Narcissistic Injury Research Articles

Treatment of Bipolar Disorder in the University Student Population

University counseling centers are faced with the challenge of effectively treating bipolar students while also utilizing brief treatment frameworks and managing high patient volumes. Potential destabilization, particularly within the elevated mood phase, poses significant behavioral management issues for university clinicians and administrators, though for many years the common default position for university counseling centers has been to refer students with bipolar disorder to off-campus resources for longer-term treatment. The author argues against this and instead poses a four-point rationale for treating most bipolar students on campus. The recommended treatment approach includes the integration of brief individual psychotherapy, psychiatric medication, and a bipolar student support group. An important additional component entails lifestyle modifications which include healthy sleep hygiene, the application of stable life patterns, effective stress management, and abstinence from the use of psychoactive substances. Normative strivings toward independence, identification with contemporary group norms, and fears of the long-term implications of bipolar disorder predictably give rise to defensive denial and resistance to the diagnosis. Such should be an essential focus of the early phase of treatment, with particular attention given to students' narcissistic injury reflecting loss of the ideal self they are striving to become. Participation in an ongoing student support group will provide important support in relation to this loss—a place to feel accurately perceived and understood and an alternate source of group identification. The potential benefit from support group involvement will also be instrumental in sustaining healthy treatment compliance.

Superego and Sexuality: An Analysis of a Psychosomatic Solution

Superego influences have been little considered in the current literature on psychosomatic illnesses; an archaic and sadistic superego, however, is often a dominating force in the maintenance of these painful bodily states. This dynamic is illustrated in the analysis of a dissociated and concrete patient, whose primary modes of defense, self-reparation, and object-relationship were at first erotized bodily pain and illness. Analysis of an intense, highly conflicted transference facilitated the gradual emergence of this patient's capacity to make use of a metaphorical interpretive process. Severe narcissistic injuries were integrated, allowing the evolution of a mourning process. This fostered individuation of the self, establishment of a differentiated body image, an integrated superego, consolidated object relations, and a more mature ego ideal.

Why Is It So Difficult to Describe What Actually Goes On in the Minds of the Patient and Analyst?

The article is devoted to an exploration of the neglect of the whole person in describing what takes place in analysis. Without reference to the whole person, the humanism within the analytic situation is frequently absent; the question of finding a way to live with one's vulnerabilities and traumas is not addressed. The author suggests two major reasons for this situation: the adherence to the canons of science of the enlightenment and the lack of attention given to the transformation of the repetition compulsion into one's narrative which necessitates living with narcissistic injuries, vulnerabilities, and helplessness. Clinical vignettes are offered to demonstrate the author's argument.

Évolution des mécanismes de défense au cours d’un traitement bref psychanalytique. Une étude de cas

The main goal of this case study is to examine the stability versus mobility of defensive functioning during a brief psychoanalytic face-to-face psychotherapy (five sessions) on a crisis situation. It proposes the study of mobilized specific mechanisms and their evolution in terms of frequency during the intervention process. The sessions were rated according to J.-C. Perry's Defense Mechanism Rating Scale. The overall defensive functioning reached, at the end of the treatment, a higher maturity level (another neurotic) than that initially observed (narcissistic). This change is discussed in terms of narcissistic wound related to the crisis and involving a temporary regression. This study tends to confirm the thesis, advanced by theorists of short therapies and usually observed in this type of practice, of the plasticity of the psychic apparatus.

Murder and Madness

This article presents a case of dual murder committed by a person having a narcissistic personality disorder with traits of borderline personality disorder. The man, who had no previous problem with the justice system and had never shown any aggressive behaviour, stabbed to death his lover who was leaving him and, a week later, killed his own son. Through weekly clinical sessions over a period of 11 months, the analysis of the crime dynamics, the criminogenesis, and psychodynamics of the two murders allowed the reconstruction of the offender's psychopathological frame of mind and, in particular, the hypothesis of a symbolic connection between the homicides: The first appears to have been the result of an act of power and control in order to heal his narcissistic wound, whereas the second was due to his need to expiate the first crime and so could be interpreted as a suicide by proxy.

