The Psychology of Serial and Mass Killers

Sam Vaknin

Object Relations - The Psychology of Serial and Mass Killers

I. Introduction

Serial killers often mutilate their victims and abscond with trophies - usually, body parts. They treat their prey as a disturbed child would treat her rag dolls. Some of them have been known to eat the organs they have ripped - an act of merging with the dead and assimilating them through digestion.

Killing the victim - often capturing him or her on film before the murder - is a form of exerting unmitigated, absolute, and irreversible control over it. The serial killer aspires to "freeze time" in the still perfection that he has choreographed. The victim is motionless and defenceless. The killer attains long sought "object permanence". The victim is unlikely to run on him or vanish as earlier objects (e.g., his parents) have done.

The killer is trying desperately to avoid a painful relationship with his object of desire. He is terrified of being abandoned or humiliated, exposed for what he is and then discarded. Many killers often have sex - the ultimate form of intimacy - with the corpses. Objectification and mutilation allow for unchallenged possession.

Many serial killers believe that killing is the way of the world. Everyone would kill if they could or were given the chance to do so. Such killers are convinced that they are more honest and open about their desires and, thus, morally superior. They hold others in contempt for being conforming hypocrites, cowed into submission by an overweening establishment or society.

Other killers "improve" the intimate object by "purifying" it, removing "imperfections", depersonalizing it, and dehumanizing it. This type of killer saves its victims from degeneration and degradation, from evil and from sin, in short: from a fate worse than death. The killer's megalomania manifests at this stage. He claims to possess, or have access to, higher knowledge and morality. The killer is a special being and the victim is "chosen" and should be grateful. The killer often finds the victim's ingratitude irritating, though sadly predictable.

In his seminal work, "Aberrations of Sexual Life" (originally: "Psychopathia Sexualis"), quoted in the book "Jack the Ripper" by Donald Rumbelow, Kraft-Ebbing offers this observation:

"The perverse urge in murders for pleasure does not solely aim at causing the victim pain and - most acute injury of all - death, but that the real meaning of the action consists in, to a certain extent, imitating, though perverted into a monstrous and ghastly form, the act of defloration. It is for this reason that an essential component ... is the employment of a sharp cutting weapon; the victim has to be pierced, slit, even chopped up ... The chief wounds are inflicted in the stomach region and, in many cases, the fatal cuts run from the vagina into the abdomen. In boys an artificial vagina is even made ... One can connect a fetishistic element too with this process of hacking ... inasmuch as parts of the body are removed and ... made into a collection."

Yet, the sexuality of the serial, psychopathic, killer is self-directed. His victims are props, extensions, aides, objects, and symbols. He interacts with them ritually and, either before or after the act, transforms his diseased inner dialog into a catechism with internal logic and self-consistency.

In some cases, the murder ritual recreates earlier conflicts with meaningful objects, such as parents, authority figures, or peers. The outcome of the replay is different, though. The killer dominates the situation. He is the one to inflict abuse and trauma on others. He outwits and taunts figures of authority - the police, for instance. It is a form of poetic justice, a balancing of the books, and, therefore, a "good" thing. The murder is cathartic and allows the killer to release hitherto repressed and pathologically transformed aggression - in the form of hate, rage, and envy.

But repeated acts of escalating gore fail to alleviate the killer's overwhelming anxiety and depression. He seeks to vindicate his negative introjects and sadistic superego by being caught and punished. The serial killer tightens the proverbial noose around his neck by interacting with law enforcement agencies and the media and thus providing them with clues as to his identity and whereabouts. When apprehended, most serial assassins experience a great sense of relief.

Serial killers are not the only objectifiers - people who treat other people as objects. To some extent, leaders of all sorts - political, military, or corporate - do the same. In a range of professions - surgeons, medical doctors, judges, law enforcement agents - objectification is an efficient defence mechanism which fends off horror and anxiety.

Yet, serial killers are different. They represent a dual failure - of their own development as full-fledged, productive individuals - and of the culture and society they grow in. In a pathologically narcissistic civilization - social anomies proliferate. Such societies breed malignant objectifiers - people devoid of empathy - also known as "narcissists".

II. Empathy

The Encyclopaedia Britannica (1999 edition) defines empathy as:

"The ability to imagine oneself in anther's place and understand the other's feelings, desires, ideas, and actions. It is a term coined in the early 20th century, equivalent to the German EinfÃ¼hlung and modeled on "sympathy." The term is used with special (but not exclusive) reference to aesthetic experience. The most obvious example, perhaps, is that of the actor or singer who genuinely feels the part he is performing. With other works of art, a spectator may, by a kind of introjection, feel himself involved in what he observes or contemplates. The use of empathy is an important part of the counseling technique developed by the American psychologist Carl Rogers."

Empathy is predicated upon the following elements:

The ability to imagine;
Self-awareness or self-consciousness;
The existence of an other (other-awareness, recognizing the outside world);
The existence of accessible feelings, desires, ideas and representations of actions or their outcomes both in the empathizing Self ("Empathor") and in the Other, the object of empathy ("Empathee");
An aesthetic frame of reference;
A moral frame of reference.

While (a) is presumed to be universally available to all agents (though in varying degrees) - the existence of the other components of empathy should not be taken for granted.

Conditions (b) and (c), for instance, are not satisfied by people who suffer from personality disorders, such as the Narcissistic Personality Disorder. Condition (d) is not met in autistic people (e.g., those who suffer from the Asperger syndrome). Condition (e) is so totally dependent on the specifics of culture, period and society - that it is rather meaningless and ambiguous. Condition (f) suffer from both afflictions: it is both culture-dependent and is not satisfied in many people (such as those who suffer from the Antisocial Personality Disorder and who are devoid of any conscience or moral sense).

Thus, the very existence of empathy should be questioned. It is often confused with inter-subjectivity. The latter is defined thus by "The Oxford Companion to Philosophy, 1995":

"This term refers to the status of being somehow accessible to at least two (usually all, in principle) minds or 'subjectivities'. It thus implies that there is some sort of communication between those minds; which in turn implies that each communicating minds aware not only of the existence of the other but also of its intention to convey information to the other. The idea, for theorists, is that if subjective processes can be brought into agreement, then perhaps that is as good as the (unattainable?) status of being objective - completely independent of subjectivity. The question facing such theorists is whether intersubjectivity is definable without presupposing an objective environment in which communication takes place (the 'wiring' from subject A to subject B). At a less fundamental level, however, the need for intersubjective verification of scientific hypotheses has been long recognized." (page 414)

On the face of it, the difference between intersubjectivity and empathy is double:

Intersubjectivity requires an explicit, communicated agreement between at least two subjects.
It involves external things (so called "objective" entities).

Yet, these "differences" are artificial. This is how empathy is defined in "Psychology - An Introduction (Ninth Edition) by Charles G. Morris, Prentice Hall, 1996":

"Closely related to the ability to read other people's emotions is empathy - the arousal of an emotion in an observer that is a vicarious response to the other person's situation... Empathy depends not only on one's ability to identify someone else's emotions but also on one's capacity to put oneself in the other person's place and to experience an appropriate emotional response. Just as sensitivity to non-verbal cues increases with age, so does empathy: The cognitive and perceptual abilities required for empathy develop only as a child matures... (page 442)

In empathy training, for example, each member of the couple is taught to share inner feelings and to listen to and understand the partner's feelings before responding to them. The empathy technique focuses the couple's attention on feelings and requires that they spend more time listening and less time in rebuttal." (page 576)

Thus, empathy does require the communication of feelings and an agreement on the appropriate outcome of the communicated emotions (=affective agreement). In the absence of such agreement, we are faced with inappropriate affect (laughing at a funeral, for instance).

Moreover, empathy does relate to external objects and is provoked by them. There is no empathy in the absence of an empathee. Granted, intersubjectivity is intuitively applied to the inanimate while empathy is applied to the living (animals, humans, even plants). But this is a difference in human preferences - not in definition.

Empathy can, thus, be re-defined as a form of intersubjectivity which involves living things as "objects" to which the communicated intersubjective agreement relates. It is wrong to limit empathy to the communication of emotion. It is the intersubjective, concomitant experience of Being. The empathor empathizes not only with the empathee's emotions but also with his physical state and other parameters of existence (pain, hunger, thirst, suffocation, sexual pleasure, etc.).

This leads to the important (and perhaps intractable) psychophysical question.

Intersubjectivity relates to external objects but the subjects communicate and reach an agreement regarding the way they have been affected by the objects.

Empathy relates to external objects (Others) but the subjects communicate and reach an agreement regarding the way they would have felt had they been the object.

This is no minor difference, if it, indeed, exists. But does it really exist?

What is it that we feel when we empathize? Is it our emotions/sensations merely provoked by an external trigger (classic intersubjectivity) or is it a transfer of the object's feelings/sensations to us?

Such a transfer being physically impossible (as far as we know) - we are forced to adopt the former answer. Empathy is the set of reactions - emotional and cognitive - to triggering by an external object (the other). It is the equivalent of resonance in the physical sciences. But we have NO WAY to ascertain the "wavelength" of such resonance is identical in both subjects.

In other words, we have no way to verify that the feelings or sensation invoked in the two (or more) subjects are one and the same. What I call "sadness" may not be what you call "sadness". Colors have unique, uniform, independently measurable properties (like energy). Still, no one can prove that what I see as "red" is what another calls "red" (as is the case with Daltonists). If this is true where "objective", measurable, phenomena are concerned - it is infinitely true in the case of emotions or feelings.

We are, therefore, forced to refine our definition:

Empathy is a form of intersubjectivity which involves living things as "objects" to which the communicated intersubjective agreement relates. It is the intersubjective, concomitant experience of being. The empathor empathizes not only with the empathee's emotions but also with his physical state and other parameters of existence (pain, hunger, thirst, suffocation, sexual pleasure etc.).

But the meaning attributed to the words used by the parties to the intersubjective agreement known as empathy is totally dependent upon each party. The same words are used, the same denotates - but it cannot be proven that the same connotates, the same experiences, emotions and sensations are being discussed or communicated.

Language (and, by extension, art and culture) serve to introduce us to other points of view ("what is it like to be someone else" to paraphrase Thomas Nagle). By providing a bridge between the subjective (inner experience) and the objective (words, images, sounds) - language facilitates social exchange and interaction. It is a dictionary which translates one's subjective private language to the coin of the public medium. Knowledge and language are, thus, the ultimate social glue, though both are based on approximations and guesses (see George Steiner's "After Babel").

But, whereas the intersubjective agreement regarding measurements and observations concerning external objects IS verifiable or falsifiable using INDEPENDENT tools (e.g., lab experiments) - the intersubjective agreement which concerns itself with the emotions, sensations and experiences of subjects as communicated by them is not verifiable or falsifiable independently.

The interpretation of this second kind of agreement is dependent upon introspection and an assumption that identical words used by different subjects still possess identical meaning. This assumption is not falsifiable (or verifiable). It is neither true nor false. It is a probabilistic statement with no probabilities attached. It is, in short, meaningless. As a result, empathy itself is meaningless.

In human-speak, if you say that you are sad and I empathize with you it means that we have an agreement. I regard you as my object. You communicate to me a property of yours ("sadness"). This triggers in me a recollection of "what is sadness" or "what is to be sad". I say that I know what you mean, I have been sad before, I know what it is like to be sad. I empathize with you. We agree about being sad. We have an intersubjective agreement.

Alas, such an agreement is meaningless. We cannot (yet) measure sadness, quantify it, crystallize it, access it in any way from the outside. We are totally and absolutely reliant on your introspection and my introspection. There is no way anyone can prove that my "sadness" is even remotely similar to your sadness. I may be feeling or experiencing something that you might find hilarious and not sad at all. Still, I call it "sadness" and I empathize with you.

This would not have been that grave if empathy hadn't been the cornerstone of morality.

The Encyclopaedia Britannica, 1999 Edition:

"Empathy and other forms of social awareness are important in the development of a moral sense. Morality embraces a person's beliefs about the appropriateness or goodness of what he does, thinks, or feels... Childhood is ... the time at which moral standards begin to develop in a process that often extends well into adulthood. The American psychologist Lawrence Kohlberg hypothesized that people's development of moral standards passes through stages that can be grouped into three moral levels...

At the third level, that of post-conventional moral reasoning, the adult bases his moral standards on principles that he himself has evaluated and that he accepts as inherently valid, regardless of society's opinion. He is aware of the arbitrary, subjective nature of social standards and rules, which he regards as relative rather than absolute in authority.

