NARCISSISM: SHAME, RAGE

AND ADDICTION
W i l l i a m N. Grosch, M.D.

This paper employs perspectives from Self psychology to illuminate our under-
standing of narcissism. Striving for complete independence and autonomy, a goal
of classical psychoanalysis, encourages the disavowal of narcissism. Instead, nar-
cissism is viewed as necessary for the survival of a sense of self and not on the same
continuum with object love. The concepts of selfobject and selfobject functions are
defined. Shame and rage are explained as byproducts of selfobject failure. It is
postulated that shame emerges out of self-depletion and that narcissistic rage
emerges out of self-fragmentation. Countertransference and treatment implica-
tions are discussed. Following Lichtenberg, addictions are viewed as deriving from
the quest for selfobject experience, regardless of the long-term detriment.

K o h u t a d v a n c e d a s h i f t f r o m F r e u d ' s e m p h a s i s on f a c i n g t h e
t r u t h a n d a c c e p t i n g r e a l i t y to e m p a t h y a n d b e i n g u n d e r s t o o d as
m o r e i m p o r t a n t v a l u e s . L e e a n d M a r t i n c h a r a c t e r i z e t h e s h i f t as
t h a t f r o m p r i d e of c l e a r v i s i o n a n d u n c o m p r o m i s i n g r a t i o n a l i t y
t o w a r d p r i d e i n t h e s c i e n t i f i c a l l y c o n t r o l l e d e x p a n s i o n of t h e self.
(1,p.l17) I n K o h u t ' s words: ~We d e f i n e t h e r a p e u t i c p r o g r e s s t o w a r d
m e n t a l h e a l t h n o t p r i m a r i l y b y r e f e r e n c e to e x p a n d e d k n o w l e d g e

William N. Grosch, M.D., is Director, Psychiatric Outpatient Clinic, Albany

Medical Center and Associate Professor of Clinical Psychiatry, Albany Medical
College. Address correspondence to the author at Psychiatric Outpatient Clinic,
Room 104, CDPC, 75 New Scotland Avenue, Albany, New York 12208.

PSYCHIATRIC QUARTERLY, Vel. 65, No. 1, Spring 1994

0033-2720/94/0300-0049507.00/0 9 1994 Human Sciences Press, Inc. 49
50 PSYCHIATRIC QUARTERLY

or increased ego autonomy, but by reference to the laying down of

permanent self structure." (2,p.153)
Along with Kohut's formulation of self development is a new
understanding and definition of narcissism. According to Freud's
economic concept of narcissism, during h u m a n development there
is a shift in libido investment in the self to others as if self love and
object love are on the same continuum. The therapist should help
support the patient's replacement of primary narcissism with ob-
ject love. Kohut thought this not only impossible but also undesir-
able. Kohut conceived of object libido and narcissistic libido as
developing along separate but parallel lines. They are not on the
opposite ends of the same continuum, but move along two separate
continua from archaic to more mature forms.
Kohut described narcissism through his understanding of the
selfobject transferences (initially called narcissistic transferences)
and what he called selfobject functions. Self psychology now sees
narcissism as pertaining ~to the maintenance, restoration and
transformation of self experience," (3,p.130) or mental activity is
narcissistic to the degree that its function is to maintain the
cohesion, stability and positive affective coloring of the sense of
self. (4,p.26) According to Wolf, ~Mature selfishness is really the
expansion of the self and its selfobjects to take in the whole world."
(5,p.130) Kohut was interested in the transformation of archaic
narcissism to mature, adaptive, and culturally valuable forms.
Self psychology h a s been referred to as a selfobject theory or a
selfobject relations theory. The concept of selfobject is essential to
understanding self psychology. What is a selfobject?
A selfobject is not really a self or an object, but the subjective
aspect of a relationship that is supportive of the self. The presence
or activity of an object, often another person, an idea, nature,
music, or a cause, helps to bring forth and sustain the person's
sense of self. Ultimately, a selfobject is an intrapsychic experience.
It involves the experience of images that are necessary to uphold
one's sense of self. It does not describe an interpersonal relation-
ship as it might be viewed by an outside observer.
When a small child experiences other people from a position of
normal healthy self-interest, based on the need to grow and expand,
perhaps to maintain a basic security, we can say the child is relat-
ing to other people narcissistically. Kohut clarifies the concept of
the selfobject when he refers to the small child's use of other people:
WILLIAM N. GROSCH 51

