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In this paper I intend to discuss my views on the origin, manifestations and treatment of narcissistic disorder based on my clinical experience. The Oxford English Dictionary defines narcissism as the ‘tendency to self-worship, absorption into one's own personal perfections’. That seems to me to describe the defence or facade which people show to the outside world when they suffer from narcissistic disorder. I consider a person to suffer from narcissistic disorder when he manifests an inability to love and value himself and hence cannot truly love others. He may appear wrapped up in and preoccupied with himself and frequently turn his innate archaic impulses on to himself instead of towards objects. He shows severe defects in his object relations which may make him feel that his life is futile and empty. In severe cases such a person feels himself outside the human ken, in a ‘living death’ and frequently suffers from a terror of non-existing. This terror and emptiness are often covered over by feelings of aloofness and superiority, at times by grandiose ideas about himself. In discussing my hypothesis about the origin of this disorder, I shall use the conceptual framework of contemporary Jungian psychology, in particular Fordham's theory of deintegration-reintegration and earliest defences. I found his concepts most helpful for understanding my narcissistic patients. Needless to say our Jungian framework has incorporated many seminal ideas of Melanie Klein, Winnicott and others. Throughout I shall illustrate my theoretical discussion with clinical material which I have discussed in greater detail in previous papers (Ledermann 1979, 1981, 1982, 1986). I shall refer to my patients with the same initials which I used in those papers.
As some readers may not be familiar with contemporary Jungian concepts, I shall now give a short exposition of those concepts used in this paper. Fordham (1957 p. 104-130) holds that the baby at birt