On This Day … 23 September [2022]

People (Deaths)

  • 1939 – Sigmund Freud, Austrian neurologist and psychiatrist (b. 1856).

Sigmund Freud

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies in the psyche through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis, Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression, and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate concerning its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives”.

What is Anal Retentiveness?

Introduction

An anal retentive person is a person who pays such attention to detail that it becomes an obsession and may be an annoyance to others.

The term derives from Freudian psychoanalysis.

Origins

In Freudian psychology, the anal stage is said to follow the oral stage of infant or early-childhood development. This is a time when an infant’s attention moves from oral stimulation to anal stimulation (usually the bowels but occasionally the bladder), usually synchronous with learning to control its excretory functions – in other words, any form of child training and not specifically linked to toilet training. Freud posited that children who experience conflicts, in which libido energy is under-indulged during this period of time, and the child is perhaps too strongly chastised for toilet-training accidents, may develop “anal retentive” fixations or personality traits. These traits are associated with a child’s efforts at excretory control: orderliness, stubbornness, and compulsions for control. Conversely, those who are overindulged during this period may develop “anal-expulsive” personality types.

Influence and Refutation

Freud’s theories on early childhood have been influential on the psychological community; the phrase anal retentive and the term anal survive in common usage. The second edition of the Diagnostic and Statistical Manual (DSM-II) introduced obsessive-compulsive personality disorder (OCPD), with a definition based on Freud’s description of anal-retentive personality. But the association between OCPD and toilet training is largely regarded as unsupported “pop-psychology” and therefore discredited by the majority of psychologists of the late 20th and early 21st centuries. There is no conclusive research linking anal stage conflicts with “anal” personality types.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Anal_retentiveness >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

Who was Emil Kraepelin?

Introduction

Emil Wilhelm Georg Magnus Kraepelin (15 February 1856 to 7 October 1926) was a German psychiatrist.

H.J. Eysenck’s Encyclopaedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century’s end. While he proclaimed his own high clinical standards of gathering information “by means of expert analysis of individual cases”, he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviours from patients with a specific diagnosis. He has been described as “a scientific manager” and “a political operator”, who developed “a large-scale, clinically oriented, epidemiological research programme”.

Emil Kraepelin in his later years.

Family and Early Life

Kraepelin, whose father, Karl Wilhelm, was a former opera singer, music teacher, and later successful story teller, was born in 1856 in Neustrelitz, in the Duchy of Mecklenburg-Strelitz in Germany. He was first introduced to biology by his brother Karl, 10 years older and, later, the director of the Zoological Museum of Hamburg.

Education and Career

Kraepelin began his medical studies in 1874 at the University of Leipzig and completed them at the University of Würzburg (1877-1878). At Leipzig, he studied neuropathology under Paul Flechsig and experimental psychology with Wilhelm Wundt. Kraepelin would be a disciple of Wundt and had a lifelong interest in experimental psychology based on his theories. While there, Kraepelin wrote a prize-winning essay, “The Influence of Acute Illness in the Causation of Mental Disorders”.

At Würzburg he completed his Rigorosum (roughly equivalent to an MBBS viva-voce examination) in March 1878, his Staatsexamen (licensing examination) in July 1878, and his Approbation (his license to practice medicine; roughly equivalent to an MBBS) on 09 August 1878. From August 1878 to 1882, he worked with Bernhard von Gudden at the University of Munich.

Returning to the University of Leipzig in February 1882,[1] he worked in Wilhelm Heinrich Erb’s neurology clinic and in Wundt’s psychopharmacology laboratory. He completed his habilitation thesis at Leipzig; it was entitled “The Place of Psychology in Psychiatry”. On 03 December 1883 he completed his umhabilitation (“rehabilitation” = habilitation recognition procedure) at Munich.

Kraepelin’s major work, Compendium der Psychiatrie: Zum Gebrauche für Studirende und Aerzte (Compendium of Psychiatry: For the Use of Students and Physicians), was first published in 1883 and was expanded in subsequent multivolume editions to Ein Lehrbuch der Psychiatrie (A Textbook: Foundations of Psychiatry and Neuroscience). In it, he argued that psychiatry was a branch of medical science and should be investigated by observation and experimentation like the other natural sciences. He called for research into the physical causes of mental illness, and started to establish the foundations of the modern classification system for mental disorders. Kraepelin proposed that by studying case histories and identifying specific disorders, the progression of mental illness could be predicted, after taking into account individual differences in personality and patient age at the onset of disease.

In 1884, he became senior physician in the Prussian provincial town of Leubus, Silesia Province, and the following year he was appointed director of the Treatment and Nursing Institute in Dresden. On 01 July 1886, at the age of 30, Kraepelin was named Professor of Psychiatry at the University of Dorpat (today the University of Tartu) in what is today Estonia (see Burgmair et al., vol. IV). Four years later, on 05 December 1890, he became department head at the University of Heidelberg, where he remained until 1904. While at Dorpat he became the director of the 80-bed University Clinic. There he began to study and record many clinical histories in detail and “was led to consider the importance of the course of the illness with regard to the classification of mental disorders”.

In 1903, Kraepelin moved to Munich to become Professor of Clinical Psychiatry at the University of Munich.

In 1908, he was elected a member of the Royal Swedish Academy of Sciences.

In 1912, at the request of the DVP (Deutscher Verein für Psychiatrie; German Association for Psychiatry), of which he was the head from 1906-1920, he began plans to establish a centre for research. Following a large donation from the Jewish German-American banker James Loeb, who had at one time been a patient, and promises of support from “patrons of science”, the German Institute for Psychiatric Research was founded in 1917 in Munich. Initially housed in existing hospital buildings, it was maintained by further donations from Loeb and his relatives. In 1924 it came under the auspices of the Kaiser Wilhelm Society for the Advancement of Science. The German-American Rockefeller family’s Rockefeller Foundation made a large donation enabling the development of a new dedicated building for the institute along Kraepelin’s guidelines, which was officially opened in 1928.

Kraepelin spoke out against the barbarous treatment that was prevalent in the psychiatric asylums of the time, and crusaded against alcohol, capital punishment and the imprisonment rather than treatment of the insane. For the sedation of agitated patients Kraepelin recommended potassium bromide. He rejected psychoanalytical theories that posited innate or early sexuality as the cause of mental illness, and he rejected philosophical speculation as unscientific. He focused on collecting clinical data and was particularly interested in neuropathology (e.g. diseased tissue).

In the later period of his career, as a convinced champion of social Darwinism, he actively promoted a policy and research agenda in racial hygiene and eugenics.

Kraepelin retired from teaching at the age of 66, spending his remaining years establishing the institute. The ninth and final edition of his Textbook was published in 1927, shortly after his death. It comprised four volumes and was ten times larger than the first edition of 1883.

In the last years of his life, Kraepelin was preoccupied with Buddhist teachings and was planning to visit Buddhist shrines at the time of his death, according to his daughter, Antonie Schmidt-Kraepelin.

Theories and Classification Schemes

Kraepelin announced that he had found a new way of looking at mental illness, referring to the traditional view as “symptomatic” and to his view as “clinical”. This turned out to be his paradigm-setting synthesis of the hundreds of mental disorders classified by the 19th century, grouping diseases together based on classification of syndrome – common patterns of symptoms over time – rather than by simple similarity of major symptoms in the manner of his predecessors.

