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REVIEW ARTICLE
Year : 2017  |  Volume : 1  |  Issue : 2  |  Page : 76-83

The development of herbert rosenfeld's views on narcissism


Consultant psychiatrist and medical psychotherapist, Leeds and York Partnership NHS Foundation Trust, Leeds, UK

Date of Web Publication8-Dec-2017

Correspondence Address:
Anuradha Menon
Leeds and York Partnership NHS Foundation Trust, Leeds
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_20_17

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  Abstract 


This review tracks the development of Herbert Rosenfeld's(1910–1986) work on the psychoanalytic concept, narcissism. The author conceptualizes the scope of this work in Darwinian terms to emphasize the extraordinarily fertile theoretical and clinical material produced by Rosenfeld, which is linked in the text to several other contemporary Kleinian psychoanalysts. The beginning of his lifelong work is examined as “Origins,” the development itself as “Evolution” and at the end of his life, the shifts in his theoretical stance is looked at as “Metamorphosis.” Clinical material is used to illustrate the core concept of narcissism as a defence against separateness.

Keywords: Countertransfernce, destructive narcissism, internal gang, libidinal narcissism, Rosenfeld, superego


How to cite this article:
Menon A. The development of herbert rosenfeld's views on narcissism. Ann Indian Psychiatry 2017;1:76-83

How to cite this URL:
Menon A. The development of herbert rosenfeld's views on narcissism. Ann Indian Psychiatry [serial online] 2017 [cited 2018 Jul 18];1:76-83. Available from: http://www.anip.co.in/text.asp?2017/1/2/76/220241




  Introduction Top


Herbert Rosenfeld(1910–1986) lived and worked in that extraordinarily fertile period in the psychoanalytic world; a period when innovative work was being done with “difficult-to-treat” patients. One of the great pioneers of his time, and a student of Freud and Klein's work, he joined Segal, Bion and Steiner in analyzing the psychotic transference, finding ways of working with patients who had previously been considered “impervious” to analysis. Steiner(2008) writes, >20years after Rosenfeld's death, that he would personally divide the great analyst's work into the “classic” period(1947–1978) and his “final phase”(1978–1986). This distinction is an important one. On careful scrutiny of the trajectory of his career in analysis, the beginning was with the landmark publication of the case of “Mildred [1]”(1947). This paper, followed by other classic papers by Bion [2],[3],[4] and Hanna [5],[6] contributed to an atmosphere of experimentation, where psychotic patients could be held in an analytic setting without requiring a change or rejection of the analytic stance. As his influence and expertise grew, Rosenfeld increasingly chose to work analytically with resistances of various kinds; leading up to an elaboration, in his final phase, of the problem of “impasse” in analysis.


  What Did Rosenfeld Stand For? Top


In 1974, Rosenfeld [7] launched a scathing attack on a paper by Greenson,[8] saying “he makes some remarks which are quite meaningless to me and which I cannot relate to my own work or that of my colleagues.” Then, he went on to clarify the nature of his own work-”In my clinical work I always try to assess from the start the state of the patient's ego;………….A great deal of my work on narcissism relates, of course, to the study of the structure of the patient's ego and how this influences the analytic process.………. In starting the analysis, I do not concentrate on discovering the patient's most deeply unconscious conflicts, but rather try to ascertain the most immediate anxiety……… Analytic intervention at the right level is particularly necessary when the anxiety is threatening to overwhelm the patient's ego and thus disrupt or even prevent analysis……”

Steiner [9] writes of his first meeting with Rosenfeld who remarked, “Ich binn kein theoretiker.[1]

The message is clear. Rosenfeld saw theory as a way of informing practice: technique was all-important. And where else would one learn but from the patient? Even in later years, the ferocity with which he defended “technique” led to differences of opinion with colleagues. Most of his work grew out of this struggle to find the right stance in the room, with the patient. He maintained that the “real” tool was the nature of the analyst's participation in the patient's paranoid experience. Ipersonally understand this process to be somewhat distinct within the idea of the countertransference.

Paradoxically, Steiner [9] also observes: “the claim not to be a theoretician is, in reality, a theoretical position in its own way, which needs to be understood in its own specificity and in the problems which arise from it.”

Here, therefore, is the true starting point of my essay on Rosenfeld's work on narcissism, and I shall divide my thesis into three parts according to the progression of his ideas: origins(early period), evolution(”classic” period), and metamorphosis(final phase).

