Narcissistic Issues Research Articles

Le primat du phallus, talon d’Achille de l’appareil psychique ? Réflexions autour du cancer de la prostate

ContextThe clinical study of prostate cancer, particularly from a psychopathological perspective, remains relatively underexplored yet it serves as a site for serious and often lasting questioning of the erectile capacities of the penis, and thus potentially of the phantasmatic investments it is subject to. Moreover, this common cancer is particularly linked to the issue of aging, which radically tests the fragilities and narcissistic resources of patients. Power, performance, endurance, and counter-investment against passivity and depression become particularly acute issues in the relationship to oneself, to women, and to men. It then appears essential to delineate the psychological stakes of phallic demand in the articulation between the psychic reality of infantile sexuality and the external realities of aging, illness, and social representations. ObjectivesThis study aims to understand how the traumatic experience of prostate cancer—an acute realization and embodiment of aging and vulnerability—reveals fault lines not only shaped by the primacy of the phallus but also reinforced by societal phallic logic, balancing constraints and ideals. It seeks to discern the fragilities and resources of male narcissism related to phallic demands and their implications. The primacy of the phallus and its associated infantile sexual theory are thus questioned in their organizing or disorganizing roles. MethodThe study is based on a multifaceted methodology: an examination of the taboo surrounding the representation of the male sex in painting, semi-structured interviews, and projective tests conducted with twenty men in their sixties who have been treated for prostate cancer. A case study allows for a thorough and heuristic articulation of theoretical and clinical questions. ResultsHonor and virility emerge as particularly significant narcissistic issues, contributing to a hypomanic masculinity that enables men to shift the stakes of various anxieties (death anxiety, passivity anxiety, and castration anxiety) into the form of another anxiety: a narcissistic death anxiety rooted in virility, the dread of no longer existing as a man in the eyes of others. At the intersection of social, psychosexual, and somatopsychic spheres, prostate cancer thus uncovers a taboo Achilles’ heel. This is composed of unconscious interactions and loyalties between the phallic demand (both internal and external) and a partial dependency on the sensory dimension of erection, necessitating a reevaluation of masculinity, the phallus, and erection independent of sensory perception. InterpretationsSociety reinforces the confusion between the sensory perception of erection and the sense of virility and masculine reassurance on a psychological level through a collective and cultural imagination that associates characteristics of power, endurance, and vigor with a “good” virility, and attributes of vulnerability with a “crisis of virility.” These observations, beyond the scope of organic pathology, could contribute to the broader debate on gender issues, the formation of ideologies, and ultra-virilist movements.

The portrait of Dorian Gray as Narcissus' ID

Aim through the analysis of a fiction novel, to review contemporary social relations where narcissistic issues manifest themselves. The modern Homo Psychologicus, a human being of the end of the 20th and the beginning of the 21st century, more and more resembles the Narcissus captured by enthusiastic self-adoration. The extreme importance of how people demonstrate themselves in society, the escalated investments in personal image, claims of omnipotence and superpowers are combined with formalism and coldness, fear of human intimacy, shame and hiding one's own underside. The narcissistic problems have long ceased to be the domain of a psychoanalyst's office and have become a part of social relations. Oscar Wilde is one of those writers who timely reflected the underlying dynamics of the essence of interpersonal communication and intrapersonal interactions with one's soul. He demonstrated how our personal and collective narcissism is reinforced and becomes more and more apparent. His literary analysis is quite relevant to psychoanalysis, which emerged a little later, a method where the clinical study of narcissism came to occupy a key position, and later extended to the social sphere as well.

The Vicissitudes of a Training Therapy

The author has given an account of a training therapy with a patient who had a very tenuous start in life, having spent three months in an incubator in a neonatal unit, where she suffered life‐threatening conditions and complications. Various difficulties, which can be particularly relevant to a training therapy, are described – in particular narcissistic issues on the part of the therapist, such as the wish for the trainee's success and the consequent pride in what can feel like a joint achievement. However, issues of identification and envy can also be very relevant to this particular work and some clinical examples have been cited. Furthermore, the author has highlighted the particular difficulties of publishing clinical material regarding patients, especially so with reference to training patients, where ethical issues require special consideration. The purpose of this paper lies in an effort to identify the rewards and pitfalls of working intensively with a trainee who is undergoing a psycho‐dynamically based training. It also explores the complexities in publication, even when the patient specifically requests to be written about.

