The Development Psychology of Psychopathology - Sam Vaknin (great novels of all time .txt) 📗

The (forward) movement toward maturation was toward object love. The movement from object love toward narcissism is a (backward) regressive movement toward a fixation point. To my mind (this) viewpoint is a theory built into a non-scientific value judgement … that has nothing to do with developmental psychology.”

(H. Kohut. The Chicago Institute Lectures 1972-1976. Marian and Paul Tolpin (Eds.). Analytic Press, 1998)

Kohut’s contention is nothing less than revolutionary. He says that narcissism (subject-love) and object-love coexist and interact throughout life. True, they wear different guises with age and maturation - but they always cohabitate.

Kohut: “It is not that the self-experiences are given up and replaced by … a more mature or developmentally more advanced experience of objects.” [Ibid.]

This dichotomy inevitably led to a dichotomy of disorders. Kohut agreed with Freud that neuroses are conglomerates of defence mechanisms, formations, symptoms, and unconscious conflicts. He even did not object to identifying unresolved Oedipal conflicts (ungratified unconscious wishes and their objects) as the root of neuroses. But he identified a whole new class of disorders: the self-disorders. These were the result of the perturbed development of narcissism.

It was not a cosmetic or superficial distinction. Self-disorders were the results of childhood traumas very much different to Freud’s Oedipal, castration and other conflicts and fears. These are the traumas of the child either not being “seen” (that is not being affirmed by objects, especially the Primary Objects, the parents) - or being regarded merely as an object for gratification or abuse. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they are worth anything (lack of self-worth, or self-esteem). They suffer depressions, as neurotics do. But the source of these depressions is existential (a gnawing sensation of emptiness) as opposed to the “guilty-conscious” depressions of neurotics.

Such depressions: “…are interrupted by rages because things are not going their way, because responses are not forthcoming in the way they expected and needed. Some of them may even search for conflict to relieve the pain and intense suffering of the poorly established self, the pain of the discontinuous, fragmenting, undercathected self of the child not seen or responded to as a unit of its own, not recognised as an independent self who wants to feel like somebody, who wants to go its own way [see Lecture 22]. They are individuals whose disorders can be understood and treated only by taking into consideration the formative experiences in childhood of the total body-mind-self and its self-object environment - for instance, the experiences of joy of the total self feeling confirmed, which leads to pride, self-esteem, zest, and initiative; or the experiences of shame, loss of vitality, deadness, and depression of the self who does not have the feeling of being included, welcomed, and enjoyed.”

(Paul and Marian Tolpin (Eds.). The Preface to the “Chicago Institute Lectures 1972-1976 of H. Kohut”, 1996)

One note: “constructs” or “structures” are permanent psychological patterns. This is not to say that they do not change - they are capable of slow change. Kohut and his self-psychology disciples believed that the only viable constructs are comprised of self self-object experiences and that these structures are lifelong ones. Melanie Klein believed more in archaic drives, splitting defences and archaic internal objects and part objects. Winnicott [and Balint and other, mainly British researchers] as well as other ego-psychologists thought that only infantile drive wishes and hallucinated oneness with archaic objects qualify as structures.

Karen Horney’s Contributions

Horney is one of the precursors of the “object relations” school of psychodynamics. She said that the personality was shaped mostly by one’s environment, society, or culture. She believed that the relationships with other humans in one’s childhood determine both the shape and functioning of one’s personality. She expanded the psychoanalytic repertoire. She added needs to drives. Where Freud believed in the exclusivity of the sex drive as an agent of transformation (later he added other drives) - Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on.

She believed that the satisfaction of these needs or their frustration early in childhood were as important a determinant as any drive. Society came in through the parental door. Biology converged with social injunctions to yield human values such as the nurturance of children.

Horney’s great contribution was the concept of anxiety. Freudian anxiety was a rather primitive mechanism, a reaction to imaginary threats arising from early childhood sexual conflicts. Horney argued convincingly that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance) - so they become anxious. Defences are developed to compensate for the intolerable and gradual realisation that adults are human: capricious, arbitrary, unpredictable, non-dependable. Defences provide both satisfaction and a sense of security. The problem still exists, but it is “one stage removed”. When the defences are attacked or perceived to be attacked (such as in therapy) - anxiety is reawakened.

Karen B. Wallant in “Creating Capacity for Attachment: Treating Addictions and the Alienated Self” [Jason Aronson, 1999] wrote:

“The capacity to be alone develops out of the baby’s ability to hold onto the internalisation of his mother, even during her absences. It is not just an image of mother that he retains but also her loving devotion to him. Thus, when alone, he can feel confident and secure as he continues to infuse himself with her love. The addict has had so few loving attachments in his life that when alone he is returned to his detached, alienated self. This feeling-state can be compared to a young child’s fear of monsters_without a powerful other to help him, the monsters continue to live somewhere within the child or his environment. It is not uncommon for patients to be found on either side of an attachment pendulum. It is invariably easier to handle patients for whom the transference erupts in the idealising attachment phase than those who view the therapist as a powerful and distrusted intruder.”

