Understanding Narcissism in Clinical Practice

Victoria Graham-Fuller, Hazel Robinson

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9780429923531
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Understanding Narcissism in Clinical Practice is a new volume in the eagerly anticipated clinical practice monograph series from the Society of Analytical Psychology. Aimed primarily at trainees on psychotherapy and psychodynamic counselling courses, these compact editions will be invaluable to all who wish to learn the basics of major psychoanalytic theories from an integrated viewpoint. The authors are Jungian analysts trained at the SAP; highly experienced in both theory and practice. Narcissism is one of the most important contributions of psychoanalysis, as well as one of the most confusing. This monograph presents the clinical condition of narcissistic disorder in a clear, concise and easy-to-read style. The myth of Narcissus, from where the term 'narcissism' originates, is presented and discussed. Several brief case studies, plus one in-depth, illustrate the manifestations of narcissistic disorder that are detailed throughout.

Chapter One
The Story of Narcissus: a psycho-sexual dynamic

Most stories have many versions, and the Greek myths concerning Narcissus and Echo are no exception. The most familiar version of the myth of Narcissus is that recorded in Ovid's 'Metamorphoses'. The tale was re-told in modern language by Robert Graves (1981), and this version closely follows his:

Narcissus was a Thespian, the son of the blue nymph Leiriope, whom the River-god Cephisus had once encircled with the windings of his streams and ravished. The seer Teiresias told Leiriope, the first person ever to consult him, 'Narcissus will live to a ripe old age, provided that he never knows himself.' Anyone might excusably have fallen in love with Narcissus, even as a child, and when he reached the age of sixteen, his path was strewn with heartlessly rejected lovers of both sexes; for he had a stubborn pride in his own beauty. One day Narcissus sent a sword to his most insistent suitor, Ameinius, who killed himself on Narcissus' threshold, calling on the gods to avenge his death. Artemis heard the plea and ruled that Narcissus should fall in love, but that love's consummation should be denied him.

Among his lovers was the nymph Echo, who could no longer use her voice, except in foolish repetition of another's words. Her muteness was a punishment by the Goddess Hera, because Echo had distracted her attention with long stories so that she did not notice her husband Zeus's nymphs getting away.

One day when Narcissus went out to net stags, Echo stealthily followed him through the pathless forest, longing to address him, but unable to speak first. At last Narcissus, finding that he had strayed from his companions, shouted: "Is anyone here?"

"Here!" Echo answered, which surprised Narcissus since no one was in sight.

"Come!"

"Come!"

"Why do you avoid me?"

"Why do you avoid me?"

"Let us come together here!"

"Let us come together here!" repeated Echo, and joyfully rushed from her hiding place to embrace Narcissus. Yet he shook her off roughly and ran away "I will die before you ever lie with me!" he cried. "Lie with me!" Echo pleaded. But Narcissus had gone.

At Donacon he came upon a spring, clear as silver, and never yet disturbed by cattle, birds or wild beasts or even by branches dropping off the trees that shaded it. As he cast himself down, exhausted, on the grassy verge to slake his thirst, he fell in love with his reflection and lay gazing enraptured into the pool, hour after hour. When, presently he tried to embrace and kiss the beautiful boy who confronted him, he recognised it was himself. How could he endure both to possess and not to possess? Torn by grief, he knew at least that his other self would remain true to him, whatever happened.

Echo, still watching, grieved with him. Although she had not forgiven Narcissus, when she saw him plunge a dagger into his breast, she sadly echoed his dying words "Ah, youth, beloved in vain, farewell!" Where his blood soaked the earth, up sprang a white Narcissus flower with its red corolla. Echo, pining for her lost love, wasted away until only her voice remained to haunt the lonely woods.

Traditionally, the myth has been read as a moral fable about the tragedy of Narcissus. It depicts a tragic stalemate, and this provides the clue that the myth is describing a universal condition. The characters of Narcissus and Echo are symbolic of a drama that has been played out by humans over millennia. Although a mythical narrative cannot be brought as 'evidence' in support of clinical discoveries, the characters of Narcissus and Echo illuminate particular pathological defences. Their interaction represents an intrapsychic dilemma, a profound split, which is not resolved. Both characters are archetypal, larger-than-life. Their actions and emotions are absolute. Each is a catalyst for the other; to view the actions of one without consideration for the other is equivalent to describing a marriage from the viewpoint of one spouse only.

Narcissus' insensitive rejection and Echo's adhesive identification both express failures to negotiate a crucial turning point in human growth. In healthy development identification with, and introjection of, the object is flexible and progressive. Jungian theory understands human psychic development as a rhythmic continuum, encompassing merger, separation and re-merger.