Sustaining an erection: brotherhood, manhood, and psychotherapy

Men have yet to see through a social revolution paralleling the feminist revolution. Lacking rite of passages, and still oscillating between primal kinship and effeminized emotionality, men today often find themselves struggling to discover masculinity that is connected both to emotions and to manhood. The author describes his own yearning for such brotherhood in his personal and professional life. But what happens when such a man appears as a client? This case study discusses Milton's fascinating journey into manhood, which includes mourning the position he assumed in his family, recognizing the deep narcissistic wound and committing to a different relationship with himself and others around him. The paper challenges the classical emphasis on the mother-baby attachment and proposes to include within it the necessity of the triadic-self, and the familial challenge of severing the parental-dyad to make space for the child without breaking it. All the while this paper describes the impossible connection between two men – client and therapist – who learn to love one another, transferentially and even more so – as two men; who struggle with the implications of such love and allow it to transform them both. Shame, self-love, and questions of reality and transference all emerge when client and therapist struggle with the forces of needs, desire, and brotherhood that bring them together through waves ruptures and repairs. Copyright © 2010 John Wiley & Sons, Ltd.

Effectiveness of poetry therapy as an adjunct to self-psychology in clinical work with older adults: A single case study

Older adults suffer from narcissistic injuries due to the multiple losses faced during later stages of life. A combination of poetry therapy and self-psychology can be an effective approach to address these losses. While self-psychology focuses on the fragmented self, and aids in the development of a more cohesive self, poetry therapy provides opportunities for expression, creativity, and life review that circumvent the limitations often faced by older adults. This paper is a single case study that explores how poetry therapy can be used to generate self-object experiences that provide structure to the older adult's ego.

Schematherapie: Ein Ansatz zur Behandlung narzisstischer Persönlichkeitsstörungen

In this article, we review the history of the con- struct of narcissism and the diagnostic criteria for narcissistic personality disorder. We then dis- cuss some etiological models of narcissism and introduce the model of Jeffrey Young, who devel- oped Schema Therapy (ST) as an alternative to standard cognitive therapy for patients with per- sonality disorders. ST differs from standard cogni- tive therapies in important respects, including limited reparenting, a focus on the patient's basic needs, and emotional activating techniques in addition to cognitive and behavioral ones. We then discuss Young's theory of basic needs, early maladaptive schemas, and Ac- cording to ST theory, narcissists are traumatized in the domain having to do with attach- ment needs. They are prone to vulnerable emo- tions in response to narcissistic injuries, although they often do not show these emotions directly. Instead, they use maladaptive coping strategies, resulting in emotional states, known as schema modes. This includes the Self-Aggrandizer mode and Detached Self-Soother mode, in which a su- perior, arrogant self-presentation and addictive or compulsive behavior serve a self-regulatory function. These concepts are illustrated by case examples of patients with Narcissistic Personality Disorder.

Prise en charge psychologique des échecs de procréation, au masculin : une blessure peut en cacher une autre

When one thinks of the failures of ART one naturally thinks of the suffering that they generate; but behind this pain, there is the suffering of infertility and, behind this latter, other distress we showed at the time of a recent research that they could play a part in infertility itself. The psychotherapy will help assume the failures, so that the traumatisms do not come to solidify in an impossible mourning, covering non elaborate former grieves. A sublimation of the desire of reproduction can make it possible for the unfertile man to peacefully consider other forms of paternity. For it to be possible, it is necessary that the subject should not be in the refusal of the psychic effraction, which the announcement of its infertility produces. When it is the case, to put on the couple on psychological assistance may help to restore a share of the narcissistic wounds; more particularly the one related to the suffering of the couple that often comes to be added to the wound of infertility.

Étiopathogénie du crime en col blanc : une étude de cas exploratoire

The present analysis is an exploratory case study that sheds light on possible narcissistic predispositions for white-collar crime. Undertaken with a former inmate imprisoned for an economic crime, this case study permits an identification of the presence of a sharp feeling of vengeance. Probably emergent from the relational dynamic between this ex-prisoner and his father, this deep vindictive feeling, known as Monte-Cristo complex, serves as a psychic fuel to actualize the compensation for the distant narcissistic wound. For a high level manager, this compensatory actualization could take, among other possibilities, the form of a white-collar crime.