'~The expected control over such (selfobject) others is then closer to

the concept of the control which a grownup expects to have over his
own body and mind, than to the concept of the control which he
expects to have over others." (6,pp.26-27)
From Kohut's posthumous work, How Does Analysis Cure?, ~'A
selfobject is that dimension of our experience of something, often
another person, that relates to this thing's or person's functions in
shoring up our own self." (2,p.49)
Many symbolic selfobject experiences replace for the adult the
more concrete selfobject needed in infancy and childhood. Experi-
encing the self-evoking, and self-maintaining selfobject function is
needed by selfs as long as a person lives. Following Ernest Wolf
(5,p.54) we can talk about a developmental line of selfobject experi-
ences. Selfobject needs can be outlined as follows:
1. A neonate needs a self-evoking experience with a real-life per-
son who, by providing certain tuned-in responses, functions as a
selfobject for that neonate.
2. An adolescent needs a self-sustaining experience with real ob-
jects or with symbols, such as provided by the adolescent subculture
in the form of speech, clothes, music, idols, and so forth, which by
their availability function as selfobjects for that particular adoles-
cent.
3. An adult needs a selfobject experience with real objects or with
symbols, such as provided by art, literature, music, religion, ideas,
which by their availability function as selfobjects for that particu-
lar adult. It is the subjective aspect of a relationship to an uncon-
scious object mediated by a symbolic presence that becomes effec-
tive by providing a selfobject function. (5,p.54)
Kohut goes on to explain that a person will feel strong and re-
silient as long as he experiences others, " . . . as joyfully responding
to him, as available to him as sources of idealized strength and
calmness, as being silently present but in essence like him,
a n d . . , are attuned to his n e e d s . . , when in need of such suste-
nance." (2,p.52)
Unlike Freud, who thought of the h u m a n infant's needs as pri-
marily physical, Kohut taught that babies need the affirmation of
admiring attention and the security of idealized parents. He be-
lieved the self was pushed by its ambitions and pulled by its ideals.
Ambitions are derived from inborn talents, which, if adequately
recognized and validated, will provide enough push from within or
52 PSYCHIATRIC QUARTERLY

behind the self to develop skill and eventually pride and enthusi-
asm. The loyal dedication to a set of values and ideals usually comes
from an omnipotent parent Cidealized parent imago"), outside and
above the self, therefore pulling the child up to the ideal. Ideally, if
a child received adequate mirroring, then healthy assertiveness,
initiative and ambition develop; if there are sufficient successful
idealizations, then values, goals, and ideals develop.
Actually, these new levels of ~'perfection" only arise as a result of
inevitable empathic failures. The primary narcissism gets dis-
turbed by the imperfections and limitations in the caregiver's min-
istrations. The baby attempts to maintain the original perfection
and omnipotence either by imbuing the rudimentary self or the ru-
dimentary ~'you," the adult, with absolute perfection and power.
To Kohut, the establishment of a narcissistic self or an idealized
parent imago is not pathological per se. These subjective states rep-
resent significant developmental achievements. Problems arise
only if traumatic experiences lead to fixations at these maturation
points and to an inability to internalize these idealized parents as
ideals. For example, ~premature interference with the narcissistic
(grandiose) self leads to later narcissistic vulnerability because the
grandiose fantasy becomes repressed and inaccessible to modifying
influences." (7,p.436)
The term narcissistic transference (in contrast with classical or
neurotic transference) was replaced by the term selfobject function.
Kohut saw mirroring, idealizing, and twinship selfobject functions
as being ways to describe specifically the needs of the narcissistic
transference.
Along the mirroring pole or line of development (or mirror trans-
ference in the treatment situation), if parents or other caregivers do
not provide sufficient attunement, acceptance, affirmation, and ad-
miration of the self in its uniqueness and particularity, normal but
still immature narcissism gets buried in unmodified form. When
this happens (failure) occasionally, the child is forced to develop his
or her own inner resources and becomes increasingly self reliant.
Along this grandiose self line of development or mirroring pole, am-
bitions become more realistic and goal oriented all along being
modified by the limits of reality, and energy is released for produc-
tive activities. If disappointments are traumatic and excessive, and
the child is abruptly cut off from narcissistic supplies, the unre-
sponded to self is not able to transform childish grandiosity into
WILLIAM N. GROSCH 53

