(1979).

 Journal of Analytical Psychology, 24(2):107-126

The Infantile Roots of Narcissistic Personality Disorder

Rushi Ledermann

Introduction
In this paper I am considering and discussing a hypothesis about the roots of narcissistic personality disorder.
My thoughts arose out of clinical work with two patients who showed many features of this disorder. I was greatly
helped in my understanding of the origin of their psycho-pathology by Jung's theory of archetypes, the work of the
London analytical psychologists and in particular Fordham's concept of the defences of the self (FORDHAM 3, 4),
and by the work of some psychoanalysts.
The two patients who, in particular, gave rise to the thoughts expressed in this paper, made inordinate demands
on my capacity to suffer intense denigration, loneliness and depression; at times I experienced considerable hate in
the countertransference. These experiences brought home to me the indispensability of agape in the analyst's
equipment, to which Lambert has drawn our attention (LAMBERT 14). Agape was reinforced in me by both
patients' desperate longing for object relations and wholeness which were deeply buried beneath many defensive
layers of detachment, denial, negativism and fragmentation.
This longing aroused in me the urgent wish to understand their plight so as to assist their in born archetypal
striving towards becoming individuals. Jung's belief in the original potential wholeness in every person, however
damaged and fragmented, gave me the courage to persevere (JUNG 7, p. 108). Although I describe these patients as
suffering from narcissistic personality disorder, I recognise that in clinical work we do not find syndromes in
pure culture. Certain pathological features pointed to areas of infantile autism and other infantile psychoses.

Narcissistic Disorder
Several definitions of narcissistic disorder have been put forward. Kohut, in his book The analysis of the self,
expressed the view that patients with narcissistic personality disorder ‘remained fixated on archaic grandiose
self configurations and/or on archaic, overestimated, narcissistically
- 107 -

cathected objects’ (KOHUT 12, p. 3). More briefly, he sees their development arrested at a very early
but healthy state of infantile development. In his recent book The restoration of the self he uses the term
‘narcissistic personality disorder’ in a different way, namely as a ‘temporary break-up, enfeeblement, or
serious distortion of the self’ (KOHUT 13, p. 193). He mentions one defensive structure in this disorder, namely
‘pseudovitality’, which, he says, covers over the primary defect in the self(Ibid. p. 3 f.). He does not attribute
that defect to defensive structures; his use of the term self is, of course, different from ours. Kohut's views as
expressed in his second book are somewhat closer to those put forward in this paper, but it will be clear from my
theoretical section that substantial discrepancies remain.
Kernberg sees patients suffering from narcissistic disorder as fixated on an early defence structure which
springs into being through serious disturbances in early object relations which threaten the person's self-regard.
Despite superficially smooth … social adaptation [such patients suffer from] serious distortions in their internal
relationships with other people. Grandiose phantasies about themselves often go along with a feeling of emptiness.
They manifest serious deficiencies in their capacity to love, chronic dissatisfaction about themselves, exploitiveness
and ruthlessness towards others (KERNBERG 11). Kernberg's view basically accords with my observations. The
patients considered in this paper are unable to love themselves. Their feelings of aloofness and superiority do not
arise from healthy infantile omnipotence characteristic of the primal self. On the contrary, they arise as an
early complex defence structure against the terror of not being able to relate and of ‘non-existing’. It is
that structure and its ensuing distortion of personal development which I wish to explore.

Clinical Material
The clinical material from the analyses of two patients suffering from narcissistic disorder has been selected and
structured so as to show how I arrived at my hypothesis of the origin of this disorder, developed in the final section.
This paper is concerned with the aetiology of the illness, so the material is predominantly derived from the early
stages of the analyses.
Mr A.
Mr A. was in psychotherapy and subsequently in analysis with me for about twelve years. I shall describe
his personality as it was at the beginning of treatment and briefly sketch his background. He was then thirty-seven
years of age. He comes from a professional English family who were conventional people. He is an academic with a
good physique.
- 108 -

He had taken an excellent university degree and had reached a position of intellectual and social prestige; yet he felt
lonely, gauche and an outsider. He concealed successfully that he did not know how to behave among people and
appeared to the world reasonably well-adjusted. Mr A. had grandiose phantasies about the world-shaking nature of
his work yet, at the same time, experienced it as sterile and futile. He felt that by using his wits he had learned how
to control his fellow beings, be liked and successful. But his achievements felt false and hollow to him. His main
complaint was that he had neither core nor backbone. ‘I need somebody to shove his arm up my backside, to give
me a spine’, he said. He felt depleted, yet his defensive grandiose self-image, which he used to call ‘my milordism’,
made him buy a regal four-poster bed and other spectacular objects which he could ill afford.
Mr A. was unable to feel love for himself or other people, and had not formed any lasting relationships with
men or women. He merely had numerous brief involvements, mostly with men, but would ruthlessly discard them
for trivial reasons and without experiencing any grief or mourning. He was compliant, submissive and placatory
towards authority figures into which rôle he cast me, and sent me huge bouquets of flowers when I was ill; but he
despised himself for his desire to please. He hated himself for never having rebelled against his parents
in childhood or adolescence. He said he experienced his mother as cold, detached and non-physical, yet possessive
and intolerant of criticism and aggression. She told him as a young child that he had been an unwanted baby. He
related that his father had a more affectionate relationship with him in infancy, but this intimacy did not continue
into childhood when he experienced his father as a total let-down, ‘a nincompoop, a spook, a phantom father’.
Moreover, his father denied his own aggression and the fact that he beat my patient as a child. The father was a
pacifist, described as hypocritical, a fanatic churchgoer but mean, weak and sentimental. He put his wife on the
pedestal of a goddess yet made her wait on him and deprived her of materialcomforts.
At the age of eight Mr A. was sent to boarding-school. This seemed to him confirmation that his family wanted
to be rid of him, and he said, ‘I am a sapling that did not grow into a tree and developed only side shoots.’ After
analysing his ‘side-shoots’, his compliant self, we had penetrated sufficiently to reach the undeveloped sapling: his
damaged and fiercely defended core. One day about that time he came to a session and said: ‘I think I shall chuck it
all in; nothing has really changed.’ He was about to discard me as abruptly as he had discarded many friends as
a child and adult.
This sudden cold detachment and ruthless statement about my use-lessness conveyed to me that we were getting
nearer to his undeveloped real self. Not surprisingly, this fact had made him take fright. We
- 109 -