Pathological narcissism and the depressive temperament

Background Although relations between depressive and narcissistic pathologies have been proposed in both psychoanalytic and phenomenological literatures, empirical research generally fails to confirm this link. Common measures of narcissism, however, emphasize grandiose rather than vulnerable traits, and include both adaptive and maladaptive features. We therefore assessed the relation between narcissistic personality and depressive temperament (DT) using a recently developed measure designed to assess a wide range of pathological narcissistic (PN) traits. We also examined the distinctiveness of the association between DT and PN controlling other temperaments. Method The Pathological Narcissism Inventory (PNI; Pincus et al., 2009), the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A; Akiskal et al., 2005), and a modified Schedule of Fatigue and Anergia (SOFA; Hadzi-Pavlovic et al., 2000), were administered to 228 university students. Results Principal component analyses yielded two components of PN: Component 1 items reflect narcissistic vulnerability—negative affect when narcissistic needs are not met; Component 2 items reflect narcissistic grandiosity—positive affect related to self-enhancement. Component 1 significantly predicted DT, an effect that remained after controlling for Component 2 and other temperaments in the TEMPS-A and SOFA. A similar effect was observed for the anxious temperament. Limitations Our study is limited by the use of a homogenous, non-clinical university student sample unscreened for clinical depression, and by reliance on self-report questionnaires. Conclusions Contrary to past research, DT is associated with narcissistic disturbance, in particular with the avoidance of narcissistic injury, when the PNI is used. Clinical intervention targeting this avoidance might help patients with a DT develop self-esteem that is not overly dependant upon recognition from others.

Why Medical Educators May Be Failing at Feedback

IN THE 25 YEARS SINCE ENDE 1 PUBLISHED THE SEMINAL ARticle on feedback in clinical medical education, many of the concepts have been verified and repeatedly emphasized. However, physicians participating in needs assessments for faculty development frequently cite feedback as an area for improvement. Considering the provision of feedback as a competency is quite appropriate, because feedback is an essential skill for learner improvement. Without effective feedback, learners struggle to achieve defined goals. Despite the focus on feedback, learners may still perceive a lack, even when explicitly informed that feedback is occurring. The stark difference between what teachers think they are delivering and what learners think they are receiving begs the question: are medical educators failing at promoting effective feedback? Some evidence indicates that feedback is not being provided effectively. Learners still complain about not receiving enough feedback. Verbal interaction analysis indicates that the feedback dialogue is too teacher centered and is skewed toward predominantly the positive or neutral. Feedback may be provided at a low cognitive level using basic and descriptive facts, precluding active engagement of the learner. Students’ dissatisfaction with feedback may reflect a greater desire for praise than for constructive information to help them learn. Desires for mainly positive feedback may become a worsening trend as the “Millennial Generation” enters US medical schools. This generation has been broadly characterized as being raised with an emphasis on being special; a previous absence of a balanced focus on weakness may present a barrier to accepting the validity of negative feedback. These studies suggest that educators might not be providing learners with effective feedback. Possible reasons are use of incorrect measures of success (eg, Likert-type student satisfaction scales) or insufficient faculty development programs. Such arguments tend to focus on external factors (such as increased productivity pressures) or teacherbased behaviors. The feedback dialogue has been overly centered on the role of the teacher while underemphasizing the role of the learner. As such, 3 potential reasons may help account for failing at feedback: poor ability of learners for selfassessment, overpowering influence of affective reactions to feedback, and lack of adequately developed metacognitive capacities. There is increasing evidence that physicians, as a group of professionals, have little ability to accurately self-assess performance and typically tend to overestimate abilities. This distorting cognitive process could be the result of a strong need to protect self-image. Physician-learners may be poor at assessing their own capabilities; even worse, the most deficient performers may be least aware of their lack of competence. A dangerous medical professional is one who is unaware of what he or she does not know and lacks the skills and insight necessary for self-assessment. Learners who tend to overestimate their own abilities may be surprised when they receive feedback incongruent with their self-perceptions. This conflicting feedback could generate more of an emotional reaction than an unemotional review of the facts, driven by feedback lessons unconsciously stored in memory from years past, possibly even from childhood experiences. Learners could view negative feedback as a personal attack. Since learners are motivated to defend their egos and often prefer information that supports their positive self-views, these attacks on the ego can trigger negative emotional reactions such as guilt, anger, or self-doubt, often at an unconscious level. These emotions can in turn block any useful feedback from reaching the learner at some cognitive level, creating an insurmountable barrier. Learners with distressing reactions to feedback tend to devalue it as not useful. Damage to the learner’s self-image by constructive feedback could lead to learners using cognitive mechanisms to protect themselves from narcissistic injury (eg, outright denial, distorting information). Discounted feedback would not result in improved learner performance. Learners with more positive self-esteem and stronger egos may seek both positive and negative feedback, whereas learners with lower self-esteem may seek only positive feedback. The latter may avoid feedback interactions as a selfprotective mechanism.

