Disorders of the Self

The term 'Disorder of the Self' comes from Kohutian 'Self Psychology'. It is a more accurate descriptive, at least of the underlying dynamics of the syndromes, than the older and more familiar term 'Personality Disorder'. However, 'Disorder of the Self' is a general term that does not distinguish between the various presentations.

The Psychodynamic model maintains there are five distinct types: The Borderline, The Narcissistic, The Closet Narcissistic, The Schizoid and The Psychopath. James Masterson suggests that the seeds for a possible full blown personality disorder are sewn during the first 36 months of life. It is generally agreed that this period is one of intense learning and experimentation; a time when the foundations of personality are set down by internalising and fine tuning the complex interactions between the physical and emotional environment and the developing psyche of the infant.

Along this time continuum of the first 36 months, there are certain well known developmental tasks that each of us is required to master or at least attempt. These are described in great detail in Margaret Mahler's tome The Psychological Birth of the Human Infant but perhaps better still, in Daniel N. Stern's more contemporary, The Interpersonal World of the Human Infant and The First Relationship. Masterson is quick to point out that personality disorders, like most other forms of mental problems, occur in degrees. He links this degree in presentation to the personal susceptibility of the individual affected and to the type, severity and duration of the traumatic interruption.

If a susceptible child experiences an emotional and or physical trauma, within this period in particular, the fragile attempts to master the developmental task at hand may be disastrously interfered with; producing what is called a fixation. That is, the task is not mastered and although the child is propelled by biology to move on, it is with an intact defect in certain important coping skills.

This leaves a particular weakness in psychic structure that tends to remain undiminished in a pervasive and undifferentiated manner. In order to circumvent or ameliorate the effects of this defect, certain - often maladaptive - forms of behaviour and or thinking may arise. This may not be overtly evident until the defective coping mechanisms are fully challenged.

For example, if separation and individuation is the task that has been derailed, a recognisable problem may first appear, only when the child reaches school age and must perforce spend long periods of time away from home. Until then, he or she may be seen as just a bit anxious and clingy. If ineptly handled, the whole thing can easily escalate into constant tantrums on separation, pan anxiety, obsessive/compulsive behaviours, psychosomatic illnesses, school refusal and eventually phobias. This sort of disturbance can become a bit of a juggernaut, especially when the initially identifiable separation anxiety becomes lost in the morass of self compounding behaviours.

Masterson contends that the type of personality disorder eventually arrived at, is directly linked to the point along this 36 month continuum of developmental tasks, at which the derailment occurs. In other words, to the actual developmental tasks at hand. He goes into great detail about the development and treatment of these disorders in his series of books on the self. As a satisfactory explanation of his ideas is far and away above the purview of this article, I recommend reading The Real Self: A Developmental, Self and Object Relations Approach, and The Narcissistic and Borderline Disorders, by James F. Masterson.

In my career, I have treated many patients, diagnosed - both correctly and incorrectly - with a personality disorder; the younger and less intractable ones, predictably doing significantly better. I would advise any practitioner seeing a patient with this condition, to have a serious look at the work of James Masterson. I am unashamedly an admirer and find his work clinically very helpful and relevant.

Dr. James F. Masterson pioneered the developmental self and object relations approach to the psychotherapy of the Personality Disorders through clinical research. He is the founding father of The Society of Adolescent Psychiatry and past president of its New York Chapter. The body of Dr. Masterson's work is represented in the books he has written, many of which have been translated into several languages, including early work in the field of the real self, which represents a breakthrough in treatment of the borderline and narcissistic disorders.

His latest book, The Personality Disorders - a New Look at the Developmental Self and Object Relations Approach was recently published by Zeig, Tucker & Theisen, Inc.. His books are required reading in courses throughout the country. As an international authority on The Personality Disorders, Dr. Masterson's articles and papers have been published in leading journals in this country and abroad. He also lectures widely.

Dr. Masterson maintains a private practice and is Professor Emeritus of Psychiatry, Joan and Sanford I. Weill Medical College of Cornell University.

(Information on James Masterson sourced from The Masterson Institute For Psychoanalytic Psychotherapy)

Posted on 03 February 2005 in - Reviews - Books

David White

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