THE AMERICAN JOURNAL OF PSYCHOANALYSIS 38:19-29 (1978)
NARCISSISM AND THE SELF IN HOMICIDAL ADOLESCENTS James B. McCarthy Even where it emerges without any sexual purpose, in the blindest fury of destructiveness, the satisfaction of an instinct is accompanied by an extraordinarily high degree of narcissisticenjoyment.., owing to its old wishes for omnipotence. I Concern about homicidal and violent behavior in children and adolescents has been reflected in attempts to study them from statistical, developmental and psychodynamic points of view. In the Ego and the Id, IA Freud related criminal behavior in youths to a powerful sense of unconscious guilt which is primarily Oedipal in origin. He later stated in his preface to Aichhorn's WaywardYouth2that neither juvenile delinquents norcriminals havethe fully developed psychic apparatus that is essential for psychoanalysis. Glover 3saw delinquent criminal behavior as a series of hostile attacks on the environment that were motivated by the delinquents' strong unconscious need for punishment. A homicidal assault could thereby represent both an attack on unrecognized persecutors and a mechanism for the alleviation of guilt, as well as an unconscious demand for punishment. Another early psychoanalytic view of criminal behavior stressed anal character traits involving a spiteful rejection of societal norms and diminished superego control over id-derived antisocial activities. 4 Even though an inquiry into the personality construction of adolescents who commit violently assaultive acts is essential for treatment, little attention has been paid to the early pre-Oedipal predisposing events. Aside from the influence o f the sociocultural milieu of the youth gang, what are the psychic events that predispose an adolescent or child to overtly express a murderous rage? Of what importance can psychotherapy be in reducing the possibility that an adolescent who has murdered will commit further acts of violence? The purpose of the present paper will be to review the studies that bear light on this issue and to focus on early object relations phenomena. The relationship between narcissism and the self in violence-prone youngsters is particularly important in the formulation of treatment issues. Within the framework of a behavioral approach, adolescent aggression has been considered to be a learned response pattern to frustratation of nurturJames B. McCarthy, Ph.D., is PsychotherapySupervisor, Queens Children's Hospital, Bellerose, NY, and Clinical Psychologist in private practice. 19
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ance or dependency needs, s The influence of the interplay between parentchild interactions and organically based development was described by Lauretta Bender in a variety of studies of hospitalized children and adolescents who committed murders. ° In Aggression Hostility and Anxiety in Children 7 she commented on the frequency in the families of such youngsters of competition and rivalry among siblings for parental attention. In a review of 34 cases of hospitalized children in New York State who had committed murders, Bender noted severe early deprivation, schizophrenic signs in many of the cases, and a general absence of guilt about the murders. The children reportedly saw their homicidal acts as having been accidental, unexpected, or unintentionally fatal. Bender attributed the homicidal behavior to the disorganizing effect of environmental factors on patterned drive control. Among these groups of institutionalized children were psychopathic children who were characteristically aggressive and lacking in anxiety. Because they were deficient in thecapacity for identification or object love owing to the lack of an early relationship with a love object, their aggression was of a diffuse nature and the victim of their assaults had little value to them. 8 An earlier study of children who committed murder had also disclosed the presence of signs of organic brain disease, epilepsy, or schizophrenia. 9 Bowlby 1° stated that prolonged separation from the mother during the first few years of life is a primary cause of delinquent character formation. The prevalence of conscious and unconscious, overt or disguised parental messages to children to express themselves through violence is a consideration that follows from Reiner and Kaufman's 11investigation of character disorders in adolescence. Delinquent behavior in children may represent the fulfillment of unconscious parental needs arising from their own unresolved aggressive conflicts. Other investigators 12 have been able to confirm the role of family dynamics in contributing to assaults and murders by children. 13 In a recent study of the family system in the development of narcissistic disorders in adolescence, the severe disturbances in self-esteem in such adolescents was noted. Berkowitz et. al. TM attributed the fluctuations in selfesteem in these adolescents, and their vacillations from feelings of grandiosity to feelings of helplessness and inadequacy, to a narcissistic vulnerability. The essence of the narcissistic disturbance was the lack of an internal system for self-esteem regulation. Tape-recorded interviews and family therapy sessions provided firm clinical data that the parents used their adolescent children as objects for the regulation of their own tenuous self-esteem. The self of the child remained a continuation of the self-system of the parent. The family unit was a continuous interlocking system between parent and child, which fostered the maintenance of a precarious narcissistic equilibrium. The adolescent who develops in such a family constellation tends to remain tied to fulfilling parental expectations and dependent on the parents for his or her
