The Restoration of the Self by Heinz Kohut | eBook

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The Restoration of the Self

By Heinz Kohut

The University of Chicago Press

CHAPTER 1

The Termination of the Analysis of Narcissistic Personality Disorders

The question whether at the point of terminating an analysis the analytic task has been completed, or termination has been premature, confronts the analyst in a variety of circumstances. There are, in addition, a number of specific problems surrounding the termination of the analysis of narcissistic personality disorders. The complexity of the subject matter of termination is increased by the fact that the views an analyst holds concerning many areas of theory and practice will influence his judgments concerning the questions how he should define an ideally completed analysis and how close to the ideal he should expect to come in reality. The topic of termination is therefore a vast one. In the present study, I shall disregard many aspects of the problem and restrict myself to an attempt to illuminate certain theoretical issues. I am undertaking this task because I believe that a change of our traditional theoretical stance will enable us to recognize the genuineness of certain terminations, will enable us to recognize that further analysis was not indicated, that the patient had not taken a flight into health—whereas an assessment of the patient's personality carried out on the basis of the traditional theories might lead us to the opposite view.

The pivotal problem concerns the area of the nucleus of the psychopathology. Insofar as the structural neuroses are concerned, we have learned to formulate our expectations in terms of the completion of the task of analyzing the patient's Oedipus complex, that is, we expect that the patient should have recognized his persisting hopeless (and disturbing) sexual love and his persisting hopeless (and disturbing) rivalrous hate for the great imagoes of his childhood and that, on the strength of this recognition, he should have become able to free himself from the emotional entanglements of his childhood and to turn in affection or in anger to the objects of present-day reality. We know, of course, to use Freud's metaphor (1917b, p. 456), that the decisive battles of the analysis of oedipal psychopathology are not necessarily fought out in the very center of the Oedipus complex itself; but whatever the content and psychic location of the tactical engagements might have been, in the end it is the relative freedom from the object-instinctual involvements of the oedipal period that constitutes the measure of the success or failure of the analysis.

When we turn to the narcissistic personality disorders, however, we are no longer dealing with the pathological results of unsatisfactory solutions of conflicts between structures that are in essence intact, but with forms of psychological malfunctioning arising in consequence of the fact that the central structures of the personality—the structures of the self—are defective. And so, in the narcissistic personality disorders, our description of the process and goals of psychoanalysis and of the conditions that characterize a genuine termination (under what circumstances we can say that the analytic task has been completed) must therefore be based on a definition of the nature and location of the essential psychological defects and on a definition of their cure.

The nuclear psychopathology of the narcissistic personality disorders (corresponding to the repressed unresolved conflicts of the Oedipus complex of the structural neuroses) consists of (1) defects, acquired in childhood, in the psychological structure of the self and (2) secondary structure-formations, also built up in early childhood, which are related to the primary defect in one of two similar, but, in certain crucial respects, different ways. I shall call these two types of secondary structures—distinguishing them on the basis of their relation to the primary structural defect of the self—defensive and compensatory structures.

Although a definition of defensive and compensatory structures that transcends being merely descriptive and metaphorical cannot be fully understood until the reader has become familiar with the concept of the bipolar nature of the self and with the child's twofold chance to build up a functioning self—topics discussed extensively later on—I shall nevertheless provide one at this point. I call a structure defensive when its sole or predominant function is the covering over of the primary defect in the self. I call a structure compensatory when, rather than merely covering a defect in the self, it compensates for this defect. Undergoing a development of its own, it brings about a functional rehabilitation of the self by making up for the weakness in one pole of the self through the strengthening of the other pole. Most frequently a weakness in the area of exhibitionism and ambitions is compensated for by the self-esteem provided by the pursuit of ideals; but the reverse may also occur.

The terms defensive structure and compensatory structure refer to the beginning and end of a spectrum which has a broad central area that contains a great variety of intermediate forms. But more or less pure forms are encountered, and the transitional ones can usually be assigned to one or the other of the two classes.

