The term narcissism, essentially defined as our love for an image of ourselves, has been so overused and misused, and has almost immediate pejorative connotations that are simplistically repeated in the bible of psychiatric classification, The Diagnostic and Statistical Manual IV. The soon to be released DSM V, rather than being a diagnostic improvement, sounds like an absurd hybrid of trait theory, categories and so on, that will be cumbersome to use and reflects no theoretical or practical advantage. The inclusion of bereavement as a disorder reflects a broader sinister trend to medicalise the simple reality that the cost of love is grief, in a positive sense of realising that people are not dispensable. The essence, in my experience, is an insatiable, self-destructive hunger or craving for recognition or admiration, often with little discrimination. Beneath the apparent egotism there lies a fragile depleted self, unable to manage a relationship with another ,psychologically separate person.
One of the fundamental problems, quite simply, is that the Diagnostic and Statistical Manual of Mental Disease (DSM) is dominated by attempts to transform what are problems of living and morality, into a disease model. Despite years of critiques in which it has been shown that many, if not most psychiatric and psychological diagnoses are not in any way similar to medical disorders that reflect some clearly demonstrable underlying disease process (Szasz, 1980). Body and mind are two sides of the same coin, so there will be physiological correlations with neurological and other bodily functions, but this is a correlation rather than a causal relationship. Attempts to medicalise may actually do a vast disservice to the sufferer. A good example being Alcoholics Anonymous (and Narcotics Anonymous) that having shifted their view of addiction to a medical disease, rather than, as was originally intended, a ‘spiritual’ disease. It is, in this author’s opinion, no coincidence, that the 12 Step Programmes success rate has declined to a mere three percent. (Baldwin Institute, 2006).
The writer is equivocal about recent cuts in medical aid funding for psychology. If I follow my own logic, psychological problems are not medical disorders. However, the habits related to psychological problems can over time result in disease as will be elaborated below. I think the danger of shifting unlimited benefits to psychiatry, cloaked in the rationalisation that it is a measure to reduce abuse is nonsense, justifying a simplistic medical ideology. It insults the integrity of psychologists - as if abuse does not occur in psychiatry! Sometimes medication is necessary, but with increasing experience, the writer has found that he is able to contain alarming symptoms with suitably intense therapy. Szasz (1972) notes that medicalisation strips symptoms of meaning, not to mention the problems of side effects such as disturbance of libido and weight gain. All too often, because a patient feels better, there is no incentive to explore patterns of behaviour(personality) that have led to the symptoms in the first instance, and because of this, may start re-emerge after a few years, requiring even more medication. As with ADHD, unless Ritalin is used to learn basic skills in listening and left-brain controls involving routines and organisation, relapse occurs as soon as medication is withdrawn.
The concept of narcissism is based on the tragic myth of Narcissus who, trapped in admiration with his own image, oblivious to Echo’s calls, drowned in his own reflection. Yet we need to rescue the concept of narcissism from its negative associations as it contains information about the manner in which all of us develop a sense of self. According to the most reputable research, narcissism is on the rise (Twenge 2008), and is associated with many psychological problems such as addictions, depression, anxieties, relational difficulties, ego- dystonic homosexuality / bisexuality as well as social issues such as racism, misogyny and sexism, and even cult behaviours and paedophilia. The events such as the mass shooting at Columbine have led psychologists, educators and sociologists to caution that it is a mistaken belief that a child will develop a good self-esteem based on endless empty praise. Rather, it seems that they will react with devastation and rage to perceived criticism.
Before proceeding, I wish to state that my own views on the increase in narcissism are based on a social ethos in which, through the seductions of consumption, we are misled into believing that loss is avoidable. A capacity to tolerate loss may lead to a deeper capacity to love rather than avoiding it in cynical despair. We need to reconcile ourselves to the human realities of mortality, sickness, ageing and death being the only certainties.
Blatt and Shahar (2004) have used the term ‘introjection’, attempting to avoid all the connotations of the word narcissism, postulating that all humans must negotiate a balance between introjective processes (concerns about self and identity) versus anaclitic ones (concerns with dependency and relationship), as two poles in the development of personality. The task is to find an optimal balance between self-regard, anchored in real nurturant relationships, not the empty virtual world of Facebook friends or fame, but real personal connections. Healthy narcissism becomes problematic when we idealise our own egos and bodies at the expense of dependency on realistic relationships with people. In optimal development, our parents are usually idealised and we gradually recognise their human limitations, expressed in Winnicott’s (1958) notion of the ‘good enough’ mother. Usually, excessive narcissism is thought to occur because of parental over, or under, involvement or impingement, or sudden traumatic disillusionment.
