OEDIPUS VS. NARCISSUS; by Susan Quinn
Published: June 30, 1981 Illustrations: photo of Heinz
Freud leave on the first leg of his flight from the Nazis. Though Kohut was an admirer, he had not met the master, but when the student tipped his hat in farewell as the train moved out, Freud tipped his own hat in return. ''I had the feeling,'' Kohut remembers, ''of a crumbling universe.''
Susan Quinn, is a freelance writer who reports frequently about the social sciences. By Susan Quinn he first parting of the ways took place more than four decades ago. Heinz Kohut, a 25-year-old medical student, stood on the platform of the railroad station in Vienna in 1938 and watched SigmundThe second parting has occurred more gradually, over the last 15 years, yet it has not lacked for drama. The student has, in significant ways, strayed from the teachings of the master. And the impact of Kohut's dissent, coming at a time when psychoanalysis itself is vulnerable, may have reverberations far beyond the boundaries of the discipline.
psychology,'' and of a new approach to the analytic process that challenge basic Freudian concepts.
Today, Heinz Kohut, 67 years of age, is a respected analyst, a veteran teacher of Freudian theory at the Institute for Psychoanalysis in Chicago and a past president of the pre-eminent American Psychoanalytic Association (A.P.A.). He is also the creator and chief expounder of a new body of analytic theory, which he calls ''selfSpecifically, Kohut has chosen to concentrate, not on the neurotic, the usual subject of modern psychoanalysis, but on the narcissist, the person whose self-love has gone awry. Kohut's explanations and treatment of the narcissist's problems essentially bypass the Oedipus complex, which is central to Freudian analysis. And he has gone on to suggest that changes in family relationships and in the society as a whole may be producing a patient population in which narcissistic disorders predominate.
By and large, the analytic establishment has been inhospitable to Kohut's views. Before he went his own way, Kohut recalls, ''I was Mr. Psychoanalysis. In every room I entered there were smiles. Now, everybody looks away. I've rocked the boat.'' But in fact, there have been indications during the past few years that the psychoanalytic community is, however begrudgingly, taking his ideas seriously. Many agree that narcissism is at the current frontier of psychiatry. Other leading analysts have been focusing on the narcissist, though usually within the Freudian framework. Kohut himself has been invited to participate in panels at psychoanalytic meetings. And last week, for the first time, one of the nation's prestigious psychoanalytic institutes - the Boston Psychoanalytic Society and Institute -sponsored a conference devoted entirely to self psychology.
Psychoanalysis has been buffeted in recent years by the growing popularity of shorter, less arduous and less expensive treatments for emotional disorders - therapies such as biofeedback techniques and est. Most authorities agree that the number of patients who seek traditional psychoanalysis has been thereby diminished. Yet the profession remains the theoretical wellspring and training resource for American mental-health professionals. Thus the debate over the theory of Heinz Kohut will inevitably have an effect on the treatment of the millions of Americans who never lie on an an analyst's couch but who still invest their hopes and their dollars in some form of the talking cure. The idea that talking could be therapeutic was first suggested to Freud by a colleague's treatment of Anna O., who suffered from disturbances of her vision and paralysis of her limbs, complaints for which doctors could find no physical explanation. Using free association, a process she described as a sort of chimney sweeping of the mind, she was able to stir up the dust of memory and bring to consciousness the origins of her distress. Her symptoms were greatly relieved. Freud learned to achieve similarly dramatic cures with other patients suffering ''hysterical'' symptoms. And out of those labors evolved the theories and practices of the discipline he called ''psychoanalysis.''
Freud's followers revised and augmented his original formulations and techniques. His analyses, for example, used to last about six months; a modern analysis is likely to last from three to six years. Nonetheless, the basic approach remains intact: The analyst plays the role of a relatively neutral listener onto whom feelings toward important persons in the patient's past are displaced (a phenomenon called transference). Eventually, the analyst begins to see emotional patterns, which he discusses with the patient. And the patient uses these interpretations to better understand his past as a means to improving his present.
