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The basic text for the understanding of patients with pathological narcissism.
- Sales Rank: #708880 in eBooks
- Published on: 1995-04-01
- Released on: 2012-08-21
- Format: Kindle eBook
Review
"...includes a careful phenomenological description of borderline personalities as well as numerous comments about treatment possibilities and problems." -- (Arnold Goldberg, 1985)
"This book should be carefully studied by all psychotherapists who work with 'difficult' patients." -- (Malcolm Pines, The British Journal of Psychiatry, 1985)
About the Author
Otto F. Kernberg, M.D., F.A.P.A. , is associate chairman and medical director of The New York Hospital-Cornell Medical Center, Westchester Division, and professor of psychiatry at the Cornell University Medical College. He is also training and supervising analyst of the Columbia University Center for Psychoanalytic Training and Research.
Most helpful customer reviews
25 of 27 people found the following review helpful.
The definitive book on Borderline Personality Disorder
By Sophia Bezirganian
When I first heard Dr. Kernberg speak, I thought he deserved his reputation as a brilliant but intimidating psychiatrist. After reading this book I came away with a very different understanding-- that he is not simply a master theoretician on personality disorder, but also a gifted healer, with deep understanding and wisdom in his approach to his patients. First written in 1975, this book remains the definitive comprehensive work on Borderline Personality Disorder and on Narcissistic pathology.
Early in his text, Dr. Kernberg summarizes the salient contributions to his evolving understanding of personality development, made by prior leading pioneers: Anna Freud (on the understanding of defense mechanisms, their essential hierarchical ordering, from primitive to most mature, based on their order of appearance in the developing child), Melanie Klein (on the origin and the nature of the infantile oral aggression which is the fundamental disturbance from which spring the hallmark symptoms of splitting, idealization, overvaluation, and their vicissitudes), Helene Deutsch (on the concept of the "as if" personality, which beautifully explains the nature of the identity disturbance and emptiness of the BPD).
He follows his literature review with what I believe is the best chapter (and one whose reading alone makes owning this book worthwhile) "The Syndrome". Here is found perhaps his greatest contribution into the elucidation of the condition (the seeds of which he gives credit to Dr. Karl Menninger): the idea of mental illness as a unitary process, and personality pathology as organized on a dimensional continuum. In this conceptualization, an understanding of BPD emerges which allows the reader to break through (what was for me) the confusing DSM IV catalogue defining the disorder as a many-headed hydra of pathological symptoms and behaviors: BPD is unstable affects--anger, rage, dysphoria, anxiety. It is emptiness, lack of identity. It is also impulsivity, promiscuity, eating disorder symptoms, substance abuse, self-injury, suicidal acts. Wait...it is also unstable relationships--frantic efforts, devaluation, idealization! Reading this chapter of Dr. Kernberg's book finally gave me a clear basis for understanding each of the DSM IV criteria, how they interrelate, how they arise within the psyche, and how the presence and severity of each, and their unique combination in each patient predicts her/his prognosis, and guides treatment.
Kernberg's great contribution is that Borderline Personality is not a separate and discrete entity. It is in fact better understood as a spectrum of "Borderline Conditions" which is then to be understood as a unique dimension of personality pathology. This dimension is in turn superimposable on a second continuum consisting of many other personality disorders. The latter in turn are ordered from the "lowest" and most severe, characterized by the most primitive defenses: Narcissistic, (containing Paranoid and Antisocial subtypes), Infantile (with Dependent subtypes), and finally Hysterical, Depressive/Masochistic, and Obsessive personalities, which utilize "higher level" defenses(Reaction Formation, Identification with the Aggressor).(Those in this last group in particular however, may be rendered much sicker if colored by severe forms of the Borderline Conditions).
The elucidation of this theory may well appear arcane and esoteric. The clinician may be tempted to dismiss it as an academic exercise with little salience to the modern treatment of Borderline and other severe personality disorders, and return to his much more user-friendly DBT manual! If he hangs in however, and forges through more of this book the reader will find that the remaining chapters are much easier to understand, once the first two sink in, and confer much wisdom into the treatment of BPD, and of the other serious personality constellations that it so often colors and coexists with, one of which, the Narcissistic constellation, receives comprehensive attention in the second half of the book.
I can touch on just a few treatment pearls that are presented:
1. How to determine capacity for intensive work thus decide if psychodynamic vs. supportive therapy is indicated; and on length of therapy and session frequency(e.g. level of anxiety tolerance, presence of the capacity for depression and guilt (indicative of more developed superego and better prognosis).
2. The potential pitfalls in therapy (transference and counter-transference based)and how to avoid them: patient idealization or devaluation of the therapist, splitting by patient of her negative states after acting out within them (rendering them unavailable to work with in therapy), therapist masochistic submission to patient's aggression (taking calls at all hours, responding to serial spurious "crises"), a sense of therapist's impotence, and/or exaggerated fear of criticism by third parties (leading to therapist fear & aggression: retaliating to patient's threats of suicide with punitive involuntary hospitalization, or with countertherapeutic "contracts" whereby the patient is given rigid conditions for ejection from therapy).
