7#$6  ڐڐڐڐ ښL۶x. N* kCH. You open up the book to the first page and read "The False Self/The Real Self: Personality Disorders"..... . `I have often thought that the beset way to define a . man's character would be to seek out the particular . mental or moral attitude in which, when it came upon . him, he felt himself most deeply and intensely active . and alive. At such moments there is a voice inside . which speaks and says: `This is the real me!'' . . William James in a letter to his wife, 1878 . . . . THE DEVELOPMENT OF THE REAL SELF . . . Concepts of the self have been around a long time. Poets and philosophers have discussed the self and written about it since ancient times wherever reflective men and women have paused to consider their true nature and purpose in life. Psychologists and psychoanalysts have been analyzing the self for at least a hundred years since Freud began practicing; and over the last century the popularization of psychodynamic theories, especially Freud's and Jung's, has allowed discussion of the basic psychological components of the self to filter into popular literature. In the past 25 years we have watched the concept of the self become an almost national obsession. From the `do your own thing' advice of the 1960s through the Me Generation of the 1970s, what Christopher Lasch has called the `culture of narcissism' has pervaded all areas of popular thought. Self expression, alternative lifestyles, the artistic explosion that came with the new video technologies, and `new age' transformational therapies of the 1980s remind us constantly of the advice Polonius gave Laertes, `to thine own self be true.' . One would think that after so much hype about the self, we would not need another book on the subject. If any generation in human history should produce experts on the nature and purpose of the self, it should be our own. But poets, philosophers, and even many psychotherapists do not look at the self from a clinical point of view. Although their works may be inspiring, uplifting, and motivating, they have not worked analytically with the self in terms of its origins, development, and capacities. Depending on their theoretical persuasion, analysts have tended to either minimize or overemphasize the self at the cost of investigating the psychological complexity of its development in early childhood and its functioning in the personality. . Freud, as the father of psychoanalysis, led early pioneers in the field down a path that would encourage work with the self in only its barest outline. Freud was primarily concerned with the instinctual drives, sex and aggression, and more or less took the self for granted. In the course of his study of the effects of oedipal conflict and castration anxiety on normal development and on the development of neuroses, Freud outlined pre oedipal development and therefore sketchily described the pre oedipal development of the self; but his probing explorations of the oedipal stage took most of his energies, and further and deeper study of the earlier development of the self was left to others. . Early psychoanalysts followed Freud's lead with the result that much was said and written about the self indirectly but there was no sharply focused study or understanding of how it is structured and how it functions. . Another factor that led generations of psychoanalysts farther afield from the self was the unfortunate fact, pointed out recently by Bruno Bettelheim, that when Freud did speak of the self, which he called the `soul,' the word was lost in translation. In his famous `three provinces of the . . . soul,' the more humanized terms I, it, and above, were translated as ego, id, and superego. What Freud called the `structure of the soul' became `mental apparatus,` and the phrase `organization of the soul' was translated as `mental organization,' all of which fostered the impression that Freud was concerned with the mechanics of the human mind, not the mysteries of the human soul. It is ironic that the term was lost over the decades, because it was Freud's belief that one must think in terms of the soul or self to understand his system of psychoanalysis. . In talking about the `self,' Freud used the word ich, in two senses: the self as the whole person and the self as simply the ego or agency of the mind. These two concepts have persisted down to the present, inspiring two distinct schools of psychoanalytic thought about the self. The difference between the two concepts is strikingly depicted in the classic split between Freud and Carl Jung in 1912. Both men were interested in how and why a person develops psychosis, but they targeted different problems in the early years of life. For Freud, the psychotic reached the oedipal stage and then, discovering that the oedipal conflict, the sexual attraction to the mother and the ensuing rivalry with the father, was too threatening, regressed to the earlier pre oedipal stage where the conflict could be avoided. Jung, on the other hand, felt that the psychotic's self never reached the oedipal level, that development was arrested at a pre oedipal stage where the self's major concern is the attempt to emerge from its identity with the mother. Jung was probably closer to the truth than Freud at that time. . Jung emphasized the self as a primordial image or archetype that expresses a person's need for unity, wholeness, and the highest human aspirations. This focus on wholeness characterized what would become the holistic school of psychoanalytic thought and initiated a shift, for the Jungians, away from the intrapsychic base, away from the importance of the ego, id, and superego and their conflictual roles. At times verging on the popular notion of the `whole person,' the concept of the whole self minimized the contribution of early development to the contents of the unconscious. It split the unconscious into a personal and a collective unconscious, placing the primary importance on the collective, which operates somewhat independently of the individual person's unique intrapsychic structure. In so doing, the Jungians down played the depth of the individual's unconscious for the unconscious, structures that all people share in common. . Freudians, on the other hand, concentrated on the ich as ego, an agency of the mind. Their concept of the self tended to become like an abstract institution or agency that operated on a set of mechanical principles almost divorced from the person's individuality. . In recent times, a movement among Freudian ego psychologists, such as Hartmann and Jacobson, has introduced the idea of the self into Freudian theory, restoring this vital notion and placing it within the context of the classical theory of id, ego, and superego. However, their emphasis is still not focused on the more personal, creative aspects of the self. . What is called for is an approach that unites the Freudian school's emphasis on the complex effects of early development on intrapsychic structures (ego, id, superego) with the recognition of the personal subjectivity and creativity of the more holistic theories. A more complete theory of the self, what I call the real self, must take into account creativity and the subjective experiential aspects of the individual, which the Freudians minimized (or considered secondary dividends of successful therapy, not part of its essence) as well as the intrapsychic depth that the Jungians tend to overlook. I don't believe we need to shy away from the importance of the ego in order to emphasize the whole person, nor do we need to minimize the intrapsychic structures and the conflict between them in order to recognize that the liberation of creativity can be a major result of therapy. Creativity is more than a byproduct of therapy; it can be a direct result. An intrapsychic emphasis can reach into the depths of the unconscious while still retaining a place for unique experiential developments of the self. The concept of the real self includes both the intrapsychic and the unique, individual aspects of the whole person. . The real self, from the perspective of object relations theory, is made up of the sum of the intrapsychic images of the self and of significant others, as well as the feelings associated with those images, along with the capacities for action in the environment guided by those images. The images of the real self are derived mostly from reality and to a lesser extent from fantasy; what one wishes as well as what one is, and its motives are directed toward mastery of reality tasks as a way of maintaining psychic equilibrium. The false self, on the other hand, is derived mostly from infantile fantasies, and its motives are not to deal with reality tasks but to implement defensive fantasies: for example, avoiding self activation to promote the fantasy of being taken care of which then becomes a way of `feeling good.' The purpose of the false self is not adaptive but defensive; it protects against painful feelings. In other words, the false self does not set out to master reality but to avoid painful feelings, a goal it achieves at the cost of mastering reality. . The real self can be viewed as mostly conscious, creating images and representations of the individual and the world, identifying our unique individual wishes and expressing them in reality, as well as maintaining the continuity and relatedness of the various images. The real self consists of all our self images plus the ability to relate them to each other and recognize them as forming a single, unique individual. These self images are the images we have of ourselves at particular times and in specific situations. They include our body images, whether they are conscious or unconscious, scious, realistic or distorted. The real self allows a person to recognize within herself that special `someone' who persists through space and time, who endures as a unique entity regardless of how the various parts of it shift and change. . Confusion can arise in trying to completely and clearly separate the concepts of the real self and the ego. Not only did Freud himself not do it but the definitions differ depending on the theoretical perspective. From the perspective of ego psychology, the real self and its functions are encompassed in the term `ego.' From the object relations perspective, the real self does not encompass the ego but functions as a parallel partner, utilizing some ego functions to accomplish its tasks, while the rest of the ego carries out the traditional functions described by ego psychologists. . The ego through its defense mechanisms maintains intrapsychic equilibrium by regulating the internal interaction between the id, superego, and reality. In addition, it also helps the real self with its tasks. For example, reality perception is essential in order to carry out a reality task. The self can be viewed as the representational partner of the ego, although it is more than that because in addition to having representational aspects of ego functions, it also has its own agenda which is to identify and express one's unique wishes. The ego can be viewed as the executive arm of the self, although it is more than that in that it also regulates the balance between id, ego, and superego. . Erik Erikson's analogy of the heart and lungs is helpful in understanding the unconscious, automatic regulating role of the ego. As our hearts and lungs operate automatically, without our being aware of them, to maintain our physical equilibrium, so do the ego defense mechanisms maintain our psychic equilibrium without our having to activate them consciously. We can rely on a reservoir of stored intrapsychic memories and habits that save us from having to think through every act and feeling of every minute each day, which would ultimately block our ability to function meaningfully in the real world. Erikson further explains that each personal identity has what he calls an ego aspect and a self aspect. The self aspect (or self identity) emerges when the ego aspect (or ego identity) successfully integrates and synthesizes the various self images that are formed in the psychosocial experiences of the individual; in simpler terms, when you manage a relationship or a task using your own unique style the experience is integrated to reinforce your self image. . The real self keeps the various subordinate images related to one another, allowing us to see how the selfimages and behaviors are linked so we can recognize them as our own and as honest expressions of ourselves. It keeps us aware of our essential, separate, unique identity and allows us to adapt creatively to changing situations so that we can continue to express the continuity and uniqueness of our identity and feel `real.' . We are very much a kaleidoscope of self images, like pieces of colored glass, forming and reforming shapes, patterns, and designs, always changing even though the pieces stay the same. The shifting patterns always resemble each other and seem to be variations of one another, suggesting that no matter how much we change, something basic in us holds its own. In addition to the self images we can see through the kaleidoscope of our lives, there is also another self: the self who holds the tube up to the light and turns the end, allowing the pieces to fall and reassemble and form new patterns. This is the functional aspect of the real self that expresses, organizes, and observes the patterns of our lives. When Malcolm Cowley wrote his memoirs at age 85, he was not concerned with the question `Who am I?' but `Who was I?' What he discovered was not always what he expected, but he hoped that the process of putting his life and memories down on paper would reveal to him `the person who is possibly the real me.' In writing an autobiography or a memoir, or whenever we look back seriously over our lives, we are confronted with a kaleidoscopic vision of ourselves, of a single life made up of many roles, situations, people, behaviors, ideas, hopes, disappointments, and successes. As genuine reflections of the real self, were they all equal? In what ways were they, or were they not, `real?' And are they still real in some ongoing fashion that contributes to the unique individuals we are today? . In looking back over your life, or pausing to consider where you are at the moment and from whence you've come, you can recognize the various separate selfimages that reflect your intrapsychic real self. Many of these are based on relationships: son, daughter, brother, sister, husband, wife, parent, friend, neighbor, enemy. Many self images derive from our work and recreations: doctor, secretary, lawyer, teacher, salesclerk, poker player, jogger, poet, artist, swimmer. The clubs, organizations, and institutions we belong to, or have in the past, also round out the real self: Republican, Democrat, Catholic, Jew, Elk, Junior Leaguer, Scout. We each wear many hats, play many roles, cross and recross many bridges. We have personal and professional self images, some known only to ourselves and those closest to us, others displayed publicly for everyone to see. . Under the guidance of the real self, we can identify our individual wishes as they change over the years and discover realistic ways to achieve them in our lives. The real self allows us to take the steps to carve out our individual places in the real world by finding the appropriate job, lifestyle, or mate. Our lives are then characterized by a harmonious interaction between the intrapsychic real self and the external environment, which, in turn, maintains our self esteem. The real self can accept and modulate the various, even conflicting, self images and resolve any apparent, temporary confusions. It can integrate diverse aspects of our lives to form a whole. It becomes the guidance system that motivates much of our behavior and keeps that behavior on the appropriate path. The real self is the person writing his memoirs as well as the various persons he was in the past. The real self knows how to relate them to each other to form a whole life, a whole self. The real self understands that what we are today is the product of the evershifting roles, behaviors, and circumstances that made up the many self images that fitted us over the years. They fitted us then, and when viewed through the wisdom of the real self, they still fit today. . Until about 25 years ago, most of what we knew about psychological development was gleaned from patients in therapy remembering and retelling childhood experiences, and it suffered from the inevitable gaps and distortions to which memories are subject. As Margaret Mahler pointed out, what we knew of normal development was often abstracted from patients' accounts of what went wrong. Far better, as we were to learn through Mahler's own studies, was to piece together a picture of `what goes right' through actual face to face studies of normal young infants and their mothers. Beginning with Mahler and others in the late 1950s, child observation studies of normal healthy two and three year olds with their mothers in real life situations have added greatly to our understanding of the processes involved in the child's successful attempts to separate from the mother physically and psychologically and develop a separate, autonomous real self. Based on observations of children and their mothers over several years, psychoanalysts and psychologists have identified the various stages of development through which a child passes as she develops a real self and learns to express it through her own unique personality, setting up many of the coping patterns that will stay with her for life. . We have learned that the building blocks of the real self consist of biological endowment (although to date, research has not revealed what these building blocks exactly consist of or to what extent they influence the development of the self), the child's experience of proprioceptive and sensory sensations from his own body, as well as pleasure in increasing mastery in coping with the environment remnant. In the early years development takes place through interactions with the mother or principal caretaker. As Mahler put it, `Insofar as the infant's development of the sense of self takes place in the context of the dependency on the mother, the sense of self that results will bear the imprint of her caregiving.' . A newborn baby has one primary goal: comfort, i.e., to seek pleasure and avoid pain. Like every human organism, the infant experiences hunger and various types of discomfort arising internally and externally, such as the internal discomfort of a full bladder or the external unpleasantness of a stuffy, overheated nursery. The child can and will take care of the full bladder; the overheated room is beyond his means. A sensitive mother or father, of course, will lower the temperature or open a window. . For many years it was thought that in the first three months the infant was a passive tabula rasa acted upon by the parents. In recent years a second wave of baby watchers with newer investigative techniques have focused their studies on these three months and their findings have drastically changed the tabula rasa theory. They have found that the baby's perceptual capacities emerge very early: at four weeks the baby develops a special response for the mother and father, and by seven weeks the baby can organize visual observations. Thus the baby becomes a far more active partner very early in its development through an active dialogue with its caretakers. Despite the fact that many contemporary men are more interested and involved in parenting than their counterparts in previous generations, in most families the mother is still the primary caretaker, particularly during the infant's first months of life. Hence the delineation between specific experiences and feelings the infant has involving each parent. This dialogue then becomes crucial for the emergence of the self. . At this point in life, the child still feels `fused' with the mother. There is not yet a sense of `I' and `not I.' The process of birth has physically separated the child from its mother, but as the child perceives himself and his mother intrapsychically, there has been no separation as yet. From the child's point of view, he and mother are still one and everything in the environment is part of his self and part of the mother. . After two or three months, however, things begin to change, as the baby begins to discover his skin, and slowly learns that he has boundaries. Although the concepts of `inside' and `outside' are still vague, he begins to grow aware of the fact that some things are outside him, including mother. As this perception grows, he realizes on a very primitive level that some needs are satisfied by the mother alone, that it is she, not the child, who brings about some pleasurable feelings and relieves unpleasurable ones. He begins to discover that she is not part of his own body, as he once perceived her. Nevertheless, because the mother comes and goes within his orbit, she is still perceived as part of himself, although not strictly speaking a bodily part any longer. . She is a mysterious part of him, another half who is different from him, an all powerful partner or pole of his being who organizes things and provides for his needs whether it be milk, a diaper changing, or a comforting hug. The child gradually becomes aware that the mother is indispensable for his sense of wellbeing. She is the master organizer of his life, mediating every perception, action, insight, and every bit of knowledge so that he comes to identify with her and her actions; and she will continue to organize for him until he develops his own internal organizer. . During these second and third months the baby will look more directly into its mother's face and focus more closely on her eyes. Eventually in the fourth or fifth month he expresses his special bond with her by the specific smile that leaps to his face only for her. Prior to this stage, infants use a non specific, social smile that charms everyone from nurses to grandparents, but though we hate to admit it, the child doesn't really mean anything personal by it. The special smile for mother, however, is different. It means something. When mother enters the room or comes into view, the baby honors her with this special smile of delight, and in so doing honors the unique relationship that he is beginning to understand he has with her and her alone. . At this stage of development the baby is also more alert when awake. The attention is more clearly directed outward toward the environment and is steadier, more constant. The child doesn't drift in and out of alertness as much as she did a few weeks ago. She seems to be less preoccupied with herself. She responds more readily and predictably to the world around her. . At six months the child is pulling at mother's hair, nose, glasses, necklace, trying to put food into her mouth. Now we notice that sometimes when mother holds her, the baby will stiffen her body and strain to push away to get a better look at the mother. When she was newborn, her body molded easily and comfortably into the contours of the mother's body and arms, a metaphorical posture that indicated she felt symbiotically fused with her. Now she wants something more. She watches the mother intently, scanning her face and body, even as she scans the environment around the two of them from her safe and secure vantage point in mother's arms. Soon the young human being's sense of `I' is different from `mother' and the `world.' In these days and nights of feedings, crying, and being held and doted on, the child's sense of self begins to emerge, a self that will be distinct from the world around her and will persist throughout life. . The baby first finds this new identity in a physical way by paying more attention to his own fingers, hands, arms, and toes, feeling himself, making sure he is there. He watches his movements in a mirror. By 12 to 18 months the child recognizes the image in the mirror as himself. He can point to it and say his name or use a personal pronoun, or if he isn't talking yet, he can point to the mirror and then proudly to himself. In the stage from the seventh or eighth month until the child is about a year and a half old, the real self is activated by the endless forays to explore the marvels of the world; and indeed, everything in the world is truly marvelous. . The child has a `love affair with life' as he learns to sit up, scoot, crawl, and walk. He plays with toys, touches and tastes everything that he can get his mouth on. As he sits up by himself, stands by holding onto a chair or piece of furniture, and learns to walk, he gains a new visual perspective of the world. Fueled by the mother's interest and enthusiasm in the discoveries of this emerging self, the child simultaneously practices the motor skills needed to make those discoveries as well as the psycho logical skills that will later become the capacities of the real self activation, self expression, and creativity. At this stage, the quality of mothering is crucial. The mother's ability to pick up the cues and signals from the child's emerging self, her own ease of self expression and creativity, her imagination; these compose the fertile soil in which the child's real self grows and develops. . Soon the child takes that first step by himself. When he actually walks on his own, the world becomes an even larger arena, as he puts more physical distance between himself and mother. Narcissism is at its peak. The child is able to search for toys, pick things up by himself, feel them, taste them, and bring them to adults. He is omnipotent, almost drunk with power, oblivious to his own limitations, busy and elated by his discoveries and his release from the confining world of the mother. Not even falls and bumps or other frustrations can stop him. . And yet the little adventurer is not as fearless as he might seem. The world might be his oyster, but mother is still home base. The child scampers off, lost in the thrill of the moment, but frequently returns to mother. He might come back simply to touch her leg briefly or grab her skirt. Perhaps he wants to toss the ball or block or rattle into her lap. Over and over, the child returns for emotional refueling, for reassurance that mother is still there. . The age old game of peekaboo is more than just fun. It becomes a minidrama of the real self's dilemma. In it, the child ducks behind something and temporarily loses the mother's image, delighting in the fact that he is not really fused with her; and yet almost as if he can not yet tolerate too much separation, he quickly makes the mother's face reappear. The child is practicing crucial tasks that will be important for the rest of life: the ability to be separate and yet negotiate closeness and distance from others, to go away and come back, to tolerate (even impose) isolation and find companionship, to be single yet social, to be for one's self and for others. . Take for example the simple ruse of running off, away from mother, hellbent for nowhere, only to have mother hot on his heels to sweep him up in her arms before he gets too far away. Almost as if the ruse were mutually agreed upon, the child has no intention of escaping for good. He learns that mother will be there to rescue him and protect him from himself as well as the real environmental dangers of which he is still unaware: the busy street at the end of the yard, the top step of the basement stairs, the low table filled with breakable objects. . Like peekaboo, this is a game of loss and recovery, of losing and regaining both mother and freedom. In one sense, it is play; but in another, it is serious practicing for the many situations in life where the individual must balance his need to be dependent on others with his desire for freedom and independence. It is also a vehicle to develop his capacity to deal with separation anxiety. . The child needs emotional `supplies` for the emerging self and will keep returning to mother to receive them, in the form of her acknowledgment and support for the unique displays of self expression and achievements the child demonstrates through curiosity and play. But as she approaches the end of her