Pathologic Forms of Self-Esteem Regulation1

"Self-esteem," in common usage, is defined by Webster as a high opinion of oneself, respect for oneself. This positive evaluation of the self obviously is a precondition for one's well-being.

There are many ways in which human beings attempt to keep up a positive evaluation of themselves. The methods they use may vary according to numerous factors, such as age, character and capacities of the ego, individual nature of conflicts, and so on. A comprehensive study of these various ways would exceed the frame of a lecture. My discussion will limit itself to certain abnormal modes of self-esteem regulation which are characteristically found in some types of "narcissistic disturbances."

Obviously, disturbances of self-esteem are a frequent symptom in schizophrenic as well as in manic-depressive states. However, I shall not deal with the psychoses but intend to concentrate on "narcissistic neurosis."

I am well aware that Freud used the term "narcissistic neurosis" to designate exclusively psychotic illness, delimiting it from transference neurosis. But it seems to me that narcissistic pathology cannot be viewed as restricted to psychosis. I would like to use this term in a much wider sense. In the course of the last decades, we have become less inclined to regard clinical entities as pertaining exclusively to certain phases of development. We know overlapping of phases to be ubiquitous. There is usually a partial regression to earlier ego and libidinal states mixed with later, more highly developed structures. Even a marked narcissistic orientation need not be completely so; i.e., it need not be characterized by a withdrawal of