In the analysis of an individual there are three primary methods employed in order to successfully assess and repair his condition- biological, cognitive, and psychoanalytic theory. In the case of narcissism, only the psychoanalytic approach will suffice to structurally repair rather than suppress manifest symptoms of the unfulfilled self. Narcissists must learn to address the needs of their childhood that have not have been satisfied and acknowledge them as the root of their grandiose actions, a facade for their inner sense of shame and insecurity (Kohut, 1978, p. 423). In the case of Mr. Z, he underwent two analyses with a five-year grace period in between, the first analysis unsuccessful in structurally curing his masochistic propensities as they merely shifted to another facet of his life (Kohut, 1979, p.10). This lack of structural change went unnoticed during the first analysis, and was only revealed through examination of the patient’s root of disturbance during the second analysis. The agent that assisted the discovery was the change in approach by the analyst within the realm of psychoanalysis, that is the shift from a focus in analysis based upon classical-dynamic structural terms to that of the psychology of the self in the narrow sense. (Kohut, 1979, p. 26).
Through observation of symptoms and examination of life occurrences, it is clear that Mr. Z exhibits the characteristics of narcissism. He has a mother that relied upon him as her self-object throughout his childhood and into his early adult years. This provided conflict in that Mr. Z needed his mother as his own self-object, and due to her selfish role-reversal, he did not receive the mirroring necessary to develop a healthy, strong self-structure. Self-objects mirror an individual, confirming one’s inner sense of greatness and perfection, provide a figure for idealization, and relate a twinship for one to identify interests and talents with, also known as an alterego (Kohut, 1978, p. 414). Mr. Z’s mother played all of these roles in his life because his father left when Mr. Z was young. One found him absent of a man with whom he could idealize and identify; hence he was incapable of asserting his masculinity. Mr. Z’s mother was of a pathological state and intermeshed her disturbance within the relationship with her son (Kohut, 1979, p. 13). Faulty interaction between the child and his self-objects result in a damaged self. (Kohut, 1978, p. 414) This abused child developed a perspective that conformed to that of his unstable self-object, rather than creating an independent center of initiative. This led to number of narcissistic preoccupations including a focus upon his productions, masochistic fantasies, defensiveness and denial, and an arrogance of demandingness (Kohut, 1979, p. 14).
The ultimate comprehension of the disturbances of Mr. Z can be attributed to the analyst’s realization of the true foundations of the patient’s symptoms. Once this realization occurred, his perspective changed in that he was able to perceive the significance of unmet essential needs as the reason for disturbances. In addition, he acknowledged that Mr. Z’s self-structure could only be repaired through time and by a more patient and understanding demeanor on behalf of the analyst (Kohut, 1979, p.12). In the first analysis, the analyst merely tolerated Mr. Z’s defensive behavior and progressively sought to oppose it, however in the second he perceived it as a transference of childhood feelings that resurfaced in therapy (Kohut, 1979, p. 12). Mr. Z had unintentionally witnessed sex between his parents at an early age and associated it with aggressiveness as his memories sequenced it following verbal battles between them. Defenses accompanying this obviously disturbing encounter include acts of grandiosity and overconfidence due to a supposed illusionistic oedipal victory (Kohut, 1979, p 26). Mr. Z was convinced that he had won because the father left; his success had achieved the power of sole possessor of his mother. However, the removal of his father soon led to Mr. Z’s mother engaging in extramarital affairs. Due to the nature of the boy’s position as her sole male possessor, these other men introduced a threat to his security; therefore, the therapist saw the patient’s defensiveness as a mechanism that shielded him against these rivals. Where the analyst went too far, discovered in the second analysis, was his assertion that the mechanism was being used against sexual rivals again in the oedipal sense, and additionally against fear of castration brought upon by awareness of his own competitive feelings towards the rivals, including his father (Kohut, 1979, p. 6). The castration anxiety, however, was no longer an oedipal victory but a defeat, for Mr. Z did not remain his mother’s sole possessor; hence his anxiety was accompanied by depression.
Similarly, the analyst attributed Mr. Z’s recurring masturbation along with masochistic fantasies to an early warped sense of the nature of lovemaking (Kohut, 1979, p. 6). His in-depth explanation linked Mr. Z’s dominatrix thoughts concerning women to his perception of a strong mother and a weak father. The castration anxiety accompanied by depression resurfaced in an additional oedipal defeat only now with the strong mother. She provided protection against the father as a castrator because she was more powerful than he was, but this then served as the basis for his masochism in his unconscious denial of the existence of people without penises (Kohut, 1979, p.7).
