Transformation of Rage. Peggy Fitzhugh Johnstone

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СКАЧАТЬ object relationship" (6). The view that attachment theory and the theory of separation-individuation are antithetical, as articulated for example by Daniel Stern in The Interpersonal World of the Infant(240-42), is, I believe, based on a misunderstanding of Mahler’s intent. Indeed, what Mahler and the attachment theorists have in common is their understanding of the young child’s development as necessarily occurring in relation to the people in his/her environment.

      In contrast to Anna Freud, Melanie Klein, and Margaret S. Mahler, whose work was focused on child development, Otto F. Kernberg, an American professor of psychiatry and training analyst, bases his theoretical formulations on his extensive experience with severely disturbed adult patients. He is probably best known for his classic work, Borderline Conditions and Pathological Narcissism, which, as he explains in his preface to the book, is the result of "thirteen years' effort to develop a concept of [the psychopathology, diagnosis, prognosis, and treatment of borderline conditions] in the light of contemporary ego psychology and psychoanalytic object relations theory." As Greenberg and Mitchell explain, Kernberg "derives most of his inferences from the transference reactions characteristically manifested [by such severely disturbed patients]" (328).

      Like Mahler, Kernberg sees individual development as necessarily occurring in relation to others in the environment. Emphasizing the importance for the formation of identity of separating self and object images and "integrating libidinally determined and aggressively determined self- and object-images" in the early stages of life (162), Kernberg defines the self as "an intrapsychic structure consisting of multiple self representations and their related affect dispositions." He explains that "the normal self is integrated, in that its component self representations are dynamically organized into a comprehensive whole." This normal integrated self relates to "integrated object representations, that is, to object representations which have incorporated the 'good' and 'bad' primitive object representations into integrative images of others in depth" (315-16).

      When early self and object configurations are not successfully differentiated and integrated, severe disturbances result and persist into adulthood. Kernberg believes that what he calls the "narcissistic personality," for example, has a pathological self-structure, originating in the second half of the oral stage, in which "there is a fusion of ideal self, ideal object, and actual self images as a defense against an intolerable reality in the interpersonal realm"; at the same time, "unacceptable self images are repressed and projected onto external objects, which are devaluated" (231-32). The narcissistic personality’s inflated self-concept thus consists of a confusion and distortion of self and parent images. Kernberg is not certain of the cause of this pathological fusion of early self and object images, although his clinical experience suggests that the background of his narcissistic patients often includes "chronically cold parent figures with covert but intense aggression," with the result that these patients have sought refuge in their own physical attractiveness or special talents "against the basic feelings of being unloved and of being the objects of revengeful hatred." Moreover, Kernberg believes that it is hard to tell to what extent the development of the "pathologically augmented development of oral aggression" in such patients "represents a constitutionally determined strong aggressive drive, a constitutionally determined lack of anxiety tolerance in regard to aggressive impulses, or severe frustration in [the] first years of life" (234-35). Thus he points to the aggressive drive that he believes is innate in the individual, at the same time that he stresses the child’s interaction with others in the environment. In his treatment of narcissistic personalities, who, he emphasizes, tend to project their aggression onto others, Kernberg attempts to get the patient to recognize the aggression that is actually coming from within.

      Like Kernberg, Heinz Kohut (d. 1981) was widely regarded as a leading professor of psychiatry and training analyst. Also like Kernberg, Kohut became best known for his work on psychological problems that persist into adulthood when individuals have not completed the intrapsychic process of differentiating and integrating infantile self and object images. In contrast to Kernberg, however, Kohut includes in his definition of "narcissistic personality disorders," as described in his first book, The Analysis of the Self, a broader range of personality and behavior problems. He sees such narcissistic disturbances in the context of what he calls "self-psychology," the term he applies to his well-known and much-debated theoretical system. Although many writers see Kohut’s system as antithetical to the mainstream of psyc hoanalytic theory, Kohut himself asserts, even in his last theoretical work, How Does Analysis Cure?(1984), that although self-psychology is "still unassimilated by the majority of analysts, … it is in the mainstream of the development of psychoanalytic thought" (95). Rather than a "deviation from traditional theory," Kohut considers it "an expansion of analytic understanding" (208). In an earlier work, The Restoration of the Self(1977), Kohut explains his (now) widely misunderstood "principle of complementarity" (279): his notion of retaining the concepts of traditional psychoanalysis, while adding to them what he sees as a new dimension of self-psychology. To cite an example: Kohut views the Oedipus complex in the context of the child’s developing self-structure; he writes that "the presence of a firm self is a precondition for the experience of the Oedipus complex. Unless the child sees himself as a delimited, abiding, independent center of initiative, he is unable to experience the object-instinctual desires that lead to the conflicts and secondary adaptations of the oedipal period" (227). By adding the dimension of self-psychology to such classical concepts, Kohut hopes that therapists can "perceive configurations that would otherwise have escaped [their] notice" (Cure 84).

      Kohut defines psychoanalytic cure in terms of structural completeness: that is, "when an energic continuum in the center of the personality has been established and the unfolding of a productive life has thus become a realizable possibility" (Cure 7). Kohut explains in The Analysis of the Self that under optimal circumstances the young child experiences gradual disillusionment with his parent figures–a process that results in "gradual . . . internalization" or the gradual "acquisition of permanent psychological structures which continue, endopsychically, the functions which the idealized self-object had previously fulfilled." If a child suffers a traumatic loss or disappointment in the parent figure(s), however, "the child does not acquire the needed internal structure, his psyche remains fixated on an archaic self-object, and the personality will throughout life be dependent on certain objects in what seems to be an intense form of object hunger. The intensity of the search for and of the dependency on these objects is due to the fact that they are striven for as a substitute for the missing segments of the psychic structure" (45). Therapy involves a process of "transmuting internalization," achieved through a "narcissistic transference" with an empathic therapist who attempts to provide the supportive milieu that is necessary for the patient to rework the past and begin to grow again (Cure 4).

      Perhaps Kohut’s greatest difference from Kernberg is his belief that aggression is not a "manifestation of a primary drive that is gradually unveiled by the analytic process, but … a disintegration product which, while it is primitive, is not psychologically primal" (Restoration 114). He sees aggression in the transferences of his adult patients as reactions to empathic failures on the part of parent figures. He explains that through the therapeutic process, the patients can reconstruct and work through "the traumatic states of early life" that resulted from the "noxious childhood environment." At the same time, through the process of transmuted internalization that occurs in therapy, the patient will attain new psychological structures, with the result that the propensity for rage will be reduced (261).

      John Bowlby, the eminent English psychiatrist, researcher, and teacher in the field of personality development, is best known for his pioneering three-volume work on Attachment and Loss, a work which explores the child’s need for the ongoing, reliable presence of attachment figures. In his volume on Attachment, Bowlby explains his belief that it is instinctive (for survival) in children under age three to maintain proximity to the mother, or attachment figure (1 :134). Moreover, observing that social interaction with the child is the most important factor in the formation of such necessary attachment, he asserts that the child’s need for the mother exists apart from the gratification of physiological needs (1 :361ff). Following Sigmund Freud’s idea that childhood trauma causes disturbances in later life, СКАЧАТЬ