Thus the bases for justifying moral standards pass from avoidance of punishment to avoidance of adult disapproval and rejection to avoidance of internal guilt and self-recrimination. The person's moral reasoning also moves toward increasingly greater social scope (i.e., including more people and institutions) and greater abstraction (i.e., from reasoning about physical events such as pain or pleasure to reasoning about values, rights, and implicit contracts)."

But, if moral reasoning is based on introspection and empathy - it is, indeed, dangerously relative and not objective in any known sense of the word. Empathy is a unique agreement on the emotional and experiential content of two or more introspective processes in two or more subjects. Such an agreement can never have any meaning, even as far as the parties to it are concerned. They can never be sure that they are discussing the same emotions or experiences. There is no way to compare, measure, observe, falsify or verify (prove) that the "same" emotion is experienced identically by the parties to the empathy agreement. Empathy is meaningless and introspection, Wittgenstein notwithstanding, involves a private language. Morality is thus reduced to a set of meaningless private languages.

The Encyclopaedia Britannica:

"... Others have argued that because even rather young children are capable of showing empathy with the pain of others, the inhibition of aggressive behaviour arises from this moral affect rather than from the mere anticipation of punishment. Some scientists have found that children differ in their individual capacity for empathy, and, therefore, some children are more sensitive to moral prohibitions than others.

Young children's growing awareness of their own emotional states, characteristics, and abilities leads to empathy - i.e., the ability to appreciate the feelings and perspectives of others. Empathy and other forms of social awareness are in turn important in the development of a moral sense... Another important aspect of children's emotional development is the formation of their self-concept, or identity - i.e., their sense of who they are and what their relation to other people is.

According to Lipps's concept of empathy, a person appreciates another person's reaction by a projection of the self into the other. In his Ã„sthetik, 2 vol. (1903-06; 'Aesthetics'), he made all appreciation of art dependent upon a similar self-projection into the object."

This may well be the key. Empathy has little to do with the other person (the empathee). It is simply the result of conditioning and socialization. In other words, when we hurt someone - we don't experience his pain. We experience our pain. Hurting somebody - hurts us. The reaction of pain is provoked in us by our own actions. We have been taught a learned response of feeling pain when we inflict it upon another. But we have also been taught to feel responsible for our fellow beings (i.e., to feel guilt). So, we experience pain whenever another person claims to experience it as well. We feel guilty.

In sum:

To use the example of pain, we experience it in tandem with another person because we feel guilty or somehow responsible for his condition. A learned reaction is activated and we experience (our kind of) pain as well. We communicate it to the other person and an agreement of empathy is struck between us.

We attribute feelings, sensations and experiences to the object of our actions. It is the psychological defence mechanism of projection. Unable to conceive of inflicting pain upon ourselves - we displace the source. It is the other's pain that we are feeling, we keep telling ourselves, not our own.

The Encyclopaedia Britannica:

"Perhaps the most important aspect of children's emotional development is a growing awareness of their own emotional states and the ability to discern and interpret the emotions of others. The last half of the second year is a time when children start becoming aware of their own emotional states, characteristics, abilities, and potential for action; this phenomenon is called self-awareness... (coupled with strong narcissistic behaviours and traits - SV)...

This growing awareness of and ability to recall one's own emotional states leads to empathy, or the ability to appreciate the feelings and perceptions of others. Young children's dawning awareness of their own potential for action inspires them to try to direct (or otherwise affect) the behaviour of others...

...With age, children acquire the ability to understand the perspective, or point of view, of other people, a development that is closely linked with the empathic sharing of others' emotions...

One major factor underlying these changes is the child's increasing cognitive sophistication. For example, in order to feel the emotion of guilt, a child must appreciate the fact that he could have inhibited a particular action of his that violated a moral standard. The awareness that one can impose a restraint on one's own behaviour requires a certain level of cognitive maturation, and, therefore, the emotion of guilt cannot appear until that competence is attained."

That empathy is a reaction to external stimuli that is fully contained within the empathor and then projected onto the empathee - is clearly demonstrated by "inborn empathy". It is the ability to exhibit empathy and altruistic behaviour in response to facial expressions. Newborns react this way to their mother's facial expressions of sadness or distress.

This serves to prove that empathy has very little to do with the feelings, experiences or sensations of the other (the empathee). Surely, the infant has no idea what it is like to feel sad and definitely not what it is like for his mother to feel sad. In this case, it is a complex reflexive reaction. Later on, empathy is still rather reflexive, the result of conditioning.

The Encyclopaedia Britannica quotes fascinating research which dramatically proves the object-independent nature of empathy. Empathy is an internal reaction, an internal process, triggered by external cues provided by animate objects. It is communicated to the empathee-other by the empathor but the communication and the resulting agreement ("I know how you feel therefore we agree on how you feel") is rendered meaningless by the absence of a monovalent, unambiguous dictionary.

"An extensive series of studies indicated that positive emotion feelings enhance empathy and altruism. It was shown by the American psychologist Alice M. Isen that relatively small favors or bits of good luck (like finding money in a coin telephone or getting an unexpected gift) induced positive emotion in people and that such emotion regularly increased the subjects' inclination to sympathize or provide help.

Several studies have demonstrated that positive emotion facilitates creative problem solving. One of these studies showed that positive emotion enabled subjects to name more uses for common objects. Another showed that positive emotion enhanced creative problem solving by enabling subjects to see relations among objects (and other people - SV) that would otherwise go unnoticed. A number of studies have demonstrated the beneficial effects of positive emotion on thinking, memory, and action in pre-school and older children."

If empathy increases with positive emotion (a result of good luck, for instance) - then it has little to do with its objects and a lot to do with the person in whom it is provoked.

Narcissists are characterized by an utter lack of empathy. Most serial and mass murderers suffer from a pathologized form of narcissism.

III. Pathological Narcissism

Pathological or malignant narcissism is a pattern of traits and behaviours which signify infatuation and obsession with one's self to the exclusion of all others and the egotistic and ruthless pursuit of one's gratification, dominance and ambition.

The Narcissistic Personality Disorder (NPD) has been recognized as a separate mental health disorder in the third edition of the Diagnostic and Statistics Manual (DSM) in 1980. Its diagnostic criteria and their interpretation have undergone a major revision in the DSM III-R (1987) and were substantially revamped in the DSM IV in 1994. The international ICD-10 basically contains identical language.

Click here to read the DSM-IV-TR diagnostic criteria for the Narcissistic Personality Disorder - and here to read my analysis of the treatment of this disorder in both the DSM and the ICD.

Whether narcissism and its pathology are the results of genetic programming (see Anthony Benis and others) or of dysfunctional families and faulty upbringing or of anomic societies and disruptive socialization processes - is still an unresolved debate. The scarcity of scientific research, the fuzziness of the diagnostic criteria and the differential diagnoses make it unlikely that this will be settled soon one way or the other.

It is the psychoanalytic belief that we are all narcissists at an early stage of our lives. As infants and toddlers we all feel that we are the centre of the universe, the most important, omnipotent and omniscient beings. At that phase of our development, our parents are perceived by us to be mythical figures, immortal and awesomely powerful, there solely to cater to our needs, to protect and nourish us.

Both Self and others are viewed immaturely, as idealizations. This, in the psychodynamic models, is called the phase of "primary" narcissism. Inevitably, the inexorable processes and conflicts of life erode these perceptions and reduce the ideal into the real.

Adaptation is a process of disillusionment. If this process is abrupt, inconsistent, unpredictable, capricious, arbitrary and intense - the injuries sustained by the infant's tender, budding, self-esteem, are severe and, often, irreversible. Moreover, the empathic support of our caretakers (the Primary Objects, the parents) is crucial. In its absence, our sense of self-worth and self-esteem in adulthood tends to fluctuate, to alternate between over-valuation (idealization) and devaluation of both Self and others.

Narcissistic adults are widely thought to be the result of bitter disappointments, of radical disillusionment in the significant others in their infancy. Healthy adults accept their self-limitations (the boundaries and imperfections of their selves). They accept disappointments, setbacks, failures, criticism and disillusionment with grace and tolerance. Their self-esteem is constant and positive, not substantially affected by outside events, no matter how severe.

Various psychodynamic models describe narcissism and its pathologies.

According to these models, parents ("Primary Objects") and, more specifically, mothers are the first agents of socialization. It is through his mother that the child explores the most important questions, the answers to which will shape his entire life. How loved one is, how lovable, how independent can one become, how guilty one should feel for wanting to become autonomous, how predictable is the world, how much abuse should one expect in life, and so on.

The mother, to the infant, is not only an object of dependence (she guarantees the toddler's survival), its love and adoration. The mother is a representation of the Universe itself. It is through her that the child first exercises his senses: the tactile, the olfactory, and the visual.

Later on, she is the subject of his nascent sexual cravings (if the child is a male) - a diffuse sense of wanting to merge with her, physically, as well as spiritually. This object of love is idealized and internalized and becomes part of our conscience ("superego" in the psychoanalytic model).

Growing up (attaining maturity and adulthood) entails the gradual detachment from the mother. At first, the child begins to shape a more realistic view of her and incorporates the mother's shortcomings and disadvantages in this modified representation. The more ideal, less realistic and earlier picture of the mother is stored and becomes part of the child's psyche. The later, less cheerful, more realistic view enables the infant to define his own individual and gender identity and to "go out into the world".

Partly abandoning mother is the key to an independent exploration of the world, to personal autonomy and to a strong sense of self. Resolving the sexual complex and the resulting conflict of being attracted to a forbidden figure - is the second, determining, step. The (male) child must realize that his mother is "off limits" to him sexually (and emotionally, or psychosexually) and that she "belongs" to his father. He must thereafter choose to imitate his father in order to win, in the future, someone like his mother.

This is an oversimplified description of the very intricate psychodynamic processes involved - but this, still, is the gist of it. The third (and final) stage of letting go of the mother is reached during the delicate period of adolescence. The person then seriously ventures out and, finally, builds and secures his own universe, replete with a new "mother-lover". If any of these phases is thwarted - the process of differentiation is not successfully completed, no autonomy or coherent self is achieved and the person is characterized by dependence and "infantilism".

What determines the success or failure of these developments in one's personal history? Mostly, the mother herself. If she does not "let go" - the child will not go. If the mother herself is the dependent, narcissistic type - the growth prospects of the child are, indeed, dim.

There are numerous mechanisms, which mothers use to ensure the continued presence and emotional dependence of their offspring (of both sexes). The mother can cast herself in the role of the eternal victim, a sacrificial figure, who dedicated her life to the child (with the implicit or explicit proviso of reciprocity: that the child should dedicate his life to her).

Another strategy is to treat the child as an extension of the mother or, conversely, to treat herself as an extension of the child. Yet another tactic is to create a situation of "folie a deux" (the mother and child united against external threats), or an atmosphere suffused with sexual and erotic insinuations, leading to an illicit psychosexual bonding between mother and child.

In the latter case, the adult's ability to interact with members of the opposite sex is gravely impaired and the mother is perceived as envious of any feminine influence other than hers. Such mothers criticize the women in her offspring's life pretending to do so in order to protect him from dangerous liaisons or from ones which are "beneath him" ("you deserve better").

Other mothers exaggerate their neediness: they emphasize their financial dependence and lack of resources, their health problems, their emotional barrenness without the soothing presence of the child, their need to be protected against this or that (mostly imaginary) enemy. The latter tactic is a pernicious variant of the guilt-related species. Guilt is a prime mover in the perverted relationships of such mothers and their children.

"When the habitual narcissistic gratifications that come from being adored, given special treatment, and admiring the self are threatened, the results may be depression, hypochondriasis, anxiety, shame, self destructiveness, or rage directed toward any other person who can be blamed for the troubled situation. The child can learn to avoid these painful emotional states by acquiring a narcissistic mode of information processing. Such learning may be by trial-and-error methods, or it may be internalized by identification with parental modes of dealing with stressful information."

(Jon Mardi Horowitz - "Stress Response Syndromes: PTSD, Grief, and Adjustment Disorders", Third Edition)

Narcissism is fundamentally an advanced version of the splitting defense mechanism. The Narcissist cannot regard humans, situations, or entities (political parties, countries, races, his workplace) as a compound of good and bad elements. He is an "all or nothing" primitive "machine" (machine being a common self metaphor among narcissists). He either idealizes his object - or devalues it.

To the narcissist, the object is either all good or all bad. The bad attributes are always projected, displaced, or otherwise externalized. The good ones are internalized in order to support the inflated ("grandiose") self-concepts of the narcissist and his grandiose fantasies - and to avoid the pain of deflation and disillusionment.