reliable self-esteem. A narcissistic disturbance develops based on

the failure of the archaic narcissism to be transformed into a more
mature form. A primitive (largely unconscious) omnipotent grandi-
osity (pathologic in the adult) is perpetuated and any threat to this
sense of self becomes experienced a s a threat to one's very existence.
This can result in self fragmentation (manifesting as death or disin-
tegration anxiety, hypochondiasis, somatization, depersonaliza-
tion, derealization and psychosis), narcissistic rage or self depletion
(with feelings of enfeeblement, shame, empty depression and guilt-
less despair.)
On the idealizing pole or line of development, ideals act as guides
rather than as absolute controls and may be transformed into such
forms as creativity, empathy, acceptance of mortality, humor, and
wisdom.
To Kohut, the twinship transference is the '~third chance" for a
cohesive nuclear self, because in it the experience of sameness or
likeness serves the function of acquiring skills and ~'tools." (1,p. 153)
In Kohut's words:
"Within the context of the transference, an outline will gradually
come to light of a person for whom the patient's early existence and
actions were a source of genuine joy; the significance of this person
as a silent presence, as an alter ego or twin next to whom the child
felt alive (the little girl doing chores in the kitchen next to her
mother or grandmother; the little boy working in the basement
next to his father or grandfather) will gradually become clear."
(2,p.104)
In Self psychology, the self is motivated to act because of
ambitions, ideals, and the need to develop competency in skills
and talents. Kohut believed these dimensions of experience to be
invaluable in evaluating the outcome of psychoanalytic psycho-
therapy:
~'In many instances, the reshaping of the narcissistic structures
and their integration into the p e r s o n a l i t y - t h e strengthening of
ideals, and the achievement, even to a modest degree, of such
wholesome transformations of narcissism as humor, creativity,
empathy, and w i s d o m - m u s t be rated as a more genuine and valid
result of therapy than the patient's precarious compliance with
demands for a change of his narcissism into object love." (7,p.460)
Kohut accepted a healthy, adaptive function for transformed
narcissism and rejected the goal of a completely autonomous self.
54 PSYCHIATRIC QUARTERLY

"Self psychology holds that self-selfobject relationships form the

essence of psychological life from birth to death, that a move from
dependence (symbiosis) to independence (autonomy) in the psycho-
logical sphere is no more possible, let alone desirable, than a
corresponding move from a life dependent on oxygen to a life
independent of it in the biological sphere." (2,p.47)
As a matter of fact, a "completely autonomous self' would be a
manifestation of nontransformed archaic narcissism. To value
autonomy and perfect freedom would be arrogant and presump-
tuous.
To Kohut, a person's striving for complete independence not
only sets an impossible goal, but disavows legitimate narcissistic
needs. These persons are ~counterdependent" rather than ma-
turely adaptive in their behavior. The apparent ~nonnarcissism"
of the completely autonomous person is a covert form of archaic
but disavowed narcissism. It is possible that the goal of classical
psychoanalysis, the complete autonomy of the patient, encourages
the disavowal of narcissism. (1,p.26)
In taking this stand against the disavowal of legitimate depen-
dency needs, Kohut was not alone. Fairbairn, Guntrip, Winnicott,
Bion, and Balint, suggested that an infant grows from infantile
dependence into mature dependence. A person feels autonomous
by being properly '~dependent-connected"to someone who provides
support. An example of this paradox is seen when the toddler
moves away from mother, looks back and sees her face. Unlike the
traditional view which would emphasize separation and loss or
the object-relations view of the child seeking reassurance that she
is still there as a source for refueling, self psychology would
highlight the toddler's looking to see if mother feels pride in the
achievement of venturing away. This is another way of speaking
about ties that free. The New Testament speaks of the obedience
of discipleship leading to perfect freedom. Kohut used the concept
of the selfobject function. To keep the self whole, a person needs
others to function as selfobjects, which are objects we experience
as part of our self. (8,p.361) To Kohut, then, the selfobject function
never disappears, it only undergoes transformation and matura-
tion: ~A self can never exist outside a matrix of selfobjects."
(2,p.61) Selfobject needs and relations simply become more diffuse
and less intense. As long as the self is securely imbedded in a
social matrix that provides a field of the needed mirroring re-
WILLIAM N. GROSCH 55

