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Inner Child Second Chance: Using Psychosis to Heal NPD, BPD

Uploaded 7/26/2022, approx. 19 minute read

Today, we are going to discuss a relatively complex topic for a change, but fascinating, in my view at least.

My name is Sam Vaknin. I'm the author of Malignant Self-Love, Narcissism Revisited, and other books about personality disorders. I am also a professor of psychology.

By the way, yesterday there was an article in Daily Mail, an interview with me, and I think it's one of the best encapsulations of narcissistic abuse that I've ever seen.

Surprising for a tabloid, but you know, you find pearls in unexpected places.

I recommend that you go and read this article. It was published, yes, on the 25th, which is yesterday. It was authored by Yves Taufik.

Today's topic is the child, the psychotic child, how we evolve from a state of psychosis to mental health, and how when things go awry, when they go wrong, we end up being narcissists, or borderlines, or psychopaths.

Start with the fact that psychosis is the natural state in childhood.

I think, co-in the term psychoticism, is suggested that it's a personality trait and that it leads to creativity, or is affiliated somehow with creativity.

Psychoticism is the state that all of us are in when we are children, and children are extremely creative. Anyone who has had children and is unhappy can tell you this.

So, what is psychosis?

Psychosis is when it's very difficult to tell apart yourself from the world, when they are merged, infused, and intermeshed, and you can't, you don't have boundaries, you don't know where you stop and the world starts. You expand outwards and consume the world and assimilate it, and so you become one with the world.

This oceanic feeling that many gurus and mystics keep alluding to is, I am sorry to say clinically, a psychotic state.

Psychosis involves a mechanism called hyper-reflexivity, and this mechanism makes it very difficult to tell apart the difference between internal and external.

Internal objects, and external objects, internal voices, introjects, and external voices. That is why psychotics hear voices, and they experience hallucinations, which are actually projections of their internal world onto reality.

So, this is psychosis, and all children are psychotic, because when children are born, when they are newborn, they can't tell the difference between inside and outside. They can't tell mommy apart from themselves, because they have no selves.

The child, until probably age 18 months and maybe even 24 months, cannot separate herself from the universe. She perceives the universe as part of herself and herself as part of the universe. It's a single organism, a single entity.

That's why children react very badly when mommy leaves the room. That's why children need to develop object constancy.

In other words, the innate belief that objects continue to exist even when they cannot see the objects.

So, psychoticism is a state where the child is totally fused with his or her environment and doesn't realize that there's anything external to it.


But what happens if the environment is frustrating? What happens if the environment is terrifying, painful, hurtful, damaging? What happens if the child is in a constant state of terror and horror, because for example, his parents, his mother, is a dead mother in the language of Andre Green in 1978, a dead mother, a mother who is absent, selfish, narcissistic, depressed.

What happens then when the child's most basic need to be seen, to be noticed, to be catered to, to be sheltered, to be fed, to be cuddled? What happens when a child is neglected and abandoned, when a child is chastised for being herself or himself? What happens when the child is not allowed to evolve and grow and develop boundaries and separate? What happens when the external environment is terrifying, when it is composed of various forms of abuse and trauma, instrumentalizing the child, idolizing the child, I don't know, corseting the child, parentifying the child? What happens then?

The transition from psychosis to health is impeded.

Now, what is health? What is a good definition of mental health?

When you can tell the difference between yourself and others, when you can tell the difference between yourself and the environment, when you realize that the environment is signaling to you, sending messages to you and you know how to read them properly.

If you don't, you may have autism spectrum disorder. If you fail to do this, you may be a narcissist. All forms of mental illness involve inability to separate yourself from the environment and or inability to read cues from the environment, signals messages properly.

The child gradually transitions from a merger and fusion with mummy. Mummy is the world.

The healthy child gradually transitions from the psychotic state to separation and individuation. He gradually breaks apart from mummy and mummy represents the world, so he breaks apart from mummy and he is able and willing to explore other objects, other entities, and to acknowledge and accept however traumatic this is, this may be, that he is not one with the world, that he is separate.

That's the healthy progression, but it can be interrupted by a frustrating, avoiding, impunitive mother.

And when such interruption happens, the child cannot complete the separation from the mother, in other words, from the world. The child gets stuck. The child becomes grandiose.

When he wishes to separate from mummy and to explore the world, he becomes grandiose. He has to take on reality that calls for a lot of suspension of disbelief and grandiosity.