The narcissist's earnestness and his (apparent) sincerity make people wonder whether he is simply detached from reality, unable to appraise it properly - or willingly and knowingly distorts reality and reinterprets it, subjecting it to his self-imposed censorship. It would seem that the Narcissist is dimly aware of the implausibility of his own constructions. He has not completely lost touch with reality. He is just less scrupulous in remolding it, and in ignoring the uncomfortable angles.

"The disguises are accomplished by shifting meanings and using exaggeration and minimization of bits of reality as a nidus for fantasy elaboration. The narcissistic personality is especially vulnerable to regression to damaged or defective self-concepts on the occasions of loss of those who have functioned as self-objects. When the individual is faced with such stress events as criticism, withdrawal of praise, or humiliation, the information involved may be denied, disavowed, negated, or shifted in meaning to prevent a reactive state of rage, depression, or shame."

(Jon Mardi Horowitz - ibid)

The second mechanism which the narcissist employs is the active pursuit of "Narcissistic Supply". The Narcissist actively seeks to furnish himself with an endless supply of admiration, adulation, affirmation and attention. As opposed to common opinion (which permeates the literature) - the narcissist is content to have any kind of attention. If fame cannot be had - infamy and notoriety will do. The narcissist is obsessed with the obtaining of narcissistic supply, he is addicted to it. His behaviour in its pursuit is impulsive.

"The hazard is not simply guilt because ideals have not been met. Rather, any loss of a good and coherent self-feeling is associated with intensely experienced emotions such as shame and depression, plus an anguished sense of helplessness and disorientation. To prevent this state, the narcissistic personality slides the meanings of events in order to place the self in a better light.

What is good is labeled as being of the self (internalized) Those qualities that are undesirable are excluded from the self by denial of their existence, disavowal of related attitudes, externalization, and negation of recent self-expressions. Persons who function as accessories to the self may also be idealized by exaggeration of their attributes. Those who counter the self are depreciated; ambiguous attributions of blame and a tendency to self-righteous rage states are a conspicuous aspect of this pattern.

Such fluid shifts in meanings permit the narcissistic personality to maintain apparent logical consistency while minimizing evil or weakness and exaggerating innocence or control. As part of these maneuvers, the narcissistic personality may assume attitudes of contemptuous superiority toward others, emotional coldness, or even desperately charming approaches to idealized figures."

(Jon Mardi Horwitz, ibid)

Sigmund Freud (1856-1939) is credited with the promulgation of a first coherent theory of narcissism. He described transitions from subject-directed libido to object-directed libido through the intermediation and agency of the parents. To be healthy and functional, the transitions must be smooth and unperturbed. Neuroses are the results of perturbations.

Freud conceived of each stage as the default (or fallback) of the next one. Thus, if a child reaches out to his objects of desire and fails to attract their love and attention - it regresses to the previous, narcissistic, phase.

The first occurrence of narcissism in life is adaptive. It "trains" the child to love an object - his Self. It ensures gratification through the availability, predictability and permanence of his Self. But regressing, later in life, to "secondary narcissism" is mal-adaptive. It is an indication of failure to direct the libido to the "right" targets (to objects such as the child's parents).

If this pattern of regression persists and prevails, a "narcissistic neurosis" is formed. The narcissist stimulates his self habitually in order to derive pleasure and gratification. He prefers this mode of deriving gratification to others. He is emotionally "lazy" because he takes the "easy" route of resorting to his self and reinvesting his libidinal resources "in-house" rather than making an effort (and risking failure) to seek out libidinal objects other than his self. The narcissist prefers fantasyland to reality, grandiose self-conception to realistic appraisal, masturbation and sexual fantasies to mature adult sex, and daydreaming to real life achievements.

Carl Gustav Jung (1875-1961) had a mental picture of the psyche as a giant warehouse of archetypes (the conscious representations of adaptive behaviours). Fantasies are just a way of accessing these archetypes and releasing them. Almost ex definitio, Jungian psychology has no concept of regression.

Any reversion to earlier phases of mental life, to earlier coping strategies, to earlier choices - in other words, any default behaviour - is interpreted as simply the psyche's way of using yet another, hitherto untapped, adaptation strategy. Regressions are compensatory processes intended to enhance adaptation and not methods of obtaining or securing a steady flow of gratification.

Actually, there is little difference between Freud and his disciple turned-heretic, Jung. Their disagreement is over semantics. When libido investment in objects (esp. the Primary Object) fails to produce gratification, maladaptation results. This is dangerous. A default behaviour - secondary narcissism - is activated. This default is functional and adaptive and triggers adaptive behaviours. As a by-product, it secures gratification.

We are gratified when we are at peace with our environment. We are at peace when we exert reasonable control over our environment, i.e., when our behaviours are adaptive. The compensatory process has two results: enhanced adaptation and the inevitable gratification that follows enhanced adaptation.

Perhaps the more serious disagreement between Freud and Jung is with regards to introversion. Freud regards introversion as an instrument in the service of a pathology (introversion is indispensable to narcissism, as opposed to extroversion which is a necessary condition for libidinal object-orientation).

Jung regards introversion as a useful tool in the service of the endless psychic quest for adaptation strategies (narcissism being one such strategy). The Jungian adaptation repertoire does not discriminate against narcissism. To Jung it is as legitimate a choice as any. But even Jung acknowledged that the very need to look for a new adaptation strategy means that adaptation has failed. In other words, the search itself is indicative of a pathological state of affairs. It does seem that introversion per se is not pathological (because no psychological mechanism is pathological per se). Only its uses might be pathological.

One would tend to agree with Freud, though, that when introversion becomes a permanent feature of the psychic landscape of a person - it facilitates pathological narcissism. Jung distinguished introverts (those who habitually concentrate on their selves rather than on outside objects) from extroverts (the converse predilection). Not only is introversion a totally normal and natural function in childhood, it remains normal and natural even if it predominates the adult's mental life.

Still, the habitual and predominant focusing of attention upon one's self, to the exclusion of others, is the definition of pathological narcissism. What differentiates the pathological from the normal is degree. Pathological narcissism is exclusive and all-pervasive. Other forms of narcissism are not.

So, although there is no completely healthy state of habitual, predominant introversion, it remains a question of form and degree of introversion. Often a healthy, adaptive mechanism goes awry. When it does, as Jung himself recognized, neuroses form. Freud regards Narcissism as a point while Jung regards it as a continuum (from health to sickness).

In a way, Heinz Kohut took Jung a step further. He said that pathological narcissism is not the result of excessive narcissism, libido or aggression. It is the result of defective, deformed or incomplete narcissistic (self) structures. Kohut postulated the existence of core constructs which he named: the Grandiose Exhibitionistic Self and the Idealized Parent Imago (see below).

Children entertain notions of greatness (primitive or naive grandiosity) mingled with magical thinking, feelings of omnipotence and omniscience and a belief in their immunity to the consequences of their actions. These elements and the child's feelings regarding its parents (which are also depicted as omnipotent and grandiose) - coagulate and form the aforementioned constructs.

The child's feelings towards its parents are his reactions to their responses (affirmation, buffering, modulation or disapproval, punishment, even abuse). These responses help maintain the self-structures. Without the appropriate responses, infantile grandiosity, for instance, cannot be transformed into adult ambitions and ideals.

To Kohut, grandiosity and idealization were positive childhood development mechanisms. Even their reappearance in transference should not be considered a pathological narcissistic regression.

In his "Chicago Lectures 1972-1976" he says:

"You see, the actual issue is really a simple one . . . a simple change in classical [Freudian] theory, which states that auto-erotism develops into narcissism and that narcissism develops into object love ... There is a contrast and opposition between narcissism and object love. The [forward] movement toward maturation was toward object love.

The movement from object love toward narcissism is a [backward] regressive movement toward a fixation point. To my mind [this] viewpoint is a theory built into a nonscientific value judgment ... That has nothing to do with developmental psychology." [pp.277-278]

Kohut's contention is nothing less than revolutionary. He says that narcissism (subject-love) and object-love coexist and interact throughout life. True, they assume different guises with age and maturation - but they always cohabitate. Kohut: "It is not that the self-experiences are given up and replaced by... a more mature or developmentally more advanced experience of objects."

This dichotomy inevitably leads to a dichotomy of disorders. Kohut agreed with Freud that neuroses are conglomerates of defense mechanisms, formations, symptoms, and unconscious conflicts. He did not object to identifying unresolved Oedipal conflicts (ungratified unconscious wishes and their objects) as the root of neuroses. But he identified a whole new class of disorders: the self-disorders. These are the result of the perturbed development of narcissism.

It was not a cosmetic or superficial distinction. Self disorders are the outcomes of childhood traumas very much different to Freud's Oedipal, castration and other conflicts and fears. These are the traumas of the child either not being "seen" - when the child's existence and presence are not affirmed by objects, especially the Primary Objects, the parents. These are the traumas of being regarded as an object for gratification, or abuse. Such children develop to become adults who are not sure that they do exist (lack a sense of self-continuity) or that they worth existing (unregulated sense of self-worth, or lack of self-esteem). They suffer depressions, as neurotics do.

But the source of these depressions is existential (a gnawing sensation of emptiness) as opposed to the "guilty-conscience" depressions of neurotics. Such depressions:

"... Are interrupted by rages because things are not going their way, because responses are not forthcoming in the way they expected and needed. Some of them may even search for conflict to relieve the pain and intense suffering of the poorly established self, the pain of the discontinuous, fragmenting, undercathected self of the child not seen or responded to as a unit of its own, not recognized as an independent self who wants to feel like somebody, who wants to go its own way ...

They are individuals whose disorders can be understood and treated only by taking into consideration the formative experiences in childhood of the total body-mind-self and its self-object environment - for instance, the experiences of joy of the total self feeling confirmed, which leads to pride, self-esteem, zest, and initiative; or the experiences of shame, loss of vitality, deadness, and depression of the self who does not have the feeling of being included, welcomed, and enjoyed."

(From: The Preface to the "Chicago Lectures 1972-1976 of H. Kohut, by: Paul and Marian Tolpin)

"Constructs" or "Structures" are permanent psychological patterns. This is not to say that they do not change - but they are capable only of slow change. Kohut and his Self-psychology disciples believed that the only viable constructs are comprised of self-selfobject experiences and that these structures are lifelong ones.

Melanie Klein harked back to archaic drives, splitting defences and archaic internal objects and part objects. Winnicott (and Balint and other, mainly British researchers) as well as other ego-psychologists thought that only infantile drive wishes and hallucinated oneness with archaic objects qualify as structures.

Horney is one of the precursors of the "Object Relations" school of psychodynamics. She said that personality was shaped mostly by environmental constraints, social or cultural. She believed that relationships with other humans in one's childhood determine both the shape and functioning of one's personality. She expanded the psychoanalytic repertoire. She added needs to Freud's drives.

Where Freud initially believed in the exclusivity of the sex drive as an agent of transformation (he later added other drives) - Horney believed that people (children) needed to feel secure, to be loved, protected, emotionally nourished and so on. She believed that the satisfaction of these needs or their frustration early in childhood are as important a determinant as any drive. Society is introduced through the parental door. Biology converges with social injunction to yield human values such the nurturance of children.

Horney's great contribution was the concept of anxiety. Freudian anxiety was a rather primitive mechanism, a reaction to imaginary threats arising from early childhood sexual conflicts. Horney argued convincingly that anxiety is a primary reaction to the very dependence of the child on adults for his survival. Children are uncertain (of love, protection, nourishment, nurturance) - so they become anxious.

Defences are developed to compensate for the intolerable and gradual realization that adults are only human: capricious, arbitrary, unpredictable, non-dependable. Defences provide both satisfaction and a sense of security. The problem still exists, even as the anxiety does, but they are "one step removed". When the defences are attacked or perceived to be attacked (such as in therapy) - anxiety is reawakened.

Karen B. Wallant in "Treating Addictions and the Alienated Self":

"The capacity to be alone develops out of the baby's ability to hold onto the internalization of his mother, even during her absences. It is not just an image of mother that he retains but also her loving devotion to him.

Thus, when alone, he can feel confident and secure as he continues to infuse himself with her love. The addict has had so few loving attachments in his life that when alone he is returned to his detached, alienated self.

This feeling-state can be compared to a young child's fear of monsters

So, the child learns to sacrifice a part of his autonomy, of who is in order to feel secure. Horney identified three neurotic strategies: submission, aggression, and detachment. The choice of strategy determines the type of personality, or rather of neurotic personality.