Narcissism and Its Discontents

Back to table of contents Previous article Next article From the ExpertsFull AccessNarcissism and Its DiscontentsGlen O. Gabbard,M.D., , Holly Crisp-Han,M.D.Glen O. Gabbard,Search for more papers by this authorM.D., , Holly Crisp-Han,Search for more papers by this authorM.D.Published Online:17 May 2018https://doi.org/10.1176/appi.pn.2018.5b12Glen O. Gabbard, M.D., is a clinical professor of psychiatry at Baylor College of Medicine and a training and supervising analyst at the Center for Psychoanalytic Studies in Houston. Holly Crisp, M.D., is a clinical associate professor at Baylor and a faculty member at the Center for Psychoanalytic Studies in Houston. They are the authors of Narcissism and Its Discontents: Diagnostic Dilemmas and Treatment Strategies With Narcissistic Patients, which APA members may purchase at a discount.The term “narcissism” has seized the popular culture in the last couple of years in a way that few might have imagined 10 years ago. Yet psychiatrists and mental health professionals continue to find the diagnosis of narcissistic personality disorder (NPD) a vexing challenge that produces a good deal of discontent. Does pathological narcissism denote too much self-love? Profound insecurity? Low self-esteem? Too much self-esteem? Selfishness? Aloofness? A conviction that one is smarter, better looking, more fashionable, or better connected than others? Incapable of tuning in to what others are feeling or thinking? Used as an adjective, “narcissistic” may refer to someone who is thoroughly unpleasant and obnoxious, someone who bristles easily and is sensitive to slights, or someone whose success and confidence are envied.Almost everyone recognizes an attribute such as healthy self-interest as a kind of narcissism that involves self-care and pride in a job well done. Whether a self-serving behavior is pathological or not may depend on other factors, such as the phase of one’s life cycle. An adolescent girl who spends hours obsessing about how she wishes to appear in the photo she is about to place on social media may well be seen as “normal” for her stage in life. However, the same phenomenon in a 48-year-old would raise concern. To complicate matters further, one person labeled “narcissistic” may respond to a slight by having an emotional meltdown, while another with the same label may appear to be impervious to any insult because of his or her apparent self-confidence.The discontent of clinicians is also linked to the frustration they experience with their attempts to treat narcissistic patients, who may insist on dictating the conditions of treatment, ignore the comments of their psychiatrists, and “correct” their clinicians by indicating to them where they have gone wrong and pointing out what they should say and when they should say it. Moreover, these patients are often frustrating because some disappear from treatment abruptly without explanation. On the other end of the continuum, when these patients stick with treatment, it may be protracted with very little sign of change. Indeed, they may seem impervious to the observations of the clinician who is treating them and yet stay in treatment without making substantial improvements. These treatments may be among the longest and most arduous and may seem interminable.From the perspective of two psychiatrists who have treated many narcissistic patients over the years, we must conclude that NPD is nothing if not pleomorphic. It is a multi-headed hydra that may present in a variety of ways depending on the idiosyncrasies of the patient and the context in which the patient lives and works. Research suggests that there is a grandiose form of narcissism that fits the criteria of DSM-5, a vulnerable or hypervigilant variant that sees narcissistic injury around every corner, and a high-functioning type whose narcissism may surface only after a considerable period of knowing the person. However, narcissistic issues may also contribute to comorbidity in patients who present with primary mood disorders, anxiety disorders, and substance use disorders.Hence, treatment must be tailored to the specific narcissistic subtype, the comorbid conditions, and the idiosyncrasies of the person with the disorder. Some narcissistic patients will agree to treatment only if it is on their terms and under their (somewhat omnipotent) control. Still others may quit abruptly when there is a small break in the clinician’s empathy or a confrontation that some of the difficulties in the patient’s life are his or her own responsibility. Fortunately, there are strategies that one can employ to help the patient out of his problems with self-esteem regulation. Some narcissistic patients can rise to the occasion and make substantial changes. There is an unfortunate stereotype that narcissistic individuals create distress in others but do not themselves feel distressed. This aphorism is misguided in that most narcissists feel desperately disappointed that they do not receive the admiration, acclaim, and love that they long for. Psychiatrists and other mental health professionals can help them come to terms with the associated pain and longing. ■ ISSUES NewArchived

