Narcissist, Psychotic Reject Reality (Keynote Speech World Conference Addiction Psychiatry, 07/2021)
Channel: Prof. Sam Vaknin
Date: 2021-07-19

Internal objects, introjects arranged in a coherent narrative which could be flexible (responsive to new information) or rigid (mental illness).

The perimeter of the narrative is guarded by psychological defense mechanisms of two types: dissociative and cognitive distortions. 

“Approaching psychological defense mechanisms from the perspective of an evolved strategy, it is proposed that there are two basic templates-dissociation and cognitive distortions. Frequently conceived of as pathological, these psychological phenomena actually constitute overlapping spectrums with milder manifestations being common and highly functional, and more severe variants less common and typically dysfunctional. Dissociation provides the capacity to adaptively detach from disturbing emotional states, and cognitive distortions place a positive ego-enhancing spin on experience. Most of the classical defense mechanisms described in the psychoanalytic literature represent a form of cognitive distortion with some containing strong elements of dissociation.”

(Psychological Defense Mechanisms: A New Perspective, Brad Bowins, April 2004, The American Journal of Psychoanalysis 64(1):1-26, DOI:10.1023/B:TAJP.0000017989.72521.26)

Dissociation results in the formation of self-states (for example: the secondary psychopath self-states in BPD). Internal Family System theories conceptualize this brilliantly.

When defenses get associated with specific self-states we gravitate towards one of two states: Narcissism (a form of introversion with no ego or constellated self) or psychosis (only ego or self, no world). 

Patients in both these conditions are cathected in their internal objects, not in reality and have impaired reality testing. The narcissistic defenses confuse external objects as internal (snapshotting) and psychoticism confuses internal objects as external (hyperreflexion).

In both cases, all relationships are internalized and when reality strongly diverges from the internal objects, there is decompensation, acting out, narcissistic injuries and mortification mediated via specific self-states. 

Anxiety and depression can be reconceived as a failure to effect such mediation and the collapse of the internal universe, rendering the patient non-agentic and far less self-efficacious.

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