The Psychodynamic Perspective

After the ancient historical incarnations of this personality pattern, many centuries passed before narcissism was given an explicit psychological definition. In 1898, Havelock Ellis, an English psychologist, used the term narcissus-like (A. P. Morrison, 1986) in reference to excessive masturbation, whereby the individual becomes his or her own sexual object. Rank (1911) published the first psychoanalytic paper specifically concerned with narcissism, linking it to vanity and self-admiration (cited in Pulver, 1970). Amazingly, Freud published only a single paper devoted exclusively to narcissism in 1914, discussing it as a libidinal investment in the self that, in healthy and reasonable quantities, would ultimately give way to mature object-relationships. The central question to Freud was how the infant, living in a universe composed only of the self, which he called primary narcissism, developed an appreciation for the existence and identity of others.

Today, the psychoanalytic literature about narcissism is so voluminous that it resists summary. The term continues to have multiple meanings that are not easily distilled into single formulation. As noted by Pulver in 1970, narcissism has become somewhat of a paradox, being one of the most important, yet most confusing, contributions of psychoanalysis. Stone (1993) regards the problem of its definition as being rivaled only by the term borderline. Currently, psychoanalysis remains divided between rival formulations of narcissism, namely the self psychology of Kohut (1971, 1977) and the object-relational theory of Kernberg (1975, 1984, 1989b, 1989c), which provide two alternative and competing accounts of narcissism.

The route from Freud's 1914 paper to contemporary conceptions is long and twisted, and space does not permit its review here. Whatever the underlying dynamics proposed, however, adult traits reminiscent of the personality disorder saturate historical portrayals, allowing continuity with contemporary conceptions. W. Reich (1933, pp. 217-218), for example, described the phallic-narcissistic character as "self-assured, sometimes arrogant, elastic, energetic, often impressive in his bearing," exhibiting a "flagrant display of superiority and dignity." Significant reactions to psychoanalytic theory began in the mid-1930s, including the emergence of the neo-Freudian schools of ego psychology, object relations, and social theory. These theorists stressed the primacy of relatedness rather than of self and, therefore, began to develop a deficit model of narcissism as stemming from problems in early relationships with caretakers (McWilliams, 1994). In contrast, because Freud's instinct model was purely intrapsychic, he could speak of narcissism only as an exaggerated self-cathexis, that is, a libidinal investment of self, as if the self were taken as a lover. If relatedness is primary, however, it follows that narcissism can only derive from a pathology of early relatedness, that is, a pathology of object relations.

These developments did not take place all at once but instead accrued slowly over time. Karen Horney (1939, pp. 89-90) regarded narcissism as essentially representing self-inflation, which, "like economic inflation, means presenting greater values than really exist," loving and admiring the self without adequate foundation, and expecting the same from others. Fenichel (1945) regarded narcissists as racing from one achievement to another but with no real satisfaction, only later realizing that the purpose of their pursuit lay in concealing a deeper emptiness. A. Reich (1960, p. 58) developed the compensatory theme that many analysts believe underlies narcissism, noting that the "exhibitionistic drive contains contempt for those whose admiration is needed." Rosenfeld (1964) noted narcissists' idealized self-image and their tendency to pervasively deny any and all deviation from perfection. Can you identify such personality facets in Leonardo and Gerald?

Although narcissists use a variety of defense mechanisms, contemporary psychoanalytic accounts stress grandiosity, rationalization, and fantasy. Narcissistic patients are often talented, with some sustained period of success or creativity (Ronningstam, Gunderson, & Lyons, 1995), yet they possess a highly unrealistic self-image. In classical analytic terms, narcissists convince themselves that they have become the ego ideal incarnate (Freud, 1914/1925), living a perfect and superior existence that they believe everyone should admire. Their grandiosity may become so extreme that they see themselves as omnipotent and invulnerable. They are capable of anything and resistant to everything. Similarly, they may assert that they do not need others because needing someone would imply some boundary to their power or imply that they are incomplete.