Footnote: Iam not a theorist.[1]

I am conscious that I have deliberately chosen Darwinian terms for my text; this seemed appropriate to me, when I reflected on the way Rosenfeld's ideas developed over the 30 odd years of his clinical work.

In Origins, I will start with his first published paper [1] just before the classic paper on psychopathology [10] in 1964. In Evolution, I have divided Rosenfeld's work into 6sections, from 1964 to the late 80s. In Metamorphosis, I will discuss his later thoughts on “Impasse” and shifts in technique [Figure 1].
Figure 1: Rosenfeld's ideas and their development (1947-1987)

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I have tried to retain true chronology of the work wherever possible, with a few exceptions.


  Origins Top


Interestingly, Rosenfeld's first paper in 1947, describing the case of “Mildred,” a highly disturbed psychotic patient, does not include a Freudian reference. Instead, he refers to Klein's [11] paper on schizoid mechanisms. His affiliation to Kleinian concepts is evident in his initial work; the clinical cases demonstrate a high degree of originality and innovation. The paper discusses ego fragmentation, splitting, projection and projective identification as seen within the framework of a psychotic transference.

The very real fear that “Mildred” had was of being intruded on by the analyst. Rosenfeld suggested that the delusional state that developed thus arose in part from the projection of the patient's own intrusiveness, colored by greed and envy. The idea of depersonalization and the schizoid mechanisms underlying it was later picked up by Bion [2],[12] in describing the mechanism of pathological splitting in psychosis.

John [13] describes how these clinical details anticipate Rosenfeld's later views on narcissistic organizations.

Mildred had a fantasy from childhood that she harbored a “devil” inside that attacked “good people,” keeping them tied up in dungeons. They were unable to get free because no sooner than they managed to, the “devil” reappeared and bound them again, ever more tightly. Rosenfeld's later description of the internal “narcissistic organization”[14] does finds its predecessor here, though this link remains unformed at this point in his work.

Ron [15] reflects that there is probably no area of psychoanalytic literature more “muddling and profuse” than that on narcissism. He points out the inability that narcissistic patients have to form an ordinary transference relationship. Using this idea as a core concept, it seems that a “narcissistic state” is not simply withdrawal from external objects to an internal object, but a particular kind of object relationship.

In tracing back the threads Rosenfeld picked up and wove into his life's work, one needs to consider Freud [16],[17],[18],[19] and Abraham.[20] Freud's views on narcissism began with his theory of male homosexuals “proceeding from a narcissistic basis” and choosing themselves as their love-objects which was taken further.[18] Freud wrote of the “return of the object-libido to the ego and its transformation into narcissism” calling this “a happy love, a primal love.” Ron [15] ruminates on this shift, suggesting that by now Freud is already identifying a particular type of relating that is conditional on the elimination of difference.

It is therefore not surprising that Freud's initial thoughts on narcissism related to homosexual object choice. Rosenfeld picks up this idea but goes on to link this to Kleinian concepts.

Narcissism, homosexuality, and projective identification

In 1949, Rosenfeld [21] linked certain aspects of homosexuality to the early narcissistic phase of development which he calls the “paranoid position.” In the analysis of a patient with a paranoid-schizoid psychosis, Rosenfeld interpreted that the patient was in identification with the “good” interpretations which represented the “good penis” that he had orally incorporated through analysis, thus explaining his homosexual feelings in the transference. In the transference relationship, the analyst stood not only for the patient's bad self but frequently for his good self; and the homosexual attraction to the analyst could be traced to phantasies where he projected his good self and other parts of himself, particularly his good penis, into him.

Rosenfeld then compared his views with that of Freud. Freud described a narcissistic type of homosexuality where the patient is attracted to a young man who represents the patient himself, implying that he was treating another as his own mother had treated him in the past. The suggested mechanism was identification with the mother.

However, Rosenfeld,[21] chose to differ from Freud. He suggested, from his case material, that the mechanism of the narcissistic attraction is frequently the projection of parts of the self, particularly the penis, into another man, causing the narcissistic homosexual attraction.

I propose that this is an early example of the Kleinians' move away from Freud in thinking about the transference in the analysis.

Narcissism and the nature of the superego

Rosenfeld [22] examined the terms “superego” and “ego-ideal.” Some elements of this discussion have direct relevance to his developing work on narcissism at this stage of his career.