second year of life, she develops a growing concern over mother's whereabouts, a concern not as intense or noticeable in the earlier months when she practiced leaving and returning to mother by charging off into the room and happily running back. In fact, the new concern doesn't seem like practice at all. It is serious business. We can see it on the child's face; she looks worried, hurt, fretful, sometimes even panicky. . Even as her ability to walk and master the world increases, the child's need for reassurance that she is not totally on her own also increases. She must balance her growing independence with assurance that mother shares her life and supports her struggling efforts to develop as a separate, autonomous person in her own right apart from the mother. She needs both mother's encouraging presence and space away from her. Her desire to explore the world on her own is tempered by her wish for reunion with mother, and even this wish is tempered by the child's fear of being engulfed by the mother. Life now becomes a kind of dance, alternating between `shadowing' the mother visually, keeping her in view, and darting away from her. . Even while playing in another room, alone or with a playmate, the child needs to know where mother is and may, in fact, scamper back to touch base, to get refueled. By means of this interplay of advance and retreat on the part of the child, the original fantasy of being fused symbiotically with the mother disappears. The increased need for reassurance parallels and reinforces the child's realization that he is indeed separate from mother. In the physical sense, he learns to put increasing amounts of distance between himself and her; and on an intrapsychic level, he experiences himself as an object separate from the object that he is learning to regard as his mother. As intrapsychic separation occurs and the real self emerges, the child develops an image of himself that is entirely separate from his image of mother. . The child now stands at an important crossroads in the development of his real self. He is ambivalent about his need for mother, fearing his new embryonic self will be `engulfed': taken over by the mother, and disappear. His budding personality is now emerginging as he learns to assert himself in his own unique ways when dealing with other children, finding his toys, relating to adults and strangers, making his needs known to those who can alleviate them. Unlike peekaboo, loss and recovery are not swift and immediate. He becomes frustrated, and his frustration tolerance, once high and unassailable, is lower. Things bother him, he can't always get his way, he falls down and it hurts. And in these new encounters with reality lie the origins of the temper tantrums that will characterize the `terrible twos.' . Living with a child through this stage is not easy. It can try the best of nerves in the most sympathetic and understanding parents. And yet these are the months in which the child's real self will emerge under the protective care of parents who can accept his ambivalent and indecisive behavior and support his emerging self. He teeters at a major threshold in personality development, torn by conflicting needs and desires. The toddler must learn to cope with the world in his mother's absence, and learning to do so requires him to venture out and be separated. . During these initial years, the father plays a pivotal role in the development of the child's real self. Whereas the child must separate the mother's image from the fused symbiotic unity he initially shared with her, no such task is required with the father. On the contrary, the father image has always been separate and distinct, coming, as Mahler says, from outer space as it were; the father is a kind of knight in shining armor whom the child becomes aware of just at the time when the child himself embarks on his first important quest to see the world. Right when the child needs him, the father pops in and out of view, representing a vast and exciting world that is totally non mother and child. His appearances and activities, even though the latter may be many of the same as the mother's, `rescue' the child from its sole dependence on the mother image. . Like the world of toys and the other mysterious rooms of the house, the father is someone to practice on. He is different and stands for non mother experience. Exploring reality through him has a special quality of exuberance. . On the intrapsychic level, the child can use the father to test his emerging self image as distinct and separate from that of the mother. With the mother, the child can often feel sucked back into the mother's orbit in a frightening and engulfing way. With the father, however, the child can experience his own otherness and individuality without the fear of engulfment. Father, coming from the outside world of reality rather than the fused symbiotic state, does not trigger symbiotic fears. When father is firmly established as both an exhilarating adventure into worldly reality and a safe haven where the child can test his intrapsychic perceptions about that reality, we can be reasonably assured that the toddler will continue to achieve his own individuality and the important psychological separation from mother, and the real self will emerge with confidence. . In the course of the intricate process of separating psychologically from the mother, the child separates `good' images from `bad' images even as he separates his own image from that of the mother. In the process, he ends up splitting his own `bad' self image from his `good' self image and the image he holds of the `bad' mother from the image of the `good' mother. During times when the child feels good;warm, fed, comfortable, safe, a `good' selfimage arises. When he feels bad; hungry, tired, uncomfortable, frightened, he develops a `bad' self image. These images are held apart by splitting them into two distinct images. The real self, as we have indicated, is a master at holding various self images together, and one of its first tasks, when the child is around age three, is to fuse and hold together the two parallel images of the self. . The same effort must be undertaken in terms of the two mother images. Every toddler holds two parallel images of his or her mother: a `good' mother image made up of the experiences in which the mother provides pleasure, comfort, warmth, affection; and a `bad' mother image from those experiences in which the mother frustrates the child's impulses, shows displeasure, punishes, or in fact physically harms or inflicts pain on the child. In normal development, the real self fuses these two images of the mother into one. Over time the child must learn to perceive both himself and mother as whole, constant individuals. There are not two selves, two mothers, one good, one bad. . Although this fantasy arises as the child differentiates and separates himself from the mother, it does not last. Split objects fuse into wholes, and the child learns that they are constant. This realization of wholeness and constancy is part of the wider knowledge that life itself is ambiguous, colored in shades of gray, rather than stark whites and blacks. For a young child, the world is truly unpredictable and kaleidoscopic; and it is an enormous feat to acquire the realistic perception that objects hold together, that the mother who scolds is the same mother who hugs, that the self that breaks the lamp is the same self who learns to balance food on a spoon and aim it successfully into the mouth. Life is both rewarding and frustrating. So is mother. So is the self. . Clearly, the images the child holds of the mother, father, himself, and the world in general may be distorted, skewed, and in complete. Take for example the child's perception of the physical environment. The room with its furniture looks enormous, the preparation of food is mysterious and magical, the place that father disappears to when he leaves in the morning is terra incognita, and as the unexplored lands on Renaissance maps indicate, `here be monsters.' . The point is not how accurate and complete a child's representation of mother, father, or the world really is; every child's set of psychic representations is subjective and incomplete. What's important at this period is their wholeness. Completing our images of mother and father is a lifelong task, always destined to fall short of the mark. But wholeness is another matter. The real self has the ability to learn at this early age of life, but with difficulty, that objects are whole and incorporate both their good and bad aspects. There is one self and one mother. . At the same time as the split is being healed, the child, through identifying with the mother, takes into himself functions the mother had performed for him before his ego was developed enough to perform them for himself. Now he begins to assume control over his own ego functions. He develops better reality perception, frustration tolerance, impulse control, and ego boundaries. Instead of allowing the images to remain split into their good and bad components, the child learns to repress the negative aspects into the unconscious. . Personality development depends on repression because the drives and feelings that are repressed enter the unconscious for sublimation. They become the raw material for creativity, the pool of energy that fuels our desires to become doctors, lawyers, mothers, fathers. If a person can't repress, he or she can't sublimate because there isn't the psychic energy to respond to life in creative and successful ways. . In the best family situations, trial and error (on the part of the parents as well as the child) gradually build up the child's confidence that the world is neither a totally threatening nor a totally pleasurable place, but an ambiguous place, an arena of opposites: safety and danger, success and failure, comfort and pain, power and helplessness, companionship and loneliness. There will be moments of happiness and elation as well as times of frustration and sorrow. Most of all, the child learns that his mother also embodies good and bad qualities. At times she rewards and comforts; at other times, she is distant, aloof, punishing. But the child discovers that his mother loves him with his emerging and separating self no matter what and that she sincerely wants him to explore the world and develop and grow in his own unique way. And as he does so, the real self emerges and develops its capacities to cope successfully with life. . The real self is stabilized intrapsychically between ages three and four, but the journey is far from over. In fact, it has only just begun. Although the intrapsychic system is in place, the years of childhood are spent learning to put that system to work in the external environment; learning how to dress, eat, get along with others; discovering interests and talents and learning how to develop them into satisfying activities. . During the grammar school years, children are exposed to a wide range of interests and activities, some of which they will get intensely involved in as hobbies or pastimes, many of which they will drop only to take up something else. At this stage the possibilities of life are too rich and various to make hard, fast decisions and commitments. The young boy, when asked what he wants to be when he grows up, may answer, `Either a truck driver or an astrophysicist.' The unlikelihood that both would appeal to the same individual is explained away when we remember that during these years, referred to as the latency period, the child is testing skills and interests to see what activities reinforce the real self. . In answering the question, the young boy is really saying that he still hasn't discovered what niche would make him feel most like him self and allow him to express his own unique characteristics. In adolescence, the real self tests its ability to handle sex and freedom from parents, finding ways to articulate itself in an expanding world of opportunities and obligations. During these years teenagers venture into the unexplored territory of personal and sexual relationships, seeking answers to questions about their real selves. Infatuations, romances, crushes, and `best friends' may come and go as adolescents seek foils and complements to test and understand their own identities. Outwardly they may appear to be auditioning their friends and acquaintances for their personality traits, values, sexual preferences, and compatibility, but inwardly they are seeking to learn more about themselves. . For most people, all of life is a period of growth and development, experimenting and testing, searching through trial and error for harmonious ways to allow the intrapsychic structure of the real self to express itself in the physical world through relationships and work. All the issues are not resolved by the end of adolescence. . While it's true that most people arrive at some definite conclusions regarding their needs and interests in their early twenties, they get their act together, as it were, and settle down in careers and relationships, it is not uncommon for them to rethink the issues again in midlife, perhaps divorcing and remarrying or switching careers. As children and young adults, we learn to stand on our own two feet both physically and psychologically, and in doing so, we develop patterns of feeling and thinking that serve as an internal guidance system for coping with problems and difficult situations. These patterns incorporate the specific strengths and capacities of the real self, which shape the way we handle relationships and express ourselves in work and other pastimes. . . . FEAR OF . ABANDONMENT . . . The Self Under Siege . . . In order to establish a coherent sense of self, the child in the first three years of life must learn that she is not a fused, symbiotic unit with the mother. As Mahler's and others' studies have clearly indicated, the mother and child (and father) engage in a kind of choreographed give and take, a dance of release and return, risk and retreat, learning and testing. The child runs off, the mother runs after her; the child explores and comes back to her for reassurance; she ventures out, buoyed by the excitement of discovery, and returns for emotional refueling when the adventure becomes too threatening or her own fragile sense of identity and permanence wears thin and feelings of abandonment overwhelm her. In the development of normal, healthy children, the mother acknowledges and supports her child's efforts. In the development of individuals dominated by the false self, these patterns of self expression and maternal support did not take place. Why? . Three factors account for the failure of some children to separate and express themselves in ways that will develop and strengthen the real self: nature, nurture, and fate. . Just as each human being is born with genetic endowments that will develop and guide physical growth within specific limits, so too each of us begins life with different genetic potentials that will affect our psychological capacities. We won't all become Olympic gymnasts, no matter how many years we practice. Nor will we all be able to take our places beside Shakespeare or Keats as poets. Physical and intellectual limitations are built into us at conception; within certain parameters, training and practice can improve our talents, but we are ultimately constrained by a set of limitations beyond which we simply were not destined to go. . The same is true of the real self's capacities. At conception, children most probably receive at least some of the potentials for the psychological capacities that can be developed over their lives. Part of our genetic inheritance and biologic makeup includes limitations and deficiencies in these psychological abilities. For example, some children and adults are naturally shy, reserved, hesitant; others are outgoing, extroverted, adventurous. Some need strong direction; others take charge by themselves. Some will always need the companionship of other people to a greater degree than will others. In some individuals, the ability to commit themselves to causes or careers or other people is stronger and more dominant than in others. Talent for talent, and skill for skill, we are not all equal, and we did not begin equal. . In my own studies with adolescents who are not able to function successfully on their own, I noticed that a few who seemed to improve with treatment while in the hospital reverted to their pathologic behaviors shortly after leaving. The latest followup studies indicated that they have never recovered. . How to explain the fact that they survived childhood without a clinical breakdown, broke down in adolescence, then seemed to repair it in the hospital, but fell apart on discharge? As the self emerges from the maternal image it internalizes or `takes in' both the image of the mother and the auxiliary functions she had performed for it. These functions (reality perception, impulse control, frustration tolerance, ego boundaries) contribute greatly to the capacity for autonomous self activation. . The fact that this image and the associated functions had not been internalized in these patients was disguised during childhood because fate was kind and did not expose these children to excess separation stress and because there is an `umbrella of dependency,' which allows the child to depend on external parental authority to help him function. In other words, the child is not expected to function autonomously. However, adolescence removes the umbrella and exposes the growing child to tasks of emancipation and the need to function autonomously. At this point, his underlying difficulty with self activation emerges in a clinical syndrome. The teenagers in my study seemed to improve in the hospital because the presence of external authority figures on whom they could be dependent reproduced the earlier childhood environment. They appeared improved, but the changes could not endure when the support of the therapist and the hospital were removed. The fact that they fell apart on discharge strongly suggested that they did not have the basic capacity to internalize these interactions either in infancy with the mother or later with the therapist, and this lifelong inability to separate and become autonomous was probably due to an innate genetic deficiency. The possibility that it might have been due to severely damaging developmental experiences was unlikely since their early histories were no worse than the early histories of other adolescent patients who did better in the study. . Currently there is little research evidence regarding the exact nature of this type of genetic deficiency, but we have seen that some severely impaired individuals, whose conditions cannot be directly attributed to failures in nurturance or to acts of fate, do not respond to therapy of any kind; we assume that the root of the problem in these cases lies in a genetic or biologic deficiency. For example, studies have shown that the infantile psychotic will not respond to even the best mothering. In these cases, it appears that some innate deficiency, not inadequate mothering, is responsible. . So nature has seen to it that we will not all go through the first three years of life with the same ease or difficulty. Some of us will separate from our mothers and express our own uniqueness more easily; some of us will have a harder struggle to do so. Nature has not endowed each of us with the same psychological seeds for developing a real self, and as adults each person has her own unique range of strengths and weaknesses in the real self's capacities. What is present at birth will grow and develop, just as in a tree, the fruit, flower, leaves, bark, and structure are contained in the smallest of seeds. . How fully, smoothly, or quickly the child's innate psychological potential develops depends in part on the mother's, and to a lesser degree the father's, psychological ability to provide the environment in which the seeds of the real self can grow. The child's self image emerges from the symbiotic image of the mother. In most families the mother is the primary caretaker and the father plays a secondary role, hence the emphasis on the mother's abilities to foster and nurture psychological growth. In this context, nurture refers not to the physical supports, such as protection, warmth, or food, but to a more specific form of nurturance that allows the unique, individuative qualities of the child's real self to emerge. Parents must be able to identify and to respond with positive emotional support to the unique, individual aspects of the young child's emerging self, which will thrive in an environment that is physically stimulating yet safe, socially challenging yet manageable for the child's stage of development, intellectually exciting yet emotionally secure. . The key is the mother's ability to perceive and to support the child's emerging self, for without that support, he experiences her as withdrawing and disapproving of his efforts. The mother may respond inadequately for a variety of reasons. She might be psychologically disturbed (borderline narcissistic, psychotic, psychopathic, or manic depressive.) She may be unable to respond adequately because she herself has suffered a loss and is depressed or even physically ill or actually absent. Her unavailability produces the climate in which the child's real self will not be able to emerge. . In my study of adolescents who had an impaired sense of self, I found that many though not all of them had mothers who themselves suffered from an impaired real self. The mothers too feared separation, and attempted to prevent it at all costs. In these cases the cost was the normal development of a real self in their children. For one example, a mother who failed to develop a confident sense of self tended to foster the continuance of the symbiotic union with her child, encouraging him to remain dependent in order to maintain her own emotional equilibrium. She seemed to be overwhelmingly threatened by her child's emerging individuality, which sounded as a warning that he was destined to leave her, eventually forever. Not being able to handle what she perceived as abandonment, she was unable to support the child's efforts to separate from her and express his own self through play and exploration of the world. Her defensive maneuvers to avoid her own separation anxieties entailed clinging to the child to prevent separation and discouraging his moves toward individuation by with drawing her support. . In short, she could not accept her child as he actually was, growing and developing with needs that must be addressed. She perceived the child as a perpetual infant, or worse, an object, to be used as a defense against her own feelings of depression over separation. Consequently, she was unable to respond to the child's unfolding individuality. The child, in turn, learned to disregard, even fear, parts of his potential self that he realized threatened the mother. In time, he suppressed those feelings, wishes, and activities in order to continue receiving approval from her. Both mother and child then denied to themselves that this interaction was destructive to the child's growth. . The mother's unavailability to supply the emotional fuel dampened or thwarted the child's desire to individuate and become his real self, with the result that the child engaged in clinging or distancing behavior. The clinging relationship was mutual, occurring at a time when the mother was not able to release the child because to do so would unleash her own separation anxieties. Therefore, both mother and child had a vested interest in clinging to each other, and the child's psyche became fixated at this point in development. If the mother's clinging was too intense the child became afraid of being taken over or engulfed, and defended against this fear by distancing himself emotionally from her and others but also, because he feared abandonment, giving up further individuation. . The vulnerability of the parents of adolescents with an impaired real self came from their own impaired real self, caused in part by the nurturing style of their own parents. This led them to repeat with their own children the behavior they had experienced with their own parents. . Consider Nancy's mother Grace. Grace was a rigid, angry, depressed, moralistic woman, who at times played the role of martyr. Her strengths lay in her basic, conscious commitment to do what was right for herself and her family once that was made clear to her. She was a bright and talented woman, quite capable of finding other interests once her children were grown. . Grace's own mother was described as a depressed, angry, highly inconsistent woman who acted out much of her resentment and frustration against Grace. She was also moralistic and rigid in setting limits for Grace. For example, she constantly accused Grace of smoking, checking her breath every time she returned from school, although there was no real basis for her suspicions. Her inconsistency was clearly demonstrated by her insistence that Grace take dancing lessons although she forbade her to go to teenage dances. Grace complied with her mother's restrictions with some awareness of a growing anger and fear over her mother's behavior. . As a mother herself, Grace had difficulty setting limits on Nancy's behavior from early childhood. She had determined to be quite the opposite of her own mother, to control her anger and behave in a rational manner, which led her to ignore Nancy's behavior until it became intolerable to her. Then she turned from being indifferent to excessively punitive. She would withdraw from Nancy, feeling guilty and frightened, thus effectively reproducing her own mother's behavior. At one point she went to the school and emptied Nancy's purse in front of her peers to see if she had cigarettes. She also obtained the combination to Nancy's locker and rummaged through it looking for cigarettes and drugs. . The fathers of patients who exhibit the false self were equally unavailable to them as an `uncontaminated' member of the family orbit who could support the child's unique self expressions, her efforts to explore the world that is not mother, and her attempts to master reality. The specifics vary from family to family, but in general the father of the borderline child does not intrude on the mother/child relationship. His influence is almost always, by default, a reinforcement of the mother/child's exclusive clinging relationship, rather than as a force to oppose it by leading the child away into the broader world. . In my study, when I examined the dynamics of the marriages of my patients' parents, I discovered that an unconscious emotional contract, most often never verbalized, had existed between the couples in which the mother allowed the father to distance himself from the home for whatever reason or interest, be it career, hobby, or other friendships, in exchange for the mother's getting the exclusive right to care for and control the child. The mother never complained about the inordinate amounts of time the father spent away from home. What I learned was that the mother didn't want the father at home, especially if he sought to play the normal role of a `rescuer' or savior to take the child out of her control and introduce the child to a larger reality that went beyond the mother's orbit and to give the child positive experiences of being able to cope successfully in that reality without her. . The effort to separate and individuate from the mother is a two track process that involves the separation of the internalized self image from the internalized mother image and the parallel evolution of the capacities of the self. These capacities are strengthened and reinforced by the child's self assertive explorations. Any events in the first three years of life that influence either of these tracks can be powerful determinants of whether or not the child completes this process. For example, a child with a congenital hip problem who wears a cast for the first 18 months will not be able to use his motility to explore his individuation farther and farther into the world beyond the