Narcissists have a tough job because perfection is viewed as either all or nothing: If you are not perfect, you are imperfect, and if you are imperfect, you are nothing. This ego ideal must then be projected as a public persona whom others must appease with sacrifices of admiration and submission. Anything short of this ideal tarnishes the self, squashing perfection outright and leading to chronic feelings of emptiness or shame. Gerald is very resistant to making any accommodations to his workplace because this would imply that he was wrong or had failed to consider something important. Similarly, even after many sessions of therapy, Leonardo shows no insight into how his actions might hurt the women he's exploited. Narcissists cannot tolerate any flaw, however small, in the perfection of the self.

Because of this intolerance, narcissists must find ways of dealing with information that is foreign to their perceptions—data that tell them that they exploit others, they make mistakes, it is they who are envious, and so on. Much of this information is simply denied or repressed, but more elaborate defenses are also frequently employed. Narcissists often use rationalization to construct alternative realities that draw on the actual substance of events but change their significance to excuse blunders and exploitations. Once a scenario is found that saves face and puts the narcissist in the best possible light, it replaces the previous version of events and becomes the working model of reality on which the narcissist proceeds. This may lead to some strange role reversals: The narcissist does not exploit others; others should be flattered that the narcissist consorts with them. The narcissist doesn't make mistakes; the narcissist is a visionary who pursues dreams others cannot possibly understand. The narcissist is not a dictator, but an enlightened autocrat. Many more variations routinely take place in the experience of these individuals. Almost undoubtedly, Leonardo believes that his conquests should be thankful they were judged worthy to be conquered by him, just as Gerald probably believes that his subordinates are privileged to work in his presence.

Such extensive use of rationalization gives us insight into the architecture of the narcissistic mind. On first impression, the internal world of the narcissist seems intelligent, solid, and substantial. Few ideas are so cherished, however, that they cannot be tailored for the admiration of an audience. When incriminating evidence surfaces, narcissists put a subtle spin on events, convincing both themselves and others that they were right all along, everything was worked out in advance, and it was all part of their grand plan. Far from being ideologically grounded, the internal world of the narcissist is wrought with flimsy constructions put together for temporary, convenient, or defensive purposes. Current rationales need not be defended as absolute, for they can always be reconfigured for new purposes as they arise. A convenient, rather than principled, interpretation of the world and a willingness to shift interpretations as necessary to support their own egocentric goals speak to a laissez-faire superego that afflicts many narcissists. Morality and values are simply a constraint on the subject's unbounded desire for omnipotence.

One of the foremost contemporary descriptions of these personalities is expressed in the Diagnostic Interview for Narcissism. As previously mentioned in Chapter 4, one of the best ways to study a construct is by examining the content of established instruments. By surveying the content on which the instrument is focused, clinicians quickly gain an appreciation for how traits of the larger personality pattern combine. In a series of studies, Gunderson and Ronningstam constructed the Diagnostic Interview for Narcissism, now in its second edition (Gunderson & Ronningstam, 1990). They began by reviewing three prominent diagnostic systems: the DSM-III (APA, 1980), Akhtar and Thomson (1982), and Kernberg (1983, 1985b). Augmented with comparisons with their own clinical experience, they created a tentative item list describing pathological narcissism as it might be expressed in the clinical interview. After evaluating the ability of each statement to discriminate narcissistic patients from other patients with a mixed group of personality disorders, the first edition of the interview was formed. In its second edition, 101 questions are grouped into 33 descriptive statements, which in turn are grouped into five topic areas. Listed in Table 10.1, these statements provide a quick and empirically supportable summary of pathological narcissism.

How does the narcissistic personality disorder develop from the psychodynamic perspective? Freud (1914, p. 48) was aware that pathological narcissism could develop because of parental overvaluation, stating that parents "are impelled to ascribe to the child

TABLE 10.1 Summary Statements from the Diagnostic Interview for Narcissism

. . . Exaggerates talents, capacity, and achievements in an unrealistic way. . . . Believes in his invulnerability, or does not recognize his limitations. . . . Has grandiose fantasies.

. . . Believes that he or she does not need other people. . . . Regards self as unique or special compared to other people. . . . Regards self as generally superior to other people. . . . Behaves self-centeredly and/or self-referentially. . . . Appears or behaves in a boastful or pretentious way.

Interpersonal Relations (The person . . .)

. . . Has a strong need for admiring attention. . . . Unrealistically idealizes other people. . . . Devalues other people, including feelings of contempt. . . . Has recurrent and/or deep feelings of envy toward other people.

