“Every age develops its own peculiar forms of pathology, which express in exaggerated form its underlying character structure. In Freud’s time, hysteria and obsessional neurosis carried to extremes the personality traits associated with the capitalistic order at an earlier stage in its development— acquisitiveness, fanatical devotion to work, and a fierce repression of sexuality. In our time, the preschizophrenic, borderline, or personality disorders have attracted increasing attention, along with schizophrenia itself. This “change in the form of neuroses has been observed and described since World War II by an ever-increasing number of phychiatrists.” According to Peter L. Giovacchini, “Clinicians are constantly faced with the seemingly increasing number of patients who do not fit current diagnostic categories” and who suffer not from “definitive symptoms” but from “vague, ill-defined complaints.” “When I refer to ‘this type of patient,’ he writes, “practically everyone knows to whom I am referring.” The growing prominence of “character disorders” seems to signify an underlying change in the organization of personality, from what has been called inner-direction to narcissism.
Allen Wheelis argued in 1958 that the change in “the patterns of neuroses” fell “within the personal experience of older psychoanalysts,” while younger ones “become aware of it from the discrepancy between the older descriptions of neuroses and the problems presented by the patients who come daily to their offices. The change is from symptom neuroses to character disorders.” Heinz Lichtenstein, who questioned the additional assertion that it reflected a change in personality structure, nevertheless wrote in 1963 that the “change in neurotic patterns” already constituted a “well-known fact.” In the seventies, such reports have become increasingly common. “It is no accident,” Herbert Hendin notes, “that at the present time the dominant events in psychoanalysis are the rediscovery of narcissim and the new emphasis on the psychological significance of death.” “What hysteria and the obsessive neuroses were to Freud and his early colleagues.. at the beginning of this century,” writes Michael Beldoch, “the narcissistic disoders are to the workaday analyst in these last few decades before the next millennium. Today’s patients by and large do no suffer from hysterical paralyses of the legs or hand-washing compulsions; instead it is their very psychic selves that have gone numb or that they must scrub and rescrub in an exhausting and unending effort to come clean.” These patients suffer from “pervasive feelings of emptiness and a deep disturbance of self-esteem” Burness E. Moore notes that narcissistic disorders have become more and more common. According to Sheldon Bach, “You used to see people coming in with hand-washing compulsions, phobias, and familiar neuroses. Now you see mostly narcissists.” Gilbert J. Rose maintains that the psychoanalytic outlook, “inappropriately transplanted from analytic practice” to everyday life, has contributed to “global permissiveness” and the “over-domestication of instinct,” which in turn contributes to the proliferation of “narcissistic identity disorders.” According to Joel Kovel, the stimulation of infantile cravings by advertising, the usurpation of parental authority by the media and the school, and the rationalization of inner life accompanied by the false promise of personal fulfillment, have created a new type of “social individual.” “The result is not the classical neuroses where an infantile impulse is suppressed by patriarchal authority, but a modern version in which impulse is stimulated, perverted and given neither an adequate object upon which to satisfy itself nor coherent forms of control.. The entire complex, played out in a setting of alienation rather than direct control, loses the classical form of symptom—and the classical therapeutic opportunity of simply restoring an impulse to consciousness.’”
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Christopher Lasch