I hope my review influences the reader who may, like myself, (in real life) have little opportunity to practice Dr. Kernberg's recommended many years of weekly psychotherapy,to dive into this book nevertheless; he will emerge with much more wisdom, understanding, and empathy for many of his sickest patients.
22 of 24 people found the following review helpful.
A Seminal Achievement
By Adam Mayer
In response to Vaknin's review:
Dr. Kernberg doesn't unequivocally suggest that narcissism is always a mere "fixation on an early developmental phase". In fact, this is one the differences between his theory of narcissism and that of Heinz Kohut, which he expounds on in his book. According to Kernberg circa this book's publication, narcissism comes in more than a few variations, ranging from infantile narcissism to healthy adult narcissism to the pathological variety. Even a personality of higher organization can possess remnants of infantile grandiosity, which can become more pronounced if a person regresses (in crises, e.g.). Kernberg does not suggest that pathological narcissism is invariably the product of developmental arrest.
Vaknin is right to note that borderline conditions and narcissism do look quite similar in this book, but Kernberg acknowledges that the two are somewhat similar insofar as similar defenses are often used in both (Kernberg refers to the a "narcissistic personality functioning on a borderline level" often to draw attention to cases of heterogenous pathology). However, narcissistic and borderline personalities employ these defenses for different reasons; in BPD, splitting is predominatly used to keep aggression and "bad" self and object representations from contaminating libido-driven "good" self and object representations, whereas those with NPD have diametrically opposed object relationships that alternate between idealization and devaluation vis-a-vis frustration, typically. Devaluation (treating a person like trash AND defiling their internal object representation) spares the narcissist an unbearable mixture of envy, rage, grief and righteous indignation when they can't obtain "narcissistic supplies" from him/her. They rely on projection of their own envy onto others to obtain relief from their painful experience of frustration and greed; as a result, they frequently experience significant paranoid symptoms when distressed . Frustration and shame are the central affects which NPD individuals unconsciously aim to keep at bay.
This book is brilliant. A cursory understanding of psychoanlytic thought and object relations would certainly increase this stunning work's "readability", but it's likely appropriate for anyone interested in the subject.
80 of 83 people found the following review helpful.
Very deep and profound, explains a lot about personality disorders
By Sammy Madison
If you are reading about narcissism, you will see Otto Kernberg's name cited as a reference more than any other. Dr. Kernberg is THE expert on the subject. Dr. Kernberg's book "Borderline Conditions and Pathological Narcissism" was obviously written for professionals and serious students of psychology, but since he does not have to rely on obfuscation to impress anyone with his credentials, he has written a book that is amazingly clear even to the layman. In our times, personality disorders have overtaken neurosis as the big problem causer for individuals, families, and society. Personality disorders are complex, with layers like an onion, but they are also interesting to research. My interest in Narcissistic Personality Disorder began with the epiphany that this disorder was what I was dealing with in a problematic significant other. Defining the problem helped a lot with my frustration and anger at having been devalued, lied to and stolen from by someone who was supposed to love me. Once I knew "what" I had encountered, I next found myself driven to find out "why". What causes the narcissist to form the false identity shell of feigned superiority, scorn for and devaluation of others, lies, cheating, and constant use of defense mechanisms? If you want to delve deeper than the pop-psyche or self help books on this subject, try reading this book. My copy is filled with highlighted paragraphs, paperclips, and notations in the margins. Here is a quote from page 81 of the paperback edition: "...a primitive, sadistic mother image may be projected onto the therapist while the patient experiences himself as the frightened, attacked, panic-stricken little child; moments later, the patient may experience himself as the stern, prohibitive, moralistic (and extremely sadistic) primitive mother image, while the therapist is seen as the guilty, defensive, frightened but rebellious little child." Of course I was not his therapist, and he not my patient, but the dynamic was obviously the same. Knowing the family history of my ex, this excerpt explained to me what was behind several years of misery and confusion for me and over forty years of the same for him. On page 124, Dr. Kernberg explains a "teasing" characteristic which, in my relationship, had me completely puzzled and frustrated: "...a patient with serious masochistic trends and rationalization of failure as being always the fault of another's aggression or of fate, and who, at the same time, presents rather sadistic behavior with a teasing quality under certain circumstances, is not disturbed at all when confronted with the contradiction between such teasing behavior and his tendency to complain about how he is being mistreated by others; the tolerance of such contradictions within established behavior patterns is a severe prognostic sign." The book is filled with similar gems of understanding, which, if you have been the victim of a narcissist, will explain so many long unanswered questions. An excellent book, you will emerge a person of clearer understanding for having read it. Just remember that an explanation of the origins of abusive behavior is not an excuse for such behavior, and that your chief (perhaps only) duty is to protect yourself from your abuser, without regard for the origins or reasons for the abuse.
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