« On bat un vieillard » : une figure des fantasmes de fustigation dans le grand vieillissement

AimIn this paper, we analyze the psychic issues entailed in mistreatment fantasies that are expressed, sometimes insistently, in the discourse of some elderly people finding themselves in a situation of dependency. MethodThis study is based on a psychodynamic understanding of psychic functioning, and it also uses clinical vignettes. We explore the fantasy of “the elderly person being beaten” which casts light on a particular mode of processing of the issues of castration and passivity, re-contextualised in the care setting and care relationships. ResultsThe pervasiveness of this fantasy appears as an attempt to bind the excitation caused by the difficulty in accepting a passive position. It also shows that the acute narcissistic issues of old extreme old age do not compromise Oedipal conflict and sexual identification issues. The re-emergence of these issues enables psychic work which can lead to new modes of elaboration. DiscussionThese considerations lead us to envisage the psychopathological characteristics of the encounter with dependency in old age in the light of the tensions between external reality and the internal world. Otherwise the risk is that the distinction between the manifest content of dependency – linked in particular to current biological and social parameters – and the psychic context in which this content is reshaped will be abolished. ConclusionAbove and beyond the evident social relationships of domination, this study aims to draw attention to the masochistic and melancholic modes of passivity that can be mobilized in this fantasized configuration.

The Theory and Art of Child Psychotherapy: A Corrective Developmental Approach.

The history of child psychotherapy is sketched from the psychoanalytic pioneers Anna Freud and Melanie Klein to the popular "nondirective" approach of Virginia Axline. The author's approach to child psychotherapy, based on contemporary psychoanalytic theories, allows the therapist to play any parental role that helps to repair developmental deficiencies and conflicts. These include nurturing, supporting, mirroring, role modeling, challenging, and limit setting. Following Winnicott, psychotherapy is conceived as a play space in which therapist and child are both spontaneous. The value of interpretation and insight in child therapy is discussed. There follows a more detailed discussion of three major problem areas in child psychotherapy: handling anger and hostile aggression; handling issues related to sexuality; and handling narcissistic issues of inferiority and shame.

Manifestations dépressives au cours de l’anorexie mentale : données de la littérature et implications pour une utilisation adaptée des antidépresseurs