sponses and the needed availability of idealizable values, the self

will feel comfortably affirmed in his or her total self with its
ambitions and goals. In short, he or she will feel strong and
paradoxically relatively self-reliant, self-sufficient and autono-
mous. Growth proceeds from primitive prestructural narcissistic
selfobject relations toward higher forms of narcissism by way of a
gradual accretion of psychic structure which takes on the function
of maintaining the sense of self.
A narcissistic disturbance refers not to a diagnostic category,
but rather to a dimension of psychopathology which cuts across all
the traditional nosological entities. Thus one would speak of the
degree of self-pathology, referring to the degree of structural
impairment and vulnerability of the sense of self, the acuteness of
the threat of narcissistic decompensation, and the motivational
priority or urgency of the narcissistic function in a variety of
pathologic states. (4,p.23)
Stolorow and Lachmann have attempted to classify degrees of
narcissistic disturbance. When the self state is predominantly
characterized by feelings of low self-esteem, but is for the most
part temporally stable and structurally cohesive, one might refer
to such cases as mild narcissistic disturbances. In other patients,
the sense of self is frequently or predominantly negatively colored
and, additionally, its organization is temporally unstable such as
experiencing identity confusion, but largely retains its structural
cohesion. One might refer to such cases as moderately severe. In a
third group of patients, structural cohesion additionally is lacking
with more prolonged states of fragmentation and disintegration.
These would be very severe narcissistic disturbances. (4,p.24)
As alluded to previously, the drive concept of narcissism leads to
the erroneous view that narcissism is by definition unhealthy
since it exists at the expense of object attachments.
If we view narcissism functionally we can distinguish unhealthy
from healthy narcissism on the basis of the degree of structural
impairment of the self, the acuteness of the threat of fragmenta-
tion, the motivational urgency of self-reparative efforts, and the
extent to which primitive sexualized and aggressivized selfobject
configurations are relied upon for the restoration or maintenance
of self-cohesion, self-continuity, and self-esteem. (4,p.25)
The drive concept of narcissism as self-love (where narcissism
and object relations are mutually exclusive) may lead us to
56 PSYCHIATRIC QUARTERLY

develop overt or covert rejection and contemptuous attitudes

toward narcissistic patients insofar as it encourages us to view
t h e m as selfish, self-absorbed, self-engrossed, and self-indulgent.
A functional conception of narcissism helps to alleviate the coun-
tertransference problems that arise by enabling us to recognize
t h a t their narcissism is in the service of the survival of their sense
of self. A functional orientation helps us to achieve empathy with
such patients as we become engaged in understanding the purpose
of their narcissistic activities and what has made them necessary.
A functional definition helps us accept their attitudes as compre-
hensible and indispensable in view of a patient's level of develop-
ment, and to endure our humble and at times thankless role in
the narcissistic (selfobject) transferences of being nothing more
t h a n a selfobject-the embodiment of a function which the patient
cannot yet perform himself. (4,p.26)

SHAME AND RAGE AS BYPRODUCTS OF

SELFOBJECT FAILURE

Disintegration anxiety or loss of self cohesion and vitality result in

"fragmentation, serious enfeeblement or uncontrollable rage."
(9,p.138) What follows is a discussion of:
1. Shame emerges out of self-depletion, and
2. Narcissistic rage emerges out of self-fragmentation. While I do
not presume these connections or correlations will always prevail,
I offer t h e m as general propositions for future confirmation or
refutation.
Kohut commented on shame and rage in 1972: ~ . . . although
everybody tends to react to narcissistic injuries with embarrass-
ment and anger, the most intense experiences of shame and the
most violent forms of narcissistic rage arise in those individuals
for whom a sense of absolute control in an archaic environment is
indispensable because the maintenance of self-depends on the
unconditional availability of the a p p r o v i n g - m i r r o r i n g functions
of an admiring selfobject or on the ever-present opportunity for a
merger with an idealized one." (10.pp.644-645)
In other words, the narcissistically vulnerable individual re-
sponds to actual or anticipated narcissistic injury either with
shamefaced withdrawal or with narcissistic rage. (10,p.637) Thus
WILLIAM N. GROSCH 57

