|
Primary Narcissism and Healthy Narcissism
Freud (1914) describes the phase-appropriate narcissism of infancy, when the baby experiences himself as omnipotent, the cause of his mother's existence and responses, her warmth, her voice, her breast and so on. Gradually, as reality impinges on the infant, causing discomfort, frustration and pain, he learns that others exist as separate entities, that he cannot control everything and he relinquishes the illusion that he is omnipotent.
Narcissism is still part of the psyche but has been transmuted, through the infant's response to good enough parenting, into a healthy, lively sense of self worth, pleasure in achievements, a sense of what is right and a sense that life has meaning and is worth living. This is made possible by the child tolerating disappointment and frustration in manageable amounts; this is painful but not catastrophic. He may wait ten minutes for his mother to feed him, not be left every day to cry for hours. He may be smacked on the hand when naughty, not beaten into unconsciousness. His parents are ordinary, fallible, mostly loving but sometimes hating, mostly fair but sometimes unreasonable; broadly, they have his best interests at heart. They regard him as a separate human being with preferences and behaviours of his own, rather than an extension of their own egos. When he grows up he knows he is ordinary and not special; he knows that others love and hate, hurt and take pleasure, as he does. He is able to empathise with others, know they are separate from him, love them and receive love from them.
Ordinary observation of infants and children indicates that in the early stages of life, we are often self-orientated. A three month old baby will cry in the night and we will not expect him to consider his mother's tiredness but to express his own needs without reference to the needs of the other. At two, children will often have tantrums if thwarted in what seem to adults to be trivial matters. Children of three, four and five obviously enjoy showing off their achievements to their mothers and being praised for them.
Gestaltists will understand that we have different needs according to our developmental stage and that in early life our organismic needs will include a higher level of self-reference than would be healthy in later life.
The child grows: the organism/environment field changes. More expectations are made of the child: that he be civil, refrain from violence, do his homework, help in the house and so on. Even with loving and responsible parents there will be disappointments, losses, pain, anger, conflict and mistakes.
In adult life, if the person's organismic needs have been adequately met, we would expect a diminution of such self-reference and an increased capacity to recognise and respond helpfully to the needs of others. For example, a reasonably healthy baby may wake his mother at 3.00 a.m.; a reasonably healthy patient will not telephone his therapist at the same time.
We would expect also that a healthy person is able to be reasonably assertive, being aware of his own organismic needs (for love, privacy, stimulation, sex and so on) and is able to reach out into the environment to satisfy them, tolerating the inevitable frustrations and losses that this will entail. He can allow himself to feel his feelings, including uncomfortable ones, without deflection, projection, retroflection, proflection, egotism or other interruptions to contact with the world and with himself.
He can take pleasure in his achievements and creations and has enjoyment in life. He is not a slave to the opinions others may hold of him.
Narcissistic Traits and Narcissistic Style
For those whose upbringings have been unfortunate, perhaps involving huge frustration and pain and who have responded to these frustrations in a certain way, then there may be narcissistic traits of various intensities, causing various problems. A person may be particularly preoccupied with his/her appearance, perhaps being perfectionist about weight, fitness, make up or clothes. Losing one's looks and sexual appeal through aging may be particularly distressing. A person may strive excessively for material success, academic achievement or promotion. Praise, approval and the esteem of others may assume undue importance. Painful narcissistic affects such as shame, embarrassment, humiliation and impotent rage may be felt when the person feels ignored, unsuccessful or dismissed (Mollon, 1993). The person may be arrogant or selfish or feel they are 'special' and deserve particular consideration.
Yalom (1980:125) refers to Fromm's story describing the self-reference which is the essence of narcissism. A patient telephones a doctor requesting an appointment that day. He is told that unfortunately the doctor has no space in his schedule. 'But, doctor' the patient exclaims, 'I live just a few minutes from your office!’.
Narcissistic qualities clearly will impair a person's ability to love and to work (Freud); others may find them irritating or demanding and they may suffer a good deal of internal distress of which others are unaware, as they usually dislike being vulnerable. Nevertheless, we are talking here about a normal range of impairment, the person may be described as neurotic, rather than character disordered. Such people will be able to form relationships of some kind; albeit less fulfilling than they might be.