So when the mother is frustrating and hurtful, the child remains stuck in its grandiosity without the ability to actually exercise it on the environment. The child transitions in this case to a borderline personality organization, a borderline personality structure.

When separation individuation is hindered, especially by the mother's behavior or misbehavior, the child gets stuck between psychosis and reality, which is an excellent description of borderline personality disorder. It's not my description, it's Otto Kernberg's description.

That's why borderline is called borderline on the border between psychosis and neurosis.

So the child remains stuck, unable to progress outward towards reality and to fully embrace it and unable to retreat, unable to go back to mummy and merge and fuse with her, go back to the womb, as it were.

In this Neverland, in this Twilight Zone, between psychosis and reality, we have all the makings of borderline personality disorder.

In borderline personality disorder, internal objects are perceived as external. In other words, there's the element of psychoticism.

The inner dialogue, the introjects, are perceived as external, as kind of voices or people out there, objects out there, when they're actually internal.

There is a false self in borderline personality disorder. It starts as an external entity. The borderline develops a special friend, usually an imaginary friend in a paracosm. We're talking about a child, remember.

So the child simultaneously remains stuck in the psychotic phase where internal objects are external, but in a desperate attempt to extricate herself from this condition, she creates an external object, totally imaginary, external object, which is essentially the false self, unable or not allowed by the dead mother to progress efficaciously towards reality, to immerse herself in reality, to explore external objects safely from a safe base.

The borderline gives up on reality by creating an alternative, imaginary reality with which it can interact safely because it's clandestine, it's secret, it's not visible to anyone.

Allow me to summarize the borderline phase.

The child, every child, starts off as psychotic. The child cannot tell the difference between external and internal insight and out. The child is one with the world and the world is one with mommy and the child is one with mommy. There's no distinction, no separation. This is a great description of psychosis. It involves a mechanism called hyperviscosity.

Then around the age of 18 months, the child begins to move away from mommy and explore external objects. As the child explores external objects, he forms a theory of the world and a theory of other minds. He forms what is called the internal framework. He is able to create a model of reality which corresponds to reality very much.

And if the child is allowed to, in a healthy way, the child becomes separated from mother, he becomes an individual, a new person. The child forms his own personhood, what Jung called the self or whatever.

I will not go right now into the question of whether there is a self or there's an assemblage of self-states. Leave that for a minute.

There is this kind of identity which forms by interacting with the world. When the child is allowed to interact with the world, he stops being psychotic. He becomes healthy.

But if this process is disrupted, this leads to borderline. The child remains stuck in the psychotic stage and tries to compensate for the lack of access to reality by inventing her own imaginary reality, a paracosm, where she has an imaginary friend, the false self.

So the borderline's false self is perceived as external and as real. And only much, much later in the disorder is it somehow internalized but never fully. That's why the borderline needs the intimate partner to act as a reification and an extension of the false self. He becomes her false self.

Okay. And this false self is a self fragment. It's a self figment. And it is the borderline's only connection to reality. It's not real reality. It's an imagined reality. It's a virtual reality. It's a concoction. It's a narrative. It's a movie. It's a piece of fiction. But it's still much more real than psychosis.

In the creation of the false self, the borderline accepts that there is at least one object, one entity, the false self, which is not her. So she's able to somehow start haltingly and pathologically the process of separation. She accepts that she is not the world.

There is a false self who is out there in the world. So there is a world. It allows her to separate. It prevents full fledged psychosis.

Because in a full fledged psychosis, there is no self and there is no world. In borderline, there is a false self, which is the world. So it's closer to health than psychosis.

It is indeed a transitory phase.

When the child experiences trauma and abuse in early childhood, the child transitions from psychosis to borderline personality organization.

What happens if the parent impedes or hinders or attacks or prevents even this minor transition to health? What happens if the parent isolates the child, penalizes, punishes the child every time she shows autonomy and independence and self-efficacy? What happens if the parent puts down the child whenever she doesn't perform as an extension of the parent?

What happens in other words, if the parent is active, an active agent of suppression? What happens when even borderline, even the borderline defense, even this desperate attempt at pretending that there is a world out there via the agency of the false self? What happens if even this is considered by the parent too much of a threat to the parental authority or parental needs? What happens if the parent stifles and smothers the child and doesn't allow the child to even become a borderline?

Because even that is one step too far, one bridge too far, one step too many.

Well, if this happens, if the false self of the borderline is attacked and disabled by abuse and trauma, the child attempts to transition to the next phase.

So we have psychosis and we have borderline. If the trauma and abuse persist, there is a transition to a third phase.