The submissive (or compliant) type is fake. He hides aggression beneath a facade of friendliness. The aggressive type is fake as well - at heart he is submissive. The detached neurotic withdraws from people. This cannot be considered an adaptive strategy.

It is by no means universally accepted that children go through a phase of separation from their parents and through the consequent individuation. Most psychodynamic theories (especially Klein, Mahler) are founded on this assumption. The child is considered to be merged with his parents until it differentiates itself (through object-relations).

But researchers like Daniel Stern dispute this hypothesis. Based on many studies it appears that what seems intuitively right is not necessarily right. In "The Interpersonal World of the Infant" (1985) Stern seems to, inadvertently, support Kohut by concluding that children possess selves and are separated from their caregivers from the very start. In effect, he says that the picture of the child, as depicted by psychodynamic theories, is influenced by the way adults see children and childhood in retrospect. Adult disorders (for instance, the pathological need to merge) are attributed to children and to childhood.

This view is in stark contrast to the belief that children accept any kind of parents (even abusive) because they depend on them for their self-definition. Attachment to and dependence on significant others is the result of the non-separateness of the child, go the classical psychodynamic/object-relations theories. The Self is a construct (within a social context, some add), an assimilation of the oft-imitated and idealized parents plus the internalization of the way others perceive the child in various social interactions. The self is, therefore, an internalized reflection, a simile, a series of introjected idealizations.

In some an intricate and multi-phased process, traumas are inevitable. In early childhood - especially in the formative years of infancy (ages 0 to 4 years) - traumas acquire an ominous aura, an evil, irreversible meaning. No matter how innocuous the event and the surrounding circumstances, the child's vivid imagination is likely to interpret it within the framework of a highly idiosyncratic horror story.

Parents sometimes have to go away due to medical or economic conditions. They may be too preoccupied to stay attuned at all times to the child's emotional needs. The family unit itself may be disintegrating with looming divorce or separation. The values of the parent may stand in radical contrast to those of society.

To adults, such traumas do not constitute abuse. Verbal and psychological-emotional abuse or neglect are judged by us to be more serious "offenses". But this distinction is lost on the child. To him, all traumas are of equal standing, though their severity may differ in line with the permanence of their emotional outcomes.

Even abuse and neglect could well be the result of circumstances beyond the abusive or negligent parent's control. A parent can be physically or mentally handicapped, for instance. But the child cannot see this as a mitigating circumstance because he cannot appreciate it or even plainly understand the causal linkage.

Where even the child itself can tell the difference is with physical and sexual abuse. These involve a cooperative effort at concealment, strong emotions of shame and guilt, repressed to the point of producing anxiety and "neurosis". Sometimes the child even perceives the injustice of the situation, though it rarely dares to express its views, lest it be abandoned by its abusers. This type of trauma which involves the child actively or passively is qualitatively different and is bound to yield long term effects such as dissociation or severe personality disorders.

These are violent, active traumas, not traumas by default, and the reaction is bound to be violent and active. The child becomes a reflection of its dysfunctional family - it represses emotions, denies reality, resorts to violence and escapism, and disintegrates.

One of the coping strategies is to withdraw inwards, to seek gratification from a secure, reliable and permanently-available source: from one's Self. The child, fearful of rejection and abuse, refrains from further interaction. Instead, it builds its own kingdom of grandiose fantasies wherein it is always loved and self-sufficient. This is the narcissistic strategy which leads to the development of a narcissistic personality.

The family is the mainspring of support of every kind. It mobilizes psychological resources and alleviates emotional burdens. It allows for the sharing of tasks, provides material supplies coupled with cognitive training. It is the prime socialization agent and encourages the absorption of information, most of it useful and adaptive.

This division of labour between parents and children is vital both to development and to proper adaptation. The child must feel, in a functional family, that he can share his experiences without being defensive and that the feedback that he is likely to get will be open and unbiased.

The only "bias" acceptable (because it is consistent with constant outside feedback) is the set of beliefs, values and goals that are finally internalized via imitation and unconscious identification. So, the family is the first and the most important source of identity and of emotional support.

It is a greenhouse wherein a child feels loved, accepted and secured - the prerequisites for emotional growth and the development of personal resources. On the material level, the family should provide the basic necessities (and, preferably, beyond), physical care and protection, and refuge and shelter during crises.

The role of the mother (the Primary Object) has often been discussed in literature. The father's part has been mostly neglected. However, recent research demonstrates his importance to the orderly and healthy development of the child.

He participates in the day to day care, is an intellectual catalyst, who encourages the child to develop his interests and to satisfy his curiosity through the manipulation of various instruments and games. He is a source of authority and discipline, a boundary setter, enforcing and encouraging positive behaviours and eliminating negative ones.

He also provides emotional support and economic security, thus stabilizing the family unit. Finally, he is the prime source of masculine orientation and identification to the male child - and gives warmth and love as a male to his daughter, without exceeding the socially permissible limits.

We can safely say that the narcissist's family is as severely disturbed as he is. He is nothing but a reflection of its dysfunction. The narcissist embodies the "emergent" pathology of his family.

Two important mechanisms operate In a dysfunctional family:

First, the mechanism of self-deception: "I do have a relationship with my parents. It is my fault - the fault of my emotions, sensations, aggressions and passions - that this relationship is not working. It is, therefore, my responsibility to make amends. I will write a play in which I am both loved and punished. In this play, I will allocate roles to myself and to my parents. This way, everything will be fine and we will all be happy."

Second is the mechanism of over-valuation and devaluation. The dual roles - of sadist and punished masochist (Superego and Ego in the psychoanalytic model), parent and child - permeate all the interactions of the narcissist. He experiences a reversal of roles as his relationships progress.

At the beginning of every relationship he is the child in need of attention, approval and admiration. He becomes dependent. Then, at the first sign of disapproval (real or imaginary), he switches to being the sadistic parent, punishing and inflicting pain.

Another school of psychology is represented by Otto Kernberg (1975, 1984, 1987), a senior member of the "Object Relations" school in Psychology (Kohut, Kernberg, Klein, Winnicott).

Kernberg disagrees with Freud. He regards as artificial the division between an Object Libido (=energy directed at Objects, towards people in the immediate vicinity of the infant and who are meaningful to him) and a Narcissistic Libido (=energy directed at the Self as the most immediate and satisfying Object), which precedes it.

Whether a Child develops a normal or a pathological form of narcissism depends on the relations between the representations of the Self (=roughly, the image of the Self that the child forms in his mind) and the representations of Objects (=roughly, the images of the Objects that the child forms in his mind, based on data and emotional reactions to the data).

It is also dependent on the relationship between the representations of the Self and real, external, "objective" Objects. Add to this instinctual conflicts related both to the Libido and to aggression (strong emotions give rise to strong conflicts in the child) and a comprehensive explanation concerning the formation of pathological narcissism emerges.

Kernberg's concept of Self is closely related to Freud's concept of Ego. The Self is dependent upon the unconscious, which exerts a constant influence on all mental functions. Pathological narcissism, therefore, reflects a libidinal investment in a pathologically structured Self rather than in a normal, integrative structure of the Self. The narcissist suffers from a Self, which is devalued or fixated on aggression.

All object relations of such a Self are distorted. They are detached from real Objects (because they often hurt). They dissociates, represses, or project unto other - imaginary or internal - objects. Narcissism is not merely a fixation on an early developmental stage. It is not confined to the failure to develop intra-psychic structures. It is an active, libidinal investment in a deformed structure of the Self.

"For very young children, self-esteem is probably best thought to consist of deep feelings of being loved, accepted, and valued by significant others rather than of feelings derived from evaluating oneself against some external criteria, as in the case of older children. Indeed, the only criterion appropriate for accepting and loving a newborn or infant is that he or she has been born. The unconditional love and acceptance experienced in the first year or two of life lay the foundation for later self-esteem, and probably make it possible for the preschooler and older child to withstand occasional criticism and negative evaluations that usually accompany socialization into the larger community.

As children grow beyond the preschool years, the larger society imposes criteria and conditions upon love and acceptance. If the very early feelings of love and acceptance are deep enough, the child can most likely weather the rebuffs and scoldings of the later years without undue debilitation.

With increasing age, however, children begin to internalize criteria of self-worth and a sense of the standards to be attained on the criteria from the larger community they observe and in which they are beginning to participate. The issue of criteria of self-esteem is examined more closely below.

Cassidy's (1988) study of the relationship between self-esteem at age five and six years and the quality of early mother-child attachment supports Bowlby's theory that construction of the self is derived from early daily experience with attachment figures. The results of the study support Bowlby's conception of the process through which continuity in development occurs, and of the way early child-mother attachment continues to influence the child's conception and estimation of the self across many years. The working models of the self derived from early mother-child inter-action organize and help mold the child's environment 'by seeking particular kinds of people and by eliciting particular behaviour from them' (Cassidy, 1988, p.133). Cassidy points out that very young children have few means of learning about themselves other than through experience with attachment figures.

She suggests that if infants are valued and given comfort when required, they come to feel valuable; conversely, if they are neglected or rejected, they come to feel worthless and of little value.

In an examination of developmental considerations, Bednar, Wells, and Peterson (1989) suggest that feelings of competence and the self-esteem associated with them are enhanced in children when their parents provide an optimum mixture of acceptance, affection, rational limits and controls, and high expectations. In a similar way, teachers are likely to engender positive feelings when they provide such a combination of acceptance, limits, and meaningful and realistic expectations concerning behaviour and effort (Lamborn et al., 1991). Similarly, teachers can provide contexts for such an optimum mixture of acceptance, limits, and meaningful effort in the course of project work as described by Katz and Chard (1989)."

(Distinctions between Self-Esteem and Narcissism: Implications for Practice - ERIC database)

Kohut, as we said, regarded Narcissism as the final product of the failing efforts of parents to cope with the needs of the child to idealize and to be grandiose (for instance, to be omnipotent). Failed idealization is an important developmental path leading to pathological narcissism.

The child merges the idealized aspects of the images of his parents (the "Imago", in Kohut's terminology) with those parts of the images of the parents which are cathected (infused) with object libido (=in which the child invests the energy that he reserves to Objects). This exerts a great and important influence on the re-internalization processes (=the processes in which the child re-introduced the Objects and their images into his mind).

Through these processes, two permanent nuclei of the personality are constructed: the basic, neutralizing texture of the psyche and the ideal Superego. Both of them are characterized by an invested instinctual Narcissistic cathexis (=invested energy of self-love which is instinctual in its nature).

At first, the child idealizes his parents. As he grows, he begins to notice their shortcomings and vices. He withdraws part of the idealizing libido from the images of the parents. This withdrawal is conducive to the natural development of the Superego. The narcissistic sector in the child's psyche remains vulnerable throughout its development. This is largely true until the child re-internalizes the ideal parent image.

The very construction of the mental apparatus can be tampered with by traumatic deficiencies and by object losses right through the Oedipal period (and even in latency and in adolescence). Traumatic disappointments by objects have the same effect.

Disturbances leading to the formation of the Narcissistic Personality Disorder (NPD) can be thus grouped thus:

1. Very early disturbances in the relationship with an ideal object

These lead to a structural weakness of the personality which develops a deficient and/or dysfunctional stimuli filtering mechanism. The ability of the individual to maintain a basic narcissistic homeostasis of the personality is damaged. Such a person suffers from diffusive narcissistic vulnerability.

2. A disturbance occurring later in life - but still pre-Oedipally

Affects the pre-Oedipal formation of the mechanisms of control, channeling and neutralizing of drives and urges. The nature of the disturbance has to be a traumatic encounter with the ideal object (such as a major disappointment). The symptomatic manifestation of this structural defect is the propensity to re - sexualize drive derivatives and internal and external conflicts either in the form of fantasies or in the form of deviant acts.

3. A disturbance formed in the Oedipal or even in the early latent phases

Inhibits the completion of the Superego idealization. This is especially true of a disappointment related to an ideal object of the late Pre-Oedipal and the Oedipal stages, where the partly idealized external parallel of the newly internalized object is traumatically destroyed.

Such a person possesses a set of values and standards but is on a constant lookout for ideal external figures from whom he can derive the affirmation and the leadership that his insufficiently idealized Superego cannot supply.

Everyone agrees that a loss (real or perceived) at a critical junction in the psychological development of the child - forces it to refer to himself for nurturing and for gratification. The Child ceases to trust others and his ability to develop object love or to idealize is hampered. He firmly "believes" that only he can satisfy his emotional needs.