Hyde (2012) and others have drawn attention to the fact that many therapists are depressive thin-skinned narcissists (The notion of ‘The Wounded Healer’). Many therapists were, according to this proposition, chosen by a parent because of their particular sensitivity as containers of their parent’s toxic feelings. This is an example of one of many reasons that adequate training as a therapist or analyst should include undergoing therapy ourselves as part of our training, otherwise we risk repeating, through our patients, our own pathology. This is an inversion of the ideal where the parent in early years needs to provide containment for the child’s unbearable feelings, in order that the child may tolerate the negative feelings in a way that enables them to make realistic adaptive changes on the world, over time creating external reality as a mirror of our internal world. This capacity to bear feelings of pain for long enough to effect changes in our realities, which is a core objective of the process of therapy.
At this point, a brief note on how we develop our ego seems relevant. Our sense of who we are is based on our parent’s ongoing commentary (echoing and mirroring), examples being “you are never satisfied, you never listen, you are just like your father, you will never be successful if you don’t change, you are impossible, you are perfect!” etc. All of these external verbal and non-verbal cues and reflections become part of our innermost self-concept (Lacan, 1953). Often key messages are conveyed in preverbal stages of development making it impossible for us to access the effects of these messages, except through a therapeutic relationship. Examples of this would be if we were an unwanted child, or the parents desired a child of another sex.
The very notion that psychoanalysis ‘cures’ patients, is questionable. Bion‘s (1962) contention is that therapy cures as a result of the restoration of the truth of our own experience. It is a game to play ‘Victim-Rescuer’ in therapy. Our task is to evoke our patient’s own self-knowledge or self-observation as to what is the best for them. Kohut (1971) based his entire treatment on the use of empathy, as his acolyte, Ornstein (1998) proudly claims, as if this is revolutionary! Kohut (1971) believed empathic deficits lay at the root of disturbed self-esteem regulation. I would agree only in part and hasten to add that this could lead to simply supportive measures and fail to develop a patient’s capacity to transform self- esteem regulation. In fact, some more radical critics such as Safoaun (1980) claim that overuse of empathy masks the therapists need to control and to be needed. It also negates the possibility of the patient recognising anger and ways in which it can form the basis for healthy self-protection or assertiveness.
Kernberg (1970) and others of more classical orientation, point to a need to confront very early problems ( first two years) in tolerating dependency, possibly due to envy and rage in accepting that the ‘good’ exists outside the self. One term that is useful that Kohut (1971) created was that of a self-object, a person who is experienced as part of oneself and not separate. There is a fusion of ‘I am perfect’ and ‘I am part of you’, which also resembles modern romantic love, the very fragile basis for so many relationships today. The term self-object is probably evident in what is nowadays termed co-dependency. Almost all couples presenting for therapy experience inevitable disillusionment after initial idealisation. The task is to work through the myth of ideal love and decide whether the basic good in the relationship outweighs the negative costs and to learn methods for adequate conflict resolution.
Before I create the impression that this is a simplistic ‘blaming the parents and past’ psychology, I think it important to emphasize that the realities of global capitalism and the logic of profit results in a relentless media assault that attempts to manipulate legitimate human needs in order to sell commodities. This is a major factor infiltrating every aspect of our lives and is often not a matter of conscious choice. However, becoming consciously aware of these forces may help parents and educators minimise the detrimental effects on our socio-psychological health. Advertising creates a craving for novelty, hankering, lamentation and subjective deprivation. Children have become major targets of the media’s manipulative strategies. Human needs such as dependence on others are being sabotaged by the dual onslaught of capitalistic values and individualism. This ideology is also a large part of the education system’s ‘hidden curriculum’ as Illich (1971) terms it. Individualistic competition, the reduction of knowledge to a possession to be sold, the taming our animal self are the real underlying aims.