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own continued self-esteem. He or she has really great difficulty in undergoing the separation phase of adolescence and in the emerging of an autonomous identity. The omnipotence and grandiosity of childhood narcissism does not become transformed or fully integrated with the ability for realistic appraisals of self and others. The central importance of underlying rage in narcissistic disturbances has been thoroughly discussed by Kohut 1~ and others in terms of its relation to self-esteem. 16 "The most violent forms of narcissistic rage arise in those individuals for whom a sense of absolute control over an archaic environment is indispensable because the maintenance of self-esteem--and indeed of the self--depends on the unconditional availability of the approving mirroring functions of an admiring self-object or on the ever present opportunity for a merger with an idealized one. '';7 The unavailability for the mirroring process of neglectful and rejecting parents has also been well-documented; 8 It is the central thesis of this paper that children and adolescents who murder are not merely lacking in impulse control, acting out of Oedipal guilt, or expressing poorly controlled rage. They are characterized by a vengeful narcissistic rage expressed through violent acts as attacks on a poorly integrated part-selfobject. Deprivation and rejection by early objects provide the framework for narcissistic disturbances in homicidal adolescents. Later parenting perpetuates their narcissistic vulnerability and feelings of shame and inadequacy. Acts of violent aggression and murder can represent not only expressions of rage, but also, simultaneously, a defensive response to lowered self-esteem and attempts at repair of the self. Violent acts by narcissistically vulnerable youths can also involve attempts at unconscious resolutions of trauma in early object relations. In a sample of adolescent murderers selected for study at Queens Children's Psychiatric Center, disturbances in self-esteem maintenance were common. These youngsters showed a propensity for narcissistic rage and vacillation between omnipotence and inadequacy, as well as a tendency to repeatedly act in a violent way. Their need for continued acts of violence marked a continuation of the same rage and a lack of repair of the self-structure. The personality characteristics of acting-out adolescents, in general, 19and of homicidal adolescents, in particular, 2° have been assessed by a variety of authors. 2~ A careful definition of delinquent adolescents' deficits emerges from the work of both Greenacre 22and Blos 23who both emphasize cognitive limitations. A predisposition to acting out exists in the distorted relationship of action to speech and thought. The expression of conflict through action, or perhaps violent assaults, becomes a substitute for the inner organization of experience. The expression of inner experience through articulate speech can be especially difficult for such a child. A selective superego deficit is common, together with a characteristic dependence on action as a replacement
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for verbalized thought. Greenacre depicts the delinquent acting-out in terms of manifest versus latent action themes. The latent meaning of a violent or delinquent act involves the consolidation of affective experience. The reliance on action is closely tied to difficulty in problem solving and concretization of thought. Rather than struggle with frustration and conflict, the delinquent typically acts out. The environment becomes only a medium for tension regulation, and other people become merely sources of need satisfaction. On an object-relations level there is a primitive continuation of partial objects. Integration of experience remains prelogical and marked by the tendency to act out rather than to reflect, assimilate, and respond. The acting-out of the delinquent can be seen as being defensive. Just as conflict resolution through acting-out emerges as a consistent pattern in delinquents, violent or homicidal acting-out can be understood in similar terms. Vacillations in self-esteem and limitations in self-esteem maintenance contribute to making viOlence ego-syntonic. A recent attempt by Miller and Looney 24to categorize murder syndromes among adolescents highlights their loss of control and their tendency to dehumanize their victims. Dehumanization involves a pathological projection of some split-off, unacceptable part of the self onto the other person. When it occurs, reality testing suffers to some degree, and the victim, who may represent an image of the depriving mother, loses his or her humanity. Menninger 2sfirst introduced the concept of episodic dyscontrol and defined it as momentary marked lapses of control that inhibit further decompensation in a disintegrating personality structure. The most-dangerous adolescents were either: first, those subject to marked episodic dyscontrol, who also showed total dehumanization of victims, or, second, those who showed partial dehumanization, with the aggressive eroticization of part objects. The former group of murderers were narcissistic omnipotent personalities for whom violence was ego-syntonic. Their capacity for dehumanization was the feature that distinguished them from merely assaultive adolescents. The latter group committed homocide when partial dehumanization occurred during a period of dyscontrol. They all revealed murderous fantasies that clearly indicated a mixture of sexuality and destructive aggression. The low-risk group (of partial dehumanizers) needed support and encouragement from external sources--i.e., the youth gang--in order to commit murder. This notion of violence as a defense against further ego-disruption is congruent with the findings of Blackman 26and those of other researchers.27In over 40 cases of people without any history of previous aggressive antisocial acts, murder was done impulsively without any apparent motive. Blackman assembled a personality profile of these cases which revealed them to be dependent, schizoid, or borderline schizophrenic males with weak masculine sexual identification who were easily provoked into rage. The