The narcissist is born into a dysfunctional family. It is characterized by massive denials, both internal ("you do not have a real problem, you are only pretending") and external ("you must never tell the secrets of the family to anyone"). The whole family unit suffers from an affective dysfunction. It leads to affective and other personality disorders displayed by all the members of the family and ranging from obsessive-compulsive disorders to hypochondriasis and depression.

Such families are reclusive and autarkic. They actively reject and encourage the rejection of social contacts. This inevitably leads to defective or partial socialization and differentiation and to problems with sexual identity. This phobic attitude is sometimes applied even to other members of the extended family. The nuclear family feels emotionally or financially deprived or threatened. It reacts with envy, rejection, self-isolation and rage.

Constant aggression and violence are permanent features of such families. The violence can be verbal and psychological (degradation, humiliation), physical, or sexual. Trying to rationalize, intellectualize, and justify its unique position and values, the family adopts a transactional approach based on cold logic, cost effectiveness, and calculations of feasibility. Such families extol knowledge as an expression of superiority and an adaptive advantage.

These families encourage excellence - mainly cerebral and academic - but only as means to an end. The end is usually highly narcissistic (to become famous, wealthy, powerful, etc.). Some narcissists react by creatively escaping into rich, imagined worlds in which they exercise total physical and emotional control over their environment. But all of them react by diverting libido, which should have been object-oriented, to their own Self.

The source of all the narcissist's problems is the foreboding sensation that human relationships invariably end in humiliation, betrayal, and abandonment. This belief is embedded in them during their very early childhood by their parents and by their experiences with peers.

But the Narcissist always generalizes. To him, any emotional interaction and any interaction with an emotional component is bound to end this way. Getting attached to a place, a job, an asset, an idea, an initiative, a business, or a pleasure is bound to end as badly as getting attached to a human being. This is why the Narcissist avoids intimacy, real friendships, love, other emotions, commitment, attachment, dedication, perseverance, planning, emotional, or other investments. Narcissists are unable to empathize and are amoral (have no conscience). They never develop a sense of security, or pleasure.

The narcissist emotionally invests in the only thing which he feels that he is in full, unmitigated control of - himself.

The first to seriously consider the similarity between narcissistic and schizoid pathologies was Melanie Klein. She broke with Freud in that she believed that we are born with a fragile, easily fragmentable, weak and unintegrated ego. The most primordial human fear is the fear of disintegration (death), according to Klein.

Thus, the infant is forced to employ primitive defence mechanisms such as splitting, projection and introjection to cope with this fear (actually, with the results of aggression generated by the ego). The ego splits and projects both the threatening parts (death, disintegration, aggression) and the life-related, constructive, integrative parts. The upshot of all these dynamics is to view the world as either "good" (satisfying, complying, responding, gratifying) - or bad (frustrating).

Klein called this split the good and the bad "breasts". The child then proceeds to introject (internalize and assimilate) the good object while keeping out (=defending against) the bad object. The good object becomes the nucleus of the forming ego. The bad object is felt as fragmented. But it is not gone, it is there.

This (the fact that the bad object is "out there", persecutory, ominous) gives rise to the first schizoid defence mechanisms, foremost amongst which is the mechanism of "projective identification" (typical of narcissists). The infant projects parts of himself (his organs, his behaviours, his traits) unto the bad object.

This is the Kleinian "paranoid-schizoid position". The ego is split. This is terrifying but it allows the baby to make a clear distinction between the "good object" (inside him) and the "bad object" (out there, split from him). If this phase is not transcended the individual develops schizophrenia and a fragmentation of the self.

Around the third or fourth month of life, the infant realizes that the good and the bad objects are really facets of one and the same object. He develops the depressive position. This depression (Klein believes that the two positions continue throughout life) is a reaction to fear and anxiety.

The infant feels guilty (at his own rage) and, anxious (lest his aggression harm the object and eliminate the source of good things). He experiences loss (of his own omnipotence since the object is outside his self). The infant wishes to erase the results of his own aggression by "making the object whole again". By recognizing the wholeness of other objects - the infant comes to realize and to experience his own wholeness. The ego re-integrates.

But the transition from the paranoid-schizoid position to the depressive one is by no means smooth and assured. Excess anxiety and envy can delay it or prevent it altogether. Envy seeks to destroy all good objects, so that others don't have them. It, therefore, hinders the split between the good and the bad "breasts". Envy destroys the good object but leaves the persecutory , bad object intact.

Moreover, it does not allow the re-integration ("reparation" in the Kleinian term) to take place. The more whole the object - the greater the envy. Thus, envy feeds on its own outcomes. The more envy, the less integrated the ego is, the weaker and inadequate it is - the more reason for envying the good object and other people. Envy is the hallmark of narcissism and the prime source of what is known as narcissistic rage. The schizoid self - fragmented, weak, primitive - is intimately connected with narcissism through envy.

Narcissists prefer to destroy themselves and to deny themselves - rather than to endure someone else's happiness, wholeness and "triumph". They fail an exam - to frustrate a teacher they adore and envy. They fail in therapy - to deny the therapist professional satisfaction.

By failing and self-destructing, narcissists deny the worth of others. If the narcissist fails in therapy - his analyst must be inept. If he destroys himself by consuming drugs - his parents are blameworthy and should feel guilty (bad). One cannot exaggerate the importance of envy as a motivating power in the narcissist's life.

The psychodynamic connection is obvious. Envy is a rage reaction at not controlling or "having" or engulfing the good, desired object. Narcissists defend themselves against this acidulous, corroding sensation by pretending that they do control, possess and engulf the good object. This is what we call a "grandiose fantasy (of omnipotence or omniscience)". But, in doing so, the narcissist must deny the existence of any good outside himself.

The narcissist defends himself against raging, all consuming envy by solipsistically claiming to be the only good object in the world. This is an object that cannot be had by anyone, except the narcissist and, therefore, is immune to the narcissist's threatening, annihilating envy. In order not to be "owned" by anyone (and, thus, avoid self destruction in the hands of his own envy) - the narcissist reduces others to "non-entities" or avoids all meaningful contact with them (the schizoid solution).

The suppression of envy is at the core of the narcissist's being. If he fails to convince his self that he is the only good object in the universe - he is exposed to his own murderous envy. If there are others out there who are better than he - he envies them, he lashes out at them ferociously, uncontrollably, madly, hatefully and spitefully.

If someone tries to get emotionally intimate with the narcissist - that someone threatens the grandiose belief that no one but the narcissist can possess the good object (the narcissist himself). Only the narcissist can own himself, have access to himself, possess himself. This is the only way to avoid seething envy and certain self-annihilation. Perhaps it is clearer now why narcissists react as raving madmen to anything, however minute, however remote that seems to threaten their grandiose fantasies, the only protective barrier between themselves and their envy.

There is nothing new in trying to link narcissism to schizophrenia.

Freud did as much in his "On Narcissism" (1914). Klein's contribution was the introduction of immediately post-natal internal objects. Schizophrenia, she proposed, was a narcissistic and intense relationship with internal objects (such as fantasies or images, including fantasies of grandeur). It was a new language.

Freud suggested a transition from (primary, object-less) narcissism (self-directed libido) to "objects relations" (objects-directed libido). Klein suggested a transition from internal objects to external ones. While Freud thought that the common denominator of narcissism and schizoid phenomena was a withdrawal of libido from the world - Klein suggested it was a fixation on an early phase of relating to internal objects.

But is the difference not merely a question of terminology?

"The term 'narcissism' tends to be employed diagnostically by those proclaiming loyalty to the drive model (Otto Kernberg and Edith Jacobson, for instance - SV) and mixed model theorists (Kohut), who are interested in preserving a tie to drive theory. 'Schizoid' tends to be employed diagnostically by adherents of relational models (Fairbairn, Guntrip), who are interested in articulating their break with drive theory... These two differing diagnoses and accompanying formulations are applied to patients who are essentially similar, by theorists who start with very different conceptual premises and ideological affiliations."

(Greenberg and Mitchell - "Object Relations in Psychoanalytic Theory" - Harvard University Press - 1983)

Klein, in effect, said that drives (e.g., the libido) are relational flows.

A drive is the relationship between an individual and his objects (internal and external). Thus, a retreat from the world (Freud) into internal objects (as object relations theorists and especially the British school of Fairbairn and Guntrip postulated) - is the drive itself. Drives are orientations (to external or internal objects). Narcissism is also an orientation (a preference, we could say) to internal objects - the very definition of schizoid phenomena. This is why narcissists feel empty, fragmented, "unreal", and diffuse. It is because their ego is still split (never integrated) and because they withdrew from the world (of external objects).

Kernberg identifies these internal objects with which the narcissist maintains a special relationship with the idealized, grandiose images of the narcissist's parents. He believes that the narcissist's very ego (self-representation) fused with these parental images.

Fairbairn's work - even more than Kernberg's, not to mention Kohut's - integrates all these insights into a coherent framework. Guntrip elaborated on it and together they created one of the most impressive theoretical bodies in the history of psychology.

W. R. D. Fairbairn internalized Klein's insights that drives are object-orientated and their goal is the formation of relationships and not primarily the attainment of pleasure. Pleasurable sensations are the means to achieve relationships. The ego does not look to be stimulated and pleased but to find the right, "good", and sustaining object.

The infant is fused with his primary object, the mother. Life is not about using objects for pleasure under the supervision of the ego and superego, as Freud postulated. Life is about separating, differentiating, achieving independence from the Primary Object and the initial state of fusion with it. Dependence on internal objects is narcissism. Freud's post-narcissistic (anaclitic) phase of life can be either dependent (immature) or mature.

The newborn's ego is looking for objects with which to form relationships. Inevitably, some of these objects and some of these relationships frustrate the infant and disappoint him. He compensates for these setbacks by creating compensatory internal objects. The initially unitary ego thus fragments into a growing group of internal objects. Reality breaks our hearts and minds, according to Fairbairn.

The ego and its objects are "twinned" and the ego is split in three (Harry Guntrip added a fourth ego). A schizoid state ensues. The "original" (Freudian or libidinal) ego is unitary, instinctual, needy and object seeking. It then fragments as a result of the three typical interactions with the mother (gratification, disappointment, and deprivation). The Central Ego idealizes the "good" parents. It is conformist and obedient. The Antilibidinal Ego is a reaction to frustrations. It is rejecting, harsh, unsatisfying, against natural needs.

The Libidinal Ego is the seat of cravings, desires and needs. It is active in that it keeps seeking objects to form relationships with. Guntrip added the Regressed Ego which is the "True Self" in "cold storage", the "lost heart of the personal self".

Fairbairn's definition of psychopathology is quantitative. Which part of the ego is dedicated to relationships with internal objects rather than with external ones (e.g., real people)? In other words: how Fragmented (=how schizoid) is the ego?

To achieve a successful transition from internal objects to external ones - the child needs the right parents (in Winnicott's parlance, the "good enough mother" - not perfect, but "good enough"). The child internalizes the bad aspects of his parents in the form of internal, bad objects and then proceeds to suppress them, together ('twinned") with portions of his ego.

Thus, his parents become part of the child (though a repressed one). The more bad objects are repressed, the "less ego is left" for healthy relationships with external objects. To Fairbairn, the source of all psychological disturbances is in these schizoid phenomena. Later developments (such as the Oedipus Complex) are less crucial. Fairbairn and Guntrip think that if a person is too attached to his compensatory internal objects - he finds it hard to mature psychologically.

Maturing is about letting go of internal objects. Some people just don't want to mature, or are reluctant to do so, or are ambivalent about it. This reluctance, this withdrawal to an internal world of representations, internal objects and broken ego - is narcissism itself. Narcissists simply don't know how to be themselves, how to acquire independence and, simultaneously manage their relationships with other people.

Both Otto Kernberg and Heinz Kohut agreed that narcissism is somewhere between neuroses and psychoses. Kernberg thought that it was a borderline phenomenon, on the verge of psychosis (where the ego is completely shattered). In this respect, Kernberg identifies narcissism with schizoid phenomena and with schizophrenia more than Kohut does.

This is not the only difference between them. They also disagree on the developmental locus of narcissism. Kohut thinks that narcissism is an early phase of development, fossilized, doomed to be repeated (a massive repetition complex) while Kernberg maintains that the narcissistic self is pathological from its very inception.

Kohut believes that the narcissist's parents provided him with no assurances that he does possess a self (in his words, with no self-object). They did not explicitly recognize the child's nascent self, its separate existence, its boundaries. The child learned to have a schizoid, split, fragmented self - rather than a coherent and integrated one. Narcissism is really all-pervasive, at the very core of being (whether in its mature form, as self-love, or in it regressive, infantile form as a narcissistic disorder).