Kraepelin described his work in the 5th edition of his textbook as a:

“decisive step from a symptomatic to a clinical view of insanity. . . . The importance of external clinical signs has . . . been subordinated to consideration of the conditions of origin, the course, and the terminus which result from individual disorders. Thus, all purely symptomatic categories have disappeared from the nosology”.

Psychosis and Mood

Kraepelin is specifically credited with the classification of what was previously considered to be a unitary concept of psychosis, into two distinct forms (known as the Kraepelinian dichotomy):

Drawing on his long-term research, and using the criteria of course, outcome and prognosis, he developed the concept of dementia praecox, which he defined as the “sub-acute development of a peculiar simple condition of mental weakness occurring at a youthful age”. When he first introduced this concept as a diagnostic entity in the fourth German edition of his Lehrbuch der Psychiatrie in 1893, it was placed among the degenerative disorders alongside, but separate from, catatonia and dementia paranoides. At that time, the concept corresponded by and large with Ewald Hecker’s hebephrenia. In the sixth edition of the Lehrbuch in 1899 all three of these clinical types are treated as different expressions of one disease, dementia praecox.

One of the cardinal principles of his method was the recognition that any given symptom may appear in virtually any one of these disorders; e.g. there is almost no single symptom occurring in dementia praecox which cannot sometimes be found in manic depression. What distinguishes each disease symptomatically (as opposed to the underlying pathology) is not any particular (pathognomonic) symptom or symptoms, but a specific pattern of symptoms. In the absence of a direct physiological or genetic test or marker for each disease, it is only possible to distinguish them by their specific pattern of symptoms. Thus, Kraepelin’s system is a method for pattern recognition, not grouping by common symptoms.

It has been claimed that Kraepelin also demonstrated specific patterns in the genetics of these disorders and patterns in their course and outcome, but no specific biomarkers have yet been identified. Generally speaking, there tend to be more schizophrenics among the relatives of schizophrenic patients than in the general population, while manic depression is more frequent in the relatives of manic depressives. Though, of course, this does not demonstrate genetic linkage, as this might be a socio-environmental factor as well.

He also reported a pattern to the course and outcome of these conditions. Kraepelin believed that schizophrenia had a deteriorating course in which mental function continuously (although perhaps erratically) declines, while manic-depressive patients experienced a course of illness which was intermittent, where patients were relatively symptom-free during the intervals which separate acute episodes. This led Kraepelin to name what we now know as schizophrenia, dementia praecox (the dementia part signifying the irreversible mental decline). It later became clear that dementia praecox did not necessarily lead to mental decline and was thus renamed schizophrenia by Eugen Bleuler to correct Kraepelin’s misnomer.

In addition, as Kraepelin accepted in 1920, “It is becoming increasingly obvious that we cannot satisfactorily distinguish these two diseases”; however, he maintained that “On the one hand we find those patients with irreversible dementia and severe cortical lesions. On the other are those patients whose personality remains intact”. Nevertheless, overlap between the diagnoses and neurological abnormalities (when found) have continued, and in fact a diagnostic category of schizoaffective disorder would be brought in to cover the intermediate cases.

Kraepelin devoted very few pages to his speculations about the aetiology of his two major insanities, dementia praecox and manic-depressive insanity. However, from 1896 to his death in 1926 he held to the speculation that these insanities (particularly dementia praecox) would one day probably be found to be caused by a gradual systemic or “whole body” disease process, probably metabolic, which affected many of the organs and nerves in the body but affected the brain in a final, decisive cascade.

Psychopathic Personalities

In the first through sixth edition of Kraepelin’s influential psychiatry textbook, there was a section on moral insanity, which meant then a disorder of the emotions or moral sense without apparent delusions or hallucinations, and which Kraepelin defined as “lack or weakness of those sentiments which counter the ruthless satisfaction of egotism”. He attributed this mainly to degeneration. This has been described as a psychiatric redefinition of Cesare Lombroso’s theories of the “born criminal”, conceptualised as a “moral defect”, though Kraepelin stressed it was not yet possible to recognise them by physical characteristics.

In fact from 1904 Kraepelin changed the section heading to “The born criminal”, moving it from under “Congenital feeble-mindedness” to a new chapter on “Psychopathic personalities”. They were treated under a theory of degeneration. Four types were distinguished: born criminals (inborn delinquents), pathological liars, querulous persons, and Triebmenschen (persons driven by a basic compulsion, including vagabonds, spendthrifts, and dipsomaniacs).

The concept of “psychopathic inferiorities” had been recently popularised in Germany by Julius Ludwig August Koch, who proposed congenital and acquired types. Kraepelin had no evidence or explanation suggesting a congenital cause, and his assumption therefore appears to have been simple “biologism”. Others, such as Gustav Aschaffenburg, argued for a varying combination of causes. Kraepelin’s assumption of a moral defect rather than a positive drive towards crime has also been questioned, as it implies that the moral sense is somehow inborn and unvarying, yet it was known to vary by time and place, and Kraepelin never considered that the moral sense might just be different.

Kurt Schneider criticised Kraepelin’s nosology on topics such as Haltlose for appearing to be a list of behaviours that he considered undesirable, rather than medical conditions, though Schneider’s alternative version has also been criticised on the same basis. Nevertheless, many essentials of these diagnostic systems were introduced into the diagnostic systems, and remarkable similarities remain in the DSM-V and ICD-10. The issues would today mainly be considered under the category of personality disorders, or in terms of Kraepelin’s focus on psychopathy.

Kraepelin had referred to psychopathic conditions (or “states”) in his 1896 edition, including compulsive insanity, impulsive insanity, homosexuality, and mood disturbances. From 1904, however, he instead termed those “original disease conditions, and introduced the new alternative category of psychopathic personalities. In the eighth edition from 1909 that category would include, in addition to a separate “dissocial” type, the excitable, the unstable, the Triebmenschen driven persons, eccentrics, the liars and swindlers, and the quarrelsome. It has been described as remarkable that Kraepelin now considered mood disturbances to be not part of the same category, but only attenuated (more mild) phases of manic depressive illness; this corresponds to current classification schemes.

Alzheimer’s Disease

Kraepelin postulated that there is a specific brain or other biological pathology underlying each of the major psychiatric disorders. As a colleague of Alois Alzheimer, he was a co-discoverer of Alzheimer’s disease, and his laboratory discovered its pathological basis. Kraepelin was confident that it would someday be possible to identify the pathological basis of each of the major psychiatric disorders.

Eugenics

Upon moving to become Professor of Clinical Psychiatry at the University of Munich in 1903, Kraepelin increasingly wrote on social policy issues. He was a strong and influential proponent of eugenics and racial hygiene. His publications included a focus on alcoholism, crime, degeneration and hysteria.