worked hard at understanding his fear of reaching his damaged infant self. At that time he frequently mentioned a
recurrent dream that had persecuted him for years: a baby on a railway platform swaddled like a cocoon
was being savaged by a cat while a train went relentlessly past. I took the cocooned baby in the anonymous
surroundings of a railway station to represent his fiercely defended infant self to whom his mother's unadapted
behaviour felt like being mindlessly savaged by a cat. He saw the train as his split-off relentless rage. It was a
warning to the analyst: do not touch my core. He erected a solid barrier between himself and me and imaged our
relationship as ‘ships passing in the night’, ‘wheels that do not engage’. He barricaded himself against me on the
couch, ‘like in a fortress’ he used to say and he insisted that he could not look at me. Whenever I referred to his
friendly or hostile feelings for me he distanced himself even further. ‘I cannot feel anything in relationto you’, ‘I
cannot focus on you’, he said. As an infant he had not experienced healthy fusion with his mother. Hence he
experienced intense terror of anacliticdependence on me as he feared that such dependence would lead to
disintegrating rage and madness. He became agitated and expressed this fear in archetypal larger-than-life terms
saying that I tried to push him over the cliff, into an acid bath or into a wall of flames. He said, ‘You are putting the
Nessus shirt on me.’ You may recall the Greek myth in which a garment soaked in the blood of the centaur, Nessus,
caused the death of Hercules. I think that these images expressed his terror of disintegration. His cold detachment
increased after each holiday separation. Denying anger and sadness during such separations, he threw himself into a
brief invariably disappointing homosexual relationship: an ‘anal feed’ by one of the ‘golden people’. ‘The golden
people’ were all the envied men who had what he called ‘the well-fed look’.
The following clinical material seemed to throw light on the disaster of his earliest infancy. He had
the phantasy that his feeds were imageless and devoid of emotional experience. He said, ‘Driven by hunger my body
must have betrayed me and forced me to drink the breast muck; but it was a mechanical event without pleasurable
experience; a purely neuro-physiological happening.’ These were his words before I came across Fordham's
observations in his recent book. There he states that if the relationship between the baby and the breast-mother was
catastrophic ‘in breast-feeding the neuro-physiological apparatus may operate without its psychic counterpart’.
(FORDHAM 4, p. 93).
Mr A. relived these stunted feeds in the transference. He maintained that there was no analyst nipple to latch on
to. I had no breasts, only toads (turds) that might jump at him and he phantasied about my ‘shitty cunt’ with
revulsion. This seemed to indicate a confusion between subject and object and a zonal confusion: he prematurely
- 110 -

moved from the mouth to the anus/vagina; by way of projective identification the shitty cunt was his own
anus/mouth filled with faecal rage with the non-existent breast. I shall return to these confusions in my theoretical
section. Whenever I likened a session to a metaphorical feed he went into a paroxysm of agitation and panic, writhed
on the couch, beat his feet against the wall as if in danger of being suffocated by me. He also brushed the imagined
faecal matter from his arms and thighs. This sometimes went on for as long as forty minutes. It seemed to express a
violent, and on account of the defensive barrier, impersonal attack on the feeding-analyst-mother.
Another of his phantasies was that his mother had wished him to die already in the womb and he imagined that
he did not want to be born. His birth was overdue and difficult and he had been a huge baby. This phantasy may be
compared with Bettelheim's speculation that children's autism may be related to their mother's deathwish against
them (BETTELHEIM 1). Confusing me with his mother he imagined that also I wanted him to die and he said, ‘If I
let you feed me you, too, will want to kill me.’ As he could not bear to think that his mother or his analyst had
breasts he imagined himself as a baby sucking milk through a long tube which was not held by his mother. This I
experienced in the countertransference as his strong desire to distance himself from me. It also seemed to express his
wish to get back inside the mother and be fed by the umbilical cord. I shall refer to this phenomenon in my
theoretical section. He hoped that one day he could vomit all my breast-muck-interpretations on to the tiles of my
fireplace. He had a screen memory of being forced to eat that old-fashioned stodgy Queen Anne's pudding, cooked
by his mother; he called it queen arse pudding and it made him feel sick. I related this to the archetypally
experienced queen-analyst's anal revolting feeds. His lack of being able to feed also manifested itself in his research:
he could not use nor refer to other people's work. He experienced this inability to feed as a phantasied organ
deficiency. ‘I lack the limb with which I could connect with you,’ he said. He likened himself to a man who feels a
ghost arm where his amputated arm should be. I wondered whether this ghost arm was a representation of the baby's
unfulfilled archetypal expectation of a linking between him and the maternal environment.
Needless to say, Mr A. could not use his penis to link with a woman. This inability to link could be due to
his mother's lack of emotional linking with her baby; or perhaps an innate deficiency in him. In
the countertransference it felt like his attack on linking with the mother-analyst. Instead of feeding he felt that he
was a hungry tiger locked in a cage or that he was stealing my food. He repeatedly dreamed of a dog stealing
his master's food. For a long time he claimed that my interpretations, although they made sense, did not touch or
change him.
- 111 -

