‘Borderline’ and ‘Narcissistic’: The problem with terms

The influential American diagnostic manual, the DSM, provides diagnostic criteria for what it terms ‘narcissistic personality disorder’ and ‘borderline personality disorder’, yet the whole concept of regarding personality traits as ‘disorders‘ has met with fierce criticism in recent years, amongst both patients and analysts. Some regard the concept of psychological ‘disorders’ as reinforcing an unnecessary and inappropriate medical diagnostic model; some see it as being rooted in a limiting post-Enlightenment ideology of rigid classification and marginalisation of anyone not deemed to be suitably socially acquiescent (see Richard Bentall, 2004; Foucault, 1961); and many patients themselves regard the concept of ‘personality disorder’ as both stigmatising and reinforcing a stereotypical and reductive image of who they are: as Rachel Rowan Olive has recently remarked, “My personality is who I am. You cannot tell me my very self is disordered and then convince me you do not want to reduce me to a stereotype” (Olive, 2018).

For these reasons, there has been a move to drop the term ‘disorder’ in recent years and replace it with less stigmatising and rigid concepts, such as ‘distress’, or simply ‘personality traits’. As Mollon suggests, the term ‘disorders’ at best simply denotes the presence of certain enduring identity disturbances, fluctuating moods, and disruptions (Link to Talk).

The specific terms ‘borderline‘ and ‘narcissistic‘ are also far from ideal. The term ‘borderline’, for instance, originated in Adolf Stern’s well-meaning but confusing description of individuals who seemed to be on the ‘border’ between neurosis and psychosis, a view that is no longer maintained but whose name curiously survives. Patients when diagnosed as ‘borderline’ often feel they must therefore be living in some sort of hinterland, between insanity and sanity, or other states, or on the edge of categories. For those with an already fragile sense of identity this is clearly unhelpful.

There is an ongoing debate about re-naming the disorder both because of its clinical confusion and because it may inadvertently stigmatise those with it: one solution proposed has been to rename it as ’emotionally unstable personality disorder’, in order to distance itself from the ‘borderline’ connotations, but creating perhaps its own problems.

The term ‘narcissistic’ is also rather problematic and open to misunderstanding, due in part to the fact that the clinical description is in many ways very different from ‘popular’ ideas about narcissism, which usually simply denote ‘self-love’. This fails to convey the deep narcissistic wound that the ostensibly self-admiring and grandiose self seeks to cover and distract itself from.

Is narcissism a defensive (compensatory) strategy or a fundamental drive?

Perhaps one of the deepest theoretical divisions in analytic literature on narcissism has centred on whether clinical ‘narcissism’ can be considered as an innate/primary personality trait or one acquired as a defensive or protective response, for example to early childhood trauma or neglect. Freud believed that narcissism was a primary state, something we are all born with, and an inevitable feature of the self-involved world of the infant – ‘His Majesty, the Baby’, as he influentially categorised this form of internalised self-libido (Freud, 1914).

But others have seen narcissism not as something innate but as a defensive response to unbearable early neglect, humiliation, or distress. The self-love associated with narcissism, Neville Symington suggests, is “merely a compensation, not a developmental drive, as Freud and his followers believed” (Link to Talk). The important psychoanalytical concept of the ‘narcissistic wound’ would also seem to suggest that this is not an innate or primary state, but the result of something done to us, which we then mirror and internalise. As Lasch notes, “In its pathological form, narcissism originates as a defense against feelings of helpless dependency in early life, which it tries to counter with ‘blind optimism’ and grandiose illusions of personal self-sufficiency” (Lasch, 1973; see also Fordham, 1974).

In this sense, narcissism might more properly be understood not as an expression of self-love, but the very opposite. Behind the apparent grandiosity and absorption with self-image there is always an intense absence of love, a lack of power and efficacy, which the generation of a narcissistic, grandiose ‘self’ seeks to desperately compensate for, stepping in to try and prevent the identity from collapsing completely. “Because they are damaged and fearful,” note Abse and Riddell, individuals with narcissistic traits “feel that the only safe way to operate is to put themselves at the centre of their universe”. Such ‘narcissism’ is therefore felt as a “justified protest” at potential abuse by the other: if they didn’t behave ruthlessly, or grandiosely, they’d be done for by the other. Narcissism would then be understood as “a defensive mode of relating, designed to protect the self from threatened pain” – from the knowledge and experience of intense shame and vulnerability.

Whereas in popular culture, narcissistic personalities are often seen in terms of simple megalomania, perhaps a wider understanding of the defensive aspect of Narcissus would help us engage with the deeper and more troubled roots of the personality.

