You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
IN 1984 EGAN AND KERNBERG POINTED OUT THAT THERE WERE FEW clinical reports on children who suffered from intense narcissism and an ego disorder. This comment encouraged me to report the initial stages of the analysis of a 5-year-old boy, whose disturbance appears to fall into this type of disorder. Apart from questions discussed in the literature with regard to the genesis and underlying factors of such disorders—for example, the contribution of family dynamics to their development and maintenance, which were also evident in my patient—I wish to describe and consider, as a special feature of the case, the difficult start in life which this child had. He was born prematurely (4 weeks early, birth weight 2,200 gm), suffered from severe respiratory distress, and had to be treated for some time in the intensive care unit of a pediatric clinic, where he was kept alive in an incubator.
In considering how to assess the significance of this postnatal trauma, associated as it was with many painful interventions and the deficit in contact between mother and child, I found Greenacre's paper "Predisposition to Anxiety" (1941) to be helpful. Greenacre attempted to relate early life-threatening situations—she explicitly mentions postnatal illness—and the resulting tension states at an organismic level, which gave rise to a raised basic level of anxiety or its organic components, to increased infantile narcissism, especially in the case of severe neurosis. "I believe this organic stamp of suffering to consist of a genuine physiological sensitivity, a kind of increased indelibility of reaction to experience which heightens the anxiety potential of later life" (p. 54). "It seems to me quite evident that an increased early infantile anxiety can be expected to be associated with a complementary