Thanks Don. One of the best lectures I’ve heard clarifying Britton’s concepts! I think the major challenge these people have is being able to tolerate the ‘otherness of the other’ and separateness!
I can offer insight as a boderline. I clearly remember what happened. My father beat me for the first time, I went to my mother afterwards crying.. she slapped me in the face and told me to go to my room and went on with my father as if nothing had happened. I think it was such an intense introduction to them having their own relationship without me I could not fully process it.
Amazing how squeemy those with NPD get when forced into that third space. The smart ones rework the thought quickly and are able to digest it as their own. Those without the high processing power are usually super sensitive and react harshly (misunderstood ones).
I enjoy watching your videos and learning about psychoanalysis. I especially enjoy learning about the different theories and concepts. I suggest making a series of videos about the applications and techniques of psychoanalysis as treatment for mental illness such as depression and anxiety.
Jonas, that would require me to educate myself thoroughly on Jung. Without doing that all I can say is that Jubg appears to equate God with the individuated Self. At least Freud requires us to get beyond the self to the other. This by the way is also Martin Buber’s critique of Jung. If I ever find the time to study Jung more deeply, I am a rise to your challenge.
@@doncarveth Thanks for the reply, Don! I am confident that Jung was onto something in terms of individuation and transformation that the spiritual traditions often refer to in terms of liberation/enlightenment, which the general psychoanalytical literature, to the best of my knowledge, don't focus on. So I was curious as to how, for instance, self-realization in the Jungian sense relates to the maturation associated with the depressive position. Although I am not a scholar within this particular area, I can certainly understand and relate to your reply. It is a substantial undertaking to cover any of the thinkers at issue in-depth. Personally I don't find it particularly rewarding to read Jung's work, although I do find his focus on the true self very apt and interesting. Well, good luck with your work anyway. I do look foward to your nexr video. They are always highly valuable!
Jonas Hjerpe , I think there is a parallel between Jung’s interest in the Tao, Transcendence of opposites, both Yin and yang, and Klein’s depressive position. Jung shared the emphasis of eastern religion on non-duality in this fits with Klein. Thanks Jonas for helping me to remember this.
@@doncarveth You're welcome. Yes there are similarities, but I gather that they don't really account for the differences in stages of realization. For example, in order to go through the individuation process that Jung referred to as self-realization, which usually happens somtimes during mid-life, if at all, the adult individual must already be quite mature, i.e. having resolved the depressive position to some degree. Jung himself is a good example of this shift. Apparently he transitioned into a deeper transformation process that started at age 37 and lasted, as far as I understand, until his early 50s. Jung was presumably well established in the depressive position well before the onset of this midlife transformation. I have no doubt that the aforementioned transformations deepened his depressive/reparative position, but it just doesn't seem right to describe the transition in terms of more of the same. Rather than some sort of quantitative increase, or deepening, it seems that this shift is essentially qualitative. It concerns the realization of the self and the capacity to live it fully. Thus, I would say that the differences between the second phase of adult maturation visavi the first phase of adulthood are more striking than the similarities (that are undeniably there). If you would like to indicate, however briefly, how conceive of this line of response, I would be most grateful! Best, J
@Don, thank you for sharing your knowledge, the lecture was very informative. Also, I noticed students asked interesting questions too. Can you please share video's about paranoia characteristic and mindset? Thank you
Mr. Carveth - I love your talks about Narcissism. One of the strangest and most glaring aspects of the disorder which is rarely discussed is the "amnesia" they experience. Otto Kernberg wrote a paper on it which I am curious to read entitled "The Destruction Of Time In Pathological Narcissism." Do you have any more information or a further opinion on the subject? Or a resource you can point me to? I found it fascinating that my Narcissistic ex could detail every last aspect of her business or traveling affairs but when it came to "emotional" or relationship issues she would suddenly have amnesia which was deeply disturbing. What is the root cause of this? Is it also to avoid their shame and prevent a superego attack? When I later allowed her to "hoover" me back in it was very strange because all of a sudden she was discussing things in the past which she "forgot" as if the amnesia suddenly disappears. Like she never forgot anything. What is the psychological underpinnings of this? Then a day later - POOF - it was like we never discussed her betrayals or they never happened, etc. Like I said, I think it's one of the most disturbing aspects of the disorder which is rarely discussed. Thanks for all of your videos! I've watched all of the Narcissism ones.
Ah - I see you started mentioning the "amnesia" later in this very video. You mentioned that you'll discuss this phenomenon in your next class/video. I would love to hear an in depth discussion on this baffling phenomenon. I'm sure there are many contributing factors to this amnesia which prevents therapeutic progress. Why do Narcissists seem to have extremely selective memory?! Please post the video to your UA-cam channel! Thanks so much! This is all so clarifying.