mother, which is a crucial part of the process of separation. . In some families, a mother and child may become physically separated before the child is psychologically ready. A mother's death, a divorce, illness, or any event that takes her away from the child for extended periods of time prevents the child from relying upon her presence and support to negotiate her separation from her. Fate separates them, at a stage when the infant cannot understand what is happening. We have learned from child observation studies that separating from the mother is an important task for the child to accomplish on her own (with the mother and father's support, of course). It is not something than can be done for the child or to the child because it is the process of separating that is crucial for developing the real self and its capacities, not the existential fact of being separate. . John Bowlby's studies of children aged 13 to 32 months who were separated from their mothers (a complementary study to Mahler's work) filled in additional pieces of the puzzle of what goes wrong, preventing the emergence of a unique and whole self. . Bowlby studied the mourning process that children who were hospitalized for a physical illness went through when they were not able to have their mothers around them as they were used to at home. He discovered that mourning could take two courses. One type of mourning enabled the individual to relate to and find satisfaction in new objects. This is considered to be a healthy way to mourn. Bowlby also discovered a second kind of mourning that pathologically prevents a person from developing new relationships and outlets. This kind of mourning proceeds through three phases. . The first is the protest and wish for reunion phase that may last a few hours or several weeks, during which the child appears acutely distressed at having lost its mother and seeks to recapture her by whatever limited means he possesses. He entertains strong expectations and wishes that she will return. He tends to reject others, such as nurses and doctors, who offer to do things for him, although some children will cling desperately to a particular nurse. In the second phase hopelessness sets in. The child sinks into despair and may even stop moving. He tends to cry monotonously or intermittently, and becomes withdrawn and more inactive, making no demands on the environment as the mourning state deepens. In the third phase the child begins to show more interest in his or her surroundings, and this is usually welcomed as a sign of recovery. The child no longer rejects nurses, but accepts their care, food, and the toys they bring. He may even smile and be sociable. But when the mother returns to visit, it is clear that he has not recovered. The strong attachment to the mother typical of children this age is strikingly absent. Instead of greeting her, he may act as if he hardly knows her; instead of clinging to her, he may remain remote and apathetic; instead of tears when she leaves, he will most likely turn listlessly away. He seems to have lost all interest in her. . If a child has to stay in the hospital for a prolonged period of time, he will become attached to a series of nurses, each of whom leaves, thus repeating again and again for him the original experience of losing the mother. In time he will detach all deep emotional feeling from relationships and act as though neither mothering nor any other human contact has much significance for him. He learns that when he gives his trust and affection to a mothering figure, he loses her. He tries again and loses the next. And so on. Eventually he gives up taking the risk of attaching himself to anyone. He becomes increasingly self centered and, instead of having desires and feelings toward people, he becomes preoccupied with material things that won't let him down such as sweets, toys, and food. He will no longer find gratification in relationships and will settle, instead, for immediate self contained gratification. A child living in a hospital or institution who has reached this state will no longer be upset when nurses change or leave. He has constructed a defense against being hurt and disappointed. He ceases to show his feelings even to his parents when they come and go on visiting days. They, too, are swept into the orbit of disappointment and pain as they realize that the child is more interested in the presents they bring than in them as people. . Reflecting on Bowlby's findings and applying them to my adolescent and adult patients, I realized that there were strong parallels between the mourning process and the defenses it produced in Bowlby's subjects and what my own patients were going through. I came to recognize that when my patients go through a separation experience that they have been defending themselves against all their lives, they seem to react just like Bowlby's infants in the second stage of despair. The separation brings on a catastrophic set of feelings, which I have called an abandonment depression. To defend against this mental state, they retreat into the defensive patterns encouraged by the false self, which they have learned over the years will ward off this abandonment depression. . In adults without a sense of their real self, the abandonment depression symbolizes a replaying of an infantile drama: The child returned for support and encouragement, but the mother was unavailable or unable to provide it. The acknowledgment and approval, so crucial to developing the capacities of expression, assertiveness, and commitment, were simply not there. Years later as adults, those patients hear the same message from those they have selected in order to repeat the pattern. It is not okay to be the unique separate self you really are, or could become. . This is how Jane, 16, suffering from headaches and nausea and unable to sleep, struggled to describe her depression: `I feel like I'm dying, powerless and sinking under five thousand pounds of self hate. I feel like a rotten tree with total despair inside. Hopeless, drained, no strength, I can't do anything. I'm badly wounded and hurt as though I'm being squashed, and there's no way out. My own emptiness frightens me. If hemlock were sitting here, I'd drink it.' . Bill, 25, tempted to quit his job as a computer analyst, put it this way: `When I sit there trying to work, I feel hurt, stepped on, crushed and want to give up. I never feel any support or connection with anyone. I'm completely lost, helpless, unable to cope with reality. I feel adrift, alone. I have no sense of worth or meaning. The feeling of being deserted kills me, and I can't work. Trying to work is tempting fate, risky, treacherous. I can almost hear voices telling me it's wrong to be myself. I have to block them out, or I think I'm dying. So I give up. I feel completely abandoned and I want to yell, 'Help me out! Where is everybody?' But the voices yell back, 'He's crazy!''' . Madge, a 30 year old divorced woman, explains her inability to accept the fact that she is a grown woman: `I've been frightened into thinking that growing up is wrong. I think I'm destined to die because I'm growing up. I can envision no life except the way I lived as a girl at home. I feel dirty and disgusting when I think about becoming a woman. Having sex, smoking grass, having a drink is throwing myself to the winds and anything can happen to me. I'm an empty shell that should be filled with grownup attitudes, but I can't put any in without breaking it...breaking who I am. Growing up is like defying God. I feel guilty and frightened.' . Scott, who idealized Mr. Spock because of his lack of human feelings and fantasized about moving to the Arctic Circle where he wouldn't have to interact with humans, wrote a composition about a statue in the park named Rich: `Rich was different. He had no parents he could remember. He could not communicate to anyone and was never accepted but was just looked at and usually that look became a stare, an unbelievable stare. Nights were the worst of all. During the day he watched people doing what normal people do. Singing, dancing, dining, talking, and just enjoying life. In the day he could pretend he was one of those happy people. But at night his fantasies died. He was desolate, cold, and lonely; he felt like crying every night, but some unexplainable force held him back, saying `Don't cry, don't give in to this world.' Many times he thought of suicide but it would not work for he was immortal; an immortal, lonely, rejected, and unwanted outcast who could not cry out for his lips were cement, too heavy to move. But one day he did cry out, although nobody heard him. And he said to this world, `I hate it, I hate it, I hate being a statue!' '' . What is the abandonment depression, as described by these four people, that can so impair the real self that it never emerges as the strong center of their lives it was meant to be? How can abandonment depression drive people into states of such unbearable loneliness, helplessness, and depression that they are unable to recognize themselves as valuable human beings? How can intelligent and wellmeaning men and women buy the false self's bill of goods: that avoiding the abandonment depression at all costs takes precedence over leading a balanced, rewarding, and creative life? . Abandonment depression is actually an umbrella term beneath which ride the Six Horsemen of the Psychic Apocalypse: Depression, Panic, Rage, Guilt, Helplessness (hopelessness), and Emptiness (void). Like the Four Horsemen of the Bible: Conquest, War, Famine, and Death, they wreak havoc across the psychic landscape leaving pain and terror in their wake. No wonder that many people prefer the unholy alliance with a strong false defender that can ward off the psychic havoc these Horsemen strew in their path. The intensity and immediacy of these six feelings can become unbearable in people with a severely impaired sense of self. To these people, the real self is under constant attack, and a siege mentality clouds their ability to perceive themselves and the world in realistic terms. In the eyes of the besieged self, the world, one's closest relationships, even one's own body can become the enemy. The world appears to be a hostile environment, so alien and threatening that the self is like a `stranger in a strange land,' uncertain and ignorant of the standard techniques that others use to cope with reality. Relationships are stifling, engulfing, or always on the verge of breakup, leaving the self hurt and abandoned. . Everyone dominated by a false self knows each of these painful feelings to some degree. They create a panicky state of helplessness, of being out of control, and an inexorable need to feel protected and safe again, even in the pseudo armor of pathologic pleasure the false self forges for the embattled self. The false self unfailingly comes to the rescue, but the payment for `feeling safe' is the failure of the real self to develop autonomy. . The lack of support for the emerging self leads to depression. We have all encountered the garden varieties of depression, either in ourselves or others: dejection, sadness, gloom, the blahs, `not feeling up to snuff.' Different people describe feeling depressed in different ways, but in normal states of depression, we can usually sleuth out the causes and handle the depression by the successful tactics we have learned to use in the past. We do things to get our mind off it; take a walk, go shopping, read a book, turn on television, talk to someone else. We need `cheering up' and our real selves know ways to go about it. Sometimes we just have to wait it out, knowing it will pass. It is a mark of maturity that we can get through periods of depression either on our own or with the help of someone who understands us and has our best interests at heart. . The experience of the abandonment depression is far more serious and devastating than the forms of depression that come and go in the course of our daily lives. In the throes of the abandonment depression, a person will feel that part of his very self is lost or cut off from the supplies necessary to sustain life. Many patients describe this in graphic physical terms, such as losing an arm or leg, being deprived of oxygen, or being drained of blood. As one patient put it, `I felt as though my legs would not work so I couldn't possibly leave the house, and when I went to fix lunch I just knew that I wouldn't be able to swallow. And if I did I would probably throw it back up.' . At the darkest level of this depression, a person can despair of ever recovering her real self, and thoughts of suicide are not uncommon. When one is brought low enough repeatedly, or for an extended period of time, it becomes increasingly harder to imagine oneself happy again or able to push through life with the strength and confidence with which the reasonably healthy go about their daily living. At this point a person can teeter on the brink of despair, give up, and consider taking her own life. If the separations they experience in their external lives are painful enough to reinforce their feelings and fear of abandonment, some will commit suicide. . In therapy, the first expressions of depression are usually not so grim. Patients often toss off their situation with statements like `Life is boring,' `I'm numb,' `There are no feelings in me,' `I always feel down even when I'm doing things I ordinarily like do ing a lot.' The common characteristic is that they seem not to derive any satisfaction from their lives. They feel cornered by duties and activities that do not trigger enthusiasm or interest. Even when they have free time to do what they want, none of the plans or activities they occasionally dream about spark their interest. Things they thought they would do, given the chance, now seem unexciting, meaningless, or too threatening. The numbness is pervasive and unending; and they can't seem to break out of it. On the surface it appears to be a strong attack of the blahs. . But the blahs alone don't bring people into therapy. There are deeper rumblings than the patient or the therapist can detect in the initial sessions. The roots of depression push farther into the past than seems apparent. In time the true sources, eating away inside, make themselves known. But initially they are well defended by the false self. . `Life had no meaning for me,' said Ted, 20, who had dropped out of college because of severe depression and an inability to apply himself to his studies or his part time job. He was at a standstill. `I suddenly realized that I had no motivation to study; I began to wonder why I was in school. Was it just because I was conditioned to go? I had no goals. I looked at myself and realized I was so sensitive that I considered everything an insult.' . As he put it, he would always look at things from other people's points of view, rather than his own, then wonder why he didn't feel that he was ever expressing his real self. Even sex had no pay offs for him. `I could sleep with a girl, but it had no meaning for me except the physical kicks. I couldn't look a girl in the eye and be open with her.' Eventually, in therapy, Ted realized why not. He had never been able to be himself. . It is the nature of the false self to save us from knowing the truth about our real selves, from penetrating the deeper causes of our unhappiness, from seeing ourselves as we really are: vulnerable, afraid, terrified, and unable to let our real selves emerge. Nevertheless, when the defenses are down and the real self is thrown into situations calling for strong self assertion, situations that trigger the repressed memories of earlier separation anxieties and feelings of abandonment by the mother, the serious nature of the depression is glimpsed and felt. At this point it is not uncommon for the patient to panic and slide down to the very bottom from which he convinces himself he will never recover. . A successful 38 year old lawyer whose wife of twelve years was leaving him because she was tired of being ignored (which came as a surprise to him!) described his sense of loss in very graphic terms. `It would be like my hand being cut off from my wrist. How would I be able to live with only one hand? How could it live without me? We need each other. I wouldn't be able to live without it.' He admitted later that he had married to set up `another home like when I was a boy, so I could devote myself to my legal practice like I used to do my schoolwork when I was a kid.' He showed little concern for his wife's needs, and his false self had persuaded him over the years to build up his life around busyness and self centered activities that brought him gratification and praise from others. Needless to say, his wife had been a primary source of praise. And now she had had enough of it. Without her, he could not imagine living, certainly not in the style to which his false self was accustomed. . Depression and rage ride in tandem. As depression intensifies and comes to the surface of awareness, so does anger. At first, most patients cannot pinpoint the reasons why they are angry. The target of their rage is rather diffuse and projected on outside sources. People describe themselves as being angry at life or the world in general, or just angry. Contemporary life is filled with plenty of frustrations that breed justifiable anger and resentment. In fact, not to be angry at something in today's society would seem a bit strange. This brand of anger is quite normal; and with a little reflection, the specific causes are soon discovered; specific injuries, frustrations, put downs, disappointments. A mature man or woman can recognize these and control the angry response in those situations where it would not be appropriate to indulge it. However in these patients, life's ordinary frustrations are used as a target upon which is projected a deep inner rage. . Anger that is part of the abandonment depression, however, has more damaging consequences. In the case of one young woman, anger led to physical and emotional collapse. As she put it, `I would get so angry, I just couldn't protect myself from it anymore. I'd start to shake and black out. I felt a craving, like heroin. I would convince myself that I couldn't make it, that I was totally helpless. I needed help, like alcohol or a drug. I just wanted to roll up in a rug on the floor like a baby. That's why I shake. I can't control that feeling, that anger. I'm afraid I'll act like a baby...either go home and drink to block it out or lie down on the floor and cry.' In this patient the intensity of the anger caused bodily shaking. She was helpless in dealing with this anger and turned it against herself. Feeling like a baby, reliving childhood strategies for avoiding painful feelings, comes easily to her and to many patients trying to avoid abandonment depression. Their anger is long lasting, building up from painful childhood experiences that may not be easily recalled because they are too solidly defended against. . Eventually, in therapy, the patient begins to focus this anger more specifically. Undifferentiated anger becomes targeted: at one's job, a colleague, a neighbor, one's mate, in the here and now. But this is just the beginning because the false self is still performing superbly, camouflaging the real target, the infantile feelings and memories beneath a tightly woven network of self destructive activity and thinking. It argues relentlessly that the root of the problem is minor and should be ignored, that `mature' men and women would not get so upset over something so trivial, that one's equilibrium should be maintained even if it means placing unreasonable limits on personal hopes and dreams and accepting life in a diminished form. And all the while, the hidden scenarios from early childhood that laid the pattern for the anger, now too painful to recall, are cleverly concealed. . The more depressed a patient becomes the angrier he gets, and eventually the real seeds of the anger are uncovered: incidents in the first years of life when the real self was trying to emerge and failed to do so. When the rage reaches a peak, a person can actually entertain homicidal fantasies. As suicide seemed appropriate for the bottoming out of depression, so homicide seems to be the only solution when anger and rage reach the levels beyond which they can no longer be endured. . An attractive 27 year old executive secretary named Anne complained to me that her life had fallen apart in the last six months. She was alarmed over her mounting anger at her husband who was becoming more and more involved in his work at a large electronics company. He seemed to her unfeeling and selfish and blamed his long hours on new contracts and foreign competition. According to Anne, he wasn't in the least concerned about her own needs. She was seriously questioning whether she wanted to spend the rest of her life with him. The more she thought about how bleak her future married to him looked, the more furious she grew at herself and at him. To assuage her feelings, she resorted to drinking and smoking pot. . Eventually she began an affair with a man at work. This man had several other relationships going, which she knew about, but Anne convinced herself that he really did love her more than any other woman in his life, even though he was not the type to get very close. In a way, that suited Anne just fine. She came to admit that she grew angry when anyone got close to her, and then she would withdraw. Overly sensitive to criticism, she assumed that no one could possibly like her if they knew how angry she was down inside. . Anne was trapped in the bind of needing intimacy but fearing rejection so much that she could not permit anyone to get close to her. She had an uncanny radar system poised to detect any real candidate for a relationship. Unable to tolerate the possibility of rejection, she would torpedo the relationship before it ever got a chance to surface. Anne's situation is not uncommon. The false self has a highly skilled defensive radar whose purpose is to avoid feelings of rejection although sacrificing the need for intimacy. This system is constructed during the first years of life, when it is important to detect what would elicit the mother's disapproval. With the proper therapy, people like Anne come to understand their self sabotaging patterns of behavior and change them. . Rage and fear lead to panic. We have all experienced it at one time or another. We get lost in the woods on a camping trip, we watch a son or daughter ride a bicycle too fast out into a busy intersection, we imagine we won't get an important report finished by the boss's deadline. These are all normal moments of panic, arising from the defense mechanism that warns us of danger so we can take the necessary steps to avoid it. Without such healthy fear, and caution, we would probably not have survived as a species. . As part of the abandonment depression, panic and fear operate on a more insidious level, arising not from legitimate and present dangers but from an abiding and unconscious fear. The false self plays its deceptive role, ostensibly protecting us but doing so in a way that is programmed to keep us fearful, abandoned, losing support, not being able to cope on our own, not being able to be alone. . Pam, the 19 year old college freshman, dropped out of classes because of depression and panic. Since childhood she had indulged in cannibalistic fantasies in which she was sometimes the victim, sometimes the cannibal. Part of her impaired self image was that she was worthless, nothing more than a bug or insect whom nobody loved and who could be wiped out as easily as one swats a spider or steps on an ant. `I feel everyone's angry at me. I'm frightened that I'll be attacked. I feel like I'm an insect, a bug, unable to defend myself.' . Panic feeds on the fear that we cannot express our anger over abandonment. It can be a claustrophobic strangling of energies, a tightening up of options: either we express our anger and risk losing the love of others or we deny the anger in order to remain in the helpless state of dependency and hold onto others. As the panic grows, patients report that it feels like facing death or actually being killed. Often this anxiety will be channeled into psychosomatic disorders such as asthma and peptic ulcers, each being a perfect metaphor for the underlying fear. The asthmatic experiences vital supplies of oxygen being cut off, and breathing understandably becomes strained and difficult. A person with a peptic ulcer is often hungering for emotional supplies that were lost in childhood or that were never sufficient to nourish the real self. As an adult, she is unable to find sources to supply the needed emotional support or to get through life without it. . Fear plays an important role in the lives of people dominated by a false self. In the early 1970s I was amazed at how many patients were mesmerized by the then popular novel The Godfather. Of course, as a best seller, the book appealed to many people who were not victims of a false self, but the degree to which patients were attracted to the characters and problems in the book was a clue for me to something serious going on in their own lives. The book, describing the Mafia's use of terror and fear of death to discipline and enforce compliance, portrayed in concrete terms a key theme that dominated the patients' own stories about their lives. Like the haunted and stalked victims of the Mafia's vengeance, my patients clearly understood the score: Comply, and you receive rewards. If you do not comply, you are killed. . A person living with a death threat, or what is perceived as a death threat, hanging over his head necessarily leads a fearful life in which every move to express himself, to allow his real self to emerge, is accompanied by the need to look over his shoulder in fear and panic. In therapy, panic can escalate as the patient slowly becomes aware of the depression and anger that have been bottled up over the years. The false self has blocked any expression of these feelings for so long that whenever they do manage to surface, even in the slightest way, the resulting panic can be paralyzing and terrifying. Fear of letting these feelings out in the open, even in therapy, can mushroom into panic proportions. . Guilt is the `fifth column' behind the patient's front line of defenses. The Horseman Guilt is not the "reasonable" guilt that a person feels when he genuinely does something he believes wrong...guilt that is appropriate for an injury or harm caused another. Appropriate guilt for the right reasons and in the right degree oils the wheels of society and keeps us civilized. . The Horseman Guilt is another matter. It is fed by the guilt we internalize in early childhood from the disapproval expressed by the mother for self actualization or individuation. It is then reinforced later in childhood and in adolescence. As the 30 year old woman we met at the beginning of this chapter described it, growing up is wrong. Becoming an adult is actually sinful. She goes on to explain, `When I assert myself rather than comply, I feel that I am nasty and impudent and that everybody will be angry with me. All the responsibilities and pleasures of adulthood are connected. If I choose one, I choose them all and lose my innocence. In other words, having sex is like lying, stealing, or rejecting the decent, wholesome little girl that I tried so hard to be for so many years.' . Even after striking out on our own, a strong, reprimanding voice, fixed in the psyche, reminiscent of parents, teachers, and authority figures from the past, can echo down the corridors of time in our daily lives when we entertain those special thoughts and wishes we know would, in the past, elicit disapproval. The real self's genuine urges, however (starting a new career, beginning a relationship with someone, moving out of town, spending an evening away from the family, spending a little extra money on a new hobby or pastime) should not produce guilt feelings. When the false self is solidly in control, those harmless, natural desires for self expression can trigger the voice of warning, the rebukes, the disapproval we have