Thinking About What We Know and What We Do Not (Yet) Know: Thoughts Stimulated by Anna Ornstein's, “Do Words Still Matter? Further Comments on the Interpretive Process”

While affirming the overall congruence of her clinical approach and Ornstein', the author delineates the distinction between defenses initially described by Kohut and Ornstein and a defense later identified by Brandchaft. Although the former protects a vulnerable self developed in malattuned environments, the latter, structures of pathological accommodation, bears the imprint of the malattuned environment; the defensive behavior carries the mark of the narcissistic injury in some amalgamation with the child's response to it. The author links the tenacity of these defenses to attachment ties, for efforts to eliminate them may threaten patients with annihilation anxiety. Ornstein and Brandchaft agree that both forms of defense may co-exist. The author briefly underlines a similarity between a case described by her and one described by Ornstein, and draws attention to the need to continue the investigation of defensive structures to improve clinical efficacy with such challenging patients. Al afirmar la cong...

Stepping Sideways

Stepping Sideways Thomas Elsaesser It is my great pleasure and honour to have been asked to address the forty-ninth annual conference of the Society for Cinema and Media Studies. That I should do so as this year's recipient of the Society's annual Lifetime Membership Award (for Distinguished Career Achievement) gives the occasion an especially festive allure, and I want to express my appreciation to the members of the committee for having selected me. As I accept the Award with gratitude, and a due sense of the responsibility that comes with such a distinction, I also want to extend warm thanks to Lucy Fisher, for her most generous introductory remarks, and to Patrice Petro for hosting me this evening as the Society's special guest. Such a lifetime membership award invites—indeed obliges—one to enter into a retrospective frame of mind. I'm not too blasé to admit that the idea of one's peers thinking one has an achievement to look back on does soothe quite a few anxieties. It soothes the worry that what one has done doesn't really amount to much; it soothes the worry that what one is personally most proud of has gone unnoticed or unrecognized; and for many other common and garden-variety anxieties, such a distinction is a wonderful plaster on the narcissistic wound and a palliative for any soul not immune to self-doubt. It's like a general amnesty—a pardon, a reprieve—in the perpetual plea bargaining between me and myself. And yet, while the pleasure is real, so is the dawning realization that this is not, say, a mid-career show. This is a "lifetime" award, and therefore a hint—a gentle hint, for sure, but a hint nonetheless—that it may be time to prepare, if not for a retreat, then for taking a step sideways. And this I am happy to do, the more so, when I think—still in this retrospective mood for a few more minutes, if you will forgive me—that my career has really been a series of sideways steps, or to put it too bluntly: my career as a film scholar has often seemed based on a series of misunderstandings—mostly productive ones, to be sure, but (in true melodramatic fashion) out of sync, too soon, too late, the right thing at the wrong place, or vice versa. [End Page 121] I do not mean the misunderstandings about my name: in the 1970s, the tease was that "Elsaesser" could only rhyme with "Althusser." And in the 1980s, when I was living in North London, I rented a flat in Stoke Newington—some of you here may even remember it—from a Hasidic landlord, who would never have signed the lease had he not thought I was Jewish, presumably because all his neighbors were called Breslauer, Wertheimer, or Rosenthaler. But because in the London telephone directory I was listed just ahead of a Dr. El-Sayed and a Mrs. El-Saway, I would regularly receive letters addressed to Dr. El-sasser, reminding me of my duty to Allah, and asking me for generous donations to the Finsbury Park Mosque. Nor do I mean the misunderstandings about my nationality, which ended (to cut short a long story of mistaken identities) with the Dutch thinking I'm English, whereas the Germans think I'm Dutch, and only the Americans have the good sense of knowing I'm from "Europe." I mean a different misunderstanding. The filmmaker Harun Farocki once told me how surprised he was about the international success of his film Images of the World and Inscription of War. He said: "I made the film in 1987 against nuclear power and cruise missiles on German soil, and it came back to me from America in 1990 as a film about the Holocaust." I think I know what he meant: I wrote an essay about melodrama in 1972, to put in my bid, as it were, in a discussion about "authorship" and "genre," hotly debated around the British Film Institute by, among others, Peter Wollen, Jim Kitses, Ed Buscombe, and Colin McArthur, and it came back to me in 1975 as...