selfobject failure may lead to shame (empty depression) or an

unbridled grandiosity which if interfered with can result in rage.
Kohut did not differentiate fragmentation from enfeeblement/de-
pletion as elements in self disintegration. Morrison (11,p.73) sug-
gests, however, t h a t fragmentation is the more archaic manifesta-
tion of self disintegration, reflecting primitive prestructural
failure of the mirroring selfobject to affirm and accept the sells
grandiosity. By contrast, Morrison believes that depletion/en-
feeblement anxiety represents failure of the idealized selfobject to
satisfy the sells idealizing/merger needs for omnipotence and ten-
sion regulation. Depletion/enfeeblement anxiety reflects threat-
ened absence of the early longed for idealized selfobject-leading to
feelings of emptiness, depression and shame. (11,p.74)
Depletion anxiety implies the presence of a more cohesive and
developmentally differentiated self-state t h a n is the case in frag-
mentation. Enfeeblement/depletion implies a greater capacity for
structuralization and selfobject idealization. In general, the de-
pleted self represents a response to the absence of the sought after,
omnipotent, idealized selfobject and its accompanying internalized
ideals, with consequent empty depression.
The current Self psychology literature tends to favor the use of
the term fragmentation for the most severe forms of breakdown of
the self. Narcissistic rage seems more associated t h a n does shame
with the extreme forms of a crumbling self. Fragmentation signi-
fies defects of the nuclear self resulting from insufficient mirroring
and affirmation of age-appropriate exhibitionistic needs. Self de-
pletion proceeds from deficiencies in the response to idealizing
needs and to voyeuristic yearnings for merger with the selfobjects'
power and its tension-regulating functions. (11,p.76) Reparation
through psychotherapy occurs when the therapist provides a con-
text of empathic mirroring and allows for optimal idealization. Self
structure can be built anew, or adequate compensatory structure
increased, through exploration and interpretation of the experi-
enced empathic microfailures of the therapist, allowing for the
transmuting internalization and structure building required to
strengthen the patient's self.
Initially, Kohut understood shame as resulting from the power of
the grandiose ambitions. Whenever the self is overwhelmed with
grandiosity, this will inevitably result in a feeling of failure and
shame. The grandiose aspirations for perfection can never in real-
58 PSYCHIATRIC QUARTERLY

ity be fulfilled. The ambitious or success-driven person in pursuit

of moral perfection or external success will respond to any failure
with shame. In making a diagnosis of pathological narcissism
(1966), Kohut focused on '~the painful affect of embarrassment or
shame which accompanies them (behavioral symptoms) and by
their ideational elaboration which is known as inferiority feeling
or hurt pride." (11,p.98) Treatment of shame-prone patients re-
quires the therapist's acceptance and confirmation of the patient's
grandiose self. Archaic grandiosity and shame-provoking exhibi-
tionism become transformed into self-esteem and pleasure in suc-
cess. Kohut discovered that, ~progress in the analysis of shame-
prone people is usually not achieved on the basis of trying to
diminish the power of overly strong ideals." (12,p.70). He thought
that aiming for such a diminution of the strength of supposedly
hypertrophied ideals was a technical error. Rather, he showed that
progress resulted from the combination of increasing mastery over
infantile grandiosity and exhibitionism and the increasing idealiz-
ation of the superego, that is, from the transformations of the
narcissistic matrix itself, from which the shame arises. (12,p.71) In
Mindell's paper, the man in the restaurant had ~two previous
therapies which focused on his fear of standing out in a social
situation in which the therapist appeared to encourage the man to
give up his yearnings to be seen and attended to as a step in his
maturation." His therapy with Mindell was more successful pre-
cisely because he was allowed ~to accept who he was at that
moment."
Kohut also came to realize that shame can arise as well from the
stirrings of the self to live up to its ideals. Shame can be experi-
enced because of failure in relationship to the idealized parental
imago. Shame over failure in the pursuit of ideals is potentially as
devastating as is the shame from overwhelming grandiosity. In
fact, failure of the parental selfobject to respond to the sells ideal-
izing needs and quest for merger is a prominent source of shame
vulnerability and a model for subsequent shame over the sells
experience of its needs. Reflecting the developmental sequence
from grandiosity to idealization, shame experienced in relation to
the idealized parental imago tends to be less archaic and more
differentiated than that experienced as a result of overwhelming
grandiosity. However, this seems quite similar to the view of
failure in the worthiness of the self to attain merger with its ideal.
(1!,p.78-79)
WILLIAM N. GROSCH 59