Yet it transpired that he took a great deal of understanding away from the sessions and used it very successfully in
the outside world, particularly in his dealings with colleagues and young people.
The following material made me think that his deintegrative processes had prematurely moved from the oral to
the anal zone, another feature which I shall discuss in my theoretical part. All his life he has enjoyed defaecating
whereas eating was simply a means of survival. He also claimed that his anus was the only place where he felt
physically loved though in an impersonal way. He remembered sitting on the pot as a little boy and warm steam
caressing his anus, but he did not know that his mother had put hot water into the pot to relieve his constipation. (I
mentioned his ‘anal homosexual feeds’ during my absences.) He tried to replace oral dependence by anal
control, Wissen ist Macht (knowledge is power) he often used to say.
 In childhood Mr A. knew each hiding-place of his siblings' toys. He carefully scanned my consulting room
every day on arrival and the slightest change did not escape his attention. Also he badly wanted to know who in my
household did the cooking, the gardening and so on. He criticised my garden and brought me vegetable plants to
have some control over what I should grow and eat. He called himself the do-it-yourself-mother: every evening
when he came home he felt panicky and poured a considerable amount of whisky down. He said, ‘I need to feel the
bang on my empty stomach to sober and calm me.’ This is possibly how an agitated baby feels when his mother fills
his empty stomach with milk. Offers of getting in touch with me instead were rejected as useless. In the early days
he also used to smoke during sessions and heavily at home. It is interesting that during that period he wrote a book
called ‘Do-it-yourself sociology’. Not surprisingly, he also practised do-it-yourself sex, masturbation, with anal
sadistic instead of genital phantasies. The stereotyped phantasy was that a giant would beat him up and then cuddle
him.
The following material seemed to me an acting out of the infantile phantasy previously mentioned of going
back into the mother's body which we can postulate feels to the baby identical with going into his own body. He
seemed to act out this phantasy by consistently hurrying home after work, shutting the front door against the outside
world, only to feel imprisoned and desolate in his own house. He paced up and down in agitation and saw himself as
a hungry tiger in a cage, refusing to be fed by me. For a long time he was haunted by the fear that his house might
burn down or blow up while he was out and in those days he frequently had to turn back on his way to work to
check whether he had turned off all electric appliances. This metaphorical return into mother's body was also
expressed in an early childhoodnightmare which he often brought up as it expressed the transference
- 112 -

feelings of that time: in this dream the floor-boards lifted up, wafted him into the air and landed him inside mother's
huge linen bag. He felt terror until his father prised it open and rescued him. The unstable floor-boards seemed to
represent the unsafe maternal environment which he transferred to the analytical one; the linen bag mother/analyst's
inside that promised security but spelled terror of imprisonment.
When he had talked about not having a core Mr A. had brought me a nest of five Russian dolls, one fitting into
the other. Only the last tiny one is solid. It occurred to me then that the little one inside the big dolls represented
himself inside the mother. He expressed the feeling of imprisonment inside me very vividly in a picturewhich he
drew at that time: a man/foetus, his feet nailed together as if crucified, gnashing his teeth, imprisoned in a black
womb. This also showed that he experienced himself as the ‘Christ-hero’ (grandiosity) and at the same time felt
totally impotent (a non-person). He said he felt himself to be a fly in my spider's web and he was
slowly being ingested by me. When I asked him what he feared most, he said: ‘to be gobbled up by you.’ This could,
of course, be understood as a reversal of his longing to gobble me up; but I think it expressed his terror of
dissolution which presumably a baby experiences when through lack of good enough maternal care he cannot
separate out from the mother and feel that he exists in his own right. This delusional phantasy of being inside
the mother which he relived with me seems to have contributed to his constant fear of disintegration and dissolution
which he so frequently expressed. I wondered whether there is a parallel to an aspect of Jung's childhood nightmare
of the tree-trunk-phallus man-eater. (JUNG 10, p. 27). I rarely dream about my patients, but at that time I had what
seemed to be a countertransference dream about Mr A.: he was on street level trying to throw himself head first into
the underground system and fell flat on his face; I rushed up to him to save him. I wondered whether this was
a representation of his flight into the dark inside of the impersonal mother.
I think he oscillated between feeling caught up inside me and adhering to, instead of depending on me. This
adhesion made him experience a woman's body as ‘sticky and tacky’. He frequently mentioned and described
a childhood memory of his mother pulling a plaster off his skin as a brutal act yet agreed that it must have stood for
an inner experience, a violation of the adhesion to his mother. He often brought the image that he feels stuck to me
like a limpet on a rock, a fly on fly-paper. For a long time he adhered to the analysis in misery and refused to go out
into life. He compared this experience with a memory from childhood: he used to sit for hours miserably on mother's
scullery steps, getting under her feet and incurring her anger; yet he refused to go out to play.
- 113 -

