remove the tension.

The principle of tension reduction by which the id

operates is the primary principle called the

pleasure principle. (Hall & Lindzey 1978, 36)

This operates when the client creates wish-

fulfillment images in daydreams, also in nocturnal

dreams, because these are the only reality that the id

knows, according to Freud. This is why dream analysis

is so important in Narcissism therapy.

Since the id dominates human responses during the

first year, which is the oral stage of life, it will

36

continue to dominate the individual for the rest of his

life if a trauma fixates the child at this stage. For

instance, continual uncontrolled, impetuous, and

self- indulgent behavior that demands immediate

satisfaction regardless of the consequences, of empathy

for, or of consideration of others would be caused by

the drive of the fixated id. In other words, what would

appear to be "infantile" or "childish" behavior is

usually id-related activity.

Splitting Process

The following are examples of the way the id begins

its splitting process.

If the mother is not only unable to take over

the developmental Narcissistic functions for the

child, but also, is herself in need of Narcissistic

supplies, she will try to assuage her own

Narcissistic needs, unconsciously and despite her

good intentions, through her child, that is, she

cathects it (the child) Narcissistically. This

does not rule out strong affection. On the

contrary, the mother often loves her child as her

self-object, passionately, but not in the way he

needs to be loved. Missing in the relationship are

continuity, security, and constancy in her love and

behavior, as well as the framework within which the

child could experience his own feelings and

37

emotions as himself. Consequently, the child

learns to repress his feelings and his real self to

serve these needs and feelings in his mother, and

sometimes, the Narcissistic father. This begins a

psychological splitting between the id and the ego

because, through devotion to his mother and her

ideals, the child eventually loses touch with his

true self, his

self-aliena ted.

feelings, and becomes

In such cases, the natural Narcissistic needs

appropriate to the child's age cannot be integrated

into the dev eloping personality. They are split

off, partially or completely repressed and retain

their early form (fixation) which makes their later

integration still more difficult. (Miller 1981,

30)

During the baby's first months when the id is in

control and the ego is be ginning to develop, their

inte gr ati on is essential to the proper functioning

capacity of the individual. When the Narcissistic

mother manipulates the child so that he is forced to

cling to her in a continuing state of dependency and

helpless mirroring of her needs, she will preclude and

prevent the child's character structure from completing

its phase-appropriate coordination of balancing the

development of the id, ego, and, eventually, the

superego.

38

Mahler (quoted in Miller 1981) wrote:

It is the specific unconscious need of the

mother that activates, out of the infant's infinite

potentialities, those in particular that create for

each mother "the child" who reflects her own unique

and individual needs that were not met by her

mother at the appropriate time in her own

development. (Miller 1981, 31)

Thus, sometimes, the child is forced to exchange

selves and must be the mythical, ideal person his mother

wishes she were.

Mahler continues:

In other words, the mother communicates a

"mirrored framework," overtly and covertly, in

infinitely varied ways to which the infant's

primitive self must accommodate. If the mother's

primary occupation with her child--her mirroring

function during the period of early childhood--is

unpredictable, insecure, anxiety-ridden, or

hostile, or if her confidence in herself as a

mother is easily shaken by the child 1 s own

reactions as a separate individual, then the child

has to face the period of indi v idua ti on without

having a reliable framework for emotional approval

and support from its symbiotic partner. He is

39

taught that his own nature, needs, desires, and

feelings are wrong and unacceptable.· (Miller 1981,

34-35)

As a result, he develops a fear of trusting himself

and his own instincts that would enable him to separate

and individuate from his mother. In addition, her

dependency upon him does not allow him to achieve

integration with his real self, nor to achieve his own

independence (autonomy).

Function and Purpose of the Ego

The dynamics of personality are to a large

extent governed by the necessity for gratifying

one's needs by means of appropriate transactions

with objects in the external world. The ego is

created to activate this purpose in the organism.

(Hall & Lindzey 1978, 37)

Since the primary process concerning the id is not

actually capable of reducing tension in a concrete way,

i.e. , the image of food does not satisfy the stomach

1 ike real food does, the ego is created to fulfill the

actual survival needs of the organism. That is, based

on the image and memory of food provided by the id, the

ego obeys and tests the reality pr i nci pl e by actively

seeking, finding, and eating food. Contrary to the id,

the ego is able to differentiate between things in the

subjective reality of the mind, which is the realm of

40

the id, and the objective reality of the external

environment in which the organism actually lives. By

obeying the reality principle, whose aim is to prevent

the discharge of tension until an object that is

appropriate for the satisfaction of the need has been

found, the ego halts and controls the pleasure principle

which creates a temporary release of tension and

activates the secondary principle, which is realistic

thinking. Once the ego formulates a plan to achieve its

goals, it tests the validity of the plan by some means

of action called reality testing. This action can be

one of common sense in the case of the normal person, or

it can become some sort of bizarre behavior in the case

of the extreme psychotic. In either case, the reality

of each individual is different and each action is an

indication of the reality of their own mind. It makes

sense to each of them, although in the case of the

psychotic it might not make sense to an observer.

Finding the sense of this "logic" would be the most

difficult task for the therapist to accomplish but is

required so that the problem could be resolved for the

analysand.

Thus the ego becomes the executive of the

personality and exists to aggrandize the aims of the id

by controlling the actions of the organism, selecting

those features of the environment to which it will

respond, and deciding which of the id' s instincts will

41

be satisfied. For example, in Narcissism, this would be

the action involved in fulfilling the needs of the

Narcissistic parent rather than in developing one's own

individuality.

At this point, the ego becomes caught "in the

middle" because it also has to try to integrate the

often conflicting demands put upon it by the id, the

superego, and the external world. When this pressure

becomes overwhelming and a child sees that its only

means of survival is to cathect (identifying with and

attaching to) the Narcissism of its mother, the ego will

have to make that choice at the expense of the id, and

usually, of the superego also.

The restraining and controlling forces of the ego

are known as anticathexes as opposed to the driving

forces, or cathexes.

Function and Purpose of the Superego

The third and last system of personality to be

developed is the superego. It is the internal

representative of the traditional values and ideas of

society as interpreted to the child by its parents, and

enforced by means of a system of rewards and punishments

imposed upon the child.

The superego is the moral arm of the

personality; it represents the ideal rather than

the real and it strives for perfection rather than

42

pleasure. Its main concern i$ to control behavior

and to decide whether something is rig~ or wrong

so that it can act in accordance with the moral

standards authorized by the agents of society, the

parents.

The superego as the internalized moral arbiter

of conduct develops in response to the rewards and

punishments meted out by the parents. Whatever

behavior or thoughts of the child which they say is

improper, forbid, or punish, will become

incorporated into the conscience, which is one of

the two subsystems of the superego. Whatever they

approve of and reward the child for doing tends to

become incorporated into its ego-ideal, the other

subsystem of the superego. (Hall & Lindzey 1978,

3 8)

The mechanism by which this incorporation takes

place is called introjection. The child absorbs, or

introjects, the moral standards of the parents. The

conscience punishes the person by making him or her feel

guilty; in contrast, the ego-ideal rewards the person by

making him or her feel proud. With the formation of the

superego, self-control is substituted for parental

control. In the case of the Narcissist, he absorbs and

fixates the introjects of the parents as his own--in the

process called mirroring--rather than continuing to grow

and develop his own values. He also forms an

43

1 44

exaggerated ego-ideal to replace lost objects, including

the ideal of his perfection, or, the approval of his

parents.

The main functions of the superego are (1) to

inhibit the impulses of the id, particularly those

of a sexual or aggressive nature, si nee these are

the impulses whose expression is most highly

condemned by society, ( 2) to persuade the ego to

substitute moralistic goals for realistic ones, and

(3) to strive for perfection. That is, the

superego is inclined to oppose both the id and the

ego, and to make the world over into its own image.

However, it is like the id in being nonrational and

like the ego in attempting to exercise control over

the insti nets. Unlike the ego, the superego does

not merely postpone instinctual gratification; it

tries to block it internally. (Hall and Lindzey

1 97 8' 3 9)

In Narcissism, the superego goes to extremes.

Either it totally fails to develop-- for example as in

the case of the cold-blooded killer who has no empathy

or conscience, or in the case of the ambitious, ruthless

man who ruins everyone on his way to the top--or, it is

overdeveloped and becomes too repressive. In the latter

state, it inhibits the behavior and the feelings of the

Narcissistic character in varying degrees depending upon

the severity of the trauma and in which developmental

stage it occurred.

In concluding this brief description of the three

systems of the personality, it should be pointed out

that the id, ego, and superego are not to be thought of

as individual and separative components that manipulate

the organism at cross purposes and for their own selfish

ends, as though the entity were a marionette on strings.

Under normal circumstances and development they become

integrated as cooperating parts of a team under the

administrative leadership of the ego. The "normal 11 ,

"mature" personality operates as a whole rather than as

three separate segments. It is only when one or the

other of these elements dominates the personality in its

functions, usually as the result of a trauma early in

life, that character disorders evolve from the ensuing

internal conflict.

Freud's Oral Stage

Psychiatrists are not all in agreement as to the

age that Narcissism begins to develop. Some of them

think· it is entirely possible that--aggravated by the

constant as soc iati on with the ca thecti ng Narcissistic

mother--Narcissism is an ongoing process that begins at

birth and continues to develop throughout the period of

early childhood, unless there is a specific fixating

trauma at any given developmental stage that would

45

identify the time of the origin of .Narcissism. Besides

Freud, James Masterson and a few others believe that the

Narcissistic infant becomes fixated in dependent

symbiosis at the oral stage. Part of the conflict among

psychiatrists concerning the first occurence of

Narcissism stems from the fact that the child cannot

speak at the age when the id is in complete control of

the organism. Therefore, any fixating trauma that

occurs during the Narcissist's first year can only be

determined by knowing how the mother, or caretakers,

cared for him in his infancy.

Since Freud's oral stage and Eriksons' stage of

Basic Trust vs. Mistrust begin at birth and last until

the infant is approximately one to two years old, the

ego is developing during the first and second years of

the child's life before he arrives at the anal stage

which occurs during the second year. There is,

obviously, some overlapping of each stage as they blend

into each other.

Erikson believed that a pa rti cul ar virtue arose

with each developmental stage and that in the oral stage

••• hope is both the earliest and the most

indispensable virtue in the state of being alive.

All the verifications of hope originate in the

mother-child world founded on a trustworthy mother

who cares properly for the child." (Erikson 1964,

57)

46

If she cares for the child in her own Narcissistic

fashion, which is to behave in either the extreme of

being overly-indulgent or coldly rejecting, it is the

virtue of hope that keeps the older infant striving to

fulfill his need of her approval, acceptance, and love.

He needs to satisfy her demands that he be perfect and

become the illusory "perfect" person that she wishes him

to be, rather than become the true "imperfect" person he

innately is, at the risk of being rejected by her. From

his position of naivete, the child's inborn sense of

trust causes him to believe that the mother is right and

his natural desires and opinions of himself are wrong.

If he hopes to win and keep her love, he must suppress

his true instincts and conform to her criteria for his

sense of self and his behavior, contrary to his own

impulses for self-wholeness wherein he can be both

"good" and "bad". Thus~ it is vital to the self-image

of the Narcissist who has been cathected to his mother

at the oral stage that he maintain these feelings of

de pendency and "reflecting 11 that are created at this

period of dependency in his life. These feelings tend

to persist all through life because they cannot and do

not change unless therapy intervenes to correct them.

Even later ego developments do not help the child

individuate and separate if he failed to do so at this

earlier phase. These feelings manifest themselves as

unconscious hungers for love, attention, and ego

47

satisfaction. They are compensated for by compulsive

oral addictions: alcoholism, compulsive eating of food

or "sweets", drug abuse, or even as a compulsive

non-stop talking as the individual grows older.

Freud's Anal Stage

A natural state of conflict arises between the

child and his caretakers as the ego develops between the

ages of one and two and the child enters Freud's anal

stage. As he begins to become ambulatory, by crawling

and learning to walk around the house, he moves away

from the more helpless immobile phase and begins to defy

his mother as he develops his will and independence.

