EBSCOhost Full Display Result 22  [Go To Full Text] [Tips]Title: Normal and pathological narcissism in adolescence.Subject(s): NARCISSISM in adolescenceSource: American Journal of Psychotherapy, Winter94, Vol. 48 Issue 1, p30, 22pAuthor(s): Bleiberg, EfrainAbstract: Studies normal and pathological narcissism in adolescence. Specific features of narcissistic personality; Clinical variations of narcissistic pathology; Narcissistic vulnerability as the central feature of adolescence.AN: 9410250985ISSN: 0002-9564Note: This title is not held locallyFull Text Word Count: 9086Database: Academic Search Premier Print: Click here to mark for print.View Item: Full Page Image XML Full Text  [Go To Citation]

 


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NORMAL AND PATHOLOGICAL NARCISSISM IN ADOLESCENCE While narcissistic vulnerability is a central feature of both normal and pathological development during adolescence, the author proposes criteria to differentiate between them. The specific features of the narcissistic personality disorders, as it begins to crystalize in childhood and adolescence include: reliance on an omnipotent sense of self, refusal to acknowledge shortcomings and vulnerability, projection of disowned self-experiences onto others, and demands for public affirmation of their power. Those clinical variations of narcissistic pathology--the histrionic-exhibitionistic, the ruthless-psychopathic, and the self-victimizing masochistic--are discussed. These subtypes are illustrated with clinical examples. The confusion and contradictions imbuing the psychological world of the adolescent are perhaps surpassed only by the formulations created to explain them. Psychoanalytic writings by Blos[1] and A. Freud[2] state that psychic turmoil and regression are not just normative but are also essential for healthy development. Such emphasis led Adelson and Doehrman[3] to quip that, in the psychoanalytic literature, the adolescent is depicted as "miraculously holding on to his sanity, but doing so only by undertaking prodigies of defense" (p. 105). From this vantage point, it is extremely difficult to differentiate the normal crisis of adolescence from the pathological manifestations of disturbed youth. Conversely, academic psychologists wax eloquently on adolescents' relentless expansion of cognitive, moral, social, coping, and adaptive capacities. The view from the academic perspective reveals young people mostly committed to a quest for truth, intolerant of adult hypocrisy, and feeling passionately and intensely about relationships and ideals. Current theories fail to adequately encompass the paradoxes of adolescence. The study of narcissistic regulation and narcissistic vulnerability does, however, provide a window onto the paradoxes marking normal and pathological development in adolescence. Better understanding these processes promises to illuminate a broad range of clinically and developmentally significant issues. Perhaps like no other phase of life, the passage through adolescence bears the hallmarks of narcissistic vulnerability: a proneness to embarrassment and shame, acute self-consciousness and shyness, and painful questions about self-esteem and self-worth. How is this vulnerability different from pathological narcissism? To answer this question we must first examine the phenomenon of narcissistic regulation against the background of some evolving ideas about how subjective experience is organized and structured. Motivational Systems, Internal Representational Models, and Narcissistic Regulation Over the past two decades, infancy studies[4,5] have produced an increasingly clearer and more coherent picture of the unfolding and structuring of infants' and young children's subjective experience and intrapsychic reality. In particular, research has systematically documented the biases, preferences, and predispositions built into the human brain; the motivational systems giving direction to the organization of experience; and the tools for information processing, memory, perception, affect, and arousal regulation that become available to infants to construct their intrapsychic world. Although the views emerging from research support a number of psychoanalytic ideas about early development, they also challenge many assumptions held by psychoanalysts about the nature and content of the infant's psychic life. The creative tension between the prospective and normative view evolving out of direct observation and research with infants and children, as well as the retrospective and pathographic perspective generated by psychoanalysis, offers a rich opportunity to enhance our understanding of psychological development in normality and in psychopathology. Two intertwined motivational systems are particularly relevant to a discussion of narcissistic regulation. Infancy research amply supports Fairbairn's[6] seminal contention of the primacy of the human craving for sustaining connections with others. Observation and research document a powerful tendency in the human species to seek out and elicit engagement with others from the beginning of life, a built-in motivation for social fittedness.[7] As Stern[8] noted, neonates are preprogrammed to recognize people, to prefer human stimulation above all other, and to develop the behavioral repertoire of attachment. Distress escalating to overwhelming anxiety and organismic vulnerability follow disruption of the infant's attachments.[8,11] The weight of the accumulated evidence led Greenberg and Mitchell[12] to conclude that the search for two-way relationships and the need for human reciprocity is as preemptory a human motive as supposedly more basic biological needs. Thus it appears highly unlikely that the pairing of human beings for the gratification of biological needs is a precondition to the child's interest in relating to other humans. We are, as Greenberg and Mitchell[12] explain, essentially drawn to relate, endowed with a brain inherently wired to generate, organize, and pattern psychological experience resulting from transactions in an interpersonal context. The affective correlate of this perceptual-cognitive bias is separation anxiety. Kandel[13] has pointed out the likely innate neurobiological readiness to trigger or downplay a fight-or-flight sequence of anger, anxiety, and hyperarousal in response to the respective absence or reappearance of caretakers. Other humans, says Kandel,[13] evoke a built-in, ready-to-be-activated signal of safety. One of the basic roots of anxiety thus appears to be a biologically programmed tendency to respond to separations with anxiety and to reunions with relief. Infancy research also strongly supports the existence of a powerful built-in predisposition toward self-regulation and mastery, and an innate tendency to create perceptual-experiential coherence and organization. As Emde[7] remarks, the infant comes into the world "with biologically prepared active propensities and with organized capacities for self-regulation" (p. 38). Sterns also noted an innate tendency to develop predictable patterns and to connect in one's mind what goes together in reality, as well as a corresponding affective response of distress when organization cannot be created or when the expected experiential coherence--the match between the mental model and reality itself--is disrupted. The distressing consequences of a disruption in experiential coherence were well described in Freud's early writings. Freud and Breuerli compared hysteria with the traumatic neurosis. In both instances, they claimed, an event had become pathogenic because it could not be integrated into the dominant mass of ideas (the psychic organization that Freud subsequently designated as the ego). Thus the experience in question could not be processed through the normal psychological mechanisms and instead persisted, unmetabolized, seeking expression through somatic channels. Almost 30 years later, Freud[15] conceptualized trauma as the experience of being overwhelmed by an adaptive demand that renders the ego passive, helpless, and unable to anticipate, cope, integrate, and retain any sense of control. According to Freud, the essence and meaning of the traumatic situation consists of "the subject's estimation of his own strength compared to the magnitude of the danger and his admission of helplessness."