The ‘annihilation’ of the breast seems to have produced persecutory guilt in him that he had murdered
his mother. After she had died he had a terrifying hallucination: she was rising from her death bed like a huge Henry
Moore figure to wreak vengeance on him. He also feared this vengeance from me: when he hoovered his home and
the vacuum-cleaner sucked up a spider that represented the analyst, he expected the damaged spider to be still alive
when he emptied the bag and to go for him in vengeance. For years previous to, and in the early stages of, the
analysis Mr A. was haunted by a nightmare: he was accused of having murdered a woman. Although he pleaded
despairingly that he did not do it he had a vague awareness, in the dream and for a long time also in his waking life,
that he had done it and knew he would be hanged according to the same incomprehensible and inexorable law by
which the outside world seemed to rule his life.
This pre-oedipal guilt had produced an urge for punishment in him: first he went for apomorphine therapy
against homosexual impulses and felt utterly degraded by this treatment; then he converted to Catholicism to
humiliate himself in confessions, and finally he wanted to punish himself by coming for analysis. His
religious conversion was also an attempt to find archetypal parents or to find a constant object instead of object
constancy, as described by Plaut (18), but it failed.
Although the following episode occurred later on in the analysis, I shall briefly mention it because I think it
shows so many features of narcissistic personality disorder. One day Mr A. found a kitten crying in a tree in my
front garden. He brought it down and asked me to look after it. After I had made sufficient enquiries as to whether
anyone locally was looking for a missing kitten, he asked me whether he could have it. Cats had by then played a
part in many of his dreams. They seemed to represent his pseudo-independent detached self that lets himself be
cared for by the mother-analyst without experiencing commitment or gratititude. At this time he could not feel in
that way towards me as he was not able to introject me. Also as he craved for the perfect fit he felt destructive
towards the good-enough care. He used to quote Robert Graves: ‘Forgive me, giver, if I destroy the gift that did so
nearly please me.’ He tried to be the perfect mother to this cat that represented part of himself and showered all
the affection on it that he could not accept from me. When after a year the cat got run over by a car, he cried
throughout two sessions, as distressed as a child would be if it was deprived of its transitional object.

Mrs B.
Mrs B. has been in analysis with me for two years. I am presenting some of her remarkable material as I think it
throws light on some of the early defence mechanisms that lead to narcissistic disorder. She
- 114 -

comes from a totally different social and ethnological background and is a married woman with three little girls. Yet
her transference projections and her archetypal images and phantasies showed some striking similarities with Mr
A.'s.
Mrs B. was thirty-eight at the beginning of analysis. She is an American Catholic. Her father was a truck driver
and very often absent from home, her mother was a barber's daughter in a small provincial town in the U.S.
Her mother sounds even colder, more detached and non-physical than Mr A's. She was unable to run the home, and
as a result they lived in filth and squalor. She wanted to put my patient into care but the authorities did not allow it.
Her mother had several psychotic breakdowns during my patient's childhood, and on two occasions she was taken to
a mental hospital in a straitjacket. Although Mrs B. felt relieved about her mother's absences, she also felt guilty as
she thought that she had caused her mother's illnesses. During her mother's first hospitalisation Mrs B. was put into
an orphanage and during the second she stayed with her grandmother, who seems to have been the only somewhat
maternal figure in her life. Her father was rough and rather violent but affectionate so long as she was obedient.
However, when Mrs B. was quite young he formed an extra-marital relationship and when she was nine he finally
left his family for the other woman. In her early teens she, like Mr A., tried to find archetypal parents. She entered a
convent intending to become a nun. She took vows, but became anorexic and suicidal and after five years was sent
to the closed ward of a mental hospital for three months. The psychiatrist warned her never to enter into close
relationships. She trained as an occupational therapist, and met her future husband, whom she described as if he
were the ideal breast/penis part object she never had, and they got married. She felt it was significant that his
Christian name happened to be the same as her family name. When she discovered that he expected a relationship of
mutuality she inwardly discarded him and would have gladly got rid of him altogether had he not been necessary for
her financial security.
Like Mr A., Mrs B. has made a reasonably good superficial social adjustment but, like him, is unable to love
herself or others or to make any lasting relationships. I thought she had quite a good relationship to her children, but
she denies this. ‘My love is only skin deep’, she says, ‘because I am hollow inside’ and like Mr A., she compared
herself to the hollow Russian dolls. Her somewhat grandiose ideas about herself manifest themselves positively in
the way she talks about her chess playing. She says that without much thinking her hands just make the right moves
and claims that she almost invariably wins. Negatively this grandiosity shows itself in her conviction that her
destructiveness has cosmic dimensions. She represented it by drawing the head of a
 - 115 -

brightly-coloured, fierce-looking devil: one eye is glowing red and the other brilliant yellow, which seems to
indicate the split in her personality. In her own words ‘he is shooting out bolts of lightning from his nostrils that
burn up my inside’. The devil's head is flanked by various part objects such as menacing mouths and eyes, which
point to her feeling of fragmentation. She declares that this devil is both in me (the analyst) and in the space
surrounding her head.
She showed typical features of narcissistic personality disorder in her relationship with me: she put up a solid
barrier, denied all feelings and said with cold ruthlessness: ‘If you don't bring me to life, I shall kill you without the
slightest compunction and then kill myself.’ By projective identification she sees her own ruthless exploitative parts
in me. Initially she would call me a hard-boiled businesswoman and claim that I only see her for my
own satisfaction and the money I can get out of her. The fact that I reduced her fees considerably and made various
concessions like seeing her during holiday times got brushed aside by her. Like Mr A. she seems unable to
use reality testing. In contrast to him she has no false compliant self. Indeed for months she used to call me a stupid,
useless monster because I take weekends and holidays.
Like Mr A. she is in a state of adhesion instead of dependence. Separation from me feels monstrously cruel to
her but she regrets that she is unable to feel sad or angry about my absences. This adhesion compels her to come five
times a week, which she can only afford by taking a part-time job, a great sacrifice for a mother with three young
children. When I asked her why she comes, she said that she hoped that one day she would be able to hope that I
could bring her to life.
Again, like Mr A. she puts a solid barrier between herself and me. At times I detect in her a glimmer of warmth
and a sense of humour, which make me feel that this barrier is perhaps not without some permeable areas.
Confusing subject and object, she experiences her phantasied murder of the breast as cosmic destruction aimed at
her: she drew herself as a charred tree-trunk in a desert after an atomic attack. She is full of paranoid fears. Like Mr
A., who barricades himself on the couch, she barricades herself on the chair. ‘I must be able to get on my feet and
run when the daemon inside you gets loose’, she says. She is also afraid of sleeping in the same room as her husband
and covers her head with a pillow at night.
There are many ways in which Mrs B. conveys to me that in phantasy she has annihilated the breast, indeed
even her mother's body and through identification her own body. She firmly declares that women have no bodies
and are animated clothes walking about. As she is not mad, she knows that this is only subjectively true for her. She
says that not having a body made her want to become a nun because nuns appeared not to have bodies. She chose
the Benedictine order because
- 116 -

