Key people and theoretical developments

1877 – Jean-Martin Charcot, at the Salpêtrière Hospital in Paris, was the leading physician of his day working on nervous disorders and, in particular, hysteria (he has also been called the founder of modern neurology). He was the first to make the link between hysteria and underlying trauma (Lectures on the diseases of the nervous system: Delivered at La Salpêtrière, 1877).

1894 – Charcot’s work on hysteria was taken up and much developed by his pupil, Pierre Janet, who laid down the foundation stones of trauma theory which are still sound today. Through extensive study, observation, and the use of hypnosis, Janet concluded that dissociation was the characteristic underlying mechanism behind hysteria. He proposed that a traumatic event gives rise to “vehement emotions” in the individual which cannot be integrated with their existing cognitive schemes and are thus split off-dissociated. The memory traces of the trauma remain in the form of what Janet called “fixed ideas”-idées fixes-in the mind of the individual. These are thoughts or mental images that take on exaggerated proportions and have a high emotional charge (Janet, 1894). They are not integrated with the normal personality and they disrupt normal consciousness.

1898 – Havelock Ellis was the first psychologist to clinically use the term “Narcissus-like”, linking the figure in Ovid’s myth to the condition of auto-eroticism (i.e., self as own sexual object) in one of his patients.Auto-eroticism: A psychological study

1899 – Paul Nacke introduced the term “narcissism” in a study of sexual perversions, drawing on Ellis’s work on “morbid self love” and his correlation of the Greek myth of Narcissus with a case of “male autoerotic perversion.” Die sexuellen Perversitäten in der Irrenanstalt

1908 – Karl Abraham analysed what was later described as destructive narcissism (Rosenfeld), where envy promotes narcissism and retards object-love.

1911 – Otto Rank wrote one of the first psychoanalytical papers specifically concerned with narcissism, linking it to vanity and self-admiration. A contribution to narcissism.

1914 – Sigmund Freud published his pivotal paper ‘On narcissism: An introduction‘, discussing narcissism from a more developmental perspective. Freud argued that narcissism was a normal maturational phase of healthy development in all children (“primary narcissism”) and a “complement to the egoism of the instinct for self-preservation”. Healthy development, for Freud, “consists in a departure from primary narcissism”, a departure in which people invest their libidinal energy into another person rather than themselves.

1932 – In his seminal ‘Confusion of tongues‘ (1932) paper, Ferenczi introduced the concept of identification with the aggressor, which was seen as a way of the child keeping safe and keeping the abusive parent as a good figure. Fairbairn was later to call this a moral defence, ‘I am bad so you (can remain) good’. Ferenczi’s insistence on the centrality of real world trauma was one of the reasons he fell out with Freud.

1938 – Adolf Stern. The first detailed description of the borderline case is found in Stern’s paper, ‘Psychoanalytic Investigation of and Therapy in the Border Line Group of Neuroses‘ (1938), and Stern is often regarded as the father of the term ‘borderline personality’. “It is well known,” he writes, “that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that this border line group of patients is extremely difficult to handle effectively by any psychotherapeutic model”.

1952 – William Fairbairn made significant contributions to understanding issues of dependency, splitting, and the importance of object relations in clients with borderline traits (see Celani, 1993). As Celani notes, “Fairbairn made the brilliant and counterintitutive observation that children that were neglected or abused were more rather than less dependent on their parents.” See Fairbairn’s Psychoanalytic Studies of the Personality, and his papers ‘Schizoid factors in the Personality’ (1940); ‘A revised Psychopathology of the Psychoses and Psychoneuroses’ (194l); ‘The Repression and the Return of Bad Objects’ (1943); ‘Endopsychic Structure Considered in terms of Object Relationships’ (1944).

1971 – Heinz Kohut (1966, 1968, 1971, 1972) wrote extensively on narcissism, and like Freud he believed that narcissism was a healthy and normal part of development and “neither pathological nor obnoxious” (1966). However, unlike Freud, he believed that primary narcissism was a state of undifferentiated union with the mother, rather than a state of total self-absorption: “the baby originally experiences the mother and her ministrations not as a you and its actions, but within a view of the world in which the I – you differentiation has not yet been established”. From this state he posited two separate developmental trajectories of focus on self and other. The Analysis of the Self.

1975 – Otto Kernberg first introduced the term ‘borderline personality organisation’ to refer to a consistent pattern of functioning and behaviour characterised by instability and reflecting a disturbed psychological self-organisation (‘Borderline Conditions and Pathological Narcissism‘, 1975), and as Marcus West suggests, he is “probably the psychoanalytic theoretician most associated with this concept” (West, 2016).

Kernberg also wrote extensively on narcissistic disorders, believing they were a subtype of borderline personality disorders (Kernberg, 1975): “These patients present an unusual degree of self-reference in their interactions with other people, a great need to be loved and admired by others, and a curious apparent contradiction between a very inflated concept of themselves and an inordinate need for tribute from others. Their emotional life is shallow. They experience little empathy for the feelings of others, they obtain very little enjoyment from life other than from the tributes they receive from others or from their own grandiose fantasies, and they feel restless and bored when external glitter wears off and no new sources feed their self-regard.” Many elements of this definition were later used to help create the diagnostic criteria for Narcissistic Personality Disorder in the DSM-III. Borderline Conditions and Pathological Narcissism.

1979 – In his best-selling book The Culture of Narcissism the American historian Christopher Laschidentified what he termed a “culture of narcissism” in post-war America, suggesting that the individual self had become weakened and infantilised by consumer society, which prolongs the experience of infantile dependence into adult life, surrounding us with “fantasies of total gratification”. As author and psychotherapist Sue Gerhardt comments, “Lasch believed that modern capitalist society reinforced narcissistic traits in everyone, and allowed ‘celebrities’ with narcissistic personalities to set the tone of public and private life” (The Selfish Society, 2010). The generation of such narcissistic traits in capitalist societies, Lasch argued, was the psychological outcome not of any innate self-preoccupation or potency, but was instead a reflection of our lack of real social or political power: “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”.

1985 – Daniel Stern‘s influential work The Interpersonal World of the Infant (1985), challenged, and offered detailed material to counter Freud’s position of Primary Narcissism.

1987 – In Impasse and Interpretation (1987), Herbert Rosenfeld describes destructive narcissism and narcissistic omnipotent object relations, as well as the concepts of thick- and thin-skinned narcissism. A classic book.

1991 – Peter Fonagy‘s (1991 & ff.) work on borderline phenomena and his integration of attachment theory has been particularly significant in recent years. See for example, Fonagy, ‘Thinking about thinking: some clinical and theoretical considerations in the treatment of a borderline patient’ (1991).

1992 – Judith Herman‘s work on trauma experienced by women, and her coining the concept of complex PTSD, was very important; Trauma and Recovery (1992)

1996 – Bessel Van der Kolk is another major figure in recent discussions of trauma and dissociation; see for example Traumatic Stress (1996), co-authored with McFarlane & Wisaeth.

2003/2004 – Ron Britton‘s classic paper on narcissism (‘Narcissistic disorders in clinical practice’, 2004) and his work in Sex, Death and the Superego (2003), delineates different kinds of narcissism and distinguishes it from hysteria (as do Bollas (2000) and Andre Green (1997)), particularly distinguishing libidinal narcissism from destructive narcissism, which he links back to Karl Abraham’s (1908) understanding of envy promoting narcissism and retarding object-love (predating Freud’s conceptualisation).