Narcissist, Psychotic Reject Reality (Keynote Speech World Conference Addiction Psychiatry, 07/2021)

Uploaded 7/19/2021, approx. 14 minute read

Dear colleagues, organizers, thank you for having me in this conference.

My name is Sam Vaknin, I am a professor of psychology in Southern Federal University in Rostov-on-Don, the Russian Federation, and I am a professor of finance and professor of psychology in SIAS-CIAPS, the Centre for International Advanced Professional Studies, which is the outreach program of the SIAS consortium of universities. Apologies for a long introduction, it is obligatory by my contract.

Today I am going to discuss cutting-edge reconception of psychological defense mechanisms.

Now, psychological defense mechanisms are of course a psycho-analytic construct. They are part and parcel of the literature of psychoanalysis, and psychoanalysis is frowned upon in the vast majority of academic institutions in the world as non-scientific, a form of literature, not serious, etc.

But this is discarding the baby with the bathwater, because psychoanalysis has many fascinating insights which are increasingly being supported by studies in neuroscience.

An extension of psychoanalysis via several generations is of course the object relations schools, especially the British Object Relations School in the 1960s. I am going to borrow from this school, but the things I am going to tell you are based on much more recent research, 10-year-old research, 15-year-old research, recent research last year, this year.

Let's start with internal objects.

It seems that every time we come across, especially as children, we come across another person, every time we come across a meaningful situation, a situation that has meaning, and so on and so forth, we tend to generate an internal object, a kind of handle or avatar or icon, if you wish, something to hold on to.

The internal object comprises memories, it comprises emotions and cognitions, and in this sense the internal object is a partial scheme, like a schema theory. It's a partial scheme.

So our mind is populated with dozens, if not hundreds, if not thousands of internal objects. Some of these internal objects are introjects. They are assimilated, internalized, and integrated voices of meaningful others, parents, role models, teachers, even influential peers.

So internal objects is a much wider universe because it incorporates a stand-in for numerous people and numerous situations and numerous locations and numerous attachments, an integral part of what is called in psychoanalytic literature cathexis, emotional or mental investment. Introjects are a subset of internal objects. They are the voices, they are the presence incorporated in our minds of meaningful others, and all of these, the internal objects, including the introjects, they are all arranged in a coherent narrative, a story.

Think of it as a movie with a script. So there is a story, a narrative that binds the internal objects and the introjects together and endows them with coherence, cohesion, and meaning.

Now the narrative could be flexible, responsive to new information, adaptable, but the narrative very often becomes rigidified, becomes rigid, ossified, and then we have mental illness.

Of course, one of the most prominent examples of a rigid narrative is personality disorders.

Actually in the Diagnostic and Statistical Manual the opening sentence for many personality disorders is a rigid pattern of dysfunction, etc. So rigid narratives give rise to mental illness.

Now one could conceive of the narrative as a universe, as a world, as a space, almost like a physical space, and it has a perimeter, it has boundaries, it has borders, personal boundaries, personal borders, and this perimeter, this borderline, border, is guarded by border police. And the border police in this case are the psychological defense mechanisms.

Psychological defense mechanisms are guardians, sentries, sentinels. Their role is to keep things out, not to allow intrusion or access on the one hand, and to selectively allow information in, providing it can be safely incorporated into the hegemonic dominant narrative.

In this sense of course, this is a model which is very akin to the immune system. It's exactly how the membrane of the cell works, and it's exactly how the immune system mobilizes to fend off invaders such as bacteria and viruses.

One could conceive of challenging, undermining, and countervailing information as pathogens which threaten the homeostasis, equilibrium, and functioning of the mental body, so to speak.

There are two types of defense mechanisms, dissociative defense mechanisms and cognitive distortions.

I would like to read to you the abstract of an excellent article published in 2004 and authored by Brad Bowden. The article is titled Psychological Defense Mechanisms: a New Perspective, was published in April 2004 in the American Journal of Psychoanalysis.

And this is the abstract.

Approaching psychological defense mechanisms from the perspective of an evolved strategy, it is proposed that there are two basic templates, dissociation and cognitive distortions.

Frequently conceived of as pathological, this psychological phenomena actually constitute overlapping spectrums with milder manifestations being common and highly functional, and more severe variants less common and typically dysfunctional.