Kraepelin was convinced that such institutions as the education system and the welfare state, because of their trend to break the processes of natural selection, undermined the Germans’ biological “struggle for survival”. He was concerned to preserve and enhance the German people, the Volk, in the sense of nation or race. He appears to have held Lamarckian concepts of evolution, such that cultural deterioration could be inherited. He was a strong ally and promoter of the work of fellow psychiatrist (and pupil and later successor as director of the clinic) Ernst Rüdin to clarify the mechanisms of genetic inheritance as to make a so-called “empirical genetic prognosis”.

Martin Brune has pointed out that Kraepelin and Rüdin also appear to have been ardent advocates of a self-domestication theory, a version of social Darwinism which held that modern culture was not allowing people to be weeded out, resulting in more mental disorder and deterioration of the gene pool. Kraepelin saw a number of “symptoms” of this, such as “weakening of viability and resistance, decreasing fertility, proletarianisation, and moral damage due to “penning up people” [Zusammenpferchung]. He also wrote that “the number of idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitic parents, and who transfer their inferiority to their offspring, is incalculable”. He felt that “the well-known example of the Jews, with their strong disposition towards nervous and mental disorders, teaches us that their extraordinarily advanced domestication may eventually imprint clear marks on the race”. Brune states that Kraepelin’s nosological system “was, to a great deal, built on the degeneration paradigm”.

Influence

Kraepelin’s great contribution in classifying schizophrenia and manic depression remains relatively unknown to the general public, and his work, which had neither the literary quality nor paradigmatic power of Freud’s, is little read outside scholarly circles. Kraepelin’s contributions were also to a large extent marginalized throughout a good part of the 20th century during the success of Freudian etiological theories. However, his views now dominate many quarters of psychiatric research and academic psychiatry. His fundamental theories on the diagnosis of psychiatric disorders form the basis of the major diagnostic systems in use today, especially the American Psychiatric Association’s DSM-IV and the World Health Organization’s ICD system, based on the Research Diagnostic Criteria and earlier Feighner Criteria developed by espoused “neo-Kraepelinians”, though Robert Spitzer and others in the DSM committees were keen not to include assumptions about causation as Kraepelin had.

Kraepelin has been described as a “scientific manager” and political operator, who developed a large-scale, clinically oriented, epidemiological research programme. In this role he took in clinical information from a wide range of sources and networks. Despite proclaiming high clinical standards for himself to gather information “by means of expert analysis of individual cases”, he would also draw on the reported observations of officials not trained in psychiatry. The various editions of his textbooks do not contain detailed case histories of individuals, however, but mosaiclike compilations of typical statements and behaviours from patients with a specific diagnosis. In broader terms, he has been described as a bourgeois or reactionary citizen.

Kraepelin wrote in a knapp und klar (concise and clear) style that made his books useful tools for physicians. Abridged and clumsy English translations of the sixth and seventh editions of his textbook in 1902 and 1907 (respectively) by Allan Ross Diefendorf (1871-1943), an assistant physician at the Connecticut Hospital for the Insane at Middletown, inadequately conveyed the literary quality of his writings that made them so valuable to practitioners.

Among the doctors trained by Alois Alzheimer and Emil Kraepelin at Munich at the beginning of the 20th century were the Spanish neuropathologists and neuropsychiatres Nicolás Achúcarro and Gonzalo Rodríguez Lafora, two distinguished disciples of Santiago Ramón y Cajal and members of the Spanish Neurological School.

Dreaming for Psychiatry’s Sake

In the Heidelberg and early Munich years he edited Psychologische Arbeiten, a journal on experimental psychology. One of his own famous contributions to this journal also appeared in the form of a monograph (p.105) entitled Über Sprachstörungen im Traume (On Language Disturbances in Dreams). Kraepelin, on the basis of the dream-psychosis analogy, studied for more than 20 years language disorder in dreams in order to study indirectly schizophasia. The dreams Kraepelin collected are mainly his own. They lack extensive comment by the dreamer. In order to study them the full range of biographical knowledge available today on Kraepelin is necessary.

Bibliography

  • Kraepelin, E. (1906). Über Sprachstörungen im Traume. Leipzig: Engelmann. ([1] Online.)
  • Kraepelin, E. (1987). Memoirs. Berlin, Heidelberg, New York: Springer-Verlag. ISBN 978-3-642-71926-4.

Collected Works

  • Burgmair, Wolfgang & Eric J. Engstrom & Matthias Weber et al., eds. Emil Kraepelin. 9 vols. Munich: belleville, 2000–2019.
  • Vol. I: Persönliches, Selbstzeugnisse (2000), ISBN 3-933510-90-2
  • Vol. II: Kriminologische und forensische Schriften: Werke und Briefe (2001), ISBN 3-933510-91-0
  • Vol. III: Briefe I, 1868–1886 (2002), ISBN 3-933510-92-9
  • Vol. IV: Kraepelin in Dorpat, 1886–1891 (2003), ISBN 3-933510-93-7
  • Vol. V: Kraepelin in Heidelberg, 1891–1903 (2005), ISBN 3-933510-94-5
  • Vol. VI: Kraepelin in München I: 1903–1914 (2006), ISBN 3-933510-95-3
  • Vol. VII: Kraepelin in München II: 1914–1920 (2009), ISBN 978-3-933510-96-9
  • Vol. VIII: Kraepelin in München III: 1921–1926 (2013), ISBN 978-3-943157-22-2
  • Vol. IX: Briefe und Dokumente II: 1876-1926 (2019), ISBN 978-3-946875-28-4

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Emil_Kraepelin >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 06 May [2022]

Events

  • 1757 – English poet Christopher Smart is admitted into St Luke’s Hospital for Lunatics in London, beginning his six-year confinement to mental asylums.

People (Births)

  • 1856 – Sigmund Freud, Austrian neurologist and psychoanalyst (d. 1939).
  • 1922 – Camille Laurin, Canadian psychiatrist and politician, 7th Deputy Premier of Quebec (d. 1999).

People (Deaths)

  • 2012 – Jean Laplanche, French psychoanalyst and author (b. 1924).

Christopher Smart

Christopher Smart (11 April 1722 to 21 May 1771) was an English poet. He was a major contributor to two popular magazines, The Midwife and The Student, and a friend to influential cultural icons like Samuel Johnson and Henry Fielding. Smart, a high church Anglican, was widely known throughout London.

Smart was infamous as the pseudonymous midwife “Mrs. Mary Midnight” and for widespread accounts of his father-in-law, John Newbery, locking him away in a mental asylum for many years over Smart’s supposed religious “mania”. Even after Smart’s eventual release, a negative reputation continued to pursue him as he was known for incurring more debt than he could repay; this ultimately led to his confinement in debtors’ prison until his death.

St Luke’s Hospital for Lunatics

St Luke’s Hospital for Lunatics was founded in London in 1751 for the treatment of incurable pauper lunatics by a group of philanthropic apothecaries and others. It was the second public institution in London created to look after mentally ill people, after the Hospital of St. Mary of Bethlem (Bedlam), founded in 1246.

Sigmund Freud

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies in the psyche through dialogue between a patient and a psychoanalyst.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis, Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression, and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Camille Laurin

Camille Laurin (06 May 1922 to 11 March 1999) was a psychiatrist and Parti Québécois (PQ) politician in the Canadian province of Quebec. A MNA member for the riding of Bourget, he is considered the father of Quebec’s language law known informally as “Bill 101”.