kept locked in our psyches over the years. . In people who have a strong sense of their real selves, such undertakings do not provoke guilt; or if they do, the real self calmly recognizes it as an echo of mother's or father's disapproving voice and perhaps even laughs at it for coming up inappropriately. Operating from their real selves, such people put aside the incipient guilty feeling and proceed as they wish. For people with an impaired real self, however, the guilt produced by this warning can be as paralyzing as it was when they were five years old. They feel guilty about that part of themselves that wants to individuate. Not being able to face up to the internalized guilt trip, these individuals will suppress making any moves in the forbidden direction and resort to the old familiar clinging behavior that they remember made them feel safe and good years ago. . In some cases, especially among adolescents and young adults, clinging behavior may be directed to the actual mother, which reinforces all the more vividly a person's sense that she is not strong enough to carve out a healthy, independent lifestyle. In other cases, the clinging may no longer be to the real mother, but to another person who represents security and approval. In effect, we expect someone to take care of us like a parent whether that person wants to or not. In either case, the false self argues convincingly that clinging is the only reliable strategy to avoid feeling guilty. . Helplessness springs from the patient's inability to activate his impaired real self to deal with these painful feelings. Everyone is helpless at one time or another. We need other people for services, knowledge, and companionship. As members of society we come to rely on others in those areas where we have little or no skill or expertise. Ordinarily such experience reminds us that we are not in total control of our lives or totally independent. As healthy individuals we accept these limitations and balance feelings of helplessness with confidence that in some areas we can and do support ourselves and satisfy our own needs. Healthy individuals evaluate the situation, recognize the extent of their own competence, and get the help they need, knowing that at other times they will be capable of handling things on their own. . Helplessness as part of the abandonment depression, however, is abiding and total. Although specific incidents can trigger it, it is not caused by specific incidents, but persists like a gloomy backdrop to life, casting a pall over most activities and life situations. Unlike a healthy man or woman who says, `Well, this is one of those situations at which I'm not very good,' the false self says, `You are totally helpless and good for nothing.' . Penny, a woman in her late 20s who had just found a good paying job and moved out of her parents' home, described her feeling of helplessness to me this way: `It's hard for me to manage myself. I never did anything completely for myself before I moved to the city. In high school and college I had no responsibilities. This is the first job that I have had with my responsibility. I feel that now I have to show initiative and set my own goals. My life has been so structured. I never had to do it before. I never had to spend time alone. I think other people should plan for me.' . Penny had a boyfriend at the time and hoped that by clinging to him she would be able to put some structure into her life. `I hate the idea of being responsible and taking care of myself. I don't think I can; it seems that I'll break down. That's why I need Rod so much. I can't take the pressure. I'm an empty personality. I'd rather be an extension of Rod. I've always structured my life for someone else to do it for me.' Penny's real problem of course eventually came out: she had an impaired real self. The way she put it was, `I've never been rewarded for being an individual, for being myself. I am also afraid of being depressed and alone with myself. I never developed anything in myself on my own. I did well in college and had lots of interests, but they were all for everybody else's approval.' . Mastery depends upon self assertion, but asserting oneself brings on the fear of abandonment. It becomes an inescapable cycle that can twist one's thinking patterns for the rest of one's life even in therapy, where it becomes translated: `Getting well' means taking charge of my life, but I can't take charge of my life until I can get over feeling so helpless, and I must be helpless or why am I still in therapy?!' And of course feeling helpless works...it is an essential feature of the abandonment depression which drives the person into a clinging relationship either with a mate, a friend, a family member, or a therapist. . Many people assume the passive, helpless role in relationships, looking for someone to take care of them rather than someone who will love and respect them as equals. The false self will keep a person playing the `little girl' or `little boy' who still needs to be told what to do and, in addition, needs a wiser, firmer hand to help him do it. At work the false self can prevent us from assuming more responsibility, applying for promotion, making decisions, standing up for what we think is right even though others around us disagree. Many people dominated by a false self stay in unrewarding jobs that neither challenges their talents and skills nor pay what those skills could command in a different job situation. To ward off feelings of abandonment, the prisoner of the false self will stay underpaid and underworked and then wonder why his or her job provides so little satisfaction. . The problem is much more serious than just the universal penchant for griping about work. It is part of the human condition to complain about jobs and the need to work for a living. A healthy real self recognizes frustrations and problems at work and either resolves them or accepts them as necessary deficiencies in an otherwise rewarding situation. For the false self, however, the lack of satisfaction has little to do with specific problems intrinsic to the line of work and more with the internal fear at activating the real self. . Peter, a 40 year old president of his own large company, rose to the top because of his superior skills as a salesman, based on his need to please others; a case of the false self succeeding in business without really trying. Unfortunately, another side of Peter's false self, the helpless self, prevented him from managing the company efficiently and with any sense of personal satisfaction. Because of his need to please others, he found himself paralyzed in situations where he should have been confident and assertive. He could not face up to the inevitable risks involved in saying no. . Early on as he was founding his company, he established a board of trustees, as was proper, but his false self totally misused it. Convinced he could not make decisions on his own, he relinquished much of his authority to the board, which he considered a superior authority, rather than a sounding board. He constantly sought the members' approval and expected them to make decisions that were properly his responsibility. The board naturally resented this, since the members had accepted their positions on the assumption that they would not be involved in the day to day decision making process. In time, they came to resent Peter and conspired to defeat him. Because he played the helpless child, hoping the board would take care of him, Peter found little genuine satisfaction in his work. But he had little hope of resolving the dilemma as long as he could not assert his real self enough to gain control over both his business and personal affairs. . A life ruled by the false self's defense against inner emptiness ends up truly empty. However, it is far from empty of pain, suffering, depression, guilt feelings, and elaborate schemes to deny one's own best interests. Many patients describe themselves, their thoughts and feelings, as `numb.' They trudge through daily tasks as if drugged, unable to find anything but a looming void at the center of their lives. As it emerges, the false self internalizes an unwarranted amount of anger and devaluation from parents, teachers, peers, and unlucky life experiences. In time those negative attitudes become the patient's own and come to dominate his way of viewing life and of approaching challenging situations, undermining or stifling positive attitudes and self concepts and reinforcing the feeling of inner emptiness. Unable to recognize his strengths and creative abilities, the individual comes to imagine that there is really little inside but the faults, failures, and disappointments that he has come to expect since childhood. These self destructive attitudes provide a poor foundation to build on, and people who view their entire lives as having never really gotten off the ground see no progress and imagine themselves still operating very much as they did when they were children. When they ask themselves, What have I accomplished in my life? their typical reply is, Nothing. . Jean, an editor of a women's magazine, felt that her life was totally empty even though she was a highly skilled writer, with a long list of freelance credits behind her and a job with a prestigious publication. But her days at the company were long and boring. She could do her work with her little finger. In her mid forties, she wondered if she should switch jobs or careers, or possibly go back to freelancing, which had given her so much satisfaction when she was younger. The thought of freelancing, however, terrified her. Jean's problem was that she took the staff job because it gave her the security she needed with the highly structured authority system comprised of several superiors who could organize her day, delegate her jobs, and keep on top of her to make sure she met deadlines. . Clearly Jean was overqualified for her position, but her false self convinced her that to satisfy her dependency needs she should stick with it. Eventually she grew more negative about herself and came to believe that her earlier success as a freelance was due to a fluke of good luck. She became convinced that she had very little real talent and that she was basically good for nothing but the unexciting job at the magazine. When the false self calls the shots, as it did in the case of Jean, we fail to recognize our own self worth. We belittle our talents and skills and we can easily come to settle for second best, overcome by the gaping void within us, which we are powerless to fill with meaningful activity or relationships. For such people, life seems empty and worthless. They have too much time on their hands. The hours and days drag on, and their lives go nowhere. How do they fill this void? Many adopt a self destructive lifestyle similar to that of drug addicts. The junkie uses the phrase `taking care of business' to refer to all the activities involved in obtaining and taking heroin. Getting money, obtaining the drug, avoiding the police, getting back home safely, shooting up, and enjoying the `high.' What those of us who know little of this world fail to realize is how time consuming and self absorbing these activities can be. An addict's total daily activity is devoted to `taking care of business.' People with no real self are not as self destructive as the heroin addict since they can function in daily life, but they resemble the addict in that `taking care of business' absorbs a large part of their day. Hours are spent `acting out' in order to avoid the abandonment depression. They have learned to engage in a long string of pathologic activities that function like a kind of armor to protect against the emptiness, helplessness, and depression that would otherwise consume them. Avoiding the abandonment depression in these self destructive ways is their `fix.' Their entire day is given to it. It's their `business.' . Some people's false self will actually lure them into drugs, alcohol, or abusive behavior. Others sink into passivity or deadend activities, such as excessive daydreaming, mindless shopping, overeating, or unfulfilling sexual liaisons. Some will cling to people, familiar places or objects such as furniture, clothing, art, or daily schedules and routines that do little to further the meaningful activities they are ostensibly engaged in. Their primary purpose is to avoid the fear associated with independence and self expression...fear of the abandonment depression. . . . PORTRAIT OF THE . NARCISSIST . . . . There is a second type of false self that, at first glance, seems totally unrelated to the deflated false self. In fact, it appears to be its polar opposite. This is the `inflated false self' of the narcissistic personality disorder. On the surface the narcissist is brash, exhibitionistic, self assured, single minded, often exuding an aura of success in career and relationships. Narcissists often seem to be the people who have everything: talent, wealth, beauty, health, and power with a strong sense of knowing what they want and how to get it. We have all known people like this, and it is not uncommon to wonder, perhaps even with a touch of envy, if underneath the grandiose style of behavior the person is not actually insecure, and perhaps miserable. In fact, the narcissist's personality is based on a defensive false self that he must keep inflated, like a balloon, in order not to feel the underlying rage and depression associated with an inadequate, fragmented sense of self. If the balloon springs a leak, he can feel as miserable and insecure as someone with a deflated false self. Whereas the borderline's false self is preoccupied with fear of and vulnerability to the abandonment depression, the narcissist's false self is characterized by an imperviousness to depression. In fact, a common impression given by the narcissist is that depression is simply not a part of his life. . The narcissist's false self is more successful than the borderline's deflated false self, which is really not very competent. It talks a good game, but cannot consistently defend the borderline from experiencing the abandonment depression. Separation stresses occur, the defenses crumble, and depression moves in. In the case of the narcissist, as long as the false self is adequately inflated, it has the ballast to keep him floating high, oblivious to frustration and depression. Often the narcissists seems to be immune to life's vicissitudes, like a manic depressive locked into the manic phase, much to the admiration or envy of those around him. . If, then, the narcissist is so well adapted to his environment and appears to be master of his life, how can we say that he has a false self? From a closer clinical look, the illusory quality of the defensive self becomes apparent in three respects: the content of the defensive self, its motivation, and the massive denial of reality it requires. . The defensive self is characterized by self importance, grandiosity, and omnipotence. As we saw with Stewart in Chapter 1, he could not be happy unless he was the best; whether it was tennis, business, or the women in his life, he had to `score' and receive his trophies. For him life was a contest, not for the sake of winning itself but to use winning as a vehicle to prove his uniqueness and perfection and win the adulation of others. Both he and Daniel, the other narcissistic personality described in Chapter 1, admitted in treatment that they need control and perfection as a prerequisite to feel good about themselves. While most people value the admiration of others, that admiration is not their primary goal. Similarly, we all want to be in control, to succeed, and to do the best possible job. But healthy people value these objectives for their own sake and not merely as a means of obtaining admiration from others. To the outside observer, as well as to the narcissist himself who has not had treatment, these activities, such as spending an unusually great amount of time on one's work, appear to be realistically and appropriately motivated; that is, they seem to be engaged in for their own sake. However, this is an illusion. The motive is to use these activities to fuel the narcissist's need for perfection and uniqueness. . The narcissist is motivated by the continuous need for `supplies' to feed this grandiose conception of himself. `Supplies' here means quite specifically those activities and relationships that reinforce his grandiosity. The false defensive self is false in that it is based on a grandiose fantasy, rather than on reality, and it is defensive in that its purpose is not to cope or adapt to reality but to reinforce grandiosity in order not to feel depressed. Typically the narcissist is a restless person, pressured to keep moving to keep reinforcing his sense of grandeur. It's not uncommon for him to be a workaholic at a job that he does well. Having nothing to do is threatening, since it does not meet his need for reinforcement or fit in with his self image of being an achiever. The narcissist has firmly adopted the old adage that `not to move forward is to drop behind.' . The term narcissist comes from the Greek myth of Narcissus, a young man who fell in love with his own reflection, mirrored in a lake. Unable to pull himself away from the contemplation of his own beauty, he eventually starved to death and fell into the water, never more to be seen. The person with a narcissistic personality disorder reenacts in his own life two key themes of the myth: he becomes totally absorbed in his own perfection and in his striving for the narcissistic supplies that he needs to keep his image full blown and intact. Beneath the grandiose false self is an impaired real self whose development has been arrested, as was the borderline's, in an effort to find protection against an abandonment depression. The grandiose self guides the patient's feelings and behavior, obscuring or hiding the underlying impaired real self with its abandonment depression. The latter will emerge in psychotherapy. . Narcissistic supplies come from `mirroring,' or what we might call `reinforcing feedback.' The narcissist looks to others in his environment, and to the environment itself; clothes, car, home, office, to reflect his exaggerated sense of importance and perfection. He must surround himself with the right people who will appreciate and advertise his best qualities, announcing to the world that he is unique, special, adored, perfect, right. Wealth, power, and beauty in himself and those who are part of his life: family, friends, colleagues must also be perfect since their perfection highlights his own and justifies his grandiose image of himself. Many observers would rightly consider these attributes to be superficial and not accurate indicators of a person's real worth, but the narcissist takes them seriously, and as long as he has enough of them, he can continue to believe in his omnipotence. Many people may seek perfection, knowing it is impossible to achieve and that they can only strive for it. The narcissist, however, not only believes it is possible but claims it rather than seeking it. In other worlds, he is perfect and is entitled to have his activities and relationships reflect it. He doesn't have to work or struggle for it. Should he not receive enough supplies to justify this claim for him self, or if the mirroring from the environment is inadequate, his grandiose self is frustrated and the anger and depression that underlie it emerge. . The successful narcissist, successful in the sense that his perception of the world and his place in it manages to prevent him from questioning his importance, must be creative and imaginative, and often quite talented, to develop a lifestyle that will resonate to his grandiose projections of himself and fuel his narcissistic needs. . Creating this self contained system of reinforcement and refueling techniques is a major accomplishment in itself, requiring enormous energy and diligence; and when done well, it too becomes a source of gratification, contributing to the narcissist's grandiose sense of himself. As he basks in the comfortable habitat that he has constructed, an airtight cocoon of narcissistic enjoyment, life can seem pretty good. In fact, he does feel good; he feels secure, and as long as nothing punctures the closed circle, he will not be aware of any serious personality problems. He thinks he has it all, and those who know him would agree, since he has carefully selected and enlisted them to be part of his world and thereby buttress his view of himself. For example, there was a widespread notion among General Douglas MacArthur's top staff that his role in postwar Japan was the equivalent of the Second Coming of Christ. The fact that very few people outside his staff thought so suggests the very real possibility that MacArthur carefully hand picked his staff to mirror his own grandiose image of himself and his role in history. . Underneath this pursuit of mirroring and narcissistic feedback lies a massive denial of reality, different from the borderline's in ability to deal with reality but sharing similar self destructive habits that prevent the real self from emerging. Whereas the borderline denies his real wishes and goals in order to avoid self activation that would bring on the abandonment depression, a reality the borderline knows only too well, the narcissist denies weakness in himself and the reality of depression altogether. . Since the narcissist will not admit that his well constructed environment can frustrate him, he cannot allow himself to be deflated by feelings of depression. He denies problems and setbacks, writing them off as something wrong with the world in general or with other individuals, never considering that they might spring from a weakness in himself or a flaw in his self concept. The narcissist's utter conviction that he is special and omnipotent blinds him to any evidence that contradicts this conception of himself. For example, when a narcissist's wife leaves him, he does not get depressed; he gets angry. If he got depressed, he would be admitting to weakness. Anger, on the other hand, implies that he has been wronged, and hence is in the right; it can be viewed as a strength. . But should a severe enough crisis occur, one in which anger cannot displace depression, the narcissist may end up in therapy where he will have to step out of his cocoon and try to activate his real self. It then becomes painfully apparent how impaired that self is in dealing with reality. All the real self's capacities are as impaired as the borderline's. When the narcissist forgoes the seeking of .narcissistic gratification and tries to activate the real self to undertake an activity for its own sake (rather than for mirroring) or to enter a relationship to care about the other person (rather than for mirroring), his facade crumbles and his real self impairment is revealed. . There is a healthy, appropriate narcissism without which we could not invest our unique self representations with the positive feelings necessary for self esteem or self assertion, and for pursuit of our own unique interests, ideals, and ambitions. Normal narcissism is vital for satisfaction and survival. All the capacities of the real self come under the heading of normal narcissism, which in effect is the capacity to identify what you want and need, get yourself together, and go after it, while also taking into account the welfare of others. This is the healthy way to feel good about yourself. This important distinction between healthy and pathologic narcissism has been blurred by the tendency to see all narcissism as pathological. . The difference between healthy and pathological narcissism can be illustrated by the difference between a healthy and a narcissistic relationship between a speaker and his or her audience. People who really enjoy public speaking or lecturing claim it makes them feel good. They are asserting their real selves by presenting their ideas to a group of people. Their motive is to present their ideas, to stimulate and educate their audience. The source of their feeling good lies in their success in achieving this goal. But if the motive for lecturing or teaching is merely to exhibit the speaker's greatness, and the audience's role is not primarily to learn but to mirror the lecturer's greatness and importance, then it is a narcissistic motive. And not just lecturers are narcissists; members of the audience can be narcissistic, too. It is appropriate to go to a lecture or take a class with the desire to learn or increase your knowledge and understanding. It is narcissistic to take a course from an important professor because it enhances your greatness to be in her class and you expect the professor to acknowledge how special you are to have gotten into the class. . A revealing example of the perfect mirroring needed by narcissists occurred several years ago when I was quoted in a New York Times article about the major symptoms of the narcissist personality disorder. Within days I received 12 phone calls from individuals who had read the article and suspected that they might have the disorder. Each came to see me for an evaluation, which as it turned out, proved them right. They were narcissistic disorders, and on finding out, they each asked if they could come for treatment. I agreed, but since I didn't have time in my schedule to take on 12 new patients, I suggested they see one of my associates in the Masterson Group. Not one returned to begin treatment, which indicated that they were not truly interested in treatment for its own sake, but rather were looking toward me as a narcissistic supply. Because of my reputation in the field and because I was quoted in the New York Times, being in therapy with me would reinforce their grandiose images of themselves, whereas being in therapy with anyone else would be seen as weakness. . The parable of the 12 narcissists who never returned clearly contains an element of humor, and in fact, the common tendency to make light of the narcissist provides some insight into the narcissist's problems and into the healthy individual's relationship to the narcissist and to his own narcissism. In early development (during the practicing phase) we all existed in a union with our mothers, in a condition of narcissism. The mother and child make up a perfect unit that rules the world, albeit the narrow world of the nursery. But to us it was the only world and because we perceived ourselves as part of the mother who was supreme master of that world, we experienced an all powerful sense of control. . None of us really wanted to leave that heady state, even though it did finally come to an end. Parts of it, however, we never gave up, and whatever vestigial memory of that time remains reminds us that we have never had it so good since. The narcissist, on the other hand, never gave it up. He presents the illusion of having it all, and for that there is a natural tendency to envy him, and a certain delight in seeing him lose it. We enjoy watching the narcissist get his due, be one upped, reveal that he is not immune to frustrations. The narcissist, however, would not share the joke be cause he cannot admit his vulnerability. The emperor must not be told he has no clothes. In therapy I often use humor with borderline patients who respond well as it helps them to gain an observing distance from their problems. Humor also serves as a respite, a much needed island of amusement in a situation that is like a sea of depression. But humor will drive the narcissist away. He gets angry and aggressive. His omnipotence and grandiosity are not joking matters. . To illustrate further how the sense of entitlement can skew the narcissist's perception of reality, consider the impact the rejection of a doctoral dissertation would have on three different Ph.D. candidates: a person with a real self and its proper sense of entitlement, a candidate with a borderline personality disorder who has no sense of entitlement, and a narcissist with an exaggerated sense of entitlement. In most cases, a student with a healthy real self, told that his thesis lacked sufficient information, was not well argued, and in