In the second analysis, it was revealed that these masochistic fantasies actually initiated due to the domination factor at the root of Mr. Z’s relationship with his mother. He possessed a defensive idealization of his strong mother as opposed to an oedipal conflict with her (Kohut, 1979, p. 26). His mother mirrored him in an unhealthy way by confirming Mr. Z’s superiority over his father provided he remained an appendage of her- this led to his grandiose attitude as well. He regarded his mother as infallible and felt inflated by identification with her (McWilliams, 1994, p. 174).
In addition, the emotional support that she provided him was purely conditional. The mother’s emotional gifts were bestowed on him under the unalterable and uncompromising condition that he submit to total domination by her. (Kohut, 1979, p.13) He could neither assert his independence nor engage in meaningful outside relationships for fear of losing her recognition and love.
She was not interested in him. Only his feces and her inspection of them, only his bowel functions and her control over them fascinated her- with an intensity, a self-righteous certainty, and adamant commitment that allowed no protest and created almost total submission (Kohut, 1979, p. 15).
Mr. Z had not elaborated on specific experiences with his mother and described her precisely as the image that she portrayed to others (Kohut, 1979, p. 13). The absence of this pertinent information surely explained the analyst’s lack of emphasis upon her personality disorder; however, the second analysis revealed the alarming details of their relationship. Suddenly the pervasive existence of the dominating mother became apparent as a detrimental factor central to the cause of Mr. Z’s disturbance. Now the analyst found it imperative to focus upon the depression and hopelessness that the mother’s attitude evoked in him. This was a key element in his recovery for the therapy in the second analysis addressed the deep-seeded essence of his symptoms.
Mr. Z had no center of initiative. His masturbation was neither a symptom of his pre-oedipal phase nor a result of drive motivation in a search for primal pleasure, but instead served as his only means of asserting his existence. In addition, it was unempathically overstimulating experience as a demand to be absorbed by the activities of the mother- submission via masochistically sexualized relinquishment of independence (Kohut, 1979, p. 16/17).
His lack of a father figure led to a homosexual relationship in which Mr. Z experienced an enriching friendship with a strong and admired man. This person provided the twinship he so desperately craved for, someone who reflected and confirmed his self and who possessed shared interests with him. He also served as a healthy figure for Mr. Z to idealize. He looked up to the man as someone he could emulate. The personality intermeshment he experienced with his mother in place of this man after the relationship terminated was not in his best interests. Ultimately, it proved to be a delusion, causing Mr. Z to relapse due to the lack of a stable and strong self-object (Kohut, 1979, p. 20). This perception surfaced in the second analysis, whereas in the first the analyst thought the homosexual relationship symbolized regression to the strong phallic mother (Kohut, 1979, p. 19).
Transference naturally followed in the patient’s effort to recover self-objects. Unfortunately, they went unnoticed during the first analysis due to the classical methods employed by the analyst. He saw material in terms of infantile drives and conflicts about them rather than the absence of self-objects, primarily a father figure. Idealization followed by twinship attempts arose as a result of a boy absent of an alterego self-object-namely his father. Once he began to solve the mystery of this man, through interaction with him and observation of him, he was able to see a strong individual. His father was independent and capable of existence without the mother (Kohut, 1979, p. 21). This realization ultimately enabled Mr. Z to begin to stand on his own and develop a strong sense of self.
Psychologists tend to focus on one area of psychological diagnosis, such as psychoanalysis, and throughout the development of the patient-analyst relationship, one becomes able to find the root of existing problems. Whether a child or adult is in a state of security, anxiety, or distress is determined in large part by the accessibility and responsiveness of his principal attachment figure. (Bowlby, 1973, p. 43) Initially the analyst possessed an insensitive notion that the patient merely needed to grow-up and relinquish his narcissistic demands being that he possessed an independent center of initiative (Kohut, 1979, p. 12). Once it was acknowledged that Mr. Z was without this important facet of self-structure, the analyst was able to work through issues in order to abet the repair of Mr. Z’s narcissistic self. The employment of the psychology of the self in the second analysis led to a focus upon the importance of the self and to relations with others in the environment (Luti, personal communication). All in all, this allowed Mr. Z to discover the reason for his disturbance and learn to lead a happy and healthy life.
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Kohut, H. (1978). The Disorders of the Self and Their Treatment. International Journal
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McWilliams, Nancy. (1994). Psychoanalytic Diagnosis. New York, Guilford Press,