Jean Laplanche

Jean Laplanche (21 June 1924 to 06 May 2012) was a French author, psychoanalyst and winemaker. Laplanche is best known for his work on psychosexual development and Sigmund Freud’s seduction theory, and wrote more than a dozen books on psychoanalytic theory. The journal Radical Philosophy described him as “the most original and philosophically informed psychoanalytic theorist of his day.”

From 1988 to his death, Laplanche was the scientific director of the German to French translation of Freud’s complete works (Oeuvres Complètes de Freud / Psychanalyse – OCF.P) in the Presses Universitaires de France, in association with André Bourguignon, Pierre Cotet and François Robert.

What is the British Psychoanalytical Society?

Introduction

The British Psychoanalytical Society was founded by the British neurologist Ernest Jones as the London Psychoanalytical Society on 30 October 1913.

It is one of two organisations in Britain training psychoanalysts, the other being the British Psychoanalytic Association.

The society has been home to a number of important Psychoanalysts, including Wilfred Bion, Donald Winnicott, Anna Freud and Melanie Klein. Today it has over 400 members and is a member organisation of the International Psychoanalytical Association.

Establishment and Name

Psychoanalysis was founded by Sigmund Freud, and much of the early work on Psychoanalysis was carried out in Freud’s home city of Vienna and in central Europe. However, in the early 1900’s Freud began to spread his theories throughout the English speaking world. Around this time he established a relationship with Ernest Jones, a British neurosurgeon who had read his work in German and met Freud at the inaugural Psychoanalytical Congress in Salzburg. Jones went on to take up a teaching post at the University of Toronto, in which capacity he established the American Psychoanalytic Association.

When Jones returned to London, he established the society in 1913, as the London Psychoanalytical Society. The society had 9 founding members including William Mackenzie, Maurice Nicoll and David Eder. Almost immediately, the society was caught up in the international controversy between Carl Jung and Sigmund Freud. Many of the society’s membership were followers of Jung’s theories, although Jones himself enjoyed a close relationship with Freud and wished for the society to be unambiguously Freudian. Jones had joined Freud’s Inner circle in 1912, and helped to oust Jung from the International Psychoanalytical Association.

However, the outbreak of World War One in 1914 meant that the nascent society, which depended heavily on correspondence with psychoanalysts in Vienna, then part of Austria-Hungary, had to be suspended. There were a few informal meetings during the war, but these became less and less frequent as the war went on.

In 1919, Ernest Jones re-founded the society as the British Psychoanalytical Society, and served as its President. He took the opportunity to define the society as Freudian in nature, and removed most of the Jungian members. With the help of John Rickman, the society established a clinic and a training arm, known as the Institute of Psychoanalysis.

Interwar Years

In the 1920s, Ernest Jones and the society grew increasingly under the influence of Melanie Klein. Jones was inspired by her writings to develop several of his own psychoanalytical concepts. In 1925, Klein delivered a series of talks at the society on her theories. Klein’s work was well received in London, but it attracted increasing controversy on the continent, where the majority of psychoanalysts were still based. Realising that her ideas were not warmly received at the Berlin Psychoanalytic Institute, where Klein was based, Jones invited her to move to London, which she did later in 1925.

The rise of the Nazi Party in Germany and later in Austria, led to increasing numbers of German and Austrian Psychoanalysts fleeing to London, where they joined the burgeoning society. By 1937, 13 out of 71 members were refugees from Europe. Ernest Jones personally intervened to bring Sigmund Freud and his daughter, Anna Freud, to London. In 1938, Sigmund Freud wrote to Jones:

“The events of recent years have made London the principal site and center of the psychoanalytical movement. May the society carry out the functions thus falling to it in the most brilliant manner.”

By the start of the second world war, 34 out of 90 members were emigres from the continent.

However, the assimilation of so many prominent Psychoanalysts from continental Europe created tensions. The huge difference in the approaches of Anna Freud and Melanie Klein led to the development of several factions. Increasingly, presentations of papers at the society became thinly veiled attacks on opposing factions theories. For example, in March 1937 Melitta Schmideberg (Klein’s daughter) presented her paper: “After the Analysis – Some Phantasies of Patients”, which viciously attacked almost all of Klein’s ideas, though it did not mention her by name.

The views of the different Psychoanalysts: Kleinian, Freudian, and those who were not affiliated with either, led to increasing dysfunction, and things became so bad that a specific committee had to be established to deal with the problem.

The ‘Controversial Discussions’

By 1942, relations between the factions within the society had become so heated that a committee had to be convened to facilitate monthly discussions on the scientific nature of the society. The committee was chaired by three members of the society, each representing one of the major factions:

  • James Strachey: A member of the British Independent Group.
  • Marjorie Brierley: An ally of Melanie Klein.
  • Edward Glover: Who identified as ‘pure Freudian’, in opposition to Melanie Klein. Glover resigned from the society in 1944, along with several other Freudian psychoanalysts.

After heated debate, the committee resolved to a “gentleman’s agreement” – which ensured that each faction would have equal representation within all committees within the society. It was also agreed that training of future psychoanalysts at the institute would be organised into two pathways: one Kleinian, and one Freudian.

After World War Two

With the resolution of the controversial discussions, the society became dominated by independent psychoanalysts such as Donald Winnicott, Michael Balint or Wilfred Bion.

The Society Today

Through its related bodies, the Institute of Psychoanalysis and the London Clinic of Psychoanalysis, it is involved in the teaching, development, and practice of psychoanalysis at its headquarters at Byron House, west London. It is a constituent organisation of the International Psychoanalytical Association and a member institution of the British Psychoanalytic Council.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/British_Psychoanalytical_Society >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is a Narcissistic Parent?

Introduction

A narcissistic parent is a parent affected by narcissism or narcissistic personality disorder.

Typically, narcissistic parents are exclusively and possessively close to their children and are threatened by their children’s growing independence. This results in a pattern of narcissistic attachment, with the parent considering that the child exists solely to fulfil the parent’s needs and wishes. A narcissistic parent will often try to control their children with threats and emotional abuse. Narcissistic parenting adversely affects the psychological development of children, affecting their reasoning and their emotional, ethical, and societal behaviours and attitudes. Personal boundaries are often disregarded with the goal of moulding and manipulating the child to satisfy the parent’s expectations.

Narcissistic people have low self-esteem and feel the need to control how others regard them, fearing that otherwise they will be blamed or rejected and their personal inadequacies will be exposed. Narcissistic parents are self-absorbed, often to the point of grandiosity. They also tend to be inflexible, and lack the empathy necessary for child raising.

Characteristics

The term narcissism, as used in Sigmund Freud’s clinical study, includes behaviours such as self-aggrandisement, self-esteem, vulnerability, fear of losing the affection of people and of failure, reliance on defence mechanisms, perfectionism, and interpersonal conflict.

To maintain their self-esteem and protect their vulnerable true selves, narcissists seek to control the behaviour of others, particularly that of their children whom they view as extensions of themselves. Thus, narcissistic parents may speak of “carrying the torch”, maintaining the family image, or making the mother or father proud. They may reproach their children for exhibiting weakness, being too dramatic, being selfish, or not meeting expectations. Children of narcissists learn to play their part and to show off their special skill(s), especially in public or for others. They typically do not have many memories of having felt loved or appreciated for being themselves. Instead, they associate their experience of love and appreciation with conforming to the demands of the narcissistic parent.