Is narcissism healthy?

Related to the discussion about whether narcissism is a primary ‘developmental drive’, as Freud and some of the earlier psychoanalysts speculated, or a pathological state arising as a defensive response to early attachment disturbance and disorganisation, is the question of whether there is such a thing as ‘healthy narcissism’. In his influential 1914 paper ‘On Narcissism’ Freud observed that “it seems very evident that another person’s narcissism has a great attraction for those who have renounced part of their own narcissism and are in search of object love.” These ideas were developed in the 1960s by Kohut, who claimed that a “normal narcissism” was the wellspring of human ambition, creativity, and empathy.

The attractiveness of narcissistic traits in certain cultures has also been a recurrent theme in many books on the subject, such as Lasch’s 1973 examination of the ‘narcissistic’ elements in modern consumer culture, and Elizabeth Lunbeck’s more recent analysis in ‘The Americanization of Narcissism’ (2014). Loving one’s self is often regarded as a healthy and attractive trait, and something actively encouraged in many contemporary cultures, especially perhaps in America and western Europe, as Lasch and Lunbeck suggest.

However, other analysts have regarded the notion of ‘healthy narcissism’ as something of an oxymoron, one that blurs popular misconceptions about ‘narcissism’ with a more problematic and precise clinical understanding. As we have seen, there is considerable research suggesting that narcissism is a compensatory response to an overwhelming sense of shame, rooted in the ‘narcissistic wound’: it is hard to think of a ‘healthy’ version of this. It is also perhaps significant that Freud associated primary or ‘normal’ narcissism with what he called “self-contentment and inaccessibility” in infants, perhaps suggesting a confusion between concepts of “self-contentment” or even simply “enjoyment” with that of grandiose self-isolation. A state of self-contentment and inaccessibility resembles in many ways the positive state that mindfulness practice and spiritual traditions seek to realise. As Mollon notes, Freud also perhaps perversely saw evidence of ‘narcissism’ not only in the happiness of children but also in animals, beautiful women (who “develop a certain self-contentment”) as well as in many “primitive peoples”, as he put it – comments that perhaps suggest the complex ways in which libido and eros is viewed with such intense suspicion and perhaps envy by the ‘reality principle’ in modern societies. “The charm of a child”, wrote Freud, “lies to a great extent in his narcissism, his self-contentment and inaccessibility, just as does the charm of certain animals which seem not to concern themselves about us, such as cats and the large beasts of prey. It is as if we envied them for maintaining a blissful state of mind-an unassailable libidinal position which we ourselves have since abandoned” (On Narcissism, 1914).

There is also the long-standing debate about whether the infant does go through a stage of Primary Narcissism, withdrawn from object relationship and in a state of hallucinatory wish fulfilment, or whether, as Klein held, the child is object related from the beginning. Margaret Mahler’s understanding of child development reflects Freud’s original conceptualisation, whilst later researchers, from Daniel Stern (in his classic book The Interpersonal World of the Infant), to Ed Tronick and Beebe and Lachmann have shown that the child does indeed engage with others from the beginning of life.

It is worth noting that Klein didn’t much use the concept of narcissism but, as Hanna Segal put is, the paranoid-schizoid position is the narcissistic position – see Hinshelwood’s A Dictionary of Kleinian Thought(1988) for a full discussion of this.

This also relates to the issue of whether the behaviour is understood to be largely self-generated or innate – viz. Freud’s primary narcissism or death instinct or Klein’s innate envy and destructiveness (also related to the death instinct), or whether the narcissistic or borderline phenomena relate to real world experience viz. Bowlby, contemporary trauma theory (such as van der Kolk), relational psychoanalysis and Fonagy.

Krystal (1978) argued that Freud held two theories concurrently, one emphasising the role of trauma and the other emphasising the individual’s innate conflicts over, for example, their infantile sexuality. It is certainly the latter view that held sway for much of the 20th Century in psychoanalytic circles, although the Middle Group of Analysts (Winnicott et al.) held an intermediate position (see West, 2016). The whole concept of the death instinct was also contentious and was one that Winnicott and the middle school also ‘tempered’.

These are not merely theoretical debates but will also influence the analyst’s attitude to the patient – for example, whether they think a particular instance of behaviour might be due to the patient’s destructiveness and intent to harm the analyst, or whether it is seen as a communication and a reconstruction or co-construction of the patient’s own early experience which this ‘enactment’ brings clearly to light.