Another major shift is evident in the rise of the internet and its various ‘social’ platforms. Most children are almost addicted to various hi-tech applications or games. At the level of the child’s world, it has changed social connection and learning where people nowadays turn to technology rather than humans as sources of knowledge. Relationships are laregely pure expedience. (Giddens, 1997). More profoundly, is the effect that all modern technology has had on work. Krause (2005) suggests that technology in the United States has actually resulted in making work not easier, but actually more intense, hours longer and more depleting than ever before. This means not only increase in stress- related anxiety and depressive reactions, but that parents are so exhausted in attempting to keep up with the production /consumption wheel, that children are minded by TV, internet, and techno- social media in place of real human touch and contact. Studies in attachment have shown that humans may need human connection and touch, even overriding a biological need for food! (Larocco, 2010)
Besides the onslaught of images of idealised youth, beauty and success, the lack of social authority and almost ubiquitous hypocrisy among priests, politicians and other leaders provides no foundation for aspiring toward real role models for parents or children. In my doctoral research, I propose that the absent father, either emotionally, due to crises in the construction of masculine identity, coupled with the increased divorce rate and single- parent families is having a very significant impact. We also face the problem of the use of romantic love as the basis for many couples marriages and relationships . The present author’s research (Wilson, 1991) confirmed the idea that romantic love is a state of temporary narcissistic fusion and mutual idealisation, which can seldom survive the test of ordinary daily realities. In Freud’s day, the nuclear family with a father was the norm, making the notion of the Oedipus complex plausible i.e. the child learns to give up fusion with the mother and for a boy, in loving rivalry, identifies with his father. Often I note that mothers are unable to find love with a husband who protects her, forming a model for the child’s behaviour toward the mother/woman. Disillusioned in marriage, many women turn for love toward their children, becoming veritable slaves to their children and forget to demand reciprocity, not teaching their own children, especially their sons, how to treat a woman Love involves service and sacrifice. Given our specific South African history, many families I see have little realisation of this, often expecting servants or mothers to clean up after them. I believe that chores are a vital part of grounding a child in a reality- based sense of contribution through service, resulting in an opportunity for belonging, and deeper familial bonds.
True self-regard necessitates recognising the need to engage in routinised regular habits to protect basic and critical needs from wreaking havoc on our psychosomatic health. These include respect for our delicate sleep architecture which must be synchronised with the circadian and diurnal rhythms. The same applies to regulated eating and the reality that food may be used for emotional comfort, often starting in childhood when a misguided or mis-attuned parent gives a child food or sweets, instead of emotional comfort or soothing. Bad dietary habits are probably the leading cause of disease, even more so than illicit drugs. This is part of the general addictiveness sweeping our societies. Both food as comfort and drugs as self-medication not only create psychosomatic troubles but result in shame, just as often as alcohol is used to ward off shyness and self consciousness, it results in a deep sense of inadequacy, setting the scene for vicious cycles of addiction shame and more drugs to mask that shame.
I have seen how true self-esteem is so critical to success in life if we realise the implications of the notion of the self-fulfilling prophecy. However inflated defensive self esteem does not result in success in life If we expect rejection, for example, we may behave unconsciously in ways that make it likely by being either too defensively aloof of or clinging! Many of our expectations are unconscious, which is where deep therapy is invaluable. Ultimately, our external world is a reflection of our unconscious beliefs and feelings.
Adolescence is usually a time of suffering and self-consciousness, where the teenager must establish a sense of identity and intimacy beyond their family. Unfortunately, another issue that is beyond scope of this introductory review is the question of medication. Medication can be a useful initial step. Most diagnoses are subject to debate and change according to fads and available drugs. Very few psychological and psychiatric diagnoses have clear unequivocal markers such as clear neurological abnormalities that would place them in the same category as physical medical disease. Psychopharmacological treatments are linked to an enormously (too much, waaaay too much) powerful industry and seldom provide permanent changes. In reality, terms such as depression or anxiety are as vague as ‘fever’ (Shedler, 2012). It tells us nothing of real causes and directions for full resolution. The writer suggests we need to understand conditions such as depression and anxiety by looking at personality, and then locating personality in the individual’s social- historical context. While drug therapy may seem cheaper and psychotherapy a great expense, effective therapy depends, like any relationship on the specific authenticity, values, wisdom, and an incisive ability to recognise patterns where normal relational dependency needs are neglected.
Fortunately, the human nervous system continues to develop up until about the ages of twenty-one, suggesting that earlier intervention makes the task much easier. It is important also to develop ideals. The ideals however should serve as guides. The person need not expect to be the ideal but use it as process -a goalpost to which one strives. The aspect of the self, the ‘ego ideal’ uses a good/bad manner of evaluating self. (Rosenberger, 2005). If we fall short of the ideals, shame and its many associated feelings arise. Usually it results in fear of exposure and the wish to hide. Sometimes it may be masked by a defensive arrogance or exhibitionism. It is important to avoid being caught up in the defences and listen to and explore the underlying feelings.