Johnson (1987), writing about the narcissistic style, rather than a full-blown disorder, emphasises the phenomenology of the narcissist, his pain and insecurity . His tone is compassionate:
'(Narcissists) are too busy proving their worth - or, more properly, denying their worthlessness -to feel the love, appreciation and joy of human connectedness which their good works could potentially stimulate in themselves and others. These people are not character disordered. They are people tortured by narcissistic injury and crippled by developmental arrests in functioning which rob them of the richness of life they deserve. They are good people, contributing people who are hurting - and often very badly. They are living and suffering the narcissistic style. ' (Ibid p.3)
People with narcissistic style are more or less incapable of forming intimate relationships with others, as they cannot see other people as separate from them. They will often have a succession of failed relationships, or maintain a loveless relationship out of convenience or propriety. Others are seen as instruments or things, giving the person narcissistic supplies of praise, approval, encouragement and envy, or being the source of money or status. Narcissists are often very hard-working and may be extremely successful in the arts, business and the professions. There is also a sense that their achievements are never enough, that the enjoyment of success is always hollow and transient; the person immediately presses on to the next venture, the second million, the next mountain to climb. They may feel empty, lonely and depressed, even when surrounded by friends, or in the midst of obvious success. Others might be amazed to discover they are deeply unhappy - 'But you have everything'. It is likely however, that they will go to great pains to hide their unhappiness, viewing vulnerability as weakness and feeling ashamed of such feelings.
Johnson assumes that the over-achieving of such people is necessary to them to cover their inherent sense of worthlessness, that it is a compensation. He writes with compassion about their plight:
'In a good deal of the literature the narcissistic style' has been given a bum rap. Largely the focus has been on those very disagreeable characteristics of the narcissistically disordered person rather than on the nature of his injury, the phenomenology of his pain, and the fragility of his self. A focus on these more phenomenological aspects of the narcissistic experience will promote for more empathy and understanding, an attitude which must be the touchstone of our therapeutic approach to all narcissistic persons.' (Ibid p.4)
In Gestalt terms we would say that the narcissist is, in some respects, confluent with others, being dependent on their praise, approval and agreement and unable to withstand the separateness of others not having a good opinion of him.
We would understand that an early experience that lacked warmth, respect and empathy would result in the child carrying unmet needs into adulthood, there would be much 'unfinished business', probably involving emotional hunger and pain and also rage at the care-givers.
In some respects the narcissist is retroflective, that is, he is not reaching out into the environment for genuine love or closeness but seeks to 'love himself', through continual self-reference. This can be understood in Gestalt terms as having been the best option for the child, a creative adjustment to the environment. That it may no longer be the best option is something a person may be able to learn within the therapeutic relationship, where the therapist is warm, respectful and empathic and does not treat the patient as a thing but as a person. The unfinished business may be re-enacted within the transferential relationship, the therapist being sometimes experienced as cruel, frustrating, manipulative and so on. The therapist's truthfulness, compassion, understanding and help in releasing these difficult feelings may result in the patient choosing to genuinely risk reaching out and to being met in a new way which will change the patient's perception of the world and himself. Ideally, the transference is worked through and the therapist is increasingly perceived as a helpful, though fallible, human being.
Narcissistic Personality Disorder
In the case of a clinically recognised disorder, the impairment must be severe and incapacitating.
The D.S.M. IV lists the behavioural criteria by which a Narcissistic Personality Disorder might be clinically diagnosed:
'A pervasive pattern of grandiosity (in fantasy or behaviour), a need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognised as superior without commensurate achievements);
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love;
3. Believes that he or she is 'special' and unique and can only be understood by, or should associate with, other special or high status people ( or institutions) ;
4. Requires excessive admiration;
5. Has a sense of entitlement, i.e. unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations;
6. Is interpersonally exploitative, i.e. takes advantage of others to achieve his or her own ends;
7. Lacks empathy: is unwilling to recognise or identify with the feelings and needs of others;
8. Is often envious of others or believes that others are envious of him or her;
9. Shows arrogant, haughty behaviours or attitudes.'
The stress in the D.S.M. IV is on the grandiosity, arrogance and lack of empathy shown by the narcissist. Within the text, mention is made of the underlying vulnerability, which is masked by the presentation of the grandiose self; however, this is not listed in the criteria. However I it would seem to be important and so I quote here:
'Vulnerability in self-esteem makes individuals with Narcissistic Personality Disorder very sensitive to 'injury' from criticism or defeat. Although they may not show it outwardly, criticism may haunt these individuals and may leave them feeling humiliated, degraded, hollow and empty.' (D.S.M. IV, p.659)
In Gestalt terms, we would understand personality-disordered people to have formed especially rigidly fixed patterns of relating to themselves and the world, so that a flexible, curious and creative response to different situations is difficult, if not impossible. Their gestalten are fixed; little that is new and exciting can happen. This is a kind of death-in-life; there is very little growth or change.
Very careful work is needed with such patients. As Yontef notes (see below) confrontative and abrasive work, which is particularly associated with the later work of Fritz Perls and some of his close followers, will tend to induce excessive shame in extremely narcissistic patients and they will often get worse. Techniques which abruptly and dramatically raise awareness (see, for instance, Perls, 1969) may be experienced as an attack.
|