This third phase is the narcissistic organization of the self. It is the proto-narcissistic personality disorder, the nucleus of NPD.

NPD is a mirror image of BPD. Why? Why isn't NPD more of BPD? Why is narcissism not an exaggeration of borderline? Why is narcissism not borderline 2.0?

Because borderline has failed. The borderline solution, the child starts as a psychotic, then subject to trauma and abuse, the child tries on the borderline solution. When the borderline solution fails as well, when the parent doesn't allow the child to even become a borderline, the child says to herself, the borderline has failed, I should try something different and I should try something that is the opposite of borderline. I should try something that is the mirror image of borderline because borderline didn't work. Mummy doesn't accept borderline. So I'll try something else. Maybe it will be palatable to Mummy, or maybe I can even get rid of Mummy altogether because I will become self-sufficient, self-contained, solipsistic, captured within a universe which I fully control, my own planet like the little prince.

So these are trial and error, heuristic procedures, where the child flails about attempting to find a solution to the impossible situation where the parent won't let him go.

The child wants to go away, wants to separate an individual because it's a biological drive and yet he's not allowed or she is not allowed.

So the child tries on all kinds of solutions. It tries to be a borderline, semi-psychotic, you know, with a reality that is not real, that is actually a false cell, doesn't work.

He says, okay, let's move on. Let's try another solution. Let's try to be a narcissist.

A narcissism is a mirror image of borderline.

While in borderline, internal objects are external because the borderline retains psychoticism, retains the psychotic element. In narcissism, external objects are internal.

While the solution in borderline is pseudo-psychosis, the solution in narcissism is fantasy and delusionality. While the borderline assumes that her internal environment is actually external, she actually projects. It's an infantile defense mechanism.

In narcissism, there is the opposite assumption that external objects are actually internal. It's a fantasy defense. It's the belief that you are the world, not the world is you, you are the world. You, the world the world is at your service. Everything out there you created. It's a god-like perception or self-perception. I made the world. I created the world. So everything in the world is an extension of me. External objects are actually internal. I made them happen. It's magical thinking. I created them and so fantasy and delusionality.

The false self in borderline starts off as an external object, special or imaginary friend. In narcissism, there's a reversal of this and the false self starts off as an internal object.

Grandiosity is a cognitive distortion. The false self starts off as an internal object. The narcissist feels, identifies with the false self. The narcissist believes that the false self is real and he is the false self.

So it starts off as internal but then the false self, like the golem in the Jewish stories, you know, takes over like Frankenstein's creation. It takes over. It starts off as internal and then it usurps numerous ego functions, ego boundary functions and other functions. It becomes the interface with the world.

So the false self becomes the sick, ontological equivalent of the ego and then the narcissist vanishes. The false self subsumes the true self, pushes it to the corner, represses it and deactivates it. The true self is disabled, the narcissist vanishes and all that's left is the false self.

So while the borderline starts off with a false self which is utterly distinguishable from her, distinguished from her, it's an external object and only much later she internalizes some of it.

She still uses external objects to regulate herself. She uses her intimate partners.

The narcissist goes the other way, exactly the opposite way. He starts off with an internal object which he believes that he can control. An internal object that helps him to extract narcissistic supply from the environment and then it goes awry. The external object becomes super strong, overpowers the narcissist and consumes the narcissist and nothing is left but the false self.

Deep inside the narcissist resents this palace revolution, this coup d'etat. He hates the false self for this hostile takeover and he needs other people to tell him that the false self is real, that he is the false self, that nothing bad has happened, that he hadn't disappeared and this is what we call narcissistic supply.

This secondary solution, because the primary solution is the transition from psychoticism to borderline, borderline personality organization. When this fails, when the parent doesn't allow the child to become a borderline, the child progresses and adopts narcissism.

What happens when narcissism fails? What happens when even the narcissistic defenses that the child tries to adopt are, for example, punished severely? When the child is mocked and ridiculed and humiliated and mortified and attacked and abused in every conceivable way, whenever the child shows any hint of grandiosity or even accomplishments, what happens when the child is not allowed to compete with the parent's own grandiosity? What happens when the parent himself is a narcissist and the child is perceived as a challenge or a competitor?

This solution fails in this case. What happens when reality mediated via the parent?

Because the parent is the agent of socialization. The parent brings reality and society into the child. That's why the parent becomes an introject, also known as conscience.

So the parent stands in for reality in society.

So what happens when reality intrudes so badly and so harshly that an inner critic is formed, a superegoist form that won't let the narcissistic solution manifest fully? What happens when reality cannot be reframed?