Archetypal splits are usually addressed during family interactions and rendered human-sized. Myths and tales from all cultures deal with this issue. For most young children, the idealisation and the ferocity in 'fairy-tales' makes sense in terms of their own blissful or murderous fantasies and impulses. It is a relief that these have been understood and described by adults, especially by parental figures. Often, the tales have a moral intention ("you'll get your come-uppance!") arousing consciousness of guilt and punishment for sins. If the paranoid-schizoid anxieties and defences are met with understanding, a depressive capacity for concern arises.

When the maternal figure has been able to accept her child's dependence, and encourage separation from her appropriately, it is likely that the child will gradually be able to progress toward independence unencumbered by excessive anxiety. If not, the child may develop pseudo-independent defensive structures designed to avert intimacy. One classic pattern is that of omnipotent role reversal, when the child may attempt to nurture a failing parent. As adults, these people remain unable to gain much-needed love, attention and admiration, and may hold chronic grudges against 'fate'.

Punishment by 'the gods' is a powerful theme in the myth: both Narcissus and Echo are cursed with suffering. Narcissus is an arrogant young man and, although aware of his physical, external beauty he is self-conscious without being self-aware. No one is good enough for him and he reacts to love with contempt and cruelty. He treats people as things, to be used and discarded, as though they have no feelings. When Ameinius dies, Narcissus does not care, but in the words of the old rhyme "is made to care".

Unable to empathise with others, to accept loss or to mourn their loss, Narcissus feels neither depression nor anxiety. But there is a price to pay for this failure of compassion: Narcissus is cursed to fall in love - in vain - and to experience the frustration and loss he has caused others to suffer; to feel, himself, the anguish of unrequited love. Only when he feels longing and reaches out for his beloved reflection does he "know himself". Unable to bear the frustration, Narcissus kills himself.

Although Narcissus appears callous and uncaring (schizoid), in the end he suffers acutely. Those hours at the pool, 'drinking in' his reflection, may appear to be merely an expression of self-love, but this also illustrates a defensive retreat within which the pain of separateness can be denied. Narcissus' inability to recognise himself when he gazes into the forest pool suggests developmental difficulty in infancy. When things go well, the mother's gaze mirrors back the infant to him or herself so that a strong sense of self and a healthy body-ego are established. Without the attentions of a 'good enough' mother, the infant has to relate to others from an intellectual or 'false' self constructed in his mind. As for Narcissus, a patient's sudden recognition of his or her previous state of total isolation can be crushing and dangerous.

Echo has also been punished for misusing her burgeoning sexuality, having tried to distract Hera's attention from Zeus' sexual dalliance with the nymphs. She is cursed by the goddess/mother with the inability to initiate relationships; her sexual power is taken away, and she suffers impotence, humiliation and rejection. Unable to approach and speak to Narcissus, she seizes the opportunity to misinterpret his wish to "come together here" to coincide with her own erotic desires, rushing out of hiding as if he has offered an invitation to a tryst. Her "masochistic fidelity only reaffirms Narcissus in his view that she is no more than a mirror and a pathetic creature" (Hamilton, 1982, pp. 128-9). Of course, she is brutally rebuffed, having tried to manipulate him into an entanglement he had neither expected nor sought. In the attempt to meet her needs, she controls rather than negotiates with him. Echo's manipulation of Narcissus results from muteness. After his rejection, Echo is engulfed by melancholia, falling into anxiety and self-absorbed rumination. Echo's silence in relation to the unattainable other illustrates the eternal repetitive damage, which ensues from narcissistic injury.

Echo's response to the rejection is characteristic of those suffering from pathological narcissism: in shame and humiliation, she withdraws whilst still anxiously clinging to her desire. Her mortification amounts to the death of creative potential, which may be manifested in a clinical setting by symptoms such as lethargy, despair and inability to take in anything good. Eventually Echo's body becomes painfully thin and wastes away until only her voice remains: the myth's warning about the ultimate prognosis of the condition if left untreated. It is not unusual to find patients suffering symptoms of anorexia and bulimia, in women especially. Hamilton (1982) has also linked Echo's plight with the profound grief that may be found at the core of patients with autistic disorders.

The interaction of Narcissus and Echo is set during adolescence, during which a young person begins to emerge from childhood dependence, through defiance, curiosity and experimentation, towards a relatively established adult identity. The figure of Narcissus is recognisable as an 'eternal adolescent' who wants excitement without commitment. During adolescence, many of the difficulties that have arisen during infancy and childhood are repeated. At the psychological heart of this stormy transition, lies a replay of pre-Oedipal and Oedipal tensions between the needs to identify and differentiate, control and negotiate, attract and reject. Issues of gender identification, and gender-role also complicate the picture.