This rather theoretical discussion starts with comparison and contrast of usage. Freud initially differentiated ego-ideal from the conscience, a special psychical agency, suggesting that the ego-ideal was related to the “narcissistic perfection of childhood.”[19] Thus, the “ideal” was a substitute for the lost narcissism in which the baby is its own ideal. Rosenfeld did not agree with the equation of the ego-ideal with narcissistic omnipotent fantasies which narcissistic patients are prone to.

Freud [23],[24] used both “superego” and “ego-ideal” interchangeably, stating they represented the same construct. But later he made a distinction between the two terms and called the superego the vehicle of the ego-ideal.[25] An identification with the parental superego at the end of the oedipal phase was thus thought of as the ego-ideal. Noting this shift, Rosenfeld theorized that the superego was divided into an “early” and “late” phase. The early superego represented the idealized and persecutory aspects of the breast and later, the penis, thus linking to Klein [26] rather than Freud. At the end of the latency period, the late superego, the forerunner of the adult superego, would develop. Thus, Rosenfeld arrived at the conclusion that along with changes in the ego and object relations, the superego also undergoes modifications with development.

In the latency period, internal anxieties deriving from the early superego exert pressure on the individual to make complete and uncritical identifications with external objects. The strength of this identification is directly proportionate to the severity of anxiety arising within early events in development(e.g. weaning experiences). In adolescence and latency, this identification is modified by external objects. Rosenfeld observes, “Thus, the analysis of the later superego is often dynamically of secondary importance because it has mainly a defensive function against the anxieties of the early superego.”[22]

To contextualize this piece of work within Rosenfeld's later work on narcissism, it is necessary to think about the “identifications and idealizations” that arise in the transference in analysis of these patients. Rosenfeld also refers to Klein's classic work [27],[28] on the paranoid-schizoid and depressive positions, where split objects are introjected into the early superego, and painful resolution occurs(or not) with time by integration.

The paper in 1962 focuses more on presenting a theoretical standpoint and case material rather than technique; however, it is here that one sees the beginnings of Rosenfeld's enquiry into the nature of the idealizations that evolve in the narcissistic transference.

Rosenfeld's admiration of the Freudian death drive is well documented, but even before this crystallized into “Destructive narcissism” he experimented with Freudian ideas around narcissism. In 1969, he goes back in time to acknowledge this process, remarking on Freud's pessimism regarding the treatment of the “narcissistic neuroses.[29]” Freud thought that these patients, having apparently given up their object cathexis, were unable to develop a transference. By 1937, Freud became even more pessimistic about analytic treatment of “narcissistic and psychotic conditions.[30]” He had reached the conclusion that, with those “psychotic” patients who showed extreme resistance in the analysis, he was dealing with the same process-”narcissism.” However Freud did signal some hope in “the outline,[31]” published posthumously, offering “splitting of the ego” as a possible mechanism in psychosis. Rosenfeld [29] considered this to be of fundamental importance in understanding narcissistic states. What follows is the next stage, a study of the peculiar nature of the transference in the analyses of narcissistic patients.


  Evolution Top


Rosenfeld's first major paper on narcissism appeared in 1964. Between 1964 and 1971, he looked at various aspects of narcissism: the nature of the transference, the nature of the defensive structures employed by these individuals and the nature of the “internal organization.” Taken together, the discussion point here is, really, object relations. But how does one start thinking about object relations in what historically was referred to as “an objectless state?” Rosenfeld attempts to resolve this question by referring us to the work of Federn [32] Abraham [33] and Balint,[34] linking these to his own work, concluding that the so-called primary narcissism described by Freud is likely to be, in fact, primitive object relations. Hence in 1964, when he writes about narcissistic object relations, he is actually describing the nature of the transference in the analysis of these individuals.

Transference

Rosenfeld observed 'As the transference is the main vehicle for any analytic investigation, it seems essential for the understanding of narcissism that the behavior of the narcissist in the analytic transference situation should be minutely observed.'[10]

The key aspects of the narcissistic object relations include omnipotence, identification(projective as well as introjective) and envy that not only contribute to the omnipotence but become the core of a split-off and denied an aspect of the ego. Inevitably, this gets played out in the transference.

I shall now use my clinical work to illustrate the above.