So, the child learns to sacrifice a part of his autonomy, of WHO he is, in order to feel secure. Horney identified three NEUROTIC strategies: submission, aggression and detachment. The choice of strategy determines the type of personality, or rather of the NEUROTIC personality. The submissive (or compliant) type is a fake. He hides aggression beneath a facade of friendliness. The aggressive type is fake as well: at heart he is submissive. The detached neurotic withdraws from people. This cannot be considered an adaptive strategy.

Horney’s is an optimistic outlook. Because she postulated that biology is only ONE of the forces shaping our adulthood - culture and society being the predominant ones - she believes in reversibility and in the power of insight to heal. She believes that if an adult were to understand his problem (his anxiety) - he would be able to eliminate it altogether. My outlook is much more pessimistic and deterministic. I think that childhood trauma and abuse are pretty much impossible to erase. Modern brain research tends to support this sad view - and to offer some hope. The brain seems to be more plastic than anyone thought. It is physically impressed with abuse and trauma. But no one knows when this “window of plasticity” shuts. It is conceivable that this plasticity continues well into adulthood and that later “reprogramming” (by loving, caring, compassionate and empathic experiences) can remould the brain permanently. I believe that the patient has to accept his disorder as a given and work AROUND it rather than confront it directly. I believe that our disorders ARE adaptive and help us to function. Their removal may not always be wise or necessary to attain a full and satisfactory life. I do not believe that we should all conform to a mould and experience life the same. Idiosyncrasies are a good thing, both on the individual level and on the level of the species.

C. The Issue of Separation and Individuation

It is by no means universally accepted that children go through a phase of separation from their parents and through the consequent individuation. Most psychodynamic theories [especially Klein, Mahler] are virtually constructed upon this foundation. The child is considered to be merged with his parents until it differentiates itself (through object-relations). But researchers like Daniel N. Stern dispute this hypothesis. Based on many studies it appears that, as always, what seems intuitively right is not necessarily right. In “The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology” [New York, Basic Books - 1985], Stern seems to, inadvertently, support Kohut by concluding that children possess selves and are separate from their caregivers from the very start. In effect, he says that the picture of the child, as depicted by psychodynamic theories, is influenced by the way adults see children and childhood in retrospect. Adult disorders (for instance, the pathological need to merge) are attributed to children and to childhood.

This view is in stark contrast to the belief that children accept any kind of parents (even abusive) because they depend on them for their self-definition. Attachment to and dependence on significant others is the result of the non-separateness of the child, go the classical psychodynamic/object-relations theories. The self is a construct (in a social context, some add), an assimilation of the oft-imitated and idealised parents plus the internalisation of the way others perceive the child in social interactions.

The self is, therefore, an internalised reflection, an imitation, a series of internalised idealisations. This sounds close to pathological narcissism. Perhaps it is really a matter of quantity rather than quality.

D. Childhood Traumas and the Development of the Narcissistic Personality

Traumas are inevitable. They are an inseparable part of life. But in early childhood - especially in infancy (ages 0 to 4 years) they acquire an ominous aura, an evil, irreversible meaning. No matter how innocuous the event and the surrounding circumstances, the child’s vivid imagination is likely to embed it in the framework of a highly idiosyncratic horror story.

Parents sometimes have to go away due to medical or economic conditions. They may be too preoccupied to stay attuned at all times to the child’s emotional needs. The family unit itself may be disintegrating with looming divorce or separation. The values of the parent may stand in radical contrast to those of society.

To adults, such traumas are very different to abuse. Verbal and psychological-emotional abuse or neglect are judged by us to be more serious “offences”. But this distinction is lost on the child. To him, all traumas are of equal standing, though their severity may differ together with the permanence of their emotional outcomes. Moreover, such abuse and neglect could well be the result of circumstances beyond the abusive or negligent parent’s control. A parent can be physically or mentally handicapped, for instance.

But the child cannot see this as a mitigating circumstance because he cannot appreciate it or even plainly understand the causal linkage.

Where even the child itself can tell the difference is with physical and sexual abuse. Here is a co-operative effort at concealment, strong emotions of shame and guilt, repressed to the point of producing anxiety and “neurosis”. Sometimes the child perceives even the injustice of the situation, though it rarely dares to express its views, lest it be abandoned by its abusers. This type of trauma which involves the child actively or passively is qualitatively different and is bound to yield long-term effects such as dissociation or severe personality disorders. These are violent, premeditated traumas, not traumas by default, and the reaction is bound to be violent and active. The child becomes a reflection of its dysfunctional family - it represses emotions, denies reality, resorts to violence and escapism, disintegrates.

One of the coping strategies is to withdraw inwards, to seek gratification from a secure, reliable and permanently-available source: from the self. The child, fearful of