STEVEN MARCUS
235
work, he states, has been "dictated by historical accident - i.e., by
the revolutions that are taking place in our lifetime, affecting our
personal fortunes as well as the symptoms presented and the uncon–
sciot,,> demands made on us by our patients ... the patient of today
suffers most under the problem of what he should believe in and who
he should-or, indeed, might-be or become; while the patient of
early psychoanalysis suffered most under inhibitions which pre–
vented him from being what and who he thought he knew he was."
These latter phenomena have been joined with a third theoreti–
cal formulation, the psychoanalytic notion of the self. Although this
conception has itself an interesting history in the various branches of
psychoanalytic thought, it has been associated most extensively with
the work of Heinz Kohut and his two substantial contributions,
The
Analysis
oj
the Self
(1971) and
The Restoration of the Self
(1977). I can do
no more than point to his major theses. The presenting symptom–
atology of patients suffering from narcissistic personality disorders
tends to be "ill defined." Originally vague complaints soon focus,
however, on "pervasive feelings of emptiness" and on impressions on
the part of the patient that he "is not fully real"; tendencies toward
feeling "vaguely depressed" regularly occur along with convictions of
being "drained of energy" and having no "zest" for work or other acti–
vities; these coexist with extreme vulnerability to shiftings in self–
esteem, and heightened sensitivity to the interest - or lack thereof–
of others in him. The patient's experience of himself tends to be frag–
mentary and discontinuous, and based once again, in a simplified
sense, on an unstable and precarious sustainment of self-esteem. A
patient will typically complain "of a pervasive feeling that he was not
fully alive (though he was not depressed); of painful tension states
which lay on the borderline of physical and psychological experi–
ence; and of a tendency toward brooding worrisomeness about his
physical and mental functions ." Vertical splittings in the ego will
separate sectors of overt exhibitionistic claims and grandiose
behaviors from central sectors of depleted self-esteem, inclinations
toward shame, and profound needs for approval. Disturbances of
self-acceptance accompany feelings of general "inner uncertainty
and purposelessness concerning widespread sectors of ... life."
It
seems on the face of it as if these people are actually suffering from
what was once called unhappiness.
What these symptoms reveal, Kohut concludes, after some
decades of clinical experience, are a number of underlying defects.
These deficits have largely to do with the inadequate formation of
the superego at a series of points of development. For example, what