Destructive narcissistic parents have a pattern of consistently needing to be the focus of attention, exaggerating, seeking compliments, and putting their children down. Punishment in the form of blame, criticism or emotional blackmail, and attempts to induce guilt may be used to ensure compliance with the parent’s wishes and their need for narcissistic supply.

Children of Narcissists

Narcissism tends to play out intergenerationally, with narcissistic parents producing either narcissistic or co-dependent children in turn. While a self-confident parent, or good-enough parent, can allow a child his or her autonomous development, the narcissistic parent may instead use the child to promote his or her own image. A parent concerned with self-enhancement, or with being mirrored and admired by their child, may leave the child feeling like a puppet to the parent’s emotional/intellectual demands.

Children of a narcissistic parent may not be supportive of others in the home. Observing the behaviour of the parent, the child learns that manipulation and guilt are effective strategies for getting what he or she wants. The child may also develop a false self and use aggression and intimidation to get their way. Instead, they may invest in the opposite behaviours if they have observed them among friends and other families. When the child of a narcissistic parent experiences safe, real love or sees the example played out in other families, they may identify and act on the differences between their life and that of a child in a healthy family. For example, the lack of empathy and volatility at home may increase the child’s own empathy and desire to be respectful. Similarly, intense emotional control and disrespect for boundaries at home may increase the child’s value for emotional expression and their desire to extend respect to others. Although the child observes the parent’s behaviour, they are often on the receiving end of the same behaviour. When an alternative to the pain and distress caused at home presents itself, the child may choose to focus on more comforting, safety-inducing behaviours.

Some common issues in narcissistic parenting result from a lack of appropriate, responsible nurturing. This may lead to a child feeling empty, insecure in loving relationships, developing imagined fears, mistrusting others, experiencing identity conflict, and suffering an inability to develop a distinct existence from that of the parent.

Sensitive, guilt-ridden children in the family may learn to meet the parent’s needs for gratification and seek love by accommodating the wishes of the parent. The child’s normal feelings are ignored, denied and eventually repressed in attempts to gain the parent’s “love”. Guilt and shame keep the child locked in a developmental arrest. Aggressive impulses and rage may become split off and not integrated with normal development. Some children develop a false self as a defence mechanism and become co-dependent in relationships. The child’s unconscious denial of their true self may perpetuate a cycle of self-hatred, fearing any reminder of their authentic self.

Narcissistic parenting may also lead to children being either victimised or bullies, having a poor or overly inflated body image, tendency to use and/or abuse drugs or alcohol, and acting out (in a potentially harmful manner) for attention.

Short-Term and Long-Term Effects

Due to their vulnerability, children are extremely affected by the behaviour of a narcissistic parent. A narcissistic parent will often abuse the normal parental role of guiding their children and being the primary decision maker in the child’s life, becoming overly possessive and controlling. This possessiveness and excessive control disempowers the child; the parent sees the child simply as an extension of themselves. This may affect the child’s imagination and level of curiosity, and they often develop an extrinsic style of motivation. This heightened level of control may be due to the need of the narcissistic parent to maintain the child’s dependence on them.

Narcissistic parents are quick to anger, putting their children at risk for physical and emotional abuse. To avoid anger and punishment, children of abusive parents often resort to complying with their parent’s every demand. This affects both the child’s well-being and their ability to make logical decisions on their own, and as adults they often lack self-confidence and the ability to gain control over their life. Identity crisis, loneliness, and struggle with self expression are also commonly seen in children raised by a narcissistic parent. The struggle to discover one’s self as an adult stems from the substantial amount of projective identification that the now adult experienced as a child. Because of excessive identification with the parent, the child may never get the opportunity to experience their own identity.

Mental Health Effects

Studies have found that children of narcissistic parents have significantly higher rates of depression and lower self-esteem during adulthood than those who did not perceive their caregivers as narcissistic. The parent’s lack of empathy towards their child contributes to this, as the child’s desires are often denied, their feelings restrained, and their overall emotional well-being ignored.

Children of narcissistic parents are taught to submit and conform, causing them to lose touch of themselves as individuals. This can lead to the child possessing very few memories of feeling appreciated or loved by their parents for being themselves, as they instead associate the love and appreciation with conformity. Children may benefit with distance from the narcissistic parent. Some children of narcissistic parents resort to leaving home during adolescence if they grow to view the relationship with their parent(s) as toxic.

What is Narcissistic Withdrawal?

Introduction

In children, narcissistic withdrawal may be described as ‘a form of omnipotent narcissism characterised by the turning away from parental figures and by the fantasy that essential needs can be satisfied by the individual alone’.

For adults, ‘in the contemporary literature the term narcissistic withdrawal is instead reserved for an ego defence in pathological personalities’. Such narcissists may feel obliged to withdraw from any relationship that threatens to be more than short-term.

Psychoanalysis

Freud used the term ‘to describe the turning back of the individual’s libido from the object onto themselves….as the equivalent of narcissistic regression’. On Narcissism saw him explore the idea through an examination of such everyday events as illness or sleep: ‘the condition of sleep, too, resembles illness in implying a narcissistic withdrawal of the positions of the libido on to the subject’s own self’. A few years later, in ‘”Mourning and Melancholia”…Freud’s most profound contribution to object relations theory’, he examined how ‘a withdrawal of the libido…on a narcissistic basis’ in depression could allow both a freezing and a preservation of affection: ‘by taking flight into the ego love escapes extinction’.

Otto Fenichel would extend his analysis to borderline conditions, demonstrating how ‘in a reactive withdrawal of libido…a regression to narcissism is also a regression to the primal narcissistic omnipotence which makes its reappearance in the form of megalomania’.

For Melanie Klein, however, a more positive element came to the fore: ‘frustration, which stimulates narcissistic withdrawal, is also…a fundamental factor in adaptation to reality’. Similarly, ‘Winnicott points out that there is an aspect of withdrawal that is healthy’, considering that it might be ‘”helpful to think of withdrawal as a condition in which the person concerned (child or adult) holds a regressed part of the self and nurses it, at the expense of external relationships”‘.

However, from the mid-20th century onwards, attention has increasingly focused on

‘the case in which the subject appeals to narcissistic withdrawal as a defensive solution…a precarious refuge that comes into being as a defense against a disappointing or untrustworthy object. This is found in studies of narcissistic personalities or borderline pathologies by authors such as Heinz Kohut or Otto Kernberg’.

Kohut considered that ‘the narcissistically vulnerable individual responds to actual (or anticipated) narcissistic injury either with shamefaced withdrawal or with narcissistic rage’. Kernberg saw the difference between normal narcissism and ‘ pathological narcissism…[as] withdrawal into “splendid isolation”‘ in the latter instance; while Herbert Rosenfeld was concerned with ‘states of withdrawal commonly seen in narcissistic patients in which death is idealised as superior to life’, as well as with ‘the alternation of states of narcissistic withdrawal and ego disintegration’.