Willwen, Freud saw both horizontal and vertical splitting. The former is repression. The latter is the kind of dissociation. Kernberg saw vertical splitting as characteristic of NPD. Freud also spoke of isolation of thoughts, a kind of compartmentalization of mind. The left hand doesn’t know what the right hand is doing. In analysis the narcissistic patient may be today in a radically different self state then yesterday and me barely remember how he was feeling or thinking yesterday. This kind of thing is Common in PS states.
This man thinks psychotherapy is a science. And he believes in the therapist strategically playing a role for technical purposes as distinct from being truthful and real. He makes no mention of conscience [as distinct from superego]. The cure of narcissism is the recovery of conscience. Intentionally re-traumatizing sounds dangerous and unethical. Save us from the technocrats of the soul.
thank you for this video . That would be great if you release more videos on youtube. quick question : based on this video can we say thin-skinned is a borderline personality disorder? do you mean by borderline "borderline personality disorder"?
There is confusion between DSM diagnosis and clean he and diagnosis. Britain sees both thin skinned and thick skinned narcissists as operating in the Klein he and PS position. He calls the thin skinned borderline in the thick skinned skin side. Both of these, and people in general who function in PS would be seen as “borderline“ by people thinking along DSM lines.
Dear Don, when you discuss the thin-skinned narcissists as borderline, do you mean borderline personality organisation or borderline as in personality disorder diagnosis. Many thanks for clarifying. And could you perhaps help point which is the crucial element that discerns the borderline structure from the BPD?
I was describing RONALD Briton’s view, not my own. It’s a confusing area. I don’t much believe in these discrete diagnostic categories. What’s important is to distinguish PS functioning from D functioning. Some define BPD very specifically, others rather vaguely. Splitting characterizes PS functioning, but it is not just “borderlines“ who split. In fact, we all split when we are operating in PS.
@@doncarveth Dear Don, thank you for clarifying. It is a confusing area indeed, especially at the training stage. My question arises from my clinical work in a secure PD unit where patients have a psychiatric established PD diagnosis, although typically present with dual or multiple diagnoses. I always wonder about the level of personality organisation. So I guess my question - although not very clear in my mind and putting it simply -, would someone at the neurotic level ever end up developing a PD? Is it that if they were to do so, these would be the higher functioning individuals with a "PD"? Or contrary to this, is the PD diagnosis signalling they are probably at a lower level, the psychotic or borderline, because of the type of difficulties and challenges they experience, hence a PD - regardless of the functioning level -? How can one discern, clinically (presenting in sessions) between psychotic or borderline organisation if this were the case? And what are the implications for treatment in your view? And a further question, in your opinion or to your knowledge, developmentally speaking - when would the "level of personality organisation" be established?
@@Vdor these are very difficult questions. I have trouble with the idea of a neurotic personality disorder. To meet personality disorder implies PS functioning. For me psychosis means delusion and hallucination although it is important to distinguish psychotic reactions, transference psychosis, and paranoid psychosis from schizophrenia. Well micro psychotic episodes may not require medication, I think more enduring psychosis usually require antipsychotic medication as well as a modified, supportive form of psychodynamic therapy to assist re-integration. I don’t feel competent to say anything about the developmental origins, the timing, etc., of development of these conditions beyond saying the pre-edible factors generally loom large in the formation of personality disorders well edible factors of course are important in the formation of the neuroses, although these two are influenced by pre-edible factors.
@@doncarveth Thank you, Don, for your answer. I realise these are very complex matters, but discussions of this sort help me. So what I take from here that seems more evident to me is that both the pre-oedipal and oedipal factors have a great pull into how someone's personality is organised and, that as a clinician, I can think about what the individual does and map it onto PS / D position, and build up my understanding of them from there. Also, Contrary to what many clinicians have told me, I gather that you think that one can work dynamically with more disturbed individuals (even those that endure psychosis or those that sometimes experience psychotic episodes) if one modifies the approach, still not abandoning the dynamic core. It is encouraging since I am interested in PD and Psychosis but have often been discouraged from pursuing work with them as "one cannot work with such patients dynamically in a meaningful way".
@@Vdor Yes, as Kurt Eissler explained many decades ago in his paper on the psychoanalysis of schizophrenia, simple humane being with the patient supportively is often more useful than giving psychodynamic interpretations which cannot only be useless but contra indicated. That doesn’t mean the psychodynamic understanding is incorrect. It may be correct but it is useless to communicate this to the patient. The psychotic patient already too much meaning. Suggesting even more meaning generally doesn’t help. But with antipsychotic medication, support and empathy the patient may gradually come to be Able to reach some dynamic understanding of what has happened to him.