they wear a big white rectangular scapula down their front which makes them look two-dimensional. Her phantasy,
that she had annihilated mother's body and hence had no body herself, brought interesting material to light about two
miscarriages she had before she gave premature birth to two of her children. She said: ‘I am flat and babies just drop
out of me; I had to have a suture on my cervix during subsequent pregnancies, otherwise I would have lost
all babies.’ During labour, when the obstetrician encouraged her to push, she said: ‘I am all hard inside and I have
nothing with which I can push.’ Another time when she talked about feeling dead she speculated about the
miscarriages: ‘I had to get rid of my babies because I could not bear strange life in the void where my own life
should be.’ She explained her anorexia by saying: ‘I did not eat in the convent because food would have increased
the void inside me.’ Now she feeds on herself instead of on me; for instance by biting blood blisters into her cheeks.
Her fetishistic object, which had some features of a transitional object, were paper dolls which as a little girl she
cut out and used to take along wherever she went. They appear to be a representation of how she felt about her
destroyed mother's body and her own non-body. Also, she could discard them like a baby does transitional objects
whenever she felt like it and she had complete control over them: ‘I decided what clothes to put on them.’ Also ‘the
dolls quarrelled without killing each other’. One day she brought some paper dolls to the session when she talked
about my not having a body. ‘You too are hollow inside; if I bash you in you become a paper doll.’ She says she
cannot make use of me just as she could not make use of the nuns who were kind and caring. She said, ‘I have
a mother-hole into which you do not fit. I cannot slot you into anything. I have nowhere to put you. I have to get rid
of you as I got rid of my mother.’ At other times she described her hole as having the shape of a gingerbread man.
The gingerbread man refers to one of the very few good oral childhood memories she has: her grandmother used to
bake gingerbread men for her. I speculated that the experience of these holes might be a representation of the
archetypal matrix of a good breast, a matrix that never got filled by a good feeding experience. ‘When I am with you
you feel like a house, but a house that disappears is no house.’
Mrs B. keeps her eyes firmly closed throughout the sessions and reports that for many years she felt tormented
because she could not take a deep breath. I wondered whether this had its origin in her defence against introjecting
her maternal environment. Likewise she drew a picture of me without a body, without a nose (only nostrils) and with
a mouth barricaded by teeth. The eyes appear to be dislocated breasts with black, sinister nipples. She accepted that
this picture could equally represent herself or her mother. She calls herself a tree without roots,
- 117 -

which reminded me of Mr A.'s image of being a stunted sapling. By splitting she dislocates parts of herself outside
herself. This gives her the terrifying experience of an extraneous present that she calls ‘the twin’. She feels that this
twin is located outside the left-hand side of her head and she experiences a great deal of turbulent activity going on
inside it. She is longing to, but also terrified of, making contact with
Fig. 1

it. She feels that it might contain essential parts of her, perhaps her core, perhaps a black mindless monster or
the devil which, at times, she projects onto me.
 The other manifestation of a dislocated part of herself is what she calls ‘the dead thing’ (Fig. 1). She drew it
before I went on holiday so as to get magically rid of it by depositing it with me. It scares her. ‘The dead thing’ is
faint, has no mouth, no nose and black sockets instead
- 118 -

of eyes. Its hair is made of dead straw and it has neither arms nor feet. It floats on a broken string around her. She
calls it the dead Egyptian mummy and recognises the double meaning of the ‘dead mummy’. She said, ‘Put it back
into the tomb’ and we both said simultaneously, ‘go back into the womb’. She added, ‘If you touch it, it will
disintegrate into dust or feel like a squashy, maggoty potato.’ She hears a scream in the ‘dead thing’; not the lusty
scream of a healthy baby but the faint scream of a dying person. It conjures up in her faces of concentration camp
inmates who are beyond anger and expectation, but who simply express vestiges of a will to survive.
This ‘dead thing’ seems to me a most interesting representation of a baby that does not link with the
maternal environment as it has neither mouth, nor sense organs, nor hands and feet. It is reminiscent of Mr A.'s
ghost arm experience. She says that she feels like a thalidomide baby that cannot connect with me. She also used to
imagine her mother with stumps in place of hands and feet. This was probably related to the image of the
gingerbread man hole, as gingerbread men have stumpy arms and legs. Like Mr A. she expresses her wish/fear of
putting roots into the archetypally experienced analyst mother by the image of standing on top of a cliff, terrified of
going over it and at the same time longing to throw herself down on to mother earth. Again, like Mr A., she
imagined her infantile feeds as having been devoid of imaginative or emotional experience. She says that she has
never enjoyed eating. As may be deduced from my theoretical section, sex is no genital experience for her. It seems
to remind her of her infancy feeds: she says sex always works but it is devoid of any emotional experience.
The anal material she brought is the vivid image of the black beady-eyed monster that mindlessly destroys and
is felt to be outside her head in the ‘twin’ or inside me. It could well be a representation of the uncared-for baby's
mindless anal destructiveness, or excessive innate destructiveness in her. She made a drawing of a black breast-
shaped mound covered with snow and full of maggots and she told me a fantastic story about cats who eat their own
worms (faeces), breathe them out and then swallow them again. Both the picture and the story have anal
connotations. The story about the cats sounds like a reference to the baby's non-object related anal phasewhich I
shall discuss in my theoretical part. Also her eagerness to acquire knowledge—she was one of the best pupils in the
convent—and last but not least her experience of herself as a computerised robot that, over the years, has
programmed itself with observations how people behave, makes me think that she, like Mr A., prematurely moved
from a most unsatisfactory oral stage to a controlling pseudo-independent anal one. Another way in which she
shows her pleasure in power is her passion for chess, and her frequent victories as she claims. When she began to
feel the threat of a dependent
- 119 -