Mr. X, a White British teacher in his late fifties, had a difficult marriage with his African wife. They had twin daughters, aged 4. He told me that as a child he knew his quiet, timid mother feared his violent father. When he was 16, he returned from school one day to find his father had killed his mother and then committed suicide. Mr. Xleft England soon after this. His love affairs were intense; he often stalked his girlfriends. Once the woman reciprocated, he would flee and travel compulsively. Xwas contemptuous of his young wife and felt she had cheated him into marrying her. He often told me how he could not understand why she accused him of the same.

Session material

It was the first session after a holiday break. He began by talking about the “women” in his life who did not speak to him-his sister who was visiting England briefly and had no interest in his conversation, his wife who left him in silence most of the time, not talking even when he tried to engage her in conversation. He spoke rather scathingly about how he felt he should not be wasting his time on these people who were not interested in his feelings. During this rant, I felt physically paralyzed, a familiar feeling in sessions with Mr. X. Imanaged to comment on the link between his anger toward these “unfeeling women” and how he may feel he wasn't understood by me. Inoted that I wanted to bring up the break in my interpretation, but was unable to. He responded by ignoring me and continuing his tirade about how it was unbearable living with his wife because he was forced to “look for little signs”-to reassure himself that things were ok. He said he felt humiliated by this.

I realized on examining my countertransference that I was a paralyzed/dead object in the room. Iassociated to an image of Adam's tragically strangled mother. Ithought Mr. X's omnipotence and fear of dependence, triggered by the break had to be split off by a denial of separateness, and any comment I made in the room needed to be passed over as if our opinions need not differ at all. His destructiveness had to be kept away from me-the idealized therapist-mother, who was the silent sufferer, ineffective, almost-dead, whose failure to protect him had to be denied and split off.

Mr. X's description of his wife and sister who lacked any understanding of his needs was displaced anger from my somehow failing, like the therapists before me. In the transference, there was, in fact, no choice but to fail him.

Drawing upon Rosenfeld's work, I can understand narcissistic object relations as a defence against separateness. Thus, the patient identifies completely with the therapist, and the various consequences in the transference include treating the analyst as a lavatory/lap, thus evacuating all undesirable affects, or ignoring/controlling the analysts' separate existence within the transference relationship.

The role of envy and the influence of Kleinian work

Rosenfeld's examination [1] of the envy projected by his patient, “Mildred,” is taken further,[33] when he remarked on the enormous quantities of envy that is projected and avoided, forming the core of a murderous superego in a schizophrenic patient. Here, he refers to “primary envy,” the envy for life itself. It is this envy that he takes up again when he goes on to describe destructive narcissism in 1971.

Rosenfeld's work follows Klein [35] and Abraham,[36] in describing how the narcissistic style of object relating defends against aggressive feelings brought up by frustration, as well as the destructive ones brought up by envy. John [13] writes of “defences against envy” as carrying the central role in narcissistic object relationships. Envy, which is unbearable for the infant, is avoided by an omnipotent possession of the breast. Ron [15] comments on Abraham's ideas on narcissism,[36] noting it as the conceptual origin for Rosenfeld's classic paper.[10] This development influenced the later clarity on the links between narcissistic problems and the negative therapeutic reaction made by Horney [37]) and Joan.[38]

A detailed exploration of the negative therapeutic reaction is beyond the scope of this paper. Ishall return to related aspects when I look at Rosenfeld's specific description of such a reaction, the “Impasse” in the analysis.

The two forms of narcissism-from Freud to Abraham to Rosenfeld

In 1924, Abraham described clinical narcissism as existing in both a positive and negative form; positive when it manifests as self-admiration, and negative when it manifests as self-denigration.

Rosenfeld's idea of two forms of narcissism emerged out of a crucible containing Abraham's(1908–1924) work, Klein's ideas on envy, and Freud's controversial death instinct(1920–1937). The distinction between predominantly libidinal and predominantly destructive narcissism is important here because in the former, though envy, revenge and resentment arises from the analyst puncturing the narcissistic belief system, this eventually diminishes negativism and enhances understanding.[15] However in the latter, envy is overwhelming, and there is a predominant, albeit hidden, wish to destroy the analyst or the self. Rosenfeld commented that in these cases, “death is idealized as the solution to all problems.[14]

In tracing Freud's writing back to 1915, Rosenfeld remarks on how “the object” makes its appearance during primary narcissism, thus heralding the entry of “hate”-which, being older than love, is the result of the narcissistic ego's repudiation of primordial stimuli. Heinz etal.[39] and linking Freud's primary narcissism to aggression, he concluded that Freud realized the obvious relationship between narcissism, narcissistic withdrawal and the death instinct. However even in 1937, in Freud's account of the hidden transference that resists treatment, which he related to the “silent operation of the death instinct,” there was no hope or clarity regarding clinical manifestation and accessibility to analysis.