I’m still struggling to fully understand how borderline and narcissism relate to eachother. They are confusing concepts to me, especially since a term like borderline can refer to a structure, a level of functioning, a disorder, a specific type of narcissism, and more. Symington’s ‘On narcissism’ has helped me understand a bit about narcissism; Kernberg’s paper helped me understand borderline. But it still is vague to me how the two relate.
Yeah. I find that the borderline is constantly splitting. They live in the ps for long stretches. They have very strong magical thinking. Bad reality testing. However I find they can tolerate the third space a lot better, even quite well. Where as the narcissists have massive problems with that third space. It is stated that the borderline and sensitive narcissist are one in the same. I also see a difference in the ego. A very early fragmented one (NPD) vs the stunted ego (childish) of the borderline.
When talking to a narcissist once I pushed into the third space repeatedly, after many episodes of rage he finally explained his thoughts about why he does not tolerate the third space, rationalizing the following "I get annoyed and cut off the other person because I already know exactly what words they are going to say to me, however, although this is usually the case many times they say something different, therefore I should listen ,(the last part in a surprised tone)". The fact that someone could actually have their own thoughts is really hard for him to accept, maybe really not even accepting it. He has to define it as people saying different words than the ones he already knows they will say. He was able to decipher what happens but can he really accept the other as a full object? He is constantly confusing the boundries. Do people with NPD actually consider the other person as really existing? Apparently in a very limited way. Self object transferance helped me understand this better. Narcissist need constant mirroring while I find the borderline doesnt. Borderlines need constant reminder of their splitting and bad reality testing.
Ingur, yes, authors mean the same thing but different concepts and different things by the same concepts. Very confusing. Better to simply be cleaning and distinguish PS from D. The PS position is narcissistic and involves splitting, Projective identification, etc. D involves the capacity for concern or true object love - i.e. the transcendence of narcissism. I fundamentally distinguish patient’s operating predominately in D from those operating predominately in PS in this way I don’t need the borderline concepts.
So much more going on fundamentally to reductively assert narcissism is "shame based", as some do, don't you think? Like.. I know there's that seeming causal-looking tether between narcissistic rage and shame.. but still. That.. internal demand to be perfect such to be safe from criticism, fascinates me. By the way my phone call with Ukraine's president was 'perfect'.
Every time questions of temperament or the “inborn“ come up, my mind goes back to a lecture of Robert Sapolsky’s on the prenatal environment and its lasting consequences. In the Anglosphere, we *should* be automatically enervated by even the whiff of the supposedly inborn, because crypto-eugenics is in the very air we breathe.
No trauma in the history is BS, I have borderline and until my older brother was on his deathbed and tipped me off I had completely repressed my first few years of abandonement and sexual abuse entirely.. That form of abuse starts DAY ONE home from the hosptial, the MINUTE the mother falls asleep. So, sure.. no trauma in memory.. no trauma as a child.. but plenty as an infant before they could talk or make sense of it. As soon as we got speech and learned to speak out to the mother, they stopped under agreement the wife/mother would forgive and stay silent. Deal with the Devil made, paid for by the child for life as the parents do all they can to ensure their kids never gets therapy lest the truth come out from the subconscious, as it did for me.
@@doncarveth a brief comment and question on this, if you'd please indulge me, Don. I think he was referring to Britton's discussion of narcissistic disorders that seem to develop without the appearance of any trauma.. I have been quite curious about this, is there anything you might want to add besides the misgivings you've expressed in this class? My sense of it is that Britton's suggestion of an autoimmune disorder is along the same lines as John Gunderson's interpersonal hypersensitivity phenotype in BPD etiology, and Nancy McWilliams's suggestion that schizoid people show a highly sensitive temperament. Comments on this if any? Thanks! (The discussion of this issue is at about 23:45 in the video.)
jiminy_cricket777 Should the mother throw that difficult baby in the garbage can or should she learn how to attune to him? It may take years for deeply buried trauma to emerge in the analysis.
Don, a brief comment and suggestion, if you'll please indulge me. I was just listening today to an interview with John Steiner, talking about his new book, Illusion, Disillusion, and Irony in Psychoanalysis. I've not read the book, but something he said in the interview reminded me of your talk about Ron Britton's paper. Steiner says that irony is the way in which, at least from the analyst's perspective, one can bridge the gap between subjectivity, that is, seeing the patient and sympathizing with his or her need for some illusionment, and objectivity, observing the patient's illusionment as illusionment, as the unrealistic phantasy that it is. This also reminds me of things you've said about a dialectical, both/and approach to analysis. Anyway, the relevant part of the interview is about 9 minutes long and it ends when the interviewer starts to introduce an audience question. Here is a link that will take you to that specific part of the interview: ua-cam.com/video/pKqG6dYZzvQ/v-deo.htmlm47s And I was struck by how much this tracks with my own self-reflections (made subsequent to a therapy which was incomplete and I chose to end a few years ago, for various reasons, some narcissistic and others not). What I have noticed is that as I try to progress from illusionment to disillusionment, that a kind of gentle appreciation of the ironies involved in my retreat and other psychopathologies, both in their genesis and their perpetuation, has been helpful in beginning to emerge from that defended space. A kind of shaking of the head and chuckling to myself, not masochistically or in self-reproach, more in the mode of conscience you've described in some of your talks. I wonder if perhaps you could talk a bit about this idea of irony, and John Steiner and his new book at some point? Thank you!