some places lacked clarity, though perhaps disappointed, would realize that the purpose of submitting the thesis at that time was precisely to learn its deficiencies so that they could be corrected. The candidate would than return to the project with creativity, commitment, and self assertion to find ways to obtain the necessary information, improve the writing, and resubmit the thesis. Her adequate sense of entitlement and self esteem, together with the capacity for self assertion, would fuel this process. Then as the student realistically mastered the task, her self esteem would he reinforced. . Because the borderline student has difficulty with self activation, assertion, commitment, and creativity, he might procrastinate and delay submitting the dissertation way beyond the deadline. He would feel that the critical comments were a rejection not of the paper but of himself, a confirmation of inadequacy. This would precipitate the abandonment depression to which the candidate would respond by helpless clinging to a teacher or other authority figure or by backing out of the program altogether. This, of course, would further reinforce the inadequate sense of self and the notion that he was not entitled to a doctoral degree. . The narcissistic student would confidently submit the thesis to the advisor convinced that it would get a glowing report. She would view the criticisms as a personal attack, and the situation would trigger her underlying anger. The candidate would defend by seeing the committee as harsh and unfair or devaluing their ability and right to criticize, or both. She might contest the decision or withdraw from the program. The reality that the paper was defective and in need of more work would be denied. . Not only are the narcissists' work lives and sense of self distorted by their need to bolster the false self, but their relationships always have hidden agendas, too. On the surface is the illusion that the individual is friendly and sincere; but underneath, the relationship exists for one primary purpose, namely to keep the narcissist's grandiosity reinforced. Other people exist in the narcissist's life to gratify her, to be used and exploited, to mirror the narcissist's image of herself as being unique, special, and important. . Because she understands her own narcissistic needs so well, the narcissist is extremely sensitive to the narcissistic needs of others (everyone has them although not to a pathological degree) and she manipulates them by gratifying their narcissism so they will then gratify hers. She knows that we all like to feel good about ourselves and that a narcissistic wound not only hurts but is hard to accept. Knowing this, she can easily exploit the narcissistic urges of others to get what she wants. Often others cannot see through her ploy, since she comes across as clever, charming, charismatic, and, on the surface at least, like a friend who makes them feel good by complimenting, cajoling, and admiring them. For example, an aspiring actress might use all her personal and physical charms to get the attention of a director in order to get a part in a play. Their affair will continue for the length of the play's run, but when the production closes, so does the relationship. The actress will then leave the director because the narcissistic goal of the relationship is fulfilled. . The reason the narcissist finds it impossible to commit herself emotionally and sincerely to another human being is that to do so would activate the underlying emptiness, rage, and depression of her impaired real self. There is little in her that is not self absorbed and self centered. To become emotionally involved would be to direct her feelings and interests to another, and as far as she is concerned there is no `other' in her life. . We have all encountered people with inflated false selves in social settings where they appear warm, interested, and open but only when they are talking about themselves or their own interests. They do not ask us about our interests or life, except in an obviously formal way out of deference to social norms or in order to manipulate us into becoming a source of narcissistic supplies. A further indication of their true motivation is that if we stop asking them about themselves, the relationship quickly disintegrates and they find ways to avoid us. When the narcissist shows his true hand in these situations, it reveals a real lack of empathy for others. _____________________________________________________Should be Second Page in VR book/Portrait of a Narcissist. To demonstrate this lack of concern for others to my classes, I often ask all those who think they have a substantially genuine interest in others in addition to their interest in themselves to hold up their hands. Everyone holds up his hand, which I suppose is to be expected in a class of students hoping to become psychotherapists. Then I tell them that this is why they will have trouble understanding how the narcissist ticks. He or she has absolutely no interest in others for themselves. Narcissists are completely foreign to most of us in this regard. They do not realize or accept the fact that the world contains other human beings who are emotionally involved with each other and with their own legitimate needs and interests, which are just as important as the narcissist's. And yet the narcissist has craftily learned how to survive in this world be cause it is only through other individuals that he will obtain gratification and maintain his inflated sense of self. Consequently, his narcissistic antennae are always extended to seek out possible sources of feedback that will confirm his notion of his own superiority and importance. . So the narcissist is in a peculiar and threatened position. He needs others to supply his narcissistic needs, but he must cultivate his relationships carefully so that they don't require too much emotional involvement or commitment. To invest his emotions in a relationship would activate a real self too impaired to follow through on the consequences of those emotions, one of which is the possibility of being hurt. . At work the narcissist needs the same mirroring he needs from personal relationships, usually in the form of praise and admiration for the great job he is performing. The narcissist expects this praise from supervisors as well as from colleagues and coworkers. Anyone who has ever worked for or with a person with a narcissistic personality disorder knows how frustrating and stressful the situation can become. In spite of the fact that the narcissist usually does a good job, he is not always pleased with the work of others. Since he can do no wrong, any difficulties have to be due to others. . It is relatively easy to spot narcissistic personalities in politics, business, and social movements. The limelight that goes with leadership is a strong magnet for narcissists, and even though success requires long hours and grueling work schedules, the payoff is worth the effort to them. Frequently, their staffs are overworked and are expected to produce perfect or near perfect results. The narcissistic leader or boss elicits martyr like devotion from followers by manipulating their desire to be part of his achievements. With rhetoric and ritual the narcissistic leader creates a sense of excitement and purpose and draws on his workers' sense of mission. He is often fulsome in his praise of their devotion. In the end, however, the shrewd observer can see through the empty praise and the facade of concern for supporters, for ultimately the narcissistic leader is only concerned about praise for his own achievements, and values others only in so far as they fulfill their role in promoting his own glory. . The narcissist tends to be a workaholic, as we have seen in the cases of Stewart and Daniel, and perfect mirroring for the workaholic requires that he be surrounded by other workaholics who can match his drive and enthusiasm for industriousness. If you have ever worked for a boss who was a workaholic, you may remember the open or implied pressure on you to show as much commitment to the job as he did and the disappointment when you didn't. One often gets the impression that no matter what you do, it isn't good enough, and on those occasions when it is good enough, the narcissistic boss manages to deflect the credit to himself. . A patient of mine who was the third ranking officer of a large company was expecting to be made president. When he was by passed for the position, he asked why and was told that his own work was superb but that he had miserable relationships with employees. They complained of his incessant pressure for performance, his unawareness of their needs, and his intolerance of mistakes. This took him by surprise. That night he went home and related the story to his wife who, to his further amazement, confirmed the company's evaluation of him, pointing out that his relationship with her and their children was just as terrible. He was rarely home, was cold and aloof when he was, and paid no attention to the needs of others in the family. At his next appointment with me, he wondered what was wrong with so many people that they couldn't see how wonderful he was! . There are three levels or types of narcissism, high, medium, and low, each referring to the degree to which the individual is a successful narcissist, successful from the narcissist's point of view, that is. The successful narcissist is the one who can make the environment continuously resonate to his narcissistic needs. People respond with praise and admiration; work provides a stunning showcase for the narcissist's talents and abilities; his possessions, hobbies, and pastimes keep him buoyed up emotionally and help him sail through life. . The high level narcissist rarely comes for treatment. Everything is going too well for him and he manages to rebuff disappointments in his usual self centered manner. Often he is in a profession that has considerable narcissistic supplies built right into it. If the narcissist finds the right niche in life, he can go for years without realizing that his life is empty at its core and that beneath the narcissistic glitter there is an impaired real self. Acting, modeling, politics, and other professions that are by nature exhibitionistic can be very protective environments for the narcissist since they offer continuous feedback and keep the narcissist's balloon well inflated. (Of course, not all people in these professions are narcissists.) . It is remarkable what serious problems a high level narcissist can tolerate or ignore as long as his balloon is full. We are all aware of some politicians, for example, who are terrors to work for, whose families lead lonely and miserable lives because of the incessant campaigning, and yet who rarely appear concerned about the very people on whose efforts their careers depend. Nothing seems to bother them, because campaigning 16 hours a day is a turn on. A work and travel schedule that would exhaust the average person is an elixir for the narcissist. . The medium level narcissist has to work harder. She has not found the knack for creating a life environment that will provide the vital supplies and narcissistic feedback. She manages mainly through denial of these difficulties until a truly serious separation stress occurs against which she has no defenses. An unrelenting marital conflict, a painful setback at work, or a serious health problem is usually necessary to deflate her balloon and bring her to seek professional help. . Lower level narcissists have extremely poor defenses and tend to oscillate in and out of depression much like the borderline, and in fact may be mistaken for borderlines because of the symptoms they present on beginning therapy. It is only after the therapists probes the patient's intrapsychic structure that the difference is apparent. Whereas the borderline complies with others and avoids self assertion to gain approval, the low level narcissist seeks adulation, praise, and perfect mirroring. . The developmental roots of the inflated false self have not been studied as thoroughly as that of the borderline's deflated false self. There is still considerable speculation on how the narcissistic personality develops. It appears, though, that the narcissist suffers a developmental arrest prior to the emergence of the real self, between 18 and 36 months. How and why this arrest occurs is not always clear. . In some cases the mothers of narcissistic personality disorders are emotionally cold and exploitive narcissistic personalities themselves. They ignore their children's separation and individuation needs in order to mold the children to fit their own perfectionistic standards and serve their own emotional needs. The perfectionist mother needs a perfect child to act as a mirror for her own perfectionist self image. The emotionally cold mother needs a child able to function as perfectly as possible on his own to minimize the amount of time and emotion that she needs to invest in him. . The child's real need to separate and establish his own individuality suffers as he resonates with the mother's idealizing projections. Repeated and continual identification with the mother's idealized image of the child preserves the grandiose self image typical of the early exploratory phase, when the crawler/toddler feels the world is his oyster and nothing can get in his way to frustrate him, or cause him pain or dissatisfaction. In reality, of course, the mother is not perfect and neither is the world, but the child is blinded to the mother's failures and imperfections which, were he to acknowledge them, would cause depression. . For the narcissistic child, the fused symbiotic image he holds of himself and the mother is never split. Mothers of normal children teach them about the realities of life by introducing them to frustration experiences in carefully measured doses that gradually dispel the notion that the fused `grandiose child omnipotent mother' entity can go on forever. They deflate their children's feelings of grandeur and bring them down to earth. The mother of the future narcissistic personality never dispels this notion. . Thus, the fused, symbiotic relationship endures, and the child grows to adulthood perceiving himself just as omnipotent and grandiose as he was as a child. He identifies on the surface with the grandiose omnipotent mother image who can do anything. However, underneath this defensive, fused, grandiose self is the inadequate, fragmented, impaired real self with its rage and depression and the intrapsychic image of the angry, attacking mother who disapproved of his emerging real self when it sought self expression along lines other than the perfection and grandiosity that she required. When the child grows up, both of these intrapsychic feelings and images are activated and form the basis of his relationships with others: When others mirror his grandiosity he likes them; when they frustrate his need for mirroring, he attacks or devalues them. . A second possibility for the origins of the narcissistic personality disorder may be in identification with the father. When a child experiences the emotional unavailability of a mother who is particularly emotionally empty and unresponsive, he can use his experiences with the father as a corrective to rescue him from the resultant depression and the mother. The child transfers his fused, symbiotic image of the mother and himself, together with all the associated feelings and yearnings, onto the father in order to deal with his abandonment depression and preserve his sense of omnipotence which he doesn't want to lose. If the father is a narcissistic personality himself and the transfer occurs while the child still believes himself to be part of the omnipotent parents the child's grandiose self will be preserved and reinforced through identification with the narcissistic father. A healthy father, on the other hand, may help to limit the evolution of the child's narcissism. . Over the years I have discovered a variation on the narcissistic personality disorder that is difficult to identify and can easily be overlooked or misdiagnosed as something else. The closet narcissist does not feel that he can express grandiosity and self centeredness directly and openly as the brash, exhibitionistic narcissist does so well. The closet narcissist must find another person, group, or institution through which he can indulge his narcissistic needs while hiding his own narcissistic personality. The closet narcissist has the same intrapsychic structure (a grandiose self image fused with an omnipotent parent image) as the exhibitionist but the major emotional investment is not in the grandiose self but in the omnipotent other. Therefore this patient does not actively seek the mirroring of his grandiose self; rather he idealizes the other and hopes to receive their admiration, or simply `basks in the other's glow.' This is how he defends against his underlying abandonment depression. There are several possibilities as to how this happens. Either one or both parents are exhibitionistic narcissistic personalities and the child is required to idealize them to survive, or in some cases, the mother might initially idealize the child's grandiosity in the earlier stages and then attack it as the child gets older and comes into conflict with her wishes. . As an example of a closet narcissist, consider Frances, 47, who came to me after a long history of therapy beginning when she was 27. She had been treated twice a week for two years by a psychologist, she had seen a psychiatrist for a number of years, and tried gestalt therapy for two more years. Nothing seemed to work. She noted that she was constantly absorbed in other people and things outside herself and had to have a structure of daily activity as well as a constant supply of friends. Otherwise she felt empty, angry, and depressed. As she said, she needed `constant connection with and continuous stroking from other people.' . Frances was the second of three children from an economically deprived home. Her father was a quiet, withdrawn, self centered, perfectionistic clergyman who spent most of his time with parishioners. Her mother totally supported and idealized the father. In the family, his perfectionistic views were always `right,' and as a child, Frances felt he knew everything but for some reason was not sharing it with her. She claimed to receive even less emotional or intellectual support from her mother, whom she described as also self centered but demanding. . As an adult, Frances frequently felt helpless and alone even when she received positive feedback from her friends and activities. She was quite aware that she contributed to these relationships only because she enjoyed the positive feedback. When she was with others, she found herself engaging in behavior that would elicit their praise and admiration, even though it required activities for which she had, in fact, little interest or enthusiasm. One of her real interests was the piano, and her talent was almost concert quality, but she tended not to practice or take her interest in it very seriously. She admitted to being overly sensitive to criticism herself and yet constantly criticized her office help for not providing perfect mirroring. . She had had two ongoing relationships with very successful but self centered men, and experienced a severe separation when each man broke off the relationship. She fell into a deep depression and remained isolated for long periods of time. Frances thought that she loved each man and was surprised to hear from them that the reason they wanted to end the relationship was that they didn't believe Frances was capable of love. . Frances was a closet narcissist, unable to forcefully express her narcissistic self; she avoided self assertion and expression of the exhibitionistic, grandiose self. Instead she assumed a defensive posture of inhibition and passivity and allied herself with friends, men, and employees whom she hoped would mirror her own grandiose self representation. When they failed to mirror her perfectly, Frances grew depressed. . An examination of the roots of the narcissistic personality disorder today would be incomplete without considering the role of broader cultural trends and themes commonly blamed for, or equated with, this form of individual psychopathology. Recently, narcissism has been associated with all that is wrong in American society, beginning with the revolution of the sixties and ending in the self fascination of the Me Decade. In fact, the sociocultural swing toward a narcissistic society began much earlier. American society was born in revolution against what was perceived, at least from this side of the Atlantic, as authoritarianism, or the principle that the individual should submit to and obey authority simply because it is authority, not because it is right. The American revolution was fought against the authoritarian attitude of the British government over taxes, property rights, land use, and economic development; and so was born a society which in theory would champion the rights of the individual over the established powers. nevertheless, authoritarianism continued to flourish in childrearing patterns, in the schools, in the courts, in business, and in many social customs, particularly those governing relations between men and women and with minority groups. . One of the principal benefits of the activism of the sixties was the change in standards in all these areas; a change from authoritarianism to a greater emphasis on individualism and entitlements. These changes ostensibly created a better environment for the flowering and expression of the real self, in other words, healthy narcissism. But to what extent, then, does the sense of individual entitlement, now woven all the more tightly into the fabric of our society, also open the door for pathologic narcissism? Or to put it another way, does the resultant narcissism contribute to a unique and healthy American character, or is it a pathological national flaw? . The narcissistic disordered self will exploit opportunities for freedom and independence to gain narcissistic, not real, self gratification and will fiercely battle any authority that would infringe on the individual's sense of entitlement. Christopher Lasch in The Culture of Narcissism has chronicled how the pendulum of sociocultural values may have swung too far in this direction. There are elements in society, similar to the traits in the narcissistic self, that have gone beyond healthy individualism to pathologic self centeredness, which results in an erosion of realistic, adaptive social standards in favor of exclusive, obsessive self gratification. This inevitably leads to inner emptiness, isolation, and loneliness even if the individual does not have a narcissistic personality disorder. If one behaves as a narcissist, one experiences some of the narcissist's isolation and loneliness. __________________________________________________. Chapter 7. . THE CHALLENGE . OF INTIMACY . . . Intimate relationships are the bete noire for the person with an impaired real self, calling as they do for self expression, self revelation, and the ability to function independently while sharing with another human being. Invariably borderline and narcissistic individuals are unable to enter into and sustain healthy relationships. For them intimacy is the ultimate stumbling block since they must enter into a state (as Webster defines it) `marked by very close association, contact, or familiarity, `engaging one's deepest nature.' This is the kind of intimacy we expect from healthy individuals who are able to reveal and share what is deepest, truest, or most real about themselves. I would define intimacy, therefore, as the capacity of two people to offer each other's real selves affection and acknowledgment in a close, ongoing interpersonal relationship. . Consequently the emerging of the real self is of vital importance to the capacity to love another person successfully in a sustained, mutually satisfying relationship. The dividends of establishing one's autonomy from the mother and being able to activate and express oneself freely, assured of her support and approval, are crucial for the development of an ego strong and secure enough to maintain a loving relationship. Particularly necessary are the ability to perceive the loved one as a complete human being with both good and bad traits; the capacity to be alone and feel genuine concern for (as opposed to a neediness for) others; the capacity to tolerate anxiety and depression; and the capacity to commit oneself emotionally to another without the fear of engulfment or abandonment. Also important is the capacity to mourn the loss of a loved one in such a way as to free oneself emotionally for a new relationship. . Since the preservation of the human race depends upon men and women relating to each other sexually to produce offspring, and since it seems that in human societies, a stable, enduring relationship between parents facilitates the survival and development of the children, it would seem that biological design would have mapped out an easy route for developing the capacity for intimacy. However, the truth is very different: whether biology has failed to provide easy means for achieving intimacy or the means exist but are diverted by societal customs and expectations, it has become extremely difficult for human beings to develop a strong capacity for intimacy. As family life is constituted today, there are two important developmental thresholds to intimacy, neither of which is easy to cross: the separation/individuation phase of development and the oedipal stage. . The first important threshold to the capacity for intimacy is crossed as the child separates and individuates from the symbiotic union with the mother during the first three years of life. If this individuation is accomplished successfully, a relationship of mutual trust emerges between the mother and child providing the basis for the all important sense of entitlement to the support and encouragement that one needs for healthy development. Here the child first learns, or fails to learn in the case of an arrested development, that the caretaking partner can be relied upon to nurture the emerging capacities of the real self for self activation and self expression. Whether the seeds of trust planted in the child's psyche continue to grow depends upon whether the environment provides or fails to provide support. The affectionate interplay that takes place between the mother and child during this period establishes the pattern that will become natural for the child in later intimate relationships. Since we all emerge somewhat wounded from this stage, most of us grow up with less than perfect capacities for trust and intimacy, just as we do with the other capacities, such as autonomy and creativity. . The oedipal threshold to intimacy occurs when the child with an autonomous self and the capacity to view the parents as whole, separate persons in their own right develops a sexual dimension to her relationship with the parent of the opposite sex and a rivalry with the same sex parent. The child invests the parent with sexual feelings and importance that take precedence over the parent's formerly one dimensional role of caretaker. Now the relationship becomes sexualized. During the latency period prior to adolescence, these feelings go underground to be revived at puberty, at which point the remaining residue of the unconscious oedipal conflict is worked through by turning to peers for sexual emancipation. The infantile sexual attachment to the parents is transformed and directed to sexual figures outside the home in the experimentation that comes with dating. The teenager's affectionate style will still resemble that established during the early years of separating from the mother, while the sexual quality of relationships will derive from the oedipal stage. It is a primary psychological task of adolescence to integrate affection and sexuality in a way that is workable for the individual. . The purpose of teenage romances, then, is twofold: to establish a confident sexual