[15] As a corollary, Freud described the ego's tendency to attempt a turnaround of such passivity and helplessness in an effort to gain (or regain) a measure of activity and mastery. Freud believed that the tendency was critical to advancing the individual's most basic narcissistic pursuits, that is, the capacity for self-preservation. Freud's ideas provide a framework for conceptualizing the phenomena of narcissistic vulnerability and narcissistic regulation. In contrast, however, to the opposition Freud[16,17] postulated between narcissism and object relatedness, developmental studies point to an intertwining of these two motivational systems. In Greenberg and Mitchell's[12] formulation, human beings are both self-regulating and field regulating. We are, say Greenberg and Mitchell, fundamentally concerned with both the efforts to create and maintain coherence, mastery, and organization and with the efforts to create and maintain connections with others. More to the point, efforts to gain mastery, reduce helplessness, and achieve experiential coherence coalesce in normal development with the pursuit of relationships in a mutually reinforcing process. Sander[18] and Ainsworth and Bell[19] make the point that the infants' competence is contingent on the presence of alert and responsive caregivers. To achieve a sense of mastery and produce a state of experiential coherence, infants can turn around their experience of passivity and helplessness, brought about by adaptive demands--whether from within or from without--only when they can signal and evoke attuned responses from their caretakers. The appropriate response, for example, to a signal of hunger transforms the infant's internal state from that of hunger--and helplessness in the face of it--to that of satiation and a regained sense of mastery. Such transactional sequences certainly permit the restoration of a physiological homeostasis, which reinforces the attachment system. They also provide the template for mental schemes of those episodes. Sterns describes how the infant's abstraction of the common or invariant features of those transactional episodes leads to the construction of representations of interactions generalized (RIGs) which are subsequently organized into internal working models or internal representations of the self in relation to others. These internal representational models (IRMs) provide a prototype for the sense of self as competent and worthy, and of others as responsive. Not surprisingly, disturbances of narcissistic regulation invariably involve concerns about being ignored or not given attention, often coupled with doubt about the ability to have an impact on or to evoke responses from others. Given this built-in motivational push toward self-regulation and object relationships, infants will almost inevitably--as soon as memory and representational capacities permit--construct IRMs both to guide their search for human connections more effectively and to anticipate reality's demands. As the infants' representational competence grows during the second half of their first year of life, they can utilize their IRMs not only to anticipate but also to organize future interactions. Stern[5] and others have described the obvious shift in the "social feel" of infants around seven to nine months. Not only are these children more likely to initiate interactions but they also appear to "demand" specific responses from caretakers--that is, responses that match their IRMs. A representational mismatch[20,21] may be a major precipitant of so-called stranger's anxiety,[22] because the stranger does not match the infant's IRMs. Yet again, object relatedness is intertwined with efforts to secure control and experiential coherence. Social referencing[23,24] is evident after six months of age. When infants are confronted with a novel or uncertain situation, that is, a situation lacking an IRM, they seek to resolve the uncertainty by obtaining emotional clues from a caretaker. The representational match is established but mediated by emotional information provided by the caretaker. ACTUAL SELF, IDEAL SELF, AND NARCISSISTIC REGULATION The growing development of categorical thinking and symbolic capacity during the second half of the second year of life provides children with an extraordinary new tool for achieving mastery, control, and experiential coherence, (i.e., narcissistic well-being). Children become increasingly capable of creating a mental representation, which Joffe and Sandler[25] call the "ideal self." This ideal self is in the shape of a self-representation associated with a sense of safety, competence, and satisfaction. The ideal self conjures up the experience of mastery, control, experiential integration, and optimal ability to meet adaptive demands. Such an "ideal self" also transacts optimally with available and responsive others. What are the building blocks of this mental representation? According to Joffe and Sandler, the ideal self is a composite of: (a) memories of actual experiences of pleasure, mastery, satisfaction, and competence (with particular emphasis on memories of the infants' successful evocation of caretakers' responses that lead to a restored sense of narcissistic well-being); (b) fantasies about such experiences (which become increasingly more elaborated symbolically and more available to serve defensive purposes); and (c) the models provided by important people who are loved, feared, or admired. An example of this representational composite is found in the following vignette. Vignette 1 A two-and-a-half-year-old boy protests loudly when his parents, both busy professionals, leave on certain evenings to attend a professional event. The parents, in attempts to comfort the child that are as driven by guilt as by empathy, tell him, "We have to go to a meeting, dear, but when you wake up, we will be back." A few weeks later, the boy is happily riding up and down the driveway on his brand new tricycle. "I'm going to a meeting," he proudly announces to his father. Rather sheepishly the father replies, "Great, Johnny, have fun." The father's endorsement, however, only elicits the child's scorn. "No, no, daddy. . .," the child chides the father with exasperation, "Cry!" When the chastised father finally "gets it" and "weeps" in distress, the child triumphantly says, "It's okay, daddy, when you wake up, I'll be back." This vignette illustrates the use of a model as a blueprint, a road map guiding the child's efforts to reverse states of helplessness and passivity. He is no longer the one being left but instead is the one leaving. Rather than be the recipient of the comforting words, he is the one attempting to soothe. The mental representation of the object provides an internal model to "match" or approximate. According to Joffe and Sandler,[25] narcissistic vulnerability results from the mismatch or incongruence between the ideal self and the actual self, which is the conscious and unconscious sense individuals have of their characteristics, capacities, and ability to respond to adaptive demands. The tendency toward experiential congruity now encompasses both external reality and the internal model of the ideal self. Narcissistic vulnerability refers to a painful state of self-appraisal whose affective correlate is the feeling of shame. The prototypical affect of narcissistic vulnerability, shame reflects the