Thank you for the clip but I’m never impressed by irony. I think it’s a defense. Maybe at times some may need this defense, for a time. I don’t really see the connection to dialectical thinking.
@@doncarveth Thanks for getting back to me so promptly. And yes, I can see how it can just be a step in the process.. your response makes me think of your comments on becoming disillusioned with disillusionment, which seems to me to be important, that we can't really be settled on anything exactly, that the work is never really done, so to speak. Irony also can have a kind of a bite to it still, at times, that while it can bring a little levity and humility, I suppose there's also a danger of slipping back into self-attack? I'm not sure if this makes sense or not. Edit: just wanted to add a point of clarification. As it relates to dialectical thinking, what I was imagining in my head when I wrote that is a patient who is either stuck in hyper subjectivity or else in hyper objectivity, that these are thesis and antithesis respectively and that irony is one way to begin to bring one into contact with the other, to link subjective and objective in the ways you talk about in relation to this Britton paper.
@@doncarveth just thinking this over a bit more, I have a couple of further thoughts in response to your reply. First, one further thought on dialecticality: seems to me like from your previous response that you've inferred (either from my initial comments or Steiner's ideas, I'm not sure which) that irony is thought of as some kind of end point. Perhaps Steiner just didn't have enough time to address this issue, it is near the end of the interview. I want to just look at what he says more carefully for a moment: So, he says "When we know we're engaging in an illusion, because we've come out and observed it, then it's both an illusion and it's a truth." Steiner then goes on to reference Paradise Lost, saying that God is portrayed as always good, to be admired and loved, but that God is also portrayed as a tyrant, and that these attitudes are there simultaneously. He then says that the only way to reconcile this is by irony. So are you taking it that Steiner's word use of the word reconciliation here implies an ending to this tension? If so then I can understand your doubts about this being dialectical, since there is no new tension following that, that needs to be worked out. If it is in fact the case that irony is an endpoint rather than an opening or a step in a process, then certainly this isn't dialectical, as a dialectical approach already implies that there is no true end point. Is that part of how Steiner thinks about it, and that's why your criticism is going there? I'm wondering because in what I said about it I spoke of it as a beginning to emergence from a retreat in which subject and object are kept separated, a beginning to an acceptance of lack, and guilt and so on. So it seems like that issue you're raising with the concept speaks more to Steiner's view on it than mine? Put simply, I'm just wondering what the source of that inference you're making is. It's hard for me to know if it is to do with Steiner as I've just started reading Psychic Retreats and I'm about 3 chapters in, so I'm still learning about Steiner's views. And I haven't got a copy of his new book either. Please forgive me if I'm just speaking from too much ignorance of Steiner in this question. Thank you again, I appreciate your time.
I think I am influenced by wider discussions of irony in postmodernism,, As an attitude toward life, I kind of cool, detached, uncommitted attitude. I think of irony as a kind of refusal to be passionately committed. Obviously there are many different understandings of the meaning of irony. I just think of mental growth is leading toward the kind of clarity. I think the goal of personal development end of psychoanalysis is salvation, and I am not at all ironic about this.
@@doncarveth okay, yes. Thank you for the clarification. I wasn't thinking about it in the context of that debate but your point is well-taken. To pick up on what you said about psychoanalysis and salvation, it reminds me of what you've said about Lacan elsewhere, that this is a salvation where one doesn't forget that one is still a sinner, or in the Kleinian language that even when we have gotten to D, we can always slip back to PS, that we need to be able to flexibly move between the two. And I think implied in your distaste for the kind of irony you're referencing is that there's a precariousness to this aspect of salvation, or mental health, that some modes of irony wouldn't want to accept, instead seeing this precariousness as a reason for nihilism. Irony then permits a kind of excuse, or a way to refuse to accept the need to grapple with the instability of salvation, or mental health. And this surely is a false end point, so if that's what you're suggesting, I agree. Anyway, thank you again for the discussion, I really appreciate it.
Thanks Don. One of the best lectures I’ve heard clarifying Britton’s concepts! I think the major challenge these people have is being able to tolerate the ‘otherness of the other’ and separateness!
I can offer insight as a boderline. I clearly remember what happened. My father beat me for the first time, I went to my mother afterwards crying.. she slapped me in the face and told me to go to my room and went on with my father as if nothing had happened. I think it was such an intense introduction to them having their own relationship without me I could not fully process it.