ObjectiveDepressive comorbidity is often associated with anorexia nervosa (AN), and antidepressant medication is widely used although it does not rely on any convincing data in the scientific literature. Our objectives were: to summarize the epidemiological, physiological, psychopathological literature about the relation between AN and manifestations of depression, and to focus on the clinical trial data assessing the use of antidepressant medication in AN in order to clarify the strategy for the use of antidepressant in AN during adolescence. MethodA manual computerised search (Medline) was performed for relevant published studies assessing the association between depressive signs or Major Depressive Disorder (MDD) and AN. Another manual computerised search (Medline) listed clinical trials assessing antidepressant in AN. ResultsOn the one hand, depressive symptoms are common during the course of AN and could have different meaning. Indeed, firstly, we can distinguish symptoms that are inherent to AN and which can be mistaken for depressive signs (for instance: low self-esteem, reduced social contacts). Secondly, long-term undernourishment can be held responsible for numerous psychological distortions, including anxiety and depression symptoms such as insomnia, impaired concentration, or social isolation. Thirdly, the natural course of AN can also lead to “depressive moments”, in particular when switching to a “purging type” AN, or when recovery mobilizes control and narcissistic issues. On the other hand, MDD is also highly prevalent among AN patients and is a negative prognosis factor. Thus, it is complex to differentiate MDD from isolated depressive symptoms that could be inherent of the AN symptomatology which raises the question of the role of antidepressant medication in treatment of depression in AN. No significant benefit of antidepressant medication in AN has been shown in clinical trials, and according to international guidelines it should be prescribed only as a second-line treatment, after appropriate refeeding, and in case of an authentic depressive disorder. Those data appear to be in contradiction with the frequent use of those drugs in clinical practice. DiscussionNevertheless, clinical trials assessing antidepressant treatment in AN suffer from methodological weakness concerning the size of the sample, the choice of the population or the evaluation criterion. This lack of proof must raise our vigilance concerning antidepressant medication in AN but should not categorically prevent the clinician from using it when necessary. We do believe that there are some indications for prescribing antidepressant in patients with AN. The clinical challenge lies in the differentiation of the depressive symptoms that are transitory and likely to improve without medication from those that signal the presence of an MDD. Three criterion could be indicative of MDD: familial history of mood disorder, as it is a major risk factor for MDD among relatives; the chronology of appearance of both disorders, when MDD pre-exists AN; a few specific symptoms cannot be attributed to undernourishment or reactive depressive signs, such as morning insomnia, daily variation of depressive symptoms, suicidal attempts or ideation and guilt ideation. Thus, in integrating the data from the literature review, we propose a pragmatic therapeutic strategy for the use of an antidepressant in AN during adolescence that lies in 3 main categories for depressive manifestations in AN: therapeutic emergencies: when an obvious and severe MDD is comorbid to AN, immediate antidepressant would be required; isolated and non-specific depressive sign: no medication would be relevant as they are supposed to improve with refeeding and psychotherapeutic support; intermediary patterns which is probably the most frequent situation. In the last case, it would be relevant to abstain from prescribing medication in first line, but an antidepressant medication should be quickly considered in the presence of one (or several) criterion listed above and its persistence despite refeeding. The general medical state of this fragile population of patients should be evaluated (standard blood test, ECG) before and during treatment.

The Skin-Ego: Dyadic Sensuality, Trauma in Infancy, and Adult Narcissistic Issues

The skin-ego is a metaphor created by the French psychoanalyst Didier Anzieu to describe the process by which the infant's emerging ego develops a container for psychic contents and achieves a secure feeling of well-being. The ego encloses the psychic apparatus as the skin encloses the body. The ego becomes able to fix barriers protecting the internal world and to screen exchanges with the id, the superego, and the outside world. The skin-ego is an envelope that contains thoughts and gives to thinking activity some limits, continuity, and a protection against the instincts. The functions of the skin-ego are to maintain thoughts, to contain ideas and affects, to provide a protective shield, to register traces of primary communication with the outside world, to manage inter-sensorial correspondences, to individuate, to support sexual excitation, and to recharge the libido. The skin-ego is the foundation of the container-contained relationship. An important part of psychoanalytic work with borderline patients is the reconstruction of the earliest phases of the skin-ego and their consequences for mental organization.

Political Narcissism and Democratic Deliberation

Deliberative theorists maintain that genuine dialogue is premised on the mutual respect of participants. Yet a great deal of what passes for civic discourse, even in mature democracies, takes place among political actors who avowedly do not respect one another – so much so that their identities are often constituted in opposition to each other. This paper contends that the construction of such identities is a symptom of political narcissism, and presents a serious obstacle to deliberative aspirations. In an effort to address the problem of political narcissism, it turns to psychoanalysis and particularly to the so-called ‘self psychology’ of Heinz Kohut, who brought narcissistic personality disorders into the mainstream of psychoanalytic theory. Analogizing political narcissism to narcissistic disturbances at the level of the individual psyche, the paper argues that marginalized political groups do not receive adequate ‘mirroring’ from their counterparts in a welcoming democratic process; as a result, their identities often harden and take on a grandiose character. Following Kohut’s approach to the treatment of narcissistic issues, the paper endorses a mode of empathy and interpretation in order to soften the oppositional character of some identities, stabilize their self-understanding, and foster the mutual respect necessary to deliberation. Against Iris Marion Young and others who regard empathy as a dangerous or futile enterprise, it argues that empathy is precisely what is needed to lift once-marginalized groups out of a preoccupation with group identity and enable them to feel (and to be) welcomed into the broader discourse.