Kernberg regards "mature narcissism" (also espoused by neo-Freudians like Grunberger and Chasseguet-Smirgel) as a contradiction in terms, an oxymoron. He observes that narcissists are already grandiose and schizoid (detached, cold, aloof, asocial) at an early age (at three years old, according to him!). Like Klein, Kernberg believes that narcissism is a last ditch effort (defence) to halt the emergence of the paranoid-schizoid position described by Klein. In an adult such an emergence is known as "psychosis" and this is why Kernberg classifies narcissists as borderline (almost) psychotics.

Even Kohut, who opposes Kernberg's classification, uses Eugene O'Neill's famous sentence (in "The Great God Brown"): "Man is born broken. He lives by mending. The grace of God is glue." Kernberg himself sees a clear connection between schizoid phenomena (such as alienation in modern society and subsequent withdrawal) and narcissistic phenomena (inability to form relationships or to make commitments or to empathize).

Fred Alford in "Narcissism: Socrates, the Frankfurt School and psychoanalytic Theory":

"Fairbairn and Guntrip represent the purest expression of object relations theory, which is characterized by the insight that real relationships with real people build psychic structure. Although they rarely mention narcissism, they see a schizoid split in the self as characteristic of virtually all emotional disorder. It is Greenberg and Mitchell, in Object Relations in Psychoanalytic Theory who establish the relevance of Fairbairn and Guntrip... by pointing out that what American analysts label 'narcissism', British analysts tend to call 'schizoid personality disorder'.

This insight allows us to connect the symptomatology of narcissism - feelings of emptiness, unreality, alienation and emotional withdrawal - with a theory that sees such symptoms as an accurate reflection of the experience of being split off from a part of oneself. That narcissism is such a confusing category is in large part because its drive-theoretic definition, the libidinal cathexis of the self - in a word, self-love - seems far removed from the experience of narcissism, as characterized by a loss of, or split in, the self. Fairbairn's and Guntrip's view of narcissism as an excessive attachment of the ego to internal objects (roughly analogous to Freud's narcissistic, as opposed to object, love), resulting in various splits in the ego necessary to maintain these attachments, allows us to penetrate this confusion" (page 67).

Rage is considered the most typical narcissistic behaviour.

Anger is a compounded phenomenon. It has dispositional properties, expressive and motivational components, situational and individual variations, cognitive and excitatory interdependent manifestations and psychophysiological (especially neuroendocrine) aspects. From the psychobiological point of view, it probably had its survival utility in early evolution, but it seems to have lost some of it in modern societies. Actually, in most cases it is counterproductive, even dangerous.

Dysfunctional anger is known to have pathogenic effects (mostly cardiovascular). Most Personality Disordered people are prone to anger. Their anger is always sudden, raging, frightening and without an apparent provocation. It would seem that people suffering from personality disorders are in a constant state of anger, which is effectively suppressed most of the time. It manifests itself only when the person's defenses are down, incapacitated, or adversely affected by circumstances, internal or external.

People suffering from personality disorders were, usually, unable to express anger and direct it at "forbidden" targets - parents, in most cases - in their early, formative years. The anger, however, was a justified reaction to abuses and mistreatment. The patients were, therefore, left to nurture a sense of profound injustice and frustrated rage.

Healthy people experience anger, but as a transitory state. This is what sets the Personality Disordered apart: their anger is always acute, permanently present, often suppressed or repressed. Healthy anger is induced by an external agent (a reason). It is directed at this agent (coherence).

Pathological anger is neither coherent, not externally induced. It emanates from the inside and it is diffuse, directed at the "world" and at "injustice" in general. The personality disordered person is often able to identify the immediate cause of his anger. Still, upon closer scrutiny, the cause is found lacking and the anger excessive, disproportionate and incoherent.

It might be more accurate to say that the Personality Disordered is habitually expressing (and experiencing) two simultaneous layers of anger. The first layer, the superficial anger, is indeed directed at an identified target, the alleged cause of the eruption. The second layer, however, is self-directed anger. The patient is angry at himself for being unable to vent off anger normally. He often feels like a miscreant. He hates and loathes himself.

This second layer of anger intermingles with frustration, irritation and annoyance. While normal anger generates action directed at its source (or at least the planning or contemplation of such action) - pathological anger is mostly directed at oneself or even lacks direction altogether ("diffuse anger").

The Personality Disordered are afraid to show that they are angry to significant others because they are afraid to lose them. The Borderline Personality Disordered is terrified of being abandoned, the narcissist (NPD) needs his Narcissistic supply sources, the Paranoid - his persecutors and so on. These people prefer to direct their anger at other, insignificant, people, people whose withdrawal will not constitute a threat to their precariously balanced personality.

They yell at a waitress, berate a taxi driver, or explode at an underling. Alternatively, they sulk, feel anhedonic or pathologically bored, drink, or do drugs - all forms of self-directed aggression. From time to time, no longer able to pretend and to suppress, they have it out with the real source of their anger. They rage. They shout incoherently, make absurd accusations, distort facts, pronounce allegations and suspicions.

These episodes are followed by periods of saccharine sweetness and excessive flattering and submissiveness towards the victim of the latest rage attack. These emotional swings make life with the Personality Disordered difficult. Anger in healthy persons is diminished through action. It is an aversive, unpleasant emotion. It is intended to generate action in order to eradicate this uncomfortable sensation. It is coupled with physiological arousal.

But it is not clear whether action diminishes anger or anger is used up in action. Similarly, it is not clear whether being aware of anger is dependent on a cognitive verbalized stream of consciousness? Do we become angry because we say that we are angry (=we identify the anger and capture it) - or do we say that we are angry because we are angry to begin with?

Anger is induced by numerous factors. It is almost a universal reaction. Threats to one's welfare (physical, emotional, social, financial, or mental) are met with anger. But so are threats to one's affiliates, nearest, dearest, nation, favorite football club, pets, and so on. The territory of anger encompasses not only the person - but his entire real and perceived environment, human and non-human. This does not sound like a very adaptive strategy. Moreover, threats are not the only situations which provoke anger.

Anger is the reaction to injustice (perceived or real), to disagreements, to inconvenience. But the two primary roots of anger remain threats (a disagreement, for instance, is potentially threatening) and injustice (inconvenience, for example, is an injustice inflicted by an uncaring world on the angry person).

These are also the two sources of personality disorders. The Personality Disordered is molded by recurrent and frequent injustice and he is constantly threatened by both his internal and his external universes. There is, therefore, a close affinity between the Personality Disordered and the acutely angry person.

As opposed to common opinion, the angry person becomes angry whether he believes that what was done to him was deliberate or not. If we lose a precious manuscript, we are bound to become angry at ourselves, though the loss was surely unintentional. If his home is devastated by an earthquake - a person rages, though no conscious mind was at work.

When we perceive an injustice in the distribution of incentives or wealth or love - we become angry because of moral reasoning, whether the injustice was deliberate or not. We retaliate and we punish as a result of our ability to morally reason and in order "to get even". Sometimes we simply wish to alleviate our anger.

The Personality Disordered suppresses the anger, but he has no effective mechanisms of redirecting it in order to correct the anger-inducing conditions. His hostile expressions are not constructive - they are destructive because they are diffuse, excessive and, therefore, unclear.

He does not lash out at people in order to restore his lost esteem, his prestige, his sense of power and control over his life, to recover emotionally, or to restore his well being. He rages because he cannot help it and is in a self destructive and self-loathing mode. His anger does not contain a signal, which could alter his environment in general and the behaviour of those around him, in particular. His anger is primitive, maladaptive, pent up.

Anger is a primitive, limbic emotion. Its excitatory components and patterns are shared with sexual excitation and with fear. It is cognition that guides our behaviour, aimed at avoiding harm and aversion or at minimizing them. Our cognition is in charge of attaining certain kinds of mental gratification. To choose among behavioural options, we predict the future values of relief-gratification versus the repercussions of our behaviour (the reward to risk ratio) - a cognitive task.

Anger is evoked by aversive treatment, deliberately or unintentionally inflicted. Such treatment must violate either prevailing conventions regarding social interactions or some otherwise deeply ingrained sense of what is fair and what is just. But the judgment of fairness or justice (namely, the appraisal of the extent of compliance with conventions of social exchange) - is also cognitive.

The angry person and the Personality Disordered both suffer from a cognitive deficit. They are unable to conceptualize, to design effective strategies and to execute them. They dedicate all their attention to the immediate and ignore the future consequences of their actions. In other words, their attention and information processing faculties are distorted, skewed in favor of the present, biased on both the intake and the output.

They feel time as "relativistically dilated". The present feels more protracted, "longer" than the future. Immediate facts and actions are judged more relevant and weighted more heavily than more challenging - but remote - conditions.

Anger impairs cognition. The angry person is a worried person. The Personality Disordered is also excessively preoccupied with himself. Worry and anger are the cornerstones of anxiety. This is where the knot is finally tied: people become angry because they are excessively concerned with bad things which might happen to them. Anger is a result of anxiety (or, when the anger is not acute, of fear).

Another striking similarity between anger and personality disorders is the deterioration of the faculty of empathy. Angry people cannot empathize. Actually, "counter-empathy" develops in a state of acute anger. Circumstances related to the source of the anger which, in a normal emotional state, would have been considered mitigating or empathy-inducing - are now taken to devalue and belittle the suffering of the angry person. They provoke anger rather than mollify it.

The anger of the personality disordered thus increases the more the victim presents with mitigating or empathy-inducing circumstances. Anger alters judgment. The seriousness of provocative acts, for instance, is judged by their chronological position. This is further compounded by the fact that an impairment of the capacity to empathize is a prime symptom in many of the personality disorders (in the Narcissistic, Schizoid, Antisocial, and Schizotypal Personality Disordered, for instance).

Moreover, the aforementioned impairment of judgment (i.e., impairment of the mechanism of risk assessment) appears in both acute anger and in many personality disorders. The illusion of omnipotence (power) and invulnerability, the partiality of judgment - are typical of both states.

Acute anger (rage attacks in personality disorders) is always incommensurate with the magnitude of the source of the emotion and is fuelled by extraneous experiences. An acutely angry person usually reacts to an accumulation, an amalgamation of aversive experiences, all enhancing each other in vicious feedback loops, many of them not directly related to the cause of the specific anger episode.

The angry person may be reacting to stress, agitation, disturbance, drugs, violence or aggression he witnessed, to social or to national conflict, to elation, and even to sexual excitation. The same is true of the Personality Disordered. His inner world is fraught with unpleasant, ego-dystonic, discomfiting, unsettling, and anxious experiences. His external environment - influenced and molded by his distorted personality - is also transformed into a source of aversive, repulsive, or plainly unpleasant experiences.

The personality Disordered explodes in rage because he both implodes and reacts to outside stimuli, simultaneously. Because he is prone to magical thinking and, therefore, regards himself as immune, omnipotent, omniscient and protected from the consequences of his own acts - the Personality Disordered often acts in a self destructive and self defeating manner. The similarities are so numerous and so striking that it seems safe to say that the Personality Disordered is in a constant state of acute anger.

Finally, acutely angry people perceive anger to have been the result of intentional (or circumstantial) provocation with a hostile purpose. Their targets, on the other hand, invariably regard them as incoherent people, acting arbitrarily, in an unjustified manner.

IV. Pathological Narcissism - The Root of Mental Illness

All personality disorders are interrelated, at least phenomenologically. We have no Grand Unifying Theory of Psychopathology. We do not know whether there are - and what are - the mechanisms underlying mental disorders. At best, mental health professionals register symptoms (as reported by the patient) and signs (as observed). Then, they group them into syndromes and, more specifically, into disorders. This is descriptive, not explanatory science. Psychological theories hitherto failed to provide a coherent, consistent theoretical framework with predictive powers.