Wonderful lectures! Thanks for posting these!
Amazing how squeemy those with NPD get when forced into that third space. The smart ones rework the thought quickly and are able to digest it as their own. Those without the high processing power are usually super sensitive and react harshly (misunderstood ones).
Most welcome.
Shane’s, well put.
I enjoy watching your videos and learning about psychoanalysis. I especially enjoy learning about the different theories and concepts. I suggest making a series of videos about the applications and techniques of psychoanalysis as treatment for mental illness such as depression and anxiety.
Nicholas, good idea. I’ll think about it. Thanks.
Don, please consider doing a video on Jung and spirituality!
Jonas, that would require me to educate myself thoroughly on Jung. Without doing that all I can say is that Jubg appears to equate God with the individuated Self. At least Freud requires us to get beyond the self to the other. This by the way is also Martin Buber’s critique of Jung. If I ever find the time to study Jung more deeply, I am a rise to your challenge.
@@doncarveth Thanks for the reply, Don! I am confident that Jung was onto something in terms of individuation and transformation that the spiritual traditions often refer to in terms of liberation/enlightenment, which the general psychoanalytical literature, to the best of my knowledge, don't focus on. So I was curious as to how, for instance, self-realization in the Jungian sense relates to the maturation associated with the depressive position. Although I am not a scholar within this particular area, I can certainly understand and relate to your reply. It is a substantial undertaking to cover any of the thinkers at issue in-depth. Personally I don't find it particularly rewarding to read Jung's work, although I do find his focus on the true self very apt and interesting. Well, good luck with your work anyway. I do look foward to your nexr video. They are always highly valuable!
Jonas Hjerpe , I think there is a parallel between Jung’s interest in the Tao, Transcendence of opposites, both Yin and yang, and Klein’s depressive position. Jung shared the emphasis of eastern religion on non-duality in this fits with Klein. Thanks Jonas for helping me to remember this.
@@doncarveth You're welcome. Yes there are similarities, but I gather that they don't really account for the differences in stages of realization. For example, in order to go through the individuation process that Jung referred to as self-realization, which usually happens somtimes during mid-life, if at all, the adult individual must already be quite mature, i.e. having resolved the depressive position to some degree. Jung himself is a good example of this shift. Apparently he transitioned into a deeper transformation process that started at age 37 and lasted, as far as I understand, until his early 50s. Jung was presumably well established in the depressive position well before the onset of this midlife transformation. I have no doubt that the aforementioned transformations deepened his depressive/reparative position, but it just doesn't seem right to describe the transition in terms of more of the same. Rather than some sort of quantitative increase, or deepening, it seems that this shift is essentially qualitative. It concerns the realization of the self and the capacity to live it fully. Thus, I would say that the differences between the second phase of adult maturation visavi the first phase of adulthood are more striking than the similarities (that are undeniably there). If you would like to indicate, however briefly, how conceive of this line of response, I would be most grateful! Best, J
Perfect
Golnoosh Shahbaz , Thank you.
@Don, thank you for sharing your knowledge, the lecture was very informative. Also, I noticed students asked interesting questions too.
Can you please share video's about paranoia characteristic and mindset? Thank you
Thanks for the suggestion.
Mr. Carveth - I love your talks about Narcissism. One of the strangest and most glaring aspects of the disorder which is rarely discussed is the "amnesia" they experience. Otto Kernberg wrote a paper on it which I am curious to read entitled "The Destruction Of Time In Pathological Narcissism." Do you have any more information or a further opinion on the subject? Or a resource you can point me to? I found it fascinating that my Narcissistic ex could detail every last aspect of her business or traveling affairs but when it came to "emotional" or relationship issues she would suddenly have amnesia which was deeply disturbing. What is the root cause of this? Is it also to avoid their shame and prevent a superego attack?
When I later allowed her to "hoover" me back in it was very strange because all of a sudden she was discussing things in the past which she "forgot" as if the amnesia suddenly disappears. Like she never forgot anything. What is the psychological underpinnings of this? Then a day later - POOF - it was like we never discussed her betrayals or they never happened, etc.
Like I said, I think it's one of the most disturbing aspects of the disorder which is rarely discussed. Thanks for all of your videos! I've watched all of the Narcissism ones.
Ah - I see you started mentioning the "amnesia" later in this very video. You mentioned that you'll discuss this phenomenon in your next class/video. I would love to hear an in depth discussion on this baffling phenomenon. I'm sure there are many contributing factors to this amnesia which prevents therapeutic progress. Why do Narcissists seem to have extremely selective memory?! Please post the video to your UA-cam channel! Thanks so much! This is all so clarifying.