Puella's shadow

Puella is the eternal girl, an aspect of the psyche that has been virtually ignored in the Jungian literature. She appears in the Western attitudes to be ever younger and thinner, devalued and stuck in the shadow of the patriarchy. Living ‘as if’, she is bolstered by persona adaptation, masking the emptiness within, experiencing but not facing the narcissistic wounds. The attachment problems result in a distorted and split self-image, divorced from her body, and difficulty with intimacy and commitment. The dreams and writings from the American poetess Sylvia Plath illustrate parallels with the Puella figure.

Our Shaken Collective Self-Esteem

How can psychotherapists best work with patients suffering in the aftermath of the recent devastating economic meltdown and deal with our shaken collective and individual self-esteem? Working with patients who have lost their jobs or their nest eggs, or whose retirement is imperiled, involves addressing the dynamics of mourning. Patients may be experiencing disbelief, shock, anger, and denial of the immensity of the loss, as well as shame and humiliation at their vulnerability. At the same time, because we personally may be confronting many of the same fears and uncertainties, it is important that we as therapists avoid overly identifying with our patients and failing to treat them as individuals in their own right. The author discusses strategies for addressing patients' defenses, a tendency to catastrophize and give way to panic, a sense of narcissistic injury, and anger directed at the people they blame for the economic collapse as well as at themselves for having gotten in over their heads. Using Kohut's concepts of a developmental line of narcissism, therapy may reinforce mature self-esteem while helping patients work through their emotions and come to terms with their new realities. Optimally, they can find new resources within themselves and grow in their ability to value relationships with others.

Narcissism: fragile bodies in a fragile world

In this two-part paper we explore how, in Western society, intensified consumer culture, playing on feelings of shame and inadequacy, can be seen as reactivating the ‘narcissistic wound’ while the recent growth of information technology increasingly provides access to a global spectacle and a virtual world that offer an escape from reality. This fuels the illusion of immortality and invulnerability to physical/emotional needs. We ask who benefits from this culture of unrelatedness and disembodiment, and what the repercussions are in terms of participation in social life and organized response to global issues. Using material from our practices and from social life, we seek to identify the collective cost of maintaining a disassociation that can permeate not only the therapeutic process but also work, personal relationships and events on the political stage. We consider a view of former president Bush as a narcissistic leader in a narcissistic culture with the Iraq war as a narcissistic misadventure and we present vignettes from the consulting room, Dance Movement Therapy work in Holloway Prison and the academic world of prehistoric archaeology to show how narcissistic behaviours are embedded in many diverse situations in Western society. We ask how the concept of narcissism in our media age can help us understand phenomena such as the rise of fundamentalism, celebrity cults, insatiable aspirations to ‘self-improvement’, obsessions with ‘success’ and consumer goods, the denial of ageing, the upsurge in cosmetic surgery, body modification and self-harm as well as growing addiction to alcohol and hard drugs. Finally, we ask how the narcissistic fantasy of self-sufficiency, the disavowal of loss and the denial of the ultimate non-discursive reality of death affect our ability to respond appropriately to human injustice and the fragility of our planet. Copyright © 2009 John Wiley & Sons, Ltd.