The ‘superego’ system, the conscience, judges in terms of right or wrong. Given the above-mentioned failure of paternal and social authority, there are often signs that the patient reacts to all limits as claustrophobic. This may range from limits, based on acceptance of being an embodied vulnerable human, to all rules, and even the limitations implicit in a relationship. However, as essentially social beings, an inability to rely on trusted family or friends is a grave warning sign. The rise in addictions of every kind, is, in my opinion, a clear example, typical of the ‘return of repressed’ processes. When healthy dependency needs are denied, very destructive dependence on an inanimate drug may replace human inter-dependency that is hard –wired into our very neurological being. Dependency returns again, but in a violently disruptive form, such as in enslavement to addictions, a prison from which release requires more than detoxification, but the establishment of many skills. These include developing a capacity to discriminate and choose dependence on people and healthy truthful associations, to develop the skills associated with self –preservation, to learn the importance of surrender and service-all of which may be aspects of a loving capacity for self and other.
The choice of a therapist with whom one feels a potentially deep mutual respect will be necessary to negotiate the initially difficult feelings that through exploration and understanding become integrated into the self. Paradoxically, it is by accepting and owning parts of ourselves that cause pain to our self-regard, which, brought into the light of disclosure, become susceptible to modification through interpersonal reality, and mutate from dangerous feelings to benign ones. Humiliation or shame may be transformed into humility and modesty, rage into a healthy capacity to recognise when we are hiding another feeling and, masochism into healthy surrender. By the ‘working- through’ process, we become aware of the ways in which our capacity for self- observation has been distorted by our conditioning. We may all benefit from the awareness of how inaccurate our self-observations usually, are unfortunately self-deception.
In closing, the author suggests that in our society there are very few ways to acquire the most valuable knowledge of all - that is knowledge of who we are! Years of education focus on learning about almost anything but ourselves and no matter what success we may attain in terms of education or material success, subtle internal processes may undermine our relationships and self-concept over time. Psychotherapy offers the only relationship of which I am aware in which we are specifically encouraged to free ourselves from any self-censorship. Although we are close to ourselves, we are often oblivious to all the non-verbal information we unconsciously express, requiring that we choose a therapist who is very (something better than 'very' perhaps) attuned to detect and verbalise these multi dimensional right –brain, body language expressions which occur hundreds of times more rapidly than verbal communications. It offers a rare opportunity to master our lives and can, provided we select our therapist with great care,(I do not have the reference but read that Jung advised that it is a choice we need to make with even greater discernment than the choice of a surgeon). The damage, often not as explicit as a surgeon’s negligence, may reflect only a confirmation of our despair that help is impossible. It can be one of the most important investments we may make. However, the skill and potential resonance with the therapist or psychologist is critical, as is the importance of choosing a person with whom we feel a possibility of deep trust in which issues not shared with any living being can be finally shared.. Normally it is wise to set up a few trial consultations , and asking the therapist for as much information as possible about their training, supervision, experience and orientation. Ultimately, just like other relationships in our lives, finding the rare factors that allow us to connect with a therapist probably outweighs diplomas, degrees and experience, but a therapist’s own self-knowledge is critical to avoid well-intentioned therapies that are nothing but ‘paid friendships’.
Freud (1937) identified, with a sense of gravity and gloom, in his final paper “Analysis Terminable and Interminable”, the notion that despite our conscious wish to co-operate with the therapist and change, we usually show a profound and deep resistance to change, which must be identified as a pre- requisite for adequate resolution of issues. The phenomena are fascinating, leading Freud (1920) to propose that a profound principle of all instincts or drives is a tendency toward a state of death, akin to entropy, exemplified by phenomena as diverse as negative therapeutic reactions, repetition compulsions, and masochism. Despite a therapist’s competence, a part of the mind may be intent on destroying any progress, or manifest dominance of the repetition compulsion, a tendency to search for destruction or ultimately revert to an inorganic state. The concept is elusive and slippery.
Many dismiss the theory of death drives as dubious pure speculation, others as an evocative and useful notion explaining the ubiquitous of destructiveness, often masked as a quest for pleasure, or overtly, in homicides, suicides, diseases, wars and self- inflicted suffering. The Kleinian(1953) theory is that envy is a manifestation of the death drives, and accounts for further impoverishment of the ego or self, as envy prevents us from recognising the good in others beyond ourselves, and prevents us from allowing ourselves to nourish ourselves with goodness in a state of gratitude. Both envy and shame seem to be core and dominant feelings in disturbances of a narcissistic or self-esteem based nature, and which prevents us from engaging, with discernment, in healing relationships with others, with whom we resonate, and realise truth and beauty in life.
David Wilson is a Clinical Psychologist in Highlands North in Johannesburg and in Bela Bela in Limpopo province.
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