Erikson called this anal-musculature stage Autonomy vs

Shame and Doubt because the child is beginning to assert

his ego drives. At the same time, he is beginning to

learn what is expected of him, what his obligations and

privileges are, and what limitations are placed upon him

and his activities. Erikson believes that the virtue of

Will ascends at this point.

Will is responsible for the child's gradual

acceptance of lawful ness and necessity. Will is

the ever-increasing strength to make free choices,

to decide, to exercise self-restraint, and to apply

oneself. Trained self-will and the example of

superior will displayed by others are the two

48

origins from which the virtue of will develops.

(Erikson 1964, p. 98)

As the child explores the world around him and

becomes more willful and independent, he triggers the

Narcissistic mother's separation anxiety and abandonment

depression. The fear of losing the child increases the

pressure on her Narcissistic needs. She reacts by

making further demands upon the child to remain

dependent upon her, further increasing his fears of

separation anxiety. It becomes a vicious circle with no

escape for either of them.

At the same time, the child has grown into the anal

stage and is in need of toilet training wherein the

"Terrible Two's" learn to withhold or give compliance at

the toilet, among other areas in their lives. The stage

is set for the great battle of wills as the child tries

to separate and individuate himself from his mother's

hold on him which is one of his natural tasks at this

age. Since society demands self-control, this is the

first time the child has actually been in a position of

needing restraints put upon him. If the mother becomes

negative, rushed, is anxious, filled with self-doubt,

guilt, or begins either scolding or neglecting the

toddler now, he will absorb her emotions, develop his

own sense of shame and guilt, as well as absorb and

reflect back to her all of her negative emotions as his

own. Some psychologists believe that this battle of

49

freedom and contest of wills causes Narcissism to begin

at this age and phase of ego development in the child's

life.

As the infant becomes ambulatory and enters

the anal stage, he begins the process of

separation-individuation from the mother. When

toilet training is initiated, usually during the

second year of 1 ife, the child has his first

decisive experience with the external regulation of

an instinctual impulse. (Freud 1917, 109)

This is the beginning of the Rapprochement Phase.

Rapprochement Phase

The Rapprochement Phase occurs when the child is

between the ages of two and five. During this time, the

child begins to recognize that he and his parents are

separate beings and that all three each have their own

unique identity. Since this recognition signals his

first awareness that he and the environment are not one,

he must begin relinquishing his sense of grandiosity and

entitlement, feelings which had arisen out of his

identification with that immense environment. He

simultaneously wants to return to "being His Majesty the

Baby" (Freud 1957, 115), yet he desires to become

autonomous. Both impulses will incite him to fight with

his parents as they prevent him from regressing to

50 i' '

infancy and restrict the complete expression of his

freedom.

The toddler's statement of independence in the

battle is to reject his mother's power over him and to

assume his own self-domination over himself and control

his bodily functions. One recourse of his own power is

to hold back his feces and become constipated. Other

consequences of this battle can affect his personality

as he grows older because of this mode or reaction is

displaced onto other ways of behaving, for example, the

child may develop a retentive character, or he can

become obstinate and stingy.

Or, under the duress of repressive measures,

the child may vent his rage by expelling feces at

the most inappropriate times. This is the

prototype for all kinds of expulsive

traits--cruelty, wanton destructiveness, temper

tantrums, and messy disorderliness, to mention only

a few. (Freud 1917, 109)

If any of these behaviors persist after this anal

phase, the individual is obviously fixated at this stage

of his development. The two functions of the superego

would also be damaged and inhibited.

In contrast,

••• creativity and productivity and other

positive traits are thought to result from

51

pleasurable toilet training wherein the infant is

praised by a relaxed mother. (Freud 1957, 110)

Phallic Stage

Once the superego has learned the appropriate time

and place to control or release his feces, according to

rules of acceptability in society, the superego has

completed the process of controlling the child's

behavior. By the ages of three to five years, the child

should complete the separation-individuation process.

By this age, boys and girls enter the phallic stage

during which the Oedipal complex develops as their

sexual and aggressive feelings begin to stir.

Oedipal Complex

The term "Oedipal complex" usually includes the

Electra complex. Briefly defined, the Oedipal complex

consists of a sexual cathexis for the parent of the

opposite sex and a hostile cathexis for the parent of

the same sex. The Oedipal complex refers to a boy

falling in love with his mother. The Electra complex

refers to a girl falling in love with her father. This

cathexis could not occur if the parents had remained an

integral part of the child, because the instinct or urge

for cathexis can only occur to a separated object.

Attitudes toward the opposite sex and toward people in

authority are largely conditioned by the Oedipal/Electra

52

complex. This precipitates the last stage of the

development of the superego because the repression of

this complex causes the superego to undergo its final

development as the bulwark against incest and

aggression. At the same time, the child is now more

objectively aware of his parents in their relationship

to each other, to him, and to his siblings (if any). He

observes the differences in the ways adults relate to

each other, to him, and to other children. He becomes

aware that each adult he knows has a different role in

life.

In addition to physical games, the child undertakes

mental games at this age by assuming the various roles

of parents and other adults in a make-believe world. By

imitating adult images and their roles, the child

realizes to some degree what it is to be like them.

However, rather than being able to choose his own role

images as a child does in normal development, the

Narcissistic child moves from playing Mommie, to

becoming Mommie, as he is sometimes forced to exchange

roles with her.

Erikson calls Freud's phallic stage Initiative vs.

Guilt--or the genital-locomotor stage--that of expanding

mastery and responsibility. Purpose is the virtue that

ascends from this stage. A new, more dreadful fear

evolves in the child at this stage. Freud believed

53

... the son fears the father will read his

lustful mind desiring his mother and the father

will then castrate him and/or kill him as

punishment. The daughter fears the mother has

already castrated her because she does not have a

penis (penis envy) and that if the mother discovers

how the daughter lusts after her father's organ,

she will annihilate the daughter. Unlike the male

whose Oedipal complex can become modified when he

reaches an identification with his father and

transmutes his lust for his mother into affection

and tenderness for her, the Oedipal or Electra

complex tends to persist into adulthood for the

female, although it undergoes some modification

because of the realistic barriers that prevent her

from gratifying her sexual desire for the father.

(Hall and Lindzey 1978, 54)

If Narcissism is solidified or created at this

stage of development, it will become the way of life for

the individual because the related fears of castration

and annihilation/death persist throughout 1 ife. Up to

this point, losing the mother's, or parental, love has

been an unconscious motivation and a feeling of vague

uneasiness in the back of the child's mind. Now, a more

"real" fear of the possible outcome of this warped

relationship is created with the child's worry over his

actual death because of the loss of his symbiosis with

54

his caretaker. His purpose now has become to survive at

all costs. He annihilates his whole, "good" and "bad,"

true self; this is a form of living internal suicide and

true self-alienation. He begins living behind all the

defense mechanisms he can muster as his protective coat

of armor.

The cathexes of the pregenital periods are

Narcissistic in character because they help to provide

additional forms of body pleasure to the child as well

as to satisfy pressing needs for survival. In the

normal course of events, from pre-adolescence to late

adolescence, most of this inner self-love shifts focus

from self to others in making the decision to choose

genuine objects to love. Erikson believes that as the

child begins to select the values in his life that will

give him his own identity, that fidelity (to the

love-object) is the virtue that arises at this stage.

The person becomes transformed from a pleasure-seeking,

Narcissistic infant to a reality- oriented, socialized

adult. Pregenital impulses are not necessarily

displaced by genital ones. Rather, the cathexes of the

oral, anal, and phallic stages become fused and

synthesized with the genital impulses, without any sharp

delineations or transitions from one phase to another.

The final personality structure is a composite of all

the contributions of each stage of development. The

principal bi ol ogi cal function of the genital stage

55

(early a dol esce nee) is reproduction. At this age, the

psychological aspects in normal growth usually provide a

certain amount of stability and security. In the normal

(later) adolescent, the creation of his own, separate

identity is paramount to this developmental stage. This

prepares him for independent adulthood. However, in the

case of dysfunctional Narcissist, his struggle to learn

who he really is and to establish his own identity is

bound and restricted by his hi story.

autonomy and free will to struggle

He lacks the

against the

introj ects of his parents and to shape himself into

being his own unique person as he identifies with his

peer group and the value of the society around him. He

is incapable of selecting his own values from all of

those present in the society around him; instead, he

identifies only with those of his mother or caretaker.

He is a true "prisoner of his childhood," to quote Alice

Miller. By early a dol esce nee, his symptomatic behavior

will begin to differentiate him from his peers who are

"normal". Even if he attempts to create other

relationships or even to marry, his condition is "set"

by the time he has reached the genital stage according

to the majority of psychiatrists. Therefore, it would

seem that his character disorder was fixated well before

the genital stage and probably flowed into and continued

to develope throughout each stage.

56

Introduction to Defense Mechanisms

Freud believed that

•.. the environment contains regions of danger

and insecurity: it can threaten as well as

satisfy. It has the power to produce pain and

increase tension. (Hall and Lindzey 1978, 48)

The developing child reacts to these negative

factors of pain and tension with fear and anxiety.

Freud believed that personality develops in response to

four major sources of tension: physiological growth

processes, frustrations, conflicts, and threats. A

child's negative reactions to these factors can inhibit

growth and the development of a high sense of self­

confidence and self-esteem which, in turn, lead to

varying degrees of neurosis and even psychosis. This is

seen in such disorders as "Failure to Thrive",

11 H istr ionic Personality", or Narcissism. All three of

these personality problems have common symptoms and

causes.

Identification and Displacement are two methods by

which the individual learns to resolve these conflicts.

Identification in Freudian context is the method by

which the ego may regain an object internally that has

been lost, as well as the method by which a person or

child takes over some of the qualities of another person

such as the caretaker, whether it be mother, father, or

whoever, and makes them a corporate part of his or her

57

own personality. Narcissism becomes an extreme form of

identification in an unconscious and involuted way as

the individual fictionalizes the return of a lost object

(such as perfection, himself, a parent, or parental love

and approval), and the Narcissist becomes that object in

his own mind to the detriment of the natural development

of his own personality. (The condition of the son in

the movie, "Psycho," was an example of this

inc or porati on.) However, the development of Narcissism

is not a superficial acquirement of "copying" behavior

or imitation of another's personality. Identification

is expressed through introjects, commands, criticisms,

or all of these, through which the child rules himself

in the silence of his own internal conversations. These

attitudes toward himself are exhibited in the way in

which he treats himself, that is, with the same degree

of self-worth, or lack thereof, with which his parents

treated him.

Displacement occurs as a substitution for an

ina ccessi bl e object,

internal or external

i.e., cathexis caused by either

barriers (anticathexis). This

continues until a final object is found that yields some

relief for the pent-up tension. This object is then

cathected until it loses its power to reduce tension, at

which time another search for an appropriate goal object

is begun. No ensuing object ever offers as much relief

as the first one, and the process of displacement can

58

become unending in its search for relief from tension.

It can act as a permanent motivating force in the

behavior of the individual as he looks constantly for

new ways and new objects to reduce tension.

The sociopathic womanizing of Don Juan was a

classic example of the displacement principle in a

Narcissist. This search accounts for the natural

variability and diversity of human behavior, as well as

for observed human restlessness. In normal character

development, compromises develop in accepting the

availability of acceptable substitute objects in the

ordinary course of living that often to lead to

stabilizing the personality as people age, but the

Narcissist is unable to compromise and falls back on the

internalized ego-ideal in the absence of appropriate

available external objects. Thus, this type of defense

mechanism prevents the establishment of long-term

relationships because no acceptable (perfect) substitute

for the original object (mother) is ever found to be as

satisfying.

A description of the Narcissistic Character

Disorder is best provided by investigating the symptoms,

feelings, behaviors, attitudes, and defenses that one

sees in dealing with these people in everyday life and

those that the therapist sees in his office or clinic.