relationship with me she said: ‘You are taking my chess away from me.’ Her love of chess seems also to derive from
an inborn longing for patterns and order as she experiences herself in black chaos. She also loves Apollonian music,
Mozart and Schubert, but cannot do with Dionysian Beethoven or Brahms. She is hoping to experience some order
through the relationship with me. ‘I come here because I cannot spend my life living with substitutes,’ she said. She
expressed her lifelong pseudo-independence by saying: ‘I have always felt that I had no mother and was my
own mother. I was impervious to what my mother said; I simply did not hear her. I must have been an
unmanageable child though I was timid and never rebellious.’
Not having experienced oral dependence, she images dependence on me as disappearing in a deep, black pool.
This sounds like Mr A.'s phantasy of being lured back into the mother, but it could also represent her sinister
destructive rage. As a child she once saw the shadow of a tree as her witch mother's cauldron and was terrified of
drowning in it. She brought a painting of an enormous black pool with herself being a small white circle surrounded
by darkness. Like Mr A., she expressed her fear of being ingested in my spider's web and likewise was terrified
of being gobbled up by me. That fear had taken on a delusional quality during her stay in the convent. When she was
called into Mother Superior's room, she felt terrified because she was convinced that the cupboards were full of half-
eaten nuns.

Theoretical Discussion
I now wish to discuss my clinical material and develop a hypothesis on the roots of narcissistic disorder. I
arrived at the view, similar to Kernberg's, that this disorder is due to early infantile defences. However, I differ from
him as to the nature of those defences. My reflections are based on Fordham's conceptual framework of
infantile development (FORDHAM 2). Fordham postulates that the baby, separated from its mother at birth, is a
wholeness which he calls the original self. The baby needs to experience a perfect fit with the mother. He can then
fuse with her and have the illusion that the mother, her breasts, hands and everything about her are part of himself:
‘self-objects’. Since he forms an ego it is assumed that the baby has an inborn drive to seek objects. That leads to the
deintegration of the original self, i.e. its spontaneous division into part systems around libidinal zones. Those zones
are pre-conscious centres, called deintegrates. A deintegrate ‘represents a readiness for experience, a readiness to
perceive and act’ (Ibid. p. 127). Perception is part of object-relating and we postulate that a correct perception can
occur only when the object(mother) exactly fits the deintegrate.
- 120 -

Feeding is the first deintegrative process. If the fit between the mother and the baby is disastrously bad, as we
must assume it was with my patients, healthy deintegration around the oral zone cannot take place. Through the
infant's blind attempt to preserve the integrity of his self an early defence system arises spontaneously out of the
primal self. Stein, in his paper ‘Introducing not-self, put forward the idea that the self can carry out defence actions
before there is an ego (STEIN 20). Subsequently Fordham developed the following theory of the ‘defences of the
self and describes their operation in his recent book (FORDHAM 4). Such defences create a barrier between the
baby's self and the environment at the time when the mother would normally be experienced as part of the infant's
self. ‘[They] are violent attempts to attack and do away with the bad object [the breast]—they can reach a level at
which one must speak in terms of annihilation’ (FORDHAM 3, p. 193). Rodrigué made similar observations, and
writes of such an infant's ‘negative hallucination of the environment’ (RODRIGUÉ 19, p. 159 and p. 175). Fordham
describes
the persistence of this defence after the noxious stimulus has been withdrawn, … little or no inner
world can develop, … all later developments based on maturational pressures result not in
deintegration but disintegration and the predominance of defence systems leads to the accumulation
of violence and hostility, which is split off from any libidinal and loving communication with
the object that may take place (FORDHAM 4, p. 91).
I found ample confirmation of Fordham's theory in my clinical material. The lack of perfect fit between baby
and mother at the beginning of life can be attributed to an innate defect in the baby and/or to grossly defective
maternal care. It will be recalled that Mr A. produced vivid body memories of the way he felt repelled by
the breast and how he phantasied about his noxious suffocating feeds.
The defences of the self prevent the baby from using any of his sense organs to introject the breast and the
maternal environment. That seems to explain the narcissistic patients’ experience of internal ‘hollowness’ and
general ‘deadness’; the ‘Russian doll’, the ‘mother-hole’ and ‘dead mummy’ experience. It also explains their
pseudo-independence and their stance of the ‘do-it-yourself-mother’ and the two-dimensional ‘paper doll’ image.
For a long time my patients could not even symbolically use me as a mother/analyst, since the analyst for them stood
for the annihilated breast. They could not draw on good memories of infantile feeds and of
a containing maternal environment; their plight was that they did not know how to use the analyst except as Mr A.
put it: ‘I want to be baptised’ and Mrs B.: ‘I want my stamp of approval.’ Also they longed to feel real, alive and
whole instead of dead and fragmented. It seemed inconceivable to them that I could help them in that quest. For, as I
have shown, they had a great dread
- 121 -