Dissociation provides a capacity to adaptively detach from disturbing emotional states, and cognitive distortions place a positive ego-enhancing spin on experience.

Most of the classical defense mechanisms described in the psychoanalytic literature represent a form of cognitive distortion, with some containing strong elements of dissociation.

We know that dissociation results very often in the formation of sub-personalities, pseudo-identities, or self-states. These are lateral fragmentations of the base host core identity and personality.

So these are not full-fledged separate personalities as one would tend to expect in dissociative identity disorder. These are more like aspects of the main personality, aspects of the core identity, angles, different ways of perceiving from different points of view.

But the self-states are distinct, and they are different to each other. Dissociation helps to keep the self-states apart. There is permeable pseudo-semi-dissociation, where the self-states communicate fully or partially information, and there is total dissociation in the case of dissociative identity disorder in most of its manifestations except OSDD.

And so if we take, for example, borderline personality disorder. In borderline personality disorder, the fracturing of the host or the core personality is pretty advanced. And so the borderline would tend to have several self-states.

One of the most prominent self-states of the borderline is the secondary psychopath. It's a protector, a protector of self-state, a saviour, a rescuer self-state. When the borderline patient is exposed to stress, anxiety, anticipated abandonment, humiliation and rejection, she tends to trot out the psychopathic self-state, the secondary psychopath, and this state protects her.

And so this is an example of a self-state that is the outcome of dissociation.

But if we accept that psychological defense mechanisms are actually dissociative states or employed dissociation massively, actually they are forms of dissociation, we should also understand that psychological defense mechanisms either are closely associated with and correlated with self-states or bring about self-states.

We can conceive of psychological defense mechanisms as triggers. They trigger self-states.

And indeed in the process of decompensation, when the vast majority of advanced, mature adult defense mechanisms shut down, the remaining primitive defense mechanisms, such as splitting or projection or rationalization, these remaining primitive defense mechanisms tend to automatically trigger the emergence of new self-states.

In the aforementioned example, the secondary psychopath is triggered by the remaining defense mechanisms when they are faced with stress, abandonment and anxiety.

Internal family system theories conceptualize this very brilliantly.

And on my YouTube channel, I have a video of one and a half hours dedicated to an exploration of internal family system theories.

When specific defenses get associated with specific self-states, when we have this scheme of self-state and defense or defenses, we gravitate towards one of two conditions, narcissism, which is a form of introversion with no ego or no constellated self, or psychosis, which is the existence of an ego or a self to the exclusion of the world.

There's only an ego, only a self, there's no world.

I want to repeat this because this is a very novel concept and would be a bit difficult to apprehend or comprehend initially.

So let me repeat this. We said that defenses are dissociative states. We also said dissociation leads to the formation and the emergence of self-states. So self-states are triggered by defense mechanisms.

The sequence is defense mechanisms dissociation self-states triggered by the defense mechanisms.

Very often these sequences become rigid. It's like a neural pathway in the brain. They become embedded, they become inextricable.

So a set of specific defense mechanisms would tend to trigger the same self-states.

When this happens we have an agglomeration, we have a conglomeration, we have a kind of scheme which incorporates both specific defense mechanisms and their specifically triggered self-states. They go hand in hand.

Defense mechanism ABC goes hand in hand with self-states DEF always.

So then we have these schemes and they result in one of two conditions.

If the rigidity spreads like a contagion, if the whole personality becomes rigid, we gravitate towards, we devolve towards two states, one of two states, either narcissism or psychosis.

Narcissism is a form of introversion. There's no ego to speak of. There's no constellated self. There's just this fragmented fractured landscape, chaotic and kaleidoscopic.

So narcissism is one way of trying to defend against this internal disorganization by rigidly attaching self-states to defense mechanisms.

The second condition is psychosis, which is exactly the opposite of narcissism actually, where there's only a self, only an ego. There's no world. The world is the self.

And so there again the defense would be, the way to cope with psychosis would be to associate specific self-states with specific defense mechanisms that keep the world out.

Patients in both these conditions, narcissism and psychosis, these patients are affected, they're mentally or emotionally invested in their internal objects, not in reality.

Healthy people are emotionally and mentally invested in reality. People with narcissism, people with psychosis, they're emotionally invested internally. They internalize their emotional, their cathexis, their emotional investment. They are self-cathected.