Destructive and libidinal narcissism

Rosenfeld's dualistic theory of narcissism refers to Klein's work. Klein [40] recognized the death instinct in the primitive envy of an early infantile negative transference. She commented that in an analysis this reappears as a need to devalue the “good,” “helpful” analytic work. In infants, this unbearable envy gets split off when the primary instinctual forces are in a state of de-fusion. In health, fusion occurs via introjections, in the service of the life instincts. Ostensibly, in severe cases of resistance to analysis, the split off defused envy becomes a problematic deterrent to any real contact between the analyst and patient. Thus, we return to Freud's theory of the fusion and defusion of the life and death instincts and taking it further; it becomes possible to identify the operation of the death instinct in the transference.

In 1971, Rosenfeld noted how Abraham went much further than Freud in studying the hidden negative transference in his narcissistic patients and clarifying the nature of their destructive impulses. Abraham had emphasized the hostility and defiance hidden behind the aloofness or as the case may be, apparent eagerness to cooperate. However, he never linked this directly with the life and death instincts.

Rosenfeld described how, in the psychopathology of a narcissistic state, severe defusion of instincts play an important role and the destructive impulses can be observed directly in the transference. He introduced the concept of a “pathological fusion” of the instincts in such states; where, in the mix of libidinal and destructive impulses, a heightened destructive state results. To understand this we need to contrast this state to “normal” fusion, in health, when good and bad aspects fuse for a modification and attenuation of destructive parts of the self, by bringing them in combination with loving feelings. In pathological fusion, the power held within the life instincts seems to strengthen the destructiveness, bringing within it the quality of sadism. Thus destructive fantasies get eroticized.

At the heart of Rosenfeld's dualism is the theme, in narcissism, of identification with the object as a way of avoiding separateness. In libidinal narcissism, the good aspects of the self and object are idealized and “possessed;” thus the pain of loss is sidestepped. In destructive narcissism, the destructive elements are idealized; reaction to separateness is more violent and felt as severe, an unbearable humiliation that warrants retaliation. In analytic work destructiveness is encountered whenever this façade of impenetrability is threatened, and the degree and quality of this destructiveness varies. In the transference, any real contact that makes evident the patient's dependence on his object is felt as an attack, leading to feelings of being “deflated;” this theme, if not faced in the transference, can make therapy feel empty, lacking any real contact.

Thinking about Klein's ideas, it now becomes possible to understand envy as clearly connected to the death instinct. John [13] writes of “the aim of envious attacks”-to “destroy difference by reducing both subject and object into a deadly nothingness. If everything is reduced to dust there is no envy, as there is nothing to be envious of.” Rosenfeld commented on the way this envy in narcissistic states can be a real obstacle to development and psychic change.

The narcissistic organization-the internal gang

When destructive aspects of narcissism predominate, envy is more violent. It manifests in the transference as a powerful wish to destroy the analytic work, the analyst,(who comes to represent the parents and the source of all life and goodness) and the self. Thus when faced with the reality of dependence, and all that follows, the narcissistic patient is impelled to destroy, to die and thus kill off any real progress made in the analysis, which comes to represent his libidinal self, the child in himself.

Here Rosenfeld starts his description of the “narcissistic organization,” of which the core is the split-off and severely defused destructive and envious elements of the self. The whole self, thus identified with the destructive self, aims to triumph over creativity, progress, and life itself. For many patients this process is temporary; the narcissistic state ebbs and flows.[41] However, Rosenfeld identified some narcissistic patients who feel superior in being able to “withhold” from the analysis. These patients have resolved the struggle between their libidinal and destructive aspects by actually ridding themselves of love and concern for their objects. This is done by “killing off” the healthy, libidinal narcissistic self. Rosenfeld likened the destructive narcissism of these patients to an “internal gang,” or “mafia,” which behaved like an autonomous entity within the narcissistic individual as if composed of elements pledging allegiance to a destructive overlord. Taking the metaphor further, he writes of how the “gang” works hard to prevent any contact with the helpful analyst, who stands for the “police,” and having to “punish informers.” Dreams of being attacked by members of the mafia or “gangs” of delinquents may occur. Rosenfeld felt that the “gang” represented the effort to maintain the power and superiority of the destructive narcissistic processes, rather than defend against guilt and anxiety.[42]

