Discussion of Robert Grossmark's Case of Pamela

The author discusses Robert Grossmark's “Case of Pamela” from the perspective of developmental (relational) trauma and offers the view that Pamela's remarkable growth as well as the stunning power of the clinical process that made it possible is best illuminated from the vantage point of self-states, dissociation, affect dysregulation, and the dread of annihilation. The phenomenon of pathological narcissism, which in a classical idiom would be a central concept in describing Pamela's personality organization, is here formulated relationally in a self-state context. That is, each self-state, to the extent that it is protectively dissociated from others becomes, inherently, an island of narcissism and is what narcissism truly means. In the face of trauma, each island of selfhood operates to obliterate, automatically, the felt invasion of otherness from parts of the self that hold alternative views of “self-truth,” as well as from an other in real life—a separate person with a mind of his or her own. As each narcissistic island of Pamela's selfhood was recognized and accepted as valid in its own terms by Robert, the experiential wholeness of Pamela's sense of self began to be restored. The clinical process through which this was accomplished is seen by the author as the expansion and enrichment of Pamela's overarching self-coherence through her gradual representation of Robert's “otherness” as part of each self-representation. This in turn allowed the restoration of safe, communicative interchange between the formerly dissociated self-state islands of narcissistic insularity.