Those who wish to understand contemporary narcissism as a social and cultural phenomenon must turn first to the growing body of clinical writing on the subject, which makes no claim to social or cultural significance and deliberately repudiates the proposition that “changes in contemporary culture,” as Otto Kernberg writes, “have effects on patterns of object relations.”+

+ Those who argue, in opposition to the thesis of the present study, that there has been no underlying change in the structure of personality, cite this passage to sup­port the contention that although “we do see certain symptom constellations and personality disorders more or less frequently than in Freud’s day, . . . this shift in attention has occurred primarily because of a shift in our clinical emphasis due to tremendous advances in our understanding of personality structure.”

In light of this controversy, it is important to note that Kernberg adds to his observation a qualification: “This is not to say that such changes in the patterns of intimacy [and of object relations in general] could not occur over a period of sev­eral generations, if and when changes in cultural patterns affect family structure to such an extent that the earliest development in childhood would be influenced.” This is exactly what I will argue in chapter VII.

In the clinical literature, narcissism serves as more than a metaphoric term for self-absorption. As a psychic formation in which “love rejected turns back to the self as hatred,” narcissism has come to be recognized as an important element in the so-called character disorders that have absorbed much of the clinical atten­tion once given to hysteria and obsessional neuroses. A new theory of narcissism has developed, grounded in Freud’s well-known essay on the subject (which treats narcissism—libidinal in­vestment of the self—as a necessary precondition of object love) but devoted not to primary narcissism but to secondary or patho­logical narcissism: the incorporation of grandiose object images as a defense against anxiety and guilt. Both types of narcissism blur the boundaries between the self and the world of objects, but there is an important difference between them. The newborn in­fant—the primary narcissist—does not yet perceive his mother as having an existence separate from his own, and he therefore mis­takes dependence on the mother, who satisfies his needs as soon as they arise, with his own omnipotence. “It takes several weeks of postnatal development . . . before the infant perceives that the source of his need . . . is within and the source of gratification is outside the self.”