identity in relationships with others; and to experiment in order to identify the type of person that attracts one and evokes one's affection. By dating and meeting a variety of individuals, the adolescent sorts out various types of people and relationships. If the adolescent has a healthy real self, the feedback from this experimentation will help determine his ultimate choice of partner, and it will be an appropriate one, with the mutual give and take that reinforces and enhances the real self of both partners. . From a developmental point of view, it is really quite a tribute to the human instinct for preservation, to the drive to assuage personal loneliness, and to the drive for sexual gratification, that so many individuals are able to surmount these obstacles with sufficient success to be able to pair up as adults, albeit with problems. The strong bonding instinct attests to the importance of intimate relationships for both the individual and the human species. . Although there are many definitions and styles of love, from the perspective of the real self and its development, love is the capacity to acknowledge the other's real self in a warm, affectionate way, with no strings attached, and to enjoy the sexual passion that energizes the relationship in such a way that the welfare of the partner, in every sense of that term, becomes as important as one's own welfare. In fact, we could say that true love is a union of two people, each for the good of the other, where the other's best interests become at least equal to one's own. In light of what we have been saying throughout this book, to love is to like, approve of, and support another's real self and to encourage the other to activate, express, and nurture that real self. This investment in the other enlarges, enriches, and completes the experience of the self. . Building an intimate, loving relationship with another is the way we overcome the essential aloneness and isolation of the self as an adult. Without such a relationship, the real self will always remain to some extent unfulfilled and incomplete, since the vestiges of that first intimate symbiotic relationship with the mother will always remain in our psyches and memories. Only by risking genuine intimacy are we likely to find a partner who will reinforce and promote a healthy kind of relationship similar to that given up so long ago but never entirely forgotten. In contrast to the relationship of the dependent child seeking nurturance from an omnipotent other, however, the adult relationship is characterized by balance, based on mutual sharing of two independent selves, acknowledging and reinforcing each other. There is more confusion and rationalization about the capacity for love than about any other human ability. No man or woman is perfect, and therefore none of us can live up to what we might envision as the perfect relationship or the perfect way of loving. In our own ways, we each fall short and are reluctant to admit our failures and accept our limitations. The desire to love and to give often exceeds our capacity to do so, and we are prone to assuage our disappointment with rationalizations. . Each type of pathology produces its own confusion and its own distorted version of loving and giving. The borderline patient defines love as a relationship with a partner who will offer approval and support for regressive behavior, usually in the form of taking responsibility for the borderline. The narcissist defines love as the ability of someone else to admire and adore him, and to provide perfect mirroring. To extend this perspective further, the schizophrenic would seek a lover who could enter his psychotic world and form a symbiotic relationship based on the patient's psychosis. . Psychopaths seek partners who respond to their manipulations and provide them with gratification. The schizoid (a disorder caused by the lack of support in the early years of childhood akin to that experienced by borderline and narcissistic patients) finds love in an internal, autistic fantasy. . Genuine intimacy begins to develop in the early overtures two people make to each other, based on self activation and self expression. As we sift and test the responses we get in these first encounters, we look to see how the other person appreciates or fails to appreciate our real selves. When the feedback is positive, affectionate and sexual feelings usually intensify along with a growing willingness on the part of the two people to become more intimately involved with each other on all levels. The rate and depth of the involvement depends on how each partner responds to this experimental process. If it works, each person spontaneously and harmoniously begins to like, acknowledge, and respond to the expressions of the other's real self. In time, the combination of the two becomes greater than the sum of the individual parts; and the real self of each experiences a sense of wholeness and completeness. The couple has achieved genuine intimacy. . There are all kinds of illusions that make it appear that intimacy is working for a couple, even when, on closer inspection, what we find is not a healthy interchange between two real selves expressing and reinforcing their capacities but a pathologic contract between two false selves which, although it may seem to survive for the moment, inevitably falls apart. A good illustration of this is the couple who always fight in public to the extent that friends wonder why they even stay together. The answer is simple: they stay together because they fight so much. It works for them. The classic example is the case of two borderline personalities who project the withdrawing, disapproving parental image onto each other so that they do not have to feel and be aware of the associated depression. As long as they are angry at their partners, they do not have to feel depressed. For them interpersonal conflict is preferable to feeling intrapsychic depression. If you ask them about their relationship, they are always `having difficulties'; but actually in a pathologic way, it is a relationship that works for them and satisfies the needs of their false selves. . A proof of the pathology behind this kind of `working' relationship is seen in treatment of both borderline and narcissistic patients. When a patient announces that she has found a new lover and that the relationship is comfortable and easygoing, I strongly suspect that the new partner is inappropriate for the patient and is providing a kind of defense against the patient's painful feelings. On the other hand, if a patient relates that the new relationship is fun and exciting, but also causes a lot of anxiety, I know the new partner is more appropriate and better for the patient in the long run because he is challenging the patient's old defenses and stimulating the patient to relate in terms of the real self. Anxiety is present because borderline and narcissistic personalities can not relate on a realistic level without giving up the defenses of the false self, which in turn makes them feel exposed and vulnerable to the anxiety and depression that they are struggling hardest to avoid. . In the case of the borderline, relationships, dominated by the need to defend against the fear of the abandonment depression, will be unreliable, vulnerable to frustrations, and heavily dependent on the mood or feeling of the moment. The borderline lover will have trouble sustaining relationships because the loved one will be seen as two entities, one rewarding and satisfying, the other withholding and frustrating. . There may be no continuity in the way the borderline views his partner. It shifts moment to moment and is either totally good or totally bad. In any event, the lover is never perceived as a complex, richly ambiguous person embodying faults and virtues simultaneously. Consequently, the borderline becomes a kind of `fair weather' lover whose emotional investment in the partner will wane in times of disagreement or when tempers flare. An exception, of course, is where both partners need to fight with each other. . Without the ability to perceive other people as whole and constant objects, it becomes difficult to evoke the image of a person when the person is not physically present. Feeling bereft of the loved one brings on the fear of abandonment, conjuring up the possibility that the person has actually disappeared or ceased to exist or is never to return. Such feelings may become so powerful that the borderline cannot imagine otherwise. Conversely, when a relationship does in fact end, the patient will not be able to mourn, in the sense of grieving over the loss or separation in a healthy, cathartic way that puts the loss behind him and allows him to get on with life and form new relationships. Since as a child the person never fully separated from, and so `lost,' the mother, he never developed the capacity to mourn and recover from a loss. . Most people suffer at least some minor trauma in separating and individuating from the mother which later shows up as some kind of minor difficulty in relationships, for there are no supermothers who are able to respond one hundred percent positively to every act of the child's unfolding individuality. But for the person with a severely impaired real self, the conflict over intimacy revolves around a single, major theme: A close emotional involvement with another person activates and reawakens his fear of being engulfed or abandoned. If he gets too close the feelings of being pulled back into the symbiotic whirlpool become too intense. If he gets to far away, the possibility of being abandoned looms before him. . On the interpersonal level, the borderline is afraid of being engulfed or abandoned by the other person. From the intrapsychic perspective, he is afraid of losing the image of himself on which he relies for a sense of identity or losing the image of the maternal object which is also a major component of his identity. . Every borderline patient has both fears; their relative strengths depend on how far along the patient was before his attempts to separate and establish his own individuality were arrested. If the arrest occurred early in the process before the ego boundaries were secure, fears of engulfment predominate; if later after the child has established a sense of himself, even though weak and unsubstantial, fears of abandonment will predominate. Borderlines may use the principal defense mechanisms of clinging and distancing either exclusively or alternately at different times. Whichever style of defense was used as a child to deal with separating from the mother becomes the dominant pattern in dealing with close interpersonal relationships. . The adult who uses the clinging mechanism is projecting and acting out his wish for reunion with the mother onto the loved one. The wish contains a fantasy of being the exclusive center of attention and receiving undiluted and constant approval from the other person. Usually in therapy, the initial complaints will focus on the other person's shortcomings in being able to fulfill this impossible demand. The borderline, however, usually doesn't realize how intolerable the demand is and will tend to deny that what he really hopes for is to be the center of an impossibly exclusive relationship. The adult who favors distancing as a defense mechanism often picks out a partner whose personality traits make any kind of relationship difficult if not impossible. The prospective partner may be aloof, self centered, too busy or inaccessible, unresponding, or even physically or psychologically abusive, all of which encourages or justifies the distancing behavior on the part of the borderline. . Most intimate relationships require too much give and take, and are too fluid and unpredictable, to allow the borderline's defenses to remain undisturbed. A Great Wall of China cannot be built on the emotional plains of intimacy; the love object cannot be held at bay or encircled and trapped like an enemy. Eventually the inevitable closeness threatens those defenses and confronts the impaired real self with the need for a genuine emotional involvement to sustain the relationship, and the impaired real self discovers that it lacks the capacities for dealing with it. . An intimate relationship is a separation/individuation stress in its own right because it requires self activation and autonomy; and a patient will respond to the anxiety it creates just as she would toward any other separation or individuation stress, by utilizing the defenses. The clinical manifestations of this are protean, and a few examples will help to flesh out the portrait: . A typical, unconscious strategy for many borderline individuals is to marry a childhood sweetheart, in effect postponing adulthood by trying to preserve childhood patterns with which they feel safe. These marriages usually occur immediately after high school or around graduation from college, when the person would normally go off into the adult world where more individuation and more adult . responsibilities are required. Marrying a childhood sweet heart provides a way of clinging to old patterns associated with childhood and family and seemingly camouflages the need to grow out of them and establish an adult life on one's own. (Of course, not everyone who marries a childhood sweetheart does so for this reason.) . The case of Becky illustrates this well. Because of her bad feelings about herself and the need to find someone who could take responsibility for her life, Becky thought that meeting John, an old high school boyfriend, again in college was the answer. They fell in love and got married in their sophomore year. John was a narcissistic type, and Becky was able to feel better about herself because she had such an idealized object. In the course of treatment, she realized this arrangement was at the heart of most of her marital problems, and in time she decided to separate. The stress of divorce was excruciating for her, and she plunged immediately into an intense round of sexual acting out as a defense against her feelings of abandonment. She could rationalize this behavior easily because she had not dated widely in high school or experimented sexually. She felt she was owed this period. So instead of clinging to her narcissistic husband to handle her anxiety, she clung to a series of men without establishing any real relationship with them beyond the sexual. Eventually she decided to live with a man who also had borderline problems and was unable to take responsibility for himself or Becky. Over time she became aware of this and began to act out her rage on him. Throughout she was able to hide her own anxiety about intimacy. Interestingly, all of the men that Becky became involved with had sexual problems of one type or another, of which Becky was extremely accepting and tolerant, another cover for her enormous anxiety about her own capacity for intimacy. . Another illustration of the borderline's problem with intimacy is Rachel, a beautiful woman from a socially prominent family, who harbored extreme feelings of inadequacy and ugliness about herself. I am always initially surprised (even though it is such a recurring pattern) to discover how easily the most beautiful, intelligent woman with a borderline disorder is incapable of realizing her beauty, talents, or other positive qualities. It attests to the power of the false self to distort self perceptions, the power of the inner self image over the outer appearance. As Rachel, sophisticated and well educated, began to move away from her parents in late adolescence, she fell in love with a poorly educated man from a different ethnic group and much lower social class. This was in part a rebellion against the upper class values of her parents but also an avoidance of her anxiety about intimacy and a confirmation of her low self esteem. They moved in together, and soon Rachel was pregnant. Rachel left her lover after the baby was born, taking the child with her as an object of her own to cling to. She dated other men, but the pattern was typical: When she got involved with an appropriate man (who activated her real self), she would grow anxious and stop seeing him. When she found someone who resonated with her negative feelings about herself and treated her as poorly as she treated herself, she felt comfortable and wanted to continue seeing him. (The epitome of this type of relationship is the sadomasochistic alliance in which both parties receive pathologic gratification.) . In many borderline relationships, the patient prefers a partner who is only partially accessible, such as one who lives a consider able distance away or is only available on weekends or works a lot or is married. In fact, borderlines have antennae a mile long listening for the subtle clues dropped early in chance meetings with potential lovers that indicate they are not available for a full time relationship. At the first mention of the fact that he works a lot, lives out of town, or is married; conditions that would discourage a normal person from getting her hopes up for a lasting relationship, the borderline grows interested. This is just what she needs. Borderlines seem to find each other and begin their affairs of convenience, unconsciously blinded to the fact that they have embarked on a deadend course. . I often tell this type of patient that they could walk through a room with 20 potential partners, 19 of whom are eligible and one of whom is ineligible, and they would spot the ineligible one immediately. Knowing the relationship has no future makes it uniquely attractive to borderline lovers because both partners know that they are freed from having to relate to each other on a realistic level, and hence they are freed from the separation anxiety that activating their real selves would entail. What they are left with is freedom to indulge in romantic feelings and fantasies about the other. Borderline patients can also indulge in intense rounds of sexual activity. The sexual intensity masquerades for real intimacy and usually succeeds in seducing the borderline into thinking that the relationship is really working. Needless to say, the borderline patient is usually shocked and devastated when the partner ends the relationship. . A typical example of the borderline's preference for self limiting relationships is Cynthia, who was married and having an affair with a married man. While they were both married their rendezvous with each other were exciting, stimulating, and fulfilling. But the man divorced his wife, got serious about Cynthia, and eventually asked her to divorce her husband and marry him. As soon as the man was free and available for a serious, full time relationship, Cynthia began to have her doubts about him. In treatment, she noted that `something was wrong' with the relationship. When I asked her what she thought it might be, she found personality and character faults with the man, and for a long time projected the problem onto him, rather than seeing it for what it was, namely, her inability to continue the relationship now that it meant facing up to the fact that it had a future, if she were willing to have it. . There are endless variations on this theme. Some can respond sexually only to partners they are not emotionally involved with, while others get serious only about those with whom they are not having sex. When the relationship turns sexual, they lose interest. Some individuals function well only where there is no continuity at all, such as with one night stands. . Consider the situation of Eileen, an attractive woman in her early 40s who could pass for early 30s; her initial complaint in therapy was that she had been worried recently about growing older. She was not happy with how her life was going; she easily grew depressed, felt lonely, found it hard to concentrate, noticed she was drinking more than usual, and in general was beginning to feel panic over not having a permanent man in her life. She had a successful job as an editor at a New York publishing house but found the work boring. She stayed on for the security and financial benefits, sometimes wondering, though, whether she shouldn't return to freelance photography, a career she had found enormously rewarding as a younger woman. . Eileen's track record with men left much to be desired. She had had no sexual experiences with men until her last year of college, when she became involved with a classmate, got engaged, graduated, and quickly broke off the engagement because of anxiety. Her next affair was in her late 20s with a married man a good deal older than she, a domineering, narcissistic individual who served as a clinging object for her. She continued to live at home until her father died and then moved out when she was 31. She married for the first time a salesman who was rarely home and not interested in maintaining a viable family life. The marriage ended in divorce a year later, and Eileen moved into her own apartment. . Since then Eileen's relationships have consisted of serial affairs with men living or stationed in distant parts of the world: Moscow, London, California. They fly into New York for a week or ten days, and get together with Eileen for theater, drinks, sex, and living out romantic fantasies; then they go. In contrast, whenever she has met a man in the city who was available for a more permanent relationship, she has suffered such severe anxiety that she has been unable to relax, think, or act appropriately. . Eileen's life was motivated by the paradox of the clinging/distancing defense. In order to avoid the anxiety provoked by the thought of a relationship with a man who lived in town, she resorted to distancing by picking men who were seldom around and to clinging by initiating instant intimacy. Immediate, casual sex does not lead to greater intimacy as we have defined it in terms of the real self. Although sex is a powerful emotional experience that can propel people into closer relationships, the relationships are not based on intimacy in any profound or meaningful way. They do not acknowledge and support the real self, or place the other's best interests equal to one's own. Instead, people in such relationships tend to be self serving, using the other person to gratify there own needs. In fact, a relationship that turns sexual early on, or even begins as a sexual relationship, can abort the experimental process so crucial to building genuine intimacy. Sex has the power to blind the couple to the realities about each other and how they function together, so that the sifting and sorting out of positive and negative qualities in order to make an honest commitment based on knowledge and understanding never takes place. This testing process can rightly cause anxiety and worry, but healthy individuals can tolerate it, knowing that as time goes by they are learning more and more about their potential partner and themselves. . It is important to keep in mind that the beginning of any relationship can be exciting and romantic precisely because we know so little about the new partner. The vast unknown can provide an arena for exploring all kinds of exciting personal fantasies, all of which is heightened by the excitement of sexual discovery. In time, as we get to know each other, this excitement fades and the relationship moves from fantasy to reality. At this point, if it is to endure, it must be based on real self involvement and commitment or it will deteriorate into a pathologic relationship motivated by false self defenses. . I confronted Eileen about her distancing defense by saying, `It seems to me that for a man to qualify for your bed he has to come by plane and be holding a return ticket.' I asked her why she could not find an eligible man in New York City. Shortly after this confrontation, she met a man in the city and began dating him, but she would dissolve into anxiety and, as she put it, `start to act like a schoolgirl again,' unable to think straight, decide what to wear, wondering if he liked her, not knowing what to say to him on the phone. True to form, she found relief from the anxiety through instant intimacy in bed. Nothing came of the relationship, it ended a few months later. . The distancing defense can be crucial for a borderline's success both at work or school. In many cases, patients perform well and enjoy notable achievements in their professional or scholastic endeavors. But when they meet someone and fall in love, they also fall apart in terms of their careers. What happens is that while they are able to hold would be lovers at bay, they feel minimal anxiety or depression. But when a close relationship materializes, it activates their selves, which lack the capacities to make the relationship work. They give up their distancing defense, but unable to participate in a relationship without some form of protection, they resort to clinging dependency which, in effect, is a form of helplessness. In a short time, helplessness comes to dominate their entire lives, including their work lives. Their performance suffers. Usually when the relationship breaks up, they pull themselves together again and return to their careers, fully capable as they were before. Being in love for healthy individuals can be a catalyst for even better performance, since feeling good about themselves carries over into their work. In the case of the borderline, feeling bad carries over, and their work suffers. . Another variation on the borderline's inability to conduct appropriate relationships is the exclusive clinging behavior which manifests itself shortly after the relationship is established. The person becomes excessively preoccupied with the new lover, vulnerable to every word or gesture or slight. The borderline patient demands exclusive and constant attention and resorts to rage at the partner if she cannot provide it. The borderline suffers enormous anxiety if this intense contact is interrupted for any reason, legitimate or `illegitimate. Women frequently express this by obsessive wondering about why a man hasn't called or dropped by. . Borderline men also have problems with intimacy characterized by clinging and distancing. Since in our culture, men have traditionally initiated sex, borderline men are often free to use instant intimacy to relieve the anxiety of getting to know a woman on other levels. Eric, a good looking, successful 35 year old business man and a member of the jet set, dealt with his fears of engulfment and abandonment by a series of short, transient relationships with women who, as he explained it, `have to be beautiful and admire me. Then I'm always turned on and eager to get to know them. But generally after a few months, the excitement wears off, I grow bored and lose interest.' In other words, as the relationship grows more intimate on psychological levels, it grows too close for comfort. As relationships move beyond the glamour of fantasy toward reality, Eric's fear of engulfment leads to depression, the causes of which he projects onto his partner, and then he breaks off the affair. . A certain type of borderline man will marry a woman or set up a live in arrangement to satisfy his passive, dependent needs. The woman agrees to support or take care of him, and he becomes the `house husband' who usually cares for the house, cooks meals, and attends to other domestic chores. In effect, he has turned responsibility for his life over to the woman. These arrangements tend to break up as the woman realizes that the man's inability to take responsibility for himself implies his inability to really care for her or shoulder any responsibility for her needs. . In all these pathologic contracts, the relationship may have the semblance of working and may provide the illusion that all is going well, when in actuality the partners are relating to their own fantasies rather than to the reality of the other person. They strongly deny the reality of their situations and use whatever compliance their partners offer to fuel their fantasies. While their fantasies are still intact, they can avoid anxiety and depression because they are living in an impermanent world of sexual and romantic excitement, grounded in their illusions rather than in reality. . A close