Clinical example

Rosenfeld describes a patient who dreamed of a little boy in a comatose condition, dying of some poisoning. In this detailed dream, the patient is standing next to the boy and does nothing to help; and he feels superior to the doctor treating the child.

In the interpretive work that follows, we see that this was a patient who kept himself cut off from real contact with the analyst. He did this by belittling the analyst, treating him with indifference and exhibiting repetitive behaviour that sabotaged any attempt made to understand him. The internal dynamic was that the healthy, libidinal part of the patient was kept deadened by the destructive narcissistic parts of the self. In this way, the patient establishes power over vulnerability and denies any need for help: at a terrible cost. The dream illustrates the patient's wish to distance himself from the analyst's help. The deeper reasons behind this seem to be that to be superior, and the cut-off is better than to be helped; the latter means one is vulnerable and open to attack.

Other types of narcissistic presentations

Rosenfeld [14] identified a link between narcissism and perversions, making a distinction again between his own views and Freud's. He described how overpowering of libidinal by destructive impulses occurs in these pathological states of fusion of instincts, similar to those in confusional states. Thus, the aggressive impulses get eroticized.

It is important to remember Rosenfeld's focus on the transference and the value of analytic work in narcissistic patients. In his description of the “psychotic narcissistic organization,” he identifies a “sane” part of the person that gets engulfed by a psychotic, omnipotent, highly ruthless part of the self. The latter exists as a “delusional world,” and lures the sane self into numbness, the patient thus being cutoff from reality, insight or anything that has the potential to achieve true contact in the analysis. Such patients lose all capacity for thinking and may seem to be in a dream-like state. There is a danger of psychotic breakdown if the turning away from the external world is permanent. Such patients could sometimes present with an acute hypochondriacal fear of death. Rosenfeld believed that this type of clinical presentation was the closest possible to viewing the death instinct in its pure form.

The death instinct is thus described: “a power that pulls the whole of the self away from life into a deathlike condition by false promises of a nirvana-like state, which would imply a completedefusion of the basic instincts.[14]” Here, the task of the analyst would be to rescue the sane part of the self from the grip of the psychotic organization. This, Rosenfeld stresses would be essentially an exposure of the infantile nature of the omnipotence that drives the isolated, destructive organization, an exposure in the transference for what it truly is: a pull away from life into death, a cutting-off from good object relations.


  Metamorphosis Top


Rosenfeld's late classic period informs much of his later work, particularly on the analytic impasse in the treatment of narcissism.

Rosenfeld [42] was under huge pressure to publish his later work; it was in fact eventually published posthumously. Impasse and interpretation contained a wealth of clinical material, supervisee's accounts and a clarification of how his views had been modified over the years. It would be interesting to pose the question: Did Rosenfeld, the champion of the analytic stance that defied all odds, in his later years allow “compromise” to seep into his analytic technique? Or, were his later observations true to the evolution of a masterly train of thought over a lifetime?

The answer probably lies somewhere in between.

Impasse deals primarily with problems encountered in analytic technique, but the focus is more on analyst-related factors, rather than a more neutral, “spirit of enquiry” within the transference. The various types of impasse with narcissistic, psychotic and borderline patients are explored; and Rosenfeld's recommendations here are sometimes strikingly different from his earlier views.

The essence of his later work is referred to in an “Afterthought.” Here, he specifically writes about “thick and thin-skinned narcissists.” In the former, quite impervious to analysis, destructive aspects of the self are thought to predominate. Rosenfeld recommends “firm” addressing of the transference to avoid impasse. “Frequent repetition of interpretations and confrontations” are useful, and when they reach the patient they can be beneficial, though painful.

In thin-skinned narcissists, however, if destructiveness is interpreted without caution, a type of repetition of childhood trauma ensues; and patients feel belittled and humiliated. This is unhelpful and can in itself lead to Impasse. The way forward with such patients, he recommends, is to help them realize the conflict between the destructive and libidinal parts of their self, and thus retain the positive aspects of their narcissistic organization.

