Freud proposed the term narcissistic neurosis as a designation for manic-depressive psychosis insofar as it was characterized by the withdrawal of libido onto the ego. German psychiatric nosology subscribed to a clinical distinction between psychoses and neuroses, but at the end of the nineteenth century only the psychoses were clearly defined, while the neuroses were still a rather disparate category.
Little by little, in the drafts Freud included with his letters to Wilhelm Fliess (1950a) and in a series of articles (1894a, 1895b, 1895c, 1896a, 1896b) contemporary with the Studies on Hysteria (1895d), Freud adopted a distinction between the "actual neuroses," related to somatic conditions, and the "psycho-neuroses" (or "neuro-psychoses"), related to mental conflicts. The Schreber case (1911c), in which homosexuality played an essential part, led him to point up the role of narcissism (1914c) in the etiology of illnesses like Schreber's. The symptoms in such cases indicated a withdrawal of libido from objects in the outside world. This libido was then redirected onto the ego, causing delusions of grandeur.
Thereafter, Freud divided the psychoneuroses into transference psychoneuroses and narcissistic psycho-neuroses, the latter corresponding to the psychoses. Only later, after the major theoretical revision occasioned by the introduction of the death instinct (1920g), and of a more radical description of the mental personality, now seen as made up of the id, the ego, and the superego (1923b), did it became possible for Freud to sum up the difference between neurosis and psychosis in a much simpler way: neurosis meant conflict between the ego and the id, while psychosis resulted from an analogous difficulty in the relationship between the ego and the external world.
While acknowledging that much remained unknown concerning the origin and role of the superego, his theory of repression led Freud to examine conflict between ego and id. Meanwhile he defined narcissistic neurosis as the outcome of a struggle between the ego and the superego. He stressed that melancholia was a prime example. All pathologies arising from conflict between the ego and the superego were to be categorized as "narcissistic psychoneuroses." The identification of this group of illnesses lying at the frontier between neuroses and psychoses cleared the way for much later discussions of borderline states, drug addiction, and for the sort of approach to psychosomatic illness promoted by the so-called Paris school.
Melancholia qualified as narcissistic psychoneurosis par excellence: a state where a "pure culture of the death instinct" supports a superego at war with the ego. "Complete and unrestricted cannibalism" is fueled by "unrestricted narcissism" (Abraham, 1924, p. 488): the melancholic is unaffected by the interests of the object, and the destruction of the incorporated object is pursued with no scruple. Such are the terms used by Karl Abraham, and there can be no doubt that Melanie Klein had them in mind later. At the same time Abraham evoked the useful idea of a more restrained narcissism, an impulse to partial incorporation that shows a degree of respect for the object—a picture demonstrating how variously having and being can be melded.
Francis Pasche (1965) sought to clarify the issue of depression by opposing an antinarcissism to narcissism, and grounding this polarity in the dualism of the life and death instincts. He called antinarcissism a "tendency whereby the subject renounces a part of himself" The idea suggested itself to him on the basis of a feeling reported by patients, for whom "the object is not formidable only because it is felt to be destructive and destructible element, but also because it can be experienced, by virtue of its very presence in the subject's emotional world, as a thief of vital forces and a drainer of energy."
Narcissism and antinarcissism, Pasche argued, were derivatives both of Eros and Thanatos. Clinical experience with psychoses invariably showed that psychotic alienation was experienced subjectively in terms of submission to an external will. Reconstruction of early mother-child relationships supported the conclusion that "the first cathexes would imply not only fusion and interpenetration, but also distinction and separation, with the resulting emergence, alongside the wish to reject and the wish to be absorbed, of a wish to confirm the object in some sense in its rightful place." Hence, the infant who drinks the mother in with its eyes, or sets her on a pedestal and invests her with the authority that is her due.
Narcissism and antinarcissism constitute a dynamic structure, a permanent combination in which the instincts are deeply rooted.
See also: Acute psychoses; Ego; Ego-libido/object-libido; Narcissism; Narcissistic transference; Neurosis; Psychosomatic.
Abraham, Karl. (1924). A short history of the development of the libido, viewed in the light of mental disorders. In Selected Papers of Karl Abraham, M.D. (Douglas Bryan and Alix Strachey, Trans.) London: Hogarth. (Reprinted as Selected Papers on Psycho-Analysis. New York: Brunner/Mazel, 1979)
Freud, Sigmund. (1894a). The neuro-psychoses of defence. SE, 3: 41-61.
——. (1895b ). On the grounds for detaching a particular syndrome from neurasthenia under the description "anxiety neurosis." SE, 3: 85-115.
——. (1895c). Obsessions and phobias: Their psychical mechanism and their aetiology. SE, 3: 69-82.
—— (1896a). Heredity and the aetiology of the neuroses. SE, 3: 141-156.
——. (1896b). Further remarks on the neuro-psychoses of defence. SE, 3: 157-185.
——. (1911c). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoids). SE, 12: 1-82.
——. (1914c). On narcissism: An introduction. SE, 14: 67-102.
——. (1920g). Beyond the pleasure principle. SE,18:1-64.
——. (1923b). The ego and the id. SE, 19: 1-66.
——. (1924b). Neurosis and psychosis. SE, 19: 147-153.
——. (1950a). Extracts from the Fliess papers. SE, 1: 173-280.
Pasche, Francis. (1965). L'anti-narcissisme. Revue française de psychanalyse, 29 (5-6), 503-518.