Psychopathology: Theory and Practice

16 January 2020 – Phil Mollon

Freud provided many interesting observations and perspectives in his classic 1914 paper On Narcissism. These were developed further in Kohut’s 1966 paper Forms and Transformations of Narcissism, in which he proposed a separate line of development of narcissism, from primitive to mature. The concept of narcissistic personality disorder did not emerge until the writings of Kernberg and Kohut in the 1970s. These authors presented contrasting, and seemingly incompatible views, a confusion compounded by their use of the same term (grandiose self) to mean quite different things – for Kohut a natural feature of childhood, for Kernberg a pathological structure consisting of a fusion of images of actual self, ideal self, and ideal other.

These contrasting visions of narcissism were later mirrored in Rosenfeld’s concepts of “thin-skinned” and “thick-skinned” narcissists. Rosenfeld observed that treating the “thin-skinned” narcissist as if they were “thick-skinned” could be very damaging. During the 1980s and 1990s, cognitive therapists, and schema therapists, began to develop concepts of narcissistic personality disorder, and the term became increasingly widely used – sometimes pejoratively and simplistically. This teaching will outline some of the core narcissistic dilemmas we all must navigate during childhood – and how these can become particularly pronounced in certain conditions, including ADHD. The realm of narcissism also interfaces with problems of human identity – and the ubiquitous tendency to become falsely identified with culturally and familiarly presented images.