Basing myself on this differentiation, I postulate that the phase of termination of the analysis of a narcissistic personality disorder has been reached when we have completed one or the other of two specific tasks: (1) When, after the analytic penetration of the defensive structures, the primary defect in the self has been exposed and, via working through and transmuting internalization, sufficiently filled out so that the formerly defective structures of the self have now become functionally reliable. (2) We have also reached the termination phase in the analysis of a narcissistic personality disorder when—after the patient has achieved cognitive and affective mastery with regard to the defenses surrounding the primary defect in the self, with regard to the compensatory structures, and with regard to the relationship between these—the compensatory structures have now become functionally reliable, independent of the area in which this success was achieved. This functional rehabilitation might have been achieved predominantly through improvements in the area of the primary defect, or through the analysis of the vicissitudes of the compensatory structures (including the healing of their structural deficiencies through transmuting internalizations), or through the patient's increased mastery resulting from his comprehension of the interrelation of primary defect and compensatory structures, or through success in some or all of these areas.

It is hardly necessary to give an illustration of the term defensive structure because it refers to a concept not only well known to every analyst but indeed indispensable to him when he orders his clinical impressions in accordance with the dynamic point of view. Every analyst knows those patients, who, for example, often to the embarrassment of those around them, tend to be overly enthusiastic, dramatic, and excessively intense in their responses to everyday events and who, analogously, romanticize and sexualize their relation to the analyst, giving at times the impression of an overtly reinstated display of oedipal passions (cf. Kohut, 1972, pp. 369–372). In cases of narcissistic personality disorder, it is not difficult to discern the defensive nature—a pseudovitality—of the overt excitement. Behind it lie low self-esteem and depression—a deep sense of uncared-for worthlessness and rejection, an incessant hunger for response, a yearning for reassurance. All in all, the excited hypervitality of the patient must be understood as an attempt to counteract through self-stimulation a feeling of inner deadness and depression. As children, these patients had felt emotionally unresponded to and had tried to overcome their loneliness and depression through erotic and grandiose fantasies. The grown-up behavior and grown-up fantasy life of these patients is usually not the exact replica of the original childhood defense because, during an excited, overly enthusiastic, hyperidealistic adolescence devoid of meaningful interpersonal attachments, the childhood fantasies often become transformed by an intense devotion to romanticized cultural—esthetic, religious, political, etc.—aims. The romantic ideals, however, do not recede into the background when the individual reaches adulthood as would be the normal, expectable course; no comfortable integration with the goals of the adult personality takes place: the dramatic, intensely, exhibitionistic aspects of the personality do not become securely alloyed with mature productivity; and the erotized, excitedly pursued activities of adult life continue to be but one step removed from the underlying depression.

Having briefly illustrated the familiar and simple area of the role played by the defensive structures in the narcissistic personality disorders, I shall now present clinical material to illuminate the less familiar and also more complex role played by the compensatory psychic structures in these disturbances.

The Terminal Phase of the Analysis of Mr. M.

Mr. M., who worked as a writer in what he described as a dependable but limiting job, sought analysis when he was in his early thirties, when his wife of six years left him. Ostensibly he wanted to undertake analysis in order to find out how he might have contributed to the failure of his marriage. But there was no doubt about the fact that his motivation for therapy was not primarily a wish for intellectual knowledge: he sought help because he suffered from a serious disturbance of his self-esteem and a deep sense of inner emptiness, a manifestation of his primary structural defect—chronic enfeeblement of his self with some tendency toward the temporary fragmentation of this structure. His apathy and lack of initiative made him feel only "half alive," and he attempted to overcome this sense of inner emptiness with the aid of emotionally highly charged fantasies, in particular, sexual fantasies having a strong sadistic cast. These fantasies of sadistic control over women (of tying them up) he also occasionally acted out. He had done this with his wife, who considered his behavior "sick." (In theoretical terms, these fantasies and enactments were attempts to cover a primary defect with the aid of defensive structures.) Of crucial significance in his personality organization, and of pivotal importance in the process of his analysis, were vaguely expressed complaints about a writing block. His work as a writer, which should have made a substantial contribution to the enhancement of his self-esteem, was hampered by a nexus of interrelated disturbances. I shall focus on two of them here. The first one was indeed a manifestation of Mr. M.'s primary structural defect; it was genetically related to the failure of his mother's self-object function as a mirror for the child's healthy exhibitionism. The second one was a manifestation of a defect in the patient's compensatory structures; it was genetically related to the failure of the father's self-object function as an idealized image.

