Every age develops its own peculiar forms of pathology, which express in exaggerated form its underlying character structure. In Freud’s time, hysteria and obsessional neurosis carried to extremes the personality traits associated with the capitalist order at an earlier stage in its development—acquisitiveness, fanatical devotion to work, and a fierce repression of sexuality. In our time, the preschizophrenic, borderline, or personality disorders have attracted increasing attention, along with schizophrenia itself. This “change in the form of neuroses has been observed and described since World War II by an ever-increasing number of psychiatrists.” According to Peter L. Giovacchini, “Clinicians are constantly faced with the seemingly increasing number of patients who do not fit current diagnostic categories” and who suffer not from “definitive symptoms” but from “vague, ill-defined complaints.” “When I refer to ‘this type of patient,’ ” he writes, “practically everyone knows to whom I am referring.” The growing prominence of “character disorders” seems to signify an underlying change in the organization of personality, from what has been called inner-direction to narcissism.
Allen Wheelis argued in 1958 that the change in “the patterns of neuroses” fell “within the personal experience of older psychoanalysts,” while younger ones “become aware of it from the discrepancy between the older descriptions of neuroses and the problems presented by the patients who come daily to their offices. The change is from symptom neuroses to character disorders.” Heinz Lichtenstein, who questioned the additional assertion that it reflected a change in personality structure, nevertheless wrote in 1963 that the “change in neurotic patterns” already constituted a “well-known fact.” In the seventies, such reports have become increasingly common. “It is no accident,” Herbert Hendin notes, “that at the present time the dominant events in psychoanalysis are the rediscovery of narcissism and the new emphasis on the psychological significance of death.” “What hysteria and the obsessive neuroses were to Freud and his early colleagues … at the beginning of this century,” writes Michael Beldoch, “the narcissistic disorders are to the workaday analyst in these last few decades before the next millennium. Today’s patients by and large do not suffer from hysterical paralyses of the legs or hand-washing compulsions; instead it is their very psychic selves that have gone numb or that they must scrub and rescrub in an exhausting and unending effort to come clean.” These patients suffer from “pervasive feelings of emptiness and a deep disturbance of self-esteem.” Burness E. Moore notes that narcissistic disorders have become more and more common. According to Sheldon Bach, “You used to see people coming in with hand-washing compulsions, phobias, and familiar neuroses. Now you see mostly narcissists.” Gilbert J. Rose maintains that the psychoanalytic outlook, “inappropriately transplanted from analytic practice” to everyday life, has contributed to “global permissiveness” and the “over-domestication of instinct,” which in turn contributes to the proliferation of “narcissistic identity disorders.” According to Joel Kovel, the stimulation of infantile cravings by advertising, the usurpation of parental authority by the media and the school, and the rationalization of inner life accompanied by the false promise of personal fulfillment, have created a new type of “social individual.” “The result is not the classical neuroses where an infantile impulse is suppressed by patriarchal authority, but a modern version in which impulse is stimulated, perverted and given neither an adequate object upon which to satisfy itself nor coherent forms of control… The entire complex, played out in a setting of alienation rather than direct control, loses the classical form of symptom—and the classical therapeutic opportunity of simply restoring an impulse to consciousness.”
The reported increase in the number of narcissistic patients does not necessarily indicate that narcissistic disorders are more common than they used to be, in the population as a whole, or that they have become more common than the classical conversion neuroses. Perhaps they simply come more quickly to psychiatric attention. Ilza Veith contends that “with the increasing awareness of conversion reactions and the popularization of psychiatric literature, the ‘old-fashioned’ somatic expressions of hysteria have become suspect among the more sophisticated classes, and hence most physicians observe that obvious conversion symptoms are now rarely encountered and, if at all, only among the uneducated.” The attention given to character disorders in recent clinical literature probably makes psychiatrists more alert to their presence. But this possibility by no means diminishes the importance of psychiatric testimony about the prevalence of narcissism, especially when this testimony appears at the same time that journalists begin to speculate about the new narcissism and the unhealthy trend toward self-absorption. The narcissist comes to the attention of psychiatrists for some of the same reasons that he rises to positions of prominence not only in awareness movements and other cults but in business corporations, political organizations, and government bureaucracies. For all his inner suffering, the narcissist has many traits that make for success in bureaucratic institutions, which put a premium on the manipulation of interpersonal relations, discourage the formation of deep personal attachments, and at the same time provide the narcissist with the approval he needs in order to validate his self-esteem. Although he may resort to therapies that promise to give meaning to life and to overcome his sense of emptiness, in his professional career the narcissist often enjoys considerable success. The management of personal impressions comes naturally to him, and his mastery of its intricacies serves him well in political and business organisations where performance now counts for less than “visibility,” “momentum,” and a winning record. As the “organization man” gives way to the bureaucratic “gamesman”—the “loyalty era” of American business to the age of the “executive success game”—the narcissist comes into his own.