of dependence. They were convinced that it would bring about their disintegration through reliving their enormously
violent rage and hate of the breast and the maternal matrix that were so catastrophically inadequate in infancy. I
mentioned that they longed for the ideal mother, an illusion they had missed at the appropriate time in infancy. Yet I
presume that their archetypal expectation of maternal care, though atrophied, made them come to analysis and
persevere despite great practical difficulties and intense fears.
My patients also saw themselves as feeding on themselves; Mrs B. bit blood blisters into the inside of her
cheeks and Mr A. filled himself up with whisky instead of getting in touch with me. He also saw himself as
uroboros, the tail-eating serpent. As we know from Jung the alchemists used that symbol to express the state of
original wholeness (JUNG 9, p. 190). That would indicate that both patients, to some extent, remained in the state of
the primal undeintegrated self. On the other hand, Jung observed that symbols of wholeness, like the uroboros,
frequently occur at the beginning of the individuation process (JUNG 8, p. 165). The fact that my patients brought
that material seemed to indicate that personal growth was possible.
The annihilation of the breast gives rise to further pathological development. As deintegration is an archetypal
process it takes place on a spectrum that stretches from an instinctual, neuro-physiological pole to an image-making
psychic one. If the baby has, in phantasy, annihilated the breast, Fordham observed that as a result of the defences of
the self, experience at the psychic pole of oral deintegration is stultified; the feed is experienced as a purely neuro-
physiological event and lacks ‘the imaginative elaboration of the healthy infant’, as Winnicott puts it. Newton and
Redfearn in their recent paper also refer to that state (NEWTON and REDFEARN 17). They say, ‘If
the mother does not confirm and help to differentiate the child's bodily experience as part of the personal interaction
spiritual/instinctive splitting may occur.’ This postulated severance of the neuro-physiological from the psychic
experience seems related to, though not identical with, Bion's notion of the presence of an excess of beta over alpha
elements (GRINBERG 5, p. 35). Bion holds the view that in health alpha elements in the psyche transform sense
impressions into visual, auditory and olfactory or other kinds of images in the mental domain. In the damaged
person, excess of beta elements prevents the transformation of sense experiences
into thinking, dreaming and remembering. The lack of emotional experience in the oral phase leads to a terror of
non-existing. The arrogance, aloofness, grandiosityand pseudo-independence which my patients manifested is
a defence against that terror. These attitudes were not the healthy illusion of infantile omnipotence which occurs so
often in analytic regression. My patients did not behave like a healthy baby that finds
- 122 -

in the analyst what he archetypally expects; or in Winnicott's terms to whom ‘hallucinating and the world's
presenting … are taken by him to be identical’ (WINNICOTT 21, p. 154).
The ‘no-breast’ experience also leads to the inability to link with a self-object that is felt to be all bad. That is
the ‘missing limb’, ‘ghost-arm-thalidomide-baby’ experience and the ‘gingerbreadman hole’ image of my patients.
Furthermore, the clinical material showed that the phantasied annihilation of the breast produces pre-
oedipal guilt and by projective identification intense paranoid fears that the outside world is murderous. Hence my
patients felt threatened by intense hostility and destructiveness from within and from the analyst. The analyst was
for them non-human, archetypal and a possible threat to their lives.
In narcissistic patients a further defensive measure erupts spontaneously. From the transference it appeared that
the infant wards off stunted oral deintegration by prematurely making the anus the focus of deintegration. The
reason for such a premature move seems to be that the anal phase has a non-object related aspect. That aspect is also
described by Paula Heimann in her paper ‘Notes on the anal stage’. She writes:
The anatomical position of the anal zone is dorsal, distal and hidden. It therefore lies outside the
infant's social contact with his mother.… Anal excitations begin and take their course independently
of any help on the part of the mother and both the somatic function and the libidinal pleasures derived
from it are regulated by the infant in an autonomous manner.… Primarily anal urges are not suitable
for the establishment or cementing of objectrelationships. For anality the object is
redundant (HEIMANN 6).
I think that a healthy baby's anal phase has an object-related as well as a non object-related aspect. The baby
who, in phantasy, has annihilated the breast seems to experience only the non object-related aspect of anality. That
reinforces the sense of pseudo-independence, the do-it-yourself mother and power in place of eros so marked in my
two patients. It also makes them feel outside the human ken, as the basis for healthy development, namely the
deintegrating sequence oral-anal-genital, got seriously disrupted. The excessive cathexis of the anus manifested
itself in both my patients' lack of interest in eating and Mr A.'s experience of his anus as the only possible receptacle
of love.
The predominance of anality also explains the excessive controlling and striving for power, which these patients
manifested. Their need to control also showed in their compulsive wish to know as much as possible about the
people in their environment. It may not be unconnected with accumulative storing up of information that both
patients experienced, as a delusion, their head as being much too large in relation to their body size. A further reason
for their over-cathexis
- 123 -
of the anus is this: if in the state of primary identity the baby in phantasy annihilated the breast, he feels that there is
no self-object (FORDHAM 2). He seems to have the illusion that he can defend himself against the effect of this
catastrophic deficiency: in phantasy he goes back, via his own anus, into his mother who at that stage is the
Great Mother. Money-Kyrle also describes this defence (MONEY-KYRLE 16). He postulates that a baby whose
experience of the good breast has been destroyed is lured towards a spurious substitute, namely its own buttocks that
resemble the breasts in shape and that seem to provide an entry into the place from which he dimly remembers that
he came. Money-Kyrle says: ‘The baby is in touch with a substitute for the breast and in projective
identification with it inside it.’ The phantasy that the baby enters through his anus into his mother's inside, confused
with his own, holds the false promise of insuring against loss and separation. But it also leads to terror of
imprisonment, dissolution, disappearing and being gobbled up by the mother. It produced Mr A's flight to the
pseudo-security of his house and the ‘fly-in-the-spider's web’ state.
My observations suggest that the defences of the self also seem to bring about the relationship of adhesion
instead of dependence on the mother. In his book Explorations in autism, Meltzer describes adhesive
identification as producing ‘a type of clinging dependence in which the separate existence of the object is
unrecognised’ (MELTZER 15). This is Mr A.'s ‘scullery-step-situation’ and the ‘limpet-on-the-rock’ image that
both patients used. The adhesive identification made Mrs B. experience my failure to be always there as monstrous.
Meltzer made a similar observation when he wrote ‘in the state of adhesion the services of the parental figure are
absolutely taken for granted in much the same way that one ordinarily takes for granted the obedience of one's hand
to one's intentions’.
The defences of the self lead to yet another defensive structure brought about by splitting mechanisms. The
baby either splits horizontally into a compliant self, as described by Winnicott, and the real self, which contains the
hungry envious rage, remains tucked away undeveloped: the ‘side-shoot-instead-of-growing-sapling’, ‘the-tiger-in-
the cage’, ‘the-dog-stealing-food’ state. This could be the origin of a subsequent identification with the persona. Or
the baby splits vertically and dislocates to the outside of himself essential parts of himself, as also described by
Fordham. That makes Mrs B. feel on the one hand a ‘tree-without-roots’ and a ‘robot’, and on the other hand gives
her the experience of an extraneous, terrifying monstrously bad ‘twin’.
Those splits seem to explain the smooth social adaptation and the lack of real involvement in personal
relationships, so characteristic of narcissistic personality disorder. The nexus of defences leads to further psycho-
pathology. Narcissistic patients do not possess the capacity for
- 124 -