neighbor of the borderline is the schizoid personality disorder. The schizoid personality is characterized by symptoms of emotional coldness and aloofness, indifference to praise or criticism from others, and close friendships with no more than one or two persons including family members. Although not as much research has been completed on the schizoid personality, substantial clinical evidence suggests that the schizoid's development is similar to that of the borderline's. What distinguishes the schizoid from the borderline is the primary defense of distancing and isolating the self from the internal object. . The schizoid personality's intrapsychic structure contains split images of the other person. The powerful rewarding image demands total obedience as the price for relatedness. The self representation linked to this rewarding image is that of a compliant, victimized, manipulated slave or object. Unlike the borderline relationship of a powerful, omnipotent parent to a helpless, regressed child, the schizoid's relationships resemble a master and slave. Dominance and submission are the major themes. When this dynamic is activated, the individual feels related to the other but at the price of feeling like a prisoner; always deceiving, hiding, fearful of entrapment. The overriding anxiety centers around being controlled and, ultimately, engulfed with a total loss of self identity. These feelings are largely defended against and only appear when the schizoid person takes up the challenge of a real relationship in the external world. . The predominant and almost continuously activated withdrawing image of the other is seen as dangerous, devaluing, and depriving. The self representation linked to it is therefore one that must be largely self contained, self sufficient, and self protective to ward off the danger of attack, criticism, ridicule, and abuse. The feelings linked to this image also have the `not free' quality; but unlike the prison like quality associated with the rewarding image, these are of the self in exile: isolated, marooned, abandoned. . The schizoid dilemma or compromise is to be neither too close and precipitate fears of entrapment and enslavement, nor too far away and trigger feelings of alienation and exile. To defend against these fears the schizoid person will most frequently substitute fantasized or imagined relations for real relationships as a defense. These revolve around caricatures of real relationships: romance that reads like a Harlequin novel, sadomasochistic fantasies, or gross distortions of real relationships that render them non threatening through role reversals. For example, the person who becomes obsessively infatuated with another will often harass the other in a sadistic, ritualistic, and controlling manner, and in so doing identify with the intrapsychic aggressor. . The inflated false self causes enormous problems with intimacy. In fact, narcissism and intimacy problems are practically synonymous. The narcissist is unable to relate to other people except in terms of his own inflated self image and his unrealistic projections of himself onto others. Every relationship involving a narcissistic personality requires adulation and perfect responsiveness from the partner or an idealization of the partner so that the narcissist can bask in the other's glow. Whenever these requirements are frustrated, or appear to be lacking from the narcissist's point of view, he resorts to rage which is always externalized and projected onto the other. . The next step is to devalue the partner since she is not living up to the narcissist's wishes. The narcissist's overblown sense of entitlement makes it almost impossible for him to see what he is doing in these situations since he cannot imagine that his own projections onto the partner are causing him such severe dissatisfaction in the relationship. He feels entitled to the narcissistic supplies and automatically responds with rage and devaluation of others when he doesn't get them. The narcissist's ability to appear charming and sensitive to others acts like a Venus flytrap for the unsuspecting lover who can often be at a loss as to how to extricate herself from the tangle of rage and blame that results from narcissistic disappointment. The more reinforcement that life provides the narcissist in terms of success, money, power, or prestige, the more the narcissistic personality feels entitled to a mate who will provide the same. This may be one of the reasons that the divorce rate runs exceptionally high among people with wealth and power; they grow so accustomed to getting what they want from others in life that they expect the same in their close relationships. . The most common arrangement is the narcissistic husband whose clinging borderline wife idealizes him and uses his sense of superiority to shore up her own inadequate self. She is usually very compliant, subservient, and eager to give him what he wants, but she always fails to meet his standards. Then her husband turns on her, attacks her for her inadequacies, and in so doing, reinforces her negative feelings about herself. It is often only in treatment that she realizes how little she is getting out of the relationship. . The case of Frank, the closet narcissist we will examine in Chapter 10, is a classic example of the vicissitudes narcissists endure trying to find the perfect mate. Because he had difficulty activating himself, it would all be up to the woman to establish the relationship, which Frank would interpret as her worshipping him. Obviously, this would make him feel good, and he in turn would idealize her and think he was in love. But when the first fervor of romance and fantasy ended, the reality would set in, and he would come to realize (without being able to admit it to himself) that she did not worship him, no matter how much she still loved and admired him. He would get angry and depressed, project it onto the woman, and conclude that the relationship was not working out. As he explained his own entrapment, `I'm constantly falling in love with women who aren't right for me. In the beginning, we get along well and it's exciting, but for some reason things fall apart. Then I go through long periods of loneliness and isolation where I can't find anyone.' . It is very common for narcissists to have sexual difficulties, often severe ones, varying from premature ejaculation to impotence in men and inability to experience orgasm in women, because sexual gratification is not high on a narcissist's hidden list of priorities. Narcissistic gratification comes first, and the threat of two bodies and two sets of emotions coming so close requires them to activate their defenses to protect their narcissistic vulnerability. With their defenses up, they are not in the most sexually receptive state for satisfying lovemaking. Nevertheless, when narcissists are not in an ongoing relationship, they can engage in a lot of sexual acting out, which may create the illusion that they can function sexually quite well. As one male patient put it, `When I have sex with a woman, it's important that she climax or else I feel like I'm a lousy lover. In fact, I'm always more concerned about her response than I am about my own satisfaction because her enjoyment is a measure of my performance, and I'm never happy with one woman for very long if I'm not at my peak sexually. Then when I finish with one, I have to go after another.' . To be engaged in a never ending pursuit for a woman who will spontaneously fulfill the narcissist's unexpressed wishes is typical of the closet male narcissist. The exhibitionist narcissist would see the woman's sexual response as part of his entitlements and would say openly that he expects her to devote herself to his needs. He would manipulate her in such a way that she would have to accept his entitlement or he would leave her. Both the male and female narcissist lack the most fundamental knowledge or instincts about how to go about realistically establishing and nurturing a relationship; and not only are these ideas and skills foreign, they are threatening. . Two narcissists who marry or continue an ongoing relationship always run into trouble. They begin by mirroring each other and enjoying the mutual narcissistic glow they provide for each other, but this cannot be maintained indefinitely. When one or both fail and disappointment sets in, they are faced with the dilemma of separating or tolerating a situation that frustrates their narcissistic needs. Judy, a narcissistic woman in her 40s with a five year old daughter, is a very successful department manager for a communications company. Her narcissistic husband is basically angry and devaluing and withholds affection from her. In addition, he will not provide her with money (he manages their combined incomes) nor help with domestic responsibilities. Despite the fact that she comes to treatment and complains about what goes on in their marriage, she tolerates it. The bottom line for her is that she prefers to blame her misery and distress on him, than to see her own part in the problem. . Ralph, in his late 50s, has had many acting out relationships with women and for years preferred one night stands or prostitutes to committing himself to any one woman. Finally he found the `perfect woman' and married her. She, too, was narcissistic. When she decided to have a career, she became less available to tend to his needs. He became furious, accused her of gross inadequacies, and they divorced. He returned to his pattern of one night stands, which he then found unsatisfying as his loneliness and isolation increased. . Bill, a 27 year old man with a schizoid disorder, in his last year of graduate school, felt increasingly paralyzed when faced with having to make important decisions about his future which included leaving home and finding women to date. Previously, relationships of all kinds had been difficult for him to initiate and keep going. He had always been a loner and unhappy because of it. He had never verbalized these feelings to anyone else in his life. Rather, he often felt that people were making fun of him and humiliating him. The prototype of these feelings was a memory of lying in his room at night when he was nine or ten and imagining that a toy clown in his room was sticking his tongue out at him. Powerlessness in his relationships was woven into these feelings of ridicule and humiliation. . He traced feelings of powerlessness back to his mother, from whom `all power and efficiency flowed to me like through a huge umbilical cord.' He felt that without her he could not function successfully. A further `condition' of their relationship was that he be what she wanted him to be, which meant `asexual.' The visual symbol for these feelings about his mother was the fact that the only photo of him that she kept at home was a portrait of him at age five sitting on her lap which reminded him of a puppet sitting on a ventriloquist's knee. . Bill was caught in a phase of life that always exacerbates the typical schizoid dilemma: the need to make career decisions and the wish to risk getting closer to another person on an emotional level. He stated repeatedly that he was in constant fear of being controlled by his mother and forced to pursue a job that he would not want. Even to discuss various options with her or to answer her questions would mean that his ideas were no longer `his own'; they would become hers, and he would have to reject them. On the other hand, moving away from her, physically and emotionally, would leave him feeling `like a stranger in a foreign land, an alien, totally losing contact and being cast out into endless, empty space, a real life man in the moon.' Once Bill was consciously aware of the dilemma, he began to understand the need to evolve a better compromise. He had to, and wanted to, take up a new position between enslavement and alienation, one that left him closer to others, yet not too close. . He was finally able to make decisions about his future and to act on them, but he was able to do so only by the extreme defense of refusing to discuss any of his future plans with his mother. He was able to manage the resulting anxiety and `fear of exile' by discussing these feelings with me and by slowly building a network of social contacts. For a long time these were in highly structured group settings, where he could more easily adjust the distance he could tolerate between himself and others. . He had been in treatment for two years when he got a job in another state. He decided he was ready for the move. One year later he called me to report that things were going well at work and with his colleagues. He had terminated all contact with his parents, which he felt was necessary, and had been able to pursue his own interests which included a marginally successful social life with women. He doubted, however, that he would ever marry since he `enjoyed his independence too much.' . Another schizoid patient was Lillian, 32, single, who complained of chronic and increasing loneliness and feelings of futility. She was successful in her career, although she had made several job changes, each one bringing her into less contact with people but also increasing her economic independence. Control, fear, and fantasy were the central themes of her life. Control was the overriding concern, as she felt that her life had been a continual struggle to escape from the sadistic, intrusive, and domineering influences of her family. She saw her family relationships as a battle of wills. She felt that if she were to try to be close to her parents she would have to totally give up her `self' and literally become their live in slave. Lillian feared her inability to maintain a separate and individuated life. She would despair and attack herself with thoughts that she was worthless, hopeless, too damaged, and so forth to ever be able to have her own life and her own relationships. . Typical ways she would express this were: `I have difficulty relating to people.... I am limited because it's always been hard to share myself with others.... If I depend on you, that implies control.... If you are important to me and you know it, it's like giving in to you.... When I'm relating to people there is a gap between what I'm saying and feeling, or not feeling, I'm just talking; it's not part of me.... I need a lot of approval, but I don't feel worthy of getting it because I don't accept myself.' . In order to deal with her fear of enslavement and alienation, Lillian had developed over a lifetime a rich, internal world, a fantasy life that she could control and which she did not have to fear. She recalled that as a young child of four or five, she would most enjoy playing alone with her many dolls. Also, by that age she could read very well and began a lifelong habit of creating close and tiny places for herself, such as in a closet or under a desk, where she curled up for hours to read. She would evolve elaborate fantasies of being a `superwoman'; powerful and perfect. All her fantasies served either to provide her with an escape from painful self perceptions or from threatening interaction with others. . Her core self image was that of being retarded and defective. She felt worthless, of no use to herself or anyone. The best she could strive for was to be competent and self sufficient and, therefore, not a burden (and hence inevitably a slave) to anyone. As she became aware of the defensive purpose of her fantasies, she would explain: `I don't know if I use day dreaming whenever I don't want to relate to people or vice versa.... I've kind of decided that my fantasies and day dreaming are a major part of my problem.... I use fantasies to escape being with people, to be alone, it's less painful, more exciting, more fulfilling.... I think my feelings toward you are basically representative of what the problem is. There are two parts to it: one is I need and fear your approval; secondly, I sexualize what is not sexual.' . In fact, Lillian had only acted out once on her sexual wishes and fantasies in a brief relationship with a therapist she had seen earlier in her life. For the rest of the time, she had maintained complicated and predominantly sadomasochistic fantasies in which she was the master and men were the slaves. She used these sadomasochistic fantasies to replace more primitive romantic fantasies whenever she felt especially disappointed, rejected, frustrated, or futile. . All three personality disorders; borderline, narcissist, and schizoid, produce distorted intrapsychic images of the other partner in a relationship. The borderline and narcissist manage to maintain an effective link with that image. The schizoid, however, is compelled to maintain a rigid defense by distancing from the other to such an extent that the intrapsychic link is disrupted and the patient substitutes autistic reveries about the relationship which become a surrogate for any attempt to establish a real relationship in actual life. The schizoid's feelings of vulnerability should he or she allow an attachment to take place are so great that continued isolation in reverie is necessary as a defense. . Because the stakes are so high and the feelings run so deep, anxiety about intimacy is almost universal. The early period of a relationship places one's self on the line where it is vulnerable to rejection. We tend to handle the resultant anxiety by minor clinging and/or distancing defenses in the early experimental stage of a relationship. As the experiment succeeds and the relationship solidifies, the anxiety subsides. Although these anxieties are similar to those in the borderline patients we have looked at, the emotional pendulum in normal individuals does not swing as wide, and anxiety is relieved by the successful interaction between the two people. . Even with reasonably successful development through childhood and adolescence, it is not easy to reach adulthood fully prepared to establish an intimate relationship based on sincere interest in the other person, and make it work. And yet if we keep our partners' welfare paramount and support and encourage them in the activities and desires that spring from the real self, we will be truly loving them by acknowledging their deepest needs and wishes. To whatever extent we still carry the anxieties about intimacy (even though we are not borderline or narcissistic) we can, with awareness and effort, limit their influence on our behavior. For example a person who becomes aware that his possessiveness is a protection against anxiety about rejection can limit those actions that are impelled by the possessiveness by seeking assurance from the other. In ways like this we can strive to curtail their effects so that they do not harm our loved ones and destroy our relationships. When anxieties become so intense that they, or the defensive strategies deployed to defend against them, threaten to prevent or destroy relationships with others, psychotherapy can provide the insight needed to change underlying borderline, narcissistic, or schizoid patterns. ___________________________. . . PSYCHOTHERAPY WITH . THE NARCISSIST . . . The narcissistic personality disorder is more difficult to treat than the borderline patient because of the unique characteristics of the defensive tactics on which the grandiose self relies. It uses aggression to coerce others, including the therapist, to resonate with its grandiose view of itself. Furthermore, this stance is maintained nearly all the time. There are few lapses. Underlying this formidable stance, however, is an extreme vulnerability. The narcissist resembles a psychological turtle with a hard, impenetrable shell in side of which is an equally soft, fearful center: the impaired real self. . The therapist who has become comfortable utilizing a confrontive stance with the borderline patient has to change his approach in dealing with the narcissistic patient so drastically as to almost seem to assume another professional identity. It is almost as drastic as a runner changing from long distance to sprinter or a musical comedy dancer attempting ballet. The therapist must be prepared for a wholly different kind of encounter and patient behavior. Instead of the avoidance of self assertion, the clinging, and the acting out that the borderline engages in both inside and outside the sessions, the therapist must now focus on the fluctuations of narcissistic vulnerability and defense within the sessions. The basic therapeutic activity must change from confrontation to interpretation of narcissistic vulnerability. All the while the therapist needs to remain keenly aware, not of resonating with the rewarding element of the borderline's intrapsychic structure, but of possible failures in empathy with the exquisite vulnerability the narcissistic patient presents. The difference is due to the fact that the narcissist feels entitled to perfect responsiveness while the borderline will settle for much less. . The core of the therapeutic problem is that the patient presents three facades, two of which are full of defensive emotion and a third which displays no emotional involvement with the therapist at all and complete detachment of feeling. The patient either exhibits the grandiose self with the need for perfect mirroring or idealizes the therapist as the omnipotent parent figure and basks in his glow. But when the impaired real self with its anger and depression emerges, it brings with it the emotional detachment from the therapist in order to protect itself against painful feelings of vulnerability to loss. Thus, the patient may complain that the therapist `means nothing to him,' he feels no involvement in the relationship, he has no reaction to the therapist as a real person, or that he does not think about therapy at all between sessions. I recall a patient who saw a psychiatrist three times a week for five years and then decided to stop, walked away, and claimed he never had another thought about the treatment or the psychiatrist. . The therapist is either an idealized or mirroring object, an attacking object, or does not exist at all in the patient's psyche. How different this is from the borderline patients for whom the therapist becomes the center of their preoccupations and their psyches. Even when they are not in a session, they cannot get the therapist out of their minds. The transference acting out, the need for perfect mirroring, and the narcissistic wounds of the impaired self do not indicate a real emotional relationship with the therapist but are rather a defensive facade underneath which lies an extreme vulnerability. . And yet there is an illusion of stability in the narcissist because he or she has become a master at refueling the grandiose self by denying depression, devaluing social and environmental traumas, and using a variety of techniques to coerce the world to resonate with his grandiose self image. Up to a point, the narcissist's denial of reality helps him to maintain his psychic equilibrium; but if the denial is too great, it will cause conflict. When the narcissist is forced by the demands of treatment to venture out of his safe, stable cocoon and activate his real self, it becomes clear how impaired that real self actually is. Then the patient will show immense difficulties in functioning and feeling. . For example, a narcissistic patient who was idealizing me as his therapist maintained that without my help he couldn't activate himself in the session. He was referring here to his impaired real self. He could not start the interviews, had no spontaneity, could not identify and express his thoughts or feelings. And on the occasions when he could activate himself, he was unable to acknowledge the fact that he had done so. The underlying lack of self entitlement or sense of self worth of his impaired real self was apparent. However, when his grandiose false self image was reinforced by others' providing the admiration or attention he needed, he felt fine and was able to activate the false self easily and successfully. Small wonder that he confused his false self with his real self. . In dealing with narcissistic patients the therapist must avoid a number of traps. It is possible to overlook the patient's emerging grandiosity because it is disguised in conventional social terms, such as a normal need for approval, when in fact it is the narcissistic need to be perfectly admired and adored. For example, the patient may speak of occasionally feeling a need for the therapist to `like' him. What lies behind this statement is the need for the therapist to admire him, not occasionally, but all the time and perfectly. Another therapeutic trap is the temptation to attempt to overcome the patient's resistance by interpreting his grandiosity prematurely, before it has fully emerged in the relationship. A patient may talk about his need for approval without being aware that it is actually adulation he seeks. The therapist may be tempted to interpret this before the patient is ready to accept it. . Emotional involvement with the therapist stirs up such painful feelings of the impaired self that the patient defends against it by detachment of feelings and strict uninvolvement. There is either idealization of the therapist or no involvement at all. The only avenue to overcome this detachment and uncover the patient's vulnerability and pain is through the therapist's carefully formulated interpretations of the patient's narcissistic disappointment with the therapist's failure to mirror him. Exploration of the disappointment in the therapist leads to its source: the patient's need for perfect idealizing or perfect mirroring as defenses against his depression and impaired real self. In the course of this exploration as the depression is worked through, the grandiosity of the false self and the underlying emotional detachment give way to a real emotional involvement with the therapist in a therapeutic alliance. . To illustrate the role psychotherapy can play in alleviating the narcissist's dependence on the inflated false self, consider the case of Walter, a 38 year old, married, successful lawyer with one child, who came to treatment because his wife of 20 years was leaving him because, she told him, she `didn't want to be abused any more.' He was depressed by this, as would be expected, but the overriding emotion was humiliation and rage at the outrageousness of her wish to leave him. `She is part of me,' he fumed. `How could part of me separate from me?' . Walter had always treated his wife as a narcissistic object from whom he expected perfect mirroring and attendance, but when their son became an adolescent, she started her own business, which required her to be out of the home a lot. Walter became increasingly enraged at her, and he spent even more time at work, buried himself in his study at night reading, attacked her work and her relationships with friends and associates. Finally, she had enough and decided to leave him. After his wife left him and he had to find a place of his own, he felt more angry, empty, impoverished, and depressed. He had difficulty arriving on time for sessions and trouble concentrating. He said, `I had this insane notion that everybody and everything should flow to me. I'm just waiting for some magical solution; I can't confront the reality that I am on my own. The idea of a task that doesn't feed my sense of self is impossible. You see I just don't want to do it alone. My wife was part of myself. I can't say good bye. It's the price I pay for having lived in a fantasy. I can't believe this is happening to me. I'm thrown into the water and I imagine that if I close my eyes I won't get wet, and yet I'm soaked.' . Walter could not accept my matter of factness as he related these feelings to me. Since I did not perfectly empathize with his situation, he raged at me. `I'm furious and fed up with your lack of concern about me. Here I am bleeding and nobody, not even you, will rescue me. It is humiliating. If I can't have the past back, I will do nothing.' Over the next sessions he continued talking about his narcissistic dependence on his wife. `I am whole only by union with another person. Separation makes me empty and collapsed. I feel