sense of deflation accompanying the inability to measure up to an ideal. Narcissistic well-being or self-esteem however, results from the successful shaping of the actual after the ideal self. Affects, as Emde[7] has pointed out, promote the organization of experience by providing a system of incentives and disincentives for functioning both on an internal psychological level and on a social interactive context. Expression of affects also serves as a social signal that evokes responses from others. In continuity with the phenomenon of social referencing, the efforts to match the ideal self require interpersonal validation. Parental pride and pleasure in the child's approximation of an ideal--which in part reflects the parents' own ideals--promotes the child's identificatory efforts while also bringing children and parents closer together. Thus, throughout development, narcissistic regulation and object relations potentiate each other in a context where intrapsychic models and interpersonal context are constantly shaping, modifying, and reinforcing one another. To appreciate the role of narcissistic regulation in development, one need only examine the transition from a dyadic world to the triangular world of the oedipal complex. The child's representational capacities during the second year facilitates achievement of a core gender identity. This aspect of the actual self is built around the organization of inner sensation; the perception of one's own and other people's genitals; and the multiple verbal and nonverbal messages, given consciously and unconsciously, that convey the family's assignment to the child of a given gender (male or female).[26] Such internal constructs serve as a guide in seeking "self-like" objects, that is, the same-sex parent,[27] to match not only his/her behavior and attitudes but also his/her subjective experience and intrapsychic world.28 In identifying with the same-sex parent, children gain a beacon that orients them in their journey of discovery during the second year of life. In their efforts to gain greater mastery and coherence, children identify with the same-sex parent as a preferential mechanism of narcissistic regulation. Children, while identifying with the same-sex parent, are also likely to attempt to match that parent's intrapsychic world, including object choices and sexual preferences, a process that powerfully pushes children toward triadic relationships.[28] In order for such identification to be beneficial, it must meet these criteria from the standpoint of narcissistic regulation: (a) The model of the ideal self must be "reachable" by the child, using actual and potential capabilities and real attributes. The ideal self functions as the child's proximal area of development,[5] that is, it serves as a preview of the person the child is about to become. The same-sex parent acquires such a privileged position in the child's ideal self because--and only when--it provides a "reachable" ideal. (b) The successful identification with the ideal results in self-esteem and interpersonal validation. The same-sex parent is an effective model when experienced by the child as worthy and effective. Equally important is the other parent's response to the same-sex parent and to the child's attempts to "become" the same-sex parent. Parental pride and pleasure in the child's identificatory efforts with the same-sex parents greatly enhance the narcissistic value of the identificatory process. Every step in development--from maturational change to new psychosocial demands--renews the likelihood of narcissistic vulnerability. Narcissistic regulation is not "settled" in a particular developmental stage but instead provides one of the fundamental engines of growth throughout life. The ideal self--open to interpersonal influences--is constantly reshaped to function as an effective guide for reversing states of helplessness and the lack of experiential coherence. Using the ideal self as a map in the journey through life permits us to reshape our self-representation--our actual self-based on our identifications. The ideal self becomes a blueprint for finding new solutions to life's dilemmas, exploring different ways of being in the world and relating to others, and attempting behaviors and attitudes that promise greater mastery, more effective coping, and increased pleasure and adaptation. Kernberg[29] has described the progressive depersonification and abstraction of the ideal self as evolving toward the end of adolescence into a direction-giving psychological system of goals and ideals: the ego ideal. Although the ego ideal remains "open" to interpersonal influences, this intrapsychic system tends to acquire some degree of autonomy from external validation and reinforcement. A two-year-old boy, for example, who has been told repeatedly that his favorite snack is only available after dinner may experience an acute longing for the special succor that only that favorite morsel can bring. As a result, the child attempts--unsuccessfully--to seduce his mother into breaking the family rule. When mother is unmoved by the child's charms, he himself ends the exchange by loudly declaring, "Johnny, you cannot has fruit bars before dinner time!" This exchange illustrates the principles involved in internalizing parental functions and identifying with the models contained in the ideal self. Faced with clear and consistent limits, children will tend to turn around the experience of passivity. They gain a measure of activity by modeling themselves after the limit-setting parent. Eventually, no loud declaration will have to come to the child's ears--not even one produced by the child himself. A silent psychological process will have replaced it. By the end of adolescence, abstract principles and values--of self-restraint, healthy habits, etc.--will replace the internal representation of a parent admonishing the child to wait until after dinner to indulge his/her cravings. PATHOLOGICAL NARCISSISTIC REGULATION Some degree of dysfunction in narcissistic regulation is present in all forms of psychopathology. The pathology disrupts the organizing capacities and abilities that people use to bring coherence to their experience. The more specific narcissistic disorders (i.e., the narcissistic personality disorder) present a particular distortion of the development and the organization of subjective experience. Children who experience narcissistic dysregulation often exhibit extremely rigid coping mechanisms that involve reliance on an omnipotent sense of self, refusal to acknowledge personal failures, projection of disowned self-experiences onto others, and demands for public affirmation of their power. Such children clearly tend, even before their school-age years, to replace ongoing efforts to approximate a constantly maturing ideal self with a defensively derived fantasy: they develop their sense of self around an illusion of power, control, perfection, mastery, and invulnerability. The ideal self no longer functions as a blueprint to guide identificatory efforts but instead is an illusory basis for the sense of self. They also rigidly persist in disowning, dissociating, and denying any experiences in which the self fails to measure up to the ideal. Experiences of helplessness, vulnerability, longings for others, envy, pain, or sadness, in particular, are experienced as "not me." A rigid discontinuity of subjective experience, held onto desperately in the face of all challenges and demands, is a hallmark of all developing personality disorders. As part of their ongoing efforts to "rid" themselves of their rejected and dissociated self-experiences, these youngsters project them onto, and attempt to evoke them in others. Thus, other people are held in contempt or may be perceived as worthless, weak, and incompetent. Significant adults are rarely seen as reliable