concern, mourning and reparation. They show all manner of zonal confusion, and primal scene phantasies are shot
through with anality and ruthless attack. Without treatment they do not develop the capacity to experience mutuality
and genital love, as their development was arrested at the anal stage. They cannot use archetypal experience but try
to defend themselves against the onslaught of archetypal forces and the constant danger of disintegration.
Following up a comment by Lambert I should like to draw attention to the remarkable way in which
narcissistic personality disorder corresponds to the collective myth of the hero described by Jung as early as
1940/I (JUNG 8).
I found that my patients showed considerable areas of psychotic disturbance. Yet their smooth social
functioning and relatively good impulse control seems to differentiate their disorder from psychosis and
other schizoid or borderline states.
Because of that nexus of defences and my patients' fragmentation, I often found it difficult to understand them.
They frequently described vividly how they felt, and at other times disowned the same feeling. Mr A. often did not
know whether a feeling was genuine, and Mrs B., when reminded of an experience she had described, said that that
was only true in another part of herself.

Summary
This paper offers a hypothesis as to the origins and nature of the narcissistic personality disorder: the nexus of
early infantile defence structures which leads to narcissistic disorder consists primarily of the defences of the self.
They bring about a premature defensive move from stunted deintegration at the oral stage to anal deintegration; an
excessive cathexis of the anus, power in place of eros. That cathexis can become reinforced by the
defensive phantasy of going back into the mothervia one's own anus. In addition, a defensive splitting seems to take
place in two ways: either a horizontal split into a compliant and real self, or a vertical one into a robot and
extraneous self. This goes some way towards explaining the smooth social functioning of such patients.
References
1 BETTELHEIM, B. (1967). The empty fortress. London, Collier-Macmillan.
2 FORDHAM, M. (1957). ‘The origins of the ego in childhood’ in New developments in analytical psychology.
London, Routledge & Kegan Paul.
3 FORDHAM, M. (1974). ‘Defences of the self’. J. Anal. Psychol., 19, 2. [→]
- 125 -

4 FORDHAM, M. (1976). The self and autism. Library of Analytical Psychology, Vol. 3.

5 GRINBERG L. et al. (1975). Introduction to the work of Bion. Ballinluig, Clunie Press. [→]
6 HEIMANN, P. (1962). ‘Notes on the anal stage’. Int. J. Psycho-Anal., 43, 6. [→]
7 JUNG, C. G. (1917). Two essays in analytical psychology. Coll. wks. 7.
8 JUNG, C. G. (1940). ‘The psychology of the child archetype’. Coll. wks. 9, 1.
9 JUNG, C. G. (1951). ‘Gnostic symbols of the self’ in Aion. Coll. wks. 9, 2.
10 JUNG, C. G. (1963). Memories, dreams, reflections. London, Collins and Routledge & Kegan Paul.
11 KERNBERG, O. F. (1974). ‘Further contributions to the treatment of narcissistic personalities’. Int. J. Psycho-
Anal., 55, 2. [→]
12 KOHUT, H. (1971). The analysis of the self. New York, International Universities Press. [→]
13 KOHUT, H. (1977). The restoration of the self. New York, International Universities Press.
14 LAMBERT, K. (1973). ‘Agape as a therapeutic factor in analysis’. J. Anal. Psychol., 18, 1. [→]
15 MELTZER, D. (1975). Explorations in autism. Ballincluig, Clunie Press. [→]
16 MONEY-KYRLE, R. (1971). ‘The aim of psychoanalysis’. Int. J. Psycho-Anal., 52, 1. [→]
17 NEWTON, K., REDFEARN, J. (1977). ‘The real mother, ego-self relations and personal identity’ J. Anal.
Psychol., 22, 4. [→]
18 PLAUT, F. (1975). ‘Object constancy or constant object?’ J. Anal. Psychol., 20, 2. [→]
19 RODRIGUE, E. (1955). ‘The analysis of a three-year-old male schizophrenic’ in New Directions in
Psychoanalysis. London, Tavistock.
20 STEIN, L. (1967). ‘Introducing not-self’. J. Anal. Psychol., 12, 2. [→]
21 WINNICOTT, D. W. (1958). ‘Primitive emotional development’, in Collected papers. London, Tavistock. [→]
- 126 -

Article Citation [Who Cited This?]

Ledermann, R. (1979). The Infantile Roots of Narcissistic Personality Disorder. J. Anal. Psychol., 24(2):107-126