The motivation that drives a person into Narcissistic

behavior is described by Arnold Rothstein's perception

59

that Narcissism is a "felt quality of perfection." He

also feels that

••• perfection is originally perceived during

the preindividuated era and fixated there to be

pursued in all adult aspects of one's life. When

Narcissistic perfection is felt to be an attribute

of the object, the subject may feel some degree of

r·everence or awe for the object. By performing

successfully for the Narcissistically invested

object, a subject feels a sense of positive self-

esteem. A similar affective response is often

associated with a subject's living up to the

standards of his ego ideal or superego.

Narcissistic injury refers to a subject's

experience of the loss of his perfection or of the

object's unavailability to provide Narcissistic

gratifications.

Fluctuating and inconsistent maternal and

paternal relatedness is common. Other symptoms are

caused by disorders in maternal

relatedness--ranging in spectrum from self-involved

hostility to cold, extractive Narcissistic

investment to unrealistic, adulating,

excessively gratifying involvement.

1980, 125)

indulgent,

(Rothstein

The mother's behavioral inconsistencies, such as

cuddling, feeding, and changing the diapers of the

60

toddler one time, and ignoring and neglecting it or

punishing it harshly for wet diapers another, for

example, serve as phase- ina ppropr ia te di sap poi ntments.

For instance, one mother tied her three-year-old to a

tree outside the kitchen window where she "could keep an

eye on her" while she cleaned house so that the child

wouldn't get in her way while she was busy or dirty the

house after she finished cleaning it. Another boy in a

hospital continually went to his closet to urinate

because he had been locked in a closet so much by his

mother that he didn't know that he should urinate in the

toilet.

Such things as violence in the family, corporal

punishment, or 1 imi ti ng the environment in general

further encapsulate the child.

The traumatic quality of the parental objects'

personalities can make a subject's experience of

normal developmental Narcissistic injuries, that

is, the perception of separateness, the limits of

socialization in general, and toilet training and

the Oedipal situation in particular--more intensely

ielt. For instance, the subject's fear of death at

the prospect of separation-individuation can be so

deep as to preclude the attempt if the person is

fixated at the castration-complex/annihilation

level. The client's continuing dreams of death,

dying, funerals, or coffins will be a clue to this

61

read:

problem with the therapist, and will need to be

explored to free him from his fears of dying if he

'deserts' his parents and becomes independent.

(Rothstein 1980, 127)

The following passage from Demian shows how

deeply the loss of the loved objects threatened

Hermann Hesse's search for his true self:

But where we have given of our love and

respect not from habit but out of our own free

will, where we have been disciples and friends out

of our innermost hearts, it is a bitter and

horrible moment when we suddenly recognize that the

current within us wants to pull away from what is

dearest to us. Then every thought that rejects the

friend and mentor turns on our own hearts 1 ike a

poisoned barb, then each blow struck in defense

flies back into one's own face, the words

"disloyalty" and "ingratitude" strike the person

like catcalls and stigma, and the frightened heart

flees timidly back to the charmed valleys of

childhood virtues, unable to believe that this

break, too, must be made, this bond also broken.

(quoted in Miller 1981, 127)

And, in "A Child's Heart," by Hermann Hesse, we

If I were to reduce all my feelings and their

painful conflicts to a single name, I can think of

62

no other word but: dread. Dread and uncertainty:

dread of punishment, dread of my own conscience,

dread of stirrings in my soul [independence] which

I considered forbidden and criminal. (quoted in

Miller 1981, 128)

There are, of course, many types of defenses that

the Narcissist learns, or develops, to protect himself.

As Masterson says:

••• faulty separation-individuation at, or

right after the oral stage, leads to depression,

which leads to defense. This developmental

sequence, or track, reflects the essence of the

developmental arrest, provides the therapist with

the most reliable guide, and should be the axis

around which other clinical observations are

organized. The individuation which begins to

unfold from within [which eventually drives the

individual to therapy] is manifested clinically by

the patient's identifying and implementing in

reality his own thoughts, feelings and wishes

[usually for the first time in their lives]. It is

the self-assertive activation of these unique

thoughts, wishes and feelings that triggers the

abandonment depression, which triggers the defense.

Often the patient's greatest resistance is in

recognizing that he feels bad because he is trying

63

to express what he wants and what he feels.

(Masterson 1981, 220)

Under the pressure of excessive anxiety, such

as the desire to individuate oneself into a whole

object, with no help from the objects, the ego will

be forced to take extreme measures to relieve the

pressure. (Masterson 1981, 52)

Repression As a Freudian Defense Mechanism

Freud 1 isted four defense mechanisms common to

everyone and especially integrated as everyday tools of

Narcissists: Repression, Projection, Reaction

Formation, and Regression. The first of these,

Repression, he assigned to the ego and that which was

repressed was assigned to the id. In terms of

Transactional Analysis, the free child would be

repressed, leaving the adapted child.

Repression is said to occur when an

object-choice that arouses undue alarm is forced

out of consciousness by an anti ca the xis. Once

formed, repressions are difficult to abolish

because they lie so deep as to be almost forgotten,

and the client must reassure himself that the

danger to him no longer exists. (Hall and Lindzey

1978, 52)

Building feelings of safety and security with the

client in the therapeutic situation can be a difficult

64

task for the therapist because of the client's history

of emotional abuse by the authorities/caretakers in his

1 ife. It will take a long time for the client to

develop his faith and trust in the therapist as well as

his feelings of being accepted for who he truly is.

Projection as a Freudian Defense Mechanism

Projection is another defense mechanism by

which internal neurotic or moral anxieties are

transformed into reality anxiety, the type most

easily borne by the ego. The Narcissist converts

both types of anxiety into an objective fear of the

external world. This method reduces the anxiety of

internal punishment which either the internal

neurotic or moral anxiety would cause by enabling

the Narcissist to repress his impulses under the

guise of [permissably] defending himself against

his enemies, expressed as "She hates me" instead of

"I hate her". (Hall and Lindzey 1978, 52, 53) [In

extreme cases, paranoia can follow.]

Reaction Formation as a Freudian Defense

Mechanism

Reaction formation involves the replacement in

consciousness of an anxiety-producing impulse or

feeling by its opposite. The Narcissistic child is

forced into a warped type of love for its parent(s)

65 t-1 '

that is false and it must deny its hatred for them

in its real,

them. This

repressed self by professing to love

"reactive-love" is marked by

extravagant showiness--the person protests their

love too much--has too much contact with the

Narcissistic parent for example, and can develop

compulsiveness and identification problems.

Regression as a Freudian Defense Mechanism

Regress ion: Since every developmental step

that is taken by a growing healthy infant entails a

certain amount of risk, frustration, and anxiety,

the infant, child, or even adult, who encounters

traumatic experiences retreats to an earlier stage

of development where it feels safer. (Hall and

Lindzey 1978, 52, 53)

Sometimes they become fix a ted there, such as the

alcoholic at the oral stage who longs to be cradled in

his mother's arms when life frustrates him. Another

example, that of the phallic stage, is that of a woman

who was freely sexual and enjoyed it before and between

marriages. However, after marriage she turned off sex

entirely and became "Miss Prude" because she identified

her own marriage with that of her mother. Her mother

and father did not have sex with each other, and,

mirroring her mother, neither did the daughter with her

own husband. In her marriages, she regressed to being

66

the prim and proper little girl at the pre-Oedipal and

Oedipal stage where she originally identified and

fixated with her mother. The consequence of regression

is the analysand's return to his former state of

dependency. If one was overly dependent as a child, one

tends to become overly dependent again as an adult when

anxiety increases to an unbearable level.

The tragedy of having to use these defense

mechanisms is that they all have two things in common:

(1) they deny, falsify, or distort reality, and (2) they

operate unconsciously so that the person is not aware of

what is taking place. Needless to say, these aspects of

character are what the therapist sees in the external

behavior of the client. He must probe gently so that

the client becomes aware of the internal causes of his

own behavior. It is the task of therapy for both

therapist and analysand to become aware of these defense

mechanisms and to correct these malfunctions.

Additional Defense Mechanisms

In addition to Freud's list, practicing

psychiatrists have added several other methods of

Narcissistic defense: avoidance, clinging, withdrawal,

rage, or acting-up, acting-out, and splitting. Kernberg

(1975) conceived the concept of splitting one part of

the self away from an awareness and identification with

another part of the self, the emotions or the body as

67

"the keeping apart of introjections and

identifications," (Rothstein 1980, 29) and as the

"essential defensive operation of the borderline

personality organization." (Rothstein 1980, 49)

Splitting

Another form of splitting is that of dividing

oneself in two parts, instead of being the

"whole-object" in which the bad part of the self

integrated along with the good part of the self. In

other words, one rejects one half of oneself. One

becomes a half-object in which only the "image" of the

good, or ideal-self is accepted, and the bad-self, being

too uncomfortable causes one 1 s own faults to be

falsified, repressed, and denied so that the Narcissist

doesn 1 t have to face them. The part-self that is

accepted is the mythical "perfect self" or ideal-self.

This means that possibly the Narcissist has been

criticized so badly that he cannot bear to have the

therapist "correct" him. If he has "elite attitudes",

he "knows," defensively, that he is so perfect that he

cannot be criticized. This distorted thinking also

causes trouble for the therapist because the therapist

must also be "perfect" and/or grandiose. He must not

make mistakes or show that he is "human" and imperfect.

This criterion is so extreme that the therapist can

damage the rapper t by sneezing at the wrong time I He

68

must have all the answers for the dependent client, and

mirror the good

••• part-self of the the Narcissist. When the

therapist makes an error in judgment about the

course of therapy, and becomes confrontive too

soon, he can expect any one or more of the defense

mechanisms to erupt, especially rage, contempt, and

possibly, withdrawal. It is a delicate spot in

which to be and requires the utmost delicacy and

tact to hang on to the client at that point without

damaging him. Resistance, denial, rebellion and

acting-out in the therapeutic relationship can also

be expected when the therapist, of necessity, must

confront the client with the reality of his

behavior or attitudes that he doesn't want to face

about himself either in the external world of job

and relationships, or in the therapy situation.

The client must eventually be able to merge his two

parts into one healthy whole and be able to "own"

his "bad"-self also. (Masterson 1981, 178)

He must learn to accept his own "human-ness" and,

thus, natural imperfection and integrate both parts into

an acceptable whole. "In defense against the threatened

destruction of their representational worlds (a self­

and object-loss anxiety)," these subjects attempt to

remove frustrations and to restore a sense of

Narcissistic perfection to their self- represe nta ti ons

69

(Freud 1926, 137-138). This restoration serves to

create the illusion that there are and will be no

frustrations and/or that the self-representation is safe

from the murderous rage of the parental introject. Any

frustration reminds the subject that the sense of

Narcissistic perfection has been lost. The sense of

perfection is constructed of Narcissistically invested

self, object, and self-object memory traces, and because

of this, any emotional injury will stimulate separation

anxiety and the subject will have lost "control" of his

life one more time.

Narcissistic Rage

Painful, frightening, and disorganizing affects are

caused by a variety of disappointing experiences in the

child's life. For example, a mother's unempathic

self-involvement durtng her toddler's rapprochement

sub-phase (about 15-22 months) confronts the toddler

with the perception of her unavailability. The child

reacts with acute feelings of anxiety and rage.

Mother's chronic unavailability leaves her child feeling

lonely, depressed, and perhaps anxiously empty. [Even

though they are older, one can't help thinking about

these same effects upon the "latch-key" children who are

left alone at home for hours after school.]

