The Restoration of the Self by Heinz Kohut

Author:Heinz Kohut
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A Classification of Self Pathology

I suggest that we first subdivide the disturbances of the self into two groups of vastly different significance: the primary and the secondary (or reactive) disturbances. The latter constitute the acute and chronic reactions of a consolidated, firmly established self to the vicissitudes of the experiences of life, whether in childhood, adolescence, maturity, or senescence. They are not important in the present context. The entire gamut of emotions reflecting the state of the self in victory and defeat belongs here, including the self’s secondary reactions (rage, despondency, hope) to the restrictions imposed on it by the symptoms and inhibitions of the psychoneuroses and of the primary disorders of the self. Still, even though heightened and lowered self-esteem, triumph and joy, dejection and rage at frustration are part and parcel of the human condition and are, in and of themselves, not pathological, they can be understood only within the framework of the psychology of the self—explanations of these affective states that disregard the ambitions and goals emanating from the pattern of the self will tend to be flat or irrelevant.

But now to the classification of the primary disturbances of the self. This group of disorders of the self includes five psychopathological entities: (1) the psychoses (permanent or protracted breakup, enfeeblement, or serious distortion of the self), (2) the borderline states (permanent or protracted breakup, enfeeblement, or serious distortion of the self, which is covered by more or less effective defensive structures), and (3) the schizoid and the paranoid personalities, two defensive organizations employing distancing, i.e., keeping at a safe emotional distance from others—in the first instance via emotional coldness and emotional shallowness, in the second instance via hostility and suspiciousness—which protect the patient against the danger of incurring a permanent or protracted breakup, enfeeblement, or serious distortion of the self. The deepest roots of these pervasive defensive positions reach back to the time when the small child’s psyche had to wall itself off against the noxious penetration by the self-object’s depression, hypochondria, panic, etc. (See pp. 88–90 for a discussion of the pathogenic sequence of the child’s attempt to merge with a soothing self-object, the self-object’s pathological reaction to the child’s need, and the child’s being flooded by the self-object’s pathological affective state.)

The preceding three forms of psychopathology are in principle not analyzable, i.e., while a rapport between patient and therapist may be established, the diseased (or potentially diseased) sector of the self does not enter into the limited transference amalgamations with the self-object imago of the analyst that can be therapeutically managed by interpretation and working through.

Two forms of primary self disturbance, however, are in principle analyzable. They are (4) the narcissistic personality disorders (temporary breakup, enfeeblement, or serious distortion of the self, manifested predominantly by autoplastic symptoms [Ferenczi, 1930], such as hypersensitivity to slights, hypochondria, or depression), and (5) the narcissistic behavior disorders (temporary breakup, enfeeblement, or serious distortion of the self, manifested predominantly by alloplastic symptoms [Ferenczi, 1930], such as perversion, delinquency, or addiction).

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