The genetic matrix of the primary defect—stunted development of the grandiose-exhibitionistic aspects of the self—was insufficient mirroring from the side of the mother. If the mother of patients with such a disturbance is still living, it is often possible to ascertain her lack of empathy or her faulty empathic responses first-hand during the analysis, since the patient, having become alerted, through the dynamics of the interplay of reactions in a mirror transference, to the fact that his self is vulnerable to faulty or disrupted empathy, and having begun to reconstruct the genetically decisive circumstances of his early life, will not only remember pathogenic moments from his childhood, but will also observe his mother's flawed empathy vis-à-vis himself or others, especially vis-à-vis children—her grandchildren, for example. In Mr. M.'s case, this direct source of information was not available because the patient's mother had died when he was twelve. Certain transference phenomena, however, as well as childhood memories, indicated that he had experienced his mother's responsiveness to him as insufficient and faulty. He recalled how, on many occasions during his childhood, he tried to look at her suddenly so that she could not have time to cover over by a falsely friendly and interested facial expression the fact that she really felt indifferent about him. And he remembered a specific occasion when he had injured himself and some of his blood had stained his brother's clothes. His mother thereupon, without discerning that it was he and not the brother who was frightened and in pain, had rushed the brother to the hospital and left him behind.

With regard to the first memory a general question of great complexity awaits answering with certainty—namely, why the child repeatedly and actively tried to bring about the very recognition he dreaded (somewhat similar, perhaps, to our repeatedly touching a sore tooth in order to test whether it still hurts—only to find out that of course it does). The psychological flavor of these memories (an anxious yet hopeful eagerness of the child's emotional state) seems to rule out the explanation that he wished to expose himself to his mother's rejection of him in order to gratify a masochistic desire. Nor do I believe that he looked at his mother's face—transforming passive into active—primarily in order to retain some control over a potentially traumatic situation (by actively ascertaining the mother's indifference he prevents the traumatic effect of being passively and unexpectedly overwhelmed by her indifference at a time when he is at a peak of vulnerability, e.g., when he is expecting positive mirroring from her). The most significant conclusion one should probably draw from his behavior is that it indicates he had not given up all hope for the mother's intuneness with him—a conclusion in harmony with the diagnostic category of the patient's psychopathology (that of narcissistic personality disturbance, not of a borderline organization). The mother's empathy, one might assume, was not lacking altogether—it was faulty rather than flat; when he injured himself, she had, after all, responded—and it did occasionally confirm the child's sense of his worthwhileness, and thus of the reality of his self.

One result of the mother's incapacity to tune in on the child and to respond with adequate empathic resonance was a specific maldevelopment in the exhibitionistic sector of his personality: he did not build up sufficient sublimatory structures in the sector of his exhibitionism because, due to the insufficiency of the mother's primary mirroring responses, no adequate basis had been set up from which her structure-building, increasingly selective secondary responses (her optimally increasing frustration of his needs) could proceed; he therefore remained fixated on archaic forms of exhibitionism; and inasmuch as archaic exhibitionism cannot find appropriate gratifications in adult life, he developed brittle defensive structures of the all-or-nothing type—he either suppressed his exhibitionism to the detriment of healthy forms of self-esteem and pleasure in himself and his performance, or his exhibitionism broke through in frantic activity and wild sexualized fantasies (occasionally carried over into actual behavior) in which the mirroring self-object (always a woman) was under his absolute, sadistically enforced control, a slave who had to comply with his every wish and whim.

With regard to his work as a writer—and it must again be stressed that his work should have made the greatest contribution to the enhancement of his adult self-esteem and should have provided the most important outlet for transformed grandiose-exhibitionistic narcissistic tensions through creativity—the structural defect caused by the failure of the maternal mirroring functions led to experiences of frightening and paralyzing overstimulation. He did not possess sufficient structures to curb and neutralize the grandiosity and exhibitionism that became activated when his imagination was mobilized. He therefore often became tense and excited when he was writing and then either had to suppress his imagination—to the detriment of the originality and vitality of the product—or cease working altogether.

The obstacles standing in the way of his creative work can not, however, be explained primarily by a scrutiny of his relation to the mirroring maternal self-object and of the resulting primary structural defect in his psychic equipment, because the abilities he employed in his professional activities were in the main not based on primary structures, i.e., on congenital capacities nurtured in the matrix of his relation to the mirroring self-object, but on compensatory structures, i.e., on talents acquired or at least decisively reinforced later in his childhood in the matrix of the relation to the idealized self-object, the father.

(Continues...)

Excerpted from The Restoration of the Self by Heinz Kohut. Copyright © 1977 Thomas A. Kohut. Excerpted by permission of The University of Chicago Press.
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