If father failed during his son's Oedipal or

latency phase, this may also stimulate feelings of

70

rage in his son. The chronic perception of

father's impotence stimulates feelings of guilt,

castration anxiety, sorrow and disappointment. A

father's premature death can leave his son feeling

a limitless depression and longing as well as an

anxiety derived from his identification with a dead

man--or, even his inability to identify with a male

image role-model at all. Father's death

terrifyingly and prematurely confronts a boy with

his own mortality. (Rothstein 1980, 112)

The loss of either parent is obviously traumatic

for boy or girl. One six year-old girl was told by her

aunt not to cry the day her mother died, and to go in

her room and play quietly by herself and not bother

anyone. Knowing how these children are taught to

repress their emotions, is it any wonder that some

children learn to shut off their emotions entirely,

especially when they observe that emotions are so

awesome in their power over them and are so frightening

that their adult role-models cannot cope with them

either? This creates an even greater sense of impotence

in the child. Or, having been cruelly treated by

Narcissistic parents, is it any wonder that street boys

can pour gasoline over an old man sleeping on a park

bench and light it and laugh at his plight as he burns

to death without having any feelings of empathy or

conscience?

71

Narcissistic rage is a secondary defensive

response that attempts to find someone or something

that can be blamed for the insulting 1 oss of

perfection. Rage at the disappointing parent or

parents may contribute to the development of a

character trait of defiance that was the result of

a Narcissistic clinging to anal eroticism, noting

that as a rule, infants do not dirty strangers.

Defiance is reflective of an underlying disorder in

super-ego integration.

Although a variety of affective signals can

provoke Narcissistic investments,

all struggle with anxiety that

these patients

heralds the

destruction of their self-representation. The

toddler is enraged at his mother in reponse to the

frustrations implicit in his state of separateness.

He feels his mother is to blame for this state of

affairs, and when she is destroyed in his fantasy

for it, the toddler anti ci pates her retaliation.

(Freud 1917, 125)

He feels so symbiotically identified with her that

he imagines she can read his mind and will avenge his

murderous thoughts by murdering him for having thought

them.

Such ubiquitous developmental events have been

more intensely felt in patients typically

considered Narcissistic personality disorders than

72

other neurotic types because of the quality of

their basic cores, the personalities of their

parents, and/or the exigencies of their lives, the

nature/nurture element. As a general iza ti on,

mothers of patients typically considered

Narcissistic personality disorders were angrier at

their children for frustrating them than were

mothers of subjects who developed normal or

neurotic character integrations. (Rothstein 1980,

1 05)

Picture the baby who cries with colic constantly:

One father walking his baby at night said it was all he

could do to keep from throwing the child out the window

in his anger. The effect of child abuse is another

extreme form of the low frustration, low tolerance, and

high anxiety levels of the Narcissistic parent.

The actual angry nature of the maternal object

intensifies the toddler's fear of being separate

and his fear of rna ternal retal ia ti on. The

toddler's rage in response to the limits implicit

in his state of separateness is reinforced and

exaggerated by his perception that his mother also

resents his separate existence. She would like him

to exist to gratify her. Because his individuation

elicits her anger, it intensifies the anxiety the

subject experiences in the process of separating

and can prevent it. (Rothstein 1980, 106)

73

Today, teenage girls often express a desire to have

a baby so that it will love them, not that they will

love the infant and be a mother to it.

By virtue of their age, experience, and size,

nature gave parents control, protection, and power over

children. Children are well aware of this and to a

certain extent it provides them with feelings of

security and being loved. In the "normal" family, the

child is expected and encouraged to develop his

independece and individuality. However, Narcissistic

parents are more manipulative than "normal" parents and

take more control and power away from their infants and

the infant soon recognizes this. Either situation

creates a paradoxical situation within the child of

needing the parents, depending upon them, yet longing

for their own autonomy. This paradox is exaggerated and

exploited in the Narcissistic family.

These perceptions and the feelings they elicit

contribute to the elaboration of the

separation-individuation processes as

self-destructive murderous acts by these toddlers.

They are convinced that the rage these processes of

differentiation stimulate will destroy their

mothers and themselves. Subsequent frustrations

are experienced as recapitulations of the original

separation experience.

74

There are three often observed, noteworthy

characteristics of these patients' elaborations of

their separation experience as a fantasied act of

self-destructive murder. First, these subjects do

not clearly distinguish between fantasy and action.

They behave as if thinking will be translated into

imminent action. If they perceive that they or

their objects are feeling angry, they are convinced

that anni hila ti ng physical violence will ensue.

Second, these self-destructive fantasies of murder

were done and undone. Representatives are killed,

but they are just as quickly revivified by virtue

of their primary process investment. Third, the

fear of imminent retaliation is reinforced by their

frequent formative experience of parents who

actually lost control. (Freud 1917, 128)

Their parents' penchant for expressing their anger

physically reinforces these patients' beliefs that

feelings really are dangerous.

Entitlement and Grandiosity as Defense Mechanisms

Another defense mechanism is the combination of

entitlement and grandiosity because one attitude does

not happen without the other. The source of the effect

of entitlement and grandiosity upon the Narcissist

derives from the child's

75

••• identification with the mother's

ideal i za ti on which leads to prese rv a ti on of the

grandiose self, which defends against the

perception of the mother's failures and the child's

associated depression. (Freud 1917, 128)

It is also a natural defense to compensate for low

self-esteem. Taken to its extremity, it becomes

megalomania.

The defensive or libidinal grandiose,

self-omnipotent object-relations fused-unit

representation [which translates to mother and

child becoming the fused-unit in the child's being]

contains all power, perfection, direction, and

supplies. The grandiose self-representation

becomes one of being superior, elite,

exhibitionistic, with an affect of feeling perfect,

special, unique. The projects of this defensive

unit is so ubiquitous, global, and airtight, that

it effectively conceals to the casual observer the

underlying pathologic aggression. (Freud 1917,

129)

Sometimes the therapist finds it difficult to like

the client and be objective enough with him when he acts

out this behavior in the office.

When projecting the grandiose self, the

patient exhibits his specialness and expects

76

perfect mirroring of his grandiosity and unique

perfection (Masterson 1981, 12)

.•• from the therapist and others. His exaggerated

expectations of entitlement lead him to expect special

treatment and favors and to be excused from reciprocity

of same.

When projecting the omnipotent object, he

idealized the perfection of the object which he

expects to share, i.e., he shares and participates

in the 'Narcissistic glow.' (Masterson 1981, 13)

He also becomes very upset in therapy when he is

not treated as someone special. When the client

discovers that he is expected to do his own work in

changing his patterns to bring about his cure, the

therapist can expect the client to exhibit rage toward

the therapist and others in his life, as well as to

act-out during the therapy sessions. Again, this is a

delicate position to maintain, but the therapist must

remain objectively clinical and distant and not allow

himself to be drawn in and manipulated by the client who

will often ask, "Can't you do it for me?"

Alexander Lowen reminds us that the over-indulgent

mother is the one who creates the aspect of grandiosity:

If, on an emotional level, the Narcissistic

character is still an infant tied to mother, how

can we explain his or her possession of an

aggression that is oriented to the world and leads

77

to achievements beyond the ~apacity of the

borderline personality? I don't believe this

problem can be resolved if we rely on the premise

of infantile omnipotence and regard Narcissism only

as the result of a failure of development. If we

drop the concept of infantile omnipotence, then we

may seek the cause for grandiosity in the parent's

relation to the child, rather than in the child's

relation to the parents. A boy doesn't think

himself a prince through any failure of normal

development. If he believes himself to be a

prince, it is because he was raised in that belief.

How children see themselves often reflects how

their parents treated them. (Lowen 1983, 9)

There are two types of depressions one may see in a

Narcissist. One is the apparently total passive, or

submissive, debilitating, enervating type. The person

"gives up" trying and has no joy or motivation to live.

This style of depression seems to develop such a grip on

its victims that he is powerless to overthrow it.

Comments on this sort of depression would be another

whole topic, and I will not discuss it here as many

books and studies have been written about it.

Another form that seems to be more common to the

Narcissist is that of a more active, vigorous behavior_

that seems to be rage. This rage is really masking the

78

depression, and the clinician must be extremely alert to

detect the underlying depression that causes the

exhibition of rage.

Abandonment Depression

Actual severe depression or raging "acting-out 11

behaviors are caused by the fear of being abandoned or

separated from the object. The client treats himself

with the same contempt with which his parents treated

him, and the therapist must steel himself against the

transference of this contempt upon him, which can be

quite vitriolic and intense. A spouse, parent, or any

authority figure who "puts down" or devalues others is

projecting this low self-esteem continually.

Abandonment depression becomes another form of

defense mechanism of the Narcissist which stimulates

these behaviors:

The aggressive acting-out client owns an

underlying pa thol ogi c aggressive or empty-object

relations fused-unit with its mother and a

representation, or identification with her that is

harsh, punitive, and attacking, and a

self-representation of being humiliated, attacked,

empty, linked by the affect of the abandonment

depression.

This perception of the abandonment depression,

if not immediately defended against by the

-~ -------------- ---~------- ----- ·-- -- -~--- -------- -~--- --- -~-~-- -

79

defensive unit, activates an alliance between the

aggressive unit (self) and the pathologic ego in

which the depression is dramatically externalized

with a projection of its object represe nta ti on

(mother) as causing the depression, with massive

denial of its reality. The preci pita tion of the

abandonment depression activates the alliance

between the grandiose fused-unit (mother/child

identi fica ti on) and the pa thol ogi c ego, and the

patient proceeds to avoid, deny and/or devalue the

offending stimulus or perception. (Masterson 1981,

13)

Depression

Depression can be triggered by a traumatic event, a

fancied or real rejection by self, toward self, by the

love-object, therapist, or anyone else. It can be

self-stimulated through some inner thought or worry from

within the client's secret self. It also can be caused

by the client's sense of failure that he is not perfect

and did not please the Narcissistic parent. Sometimes

the Narcissist reacts to this by hiding his feelings of

abandonment and the resultant depression from his own

awareness by acting in an aggressive manner.

This restores the balance of his Narcissistic

equilibrium and avoids the experiencing of

depression. The continuous, global projection of

80

this defensive unit allows the Narcissistic

personality disorder to minimize the experience of

depression and makes it appear that he gets his

emotional supplies from within. In addition, the

relatively free access to aggression enables the

Narcissistic personality disorder either,

aggressively, to coerce the environment into

resonating with his Narcissistic projections or, if

this fails, to deal with that failure by avoidance,

denial and devaluation. (Masterson 1981, 15)

Abandonment and Engulfment

The upper-level borderline's clinical picture

is most often neurotic-like. Although he has the

twin fears of abandonment or engulfment, his

principle fear is abandonment, and his principal

form of defense is clinging, not distance. The

reverse can be said of the lower-level borderline,

who also has fears of both engulfment and

abandonment, but whose principal fear by far is

that of engulfment and whose principal defense is

distancing. The 1 ower-level patient is prone to

temporary psychotic attacks under separation stress

as well as to feelings of depersonalization,

unreality, and pa ranoi d-proj ecti ons. (Masterson

1981,6)

81

For example, if he is hospitalized, he may be

acting and feeling quite well and normal until hospital

discharge is imminent. Then an acting-out destructive

psychotic episode transpires, such as a suicide attempt,

or breaking windows, which is designed to keep him there

and cover his individuation-separation anxiety.

The individual repeats in his development the

same stages and struggles the civil iz ati on went

through. For example, the sexual sadist who writes

messages on the mirror with lipstick for someone to

restrain him but continues to abuse sexually and

murder, rather than give himself up, is an example

of the history of the Talionic impulse--seeking

revenge through an eye for an eye and a tooth for a

tooth. When one examines the past histories of

these indivudals, one finds evidence of such cruel,

barbarous, torturous exploitation of their

infantile dependence and helplessness that even

their later-life crimes pale by comparison. [The

case of Sybil was an example.] They seem to be

carrying out that deepest and most ancient of human

responses, the Talionic impulse--an automatic

defense response to inflict injury when injured.

(Masterson 1981, 186)

Usually they show no feeling for themselves or the

victim as in the example of the boys who laughed when

they set an old man afire.

82

One aspect of distraught emotions is somatic, of

course, ranging from mild muscular body tensions to

serious illnesses. For example, some people have tense

jaw and throat muscles from suppressing tears and

crying, and tense neck and shoulder muscles can derive

from suppressing anger and rage. Narcissists, as well

as all of us, can suffer physical problems from mild

tension to seriously exaggerated somatic ailments. The

self-concern of some hypochondriacs can be a dimension

of Narcissistic dependency.

