23 July 2011

Me & You & Everybody We Know

Filed under: Psychology, Reflections — ktismatics @ 10:58 am

From The Analysis of Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders (1971) by Heinz Kohut, Chapter 1:

The patient will describe subtly experienced, yet pervasive feelings of emptiness and depression… [H]e has the impression that he is not fully real, or at least that his emotions are dulled; and he may add that he is doing his work without zest, that he seeks routines to carry him along since he appears to be lacking in initiative…

[U]pward swings are generally short-lived. They tend to become the cause of uncomfortable excitement; they arouse anxiety and are then soon again followed by a chronic sense of dullness and passivity, either experienced openly or disguised by long hours of mechanically performed activities… A rebuff, the absence of expected approval, the environment’s lack of interest in the patient, and the like, will soon again bring about the former state of depletion…

It must be stressed again that the overt manifestations presented by the narcissistic personality disorders are not a reliable guide toward the answer to the crucial diagnostic question: whether or not to treat the patient psychoanalytically. Yet, having expressed the warning, I shall… enumerate some of the syndromes encountered in those cases where the psychopathology of the narcissistic personality is expressed in more circumscribed and colorful syndromes. In such instances the patient may voice the following complaints and present the following pathological features:

(1) in the sexual sphere: perverse fantasies, lack of interest in sex;

(2) in the social sphere: work inhibitions, inability to form and maintain significant relationships, delinquent activities;

(3) in his manifest personality features: lack of humor, lack of empathy for other people’s needs and feelings, lack of a sense of proportion, tendency toward attacks of uncontrolled rage, pathological lying; and

(4) in the psychosomatic sphere: hypochondriacal preoccupations with physical and mental health, vegetative disturbances in various organ systems.



  1. Says Fink at the very beginning of his Lacanian Psychoanalysis book:

    Patients often go into therapy because they no longer have any will to live, or to do anything at all, because they sense that their libido is stifled or withering; in short, their desire is dying.

    This beginning position of the analysand sounds like Kohut’s description of the narcissistic position. As analysts, both Kohut and Lacan want to supply, at least temporarily what’s missing in the analysand: ego strength in Kohut’s case, desire in Lacan’s. Fink wonders why someone who has been reduced to this undesiring undead condition would bother to come in for analysis in the first place. Crisis, says Fink: the symptom stops working. But when the inability to experience crisis is itself the primary symptom, then what?


    Comment by ktismatics — 24 July 2011 @ 8:55 am

    • It may well take some ego and some narcissism to be a true suicide. This isn’t very generous, but they may have no libido, but they’re still scared of death as ‘being even worse’. Because some casehistories I’ve read of suicide-prone types showed them as very overt, and even enjoying themselves just before they killed themselves. Although that’s probably not so common. I see on the street every day so many totally beaten-down, physically disastrous people, including some with serious defects in which they walk at a right angle, there is one old woman who is so bent over she can’t even stand in a ‘bent position’ and just leans over her shopping cart–that I can’t see how they’d go on. Some people I’ve known have been wheelchaired after having been professional dancers, and yet have reasons to live, and I knew a Multiple Sclerosis victim who lived with the disease totally paralyzed for some 18 years, before finally dying. He was considered by many in my old home town (which I haven’t been to for 14 years) to have a ‘good attitude’ about it, but that didn’t stop some of his old friends from coming to visit him; it freaked them out to be around him. I’m not that good at staying with sick people for long periods, but I’m not incapable of spending a few hours with them. That’s a special gift that I know that certain people have, a girl across the hall from me was able to spend the whole last days with certain of her friends in the hospital, and Cynthia O’Neal, whom Jack has drawn in the book has for some 20 years been spending enormous amounts of time with dyind AIDS and cancer patients on a regular basis–and SHE, as you will have picked up, had been living as a real New York socialite for years, before she discovered she had this gift. I gave her a comp of the book, and took it to her offices, where she does the ‘Big Groups’ of dying, bereaved, and grief-stricken, but she hasn’t responded, and probably won’t. I couldn’t take it to her meetings with the people who had just gotten the diagnosis or are freaking out. As well, I think she knows I’ve got some problems with some of the New Age ‘heaing practises’ she’s derived her work from. Her best friend Mike Nichols, who directed her in ‘Carnal Knowledge’, financed this when Cynthia broke away from Marianne Williamson, that more aggressive New Agey type who made a big splash on Oprah in the 90s, and is perfectly drear and full of shit (makes you hold hands at her lectures etc., gross things to make it really tacky.)


      Comment by Illegal dances of New York City — 24 July 2011 @ 9:37 am

  2. Probably this is why suicide is a fairly common side effect of antidepressants: the drug generates enough energy actually to do the deed. I like Kohut’s reference to “more colorful syndromes” of narcissism: he’s expressing his analyst’s desire here, getting off on his patients’ entertaining symptomatology. Lacan is explicit about it at least: it’s the analyst’s desire that keeps the analysand coming — he wants you to come for more and more sessions. If a cure is achieved, then the colorfulness goes away, the analyst loses interest, and the case is closed.


    Comment by ktismatics — 24 July 2011 @ 10:28 am

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