The Ethical Dimension of Psychoanalysis: A Dialogue

CHAPTER SEVEN Narcissism and Egoism

CHAPTER SEVEN Narcissism and Egoism Probably no concept in the analytic lexicon carries as heavy a weight of ethical implication as narcissism. There is little in the realm of ethical action that is not tinged, if not deeply permeated, with narcissistic dynamics and implications. To think for a moment of the polarity of egoism versus altruism, for example, both sides of that dichotomy are riddled with narcissistic implication. This is more obvious in the case of the narcissistic selfenhancement and self-centeredness associated with egoism, but narcissism is also imbricated in the web of altruistic devotion to the welfare and wellbeing of love objects—love of the other and being loved by another is selfenhancing , and forms of altruistic sacrifice or surrender are tinged with narcissistic gratifications related to the ego ideal. The asceticism of the saint, in this sense, is narcissistic insofar as it involves fulfillment of an ideal of religious self-denial and devotion.1 These issues are pervasive in the analytic consulting room as well. Much of the patient’s neurotic difficulties—some patients more than others, but to some extent all patients—are caught up in the patient’s need to balance narcissistic needs with the demands of reality, not only the reality of the world he lives in, but more especially the reality of those who he loves or hates and who form the intimate fabric of his life. I am arguing that the patient, who proclaims and defends his narcissistic needs and entitlements regardless of consequences for himself or others, is caught up in a struggle that has ethical implications. Actions dictated by such needs and demands have effects both for the actor himself and for those whom they might affect. In some measure, he does good or evil to himself or to others. Neither the analyst nor the analytic process take any direct interest in the patient’s doing good or evil, but they do concern themselves with helping the patient come to a realization of these consequences and facilitating that development within him that enables him to become a relatively 131 autonomous, free ethical decision-making agent, capable of making mature, prudential, and responsible choices and decisions regarding the courses of action that have meaning, purpose, and adaptive advantage in his life. One patient particularly comes to mind.2 He was a young man in his early twenties, who at the time of his analysis had graduated from medical school and was still in residency training. His neurotic burden centered around his narcissistic entitlement. His prevailing attitude was that he was entitled to recognition, acknowledgment, an easy life, and generous loving attention and consideration from anyone with whom he had any involvement . Life, love, and work should be easy, nondemanding, and convenient. Any demand, any infringement on his time, and any requirement for extra energy or work, were responded to as if insufferable outrages that were met with resentment, righteous protests of unfairness, and violations of his sense of privilege. If a patient spiked a fever requiring extra lab work, or if a patient were to be admitted shortly before his time to leave the hospital, if his girlfriend asked him for a favor, and later after they married if she insisted that he help with the household tasks, and even later that he help in taking care of the baby—all were occasions for outraged protets and bitter resentment. He protested angrily that they were her dishes, her garbage, her baby, and not his. The narcissistic quality in all of this was unmistakable, but what about the ethical dimension? I would argue that, at minimum, there are two aspects of this pattern of behavior that speak to ethical issues. On the object-related side, he treats unfairly and does wrong to those with whom he has to deal and toward whom he is in some fashion obligated and for whose well-being he is responsible. He owes his patients careful, caring, solicitous, thoroughgoing, and responsible attention. His attitude is more likely to short-circuit these qualities and to undermine not only the quality of his work but the quality of his personal involvement with his patients. If he blames them for his problems, these feelings will inevitably corrode his interaction with them. And the situation would be no different with his wife—how long would she tolerate his pejorative, uncooperative, and thoroughly selfish attitude? The other side of the ethical equation is injury and disadvantage he causes to himself. His entitled...