Thursday, June 28, 2012

Rushi Ledermann - Narcissistic Disorder

"Before discussing the treatment of narcissistic disorder I shall outline my view of its nature, since I believe that this syndrome differs from other personality disorders. Some points will recur which I made in my previous papers on the subject (LEDERMANN 10, 11). Psychoanalysts and analytical psychologists are well-known to disagree, in some respects, about the nature of narcissistic disorder. Both consider it to be a disorder of the self, but they work with different concepts of the self. I see pathological narcissism as the opposite of what narcissism means in ordinary parlance. The Oxford English Dictionary defines narcissism as the ‘tendency to self-worship, absorption in one's own personal perfections’. That seems to me to describe the defence or facade in people who suffer from narcissistic disorders. The actual disorder is, in fact, the opposite of self-worship. It is the inability to love oneself and hence the inability to love another person. As I said in my previous papers, narcissistic patients suffer from severe defects in their object relations which make them appear self-absorbed. They are fixated on an early defence structure which springs into being in infancy—when, for whatever reasons, there is a catastrophically bad fit between the baby and the mother, frequently compounded by the lack of an adequate father and by other inimical experiences in childhood.

Babies, thus deprived, grow into persons who lack trust in other people. They replace mature dependence by spurious pseudo-independence and delusions of omnipotence. They experience their lives as futile and empty, and their feelings as being frozen or split off. In severe cases these patients feel themselves outside the human ken and suffer from a terror of non-existing. This terror and emptiness are frequently covered over by a superficially smooth social adaptation, sometimes by feelings of aloofness and superiority, at times even by grandiose ideas about themselves.

In my previous papers I have discussed how Fordham's theory of deintegration and of the earliest defences of the self in infancy has helped me to understand the origin of narcissistic disorder. I speculated that with such early defences the process of deintegration is defective from the start. This leads to a badly formed ego that, in my view, is an essential feature of narcissistic disorder. I was interested to see that Kohut also speaks of selfnuclei not yet stably cohesive in what he terms borderline patients (quoted by Schwaber 15, p. 468). It is remarkable how close he comes to Fordham's theory of ego formation, but it is beyond the scope of this paper to elaborate this point.

A baby who, in phantasy, does away with the mother has the experience of, one might say, being himself baby and mother, lonely and omnipotent. He does not expect any good to come from the outside world and cannot put his trust into anything good that even an unsatisfactory mother provides. Moreover, as he has abolished his noxious mother in infancy, he sometimes feels as if he had killed her. If his mother is incapable of being a mother to him and appears to be impervious to his demands, or if an inborn defect in the baby makes it impossible for him to use her motherliness, then the delusion that he is murderous gets reinforced. Such a baby, of course, lacks the foundations for object relations which are based on his relationship to his mother. It is not surprising that such patients have enormous resistance against relating to the analyst. I have further postulated that a baby with stunted oral deintegration also suffers from pathological deintegration at the anal stage of development. Moreover, deintegration at the anal stage is not object-related because he has ‘abolished’ the object. The healthy mother of a healthy infant, as it were, detoxicates her baby's angry faeces that, in phantasy, he expels into the part-object, the breast. The narcissistically damaged baby has intense destructive impulses. But as he cannot (in phantasy) discharge them into the mother he expels them into what he experiences as nothingness or outer space. There they are uncontained, undetoxicated and they become enormously threatening. This, it would appear, is why narcissistic patients feel so bad and so persecuted and at the same time deny their personal hate. This unrelated aspect of the anal phase reinforces the experience of the stunted oral phase: that of arid power.
" (pp. 303-304)

Rushi Ledermann (1982). Narcissistic Disorder and Its Treatment. Journal of Analytical Psychology, Vol. 27, pp. 303-321

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