Failure to attain an ideal or goal serves, then, as a major precipi-

tant of shame, with the concomitant threat of rejection or abandon-
ment. Of course, the threat of abandonment may also reflect an
earlier experience of failed mirroring of the sells healthy exhibi-
tionistic strivings by the parental selfobject. Failure of the mirror-
ing selfobject may then lead to a compensatory pursuit of ideals
aimed at reversing the experience of selfobject disinterest and
apathy. However, further failures in empathic responsiveness by
the idealized selfobject to the sells quest for merger will, in turn,
lead to a sense of emptiness, depletion, and despair.
According to Morrison, shame is the hallmark of the defeated
self in a state of depletion, the self that has fallen short of its goals.
This would be true whether it reflects the subjective experience of
frustrated grandiose ambitions, failed attempts to compensate for
unrealized ambitions, or unmet yearnings to attain ideals.
(11,p.80-81)
The discovery, examination and working through of shame by
the patient with the realization that they can be accepted is what
makes successful treatment possible. (The man in the restaurant:
Mindell) Therapists should be helped and guided by recognition,
through vicarious introspection of their own personal failure to
achieve goals and to realize ambitions and ideals, of personal
grandiosity and failures. In short, therapists must be willing to
face and acknowledge their own shame and the pain that accom-
panies it.
Morrison believes that shame reflects primarily a selfobject fail-
ure to meet the age-appropriate needs of the self, particularly
those of the self striving to achieve vigor through attainment of its
ideals. As a result of early repetitive selfobject failure, particularly
with regard to idealization, the self experiences shame in the
presence of need itself. In other words, w h e n one is unable to attain
alone the ideal of power or self-soothing and looks instead to
another (the idealized selfobject) to provide such functions, one
frequently feels shame at the sells passivity, weakness, and need.
Shame occurs in the face of repeated selfobject failures to meet
such needs, especially but not exclusively, in the realm of ideals.
(11,p.83) Shame as an affective experience can best be appreciated
as a reflection of passive failure, defeat or depletion. (11,p.82)
The treatment of patients exhibiting narcissistic rage requires
the identification of the precipitating narcissistic injuries within
the transference and the demonstration of their dynamic-genetic
60 PSYCHIATRIC QUARTERLY

meaning, i.e., the acknowledgement that the rage reaction makes

sense in the context of the archaic experience. It is this approach,
rather than the investigation of the experiential content of the
rage that will restore the narcissistic equilibrium, i.e, the cohe-
siveness of the transference and with it the cohesiveness of the
self. (12,p.72) In Dyer's paper we see described a 31 year old
housewife with headaches. She developed a ~walloping headache,"
to avoid a meeting with the medical students. According to Dyer,
~She was in a r a g e . . . Her headache spoke for her." He did not
order the narcotic she requested; instead he interpreted the depen-
dency (not the anger). Her rapid progress was attributed to cogni-
tive tools, muscle relaxation and the idea of being in control of her
own body. I think, additionally, she felt stronger, less fragmenta-
tion-prone and less rageful because she felt responded to as a total
self in terms of what was best for her overall, rather than more
narrowly responded to in terms of symptom relief alone. To offer a
narcotic would have been to miss the forest for the trees. She
improved, I suspect, largely because she felt understood rather
than because she was the recipient of a quick fix approach which
would have been too superficial and too good to be true.
Finally, narcissistic rage tends to be more commonly associated
with fragmentation-prone personalities characterized by a lack of
adequate mirroring and a deficiency in the structural cohesion of
the self.

ADDICTIONS

The following discussion of addiction borrows from Lichtenberg.

(13,pp.455-479) During development, the child will respond to
disappointment and distress by looking for someone or something
that will activate selfobject experiences that affirm self-cohesion
and vitality. If needs are consistently not met, the individual will
seek satisfaction, joy, security, relief, self-cohesion, and vitality
through alternative means. Certain intense experience can be
sought after regardless of their long-term destructive, self-defeat-
ing aspects and maladaptation.
The assumption that the effect of abnormal or variant develop-
ment is to seek selfobject experience through means other than
ordinary responses to ordinary needs is compatible with the Self
WILLIAM N. GROSCH 61

