LETTERS TO THE EDITOR

To the Editor:

Dr. van den Daele and the contributors to the recent "Symposium on Narcissism" in Vol. 41, No. 4 are to be commended for their helpful eluci- dations of narcissism, perceived more and more as the disorder of our age. How it has become so was explored by Dr. Rendon in his excellent paper.

Nevertheless, I have reservations, as did Homey, about the real useful- ness of the term "narcissism," believing it to be overextended. Horney hesi- tated over using the term altogether because in the classical psychoanalytic literature "it includes rather indiscriminately every kind of self-inflation, egocentricity, anxious concern with one's welfare, and withdrawal from others . . . . Self-idealization occurs in all neuroses and represents an attempt to solve early inner conflicts. Narcissism, on the other hand, is one of several solutions of the conflict between expansive and self-effacing drives" (Neurosis and Human Growth).

Horney's definition of narcissism is consistent, not only with popular usage, but the DSM-III criteria for Narcissistic Personality Disorder. By this definition, narcissism refers to buoyant self-confidence and self-admiration that is pathologically self-centered. For Horney, it is an attempt at reconcil- ing inner conflict through identifying with an unconscious idealized image. As with the perspectives of Kohut and Kernberg, for Horney the narcissist's grandiosity is both fragile as a conscious experience and dependent on predictable patterns of externalization (such as Kohut's "idealizing" and "mirroring transference").

I regretted that none of the papers presented in the symposium under- scored the distinction between Horney's usage of "narcissism" and the usages employed by the other workers. These distinctions arise largely from their metapsychological orientations. In his very illuminating paper, Dr. van den Daele, for example, sought to underscore the parallels be- tween Horney's idealized image and Kohut's grandiose self. From this view, Horney's theoretical frame organizes a comprehension of narcissistic disorders, not neurotic ones. That is, we would be more fashionable to speak of "narcissistic self-effacement" instead of "neurotic self-effacement," or "narcissistic perfectionism" instead of "neurotic perfectionism," and so forth. In using the qualifier "narcissistic," one is merely indicating the struc- turing presence of an idealized image (Homey) or of a grandiose self (Kohut, Kernberg).

My objection to such a substitution (though I accept its value in informal communication with Freudian workers) proceeds from two considerations.

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First, I am concerned that if we borrow the Freudian usage of"narcissism," we may increasingly borrow other concepts, supposing them to improve understanding. If understanding truly improved, fine. But all that such bor- rowing may accomplish is to distract us from exploring how to apply and extend Horney's own concepts. My second objection concerns popular usage. The image of a "narcissist" in our society is not consistent with that of the self-effacing person or the resigned type, at least not yet. The term "neurotic" continues to be effective for speaking to lay persons. Its value lies in its being highly general and blurred, and in its referring to lasting, destructive, personality elements. "Narcissistic" is perceived as meaning something quite different, as Horney correctly emphasized.

Douglas H. Ingram, M .D .

Reply to Dr. Insram's Letter

I agree with Dr. Ingram that the term "narcissism" readily may lead the reader to conceptual confusion, and in retrospect, the Symposium on Nar- cissism might better have been titled "Symposium on Self Psychology." "Narcissism" may be used in a number of ways with various meanings, which is not unusual for a term with such a lengthy and important history in psychoanalytic theory and explanation. Many terms possess a similar characteristic; context must determine meaning. When a word is taken out of context, its usage may mystify the reader.

The usage of narcissism which engenders confusion hinges upon two senses of the word: first, as a descriptive term for a certain personality syn- drome and, second, as a general term for the quality of self-cathexis, self- feeling, or self-love. As Dr. Ingram points out, Homey favored the typological usage as does, not surprisingly, DSM III. In contrast, Freud, Mahler, Jacob- son, A. Reich, Kernberg, and Kohut among others apply the term in the descriptive and general sense.

To analyze narcissistic disturbances in the general sense inevitably leads to the investigation of the self which is disturbed, its development and dynamics. In particular, Kernberg's and Kohut's paradigm of self-psychology approximates Horney's views in important respects. Such duplication of discovery is not infrequent in other branches of science and confirms earlier work.

However, it would be incorrect to conclude that Kohut or Kernberg sim- ply reiterate Horney's observations. This is true only with reference to cer- tain general facets of self-pathology. Kohut, for example, differs from

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Horney in his greater attention to the genesis and development of neurotic solutions where Horney's theory is relatively incomplete. Contrariwise, Homey provides a relatively rich description of the structure and dynamics of mature neurotic solutions which can only fill out Kohut's less compre- hensive formulation. This is not a "replacement" or an adulteration of one view or the other, but a complementarity which enhances psychoanalytic understanding and technique.

Since no single psychoanalytic theory yet embraces the enormous com- plexity of the development, structure, and dynamics of the human person- ality, dialogue among psychoanalysts is essential toward the goal of integration of psychoanalytic theory. This is a general goal of scientific endeavor and, in psychoanalysis, a condition for improved diagnosis and treatment. However, this cannot be accomplished without accommodation to the defi- nition and usage of various theoretical languages. This is not to "borrow" or a matter of "informal communication," but an essential step to define con- gruities, similarities, and genuine differences. Perhaps, in time, Homey theory may incorporate new terms and undergo some reformulation, but so also may psychoanalytic theory generally.

Leland van den Daele