What happens then is the false self remains internalized. It cannot be externalized. The externalization of the false self is the culmination of the narcissistic solution. It is a dead point that we can say, ironically, that the narcissistic solution has worked and has been successful.

When there is interference in the narcissistic solution, the false self remains internalized, which is another way of saying when the child is not allowed to become a narcissist, she remains stuck in the borderline phase.

So psychosis progresses to health.

But if interrupted, psychosis progresses to borderline. If the borderline solution is penalized or hindered or obstructed, the child attempts to become a narcissist. If the child is not allowed to become a narcissist, the child remains stuck in the borderline phase.

And later on, as an adult, becomes someone with a borderline personality disorder. If the child is allowed to progress and adopt the full fledged narcissistic personality disorder, the child disappears altogether. And all that's left behind is the false self.

So this issue of emptiness, nobody's home, is common to both borderline and narcissism.

Kernberg said that borderline and narcissistic character disorders or personality disorders are essentially two phases of the same coin. I cannot agree more. I fully agree. They both emanate from and they are both attempts to resolve an empty schizoid core.

This void, this black hole, this emptiness is in the shape of the mother who should have been a good enough mother, but never was. Her absence is internalized. Healthy children internalize the presence of the mother. Sick children, children who later become borderlines and narcissists, they internalize the absence of the mother.

And itthis howling absence, this eternal deep space that controls their lives and becomes a substitute for what should have been a core identity. That's why borderlines have identity disturbance. And that's why narcissists are clinically dissociative, so dissociative that it's dissociative identity disorder.

Narcissists have two selves, at least.

And so when some children, not many, when they fail with a borderline solution, they fail with a narcissistic and narcissistic solution. They become rebellious. They become defiant. They become reckless. They develop something called reactance. Small percentage. Majority remain borderlines. A small sizable minority become narcissists. And a tiny minority become psychopaths.

When the parent wouldn't allow the child to resolve the lack of separation, individuation, the merger in the fusion, to resolve it by resorting to an imaginary reality, like the borderline, or by resorting to an imaginary self, like the narcissist, some children rebelled, became contumacious, the reject authority, and they transition to psychopathy.

Now, in psychopathy, only external objects exist. You remember, in borderline, internal is confused with external objects.

In narcissism, external objects are confused with internal objects. In psychopathy, there's no such confusion because there are no external, no internal objects left. In psychopathy, there's no internal object of any shape, kind, or form. There's only external objects. And there is no false self because there's no self of any kind.

Reality testing is actually intact, much better than with the narcissist or the borderline.

Psychopathy is much better equipped to assess reality and function in it. It's because he has only external objects.

In a way, psychopaths are not human. They are like computer code, in a way, which is why I firmly believe that artificial intelligence will prove to be psychopathic.


Now, is there anything we can do about this progression, about this sequence?

Yes, actually. There is something called decompensation.

Decompensation is when all the defenses crumble. The narcissist's false self is disabled.

This is what I do in cold therapy. I disable the false self.

The borderline's imaginary friend is deactivated. We can put a lot of stress, a lot of force on the defenses and resistances of narcissism and borderline and then disable them.

And then the narcissist and borderline remain defenseless. They remain exposed face to face with their own disorder.

Now, there are several therapies which create artificial decompensation. And decompensation creates regression.

If you decompensate the psychopath, it becomes narcissist. You decompensate the narcissist, he becomes borderline. You decompensate the borderline, she becomes psychotic.

Remember the sequence? Psychosis, borderline, narcissism, psychopathy. It goes both ways. It progresses this way, but it can regress the other way.

Psychopathy, narcissism, borderline, psychosis. We can affect regression in therapy and we can fix the failures. We can give the inner child a second chance so we can lead very carefully this regression all the way back to the psychotic phase.

And then as therapists, using transference, we can somehow encourage the inner child who is now regressed to the psychotic phase to try again.

This time as therapists, we provide a safe base, a safe and secure environment, a holding containing environment. We allow the child to start again from scratch, from the psychotic phase to progress to health, not to borderline, because there's no need.

We are not challenging the child, the inner child. We are not merging with the inner child or fusing with it, at least not if we are good therapists.

We just create the environment where the patient feels safe to regress from psychopathy to narcissism, from narcissism to borderline, and from borderline to psychosis.

And then we hold the patient's hand as parental figures and we encourage the patient to try again to become healthy by separating from us and becoming an individual.

But this is a topic for the next video.

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