psychology view of the genesis of psychopathology. This view

states that while pathology often results from what has been done
to the developing child in the form of neglect, abuse and traumatic
events, the experience of these happenings centers on what has
failed to be done in the form of empathic responsiveness to the
child's needs.
When a deficit of affective vitalization from ordinary sources
occurs, three conditions may be responsible for children or adults
discovering that they experience and seek vitality and cohesion
from maladaptive, perverse, or pathologic sources.
First, the repetition of experiences of a traumatic or abusive
nature may have a strong organizing effect because of the inten-
sity of the experience. Where physical pain has been a recurrent
experience, it may create a more cohesive experience than comfort.
Where humiliation or guilt has been a recurrent experience (14)
these negatively toned affects may convey more intensity of an
intimate relationship than respect. Anger, especially tantrum-like
destructive rage, may be sought for temporary vitalization; ex-
tended states of hatred and of the pursuit of vengeance may be
resorted to for long-term contributions to self-cohesion. ~Even ha-
t r e d - t h a t is, h u m a n hatred which confirms the victim's human-
n e s s - i s sustaining. What leads to the h u m a n sells destruction,
however, is its exposure to the coldness, the indifference of the
nonhuman, the nonempathically responding world." (2,p.18)
A second source of pathological selfobject experience may arise
from those objects or substances that can serve as a means to
provide comfort or relief from a wide range of discomforts and
dystonic experiences. The mother's hand to hold and finger to suck,
the pacifier, and the transitional object are the normal prototypes
for later, more problematic activities, objects, or substances. These
activities, objects, or substances do not deal directly with the
specific source of the discomfort, as would be food for hunger, a
lively toy with boredom, or a playmate with loneliness. These
substances, activities, and objects have hedonic and regulatory
effect in their own right because of their inherent triggering of
affects. One group of activities triggers affects through either the
calming or the stimulation of sensual pleasure, as when a child in
a state of loneliness, boredom, uncertainty, hyperactivity, or gen-
eralized excitement will reach for his genital. Other activities that
become available as inherent triggers of affect are risk taking such
62 PSYCHIATRIC QUARTERLY

as gambling, the multiple stimulating and calming effects of smok-

ing, and the whole range of effects of drugs, drinking and toxic
substance usage. The great significance of these activities, objects,
or substances lies in their providing relief not for one specific need
but for a panoply of present or potential distress and discomforts.
Threats of the unavailability of the multi-purpose relief or security
giver become a major source of distress, sometimes far greater
t h a n would be the distress of the primary source of discomfort.
Once a child has come to rely on a cuddly for comfort regardless of
the source of distress, the expectation of a period of hunger,
mother's absence, the unavailability of toys, or being punished will
often not evoke the kind of alarm that the loss of the cuddly
triggers. Similarly a habitual smoker may be able to bear a sleep-
less night without snack, spouse, or book but be driven to find an
open convenience store on discovering he has r u n out of cigarettes.
Similar to a toddler's use of his security blanket, the utilization
and reliance on any age-appropriate means to obtain a selfobject
experience that relieves a multitude of possible discomforts are not
pathologic in themselves. They become pathologic when obtaining
and preserving the activities, objects, or substances become a cen-
tral focus of the person's motivation. The sources of discomfort are
not then subjected to recognition and a search for solution. The
goal has become to assure the availability of the means to obtain
the relief; the addictive demand is for the activity (being repeat-
edly reassured, the gambling casino), the object (the therapist, the
fast car, the jewel), or the substance (cigarettes, alcohol, cocaine).
A third source of selfobject experiences derives from ideation
associated with experiences that provide a powerful boost to vital-
ization and cohesion of the self. The belief or illusion only assumes
pathologic consequences if an individual is unwilling to recognize
t h a t it is serving as a means to create an affect state of invigora-
tion or cohesion that might otherwise be lacking. As long as the
person's dominant motivation is to pursue the fantasy and resist
every effort to create doubt about its validity or its compatibility
with other goals, little attention can be given to the actual sources
of distress. From the person's point of view, distress arises from the
t h r e a t to dislodge the belief or illusion or unconscious fantasy that
has become the source of a vitalizing experience he relies on to
cope with stress from a variety of sources. Omnipotence (such as
illusions of indispensability and indefatigability) and over-idealiz-
WILLIAM N. GROSCH 63

ation (as with some members of cults) are frequent fantasy elabora-
tions used in this way as a means to create illusory, but consis-
tently re-creatable selfobject experiences, however brief and vul-
nerable. For patients whom we are able to help in psychotherapy, a
strong desire for sustainable selfobject experiences from more ordi-
nary sources persists alongside of the addictive search for alter-
nate triggers recognized to be maladaptive.

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