Willwen, Freud saw both horizontal and vertical splitting. The former is repression. The latter is the kind of dissociation. Kernberg saw vertical splitting as characteristic of NPD. Freud also spoke of isolation of thoughts, a kind of compartmentalization of mind. The left hand doesn’t know what the right hand is doing. In analysis the narcissistic patient may be today in a radically different self state then yesterday and me barely remember how he was feeling or thinking yesterday. This kind of thing is Common in PS states.
This man thinks psychotherapy is a science. And he believes in the therapist strategically playing a role for technical purposes as distinct from being truthful and real. He makes no mention of conscience [as distinct from superego]. The cure of narcissism is the recovery of conscience. Intentionally re-traumatizing sounds dangerous and unethical. Save us from the technocrats of the soul.
thank you for this video . That would be great if you release more videos on youtube. quick question : based on this video can we say thin-skinned is a borderline personality disorder? do you mean by borderline "borderline personality disorder"?
There is confusion between DSM diagnosis and clean he and diagnosis. Britain sees both thin skinned and thick skinned narcissists as operating in the Klein he and PS position. He calls the thin skinned borderline in the thick skinned skin side. Both of these, and people in general who function in PS would be seen as “borderline“ by people thinking along DSM lines.
Dear Don, when you discuss the thin-skinned narcissists as borderline, do you mean borderline personality organisation or borderline as in personality disorder diagnosis. Many thanks for clarifying. And could you perhaps help point which is the crucial element that discerns the borderline structure from the BPD?
I was describing RONALD Briton’s view, not my own. It’s a confusing area. I don’t much believe in these discrete diagnostic categories. What’s important is to distinguish PS functioning from D functioning. Some define BPD very specifically, others rather vaguely. Splitting characterizes PS functioning, but it is not just “borderlines“ who split. In fact, we all split when we are operating in PS.
@@doncarveth Dear Don, thank you for clarifying.
It is a confusing area indeed, especially at the training stage. My question arises from my clinical work in a secure PD unit where patients have a psychiatric established PD diagnosis, although typically present with dual or multiple diagnoses. I always wonder about the level of personality organisation.
So I guess my question - although not very clear in my mind and putting it simply -, would someone at the neurotic level ever end up developing a PD? Is it that if they were to do so, these would be the higher functioning individuals with a "PD"? Or contrary to this, is the PD diagnosis signalling they are probably at a lower level, the psychotic or borderline, because of the type of difficulties and challenges they experience, hence a PD - regardless of the functioning level -? How can one discern, clinically (presenting in sessions) between psychotic or borderline organisation if this were the case? And what are the implications for treatment in your view?
And a further question, in your opinion or to your knowledge, developmentally speaking - when would the "level of personality organisation" be established?
@@Vdor these are very difficult questions. I have trouble with the idea of a neurotic personality disorder. To meet personality disorder implies PS functioning. For me psychosis means delusion and hallucination although it is important to distinguish psychotic reactions, transference psychosis, and paranoid psychosis from schizophrenia. Well micro psychotic episodes may not require medication, I think more enduring psychosis usually require antipsychotic medication as well as a modified, supportive form of psychodynamic therapy to assist re-integration. I don’t feel competent to say anything about the developmental origins, the timing, etc., of development of these conditions beyond saying the pre-edible factors generally loom large in the formation of personality disorders well edible factors of course are important in the formation of the neuroses, although these two are influenced by pre-edible factors.
@@doncarveth Thank you, Don, for your answer. I realise these are very complex matters, but discussions of this sort help me. So what I take from here that seems more evident to me is that both the pre-oedipal and oedipal factors have a great pull into how someone's personality is organised and, that as a clinician, I can think about what the individual does and map it onto PS / D position, and build up my understanding of them from there. Also, Contrary to what many clinicians have told me, I gather that you think that one can work dynamically with more disturbed individuals (even those that endure psychosis or those that sometimes experience psychotic episodes) if one modifies the approach, still not abandoning the dynamic core. It is encouraging since I am interested in PD and Psychosis but have often been discouraged from pursuing work with them as "one cannot work with such patients dynamically in a meaningful way".
@@Vdor Yes, as Kurt Eissler explained many decades ago in his paper on the psychoanalysis of schizophrenia, simple humane being with the patient supportively is often more useful than giving psychodynamic interpretations which cannot only be useless but contra indicated. That doesn’t mean the psychodynamic understanding is incorrect. It may be correct but it is useless to communicate this to the patient. The psychotic patient already too much meaning. Suggesting even more meaning generally doesn’t help. But with antipsychotic medication, support and empathy the patient may gradually come to be Able to reach some dynamic understanding of what has happened to him.
Yes
lol i am the thin skinned one god help me let the therapist in 🙏
I’m still struggling to fully understand how borderline and narcissism relate to eachother. They are confusing concepts to me, especially since a term like borderline can refer to a structure, a level of functioning, a disorder, a specific type of narcissism, and more.