protectors, limit-setters, sources of support, or interpreters of reality. Instead, people are mere tools to be manipulated or objects from which to extract gratification. They also often make angry or manipulative demands to extract from others their needed confirmation of their power, magnificence, control, or omnipotence. The narcissistic individual's insistence that the real world matches and supports a rigidly held intrapsychic configuration is another hallmark of a developing personality disorder. Yet no matter how much confirmation of omnipotence is received, the person is continually haunted by the specter of shame, the ever-present threat that any rejected vulnerability will be uncovered, paving the way for vicious attacks and humiliation. Clinical observations of narcissistic youngsters appear to support Kernberg's[30] notion that the development of these children is not arrested in an earlier form of narcissistic regulation but rather is becoming organized in an inflexible and distorted fashion. Narcissistic children's demands for control (whether hidden or overt), are excessive and can never be fulfilled. These children, who are unable to feel gratitude, have been used to giving orders and setting the tone of the household from a remarkably young age. As Noshpitz[31] points out, they insist on having their own way--and their parents are unable to manage them. They struggle with all their might to be the center of everyone's attention and, when frustrated, fly into a towering rage. Their inability to expose their vulnerabilities also interferes with their schoolwork. Unable to acknowledge their limitations and accept help from their teachers, they adopt instead the stance of refusing to work rather than admitting their shortcomings. Their language may be precocious and impressive, prompting teachers to harbor expectations of academic achievement. But their verbal cleverness often expresses basically empty intellectualizations and word play. Tall tales and lies cover a limited capacity for sustained attention and difficulty with solving problems in reality. Language becomes a tool for exhibitionism and manipulation, a defense against shame, envy, and vulnerability, and a weapon to control, intimidate, and keep people at a distance. NARCISSISTIC VULNERABILITY Normal adolescence is indeed a time of heightened narcissistic vulnerability. Biological, cognitive, emotional, sexual, and psychosocial changes impose a complex array of adaptive demands that the adolescent often feels ill equipped to master and integrate. The very core of the sense of self requires reorganization. The youngster has to integrate dramatic neurohormonal and physical changes, heightened sexuality and newly acquired reproductive capacities, and profoundly transformed affective experience and cognitive capabilities. Self-regulating capacities--largely based on the adolescent's identification with the internal models provided by parents--are eroded by the need to disengage from the parents, as both real and internal presences. The need for disengagement is fueled by progressive pressure to emancipate and gain greater autonomy and self-reliance, which stems from psychosocial demands and expectations and from the adolescent's own forward thrust. Disengagement from one's parents is also grounded in a defensive need to distance from the real as well as the internalized parents who are associated with regressive longings for dependency, threats to personal boundaries and autonomy, and reactivated oedipal conflict. The regressive pulls of adolescence are not generated by the adolescent's intrapsychic changes alone. The parents of adolescents are also changing. Parents are often aroused by, and envious of, the energy and attractiveness of their youngsters, who are freshly facing the promises and excitement of intimate relationships, erotic passion, and life's seemingly endless opportunities. The parents, conversely, must grapple with the decline of their own strength and vigor and the painful coming to terms with life's limitations that mark middle age. A regressive pull in the parents thus encourages and potentiates the youngster's regressive tendencies and vice versa. As Adelson and Doehrman[3] have pointed out: "The child's nubility may awaken conflicted, unconscious emotions of rivalry and desire, along with a sense of time's passing and the waning of one's own power and beauty. One will often discern, even in households characterized by self-control, a certain amount of semiconscious, semierotic 'gesturing' between parents and their adolescent children" ( p. 105 ). The adolescent's moves to distance from parents--and their internal representations--thus come both from progressive pressures and from defensive pursuits. Such distancing, in time, diminishes the effectiveness and authority of the parents as models incorporated into the adolescents' ideal self. The power of these models is also under attack from the adolescents' recently acquired critical capacities. In their heads, using only thoughts and words, adolescents can project themselves into the future (the realm of the possible), and in so doing can explore the full range of possibilities inherent in a problem. As Anthony[32] has explained, new categorizing and argumentative language emerges, with adolescents subjecting their own and other people's beliefs to systematic scrutiny and criticism. Such scrutiny regularly exposes the inconsistencies and contradictions of parental values, ideals, and behavior. Thus adolescents are uncertain of who they are, torn between progressive and regressive trends and bereft of a clear road map to guide their transition into adulthood. Although many adolescents welcome a moratorium on this journev,[33] they are also aware of the relentless psychosocial and developmental demands on them to separate from the family, to find an independent niche in the world, and to engage in sexual and emotional intimacy. Clearly, one of the central developmental tasks of adolescents is the creation of a new direction-giving, self-esteem regulating system.[34] This task is not beyond the reach of normal adolescents. For them, the self-regulating functions and capacities that were internalized during childhood have achieved a significant degree of depersonification. Self-soothing, limitsetting, direction-giving functions are far less bound to the internal presence of a parent. Thus normal adolescents can contemplate disengagement from their internalized parents without concomitantly finding themselves bereft of their self-regulating capacity. Furthermore, in spite of squabbles and conflicts with parents, and the reorganization of internal relationships, normal adolescence does not require a total cut off from parental figures. In healthy development, youngsters typically manage to construct mental representations of their parents that are imbued with love and respect. Parents in general provide their children with reasonably competent models for their efforts to negotiate reality and are experienced as generally supportive of children's growth and autonomy. Thus normal adolescents maintain basically good relationships with both their real and their intrapsychic parents. Normal adolescents build an ideal self by using selectively their own memories, fantasies, parental models, and the new extrafamilial objects of their expanding world. They construct an internal ideal that matches their real talents, characteristics, and the realities of their physical and social world. In other words, adolescents are normally not subjected to extreme narcissistic vulnerability. They can build in their minds a model of an achievable future and can take steps to approximate their own ideals, resulting in greater competence, self-esteem, and adaptation. By contrast, youngsters whose previous solutions to narcissistic vulnerability are grounded