~ Oral Addictions of the Narcissist

One last symptom is that of the oral addict, the

alcoholic, drug addict, smoker, food or chocolate

addict, or any other manifestation of oral ingestion, as

displaying a definite type of Narcissistic behavior,

which, though too complex to be incorporated in this

discussion, warrants mention.

Forrest has written seven books on alcoholism. In

Intensive Psycho Therapy of Alcoholics, he has provided

the most detailed etiology, case studies, and methods of

treatment of the alcoholic using his Freudian knowledge

of Narcissism. Alcoholics suffer acute and chronic

anxiety and panic because they received a narcissistic

injury during the oral phase of their development. They

live in terror of their mother because of her

indifferent or hostile attitude toward them during this

83

stage of their growth.

gratification through

As adults,. they experience oral

drinking. Just as infants

experience tension and anxiety reduction while nursing

(drinking milk), and, satiated, fall asleep, alcoholics

"experience anxiety reduction and a plethora of other

affective and cognitive changes" while drinking alcohol.

(For rest 1 984, 1 4) Usually alcoholics relieve their

tension by falling into a sleepy stupor. Drinking also

gives them a way to cathect orally "their angry feelings

against the self and others." ( 1984, 15) Alcoholics

employ the defense mechanisms of denial, distortion, and

pr oj ecti on to construct an av oi da nee defense against

experiencing "self-perception, feelings and affects, and

self-dialogue." (1984, 14)

Addicted persons have experienced chronic

Narcissistic need and entitlement deprivation

during the epochs of infancy and childhood.

Alcohol, and especially drugs are 'magic

substances'. By ingesting this magical substance,

the addict becomes capable of accomplishing rna ny

magical things. (Forrest 1982, 29)

To a lesser degree, food, cigarettes, and candy

provide a sense of relief that is not quite so profound

as alcohol or drugs, but these addicts' need is not

quite so great as that of the alcoholic and drug addict.

The addict chooses to become and remain

addicted. The ingestion of any of these substances

84

can make people feel better. and dulls their

physical and psychological pain. As a result of

intoxication, for instance, the alcoholic feels

less insecure, less anxious, less depressed, and

falsely, more in control of himself and others.

(Forrest 1983, 30, 31)

For example, babies on a rigid four-hour feeding

schedule who were hungry and cramping every two hours

yet have been left to cry it out for every alternating

two hours around the clock for weeks experience a great

deal of physical pain and emotional abandonment. This

neglect and abandonment begins to create feelings of low

self-worth,

hopelessness.

worthlessness, hel pl essne ss, and

85 ~ .

CHAPTER IV

TYPES OF NARCISSISM

There are many types of Narcissistic character

disorders, varying in degree of severity and

incapacitation of normal life-functioning. The

following chapter will introduce each type of behavior

dysfunction so that the novice therapist will more

easily be able to identify the different Narcissistic

styles and to provide the proper treatment for them.

Definition of "Positive" or "Healthy" Narcissism

The same kind of internalization process develops

in a person with positive Narcissism as well as

Negative, with the exception that the "positive"

individual has managed to separate himself from the

object, whereas the one with negative Narcissism has

not. The "positive" person has learned to identify with

the healthy self--from the process of individuation and

the acceptance of himself the mother has given him. He

has developed and strengthened his own actual

reality-based core-self and does not need to rely upon a

mythical "idealized" self.

It will be helpful, at this point, to discuss the

qualities that constitute healthy developmental

86

Narcissism before we discuss the manifestation of the

various types of Narcissistic character disorder.

We are all born, presumably, with a healthy state

of Narcissism, which is, according to the Random House

Dictionary of the English Language, (Unabridged edition)

Self-love, or, an erotic gratification derived

from admiration of one's own physical or mental

attributes, being a normal condition at the

infantile level of personality development.

A good sense of self-esteem is necessary for an

individual to function successfully in society, and

though we are born Narcissistic and self-centered, the

hope is that mature people will outgrow it. Narcissists

tend to retain this trait as a character disorder which

continues to disrupt their lives and relationships.

However, each individual needs to retain some aspect of

heal thy Narcissism because this trait contributes to a

healthy sense of self-worth and confidence.

Alice Miller, in Prisoners of Childhood, ( 1981)

defines healthy developmental Narcissism:

If a child is lucky enough to grow up with a

mirroring mother, who allows herself to be "made

use of" as a function of the child's development as

Mahler (1968) says--then a healthy self-feeling can

gradually develop in the growing child. Ideally,

this mother should also provide the necessary

positive emotional climate and understanding for

87

the child's needs. But even a mother who is not

especially warm-hearted can make this development

possible, if she only refrains from preventing it.

This enables the child to acquire from other people

what the mother lacks. Heal thy self-feeling means

the unquestioned certainty that the feelings and

wishes one experiences are a part of oneself.

This automatic, natural contact with his own

emotions and wishes gives an individual strength

and self -esteem. He may live out his feelings, be

sad, desparing, or in need of help, without fear of

making the introj ected mother (himself) insecure.

He can allow himself to be afraid when he is

threatened, or angry when his wishes are not

fulfilled. He knows not only what he wants, but

what he does not want and is able to express this,

irrespective of whether he will be loved or hated

for it. (Miller 1981, 5-6)

In short, his self-awareness, or self-image will be

integrated into wholeness. His parents will have

succeeded in giving him a healthy sense of self-esteem

and self-respect. He will be aware of a secure feeling

of his positive entitlement by the knowledge that they

loved him properly, supported his growth process, and

gave him freedom and autonomy, as well as appropriate,

timely discipline when he knew he needed it. Miller

continues:

88

The following constructions of phenomena are

only approximated in reality, and actually

constitute the ideal. They also could be called

inner freedom: ••• Aggressive impulses could be

neutralized because they did not upset the

confidence and self-esteem of the

parents •.•. Strivings toward autonomy were not

experienced as an attack upon the parents ( ••• or

the family system) •••• The child was allowed to

experience and express "ordinary" impulses (such as

jealousy, rage, defiance) because his parents did

not require him to be "special" or "unique" to

represent their own ethical attitudes of "purity"

and "perfection. 11 ••• There was no [exaggerated] need

to please anybody (under optimal conditions, and an

almost impossible ideal) and the child could

develop and exhibit whatever was active in him

during each developmental phase within acce pta bl e

limits •••• He could use his parents because they

were independent of him. [They did not force or

allow him either to take over or to control the

family because of their Narcissistic inade­

quacies.] ••• Because the child was able to display

ambivalent feelings, he could learn to regard both

his self and the object as "both- good and bad"

[accepting the reality that people, parents, and

himself, are not perfect] and did not need to split

89

off the "good" from the "bad" object, thus,

learning to accept both his parents and himself as

whole objects, and accepting the fact that he and

others make mistakes •••• Object love was made

possible because the parents also loved the child

as a separate object from themselves. [This is

seen as reciprocal.] ••• Provided there were

phase-appropriate and non-traumatic frustrations

(rather than fixating traumas), the child was able

to integrate his Narcissistic needs and did not

have to resort to regression, denial, splitting, or

other defenses •••• This integration made their

transformation possible, as well as the development

of a drive-r:egulating matrix, that was integrated

and based on the child's own trial-and-error

experiences. (Miller 1981, 7-8)

~ Range of Narcissistic Character Disorders

Having defined the constitution of healthy

Narcissism, we will discuss the types of Narcissistic

Character Disorders beginning with the almost heal thy

and ranging to the pathological.

Neurotic Narcissistic Personality

Just about all of the "normal" people in the world

exhibit signs of the Neurotic Narcissistic Personality,

90

which is the healthiest end of the spectrum of the

character disorder.

Despite regressive and defensive responses to

Narcissistic injuries, they prove flexible enough

to return to reality and to progress to more

intimate involvement with others. These are

individuals who, ultimately, are able to respond to

the exigencies of 1 ife with progressive growth.

They relate to warm, related, respectable parents

in a progressively realistic manner and idealize

and identify with them. (Rothstein 1980, 121)

They are more aware of their whole-object self,

feelings, and bodies because "an adult can only be fully

aware of his feelings if he has internalized an

affectionate and empathic self-object." (Rothstein 1980,

21)

For instance, this adult might be considered

neurotic because he has an intact superego and an

ego ideal which are composed of abstract and

humanistic ideals of 1 ov ing. Perhaps his major

defense is repression of both rage and sexual

desires. He is 'neurotic' rather than 'normal'

because his conflicts of rage and sexuality lend a

strict quality to his superego. He is excessively

hard on himself and somewhat inhibited in the

pursuit and enjoyment of personal success and

exhibitionistic, sensual, or sexual pleasure. His

91

ego and his neurotic character integration

facilitate his struggle between the pursuit of

illusion and object relatedness. (Rothstein 1980,

123)

Phallic Narcissistic Personality

Freud 1 s third stage of a child 1 s development is

Phallic, and exists approximately from 3 to 5 years of

age--similar to the Oedipal stage. The fixation at this

stage causes Phallic-Narcissism. This style of

Narcissism can be identified by the person's apparent

arrogance and conceit.

Grandiosity, and thus, Narcissism, is a

function of the discrepancy between the image and

the self. That discrepancy is at a minimum in the

case of the Phallic-Narcissistic character which is

why that personality structure is next closest to

health on this spectrum. The importance of the

concept of Phallic-Narcissism is two-fold. First,

it underlines the intimate connection between

Narcissism and sexuality--specifically, sexuality

in terms of erective potency, the symbol of which

is the phallus. Second, it describes a relatively

heal thy character type, in whom the Narcissistic

element is almost at its minimum. (Rothstein 1980,

125)

92

In its least pathological form, Phallic-Narcissism

is placed just after Neurotic-Narcissistic Personality,

neither of which is really pathological because of the

connectedness between the body and the feelings,

.•• Narcissism is the term applied to the

behavior of men whose egos are invested in the

seduction of women. Their Narcissism consists of

an inflation and preoccupation with their sexual

image. [Many of them can be found in gyms "pumping

iron". J This type is self-confident, often

arrogant, elastic, vigorous and often impressive.

(Wm. Reich 1959, p. 201)

The female, too, is self-confident, often

arrogant, vigorous and impressive. Her Narcissism

comes out in a tendency to be either coquettish or

seductive and to measure her value by her sexual

appeal, based on her "feminine charms." She is,

and feels herself to be, attractive to men, and she

has a relatively strong sense of self. She differs

from the Phallic-Narcissistic male in that softness

is her essential quality (the softness of the womb)

as opposed to his identification with the hardness

of his erection. The Phallic-Narcissists are also

closer to the healthy scale because they often show

strong attachment to people and things, and are

more aware of self and others. Successful

functioning in the phallic mode more frequently

93

results in a greater degree of autonomy than do

activities based on fixations to modes dependent

upon the response of the external object. (Lowen

1983, 15)

For example,

One client viewed his body as being the penis

and the glans his head and admired himself for his

'erect' posture as well as his 'hard' upright

attitude in 1 ife. He was responding to his

mother's covert seduction of him, when as a child

he was allowed to lie in bed with her and they

touched feet. Needless to say, he had been

divorced twice and was having trouble with his

present girl friend. He felt alienated from his

own 1 ov ing/se xual feelings and disowned his own

penis, although he was very active sexually. He

was busy proving his 'macho' role, but was unable

to feel love connected with the intimacy of

sexuality. (Lowen 1983, 16)

Another type of phallic behavior is related to what

appears to be the charming sociopath, or hedonist, type.

