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.”