Schizoid Withdrawal

Closely related to narcissistic withdrawal is ‘schizoid withdrawal: the escape from too great pressure by abolishing emotional relationships altogether’. All such ‘fantastic refuges from need are forms of emotional starvation, megalomanias and distortions of reality born of fear’.

Sociology

‘Narcissists will isolate themselves, leave their families, ignore others, do anything to preserve a special…sense of self’ Arguably, however, all such ‘narcissistic withdrawal is haunted by its alter ego: the ghost of a full social presence’ – with people living their lives ‘along a continuum which ranges from the maximal degree of social commitment…to a maximal degree of social withdrawal’.

If ‘of all modes of narcissistic withdrawal, depression is the most crippling’, a contributing factor may be that ‘depressed persons come to appreciate consciously how much social effort is in fact required in the normal course of keeping one’s usual place in undertakings’.

Therapy

Object relations theory would see the process of therapy as one whereby the therapist enabled his or her patient to have ‘resituated the object from the purely schizoid usage to the shared schizoid usage (initially) until eventually…the object relation – discussing, arguing, idealizing, hating, etc. – emerged’.

Fenichel considered that in patients where ‘their narcissistic regression is a reaction to narcissistic injuries; if they are shown this fact and given time to face the real injuries and to develop other types of reaction, they may be helped enormously’ Neville Symington however estimated that ‘often a kind of war develops between analyst and patient, with the analyst trying to haul the patient out of the cocoon…his narcissistic envelope…and the patient pulling for all his worth in the other direction’.

Cultural Analogues

  • In I Never Promised You a Rose Garden, the therapist of the protagonist wonders ‘”if there is a pattern….You give up a secret to our view and then you get so scared that you run for cover into your panic or into your secret world. To live there.”‘.
  • More generally, the 1920s have been described as a time of ‘changes in which women were channelled toward narcissistic withdrawal rather than developing strong egos’.

What is Narcissistic Mortification?

Introduction

Narcissistic mortification is “the primitive terror of self dissolution, triggered by the sudden exposure of one’s sense of a defective self … it is death by embarrassment”.

Narcissistic mortification is a term first used by Sigmund Freud in his last book, Moses and Monotheism, with respect to early injuries to the ego/self. The concept has been widely employed in ego psychology and also contributed to the roots of self psychology.

When narcissistic mortification is experienced for the first time, it may be defined as a sudden loss of control over external or internal reality, or both. This produces strong emotions of terror while at the same time narcissistic libido (also known as ego-libido) or destrudo is built up. Narcissistic libido or ego-libido is the concentration of libido on the self. Destrudo is the opposite of libido and is the impulse to destroy oneself and everything associated with oneself.

Early Developments: Bergler, Anna Freud, and Eidelberg

Edmund Bergler developed the concept of narcissistic mortification in connection with early fantasies of omnipotence in the developing child, and with the fury provoked by the confrontations with reality that undermine his or her illusions. For Bergler, “the narcissistic mortification suffered in this very early period continues to act as a stimulus throughout his life”.

Anna Freud used the term in connection with her exploration of the defence mechanism of altruistic surrender, whereby an individual lives only through the lives of others – seeing at the root of such an abrogation of one’s own life an early experience of narcissistic mortification at a disappointment with one’s self.

Psychoanalyst and author Ludwig Eidelberg subsequently expanded on the concept in the fifties and sixties. Eidelberg defined narcissistic mortification as occurring when “a sudden loss of control over external or internal reality…produces the painful emotional experience of terror”. He also stressed that for many patients simply to have to accept themselves as having neurotic symptoms was itself a source of narcissistic mortification.

Kohut and Self Psychology

For Heinz Kohut, narcissistic injury – the root cause of what he termed narcissistic personality disorder – was broadly equivalent to the humiliation of mortification. Kohut considered that “if the grandiosity of the narcissistic self has been insufficiently modified…then the adult ego will tend to vacillate between an irrational overestimation of the self and feelings of inferiority and will react with narcissistic mortification to the thwarting of its ambitions”.

Object Relations Theory

Unlike ego psychologists, object relations theorists have traditionally used a rather different, post-Kleinian vocabulary to describe the early woundings of narcissistic mortification. Recently however such theorists have found analogies between Freud’s emphasis on the sensitivity of the ego to narcissistic humiliation and mortification, and the views of Bion on ‘nameless dread’ or Winnicott’s on the original agonies of the breakdown of childhood consciousness. At the same time ego psychologists have been increasingly prepared to see narcissistic mortification as occurring in the context of early relations to objects.

Physical Sensations and Psychological Perceptions

An individual’s experience of mortification may be accompanied by both physical and psychological sensations. Physical sensations such as: burning, painful tingling over the body, pain in the chest that slowly expands and spreads throughout the torso, dizziness, nausea, vomiting, sweating, blanching, coldness and numbness can be experienced by the individual suffering from mortification. The psychological sensations described are feeling shocked, exposed, and humiliated. Descriptions of this experience can be, for example: “It feels like I won’t survive” and “I have the absolute conviction that he or she hates me and it’s my fault”. These sensations are always followed by shock, although they may have happened on various occasions, they also prompt the need for the individual suffering to do something both internally and externally, to effect a positive self-image in the eyes of their narcissistic object. Narcissistic mortification is extreme in its intensity, global nature, and its lack of perspective, causing the anxiety associated with it to become traumatic.

Normal versus Pathological

In Eidelberg’s view, a normal individual would usually be able to avoid being overwhelmed by internal needs because they recognise these urges in time to bring about their partial discharge. However, Eidelberg does not view occasional outbursts of temper as a sign of disorder. An individual experiencing pathological narcissistic mortification is prone to become fixated on infantile objects, resulting in an infantile form of discharge. He or she cannot be satisfied by the partial discharge of this energy, which takes place on an unconscious level, and this in turn interferes with their well-being. According to Eidelberg, the denial of an infantile narcissistic mortification can be responsible for many defensive mechanisms.

Internal versus External

Narcissistic mortification can be:

InternalOccurs when an individual is overstimulated by their emotions. For example, while debating with classmates on the importance of stem cell research an outspoken student loses his temper causing an uproar. The student has just exhibited an overstimulation of his emotions and used this outburst to relieve internal tension.
ExternalOccurs when something out of one’s control influences a situation, for example, an individual who is held at gunpoint while having their wallet stolen. This individual does not hold any control over the scenario nor the actions of the gunman, but their reaction to being held at gunpoint influences the next scenario and what the gunman does next.

In Cult Leadership

To escape the narcissistic mortification of accepting their own dependency needs, cult leaders may resort to delusions of omnipotence. Their continuing shame and underlying guilt, and their repudiation of dependency, obliges such leaders to use seduction and manic defences to externalise and locate dependency needs in others, thus making their followers controllable through a displaced sense of shame.

Death, Anxiety, and Suicide

Because in Western culture death is sometimes seen as the ultimate loss of control, fear of it may produce death anxiety in the form of a sense of extreme shame or narcissistic mortification. The shame in this context is produced by the loss of stoicism, productivity, and control, aspects that are highly valued by society and aspects that are taken away as one ages. Death according to Darcy Harris:

‘is the ultimate narcissistic wound, bringing about not just the annihilation of self, but the annihilation of one’s entire existence, resulting in a form of existential shame for human beings, who possess the ability to ponder this dilemma with their higher functioning cognitive abilities.’

