Narcissistic neurosis is a term introduced by Sigmund Freud to distinguish the class of neuroses characterised by their lack of object relations and their fixation upon the early stage of libidinal narcissism. [1] The term is less current in contemporary psychoanalysis, [2] but still a focus for analytic controversy. [3]
Freud considered such neurosis as impervious to psychoanalytic treatment, as opposed to the transference neurosis where an emotional connection to the analyst was by contrast possible. [4]
Freud originally applied the term "narcissistic neurosis" to a range of disorders, including perversion, depression, and psychosis. [5] In the 1920s, however, he came to single out "illnesses which are based on a conflict between the ego and the super-ego... we would set aside the name of 'narcissistic psycho-neuroses' for disorders of that kind" [6]— melancholia being the outstanding example.
About the same time, in the wake of the work of Karl Abraham, he began to modify to a degree his view on the inaccessibility of narcissistic neurosis to analytic treatment. [7] However his late lectures from the thirties confirmed his opinion of the unsuitability of narcissistic and psychotic conditions for treatment "to a greater or less extent"; [8] as did his posthumous 'Outline of Psychoanalysis'. [9]
From the twenties onwards, Freud's views of the inaccessibility of the narcissistic neuroses to analytic influence had been challenged, first by Melanie Klein, [10] and then by object relations theorists more broadly. [11]
While classical analysts like Robert Waelder would maintain Freud's delimiting standpoint into the sixties, eventually even within ego psychology challenges to the 'off-limits' view of what were increasingly seen as borderline disorders emerged. [12]
Relational psychoanalysis, like Heinz Kohut, would also take a more positive approach to narcissistic neurosis, emphasising the need for a partial or initial participation in the narcissistic illusions. [13]
In retrospect, Freud's caution may be seen as a result of his unwillingness to work with the negative transference, unlike the post-Kleinians. [14]