Advanced Psychopathology

Monday, April 03, 2006

 

Kohut, Bromberg & Narcissism

Bromberg proposes several modifications and additions to Kohut’s seminal theory of narcissism. Bromberg’s most radical departures from Kohut are in his treatment approach for narcissism and, in defining the roots of narcissism, his movement away from a strict “blaming the parents” model. Bromberg implicates inevitable existential disruptions and a self-obsessed culture in forming the narcissistic personality.

While departing from Kohut at times, Bromberg remains on the Kohutian theoretical trajectory in defining narcissistic disorders. In describing narcissistic personalities, Bromberg and Kohut agree on a developmental arrest model, an unstable, fragmented self, and a typical constellation of behaviors.

Bromberg departs from Kohut in several ways, however. Where Kohut suggests that the developmental roots of narcissistic disorders are parental failures to manage normal childhood narcissistic needs, Bromberg suggests that narcissism develops as a defense against the inevitable pain of development. Bromberg suggests that movement from the womb to the outside world is the original trauma for the child, as he moves from an illusion of utter self-sufficiency to an awareness of need and vulnerability. The movement from the womb to the world establishes the paradigm for the rest of life, in which every new developmental stage contains discrepant challenges and in turn, the difficulty of adaptation. While it is possible to infer from Bromberg that the parents have a role in facilitating the child’s movement through life’s challenges, his theory (or the holes in his theory) seems to place greater emphasis on the individual – something about the individual (is it his ego strength? is it temperament? Is it object relations) will allow him to use narcissism and its defenses adaptively or maladaptively. Kohut also suggests that narcissism protects the self from vulnerability, but Kohut’s vulnerability stems from unmet narcissistic needs in childhood. For Kohut, narcissists are developmentally stuck at the point before transmuting internalization turns ideal parental imagos into ego ideals. For Kohut, insensitive parenting drives insufficient resolution of narcissistic challenges. Bromberg seems to suggest that life itself throws challenges in our way, and our narcissistic stance is a buttress against it; of course, if the narcissistic stance is used inflexibly, it becomes destructive.

Bromberg’s mirror & mask metaphor presents a less polar version of the narcissist than Kohut’s theory. Bromberg suggests that the narcissist moves between a self-experience based on how others view them (the mirror) and on the success of his operations/manipulations of others (the mask). Kohut suggests that the narcissistic self typically will be organized in a unipolar fashion, pertaining either to the grandiose self OR the idealized object.

Bromberg goes beyond the parents – the prime suspects in Kohut’s developmental failures -- in looking for environmental roots of narcissistic disorders. Citing Becker, Bromberg contends that narcissism is tied up in and defends against humans’ sense of mortality. Bromberg also contends that narcissism is valued in contemporary Western culture, as the perfection of self is valued over community, religion, and family. Interestingly, Bromberg sees the analytic situation as a cultural alternative to larger culture’s encouragement of narcissistic self.

Bromberg proposes technical interventions to Kohut’s therapeutic technique as well. Bromberg’s therapy consists of two elements. The first order of business is to give the patient a self-experience and structure through empathic acceptance. The analytic relationship fills a developmental void. Then, in time, Bromberg suggests using interpretation to augment the patient’s understanding of himself and the interpersonal situation of analysis. Further, Bromberg suggests tailoring the analytic situation to the ego strength, developmental level, and anxiety tolerance of the individual patient. Bromberg’s proposed therapeutic stance is more active than Kohut’s. In Kohut’s therapeutic model, the analyst remains empathic but non-interpretive, and waits for the patient to be disappointed by the analyst’s failure to meet all of the patient’s narcissistic needs. In the Kohutian model, this naturally arising disappointment spurs growth.

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