You can see this in their psychosexuality. They tend to be autoerotic. And so they're invested internally in their own internal objects and not in reality.

And consequently, these patients have of course impaired reality testing.

The narcissistic defenses confuse external objects as internal objects. In other words, the narcissist mistakes external objects, including other people, as internal objects. He tends to think of other people as he would think about his own internal objects.

Actually, there's a process in narcissism, which I call snapshotting, where the narcissist converts people around him into internal objects, and not only people, but also meaningful objects, locations, memories, he tends to convert them into internal objects via the process of snapshotting.

And then he confuses of course, the internal objects, which he experiences very vividly and revively. He confuses these internal objects with the external objects that gave rise to them.

So there's a confusion between external and internal.

Actually, in psychoticism and in psychotic disorders, there's a confusion between internal objects and external objects. In other words, the narcissist thinks that external objects are actually internal. The psychotic thinks that internal objects are actually external.

Two ways. I repeat, the narcissist mistakes external objects as internal objects, and the psychotic mistakes internal objects as external objects, a process known as hyper reflection.

And so there is this enormous confusion, which is the direct outcome of a lack of boundaries, a lack of functional psychological boundaries. Boundaries are not only about what I don't want you to do. Boundaries are not rules of conduct. Boundaries are the realization where I stop and you begin, where I end, and reality starts.

In the absence of such boundaries, it's very difficult to tell who one is. It's very difficult to form an identity, a core, and it's very difficult not to merge with others and with the environment. It's very difficult to not be in flux, to not be a river rather than a lake. In both cases, narcissism and psychosis, all relationships are internalized because all relationships are with the internal objects.

Both the narcissist and the psychotic maintain, cathexis maintain investment interact with exclusively internal objects, never with external objects.

When reality strongly diverges and deviates from the internal objects, when there is a discrepancy, a conflict, a contradiction between reality and an internal object, there is mayhem, havoc, panic, anxiety rises, and the process starts, which involves decompensation.

So when the narcissist or the psychotic person are confronted with a reality which challenges their universe of internal objects, its cohesion, its functioning, its coherence and congruence, they fall apart.

The first thing they do, they shut off mature adult defenses such as they have. They don't have many, and they remain with extremely primitive defenses. In other words, they regress to an infantile state. It's known as decompensation.

Now some of them, for example, in borderline personality disorder, act out. They become secondary psychopaths and they try to compensate for a lack of internal control by trying to obtain control over their environment. They become defined, consummation, impulsive, reckless, aggressive, etc. So acting out.

The narcissist experiences narcissistic injuries and narcissistic mortification. These are mediated via specific self-states and they lead to a total disintegration of the precarious house of cards that the narcissist constructs over many years.

When this happens, narcissistic injury, mortification, challenges from reality, waking up to the fact that your internal objects are not real, they're not external, facing your own cognitive distortions such as grandiosity, when your defense mechanisms don't work as a narcissistic patient or a psychotic patient. When all this happens, of course it leads to anxiety and depression. And anxiety and depression can be reconceived as a failure to affect this mediation, to affect the mediation via self-states.

When the mechanisms of internal objects, self-states, when they fail, the person experiences this failure, this collapse of the internal universe, experiences it as depression and anxiety. The patient becomes non-agenic and far less self efficacious because he is unable and does not possess the skills to cope in a totally external world.

The narcissist and the psychotic, when I say narcissist, I mean anyone with narcissistic disorders, that includes borderline and so on, when they are confronted with reality, they can't cope because they had developed over many decades a set of skills which is highly specific to managing and micromanaging the universe of internal objects. They're not trained, they don't know how to cope with truly external objects, with self autonomy, with personal independence and so on so forth, they don't know how to do this.

And this creates enormous anxiety. This inability to function in a totally external environment creates a lot of anxiety and finally creates depression. As aggression cannot be externalized, it is internalized. All the effects are internalized, but this time there are no internal objects which can absorb this onslaught of negative affectivity and negative emotionality, and this results in depression.

So this is a real conception of several issues, most notably psychological defense mechanisms and their role in narcissistic disturbances of the self and psychotic disorders.

Thank you very much for listening and I'm open to questions. ###

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