In psycho-sexual development, the baby boy's first identification is with his mother, and in order to establish his gender identity the male infant must adjust to the not-female or not-mother bias, and form a positive identification with the father. For a girl, gender identity is built on her primary identification with her mother. The difficulties girls experience in establishing their feminine identities can arise from ambivalent experiences with mothers and distant fathers. Different developmental impulses, specific to male and female gender identification, can create a tension of opposites within the totality of the human psyche.

Although the myth describes the behaviour and reactions of an individual man and woman, their emotional interaction can be seen symbolically to represent an intrapsychic dynamic within the same individual which is not inherently allied with one gender or the other.

Jung came to believe that beneath the conscious (gendered) personality there lay another one of a quite different nature - an unconscious female within a man, and vice versa. He called these contra-sexual archetypes the anima (in man) and animus (in woman). These archetypes are 'realised' through projection onto another, usually of the opposite gender. Although they inevitably reflect characteristics from the collective social and political norms of any given time, Jung emphasised their timeless qualities that are not exclusive to one gender or the other (Hopcke, 1989). Jung was interested in providing a conceptual framework for understanding what each sex feels and thinks about the other, as a perceived opposite.

"The role of anima and animus as soul images ...explains their particularly intense fascination: they are suffused with enigmatic hints of hidden depths which are in fact intimations of the unknown continent of our own interior being. The longing and desire we feel for those who personify them, whether actual love objects or imaginary figures...is a reflection of the longing we feel to be united with our 'other half, it is the thirst for wholeness and the union of opposites..." (Caiman, 1998, p. 202)

Mothers and fathers, as well as social institutions and norms, reinforce certain gender role expectations. Little boys may come to deny the feminine or anima in themselves, in an effort to maximise their masculinity through self-sufficiency, ambition and competition. This model contrasts markedly with that for little girls. For the female child, the concept of relationship provides the ideal pattern for self development: a capacity for empathy, and responsiveness to others' needs is encouraged by mothers or caregivers in most cultures (Chodorow, 1985).

This perspective gives an added dimension to the mythical drama enacted by Narcissus and Echo. The inability of the two to engage in a relationship may be interpreted not only as pathology but as an illustration of how different developmental impulses, specific to acculturated male and female gender identification, can become polarised within the human psyche, leading to a denial of the balancing contra-sexual component.

Patients coming for therapy frequently pose their problems in terms of unsatisfactory partners. The inability to appreciate the 'other' in a relationship often reflects the super-imposition of gender stereotyping onto narcissistic pathology. Patients often feel anguish, aware of some defect in their interactions with others, but powerless to change. There is frequently a deep sense of shame about their emptiness, but it is not a question of moral weakness. Narcissus' pseudo-independence and Echo's longing for merger both express a disturbance of the capacity to relate.

Chapter Two
Some Clinical Examples

Alan

Alan, an advertising copy-writer in his early thirties, reluctantly agreed to consider psychotherapy at the suggestion of his mother. She was in the process of divorcing Alan's father, and Alan had been telephoning her several times a day in an agitated state. At the beginning of his two psychotherapy assessment sessions with Mrs A, Alan denied that he had any anxiety about the divorce himself, but expressed resentment about the emotional demands for support that he believed his mother was subtly placing upon him by her constant demands. He felt drained and exhausted by the constant hassle of helping her to sort things out.

Alan complained that his current girlfriend made similar demands for his attention. His male friends jokingly called him "a lady killer" because he had so many girlfriends. Whenever a relationship reached the point where it might involve commitment, he would quickly extricate himself and move on. He took some pride in this reputation but confessed that he had sometimes feared he might be gay: at least with blokes there were no emotional ties involved. Reflecting on his childhood, Alan described his parents as having been beautiful but distant. They had built up a highly successful fashion business, largely run by his energetic mother. They were both frequently abroad, and attention to Alan's needs had often been left to a series of nannies and au pairs. With pride, Alan described how he had taken on the responsibilities of 'housekeeper' in the family home, making shopping-lists and trying to do household repairs. To Mrs A, these tasks sounded quite inappropriate for his age, but she suggested to Alan that they must have given him a feeling of being needed and important. Alan agreed: although his parents had been much amused by his activities, he had felt superior to his ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• About the Authors
• Preface to the Series
• Introduction
• CHAPTER ONE The Story of Narcissus: a psycho-sexual dynamic
• CHAPTER TWO Some Clinical Examples
• CHAPTER THREE Manifestations of Narcissism
• CHAPTER FOUR Therapeutic Challenges
• CHAPTER FIVE The Development of Narcissism as a Clinical Concept
• References
• Index