in the illusion of omnipotence and the dissociation of vulnerability find the pressures of adolescence difficult to bear. Their need to feel omnipotent jeopardizes their ability to take advantage of the developmental opportunities of adolescence, thus exacerbating their predicament. Unable to achieve real competence and effectiveness, they only intensify their claim to omnipotence and are thrust into an even more extreme grandiosity and a variety of desperate defensive maneuvers directed at protecting a precarious self-esteem and an illusory sense of control. Needing to devalue others, fearing closeness, burdened by needs for perfection and a driving concern to protect themselves from vulnerability and humiliation, narcissistic adolescents fail to construct an ideal self that approximates their talents and opportunities. They feel like persistent failures, lacking a realistic road map to adulthood, while they strive to achieve impossible goals. They denigrate their parents for their inability to live up to ideal standards, vet they cannot truly separate from them because they are convinced that their family will collapse if they do. They watch their peers move, propelled by a passion and a search for love and intimacy that they entry. But closeness only brings anxiety and leaves narcissistic adolescents worn out and jaded, longing to get away or feeling choked by dependence. At the end, the crowning achievement of adolescence, the capacity for love and intimacy, eludes their grasp. VARIATIONS OF PATHOLOGICAL NARCISSISM Different developmental paths lead to these distortions in narcissistic regulation. Paulina Kernberg[35] described several groups of children at particular risk for developing a narcissistic personality: children of narcissistic parents, adopted children, abused children, overindulged or wealthy children, children of divorce, and children who had lost a parent through death. Clearly, these diverse sets of developmental circumstances are unlikely to result in a homogeneous condition. Instead, several subtypes of narcissistic pathology can be distinguished in which one or more of the key elements of the narcissistic organization of experience (e.g., omnipotence, dissociation of vulnerability, control of others) is more or less emphasized. NARCISSISTS I will briefly discuss three such subtypes of narcissistic pathology: The histrionic-exhibitionistic narcissist, the ruthless psychopathic narcissist, and the masochistic narcissist. 1. The histrionic-exhibitionistic narcissist: In this subgroup of narcissistic disorder, the predominant features are the organization of the sense of self around one's beautiful, charming, talented, and dramatic features, coupled with an ongoing need for admiration and attention from others. When applause is forthcoming and others "confirm" the beauty, charm, and talent of these youngsters, they experience an ebullient state of exhilaration. In contrast, they become spiteful or feel crushed when ignored or denied the recognition they crave. The developmental history of these youngsters is perhaps best characterized by Rinsley's[36-38] formulations of early misattunement. According to Rinsley, the mothers of future borderline individuals take pride in and find gratification in their children's dependency. These mothers reward passive dependent, clinging behavior, while withdrawing or otherwise punishing their children for actively exploring or striving for autonomy. The mothers are attuned to states of helplessness and proximity-seeking behavior, which they validate and respond warmly to, but they subtly or overtly rebuff their children for showing evidence of autonomy or independence. The central message, says Rinsley,[38] which is communicated to the children both verbally and nonverbally, both consciously and unconsciously, is that: "You must not attempt to separate from me under penalty of loss of my nurturance; any effort toward accomplishment or success indicative of such an attempt will cause either or both of us to suffer and possibly to perish" (p. 702). The following clinical example will serve as an illustration. Vignette 2 Elliot was adopted when he was one week old. His adoptive father, a successful investment banker, already felt burdened by the demands imposed on him by his three natural children. Elliot's mother, however, was determined to adopt a child who would replace her last child, a stillborn baby boy. From the outset the mother felt enormously drawn to this bright and alert baby. She marveled at the child's ability to keep track of the comings and goings of people and at his apparent sensitivity to interpersonal nuances. She felt, in fact, that this exquisitely sensitive baby had to be shielded from the onslaughts of her rough, pushy, and aggressive husband. Thus Mrs. B. anxiously held Elliot in a tight embrace that kept Mr. B. at bay. Soon the baby cried if Mr. B. even approached him. Mrs. B., in turn, could hardly disguise the pride and pleasure she derived from the boy's precocious achievements as well as from his unique relationship with her. This boy was, after all, exclusively hers, because his "creation" had not required her husband's intervention. Because Elliot was not talking as fluently as she hoped by the time he was a year old, Mrs. B. had him evaluated at a speech and language clinic and enrolled him in speech therapy before he was 18 months old. Before long Elliot was talking in adult expressions, to the amazement of everyone and to the delight of his mother. As Elliot grew, he insisted on being in charge of his own and everyone else's affairs. When efforts were made to set limits--particularly by his father--he responded with terrible temper tantrums. He demanded constant attention and seemed determined to turn every situation, from a family dinner to an English class, into an opportunity for frantic, clownish exhibitionism. He prided himself on his ability to impersonate show-business personalities or noted politicians and missed no opportunity to display his talents. His clownish antics easily turned into vicious parodies of other people's vulnerabilities. When he was brought for consultation at age 10, he conceded that his problem was his inability to "stop living in the future," referring to his insistence on "being 25," which included watching over his adoptive mother (whose life he believed he saved when he found her unconscious after she had taken an overdose of barbiturates). He was interested in some form of treatment that would help him become more organized, because he was concerned that his chronic inability to sustain attention on tasks that lacked immediate gratification would interfere with his plans to become a brilliant archeologist, the world's best neurosurgeon, and president of the U.S. Elliot suggested that his mind was like an ill-fitting puzzle. I inquired whether one of the pieces might be the self-assured impersonator, who thought of becoming president and was masterful at knowing which buttons to push to elicit responses from the environment. Another piece, however, might be the sad and vulnerable boy who sometimes felt lost and in pain. Elliot quickly replied that he knew one of the pieces well. His life, he stated, had been devoted to achieving control of "mind over body." Pain, on the other hand, was an alien experience for him. With a straight face and apparent conviction, he related his belief that babies experience pain and cry only when their mothers "get all frantic and worried" after, say, a fall or a scratch. Without a worrying mother, he thought, the baby is unaware of hurt and experiences no pain. One anecdote sums up Elliot's experience: One day when he was six years old, he cut his finger, which bled profusely. He did not notice what had happened until his sister called attention to the trail of blood he was leaving. When he asked his mother what to