Individuals who hold this anxiety are ashamed of mortality and the frailty that comes along with it; and may attempt to overcome this reality through diversions and accomplishments, deflecting feelings of inferiority and shame through strategies like grandiosity in similar fashion to those with narcissistic personality traits.

Narcissistic mortification may also be produced by death of someone close. Such a loss of an essential object may even lead through narcissistic mortification to suicide.

Among the many motives behind suicidal activities in general are shame, loss of honour, and narcissistic mortification. Those who suffer from narcissistic mortification are more likely to participate in suicidal behaviours and those who do not receive the proper help more often than not succeed. Suicide related to narcissistic mortification is different from normal sorrow in that it is associated with deep rooted self-contempt and self-hatred.

Treatment

According to a paper presented by Mary Libbey, “On Narcissistic Mortification”, presented at the 2006 Shame Symposium, long-term goal of psychoanalytic treatment for those who suffer from narcissistic mortification is to transform the mortification into shame. She says by transforming it into shame it enables the sufferer to tolerate and use it as a signal; the process of transforming mortification into shame entails working through both the early mortifying traumas as well as the defences, often unstable, related to them. If an individual sufferer does not go through this transformation, he or she is left with two unstable narcissistic defences. Libbey says these defences are: self-damning, deflated states designed to appease and hold on to self-objects, and narcissistic conceit, which is designed to project the defective self experiences onto self-objects. Both of these defensive styles require a continuation of dependence on the self-object. Transforming the mortification into shame makes it possible for self-appraisal and self-tolerance, this ultimately leads to psychic separation and self-reliance without the need to sustain one’s mortification, according to Libbey’s paper.

In the 21st Century

Postmodern Freudians link narcissistic mortification to Winnicott’s theory of primitive mental states which lack the capacity for symbolisation, and their need for re-integration. Returning in the transference to the intolerable mortification underpinning such narcissistic defences can however also produce positive analytic change, by way of the (albeit mortifying) re-experience of overwhelming object loss within an intersubjective holding environment.

21st century American analysts are particularly concerned with the potential production of narcissistic mortification as a by-product of analytic interpretation, especially with regard to masochistic personality disorder.

Literary Uses

  • Narcissistic mortification at injuries to self-esteem has been seen as pervading Captain Ahab’s motivations in his confrontation with Moby-Dick.
  • Mortification at one’s self is seen in Mary Shelley’s Frankenstein when the Creature stares at his reflection in a pool of water. This is where he becomes convinced that he is in fact the Creature and becomes filled with despondence and mortification.

What is Narcissistic Injury?

Introduction

Narcissistic injury, also known as “narcissistic wound” or “wounded ego” are emotional traumas that overwhelm an individual’s defence mechanisms and devastate their pride and self worth.

In some cases the shame or disgrace is so significant that the individual can never again truly feel good about who they are and this is sometimes referred to as a “narcissistic scar”.

Freud maintained that “losses in love” and “losses associated with failure” often leave behind injury to an individual’s self-regard.

Treatment

Adam Phillips has argued that, contrary to what common sense might expect, therapeutic cure involves the patient being encouraged to re-experience “a terrible narcissistic wound” – the child’s experience of exclusion by the parental alliance – in order to come to terms with, and learn again, the diminishing loss of omnipotence entailed by the basic “facts of life”.

Further Psychoanalytic Developments

Freud’s concept of what in his last book he called “early injuries to the self (injuries to narcissism)” was subsequently extended by a wide variety of psychoanalysts. Karl Abraham saw the key to adult depressions in the childhood experience of a blow to narcissism through the loss of narcissistic supply. Otto Fenichel confirmed the importance of narcissistic injury in depressives and expanded such analyses to include borderline personalities.

Edmund Bergler emphasized the importance of infantile omnipotence in narcissism, and the rage that follows any blow to that sense of narcissistic omnipotence; Annie Reich stressed how a feeling of shame-fuelled rage, when a blow to narcissism exposed the gap between one’s ego ideal and mundane reality; while Lacanians linked Freud on the narcissistic wound to Lacan on the narcissistic mirror stage.

Finally, object relations theory highlights rage against early environmental failures that left patients feeling bad about themselves when childhood omnipotence was too abruptly challenged.

Perfectionism

Narcissists are often pseudo-perfectionists and create situations in which they are the centre of attention. The narcissist’s attempts at being seen as perfect are necessary for their grandiose self-image. If a perceived state of perfection is not reached, it can lead to guilt, shame, anger or anxiety because the subject believes that they will lose the admiration and love of other people if they are imperfect.

Behind such perfectionism, self psychology would see earlier traumatic injuries to the grandiose self.

Criticism

Wide dissemination of Kohut’s concepts may at times have led to their trivialization. Neville Symington points out that “You will often hear people say, ‘Oh, I’m very narcissistic,’ or, ‘It was a wound to my narcissism.’ Such comments are not a true recognition of the condition; they are throw-away lines. To really recognise narcissism in oneself is profoundly distressing and often associated with denial.”

What is Love and Hate (Psychoanalysis)?

Introduction

Love and hate as co-existing forces have been thoroughly explored within the literature of psychoanalysis, building on awareness of their co-existence in Western culture reaching back to the “odi et amo” of Catullus, and Plato’s Symposium.

Love and Hate in Freud’s Work

Ambivalence was the term borrowed by Sigmund Freud to indicate the simultaneous presence of love and hate towards the same object. While the roots of ambivalence can be traced back to breast-feeding in the oral stage, it was reinforced during toilet-training as well. Freudian followers such as Karl Abraham and Erik H. Erikson distinguished between an early sub-stage with no ambivalence at all towards the mother’s breast, and a later oral-sadistic sub-phase where the biting activity emerges and the phenomenon of ambivalence appears for the first time. The child is interested in both libidinal and aggressive gratifications, and the mother’s breast is at the same time loved and hated.

While during the pre-oedipal stages ambivalent feelings are expressed in a dyadic relationship between the mother and the child, during the oedipal conflict ambivalence is experienced for the first time within a triangular context which involves the child, the mother and the father. In this stage, both the boy and the girl develop negative feelings of jealousy, hostility and rivalry toward the parent of the same sex, but with different mechanisms for the two sexes. The boy’s attachment to his mother becomes stronger, and he starts developing negative feelings of rivalry and hostility toward the father. The boy wishes to destroy the father so that he can become his mother’s unique love object. On the other hand, the girl starts a love relationship with her father. The mother is seen by the girl as a competitor for the father’s love and so the girl starts feeling hostility and jealousy towards her. The negative feelings which arise in this phase coexist with love and affection toward the parent of the same sex and result in an ambivalence which is expressed in feelings, behaviour and fantasies. The negative feelings are a source of anxiety for the child who is afraid that the parent of the same sex would take revenge on him/her. In order to lessen the anxiety, the child activates the defence mechanism of identification, and identifies with the parent of the same sex. This process leads to the formation of the Super-Ego.