When an original object-choice, for example,

the mother, of an instinct is rendered inaccessible

by external or internal barriers (anticathexis), a

new cathexis is formed unless a strong repression

takes place. If not, this object is then cathected

until it loses is power to reduce tension, at which

94

time, another search for an appropriate goal object

is instituted. (Masterson 1981, 65)

This process can be repeated many times in the

effort to reduce tension. An example would be the

Phallic-Narcissistic person who chases someone only to

conquer them--the pleasure being in the chase and

victory. Success loses its pleasure with conquest, and

he loses interest precisely because of his success. He

drops the "conquered" partner with such excuses as she

is not "perfect" or "ideal," or she has a flaw in her

personality, because he is unable to transact intimately

with a whole-object. From being the example of the

perfect, or ideal love-object, she becomes someone to be

devalued and despised by him. Then, he begins the

pattern over again and seeks another object to pursue,

always in the pursuit of the myth of the "perfect"

object. Of course, this Narcissist is pursuing his

perfect "parent" (unresolved aspect of the Oedipal

complex) and/or his or her own "perfect ego-ideal".

Still another aspect of the Phallic-Narcissistic

state seldom discussed is the homosexual response:

Because the parent is experienced as

di sa ppoi nti ng and not admirable, the superego

structuralization is relatively deficient of

sublimated homosexual libido" (Freud, 1914, p.

96), "or, of a loving investment in the

95

obj ect-represe nta ti on from which it is derived."

(Masterson 1981, 64)

Since Freud thought everyone was innately bisexual,

one result of frustrations at the Oedipal phase in the

developing Narcissism can be homosexual adaptation:

The future inverts, in the earliest years of

their childhood, pass through a phase of very

intense but short-lived fixation to a woman

(usually their mother), and, after leaving this

behind, they identify themselves with a woman

[their mother] and take themselves as their sexual

object as a woman. That is to say, they proceed

from a Narcissistic basis from their female role

and 1 o o k for a you n g man [ i f m a 1 e , or w om an , if

female] who resemble themselves (or the introjected

ideal-object) and whom they may love as their

mother loved them. (Rothstein 1980, 145)

Freud believes they fall in love, therefore, with

themselves as the ideal of the opposite sex.

When structured, narcissistically invested

defenses are prominent, often central, features of

an individual's character organization, he is

designated as a "typical" Narcissistic personality

disorder. If these defenses function as previously

discussed, the subject feels safe. (Rothstein

1980. 54-59.)

96

Narcissistic Character

The Narcissist's behavior is based upon those of

the Narcissistic defenses which work best for him. On

the spectrum of Narcissism vs. health, this is the main,

or most common disorder, and ranks third from health,

or, approximately in the middle of the seale with

pathology at the further end.

Narcissistic Characters have a more grandiose

ego image than Phallic-Narcissists. They believe

that they are not just better, they are the best.

As Masterson points out, they have a need to be

perfect and have others see them as perfect.

Actually many of them can display numerous

achievements and seeming success, for they often

show an ability to get along in the world of power

and money. Others may think highly of them, too,

because of their worldly success. However,

Narcissistic Characters are out of place in the

world of feeling and do not know how to relate to

other people in a real, human way. One man was

overl coked for promotion to vice- president of his

company because of his compulsive, harsh behavior

and cr i ti ci sm of people under him. He was unaware

of his attitudes and actions, but when he was

confronted with it at work, he had to have it

verified by his wife and children. Luckily, this

knowledge sent him into therapy. Another man felt

97

so sexually attractive and superior to people as he

walked down the street that he felt that people

stepped aside for him like the parting of the

waters of the Red Sea. (Lowen 1983, 17)

The true Narcissistic Character has an

obsessional neurotic integration. For example, his

Narcissism is primarily invested in his 'political'

career on the job, and in the ego functions

associated with gaining power and advancement

through winning the approval of his superiors, [a

substitute for mother's smile of approval J. His

sense of well-being derives from that

accomplishment. He gains smiling attention by

being thorough and conscientious in his work and by

being par ti cul arl y well- informed. He feels it

imperative that he be informed about everything

that anyone important might ask him in order to

feel safe. At the moment he demonstrates that his

knowledge is 'perfect', a sense of original

Narcissistic perfection is recaptured: He is

smiled at either by himself or by a respected

object. (Rothstein 1980, 135)

Again, he feels safe and approved, as he did when

he performed perfectly for his mother in his childhood.

Arnold Rothstein defines another style of

Narcissism that is closely related to the above:

Narcissistic Investment in Thinking.

98

Narcissistic Investment in Thinking

This person ponders weighty, abstract,

intellectual questions such as 'Is there a line

drawn between psychological and physiological

phenomena in man?' but avoids more important

questions concerning the meaning of life and death

to himself. Many questions are asked, but none are

experienced personally. His intellect is not

employed to deepen his involvement in life. Rather

it is a shield from involvement and is exhibited as

a product to win the object's adm irati on. He

avoids the personal and humanistic implications.

This person's investment in elite abstractions of

thought is life-long and integrated in a neurotic

obsessional organization and defends him against a

quality of perceived potential rejection. As 1 ong

as he feels brilliant, he feels safe from

rejection. The object reflects his brilliance,

while his energies are invested in a self-loving,

self-involved pursuit of his self-deceptive

fantasied genius. (Rothstein 1980, 226)

Borderline Personality

The Borderline Personality's intrapsychic structure

consists of a grandiose image and entitlement, but the

borderline patient does not have as free access to

aggression as does the Narcissistic personality

99

disorder; therefore, this is a disorder farther away

from health and closer to the pa thol ogi c seale. Thus,

self-assertion, coming up against the maternal

withdrawal projection, is not available for self-esteem.

This calls for passive-regressvie behavior which

requires the foregoing of the true-self and

self-assertion. Unlike the Narcissistic patient, the

borderline is hypersensitive to reality, particularly to

people's rewarding and withdrawing responses.

Since they are so chameleon-like, Masterson warns

the therapist that they will see his every facial

expression, body movement, or tone of voice as "meaning

something in relation to them, and will want an

interpretation, or will internalize it as a secret fear

or worry." (Masterson 1981, 123)

The borderline perceives the reality as

inducing depression and then clings to or distances

from the object for relief, by withdrawing or

rewarding behavior, meanwhile denying the

destructiveness of these defenses to adaptation and

to his true self.

The differences in developmental level and

intrapsychic structure are cl ini call y seen most

clearly in the transference acting-out. The

continuity of the self- represe nta ti on of the

Narcissistic character disorder in treatment

presents a seemingly invulnerable armor of

100

grandiosity, sel f-ee nteredne ss, exh i bi ti oni sm,

arrogance and

characteristics

devaluation of others. These

are in marked contrast to the

self-representation of the borderline, which

alternates be tween brittle, vulnerable,

self -de precia ti v e, clinging behavior and erratic

and irrational outbursts of rage. (Masterson 1981,

29)

It is sometimes difficult to separate the

Borderline from the Narcissistic Character disorder, and

sometimes it is only a rna t ter of degree and quite

confusing when it comes time to make the formal

diagnosis because their symptoms are so similar.

The depression beneath the Narcissistic

personality disorder's defense is heavily colored

with Narcissistic outrage and feelings of

hum ilia ti on. The rage has a quality of "coldness"

or lack of relatedness. In contrast, the

borderline patient's depression is dominated by

feelings of ina deq ua cy about and hostility toward

the self, and the rage shows intense relatedness.

Envy in the borderline is subordinated to

depression and anger at the loss of the wished-for

supplies, while it is a prominent theme in the

Narcissist. The themes of pursuit of power and

perfection, wealth and beauty so prominent in the

1 01

Narcissist are, at best, minor in the borderline

and they express more fears. (Masterson 1981, 30)

Normal Suppliant Personality Disorder

Rothstein adds this style to our general knowledge.

This type displays the moral masochist's almost total

inability to tolerate adm irati on. This gives the

Narcissist the illusion of being self-contained, an

isolated tower of independence and strength, or of an

inner-directedness. He apparently is not seduced by

praise. In reality, though, this person has a very low

sense of self-esteem, or nnegative entitlement" with a

resulting masochistic character integration.

The self-absorption is a massive inhibition of

appropriate self-oriented pleasure. Stolow (1975)

conceived of masochistic activities as functioning

to maintain the stability of the

self-representation and thus as serving a

"Narcissistic function," (p. 442), i.e., the denial

of pleasure. Although explicitly functional, this

definition is implicitly dynamic, for it presents

these activities as defensively motivated responses

to the ego's perceptions of external reality or the

internal representational world-perceptions that

threaten the cohesiveness of the

self-representation.

102

The terms Narcissism and masochism, as used

here, de note contents of identi fica tory pr oce sse s

which are mediated by the integrative and synthetic

functions of the ego, maintain the stability of the

self-representation and help them overcome

Narcissistic injuries.

However, masochists feel helpless and hopeless

a bout any possi bl i ty of undoing a rejection that

has been profoundly injurious to their self-esteem.

They feel unl ovea bl e and very unworthy, de serving

of punishment. They often unconsciously look for

the sadist to punish them for their unworthiness.

They feel guilty when nice things happen to them

and they deny themselves the pleasure principle.

The subject and object in the sado-masochistic

relationship are difficult to pry apart because of

the fear of abandonment separation and the low

self-image of the client. When the self-esteem and

independence of the suppliant masochist is

sufficiently raised to a healthy level, which takes

therapeutic time, the separation will transpire

naturally. (Rothstein 1980, 128)

Their feelings of helplessness arise from the

powerlessness they experienced as small children. For

example, if they were denied the normal entitlement of

such care as having their diapers changed or being fed

on time, they will have difficulty believing that they

103

are valuable persons and will continue to seek the

punishment they seem to deserve. Developing feelings of

worthiness and self-value in therapy will counteract the

need to respond masochistically to real or fancied

rejection.

Such a masochistic view of self is often

complemented by a suppliant attitude toward the

object and the patient expects to find safety from

the rejection, rage, cruelty, and/or separation of

the object. (Rothstein 1980, 15, 129)

Many factors influence the choice of a

symptom, character organization, or defensive

response. The perspective being stressed here is

the subject's attitude of self and its relationship

to the quality of parenting. Pursuit of a

Narcissistic solution is organized around a

self-perception that contributes to the subject's

feeling he can undo the injury. A masochistic

solution is constructed from internalized memory

traces of rage-filled maternal dissatisfaction and

of the subject's inability to reverse it. No

matter how "good" he tried to be or how perfectly

he acted, he could never please the object until

this pattern became his way of life. Internalized

parental attitudes (whether they be praise or

cricitisms) contribute affective components to the

subject's ide nti fica ti ons, which are secondarily

104

reinforced by ego endowments also including gender,

anatomy, cultural attitudes, and sociocultural

opportunities. (Rothstein 1980, 16)

Schizophrenic Personality

Although schizophrenia is a character disorder so

large that it has its own topically related research,

Freud noted in his chapter "On Narcissism, an

Introduction," that it has a decided relationship to

Narcissism. It 1 ies somewhere along the Narcissistic

spectrum between or alongside the psychopathic and

paranoid personalities. The schizophrenic, paranoid,

and psychopathic personalities are noted for

dissociation, withdrawal, depression, autistic

fantasies, passivity and/or violent outbursts. These

behavior patterns arise out of a Narcissistic splitting

which has been carried to such an extreme that the

patient cannot relate either to himself, to others, or

to reality in a coherent or responsible way. The

difference among these character disorders is primarily

that schizophrenic personalities are usually violent

only toward themselves, rather than toward others.

Spotni tz "ultimately came to the cone! us ion that the

primary problem with schizophrenics, as known

Narcissists, was to work through their 'internalized

aggression'"· (Nelson 1977, 16)

105 ,, '

The schizophrenic patient is so thoroughly split

away from himself that he frequently hears "voices"

internally telling him what to do, how to act, and how

to live. The Narcissistic introjects have become so

strong in the schizophrenic that they seem to have

acquired a life of their own. Usually the patient talks

back to these voices, believes in them more than he does

to real persons speaking to him, and has to have his

attention brought back to the present moment forcefully.

Like the paranoid and psychopathic personalities, the

schizophrenic personality frequently must be

hospitalized.