do, her reply was typical: "Be careful and don't stain the furniture. Blood is hard to clean and, yes, you can go to the drugstore across the street. The druggist will take care of your finger." Elliot's case supports Rinsley's developmental scenario. Absorbed in her own narcissistic needs, Elliot's mother acquired a child who could serve as a companion, a source of pride, a precious extension of herself--and a phallic weapon to attack her husband. To enhance her own self-esteem, she assigned him a special role in her life as her very own exclusive creation, and she loved him in direct proportion to his capacity to meet the demands of that role. She rewarded and fostered his sense of uniqueness, his exhibitionistic display of talent, and his parroting of adult expressions. Yet, she found his pain or vulnerability a messy nuisance, which led her to withdraw and to threaten him none too subtly with abandonment. Thus Elliot was faced with an overdetermined push to perfect his own ability to tune in to his mother's moods. After all, failure to monitor and relieve his mother's distress and depression could result in her death. These children typically possess innate gifts of unusual talent, beauty, charm, or intelligence. Precocious language development and special skills in picking up interpersonal clues are also common. Such gifts not only fuel parental hopes that this special child will relieve the burdens of the parents' thwarted narcissistic aspirations but also increase the odds that the child will be called upon to play a unique role in maintaining the parents' self-esteem. 2. The ruthless psychopathic narcissist: In this subtype of narcissistic disorder the most salient features are: the dissociation and denial of pain, helplessness, and vulnerability; rigid, desperate efforts to maintain a sense of self based on an illusion of control and invulnerability; and ruthless exploitation, intimidation, and manipulation of others. These youngsters carefully scan the environment for threats or blame and are perennially haunted by the expectation of being attacked. They anticipate that if their shortcomings are revealed, and their illusion of control and power punctured, they will be painfully humiliated and viciously destroyed. From others, they expect only the same ruthlessness and lack of compassion that they themselves exhibit. This subtype of narcissistic pathology develops more commonly among children who are both endowed with innate interpersonal skills and resourcefulness and faced with a set of circumstances that promotes a closure of dependency, disavowal of vulnerability, and reliance on self-nurturing capacities. Some of these limiting circumstances include abuse and neglect; chaotic, violent! and impoverished environments; inconsistent and incompetent parenting; parents who are chronically depressed, psychotic, or intoxicated; and exhausted and overwhelmed teenage parents. All these life circumstances share a developmental context in which efforts to secure protection and comfort from others lead only to greater pain and vulnerability, while physical and psychological survival seems predicated on ruthless manipulation, "toughness," and self-reliance. These youngsters harbor a deep reservoir of rage. They are callous and disrespectful of their victims and indifferent to human warmth. They exhibit the telltale signs of narcissistic disorders identified by Noshpitz[31] who found that these young people, when apprehended, are "arrogant rather than repentant, angry, not crestfallen, haughty and demanding, instead of apologetic and guilt stricken" (p. 17). Empirical studies discussed by Sroufe[39] are beginning to document prospectively the link between early rebuffs of infants' approaches and the subsequent development of traits highly suggestive of narcissistic-psychopathic pathology: minimal recognition of others' feelings, frequent hostility, unprovoked aggression, exploitativeness, and efforts to physically and verbally subjugate others. Various aspects of pathological development may occur independently or may build on each other to lead to the narcissistic disorder. Vulnerable children often develop any of several unique coping abilities, including self-numbing to externally inflicted pain, fantasized omnipotent control, and projection of intolerable self-experiences onto others to distance from those experiences. The first developmental step involves the youngsters' attempts to obliterate those self-aspects associated with pain, helplessness, sadness, and vulnerability. Lenore Terr[40] described one chronically abused young boy, who was finally removed from his home and placed in a group home. Terr observed the child fearlessly challenging much bigger children, undaunted by the obvious mismatch, seemingly unconcerned about the beatings he received, as if oblivious to pain. Terr discussed the boy's apparent anesthesia to pain: Frederick was seven years old when he was sent to live with his aunt because his mother found out, through a tape recording set up to catch her husband at infidelity, that Frederick's stepfather had been throwing him against walls while she worked the evening shift. Frederick did not tell anyone his year-long story, despite two visits to the emergency room and one neighbor-instigated protective service investigation. While in his aunt's custody, Frederick glanced down at the playground pavement one day and saw blood. After several seconds of searching for a wounded companion, Frederick realized that it was he who was bleeding. The boy realized he could feel no pain. In a psychotherapy session I asked Frederick how he could make this sort of thing happen. "It jus' happens now," he said. "I used to pretend I was at a picnic with my head on Mommy's lap. The first time my stepdaddy hit me, it hurt a lot. But then I found out that I could make myself go on Mommy's lap (in imagination), and Winston couldn't hurt me that way. I kept goin' on Mommy's lap I didn't have to cry or scream or anything. I could be someplace else and not get hurt. I don't know how many times Winston punched me out. I wasn't always payin' attention. Like I told you, first I'd be at a picnic on Mom's lap. Later I didn't have to think of no picnic--jus' her lap. Now if somethin' makes me bleed, I don't think of no lap at all. I jus' don't feel no pain.[40] The second step involves an effort to create an illusion of control whenever real mastery is impossible. Chronically abused children, for example, become experts at evoking abuse from others. The beatings may still hurt, but the passivity and helplessness--the essence of trauma--are averted by the children's conviction that making them happen is better than passively waiting for them to occur. In a similar vein, children who experience repeated disruptions of attachment can become skillful at eliciting rejection. Instead of anticipating the seemingly inevitable abandonment, they actively stimulate--and elicit--it, gaining a sense of control and power in the process. Provocative behavior also evokes punitive responses. The hate of others confirms that the child is "bad," thus deserving of abuse or abandonment. Such constructions can spare the mental representation of the parents from becoming the target of the children's hatred. In addition, provocative behavior may force depressed, ineffectual, or overwhelmed parents to respond to their children. Efforts to evoke abuse or abandonment can become the currency of parent-child relationships every bit as much as they can be a protest of neglect or an attempt to produce the very misery these children expect to befall them. Finally, the third step toward pathological development includes the efforts to evoke in others the helplessness and vulnerability these youngsters cannot tolerate in themselves. By imposing their dreaded self-experience onto others, thus ridding themselves