According to Freud, ambivalence is the precondition for melancholia, together with loss of a loved object, oral regression and discharge of the aggression toward the self. In this condition, the ambivalently loved object is introjected, and the libido is withdrawn into the self in order to establish identification with the loved object. The object loss then turns into an ego loss and the conflict between the Ego and the Super-Ego becomes manifested. The same ambivalence occurs in the obsessional neurosis, but there it remains related to the outside object.

In the Work of Melanie Klein

The object relations theory of Melanie Klein pivoted around the importance of love and hate, concern for and destruction of others, from infancy onwards. Klein stressed the importance of inborn aggression as a reflection of the death drive and talked about the battle of love and hatred throughout the life span. As life begins, the first object for the infant to relate with the external world is the mother. It is there that both good and bad aspects of the self are split and projected as love and hatred to the mother and the others around her later on: as analyst, she would find herself split similarly into a “nice” and a “bad” Mrs Klein.

During the paranoid-schizoid position, the infant sees objects around it either as good or bad, according to his/her experiences with them. They are felt to be loving and good when the infant’s wishes are gratified and happy feelings prevail. On the other hand, objects are seen as bad when the infant’s wishes are not met adequately and frustration prevails. In the child’s world there is not yet a distinction between fantasy and reality; loving and hating experiences towards the good and bad objects are believed to have an actual impact on the surrounding objects. Therefore, the infant must keep these loving and hating emotions as distinct as possible, because of the paranoid anxiety that the destructive force of the bad object will destroy the loving object from which the infant gains refuge against the bad objects. The mother must be either good or bad and the feeling experienced is either love or hate.

Emotions become integrated as a part of the development process. As the infant’s potential to tolerate ambivalent feelings with the depressive position, the infant starts forming a perception of the objects around it as both good and bad, thus tolerating the coexistence of these two opposite feelings for the same object where experience had previously been either idealised or dismissed as bad, the good object can be accepted as frustrating without losing its acceptable status. When this takes place, the previous paranoid anxiety (that the bad object will destroy everything) transforms into a depressive anxiety; this is the intense fear that the child’s own destructiveness (hate) will damage the beloved others. Subsequently, for the coexistence of love and hate to be attainable, the child must believe in her ability to contain hate, without letting it destroy the loving objects. He/she must believe in the prevalence of the loving feelings over his/her aggressiveness. Since this ambivalent state is hard to preserve, under difficult circumstances it is lost, and the person returns to the previous manner keeping love and hate distinct for a period of time until he/she is able to regain the capacity for ambivalence.

Refer to The Life and Death Instincts in Kleinian Object Relations Theory.

In the Work of Ian Suttie

Ian Dishart Suttie (1898-1935) wrote the book The Origins of Love and Hate, which was first published in 1935, a few days after his death. He was born in Glasgow and was the third of four children. His father was a general practitioner, and Ian Suttie and both of his brothers and his sister became doctors as well. He qualified from Glasgow University in 1914. After a year he went into psychiatry.

Although his work has been out of print in England for some years, it is still relevant today. It has been often cited and makes a contribution towards understanding the more difficult aspects of family relationships and friendships. He can be seen as one of the first significant object relations theorists and his ideas anticipated the concepts put forward by modern self psychologists.

Although Ian Suttie was working within the tradition set by Freud, there were a lot of concepts of Freud’s theory he disagreed with. First of all, Suttie saw sociability, the craving for companionship, the need to love and be loved, to exchange and to participate, to be as primary as sexuality itself. And in contrast with Freud he didn’t see sociability and love simply as a derivative from sexuality. Secondly, Ian Suttie explained anxiety and neurotic maladjustment, as a reaction on the failure of finding a response for this sociability; when primary social love and tenderness fails to find the response it seeks, the arisen frustration will produce a kind of separation anxiety. This view is more clearly illustrated by a piece of writing of Suttie himself: ‘Instead of an armament of instincts, latent or otherwise, the child is born with a simple attachment-to-mother who is the sole source of food and protection… the need for a mother is primarily presented to the child mind as a need for company and as a discomfort in isolation’.

Ian Suttie saw the infant as striving from the first to relate to his mother, and future mental health would depend on the success or failure of this first relationship (object relations). Another advocate of the object relations paradigm is Melanie Klein. Object relations was in contrast with Freud’s psychoanalysis. The advocates of this object relations paradigm all, in exception of Melanie Klein, held the opinion that most differences in individual development that are of importance for mental health could be traced to differences in the way children were treated by their parents or to the loss or separation of parent-figures. In the explanation of the love and hate relationship by Ian Suttie, the focus, not surprisingly, lies in relations and the social environment. According to Suttie, Freud saw love and hate as two distinct instincts. Hate had to be overcome with love, and because both terms are seen as two different instincts, this means repression. In Suttie’s view however, this is incompatible with the other Freudian view that life is a struggle to attain peace by the release of the impulse. These inconsistencies would be caused by leaving out the social situations and motives. Suttie saw hate as the frustration aspect of love. “The greater the love, the greater the hate or jealousy caused by its frustration and the greater the ambivalence or guilt that may arise in relation to it.” Hate has to be overcome with love by the child removing the cause of the anxiety and hate by restoring harmonious relationships. The feeling of anxiety and hate can then change back into the feeling of love and security. This counts for the situation between mother and child and later for following relationships.

In Suttie’s view, the beginning of the relationship between mother and child is a happy and symbiotic one as well. This happy symbiotic relationship between mother and baby can be disrupted by for example a second baby or the mother returning to work. This makes the infant feel irritable, insecure and anxious. This would be the start of the feeling of ambivalence: feelings of love and hate towards the mother. The child attempts to remove the cause of the anxiety and hate to restore the relationship (retransforming). This retransforming is necessary, because hate of a loved object (ambivalence) is intolerable.

In the Work of Edith Jacobson

The newborn baby is not able to distinguish the self from others and the relationship with the mother is symbiotic, with the two individuals forming a unique object. In this period, the child generates two different images of the mother. On one hand there is the loving mother, whose image derives from experiences of love and satisfaction in the relationship with her. On the other hand, there is the bad mother, whose image derives from frustrating and upsetting experiences in the relationship. Since the child at this stage is unable to distinguish the self from the other, those two opposite images are often fused and confused, rather than distinguished. At about six months of age, the child becomes able to distinguish the self from the others. He now understands that his mother can be both gratifying and frustrating, and he starts experiencing himself as being able to feel both love and anger.

This ambivalence results in a vacillation between attitudes of passive dependency on the omnipotent mother and aggressive strivings for self expansion and control over the love object. The passive-submissive and active-aggressive behaviour of the child during the pre-oedipal and the early oedipal period is determined by his ambivalent emotional fluctuations between loving and trusting admirations of his parents and disappointed depreciation of the loved objects. The ego can use this ambivalence conflicts to distinguish between the self and the object. At the beginning, the child tends to turn aggression toward the frustrating objects and libido towards the self. Hence, frustration, demands and restrictions imposed by parents within normal bounds, reinforce the process of discovery and distinction of the object and the self. When early experiences of severe disappointment and abandonment have prevented the building up of un-ambivalent object relations and stable identifications and weakened the child’s self-esteem, they may result in ambivalence conflict in adulthood, which in turn causes depressive states.