Symington’s ‘On narcissism’ has helped me understand a bit about narcissism; Kernberg’s paper helped me understand borderline. But it still is vague to me how the two relate.
Yeah. I find that the borderline is constantly splitting. They live in the ps for long stretches. They have very strong magical thinking. Bad reality testing. However I find they can tolerate the third space a lot better, even quite well. Where as the narcissists have massive problems with that third space. It is stated that the borderline and sensitive narcissist are one in the same. I also see a difference in the ego. A very early fragmented one (NPD) vs the stunted ego (childish) of the borderline.
When talking to a narcissist once I pushed into the third space repeatedly, after many episodes of rage he finally explained his thoughts about why he does not tolerate the third space, rationalizing the following "I get annoyed and cut off the other person because I already know exactly what words they are going to say to me, however, although this is usually the case many times they say something different, therefore I should listen ,(the last part in a surprised tone)". The fact that someone could actually have their own thoughts is really hard for him to accept, maybe really not even accepting it. He has to define it as people saying different words than the ones he already knows they will say. He was able to decipher what happens but can he really accept the other as a full object? He is constantly confusing the boundries. Do people with NPD actually consider the other person as really existing? Apparently in a very limited way. Self object transferance helped me understand this better. Narcissist need constant mirroring while I find the borderline doesnt. Borderlines need constant reminder of their splitting and bad reality testing.
Ingur, yes, authors mean the same thing but different concepts and different things by the same concepts. Very confusing. Better to simply be cleaning and distinguish PS from D. The PS position is narcissistic and involves splitting, Projective identification, etc. D involves the capacity for concern or true object love - i.e. the transcendence of narcissism. I fundamentally distinguish patient’s operating predominately in D from those operating predominately in PS in this way I don’t need the borderline concepts.
Don Carveth Thank you, that is very helpful!
So much more going on fundamentally to reductively assert narcissism is "shame based", as some do, don't you think? Like.. I know there's that seeming causal-looking tether between narcissistic rage and shame.. but still.
That.. internal demand to be perfect such to be safe from criticism, fascinates me.
By the way my phone call with Ukraine's president was 'perfect'.
Yes, that dynamic certainly applies: the need to be perfect in order to ward off a superego attack.
Every time questions of temperament or the “inborn“ come up, my mind goes back to a lecture of Robert Sapolsky’s on the prenatal environment and its lasting consequences. In the Anglosphere, we *should* be automatically enervated by even the whiff of the supposedly inborn, because crypto-eugenics is in the very air we breathe.
Then, there are Covert Narcissists.
No trauma in the history is BS, I have borderline and until my older brother was on his deathbed and tipped me off I had completely repressed my first few years of abandonement and sexual abuse entirely.. That form of abuse starts DAY ONE home from the hosptial, the MINUTE the mother falls asleep. So, sure.. no trauma in memory.. no trauma as a child.. but plenty as an infant before they could talk or make sense of it. As soon as we got speech and learned to speak out to the mother, they stopped under agreement the wife/mother would forgive and stay silent. Deal with the Devil made, paid for by the child for life as the parents do all they can to ensure their kids never gets therapy lest the truth come out from the subconscious, as it did for me.
Where in that video was the denial of trauma? Of course there is infantile trauma that has had zero processing and is not in memory.
@@doncarveth a brief comment and question on this, if you'd please indulge me, Don. I think he was referring to Britton's discussion of narcissistic disorders that seem to develop without the appearance of any trauma.. I have been quite curious about this, is there anything you might want to add besides the misgivings you've expressed in this class? My sense of it is that Britton's suggestion of an autoimmune disorder is along the same lines as John Gunderson's interpersonal hypersensitivity phenotype in BPD etiology, and Nancy McWilliams's suggestion that schizoid people show a highly sensitive temperament. Comments on this if any?
Thanks!
(The discussion of this issue is at about 23:45 in the video.)
jiminy_cricket777 Should the mother throw that difficult baby in the garbage can or should she learn how to attune to him? It may take years for deeply buried trauma to emerge in the analysis.
Don, a brief comment and suggestion, if you'll please indulge me. I was just listening today to an interview with John Steiner, talking about his new book, Illusion, Disillusion, and Irony in Psychoanalysis. I've not read the book, but something he said in the interview reminded me of your talk about Ron Britton's paper. Steiner says that irony is the way in which, at least from the analyst's perspective, one can bridge the gap between subjectivity, that is, seeing the patient and sympathizing with his or her need for some illusionment, and objectivity, observing the patient's illusionment as illusionment, as the unrealistic phantasy that it is. This also reminds me of things you've said about a dialectical, both/and approach to analysis.