. . . Reports being or behaves entitled, i.e., has unreasonable expectations of favors or other special treatment. . . . Appears or behaves in an arrogant, haughty, or condescending way. . . . Is exploitive, i.e., takes advantage or uses other people.

. . . Lacks empathy (is unable to both understand and feel for other people's experiences). . . . Has been unable to make close, lasting emotional commitments to others.

Reactiveness (The person . . .) . . . Is hypersensitive.

. . . Has had unusually intense feelings in response to criticism or defeat. . . . Has behaved or felt suicidal or self-destructive in response to criticism or defeat. . . . Has reacted with inappropriate anger in response to criticism or defeat. . . . Has had hostile, suspicious reactions in response to the perception of others' envy. Affects and Mood States (The person . . .) . . . Has sustained feelings of boredom. . . . Has sustained feelings of meaninglessness. . . . Has sustained feelings of futility. . . . Has sustained feelings of hollowness.

. . . Often feels emotionally impoverished: Yearns for deeper emotional experiences.

Social and Moral Adaptation (The person . . .)

. . . Has superficial and changing values and interests. . . . Shows disregard for unusual/conventional values or rules of society. . . . Has corruptible moral and ethical standards.

. . . Has broken laws one or a few times under circumstances of being enraged or as a means of avoiding defeat. . . . Has recurrent antisocial behavior (scored negatively in this section, does not indicate narcissism). . . . Exhibits sexual behavior that includes perversion, promiscuity, and/or lack of inhibitions.

Adapted from Gunderson and Ronningstam, from "The Diagnostic Interview for Narcisstic Patients" in Archives of General Psychiatry, copyright © 1990.

all manner of perfections which sober observation would not confirm, to gloss over and forget all his shortcomings" and even "the laws of nature, like those of society, are to be abrogated in his favour." Only and oldest male children were especially vulnerable. Hor-ney (1939, p. 91) remarked, "Parents who transfer their own ambitions to the child and regard the boy as an embryonic genius or the girl as a princess, thereby develop in the child the feeling that he is loved for imaginary qualities rather than for his true self." The case of Gerald, for example, mentions that he is the only child of a widowed mother, her "pride and joy," and his mother has told him all his life that he would do something important.

More recent psychoanalytic opinion has often been divided between the object-relations theory of Otto Kernberg (1975, 1984) and the self-psychology of Heinz Kohut (1968, 1971, 1977). Both theorists are summarized in Summers (1994), to which the following is indebted. For Kernberg (1975, 1984), the narcissistic personality is essentially a defensive organization. Narcissists fail to develop integrated conceptions of self and other object-images. In other words, their object-representations are split into all-good and all-bad components, much like other personalities functioning at the borderline level (see Chapter 14 on the borderline personality for a more extensive discussion of this concept). Narcissists, however, develop an intrapsychic organization that compensates somewhat for identity diffusion and rapidly changing emotions. To achieve a more cohesive self, narcissists fuse the ideal self, ideal object, and self-image, an explanation reminiscent of Freud. Although such a fusion distorts reality, it nevertheless permits greater continuity of experience and a measure of social adaptation.

In Kernberg's formulation, then, the narcissistic personality is a compensation, a defense against early developmental arrest. Fusion of self-image and ideal self leads to conceptions of grandiosity and omnipotence, as exemplified in notions that one is brilliant, ahead of the times, deserves to be famous, and so on. It is clear from this perspective, then, how any minor faults in this unyielding personality landscape would tear at the soil composing the person's psychic defenses, opening pathways to acute psychological symptoms. Gerald, for example, probably fears that his abilities do not measure up to his ambitions, yet if his insecurities and true beliefs about the self were available for conscious inspection, he would probably be overcome with depression and would accomplish nothing. His self-deception is both created and supported by his mother, who long before set his standard for "what is worthy and unworthy," as for his conviction that his destiny is incontrovertibly to "do something important." This is also why Gerald is so angry with his coworkers. By resisting his changes and insisting on realism, they fall far short of the admiring ideal other who automatically complies with the narcissist's desires.