of it, narcissistic-psychopathic youngsters achieve the illusion that their vulnerability can be conquered. Control and intimidation over others confirm their power and invulnerability. The significance of this step in shaping relationships is illustrated in Fraiberg, Adelson, and Shapiro's[41] classic study, the "Ghosts in the Nursery." Fraiberg points out that abused children do not necessarily grow up to become abusive parents. The greater their emotional dissociation, which was the main difference between abused individuals who grew up to abuse their children and those who did not, then the greater likelihood they would become abusive parents themselves. All the mothers studied by Fraiberg remembered the beatings they had suffered as children. Some, however, did not have available to them the pain, rage, helplessness, and vulnerability that had been part of the experience. Those mothers were the ones more likely to abuse their own children. The need to create and preserve such discontinuity of internal experience points to the necessity for shaping interpersonal relationships to contain the rejected--both feared and despised--aspects of the self. For these parents, their only children become an obvious target of their hatred and vulnerability. The children evoke the memory of the parents' own vulnerable, helpless, rageful self now threatening to come back and haunt them. When children identify with the parents' rejected self-experiences, thus completing the cycle of projective identification, they assume the hated and hateful self-aspects the parents cannot stand in themselves, they end up planting the seed for the intergenerational transmission of abuse. In contrast, those individuals who retain the emotional-cognitive integration remembering the beatings together with the associated affects, are much more likely to experience with conviction and empathy the pain that parental brutality can inflict on children. These parents are the ones who conclude that mastery of the traumas of the past will not be found in the illusory solutions of emotional dissociation and projective identification but rather in the healthier future they can help their children achieve. 3. The self-victimizing masochistic narcissist: The central aspect of this subtype of narcissistic pathology is the persons' organization of the sense of self around the experience of being victimized. Although these persons may present themselves as helpless, anxious, and dependent, their facade hides a well-concealed conviction of power, control, and superiority. Cooper[42] summarized the injustice-collecting sequence typical of masochistic individuals: first, through their own provocation, or by failing to use available opportunities, they arrange to experience disappointment, rejection, and humiliation. Second, they respond with righteous indignation and rage to the people who rejected, victimized, or humiliated them. Third, their rage peters out and gives way to depressive and self-pitying feelings of "this only happens to me." Masochism may develop in some children when pain becomes a precondition for relatedness.[42] Chronic illness or physical handicaps, evoking guilt, anxiety, and shame in the parents, can become the focus and the major organizer of the caretaker's relationships, in fact, it may become the focus and organizer of the life of the entire family. Children with chronic illness or a physical handicap are at particular risk for developing a masochistic personality organization. Their pain, disability, or defect is a salient feature of their self-experience that also gives them enormous power in their interpersonal world. Pain or a sneeze--trigger frantic responses. Mastery, control, and narcissistic regulation become entangled with the feelings of pain or handicap, countering the narcissistic vulnerability of an illness or a defect that cannot be realistically overcome. A sense of entitlement soon joins with efforts to secure mastery. The world owes them something, and their parents often behave accordingly. Overvaluation of the body--and its pain or defects--and entitlement come both from within and without. Chronic illness or a handicap are not, however, the only route to . masochistic-narcissistic configuration. The most basic narcissistic vulnerability is faced by infants whose parents are grossly self-absorbed, indifferent, or otherwise unable to become attuned to the baby's signals. Novick and Novick[43] point out that, in contrast to other channels of exchange and contact between infants and caretakers (e.g., vocalizations, smiling, or eye contact), skin contact is hardly avoidable and largely independent of emotional synchronicity. Touch thus becomes both the available channel to maintain relatedness as well as the embodiment of the frustration generated by chronic mismatch and skewed attunement. As these children discover that pain gives them a tool to impact their caretakers, masochism becomes an effective adaptation. Eventually, self-inflicted pain, whether concretely achieved as in self-mutilation or in anorectic self-denial, or symbolically as in emotional pain, procures them enormous power and a sense of effectiveness that counters chronic feelings of helplessness and vulnerability. The masochistic "solution" also serves to turn around the individual's sense of passivity and helplessness in a different, more specific way. By garnering injustices and humiliation from others, masochists actively produce the very suffering they fear passively. In time, masochistic youngsters discover the narcissistic prerogatives of masochism: they are unique because they have suffered so much and are thus entitled to preferential treatment and recognition. As victims, they belong to the special breed of humankind known as martyrs, those morally superior individuals who tower above other human beings. This budding personality organization of the masochistic narcissist receives further reinforcement from its additional defensive functions. Self-victimization becomes both a defense against and a punishment for a child's hostility toward disappointing, frustrating parents. Denying such hostility is important, though, because it reminds youngsters of their longings for parental responsiveness and their own ineffectiveness in evoking such responses. With their self-inflicted pain, they possess a major weapon to torment their parents while also pitifully denying any hostile intent. Finally, self-inflicted pain can foster an illusion of control over bodily sensations. Some self-mutilation, as well as the self-denial of anorectics, can become an eroticized, narcissistic substitute for sexual relationships with real partners in an interpersonal world fraught with narcissistic vulnerability, shame, and feelings of inadequacy. This sketchy review offers only a glimpse of some aspects of narcissistic organizations that typically achieve greater configurational stability during adolescence. They serve to remind us, as Novick and Novick[43] have pointed out, that the classic psychoanalytic formulation (the failure of omnipotence leads to an acceptance of reality) needs revision. For many youngsters the failure of reality pushes them to embrace omnipotence as their only hope for a semblance of mastery and self-esteem. SUMMARY Narcissistic vulnerability is a central feature of both normal and pathological adolescence. Examining the unfolding of self-esteem regulation against a developmental background, the author proposes a framework to differentiate normal adolescent vulnerability from pathological narcissistic regulation and narcissistic psychopathology. Normal adolescents achieve a partial disengagement from their internalized parents without finding themselves bereft of limit-setting and direction-giving capacities or unable to maintain basically good relationships with both their real and their