Psychopathic Personality

This sty 1 e is further along the spe ctr urn from

health toward pathology. Like the schizo~hrenics, these

Narcissists deny their feelings even more than the

Borderline Narcissists, and are even more unaware of and

unrelated to their bodies and feelings. In extreme

cases, psychopathic personality types are known to

injure themselves compulsively, apparently feeling no

pain. One girl would slice her arms with knives or tops

of tin cans and couldn't stop herself. Some burn

themselves with cigarettes in their self-hate. They

will lie, cheat, steal, and the extreme psychopath will

even kill without any sign of guilt or remorse. There

is no development of the superego to integrate into the

106

subject. In effect, they have killed their own internal

adult and parent (in terms of Transactional Analysis) or

Freudian ego and superego and only a negative,

destructive, free child is left to act out. The

"splitting" of self is complete in this style of

Narcissist.

This extreme lack of feelings for fellow

humans, and their lack of conscience makes

psychopathic personalities very difficult to treat.

The term "acting out" describes an impulsive type

of behavior that ignores the feelings or property

of other persons and is generally destructive to

the best interests of the self. The person is

generally antisocial, usually of long duration,

more a matter of degree rather than kind, except

for the violent types. Cold-blooded murder is an

extreme example of acting out, and on a lesser

seale alcohol ism, drug abuse, and sexual

promiscuity are also ways of acting out. The

impulses underlying their behavior stem from

experiences in early childhood that were so

traumatic and so overwhelming that they could not

be integrated into the developing ego, or superego.

As a result, the feelings associated with these

impulses are beyond the ego's perception and the

superego's control.

107

One must remember that in other respects,

namely, in their ability to manipulate other

people, organize and promote schemes, and attract

followers, Narcissistic characters and psychopathic

personalities are anything but infantile.

In saying this, I should add that psychopathic

personalities are not necessarily what society

calls "1 oser s". There are successful psychopaths

studied by Alan Harrington who are brilliant,

remorseless people with icy intelligence, incapable

of love or guilt with aggressive designs on the

world. Such an individual may be an able lawyer,

executive or politician.

Hitler and Reverend Jones are good examples of this

kind of psychopath. Their need for the power and

control they didn't have as an infant motivates the

ruthless ambition of this type of Narcissist.

Instead of murdering others, this person might

become a corporate raider and murder companies,

firing people instead of killing them (which is

financial murder of their careers and incomes) and

chopping up their functions instead of their

bodies. Ironically, the key to this kind of

'success' is the person's lack of feeling--which is

the key to all Narcissistic disturbances. As we

have seen, the greater the denial of feeling, the

108

more Narcissistically disturbed the individual is.

(Lowen 1983, 22, 23)

The book and movie, What Makes Sammy Run, is an

example of the ruthless Narcissistic corporate

executive, as is J. R. Ewing on Dallas.

The Paranoid Personality

At the pathological end of the spectrum, furthest

removed from health is the paranoid personality showing

clear-cut megalomania. Paranoid personalities believe

that people are not only looking at them but talking

about them, even conspiring against them, because they

are very special and very important. They may believe

that they have extraordinary powers (magic). When they

become unable to distinguish fantasy from fact, their

insanity is clear. In that case, we are dealing with

full-fledged paranoia--a psychotic rather than a

neurotic condition and the treatment differs. They also

defend themselves with extreme grandiosity and

arrogance, inse nsi ti vi ty to others, denial, projection,

and a marked discrepancy between the ego-image and the

actual self. They feel they are "elite" and due an

unlimited amount of special treatment and entitlement.

They are very arrogant and demanding people.

The term "borderline Narcissism" was created

to denote a personality structure that is halfway

between sanity and insanity. In summary, if sanity

109

is measured by the congruence of one's ego image

with the reality of the self and/or body, then we

may postulate that there is a varying degree of

insanity in every Narcissistic disturbance. (Lowen

1983, 23, 24)

11 0

CHAPTER V

THERAPEUTIC PROCESS AND TECHNIQUES

Goals of Therapy

Spotnitz succinctly outlined the ten goals toward

which the therapist must work and through which the

therapeutic situation must progress to achieve the final

independence of the patient:

1. Developing the alliance with the patient.

2. Developing the patient's transference to

the therapist.

3. Overcoming the patient's resistance.

4. Overcoming the analyst's counter­

transference resistance.

5. Developing a deeper relationship between

patient and therapist.

6. Overcoming and working through the

patient's Narcissistic counter-

transference resistance by opening up the

patient's ability to release hostility in

the session together by recalling the

patient's early life.

7. Developing the object-transference to the

analyst wherein the analyst becomes the

Narcissistic self of the patient; wherein

the analyst would sometimes be the

111

patient, or the latter's father or

mother; and interventions.

8. Working with the analyst's own counter­

transference resistance.

9. Eventually working through the patient's

object-transference resistance as he

found more understanding of himself.

10. Finally, resolving the patient's

resistance to termination of therapy.

(Nelson 1977, 85)

Pragmatic Delineation of Therapeutic Process

Although the beginning therapist must keep

Spotnitz' goals in mind as he works with a client, these

steps actually manifest themselves during the

therapeutic relationship in a creative,

non-differentiated current during the exchanges between

therapist and analysand.

No single work discusses the actual, pragmatic

techniques required in a therapeutic situation.

However, Masterson and a few others have provided some

initial, constructive guidelines for the beginning

therapist that will help him cope with the difficulties

arising during the therapeutic hour spent counseling the

Narcissist.

Having the following information will give the

therapist the self-confidence he will need to provide a

112 ,, .

constructive therapeutic rel a ti onsh i p with the

Narcissist.

Establishing the Therapeutic Alliance

Once a therapist suspects that he is treating a

client who suffers from a Narcissistic d:l sorder, the

therapist will need to be alert to use his functional

knowledge of the disorder and its defenses in order to

provide constructive therapy for the analysand.

Patience is a prime requisite because it takes a long

time to establish the therapeutic alliance, or rapport,

with these patients. Building alliance and trust are

the most important and almost the most difficult aspects

to develop in the therapeutic process, according to

Masterson, because clients react to the therapist as

they did to their mother or to the Narcissistic parent.

It is also trying because the analysand's protective

lack of awareness of self and their own feelings is so

deeply ingrained.

Being Prepared for the Use of Defense Mechanisms

The growth toward individuation, autonomy, and

independence is the obvious goal of therapy. Since the

Narcissist has been avoiding this process assiduously

all of his 1 ife, the therapist can expect intensive

defense reactions as the client continues to try to

resist facing this emotional conflict in therapy, even

113

though he wants to make the change. The therapist can

expect many types of cycles, much acting out, and an

intensity and variety of defense mechanisms projected v

upon him, not as a separate "whole object" who is

allowed to be human, make mistakes and be imperfect, but

as a projection of the infantile self, part-object of

the patient. The therapist must also "be perfect or

else!" The "else" will be a client who is very upset

and "acting-out"; the therapist had better expect these

responses when he makes mistakes. These factors cause

many therapeutic difficulties, and the therapist must be

prepared for this. He must marshall all of his

knowledge of the disorder in order to maintain his

clinical objectivity when the analysand employs his

arsenal of defense mechanisms toward the therapist.

Self Control Critical to Therapist

There are several things Masterson cautions

therapists about: Since Narcissists are so

chameleon-like, every nuance, facial expression or

body-language will be over-interpreted by the patient.

For example, the therapist's sneeze at the wrong moment

may be interpreted as total rejection by the client,

because he is super-sensitive. The therapist must watch

himself carefully, so that what he does or says can't be

interpreted negatively by the client. On the other

hand, a positive aspect of the client's observing and

114

copying behavior is that the Narcissist can be

encouraged to use the therapists' positive attributes as

a role-model.

Narcissist's Manipulation of Therapist

The therapist must be aware of the Narcissist's

ability to manipulate others and must not allow himself

to become drawn into any of the client's behavior

patterns, especially those that are self-defeating. The

therapist must maintain his clinical objectivity,

neutrality and control at all times because the violence

of the rage, devaluation, and contempt that will be

projected toward him is designed to captivate his ?Wn

defense mechanisms and thwart therapy. He must maintain

his "cool", in street parlance. He must also be able to

resist the depressive cycles of the client and to

recognize the Narcissistic compulsion to repeat behavior

until, from lack of the therapist's reactions to it, the

behavior wears out. The therapist must allow all the

time that is necessary for the client to reach this

point in order for time to extinguish this behavior.

Counter-Transference

Masterson's final caution lies in the realm of

counter-transference. He warns: Do not play the part

of the hero and come to the patient's rescue as a

parent- substitute. The client is very skillful at

115

manipulating people and can draw in the therapist by

taking advantage of the latter's own sympathetic nature.

Above all, the client must learn to be independent and

do his own healing work for himself. The client is not

used to this and will use every device at his command to

avoid it. He must be confronted gently and be made

aware of this.

Tracking Affect: Gentle Confrontation

The key to the work in the beginning of

treatment is Affect--to track and bring to the

patient's attention the discrepancy between his v

behavior and his feeling state while setting limits

to the 'rewarding unit-projections' (therapist).

This inevitably leads to the triggering of the

withdrawing unit, which must then be confronted.

(Masterson 1981, 126)

Masterson believes the only technique possible to

use at first is a gentle confrontation, not a hostile

aggressive attack upon the patient, but constant,

repetitive reminders of reality and awareness of

behavior, defenses and feelings. After several years,

analytical interpretations may be made when the

patient's ego strength and its ego-observing abilities

have been built up. Done too soon in therapy,

interpretation (asking why did you do that, and

analyzing it) will be destructive because the patient

116

does not have the capacity to handle that awareness yet,

nor can he be objective enough. At first, therapy

really becomes more Gestalt in approach than analytical.

Without realizing it, Masterson's recommendations for

the therapist really enjoin an eclectic variety of

processes that seemingly he was not overtly aware of;

yet he had learned to use them because they worked, for

example, Rogers' "mirroring" technique, among others. ,

He-Parenting

Another goal of therapy is to re-parent the

false-self of the patient by allowing him to act out in

the safety of therapy and to promote his growth to

autonomy by the proper integration of the id, ego, and

superego. According to Masterson, the therapist must

take the patient back to infancy, and allow him to grow

step by step through each of his developmental phases in

a supper ti v e, approving climate that he failed to

receive earlier. The therapist must pay particular

attention to dreams such as those of coffins, death and

dying because these reflect the patient's internal

feelings of being dead inside, or committing suicide.

The therapist must teach the Narcissist techniques of

self-assertion and the client must practice them daily

in his activities as an aid to his self-expression and

self-preservation.

117

Role-Reversal

Role-reversal is a good therapeutic technique to

employ after trust and a mutual alliance created for

growth have been established between therapist and

analysand. It definitely should not be employed before

this development in the relationship. Using the empty

chair technique and reversing roles as he sits in each

chair conversing with his "antagonists," the patient

will develop a better understanding of both sides of the

si tua ti on. This will help him understand others and

grow beyond his self-centered viewpoint. Therapy is a

learning situation for the Narcissist. In the chair, he

will learn to mourn his lost childhood; he may defend

himself from his negative parents; and he may criticize

their "bad" parenting. Through this exercise, he will

learn to give up his defensive illusiou of happy

childhood and his lack of positive entitlement. He can

"wear out" his rage and resentment of abuse as he vents

his feelings for his parents in the empty chair. Unti 1

the mourning period can bring about tears, his growth

will be inhibited. This will be his first connection

with his feelings. Additionally, the patient must learn

to face his denial, avoidance, clinging, withdrawal, and

all his other defense mechanisms by projecting them to

the opposite chair. He can be introduced to his real

self and connect and integrate the "bad" and "good"

part-selves into his whole, or true, self, and learn to

118

accept others with all their imperfections as whole

selves (whole objects). Through the technique of

role-reversal, he will forgive them and himself for

being "human" and, thus, imperfect. He will learn to

resist the demands of his parental introjects and

develop his own world. He must learn he has the right

and ability to make choices in his life and to take

control and power over himself, not abrogate it to

others.

Gestalt Therapy

The initiation of "gentle" Gestalt is almost a

requirement in the 1 ast stages of therapy because by

that time the client must become able to handle true

reality better and become his own whole-object. Gestalt

will be consistent in making him aware of his present

reality. Gestalt also employs the empty chair and

role-reversal technique which are beneficial in

expanding the viewpoint of the Narcissist.