Au-delà de la névrose traumatique… Vers une théorie unifiée du trauma ?

As Freud proposed in 1938, could traumatic neurosis constitute an “exception”, because it evicts the sexual and infantile question? ObjectiveThis would essentially mean ceasing to contrast the initial conceptions of the theory of seduction, which made it possible for psychoanalysis to establish itself in its field and in its relationship with the unconscious, with subsequent theories addressing life and death instincts, bringing to the fore not only sexual issues but narcissistic issues as well. MethodBy analyzing Mathilde's story, the purpose of this article is to start from scratch, on the basis of the premise that traumatic neurosis should be regarded as “traumatised neurosis”. ResultThis “traumatized neurosis” could be defined as psychoneurosis struck with terror, whereby a traumatic encounter freezes or annihilates the subject's unresolved sexual issues. DiscussionCould this case study of Mathilde challenge theories centered on fright? Alternatively, could it be sufficient to analyze the traumatic aspects of neurosis to shed light on the issue, and thus remove the symptoms of PTSD? The exploration and the experiencing of these narcissistic challenges are necessary to revive libidinal energy and the life instinct, and could constitute a first step in the reinstatement of infantile neurosis. ConclusionWe therefore propose to contrast the theories on fright and the encounter with the “reality of death” with the theories that focus on traumatic seduction and infantile sexuality, in order to articulate them more efficiently to assist clinical psychoanalytical practice.

Narcissistic Pathology as Core Personality Dysfunction: Comparing the DSM‐IV and the DSM‐5 Proposal for Narcissistic Personality Disorder

Narcissistic personality disorder and related concepts have a complex history and have been subject to extensive theoretical discourse but relatively little empirical research. An initial proposal for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) that suggested eliminating this disorder as a discrete personality disorder type met with considerable controversy that ultimately led to its reinstatement in subsequent proposals. Nonetheless, the DSM-5 proposal for personality disorders as a whole would involve a significantly different formulation of narcissistic personality from that described in DSM-IV-one that places a greater emphasis on shared deficits among all personality disorders that tap elements thought to fall on the narcissistic spectrum, such as deficits in empathic capacity. This article describes this revised formulation, and presents a case study that illustrates the similarities and differences in the DSM-IV and proposed DSM-5 portrayal of narcissistic issues and related clinical problems over the course of a particular treatment.

Overcoming our own pride in the treatment of narcissistic patients

The philosopher Seneca once said that we spend our whole lives preparing to die. Far from a morbid statement, I see this as expressing the truth that all human beings spend their whole lives overcoming their narcissism. We have to make a significant enough investment in the lives of others, and in ongoing life, so that the loss of our own, personal lives is bearable to us. How can we help our patients overcome their excessive narcissism? The analyst must be a person who has, to some degree, overcome some part of his or her own narcissistic issues. This means that he or she values human life more than pride. Our ability to make the meaning of the patient's life a priority is a key part of the treatment. In how he or she behaves, the analyst must embody the principle that the quality of a life is more important than the appearance of success or failure.

A Clinical Application of the Training Model

This article offers a perspective and a summary of Jack Danielian's (2010) Horneyan training model, highlighting the benefits of a meta-psychological approach for analysts in training and seasoned practitioners alike. To help illustrate the complexity of Karen Horney's views of character structure and character pathology, this article presents a model that reflects the dynamic tensions at play within individuals with narcissistic issues. It suggests that therapeutic listening can be tracked and that thematic material unfolds in a somewhat predictable, sequential, yet altogether systemic manner. Listening is not just art or intuition, nor is it merely interpretation of content based on a theoretical framework. It represents a way of holding the dialectic tension between conscious and unconscious, syntonic and dystonic. If we can better track these dynamic tensions, we can better anticipate and hopefully avoid clinical ruptures through the acting out of negative transference.