Anyway, the relevant part of the interview is about 9 minutes long and it ends when the interviewer starts to introduce an audience question. Here is a link that will take you to that specific part of the interview: ua-cam.com/video/pKqG6dYZzvQ/v-deo.htmlm47s
And I was struck by how much this tracks with my own self-reflections (made subsequent to a therapy which was incomplete and I chose to end a few years ago, for various reasons, some narcissistic and others not). What I have noticed is that as I try to progress from illusionment to disillusionment, that a kind of gentle appreciation of the ironies involved in my retreat and other psychopathologies, both in their genesis and their perpetuation, has been helpful in beginning to emerge from that defended space. A kind of shaking of the head and chuckling to myself, not masochistically or in self-reproach, more in the mode of conscience you've described in some of your talks.
I wonder if perhaps you could talk a bit about this idea of irony, and John Steiner and his new book at some point?
Thank you!
Thank you for the clip but I’m never impressed by irony. I think it’s a defense. Maybe at times some may need this defense, for a time. I don’t really see the connection to dialectical thinking.
@@doncarveth Thanks for getting back to me so promptly. And yes, I can see how it can just be a step in the process.. your response makes me think of your comments on becoming disillusioned with disillusionment, which seems to me to be important, that we can't really be settled on anything exactly, that the work is never really done, so to speak. Irony also can have a kind of a bite to it still, at times, that while it can bring a little levity and humility, I suppose there's also a danger of slipping back into self-attack? I'm not sure if this makes sense or not.
Edit: just wanted to add a point of clarification. As it relates to dialectical thinking, what I was imagining in my head when I wrote that is a patient who is either stuck in hyper subjectivity or else in hyper objectivity, that these are thesis and antithesis respectively and that irony is one way to begin to bring one into contact with the other, to link subjective and objective in the ways you talk about in relation to this Britton paper.
@@doncarveth just thinking this over a bit more, I have a couple of further thoughts in response to your reply.
First, one further thought on dialecticality: seems to me like from your previous response that you've inferred (either from my initial comments or Steiner's ideas, I'm not sure which) that irony is thought of as some kind of end point. Perhaps Steiner just didn't have enough time to address this issue, it is near the end of the interview. I want to just look at what he says more carefully for a moment:
So, he says "When we know we're engaging in an illusion, because we've come out and observed it, then it's both an illusion and it's a truth." Steiner then goes on to reference Paradise Lost, saying that God is portrayed as always good, to be admired and loved, but that God is also portrayed as a tyrant, and that these attitudes are there simultaneously. He then says that the only way to reconcile this is by irony. So are you taking it that Steiner's word use of the word reconciliation here implies an ending to this tension? If so then I can understand your doubts about this being dialectical, since there is no new tension following that, that needs to be worked out.
If it is in fact the case that irony is an endpoint rather than an opening or a step in a process, then certainly this isn't dialectical, as a dialectical approach already implies that there is no true end point.
Is that part of how Steiner thinks about it, and that's why your criticism is going there? I'm wondering because in what I said about it I spoke of it as a beginning to emergence from a retreat in which subject and object are kept separated, a beginning to an acceptance of lack, and guilt and so on. So it seems like that issue you're raising with the concept speaks more to Steiner's view on it than mine?
Put simply, I'm just wondering what the source of that inference you're making is. It's hard for me to know if it is to do with Steiner as I've just started reading Psychic Retreats and I'm about 3 chapters in, so I'm still learning about Steiner's views. And I haven't got a copy of his new book either. Please forgive me if I'm just speaking from too much ignorance of Steiner in this question.
Thank you again, I appreciate your time.
I think I am influenced by wider discussions of irony in postmodernism,, As an attitude toward life, I kind of cool, detached, uncommitted attitude. I think of irony as a kind of refusal to be passionately committed. Obviously there are many different understandings of the meaning of irony. I just think of mental growth is leading toward the kind of clarity. I think the goal of personal development end of psychoanalysis is salvation, and I am not at all ironic about this.
@@doncarveth okay, yes. Thank you for the clarification. I wasn't thinking about it in the context of that debate but your point is well-taken. To pick up on what you said about psychoanalysis and salvation, it reminds me of what you've said about Lacan elsewhere, that this is a salvation where one doesn't forget that one is still a sinner, or in the Kleinian language that even when we have gotten to D, we can always slip back to PS, that we need to be able to flexibly move between the two.
And I think implied in your distaste for the kind of irony you're referencing is that there's a precariousness to this aspect of salvation, or mental health, that some modes of irony wouldn't want to accept, instead seeing this precariousness as a reason for nihilism. Irony then permits a kind of excuse, or a way to refuse to accept the need to grapple with the instability of salvation, or mental health. And this surely is a false end point, so if that's what you're suggesting, I agree.
Anyway, thank you again for the discussion, I really appreciate it.
Schizoid type sounds more psychopathic.
I think you are going in wrong direction.