like I'm walking through a movie set as an extra where I had once been the star. I didn't need intimacy with my wife. It was only when she began to frustrate my sense of importance that I grew angry and withdrew.' Volume II. To create a therapeutic alliance and transference, I began to make comments (mirroring interpretations) about how his need for other people to admire him was a way of dealing with these painful feelings associated with being on his own. These led Walter to begin to recognize his grandiosity and open up and elaborate on it. . `The loss unmasks what I have tried to keep hidden all my life: my unwillingness to take responsibility for myself. I've always been terrified of being on my own, which means being alone feeling naked and vulnerable without my entitlements. I'm afraid without the dream of perfection I have no capacities. What tied me together, gave me discipline and grit, was the dream, the entitlement dream.' . As he separated from his wife and began to build a new life, Walter started dating and became more aware of his narcissistic entitlement fantasies as they began to emerge in his new relationships. `I'm seeing this girl and realized that I want her to do what I want. When I talk, I want her to listen. I want to have sex when I want and not when she wants it. I find myself losing interest in her conversation and in her interests. Is this because we don't have anything in common or is it because I expect too much?' With time, Walter saw that he was only attracted sexually to women who saw him as a king or potentate, women who would belong to him and whom he could control. He admitted, `As soon as I'm interested in a woman, she is to amend her life completely to suit me.' . Very slowly and painfully Walter began to activate his real self. He contacted his son who was living with his mother and began to see him. These encounters led to many sessions in which we discussed differentiating the son's needs from the father's and the need for the father to father the son. He also began to utilize his real self in sessions to reevaluate his relationship with his wife, not from the point of view of his loss of entitlements but rather from the realization that he had provided very little emotional satisfaction for her while they were married. . As his interest in work returned, he realized how his enjoyment of it had come primarily from its ability to boost his ego. He saw that his career satisfaction was a combination of mastery, achievement, and being the center of attention as the unique, idealized figure for his entire staff. He also began to understand how he created antagonisms among his peers because of his arrogant, harsh, and devaluing behavior. In our sessions we discussed the principle of collegiality among peers and how it is necessary to acknowledge the real selves of others if one expects to have relationships with them. We also explored the roles that mastery and achievement play in deriving satisfaction. In time Walter began to see how he used work principally as a source of perfect mirroring rather than to satisfy and develop his real self. . Sometimes these discussions took place in the framework of communicative matching. For Walter, these sessions were his first encounters with the commonsense judgments that govern parenting, working, dating, being with others. For example, in work, Walter had been a workaholic, and his busyness reinforced his narcissistic armor and emotional detachment. We talked about how his schedule was `unrealistic' and that 'the schedule is made for the man, not the man for the schedule.' He also began to see the need for time to pursue recreational interests to balance the time spent at work. . The biggest arena for communicative matching was his relationship with women. He had had almost no dating relationships prior to marrying his wife. His whole perspective was dominated by his sense of narcissistic entitlement. He wanted to be the center of a woman's life and felt that she, like his mother, should subordinate herself to him in all ways. I explained to him how the real self forms relationships as opposed to the way the narcissistic self goes about it. But Walter found it extremely difficult to understand or implement this in his social life. . As a financially well off, professional man, he soon became the center of attention for a number of women who pursued him. He would form instant relationships based on their providing social and sexual gratification, but when his partners would express their own needs for a more enduring relationship, he would explode with narcissistic rage and drop them. These experiences gave us opportunities to differentiate between the narcissistic and real self. We discussed his habit of impulsively initiating sex with women without first exploring their personalities, only to recoil in disappointment and rage when he discovered their shortcomings, inadequacies, or demands for a permanent relationship. This is a very common experience of people who have never learned the simple rules of how to go about discovering another individual's personality and evaluating how compatible it is with their own. He had trouble distinguishing whether he liked a woman for herself or because she mirrored him. More often, it was the latter. He would say, `I haven't learned how to be friends with a woman. I may only be attracted to women who see me as a king and who belong to me and let me control them.' . He began to experience what he called `a profound change' in his lifestyle as his real self emerged. He was enjoying his mastery at work, relating more to his colleagues on a sharing basis rather than a need for mirroring and getting good feedback from them. He found more recreational time, curtailed his restless, impulsive manner of organizing his time, and was able to view himself and others, particularly women, more realistically as he experimented with his real self. . `I'm trying to contain myself and think rather than act,' he explained. `I'm less afraid or uncomfortable with myself, more willing to try to understand what other people's needs are.' . After extensive dating, he found a single woman about ten years younger than himself. Again he initiated `instant intimacy' and began to see her exclusively. They fell in love and talked about getting married, as Walter was in the final stages of clearing up his divorce. When the woman insisted that she wanted a child, Walter balked. As a result of both his narcissism and the fact that he already had two children, he told her he did not want another child. He at first denied to himself the potential conflict involved in marrying a woman who wanted a child when he did not. Could she be satisfied without a child? Eventually he realized she would not and broke off the relationship. . Because his company was going out of business, Walter had to find a new job. He ended up taking a position with a firm that he had not adequately examined and researched and discovered it was a bad `fit.' He sound found that his coworkers were quite mediocre, and the combination of his outstanding ability and his narcissistic manner had them up in arms against him within a few months. He had to resign and move on. He learned from this experience, pursued his job search more thoroughly this time, and found a suitable position. . Finally, the day came when he said, `My real self is beginning to emerge. Although I'm not clear who I am, I am no longer a potentate or star, but there is more to me than that. There is some thing coming out that is authentic and real.' He was no longer a workaholic and had a more flexible work schedule. He was far more aware and considerate of others' feelings. He was much better able to accept criticism and to involve himself in activities where he was not the center of attention. The old, rigid, detached need for entitlement was dissolving and a new, more flexible human concern for others as well as himself was beginning to emerge. . Frank's case demonstrates the difficulties in working with the closet narcissist who has built up barriers to avoid recognizing his grandiose self. Frank, a 52 year old single businessman, had two years of behavior therapy without any significant improvement before coming to see me six months later. His experiences with therapy had begun in his late 20s, and over the years he had been in and out of different types of treatment. Nothing worked. He said he still felt an inner grayness, anger, resentment, depression, and did not feel good about himself. He felt hopeless about treatment ever working because of his long history. Frank was the second of four children in a middle income family. His father was an arrogant, self centered artist who was rarely home. He seemed more drawn to the outside world than to the family. His mother, whom Frank described as emotionally and intellectually dull, idealized and praised the father and supported his behavior. Frank felt he received no emotional or intellectual input from her or from his father. He described himself as having been a quiet, obedient, `good boy,' who did fairly well in school, rarely caused trouble there or at home, was average in sports, and was interested in outdoor activities. . Nevertheless he felt, `I was boring, missing something. I had a fear of what it would be like to be out in the world on my own when I grew up.' Frank finished high school, attended college, served in the Navy, and returned to establish himself in business, where he was both competent and successful. . Frank said he was absorbed in other people and things outside himself and that he needed a tight daily structure as well as a constant supply of friends, otherwise he would feel empty, angry, and depressed. He needed constant stroking from other people, yet he contributed very little of himself to his friendships and consequently felt isolated and alone most of the time. He tended to ignore his own wishes in order to please others and obtain their praise or approval. He was extraordinarily sensitive to and intolerant of criticism. He often felt frustrated. At work he would constantly criticize his employees. . When Frank came to me, he was not in a relationship with a woman. He had had a number of girlfriends over the years. The most recent exclusive relationship had been eight years ago with a woman he claimed to have loved but who turned him down be cause she said she felt he was unable to love. He had previously had an identical experience with another woman, and apart from these two relationships, most of Frank's involvement with women consisted of dating. . Outside of work, Frank spent his time playing on a local softball team, reading, and collecting antique guns. Intrapsychically, Frank was typical of the narcissist in general and the closet narcissist in particular. From childhood he carried a grandiose self image still fused to a combined maternal paternal image that was omnipotent, capable of providing perfect wisdom, knowledge, direction, and care. Frank's mother idealized the exhibitionistic father so that this image of the father was superimposed on the image of his mother. His companion grandiose self image felt good, unique, or special when he received perfect wisdom, direction, and knowledge from the omnipotent mother and father, which he equated with love. When he felt he was not receiving this emotional input from others, it evoked the underlying negative representation of the omnipotent figure which he then experienced as either withholding or harsh and attacking. . The companion self image was of feeling empty, full of rage, depressed, confused, and helpless. These omnipotent, grandiose images were allied with the pathologic ego's defense mechanism of avoidance, denial, splitting, mirroring, projection, and acting out. They operated as follows: Frank avoided asserting and expressing his exhibitionistic, grandiose self by posing as inhibited and passive, looking to others to acknowledge his greatness. This behavior was motivated by a fantasy that he must remain `hidden' and never express his grandiose self for to do so would frustrate and alienate his exhibitionistic, narcissistic father. By keeping the grandiose self hidden he was able to stimulate the omnipotent figure to provide the mirroring. When Frank's behavior was motivated by this need to hide, he was inhibited, compliant, eager to please, but suffered from much anxiety and tension. However, when this need was frustrated, it evoked the underlying depression and rage. The psychotherapy began with this pattern: Frank's defensive strategy was continuously activated, so he avoided and inhibited self activation, sitting passively without much awareness of his feelings. He intellectualized and rationalized his projection and acting out of the omnipotent figure onto me by saying that since he couldn't activate himself, it must come from me as his therapist. As the therapist I had the knowledge he required and he wanted me to provide it with direction, advice, and reassurance. My failure to do this and my quiet pursuit of therapy (listening silently, questioning when appropriate) triggered the underlying depression and rage. Frank then perceived me as withholding from him or attacking and demeaning him. Because he felt empty, fragmented, `missing a piece,' helpless, and hopeless (as well as disappointed and enraged), he would be unable to act. Because he could not express his rage at me, he would handle it by acting it out on others for their `failure to meet his needs.' . Whenever my comments or observations spoke directly to his problems, he seemed to respond to them with enthusiasm, but as they never reappeared in later interviews, it became evident that he did no further work on them nor did he apply them to his life between sessions. This apparent paradox can be understood in light of the narcissist's need for mirroring and the underlying impairment of the real self. While I spoke to him and about him, he was the center of attention and basked in the glow. Outside the session, however, he was unable to activate himself to integrate what I had said into his life. In fact, it was threatening for him to do so. Consequently, there was no continuity of theme from session to session. . The beginning of every session was agony for Frank because it confronted him with his basic dilemma: My silence left it to him to start the interview; he felt unable to do so on his own; when he failed at provoking me into initiating the session, he would feel angry, which he expressed by silence. On the few occasions when he would try to activate himself, he would quickly collapse with blocking, protestations of ignorance, and feelings of hopelessness and helplessness. . The first objective of treatment was to make Frank aware that beneath his need for continuous stroking and connection was the exquisite sensitivity to any and all failures to meet his need for perfect mirroring. It was also necessary to show him that his seeking of narcissistic mirroring, while it provided for psychic equilibrium, prevented him from leading a life of autonomy and real self activation. . I began with narcissistic mirroring interpretations to remove the defense and establish a therapeutic alliance. I suggested to him that his silence was a reflection of how painful it was for him to talk about himself. When I further questioned why he had such difficulty overcoming his silence, he became mad at me, accused me of not doing my job, and pleaded that he was unable to talk about himself without questions from me. When I asked why simply doing my job as a therapist (listening) upset him so, he said it made him feel that I was withholding and that I was not truly interested in him. When I asked him where these attitudes came from, he was unable to elaborate. He repeated that my silence meant I was not interested in him. . The first two years of therapy consisted of the silence, arguments, and acting out of rage outside the office. No material from Frank's past emerged, for when the patient is engaged in transference acting out, there is no past. His attention and feelings are concentrated on his relationship with the therapist. Should the therapist bring up historical material by questioning the patient about his past, the patient would merely report facts but without feeling. When a patient discusses his past intellectually, there can be no real progress because the feeling component is missing. The patient may think he is dealing with the past by working it through, but in fact he is not. . Eventually my narcissistic mirroring interpretations that Frank's silence was due to his emotional pain began to establish a therapeutic alliance between us, and for the first time he gave up the silence and tried to activate himself to take responsibility for re porting his thoughts and feelings in the session and to make an effort to understand them. However, he became confused, would mumble, start and stop, and eventually say tearfully, `I don't know, I don't have the knowledge. I can't do it. The situation is hopeless.' . My efforts were next directed at making him aware of his narcissistic vulnerability to me in the sessionshow extraordinarily sensitive he was to my every facial expression, the tone of my voice, and the nature of my comments. When I said something that Frank thought was way off target, his face clouded with disappointment. I had not mirrored him perfectly. This would occur even if I changed my facial expression or my eyelids flickered. These minute disappointments then became the focus of our discussion, and we discussed how his emotional antennae were six miles long. He was constantly plugged into a radar system that could pick up temperature changes of one degree or the slightest shift in the wind. He acknowledged the accuracy of these observations, elaborating that whenever he had to activate or assert himself at home or at work (give up his need for mirroring), he developed the same feelings of confusion, rage, and depression that he demonstrated in the sessions. . After about two and a half years of therapy a breakthrough finally occurred in the context of a new romantic affair Frank was having with a woman named Nina, whom he described as a `goddess of perfection.' She was the ideal woman, physically, emotionally, intellectually, and her admiration for Frank was open and lavish. Their relationship included intense sexual activity. Frank was euphoric. However, after a period of several months, as the whirlwind romance settled down, Nina fell in love with him. At this point, Frank began to be bothered by her `flaws' and felt that she was no longer good enough for him. She had lost her perfection, and he focused on finding things wrong with her. His narcissistic glow had faded. He was not at all sure what had done it, but he no longer cared for her as he had before. . We were then able to link his need for perfect mirroring in sessions to his need for perfect mirroring from Nina. I suggested that it was normal in relationships for the initial romantic fervor to recede and the reality of the other person to come into focus along with the defects. Normal people do not have to see themselves or their loved ones as perfect. Lovers who are not narcissistic personalities continue to love each other `warts and all.' But for Frank the disappointment was a fatal blow that led to depression and rage at Nina, which killed any feeling he had had for her. I pointed out that his disappointment was due to his need for her to be perfect and not to any fatal flaws in her. He was angry at Nina for the same reason he was angry at me. We frustrated his need for mirroring. I suggested that no one could possibly gratify this need and that if he really wanted to improve, he had better try to use therapy to understand why he felt the need for it. . As Frank's narcissistic defenses were broached, he reported for the first time the activation of his underlying angry self through a fantasy of smashing the desk in my office. `I wanted you to calm me down and be sympathetic, and you wouldn't and your outrage at my demand would be so great, you would throw me out.' He went on to accuse me of being `hard and cold' and having `no feeling or concern' for him. He expressed his need for mirroring: `I demand and want you to care for me and stop pursuing your own objectives and withholding from me. I want you to give me something, not just leave me there hanging.' This outburst of feeling triggered tears, but Frank could not identify their source, except to say they were a demand for me to `hold him and make him feel better.' In one session he recounted his anger at his lawyer, who made one mistake after ten faultless years of service. I pointed out the link between his need for perfect mirroring from both me and the lawyer and his rage when he did not get it. I added that even when I merely asked a question, it seemed to interrupt the mirroring and make him feel as if he were under attack. . As therapy progressed, sessions went reasonably well and Frank felt elated. `After the last session, I felt more like a peer with you. I felt great, but it stopped when I got back to work. I could feel the anger starting again. I get afraid that I might do something wrong or be caught messing up in some way. I only want to be seen doing something right' (that is, perfectly). . As Frank took a more active part in sessions, he began to introduce historical material, slowly, in bits and pieces. `In my family the style was to point out flaws and ignore achievement. As far as my father and brother were concerned, I didn't exist unless I did something wrong. Then they noticed me and criticized me for it.' At one point he explained, `My father always asked, `Why can't you be more outgoing?' But I was always afraid of screwing up or being laughed at if I was more outgoing with friends and family members.' . Frank would relate his feelings stemming from his defensive self: `Part of me wants to be adored, receive all the attention in the world, and be loved.' Then he would report criticism from the aggressive self: `Another part says, `I'm no good.' I have to hide until somebody else makes me feel like a real person. On my own I'll show nothing until I know I'm the best.' . As Frank activated his impaired real self in this way, the abandonment depression became more intense. `There's nothing going on in me, no motivation, direction, interest, or energy. I feel isolated, alone, on the periphery. I give to no one. I have to do it, live my own life, but I don't do it. I had a dream that I was with an old girlfriend, expecting sex. She seemed to go along with me and then said, `No.' He free associated: `No, you can't have that; you want it, but you can't have it. I feel disappointed, resentful, but recognize that she's playing it straight and that I'm the one who's playing a game. What do I want?' He projected the dream on to me. `I want you to be there, say something; but no, nothing you can say will make me better. Why don't I talk instead of just sit here thinking? To show off, get a response from you that will make me feel good? I want to take a trip, get away, escape, but I know it won't do any good. I hate it here, going around in circles. I feel helpless, like no one cares.' . At this point his depression took over and he cried. `The crying annoys me. It gets nowhere. It interrupts my train of thought. I feel aging, dying, hopeless. I need you to say something, your voice, or I stay locked in the trap. Everything is in your voice, in women, in trips to escape, anything to get away from these feelings. In a later session, he said, `At work I'm being more realistic than perfectionistic. I don't have to eradicate all the problems. After all, I've been coming to you for four years now, and you're not upset that I'm no better.' . At this first introduction of humor into our sessions, I responded in kind, `Well, if I can do so poorly in my job and get away with it, why can't you?' He laughed, the first small sign that the therapy was beginning to take effect and that he was beginning to change. . Frank continued to report further signs of improvement in the next months, feeling confident and taking pleasure in activating his real self. `I bought a wonderful antique gun. The salesman treated me as if I were ignorant about guns, and I was tempted to withdraw and let him put me down. But instead I decided to confront him and told him off.' This direct self assertive act contrasted with Frank's usual hiding and withdrawing. Then he teared as he thought about this, and he realized that he felt noble, solid, and free of what others thought about him. His working through of these painful emotions led to fantasies. `I had a fantasy of you, father, and me on a huge stage feeling overwhelmed. I asked, `What is going on?' I waited for father's approval, and it never came. Mother said father was intelligent. Well, where the hell was it? I rarely saw him at home.' . As therapy progressed, Frank turned more and more to direct images of his family. `We never ate together. Mother and father's talk was trivial, boring, uninteresting. I feel scorn for father's self centeredness. I'm helpless, know nothing, and father is supposed to help and teach me, but he doesn't.' . In a dramatic session, Frank moved further into the working through phase. He began by discussing his search for the perfect antique gun, comparing it to his search for perfection in women. He often couldn't make a choice because he felt that there was always someone or something else that would be better. He didn't want to be caught without the best. I pointed out that these two pursuits existed on different levels: one, the level of reality where he would like an antique gun and a girlfriend to enjoy; the other on the level of fantasy where he looked for perfection, which al ways seemed to lead inevitably to disappointment, whether it was with antiques, women, or me. . He responded that the fantasy of perfection gave his life excitement. Without it he felt disappointment and impending death. Only others, things or people, made him feel good. Frank wondered out loud, `What's wrong with this therapy? Something is supposed to be happening here if I'm doing it right!' I replied, `Something is happening but it is unpleasant.' `I have no inkling of improvement,' countered Frank. `I want to feel good, and I'm not. If I'm handling this right, where are my rewards?' I explained, `The treatment leads you to recognize your imperfections, and then you get angry and begin to intellectualize.' . That is, there was a process involved and it was working. Frank was investigating how he protected himself from his bad feelings about himself. Therefore, the bad feelings emerged as a part of the process of getting to the bottom of the whole problem. Frank acknowledged that the therapeutic process of remembering and expressing feelings did seem to be working better than at any time before in his life; there did seem to be continuity and some kind of overall pattern emerging. . Frank arrived at the next interview with another positive break through, reporting that he had a very exciting day after the last session. He felt good, spontaneous, involved, outgoing, `feeling his oats' as he had never felt before in his life. . Much remained to be done, and there were many further episodes of transference acting out; but the momentum of working through had taken over, and Frank was solidly committed to the treatment process. Therapy with people like Frank with narcissistic personality disorders brings to mind the procedures necessary to allow an orbiting space capsule to reenter the earth's atmosphere. The capsule must be set at the right angle and the right speed at the appropriate time in order for it to leave the orbit and reenter. If any of these procedures are inappropriate, the capsule will not reenter but `skip off' into outer space. In an analogous fashion, the narcissistic personality disorder requires carefully timed interpretation of his or her narcissistic vulnerability in order to give up the self defeating orbit of defenses and reenter the world of childhood to reexperience and work through early conflicts in order to be able to grow. . 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