Beyond “Dry Drunkenness”: Facilitating Second Stage Recovery Using Wilber's “Spectrum of Consciousness” Developmental Model

ABSTRACT The usefulness of Wilber's “Spectrum of Consciousness” developmental model in the treatment of substance abuse is demonstrated by a case study that illustrates how underlying emotional pain and intimacy issues can be worked through in the counselling process with a client during the second stage of recovery from addiction. Wilber's model allows for narcissistic, critical self, social, identity, intimacy, existential, and psycho-spiritual issues to be integrated into the counselling process for long-term recovery. This model provides social workers and addictions counselors with a useful map in embracing client recovery.

Élaboration des problématiques narcissiques par le psychodrame individuel en groupe d'adolescents

The authors depict the functioning of a psychoanalytic psychodrama regrouping young adolescents with narcissistic vulnerabilities. Sessions show a strong appeal to primitive fantasies embodied in totemic characters and an universal heritage background. This rich figuration of anxious affects leads to the building up of a mythic theory of origins, which encompasses the history of the group and the participants' roots. As a protective shield for the group, the leader secures the session progression and the therapeutic frame. Such psychodrama techniques allow for the working through of narcissistic issues while avoiding direct confrontation to the youths' narcissistic injuries.

What is the prevalence of narcissistic injury among trainee counselling psychologists?

The purpose of this study was to ascertain the level of narcissistic injury among trainee counselling psychologists using the Narcissistic Injury Scale (Slyter, 1991). This 38-item Likert scale is based on Miller's (1981) definition of narcissistic injury; a specific type of psychological damage which focuses on feelings about the self and past relationships related to self-development. Theorists suggest that if untreated, narcissistic issues can interfere with client work and lead to a number of problems for trainees, influencing drop-out rates and increasing burnout. The results of the study indicate that a high degree of narcissistic injury may be prevalent among trainee counselling psychologists and furthermore, that narcissistic injury does seem to be related to the quality of the perceived parent-child relationship. Consequently, the study suggests that therapeutic work could be affected in those trainees who fail to address their own narcissism. The study provides some tentative support for the utility of the Narcissistic Injury Scale.

Boyhood gender nonconformity: Reported parental behavior and the development of narcissistic issues

Boyhood gender nonconformity: Reported parental behavior and the development of narcissistic issues

The Nature and Function of a Pathological Oedipal Constellation in a Female Patient

The first analysis of a female patient dealt essentially with separation-individuation and narcissistic issues. During the second analysis a dynamic constellation of narcissistic character pathology, some psychopathic tendencies, perverse fantasies, and enactments emerged. Prominent was an unconscious fantasy of stealing the sexual organs of one parent to sexually satisfy the other parent. The etiology of this constellation and its transmutations in analysis are described.

Narcissistic characters with obsessive features: diagnostic and treatment considerations.

In sum, in this article a mixed personality disorder is described that combines narcissistic and obsessive-compulsive features. These features include extreme perfectionism, narcissistic cathexis of the intellect, and obsessive-compulsive defenses against underlying narcissistic issues. In therapy, narcissistic characters with obsessive features frequently struggle between a need for engagement with and fear of engulfment by the therapist. Thus, while they may appear extroverted, they often remain aloof, and while they have a strong need to be understood, they frequently reject the therapist’s empathic statements. Therapy of the narcissistic character with obsessive features consists of two stages. In the first phase of treatment, the therapist addresses the patient’s narcissistic issues and provides an appropriate selfobject relationship. In the second phase of treatment (after greater self-development is established), the therapist begins to address the obsessive-compulsive issues of affective expression and control by assuming a more engaged, initiating, and personal stance with the client.

Narcissistic issues in therapists: Diagnostic and treatment considerations.

Narcissistic issues in therapists: Diagnostic and treatment considerations.