Patients suffering from personality disorders have many things in common:

Most of them are insistent (except those suffering from the Schizoid or the Avoidant Personality Disorders). They demand treatment on a preferential and privileged basis. They complain about numerous symptoms. They never obey the physician or his treatment recommendations and instructions.
They regard themselves as unique, display a streak of grandiosity and a diminished capacity for empathy (the ability to appreciate and respect the needs and wishes of other people). They regard the physician as inferior to them, alienate him using umpteen techniques and bore him with their never-ending self-preoccupation.
They are manipulative and exploitative because they trust no one and usually cannot love or share. They are socially maladaptive and emotionally unstable.
Most personality disorders start out as problems in personal development which peak during adolescence and then become personality disorders. They remain as enduring qualities of the individual. Personality disorders are stable and all-pervasive - not episodic. They affect most of the areas of functioning of the patient: his career, his interpersonal relationships, his social interactions.
The patient is not happy. He is depressed, suffers from auxiliary mood and anxiety disorders. He does not like himself, his character, his (deficient) functioning, or his (crippling) influence on others. But his defences are so strong, that he is sometimes unaware of the distress, let alone its reasons.
The patient with a personality disorder is vulnerable to and prone to suffer from a host of other psychiatric disturbances ("co-morbidity". It is as though his psycho-immunological system has been disabled by his personality disorder and he falls prey to other variants of mental sickness. So much energy is consumed by the disorder and by its corollaries (obsessions-compulsions, depressive episodes), that the patient is utterly self-consumed by it.
Patients with personality disorders have alloplastic defences. In other words: they tend to blame the world for their mishaps. In stressful situations, they try to pre-empt a (real or imaginary) threats, change the rules of the game, introduce new variables, or otherwise influence the outside world to conform to their needs. This is as opposed to autoplastic defences exhibited, for instance, by neurotics (who change their internal psychological processes in stressful situations).
The character problems, behavioural deficits, emotional deficiencies, and instability (lability) displayed by patients with personality disorders are, mostly, ego-syntonic. This means that the patient does not, on the whole, find his personality traits or behaviour objectionable, unacceptable, disagreeable, or alien to his Self. As opposed to that, neurotics are ego-dystonic - they do not like who they are and how they behave.
The personality-disordered are not psychotic. They have no hallucinations, delusions or thought disorders (except those who suffer from the Borderline Personality Disorder and who experience brief psychotic "micro-episodes", mostly during treatment). They are also fully oriented, with clear senses (sensorium), good memory and a general fund of knowledge.

The Diagnostic and Statistical Manual (DSM) - IV-TR (2000) defines "personality" as: "...enduring patterns of perceiving, relating to, and thinking about the environment and oneself... exhibited in a wide range of important social and personal contexts."

Click here to read the DSM-IV-TR diagnostic criteria for the Narcissistic Personality Disorder.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM IV-TR). Washington, DC: American Psychiatric Association.

A structural abnormality of personality arises only when recurrent attempts to eliminate an impediment to growth, or to overcome a trauma fail. The contrast between the fantastic world (temporarily) occupied by the individual and the real world in which he keeps getting frustrated and abused - is too acute to countenance for long. The dissonance gives rise to the unconscious "decision" to occupy the world of fantasy, grandeur, grandiosity and entitlement. It is better to feel special than to feel inadequate. It is better to be omnipotent than impotent. To (ab)use others is preferable to being (ab)used by them. In short: it is better to remain a pathological narcissist than to face one's helplessness.

Not all psychopathologies are narcissistic in character and not all personality disorders are narcissistic. Yet, when growth is stunted, the default behavior is the narcissistic phase of personal development. How can this be reconciled with the diversity of psychopathologies/personality disorders?

"Narcissism" can be defined more broadly as the substitution of a False Self for the True Self. This, arguably, is the predominant feature of narcissism. The True Self is repressed and suppressed, relegated to irrelevance and obscurity, left to degenerate and fossilize. It is replaced by a psychological structure which is projected unto the outside world - the False Self.

People reflect the False Self back at the narcissist. This "proves" to him that the False Self has an independent existence, that it is not entirely a figment of his imagination and, therefore, that it is a legitimate heir to the True Self. It is this characteristic which unites all psychopathologies: the emergence of false psychic structures which usurp the powers and capacities of the previous, legitimate and authentic ones.

Horrified by the absence of a clearly bounded, cohesive, coherent, reliable, and self-regulating self - the mentally abnormal person resorts to one of the following solutions, all of which involve reliance upon fake or invented personality elements:

The Narcissistic Solution - The substitution of the True Self with a False Self as in the Narcissistic Personality Disorder. The Schizotypal Personality Disorder largely belongs here too because of its fantastic and magical thinking. The Borderline Personality Disorder is a failed narcissistic solution. In BPD, the patient is aware (at least unconsciously) that the solution she adopted is "not working". This is the source of her anxiety and fear of abandonment. This gives rise to an identity disturbance, affective instability, suicidal ideation, and suicidal action, chronic feelings of emptiness, rage attacks, and transient (stress related) paranoid ideation.
The Appropriation Solution - This is the appropriation, the confiscation of someone else's self in order to fill the void left by the absence of a functioning Ego. While, in this solution, some of the Ego functions are still available, other roles are "borrowed" from other people by the "appropriating personality". The Histrionic Personality Disorder is an example of this solution. Mothers who "sacrifice" their lives for their children, people who live vicariously - all belong to this category. So do people who dramatize their lives and their behavior in order to attract attention. The "appropriators" misjudge the intimacy of their relationships and the degree of commitment involved, they are easily suggestible and their whole personality seems to shift and fluctuate with input from the outside. Because they have no Self of their own (even more so than narcissists), the "appropriators" tend to over-rate and over-emphasise their bodies. Perhaps the most striking example of this type of solution is the Dependent Personality Disorder.
The Schizoid Solution - These patients are mental zombies, trapped in the no-man's land between stunted growth and the narcissistic default. They are not narcissists because they lack a False Self - nor are they fully developed adults, because their True Self is immature and dysfunctional. They prefer to avoid contact with others (they lack empathy, as the narcissist does) in order not to upset their delicate tightrope act. Withdrawing from the world is an adaptive solution because it does not expose the inadequate personality structures (especially the self) to onerous - and failure bound - tests. The Schizotypal Personality Disorder patient is a mixture of the narcissistic and the schizoid solutions. The Avoidant Personality Disorder is a close kin.
The Aggressive Destructive Solution - These people suffer from hypochondriasis, depression, suicidal ideation, dysphorias, anhedonia, compulsions and obsessions and other expressions of internalized and transformed aggression directed at a self which is perceived to be inadequate, guilty, disappointing and worthy of nothing but elimination. Many of the narcissistic elements are present in an exaggerated form. Lack of empathy becomes reckless disregard for others, irritability, deceitfulness and criminal violence. Undulating self-esteem is transformed into impulsiveness and failure to plan ahead. The Antisocial Personality Disorder is a prime example of this solution, whose essence is: the total control of a False Self, without the mitigating presence of a shred of the True Self.

Perhaps this common feature - the replacement of the original structures of the personality by new, invented, mostly false ones - is what causes one to see narcissists everywhere. This common denominator is most accentuated in the Narcissistic Personality Disorder. The interaction, really, the battle, between the struggling original remnants of the personality and the malignant and omnivorous new structures - can be discerned in all forms of psychic abnormality. The question is: if many phenomena have one thing in common - should they be considered one and the same?

I say that the answer in the case of personality disorders should be affirmative. I think that all known personality disorders are forms of malignant self-love. In each personality disorder, different attributes and behavior patterns manifest idiosyncratically. But these distinctions (differential diagnoses), in my view, are all matters of quantity, not of quality.

V. Narcissism as a Cultural Trait

Pathological narcissism is the result of individual upbringing (see: "The Narcissist's Mother" and "Narcissists and Schizoids") and, in this sense, it is universal and cuts across time and space. Yet, the very process of socialization and education is heavily constrained by the prevailing culture and influenced by it. Thus, culture, mores, history, myths, ethos, and even government policy (such as the "one child policy" in China) do create the conditions for pathologies of the personality.

The ethnopsychologist George Devereux ("Basic Problems of Ethnopsychiatry", University of Chicago Press, 1980) suggested to divide the unconscious into the id (the part that was always instinctual and unconscious) and the "ethnic unconscious" (repressed material that was once conscious). The latter includes all our defence mechanisms and most of the superego. Culture dictates what is to be repressed. Mental illness is either idiosyncratic (cultural directives are not followed and the individual is unique and schizophrenic) - or conformist, abiding by the cultural dictates of what is allowed and disallowed.

Our culture, according to Christopher Lasch teaches us to withdraw into ourselves when we are confronted with stressful situations. It is a vicious circle. One of the main stressors of modern society is alienation and a pervasive sense of isolation. The solution our culture offers us - to further withdraw - only exacerbates the problem.

Richard Sennett expounded on this theme in "The Fall of Public Man: On the Social Psychology of Capitalism" (Vintage Books, 1978). One of the chapters in Devereux's aforementioned tome is entitled "Schizophrenia: An Ethnic Psychosis, or Schizophrenia without Tears". To him, the whole USA is afflicted by what came later to be called a "schizoid disorder". C. Fred Alford (in "Narcissism: Socrates, the Frankfurt School, and Psychoanalytic Theory", Yale University Press, 1988) enumerates the symptoms:

"...withdrawal, emotional aloofness, hyporeactivity (emotional flatness), sex without emotional involvement, segmentation and partial involvement (lack of interest and commitment to things outside oneself), fixation on oral-stage issues, regression, infantilism and depersonalization. These, of course, are many of the same designations that Lasch employs to describe the culture of narcissism. Thus, it appears, that it is not misleading to equate narcissism with schizoid disorder." (page 19).

In their book "Personality Disorders in Modern Life", Theodore Millon and Roger Davis state, as a matter of fact, that pathological narcissism was the preserve of "the royal and the wealthy" and that it "seems to have gained prominence only in the late twentieth century". Narcissism, according to them, may be associated with "higher levels of Maslow's hierarchy of needs ... Individuals in less advantaged nations .. are too busy trying (to survive) ... to be arrogant and grandiose".

They - like Lasch before them - attribute pathological narcissism to "a society that stresses individualism and self-gratification at the expense of community, namely the United States." They assert that the disorder is more prevalent among certain professions with "star power" or respect. "In an individualistic culture, the narcissist is 'God's gift to the world'. In a collectivist society, the narcissist is 'God's gift to the collective'".

Millon quotes Warren and Caponi's "The Role of Culture in the Development of Narcissistic Personality Disorders in America, Japan and Denmark":

"Individualistic narcissistic structures of self-regard (in individualistic societies) ... are rather self-contained and independent ... (In collectivist cultures) narcissistic configurations of the we-self ... denote self-esteem derived from strong identification with the reputation and honor of the family, groups, and others in hierarchical relationships."

Having lived in the last 20 years 12 countries in 4 continents - from the impoverished to the affluent, with individualistic and collectivist societies - I know that Millon and Davis are wrong. Theirs is, indeed, the quintessential American point of view which lacks an intimate knowledge of other parts of the world. Millon even wrongly claims that the DSM's international equivalent, the ICD, does not include the narcissistic personality disorder (it does).

Pathological narcissism is a ubiquitous phenomenon because every human being - regardless of the nature of his society and culture - develops healthy narcissism early in life. Healthy narcissism is rendered pathological by abuse - and abuse, alas, is a universal human behavior. By "abuse" we mean any refusal to acknowledge the emerging boundaries of the individual - smothering, doting, and excessive expectations - are as abusive as beating and incest.

There are malignant narcissists among subsistence farmers in Africa, nomads in the Sinai desert, day laborers in east Europe, and intellectuals and socialites in Manhattan. Malignant narcissism is all-pervasive and independent of culture and society.

It is true, though, that the way pathological narcissism manifests and is experienced is dependent on the particulars of societies and cultures. In some cultures, it is encouraged, in others suppressed. In some societies it is channeled against minorities - in others it is tainted with paranoia. In collectivist societies, it may be projected onto the collective, in individualistic societies, it is an individual's trait.

Yet, can families, organizations, ethnic groups, churches, and even whole nations be safely described as "narcissistic" or "pathologically self-absorbed"? Wouldn't such generalizations be a trifle racist and more than a trifle wrong? The answer is: it depends.

Human collectives - states, firms, households, institutions, political parties, cliques, bands - acquire a life and a character all their own. The longer the association or affiliation of the members, the more cohesive and conformist the inner dynamics of the group, the more persecutory or numerous its enemies, the more intensive the physical and emotional experiences of the individuals it is comprised of, the stronger the bonds of locale, language, and history - the more rigorous might an assertion of a common pathology be.

Thus, if recurrently traumatized or abused by external or internal forces, a group of people may develop the mass equivalent of pathological narcissism as a defense or compensatory mechanism. By "abuse" and "trauma" I mean any event, or series of events, or circumstances, which threaten the self identity, self image, sense of self worth, and self esteem of the collective consistently and constantly - though often arbitrarily and unpredictably. Human collectives go through formation, individuation, separation - all the phases in individual psychological development. A disturbance in the natural and unhindered progression of these phases is likely to result in psychopathology of all the members of the collective. Being subjugated to another nation, being exiled, enduring genocide, being destitute, being defeated in warfare - are all traumatic experiences with far reaching consequences.