On reflection, I feel that Rosenfeld reached this point in his thinking mainly because he became certain about a definite difference between narcissistic individuals who identified with their destructiveness, and those who were mostly “in the grip,” while not fully identified. He felt, therefore, that these two types of patient needed different approaches. Bateman [41] extends this idea creatively, writing about how the same patient can move between the two states within the analysis; and thus he recommends fluidity of the analytic stance.

Rosenfeld himself writes about flexibility in analysis “The crucial point about my current approach is that analysis should not be carried out rigidly.” Commenting on the analysis of negative transferences and aggression, he acknowledges a shift in his own method: saying, “care needs to be taken in tearing down idealizations.” If care is not exercised, the patient may be left feeling unable to cope.

Interestingly, he adds that the “analysis needs to be experienced as enlivening, the analyst needs to be aware that the setting and stance can have a deadening effect” and that an attitude of detachment may be experienced in the transference as deeply rejecting. “We as analysts must understand how strong influence on our patients we have,” he concludes, describing analysis as a “two-way process,” highlighting the importance of countertransference. For Rosenfeld, countertransference is the tool that helps the analyst gauge the stance required for each patient. This is somewhat different from his earlier neutral stance and is analyst-centered.


  Influences on Clinical Work Top


Rosenfeld, along with Segal and Bion, made pioneering contributions to the analytic treatment of psychoses. He constantly referred back to Klein's concept of projective identification, but fleshed this out in a way that allowed it to be used in the treatment of psychotic patients(1947–1952).[43] This was taken forward by later Kleinians. His major contribution to later work was his conceptualisation of the “confusion of self and other” as a defence against splitting in a psychotic patient. His researches on Narcissism have been critically developed by Otto Kernberg in America and by André Green in France, among others, and have had a fundamental influence on the whole Kleinian approach to the study of perversion and borderline conditions during these last 15years.[44]

In a review of his book, Brandchaft and Rosenfeld [45] writes, “Although he acknowledges that the task is strenuous and that its success is at the moment limited, Rosenfeld nonetheless believes firmly that psycho-analysis can and should be applied in the treatment of even the most severely regressed and negativistic patients. It is the preferred approach in both acute and chronic cases.” For instance, he gives clinical examples to describe intense negativism which is a paralysing defence that is employed to protect from unmanageable fears of either being invaded or of invading the other. Here, there is a suppression of all feelings. In another example in his early paper on his patient “Mildred,” there is an important point made on the relevance of the mother-infant relationship in the etiology of schizophrenia. When the mother is unable to bear the projected pain and primitive anxiety of the infant, the infant's omnipotent belief is reinforced; his intrusion into mother must be responsible for this state.

It is interesting to read Steiner's views [13] on the palpable shift in Rosenfeld's perspective in his later years. On balance, I feel that it speaks for the extraordinary quality of Rosenfeld's influence on his colleagues who, like him, struggled with difficult-to-reach patients, that even criticism reads like praise. In Steiner's opinion Rosenfeld's shift from “maintaining the analytic stance at all cost” to an analyst-centered examination of impasse came as a shock to many-”I particularly admire the subtle observations and balance which characterized Rosenfeld's work at its best, when he could so wonderfully put himself in the patient's position without losing his analytic perspective. Ibelieve this is missing from his late work………” Steiner resolves this conflict somewhat by stating that as an “exposition of problems in the analyst,” impasse and Interpretation is noteworthy, rather than as a book on good analytic technique.

Steiner [9] writes, “some of his later work seems to support some of his patients too much…”

I feel that Rosenfeld's shifts in technique demonstrated experience gained over a lifetime. It is ironic that in espousing “flexibility” he would be accused of entertaining certainties, somehow seeming to betray the fluid work of his earlier days. However, if one tries to understand the perspective of a man charged with the job of clarifying a body of work, accepting the pressures of reality, acknowledging the impact of time on theory; and all this while, grappling with his own mortality, one can accept a process that I would like to think of as Metamorphosis.

Rosenfeld's real contribution, though, in the illustrious company of his fellow-Kleinians, is to tread boldly where no “guidelines” exist; he remains a shining example of all that is exemplary and unique in the true scientific enquiry.

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

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