Large-group Narcissism and Political Leaders with Narcissistic Personality Organization

<P>Massive traumas at the hands of “others” lead to shared humiliation, shame, fear of being assertive, and difficulty mourning for large ethnic, national, or religious groups. Large-group narcissistic injury may lead to a corresponding defensive increase of shared narcissism linked to large-group identity. Once the traumatic event is over — following the end of an occupation by the “other,” the removal of the oppressive regime, or the break-up of a political system — smoldering narcissistic injuries among the former sufferers and among their descendants through transgenerational transmissions can spark new large-group processes of “entitlement ideologies.” Such processes, with or without a change in function, may remain active for generations, at times with malignant and destructive consequences. When exacerbated, they play a role in the creation of an atmosphere that encourages leaders with narcissistic personality organization to reactivate and manipulate “entitlement ideologies” and related emotions within the large group. This, in turn, increases the shared narcissistic investment in large-group identity and changes its characteristics. Such leaders can function to repair old wounds, returning mature pride and confidence to the group, or conversely, narcissistic leaders with an underlying paranoid orientation can foment violence and massive destruction in the name of “ethnic cleansing” and genocide. </P><H4>ABOUT THE AUTHORS</H4><P>Vamik D. Volkan, MD, is Senior Erikson Scholar, Erik H. Erikson Institute, Austen Riggs Center, Stockbridge, Massachusetts. J. Christopher Fowler, PhD, is Director of Research, Erik H. Erikson Institute. </P><P>Address correspondence to: Vamik Volkan, MD, 25 Main St., Stockbridge, MA.01262 </P><P>Dr. Volkan and Dr. Fowler have disclosed no relevant financial relationships.</P><P><H4>EDUCATIONAL OBJECTIVES</H4><OL><P><LI>Describe large-group narcissism and how to detect it. </LI></P><P><LI>Outline the role of “chosen traumas” in sustaining and fomenting large-group narcissism. </LI></P><P><LI>Describe the interplay between narcissistic leaders and the need for a savior in large groups. </LI></OL>

Sense of personal identity and focal brain lesions

The sense of personal identity is an element of the Jasperian definition of self-conscience. Each of us is convinced of being a unique and stable individual, different from other individuals. These properties - stability ad coherence - belong to an image of ourselves that was proposed to us by the Other's look during the mirror phase. Brain focal lesions may threaten this certitude in two ways: 1) brain lesions result in deficiency, disability or handicap, which are experienced as a narcissistic injury. The patient questions himself about the image he offers to the Other's look, and, as a result, his sense of personal identity is unsettled; 2) a variety of focal brain lesions or dysfunctions may alter the activity of areas which are necessary for maintaining a stable image of the patients' body or self. This may lead patients to experience depersonalisation, autoscopy, somatoparaphrenic "delusions" or disturbed agency. The sense of personal identity may be disturbed during brief paroxystic or psychologically traumatic phenomena. However, this is not observed in chronic sequelae of brain lesions (e.g. right hemisphere syndrome or amnesic syndrome), even though the patients may present a broken up image of themselves.

Emotional abuse of students of color: the hidden inhumanity in our schools

Illuminating and understanding the emotional abuse inflicted on many students of color is a necessity in creating conditions for their school success. However, this topic is rarely discussed among educators and those preparing educators. However, from the author’s recent experiences conducting research in racially diverse schools as well as her nearly 30 years working in such schools, it is apparent that some teachers, consciously or unconsciously, act in ways toward their students that constitute abuse, i.e. the infliction of narcissistic injuries. The possible sequelae of these injuries may have deleterious effects on the future academic, emotional and physical health of the students.