intrapsychic parents. Normal adolescents can construct an ideal that guides their transition into adulthood. In pathological narcissism, by contrast, youngsters crystalize their reliance on an omnipotent sense of self, refuse to acknowledge their shortcomings and vulnerabilities, project onto others disowned self-experiences, and demand public affirmation of their illusory power. Multiple developmental factors transact, in different proportions, to produce the specific features of narcissistic personality disorder. Several clinical subtypes of narcissistc pathology can be distinguished, representing the predominance of particular sets of developmental forces. In the histrionic-exhibitionistic type, the predominant features are the organization of the sense of self around the adolescent's talents or beauty, coupled with an ongoing need for admiration and attention from others. They feel exhilarated when they find confimation but become spiteful or feel crushed when ignored. Ruthless psychopathic adolescents dissociate and deny pain, helplessness, and vulnerability; rigidly attempt to maintain an illusion of control and invulnerability; and ruthlessly exploit, intimidate, and manipulatae others. They scan constantly for threats or blame and are haunted by the expectation of attack. Self-victimizing, masochistic youngsters organize their sense of self around the experience of being victimized. Their apparent helplessness, however, feeds a secret conviction of power and superiority. [*] Vice President for Education, Research and Applications at The Menninger Clinic: Dean, Karl Menninger School of Psychiatry and Mental Health Sciences, Menninger. Mailing address: Menninger, Box 829. Topeka, KS 66601-0829. REFERENCES [1.] Blos, P. (1967). The second individuation process of adolescence. Psychoanalytic Study of the Child, 22, 162 186. [2.] Freud, A. (1958). Adolescence. Psychoanalytic Study of the Child, 13, 55-278. [3.] Adelson, J. & Doehrman, M. J. (1980). The psychodynamic approach to adolescence. In J. Adelson (Ed.), Handbook of adolescent psychology. New York: Wiley-Interscience, pp. 99 116. [4.] Sameroff. A. & Emde, R. (1989). Relationship disturbances in early childhood. New York: Basic Books. [5.] Stern, D. (1985). The interpersonal world of the infant. New York: Basic Books. [6.] Fairbairn, W. R. D. (1952). An object relations theory of the personality. New York: Basic Books. [7.] Emde, R. (1989). The infant's relationship experience: developmental and affective aspects. In Sameroff, A. & Emde, R. (Eds.), Relationship disturbances in early childhood. New York: Basic Books, pp. 33 51. [8.] Bowlby, J. (1969). Attachment Vol. I. New York: Basic Books. [9.] Bowlby, J. (1973). Separation Anxiety and anger, Vol. II. New York: Basic Books. [10.] Spitz, R. (1945). Hospitalism: An inquiry into the genesis of psychotic conditions in earl\childhood. Psychoanalytic Study of the Child, 1, 53-73. [11.] Spitz. R. (1946). Anaclitic depression: an inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 2, 313-342. [12.] Greenberg, J., & Mitchell, S. (1983). Object relations in psychoanalytic theory, Cambridge, MA: Harvard University Press. [13.] Kandel, E. (1983). From metapsychology to molecular biology: explorations into the nature of anxiety. American Journal of Psychiatry, 140, 1277-1293. [14.] Freud, S., & Breuer, J. (1893). Studies on hysteria. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud, Vol. II. London: Hogarth Press, 1955, pp. 1-16. [15.] Freud, S. (1926). Inhibitions, symptoms and anxiety. In J. Strachey (Ed.), The standard edition, Vol. XX. London: Hogarth Press, 1959, pp. 77-178. [16.] Freud, S. (1915). On narcissism: An introduction. In J. Strachey (Ed.), The standard edition, Vol. XIV. London: Hogarth Press, 1957, pp. 73-102. [17.] Freud, S. (1917). Mourning and melancholia. In J. Strachey (Ed.), The standard edition, Vol. XIV. London: Hogarth Press, 1957, pp. 237-260. [18.] Sander, L. (1975). Infant and caretaking environment: Investigation of conceptualization of adaptive behavior in a system of increasing complexity. In E. J. Anthony (Ed.), Explorations in child psychiatry. New York: Plenum Press. [19.] Ainsworth, M., & Bell, S. (1974). Mother-infant interaction and the development of competence. In K. Connelly and J. Bruner (Eds.), The growth of competence. New York: Academic Press. [20.] Horowitz, M. J. (1987). States of mind Configurational analysis of individual personality. New York: Plenum Press. [21.] Horowitz, M. J. (1988). Introduction to psychodynamics. New York: Basic Books. [22.] Spitz, R. (1965). The first year of life. New York: International Universities Press. [23.] Campos, J. J., & Stenberg, C. (1981). Perception, appraisal, and emotion: the onset of social referencing. In M. Lamb & L. A. Sherrod (Eds.), Infant social cognition. Hillsdale, NJ: Lawrence Erlbaum, pp. 273-314. [24.] Hornik, R., & Gunnar, M. R. (1988). A descriptive analysis of infant social referencing. Child Development, 59, 626 634. [25.] Joffe, N. G., & Sandler, J. (1967). Some conceptual problems involved in the consideration of disorders of narcissism. Journal of Child Psychotherapy, 2, 56 66. [26.] Stoller, R. (1975). Sex and gender. New York: Science House. [27.] Tyson, P. (1982). A developmental line of gender identity, gender role and choice of love object. Journal of the American Psychoanalytic Association, 30, 61-86. [28.] Ogden, T. (1989). The primitive edge of experience. New York: Jason Aronson. [29.] Kernberg, O. (1966). Object relations theory and clinical psychoanalysis. New York: Jason Aronson. [30.] Kernberg O. (1975). Borderline conditions and pathological narcissism. New York: Jason Aronson. [31.] Noshpitz J. (1984). Narcissism and aggression. American Journal of Psychotherapy, 38, 17-34. [32.] Anthony, E. J. (1982). Normal adolescent development from a cognitive viewpoint. Journal of the American Academy of Child Psychiatry,21, 318-327. [33.] Erickson, E. (1968). Identity: Youth and crisis. New York: W. W. Norton. [34.] Wolf, E. S., Gedo, J. E., & Terman, D. M. (1972). On the adolescent process as a transformation of the self. Journal of Youth and Adolescence, 1, 257-272. [35.] Kernberg, P. (1989). Narcissistic personality disorder in childhood. The Psychiatric Clinics of North America, 12, 671-694. [36.] Rinsley, D. B. (1980). The developmental etiology of borderline and narcissistic disorders. Bulletin of the Menninger Clinic, 4 4, 127-134. [37.] Rinsley, D. B. (1988). A review of the pathogenesis of borderline and narcissistic personality disorders. Adolescent Psychiatry, 15, 387-406. [38.] Rinsley, D. B. (1989). Notes on the developmental pathogenesis of narcissistic personality disorders. The Psychiatric Clinics of North America, 13, 695-707. [39.] Sroufe, L. A (1989). Relationships, self, and individual adaptation. In Sameroff, A & Emde, R. (Eds.), Relationship disturbances in early childhood A developmental approach. New York: Basic Books. [40.] Terr, L. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 1-17. [41.] Fraiberg, S., Adelson, E., & Shapiro, V. (1975). Ghosts in the nursery: a psychological approach to the problems of impaired infant-mother relationships. Journal of the American Academy of Child Psychiatry, 14, 387-421. [42.] Cooper, A. (1989). Narcissism and masochism. The Psychiatric Clinics of North America, 12, 541-552. [43.] Novick, K., & Novick, J. (1987). The essence of masochism. The Psychoanalytic Study of the Child, 42, 353-384. ~~~~~~~~ By EFRAIN BLEIBERG, M.D.[*] Copyright of American Journal of Psychotherapy is the property of Association for the Advancement of Psychotherapy and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.Source: American Journal of Psychotherapy, Winter94, Vol. 48 Issue 1, p30, 22p.Item Number: 9410250985  Result 22  [Go To Full Text] [Tips]© 2002 EBSCO Publishing. Privacy Policy - Terms of Use