Therapeutical techniques must be flexible, possibly

creative, and certainly adaptable to the progress or

regression of the client. The therapist must be in

control and able to select the most appropriate therapy

for the moment. If something doesn't work, he must be

quick to drop it. He must use whatever does work for

each client since this disorder, more than any other,

really seems to require the greatest amount of

1 1 9

individualized "made-to-order" therapy. In short, the

eclectic approach would seem to work the best, according

to Dr. James Masterson.

Bioenergics

Dr. Lowen added a new dimension, however, when he

added bioenergics as a technique in which he gave

breathing and physical exercises to the patient in order

to "ground 11 them into an awareness of their physical

bodies. He would have them put on comfortable exercise

clothes and he would check over their body muscles for

tension spots and relate those spots to whatever emotion

they were holding in. He would massage the tense areas

lightly until the muscles would relax. At the same time

he would encourage the client to give vent to the

emotions relating to those particular areas, for

example, jaw and throat muscles prevent the vocalization

of their persona and inhibit and suppress tears, crying,

and sobbing. Sometimes these people hadn't been allowed

or encouraged to cry since they were tiny tots. We've

all heard parents say, "Don't cry or I '11 give you a

beating to cry about", or "Boys don't cry. Don't be a

sissy". For example, in the case of the Phallic­

Narcissist who thought his body was a penis, his pelvic

muscles were tensely maintained so that he could block

off his pleasurable sexual sensations. He punished

himself by not relaxing and enjoying his sex life. Yet,

120

this man was sexually very active. He had to learn to

associate loving feelings with his partners (objects) as

he had intercourse with them. Lowen worked with

massaging those lower stomach muscles and relaxing them

as part of the therapy for this man as he helped him

grow beyond the Oedipal phase and his mother r s covert

seduction.

The Narcissist must become acquainted with his own

feelings and sense his own body and its feelings, along

with becoming aware of the new image of who he is

becoming and projecting to the world. To do this, he

must become aware of his emotional and behavioral cycles

and learn to accept them and work to improve and balance

them, and to become grounded within his own body.

Breathing exercises and physical exercises under the

guidance of the therapist can help make these bodily

connections, such as slow-stretching exercises

pin-pointed to release the fight or flight tension in

tight muscles.

Constructive Release of Rage

As has been mentioned, Narcissists compulsively

repress the expression of their feelings of rage toward

their parents for fear of losing the parent's love, or

for fear of their own annihilation by the parents, or of

separation- indi v idua ti on from the parent. Narcissists

have grown up, using the term loosely, discharging their

121

rage by attacking themselves internally with their own

silent dialogue, also by their self-destructive

"acting-out" and "acting-up" behavior. Along with many

therapists, Dr. Alex a nder Lowen r s technique, besides

analysis, is to allow the "acting-out" of rage by having

the patient hit the cot or couch in his office with a

soft bat or tennis racquet in order to bring the rage

and anger to the surface and allow a safe venting under

the therapist r s control. He encourages his patients to

curse, rant, rave, and scream at the faulty parents.

This technique is used in almost every type of therapy

now but must be used with control.

Group Therapy

Eventually, when the client r s ego strengthens, it

may be a good idea to recommend the adjunct of group

therapy for him. The individual may need group therapy

because his feelings of 111 ack rr are so strong that he

cannot overcome his compensating addictions until he

learns to love himself in a proper and constructive way.

The support of a group can be very constructive in

reinforcing his sense of worth. His "mind-set" will be

broadened by seeing the problems and constructive coping

mechanisms of other people. This process will help

expand, gradually, his own awareness of other people.

It will help him overcome his protective

122

self-centeredness but only when he is ready to move

outward from concentrating upon himself.

Other Technigues

When a patient expresses his fantasies about

himself, the therapist should not immediately and

aggressively deny them. Rather, the therapist should

give free rein to the patient's fantasies about his

talents and abilities to see where the fantasies lead,

then gently confront the unreality of the exaggeration

with the reality of the patient's true strengths and his

potential qualities that have not yet been developed.

Once the patient realizes the potential of his own

power, he can begin to develop the strength his ego

needs to create the balance required between itself and

the id and superego.

As Hamilton pointed out in her counterstatement on

the Oedipal complex, Oedipus' real task was to search

for his own identity, which he could only know after

learning who his parents were--that is to say, after he

learned about his own history.

Since Narcissism is caused by a lack of the

infant's dif~erentiation with his mother and a lack

of identification with the father, Narcissism can

seem to be an Oedipal complex. However, it is not

always one. It is the obl iga ti on of the therapist

to help the individual explore life and himself and

123

124

tread the road beside both Narcissus and Oedipus in

order to leave behind his "undifferentiation" with

his "self" and his object, or mother, and seek and

discover his own true identity from an enlightened

form of knowledge which the clinician can give to

him in therapy. (Hamilton 1982, 16)

Since all the literature I have read on this topic

was written by psychiatrists whose mode of therapy was

psychoa naly sis, they, naturally, did not mention other

theories. Even Masterson did not mention his eclectic

choices per se, he simply showed how he used them

without naming them. However, I can see where an

intelligent and judicious use of many others could be

substantiated. Behavior modification and R.E.T.

exercises could be very beneficial, along with the

patient's keeping a journal. Adlerian, and Rogerian

"mirroring" techniques are both gentle and supportive

enough to use in beginning therapy. In later therapy,

educating the client about Transactional Analysis and

acq uai nti ng him with his child, parent, and adult

components would be very helpful to him in relating

these connections to the functions of his id, ego, and

superego. Later in therapy, this awareness will help

him understand himself better.

Narcissism and Child Therapy

The standard techniques for child therapy must be

applied to young Narcissists. There was nothing in the

1 i tera ture concerning children and this particular

disorder, possibly because it doesn't really reach its

most degenerative form until adolescence and young

adulthood. Apparent! y, the majority of clients seen

with this disorder in the past have been of adult age,

but the alert therapist can see the tendencies in his

clients who are younger. However, if a child patient is

suspected of having this disorder, it seems unlikely

that he can be rescued and "cured" by treating him

alone. With out mentioning the disorder by name, one

would have to recommend either family therapy for the

entire family, or parallel therapy for at least the one

parent who seems to have the same problem. Otherwise,

as soon as the parent sees the child beginning to

separate and individuate and threaten the separation

anxiety of the parent, that child will be withdrawn from

the therapeutic situation. It really is an

all-or-nothing therapeutic requirement to "save" a child

from this situation, and one must resign oneself to the

child's fate if it is a "nothing" exercise,

unfortunately.

125

126

Therapeutic Discrimination

The therapist must also be aware of his own

limitations and be willing to relinquish those patients

whom he sees will not work well wj.th himself, because

there is not always a 100% level of success with every

client. Occasionally, referrals may be necessary to

benefit both the mental esteem and health of the

therapist and the client, especially since the treatment

of Narcissism takes years.

The Final Step: Concluding Therapy

In reference to the ten steps Spotnitz describes as

the therapeutical process, the time will come when the

growth of the client will determine a natural end to

therapy. The therapist must be aware of the

psychological process which will take pla0e within the

client as he approaches the successful conclusion to

therapy. Hamilton describes it as follows:

••• if treatment has proved helpful, the

patient may begin to wonder how he will leave the

analysis. What happens when the patient tries to

place the analyst "outside the area of omnipotent

control "--that is, outside the transference of

outside or past figures? I suggest that we label

the class of interactions engaged in at this stage

as "the differentiating transferences."

Much has been written about the content of the

transference in analytic work but little has been

said about the patient's perception of

transference, which requires the perception of a

different order of abstraction. In the

differentiating transferences,

continues to transfer onto the

the patient

analyst the

interactions and role-relationships involved in his

earlier attempts at individuation and

differentiation. However, as these transferences

are sorted out and understood within the analysis

the previously inhibited process of

separation-individuation evolves for the first

time. This means that the analyst must at times

exist as a person out side the differentiating

transference. The patient, now freed from the

compulsion to repeat familiar patterns, approaches

the strange, a domain which includes the analyst,

who has remained largely unknown outside the

transference ••.• The process of differentiation,

which has been facilitated by the analysis, is not

part of the differentiating transference. If the

patient is to acknowledge his analyst as a person

outside the area of projection, the analyst must

accept extra- transferent i al communi cations. Not

everything is contained in the transference

relationship or frame.

127

When the differentiating transference is

allowed to proceed, the transferential aspect of

the relationship recedes, thus enabling the

analysand to differentiate himself from the

analytic process. Like the teddy bear, the

maximally used analyst is not forgotten, but "loses

meaning" as a phantasy, and (later in the analysis)

transitional, object. (Hamilton 1982, 284)

The client finally separates himself in a healthy

fashion from his environment and now stands as a unique

and autonomous individual.

Conclusion

In conclusion, it would appear that the character

disorder of Narcissism is like the trunk of the tree and

other similar and related character disorders are the

branches. To treat the symptoms and behavior of

Narcissism would undoubtedly relieve the individual of

the major symptoms of the related illnesses which

overlay Narcissism and would speed his progress toward

healing.

Alice Miller, author of Prisoners of Childhood,

obviously with tongue in cheek, believes that:

••. all therapists have a touch of Narcissism

that will help them deal with this disorder because

what other type of personality would be willing to

sit hour after hour, listening, trying to help

128

another, and being willing to mirror back to the

client what the client so desperately needs to

hear?

129

BIBLIOGRAPHY FOR NARCISSISM

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Encyclopedia Britannica. vol. 16. Chicago, IL: William Benton, Pub., 1967.

Erikson, E. H. Insight and Responsibility. New York: Norton, 1964.

Forrest, G. G. Alcoholism, Narcissism, and Psychopathology. Spri ngf iel d, IL: Charles C. Thomas, Pub., 1983.

Intensive Psycho Therapy of Alcoholics. Springfield, IL: Charles C. Thomas, Pub., 1984.

Freud, Sigmund. A General Selection from the Works of Sigmund Freud. New York: Liveright Publishing Corp., 1957.

--· Introductory Lectures on Psycho-analysis. In Standard Editions. vols. 15-16. New York: Hogarth Press, 1963. (First German Edition, 1917).

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Gear, M. C., M. A. Hill, and E. C. Liendo. ' 1981.

Working Through Narcissism. New York:

Grunberger, B. Narcissism. New York: International Universities Press, Inc., 1971.

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Kernberg, 0. F. Borderline Conditions and Pathological Narcissism. New York: J. Aronson, 1975.

Klein, Melanie, and Psycho-Analysis. Hogarth Press and 1970.

others. Developments in edited by Joan Riviere. London: the Institute of Psycho-analysis,

130

Kohut, H. Analysis of the Self; a Systematic Approach to the Psychoanalytic Treatment of the Narcissistic Personality Disorder. New York: International Universities Press, 1971.

Lowen, A. Narc iss ism. London: MacMillan Pub. , 1 983.

Masterson, J. F. The Narcissistic and Borderline Disorders. New York: Brunner/Mazel Pub., 1981.

Miller, A. Prisoners of Childhood: the Drama of the Gifted Child and the Search for the True Self. New York: Basic Books, Inc., 1981.

Nelson, M. C. The Narcissistic Condition. New York: Human Sciences Press, 1977.

Random House Dictionary of the English Language. Unabridged ed. Jess Stein, ed. New York: Random House, 1973.

Rothstein, A. The Narcissistic Pursuit of Perfection. New York: International Universities Press, 1980.

Schwartz-Sal out, N. Transformation.

Narcissism and Character Toronto: Inner City Books, 1982.

Spotni tz, H. and P. Mea dow. Treatment of the Narcissistic Neurosis. New York: Manhattan Center for Advanced Psychoanalytic Studies, 1967. ·

Stern, A. Me: The Narcissistic American. New York: Ballantine Books, 1979.

Zweig, P. The Heresy of Self-Love. New York: Basic Books, Inc., 1968.

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