While this fusion of ideal self and self-image explains the grandiosity of narcissists, the fusion of the ideal other and self-image explains their need for admiration and sense of entitlement. The ideal other is admiring to the point of being reverential and fully devoted to sustaining the illusion of the narcissist's central and unrivaled importance. Moreover, because the ideal other is merged with the ideal self, those who associate with the narcissist should be perfect as well. Imperfections in others are incongruent with the self-image and often lead to expressions of ridicule and contempt. This is one reason Gerald expresses such disdain for his coworkers; rather than automatically dispense admiration and automatic compliance with his notions, they understandably resist his entitlement and press for realism, an enemy of grandiosity. As Kernberg (1967, p. 655) notes, narcissists "present an unusual degree of self-reference in their interactions with other people, a great need to be loved and admired by others, and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others."

Kernberg's theory stresses that the family environment is fundamental in instigating the development of grandiose fantasies. On the one hand, caretakers are likely to be cold and indifferent, perhaps even sending messages that are implicitly spiteful and aggressive. Obviously, this damages the self-concept and sets the stage for the development of some pathological means of self-esteem regulation. Given an inferior or inadequate self-concept, the child is ready to embrace some saving defensive mechanism. The family supplies this by finding in the child some exceptional talent, perhaps the role of family genius, which becomes a refuge from the inferior or inadequate self, thus offsetting parental neglect and rejection. If circumstances rule out an integrated, normal self-identity, a grandiose self becomes attractive, if only because this is the only self the caretakers are willing to accept. Although pathological, such love requires adoption of the compensatory genius or special role, a means of up-regulating self-esteem in the face of a family environment devoid of authentic warmth and love.

Most of the time, according to Kernberg (1975, 1984), the grandiose self holds control. Remember, though, that the grandiose self is an adaptation that conceals not only an inadequate, defective self, but also oral rage—an intense, hidden aggression originally intended for caretakers unwilling to offer unconditional love. This rage is always lurking in the unconscious, ready to be vented against anyone who withholds a steady supply of compliments or, worse, anyone who is critical. Lovers or spouses who were the subject of idealization may suddenly find themselves completely devalued as the all-good image is replaced by an all-bad, persecutory image. Because the grandiose self is a compensation, narcissists are highly sensitive to comments that seem to disparage the qualities of their sacred self-image. The more fragile the grandiose self, the more sensitive narcissists are and the more easily oral rage is brought to the surface.

The writings of another analytic theorist, Heinz Kohut, focused largely on narcissistic personality development. The movement spawned by his writings, which were considered esoteric even for psychoanalytic literature, is now influential well beyond psychoanalytic circles. This movement has become known as self-psychology, named for Kohut's integral addition of the self to the classical analysts' pillars of human nature: the instinctual sexual and aggressive drives of the id and the moderating psychic structures of ego and superego. In the classical model, the self is considered a function or subset of the ego. In contrast, Kohut makes the self the central focus of development, the essence of what it means to be human. Kohut regards the self as complementary, as finishing the natural evolution of psychoanalysis that began with the drive model, not as its replacement. Again, this summary is indebted to Summers (1994).

As with Freud, Kohut holds that development begins in a state of unawareness called primary narcissism, in which no self yet exists. Fortunately, the child begins life with a mother who responds to his or her needs, nursing and nurturing empathically. Soon, the infant realizes that rewards come not from inside the self, but from the external world, and develops what are called self-objects. These are not just basic images of others, but perceptual interpretations of others as they are important to the self. In the beginning, the infant expects absolutely perfect nurturing—to be changed or fed immediately as needed. However, because no mother is capable of perfect nurturance, the child soon begins to feel uncertain about whether needs will continue to be met. With this uncertainty comes an overwhelming sense of vulnerability. To compensate, the child seeks to return to the bliss of primary narcissism by idealizing the parent, once again perfectly nurtu-rant, and by developing a grandiose self, which provides a sense of omnipotence. Kohut thus paints the grandiose self not as a pathological intrapsychic structure, but instead as a normal developmental phenomenon. As normal empathy subsequently develops, the grandiose self will eventually be given up and incessant, infantile demands will gradually be transformed into realistic ambitions. Developmental arrest occurs, however, when maternal empathy at this stage is grossly defective; then, the grandiose self continues as a defense against the vulnerabilities of an unkind world. See Summers (1994) and Greenberg and Mitchell (1983) for more comprehensive discussions of self-psychology.

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