The members of the collective form a "condensate" (in physical terms) - a material in which all the atoms vibrate with the same frequency. Under normal circumstances, group behavior resembles diffuse light. Subject to trauma and abuse - it forms a malignant laser - a strong, same wavelength, potentially destructive beam. The group becomes abusive to others, exploitative, detached from reality, bathed in grandiose fantasies, xenophobic, lacking empathy, prone to uncontrolled rages, over-sensitive, convinced of its superiority and entitlement. Force and coercion are often required to disabuse such a group of its delusions. But, this of course, only cements its narcissism and justifies its distorted perception of the world.

Such an all-pervasive and extensive pathology manifests itself in the behavior of each and every member. It is a defining - though often implicit or underlying - mental structure. It has explanatory and predictive powers. It is recurrent and invariable - a pattern of conduct melded with distorted cognition and stunted emotions. And it is often vehemently denied.

A possible DSM-like list of criteria for narcissistic organizations or groups:

An all-pervasive pattern of grandiosity (in fantasy or behavior), need for admiration or adulation and lack of empathy, usually beginning at the group's early history and present in various contexts. Persecution and abuse are often the causes - or at least the antecedents - of the pathology.

Five (or more) of the following criteria must be met:

The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - feel grandiose and self-important (e.g., they exaggerate the group's achievements and talents to the point of lying, demand to be recognized as superior - simply for belonging to the group and without commensurate achievement).
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are obsessed with group fantasies of unlimited success, fame, fearsome power or omnipotence, unequalled brilliance, bodily beauty or performance, or ideal, everlasting, all-conquering ideals or political theories.
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are firmly convinced that the group is unique and, being special, can only be understood by, should only be treated by, or associate with, other special or unique, or high-status groups (or institutions).
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - require excessive admiration, adulation, attention and affirmation - or, failing that, wish to be feared and to be notorious (narcissistic supply).
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - feel entitled. They expect unreasonable or special and favorable priority treatment. They demand automatic and full compliance with expectations. They rarely accept responsibility for their actions ("alloplastic defences"). This often leads to anti-social behavior, cover-ups, and criminal activities on a mass scale.
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are "interpersonally exploitative", i.e., use others to achieve their own ends. This often leads to anti-social behavior, cover-ups, and criminal activities on a mass scale.
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are devoid of empathy. They are unable or unwilling to identify with or acknowledge the feelings and needs of other groups. This often leads to anti- social behavior, cover-ups, and criminal activities on a mass scale.
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are constantly envious of others or believes that they feel the same about them. This often leads to anti-social behavior, cover-ups, and criminal activities on a mass scale.
The group as a whole, or members of the group - acting as such and by virtue of their association and affiliation with the group - are arrogant and sport haughty behaviors or attitudes coupled with rage when frustrated, contradicted, punished, limited, or confronted. This often leads to anti-social behavior, cover-ups, and criminal activities on a mass scale.

VI. Serial Killers and Mass Murderers

Are all politicians narcissists? The answer, surprisingly, is no. The preponderance of narcissistic traits and personalities in politics is much less than in show business, for instance. Moreover, while show business is concerned essentially (and almost exclusively) with the securing of narcissistic supply - politics is a much more complex and multi-faceted activity. Rather, it is a spectrum. At the one end, we find the "actors" - politicians who regard politics as their venue and their conduit, an extended theatre with their constituency as an audience. At the other extreme, we find self-effacing and schizoid (crowd-hating) technocrats. Most politicians are in the middle: somewhat self-enamored, opportunistic and seeking modest doses of narcissistic supply - but mostly concerned with perks, self-preservation and the exercise of power.

Most narcissists are opportunistic and ruthless operators. But not all opportunistic and ruthless operators are narcissists. A narcissistic politician would do anything and everything to remain in power, or, while, in power, to secure his narcissistic supply. A common error is to think that "narcissistic supply" consists only of admiration, adulation and positive feedback. Actually, being feared, or even derided is also narcissistic supply. The main element is attention. So, the narcissistic politician cultivates sources of narcissistic supply (both primary and secondary).

Often, politicians are nothing but a loyal reflection of their milieu, their culture, their society and their times (zeitgeist and leitkultur). This is the thesis of Daniel Goldhagen in "Hitler's Willing Executioners".

Terrorists, serial killers, and mass murderers can be phenomenologically described as narcissists in a constant state of deficient narcissistic supply. The "grandiosity gap" - the painful and narcissistically injurious gap between their grandiose fantasies and their dreary and humiliating reality - becomes emotionally insupportable. They decompensate and act out. They bring "down to their level" (by destroying it) the object of their pathological envy, the cause of their seething frustration, the symbol of their dull achievements, always incommensurate with their inflated self-image.

They seek omnipotence through murder, control (not least self control) through violence, prestige, fame and celebrity by defying figures of authorities, challenging them, and humbling them. Unbeknownst to them, they seek self punishment. They are at heart suicidal. They aim to cast themselves as victims by forcing others to punish them. This is called "projective identification". They attribute evil and corruption to their enemies and foes. These forms of paranoia are called projection and splitting. These are all primitive, infantile, and often persecutory, defence mechanisms.

When coupled with narcissism - the inability to empathize, the exploitativeness, the sense of entitlement, the rages, the dehumanization and devaluation of others - this mindset yields abysmal contempt for the narcissist's victims. The overriding emotion of terrorists and serial killers, the amalgam and culmination of their tortured psyche - is deep seated disdain for everything human, the flip side of envy. It is cognitive dissonance gone amok.

On the one hand the terrorist, or serial killer derides as "false", "meaningless", "dangerous", and "corrupt" common values, institutions, human intercourse, and society. On the other hand, he devotes his entire life (and often risks it) to the elimination and pulverization of these "insignificant" entities. To justify this apparent contradiction, the mass murderer casts himself as an altruistic savior of a group of people "endangered" by his foes. He is always self-appointed and self-proclaimed, rarely elected. The serial killer and the mass murderer rationalize and intellectualize their murders by purporting to "liberate" or "deliver" the victims from a fate worse than death.

The global reach, the secrecy, the impotence, and growing panic of his victims, of the public, and of his pursuers, the damage he wreaks - all serve as external ego functions. The terrorist and serial killer regulate their sense of self esteem and self worth by feeding slavishly on the reactions to their heinous deeds. Their cosmic significance is daily sustained by newspaper headlines, ever increasing bounties, admiring copycats, successful acts of blackmail, the strength and size of their opponents, and the devastation of human life and property. Appeasement works only to aggravate their drives and strengthen their appetites by emboldening them and by raising the threshold of excitation and "narcissistic supply". Terrorists and killers are addicted to this drug of being acknowledged and reflected. They derive their sense of existence, parasitically, from the reactions of their (often captive) audience.

Erich Fromm suggested that both Hitler and Stalin were narcissistic mass murderers.

Hitler and Nazism are often portrayed as an apocalyptic and seismic break with European history. Yet the truth is that they were the culmination and reification of European history in the 19th century. Europe's annals of colonialism have prepared it for the range of phenomena associated with the Nazi regime - from industrial murder to racial theories, from slave labour to the forcible annexation of territory.

Germany was a colonial power no different to murderous Belgium or Britain. What set it apart is that it directed its colonial attentions at the heartland of Europe - rather than at Africa or Asia. Both World Wars were colonial wars fought on European soil. Moreover, Nazi Germany innovated by applying prevailing racial theories (usually reserved to non-whites) to the white race itself. It started with the Jews - a non-controversial proposition - but then expanded them to include "east European" whites, such as the Poles and the Russians.

Germany was not alone in its malignant nationalism. The far right in France was as pernicious. Nazism - and Fascism - were world ideologies, adopted enthusiastically in places as diverse as Iraq, Egypt, Norway, Latin America, and Britain. At the end of the 1930's, liberal capitalism, communism, and fascism (and its mutations) were locked in mortal battle of ideologies. Hitler's mistake was to delusionally believe in the affinity between capitalism and Nazism - an affinity enhanced, to his mind, by Germany's corporatism and by the existence of a common enemy: global communism.

Colonialism always had discernible religious overtones and often collaborated with missionary religion. "The White Man's burden" of civilizing the "savages" was widely perceived as ordained by God. The church was the extension of the colonial power's army and trading companies.

It is no wonder that Hitler's lebensraum colonial movement - Nazism - possessed all the hallmarks of an institutional religion: priesthood, rites, rituals, temples, worship, catechism, mythology. Hitler was this religion's ascetic saint. He monastically denied himself earthly pleasures (or so he claimed) in order to be able to dedicate himself fully to his calling. Hitler was a monstrously inverted Jesus, sacrificing his life and denying himself so that (Aryan) humanity should benefit. By surpassing and suppressing his humanity, Hitler became a distorted version of Nietzsche's "superman".

But being a-human or super-human also means being a-sexual and a-moral. In this restricted sense, Hitler was a post-modernist and a moral relativist. He projected to the masses an androgynous figure and enhanced it by fostering the adoration of nudity and all things "natural". But what Nazism referred to as "nature" was not natural at all.

It was an aesthetic of decadence and evil (though it was not perceived this way by the Nazis), carefully orchestrated, and artificial. Nazism was about reproduced copies, not about originals. It was about the manipulation of symbols - not about veritable atavism.

In short: Nazism was about theatre, not about life. To enjoy the spectacle (and be subsumed by it), Nazism demanded the suspension of judgment, depersonalization, and de-realization. Catharsis was tantamount, in Nazi dramaturgy, to self-annulment. Nazism was nihilistic not only operationally, or ideologically. Its very language and narratives were nihilistic. Nazism was conspicuous nihilism - and Hitler served as a role model, annihilating Hitler the Man, only to re-appear as Hitler the stychia.

What was the role of the Jews in all this?

Nazism posed as a rebellion against the "old ways" - against the hegemonic culture, the upper classes, the established religions, the superpowers, the European order. The Nazis borrowed the Leninist vocabulary and assimilated it effectively. Hitler and the Nazis were an adolescent movement, a reaction to narcissistic injuries inflicted upon a narcissistic (and rather psychopathic) toddler nation-state. Hitler himself was a malignant narcissist, as Fromm correctly noted.

The Jews constituted a perfect, easily identifiable, reification of all that was "wrong" with Europe. They were an old nation, they were eerily disembodied (without a territory), they were cosmopolitan, they were part of the establishment, they were "decadent", they were hated on religious and socio-economic grounds (see Goldhagen's "Hitler's Willing Executioners"), they were different, they were narcissistic (felt and acted as morally superior), they were everywhere, they were defenseless, they were credulous, they were adaptable (and thus could be co-opted to collaborate in their own destruction). They were the perfect hated father figure and parricide was in fashion.

This is precisely the source of the fascination with Hitler. He was an inverted human. His unconscious was his conscious. He acted out our most repressed drives, fantasies, and wishes. He provides us with a glimpse of the horrors that lie beneath the veneer, the barbarians at our personal gates, and what it was like before we invented civilization. Hitler forced us all through a time warp and many did not emerge. He was not the devil. He was one of us. He was what Arendt aptly called the banality of evil. Just an ordinary, mentally disturbed, failure, a member of a mentally disturbed and failing nation, who lived through disturbed and failing times. He was the perfect mirror, a channel, a voice, and the very depth of our souls.

next: Serial Killers as a Cultural Construct

APA Reference
Vaknin, S. (2008, November 3). The Psychology of Serial and Mass Killers, HealthyPlace. Retrieved on 2024, November 14 from https://www.healthyplace.com/personality-disorders/malignant-self-love/psychology-of-serial-and-mass-killers

Last Updated: July 4, 2018

The Psychology of Serial and Mass Killers

Object Relations - The Psychology of Serial and Mass Killers

I. Introduction

II. Empathy

III. Pathological Narcissism

IV. Pathological Narcissism - The Root of Mental Illness

V. Narcissism as a Cultural Trait

VI. Serial Killers and Mass Murderers

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The Psychology of Serial and Mass Killers

Object Relations - The Psychology of Serial and Mass Killers

I. Introduction

II. Empathy

III. Pathological Narcissism

IV. Pathological Narcissism - The Root of Mental Illness

V. Narcissism as a Cultural Trait

VI. Serial Killers and Mass Murderers

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Physique Dysmorphique - Distorted Physical Self-Image

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