To embark on a psychoanalysis, a patient must have time, money (from $40 to $125 per 50-minute hour) and, paradoxically, a personality that is sufficiently intact to bear up during the often stormy journey backward into memory. During the last decade, many have found less arduous treatments for their emotional ills. In psychotherapy, for example, patients sit up and meet with their doctor once or twice a week, as opposed to the four-or-five-times-aweek analytic schedule. The therapist may proceed along neutral, Freudian lines or may be openly supportive, advising the patients on their current problems. Behavior modification or group therapy, as analysts themselves acknowledge, may also be useful for many patients. ''If you can overcome a potency problem in six easy lessons,'' notes the psychoanalyst Philip S. Holzman, a professor in the department of psychiatry at Harvard University Medical School, ''why spend years in analysis?''
The vulnerability of the profession to new, competing modes of treatment has not thus far made a perceivable dent in the roster of psychoanalysts. The membership of the A.P.A., for instance, is now 2,632, a rise of 30 percent in the last five years. But the number of psychoanalytic patients, as measured by applications for low-fee analysis, has been steadily falling. Over the last decade, there has been a 40-percent decrease at the institute in Boston and a 40-percent drop at the New York Psychoanalytic Institute. Individual analysts confirm the trend. Meanwhile, there has been a growing impression within the profession that, among those who do enter psychoanalysis, a new kind of complaint is prevalent.
During the early years of psychoanalysis, many patients suffered from hysterical symptoms, but today such patients are extremely rare. One reason, analysts suggest, is that sexual repression has lessened. The more usual patient in recent decades has been what the profession calls the ''classic neurotic.'' He has a specific symptom - premature ejaculation, for instance, or fear of job failure. But today, the classic neurotic may be yielding his place on the couch to the narcissist. Narcissism, or self-love, is a vital dimension of mental health. It begins in the infant as a feeling that the world revolves around him. Then, under normal circumstances, the love bestowed by parents on the child is internalized and becomes the basis for the child's sense of self-worth. A ''narcissistic character disorder,'' as described by analysts, occurs when the child fails to develop this independent sense of self-love. He will then spend the rest of his life seeking a sense of self through the affirmation of other people.
Unlike the traditional neurotic, who comes into analysis with one symptom, the narcissistic patient is likely to experience a generalized feeling of discontent. He has great difficulty in forming lasting, deep relationships with others - and may not even acknowledge the need for such relationships. A charming and engaging surface may conceal an underlying indifference or ruthlessness. Often the narcissistic patient feels an insatiable hunger for admiration, coupled with an excessive readiness to feel ashamed. Neither the accomplishments of yesterday nor the possibilities of tomorrow gratify him for long. Without a loved one to grow old with and lacking the ability to identify with others, including his children, the narcissist's problems are likely to become increasingly acute with age.
The increased incidence of narcissistic problems - what Heinz Kohut calls ''disorders of the self'' - is attested to by such observers as Arnold H. Modell, who trains analysts at the Boston Psychoanalytic Institute. He reviews the applications of would-be psychoanalysts and also of applicants for low-fee analyses done by analytic trainees. In both groups, he says, narcissism is increasingly a core problem. He calls it today's ''paradigmatic'' complaint. Many individual psychoanalysts say their practices have witnessed a similar change, though there are those who have their doubts. ''Any epidemiologist will tell you,'' says Harvard's Philip Holzman, ''that waiting to see who comes into your office is a very bad way to do case finding.''
Heinz Kohut suspects that any increase in narcissistic disorders may have been caused by a change in the quality of family life during the last century. The middle-class Victorian household was bustling with servants and extended family members, all of them involved with the children; that, says Kohut, provided a child with an excess of stimulation, including sexual stimulation. The modern household, he says, with only one or two parental figures, tends to provide a child with too little stimulation, and that can lead to feelings of isolation and disconnectedness.