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murders they committed followed periods of profound struggle against dependency, feelings of helplessness, and impeding psychotic episodes. In a very detailed study of adolescent murders, Smith ~8 studied eight murderers ranging from age 14 to 21 and found a pattern of ego weakness, susceptibility to loss of control, and a character structure traceable to early oral deprivation. These adolescents' histories revealed: oral incorporation fantasies, an infantile clinging to love objects, and early disruption in family relationsh i ps. Edith Jacobson29portrayed the parents' role as one of aid ing the child's ego development by assisting in the neutralization of sexual and aggressive energies. The unavailability of the parents of adolescent murderers intensifies these youngsters' superego deficits. The superego of the adolescent murderer allows for eruptions of rage and limitations in avenues for its expression. When disappointment or frustration unleashes a primitive infantile rage in such adolescents, there seems to be a sudden loss of ego-object differentiation. Homicide is then a multidetermined response to the fear of being destroyed. 3° Smith's findings and the data below both support Eissler's view 31that aggression stems from anxiety and panic in the delinquent adolescent. The panic occurs because of a fixation atthe phase of infantile omnipotence. The clinical insights in this paper rely on interviews conducted by and data collected by Dr. Donn Winn of Queens Children's Psychiatric Center in 1975. Ten inpatient adolescents who had committed murder were compared in terms of early history, symptoms, and psychopathology. They included nine males and one female, aged 12 to 16 years. Nine of the adolescents had been deserted by one or both parents. The parents had either left their families permanently or were absent from the home for long durations owing to prolonged psychiatric hospitalization. Nine of the ten had histories of transient psychotic schizophrenic episodes and extensive histories of fighting, antisocial behavior, and in several cases, fire-setting. Their victims ranged in age from younger children to peers, adults who were strangers or neighbors; and in one case, a youngster murdered his mother. A lack of concern for the victims was generally noted, together with a fear of punishment or retal iation, rather than remorse or guilt. A, an only child, is now a 17-year-old boy who stabbed his mother to death a year after a period of hospitalization for assaultive behavior. After the death of his father at age 12, A's mother became increasingly ambivalent and seductive to him. A showed no overt symptoms of psychosis, but exhibited both borderline and psychopathic features and had a long history of violent, antisocial behavior. He was subject to feelings of inferiority and inadequacy to which he responded by assaultive behavior with littleor no provocation. In spite of dull normal intelligence and a third-grade reading level, he fantasized that he would become a world-famous archeologist. Poorly controlled rage,
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dehumanization and the potential for violent acting out permeated A's test materials. His self-esteem was enhanced prior to hospitalization by constantly carrying a knife and encouraging other boys to engage in violent antisocial acts. His productions showed: an ego-syntonic need for violent behavior, a lack of concern for the consequences of his actions, and a pervasive poorly controlled rage. B is a 1 7-year-old girl who was hospitalized during a psychotic episode after committing homicide. She stabbed an older female neighbor after a minor argument in which the woman criticized her. B was an out-of-wedlock child who lived with her mother and had little contact with her father. Depressed and isolated throughout her early childhood, B became outwardly aggressive and provocative after puberty. B feared men and women. These fears stemmed from projected fears of her own rage (which was directed against herself and her mother). Her dependency needs augmented her unconscious image of her mother who was herself psychopathic, depressed, and unavailable. Her need to protect and maintain a positive idealized maternal image played a dynamic role in her depression and outbursts of aggressive behavior. Whenever B was slighted or insulted in an argument, the need to express her violent aggressive feelings became powerful. The neighbor's criticism dealt a severe blow to her self-esteem and became a triggering mechanism for her highly charged, internalized attacks against the combined image of herself and her mother. B was severely depressed for four months following the homicide and presented a high suicide risk. After the acute phase of her schizophrenic episode and a period of ego reintegration, B was able to verbalize highly charged patterns of thinking and ambivalence towards her mother. When less-defensive with her therapist, she talked about a series of fantasies that centered around two sets of themes: "people jumping out of windows" and "people bleeding, being cut up." However, her character structure and paranoid suspiciousness made progress in therapy quite limited. Once her defensive network was reconstituted after her schizophrenic episode, her suspiciousness and need to defend herself against her female therapist created a therapeutic impasse and a barrier to emotional growth. Mental status interviews and psychological tests administered to these youngsters confirmed the presence of narcissistic disturbances and narcissistic rage. Early psychic events and "cumulative trauma" contributed to the narcissistic disturbances. Evidence of a schizophrenic process or organic impairment was not generally related to the homicidal behavior. These homicidal youngsters did show both primitive object'relations and vacillations in the sense of self-worth from infantile omnipotence..to profound feelings of inadequacy. Projective test protocols contained evidence of both episodic dyscontrol and dehumanization. On the Rorschach test, for exam-
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25
pie, several youngsters repeatedly saw statues in human-like movement instead of popular human-movement responses. Their vacillations in selfesteem can be understood in terms of what Kohut described as the lack of integration between the "grandiose self" and the "idealized parental image. ''~8 Their lack of cohesion of the self was illustrated by the use of splitting concretization and a generally primitive level of defenses. All of the ten patients showed a lack of concern for the victim after the murder and a tendency to contin ue the overt expression of violence. Aside from the specific dynamic conflicts which triggered off their homicidal assaults, narcissistic rage was at the intrapsychic core of their violent acts. Blows to their selfesteem assaulted their grandiosity and triggered off a powerfully destructive rage. In my view, their expression of the homicidal rage can be understood as an attempt at reparation of the self. Its expression affirmed a sense of reality and restored infantile omnipotence. These adolescents' lack of concern for their victims stemmed not simply from a psychopathic lack of guilt, but a dehumanization of the victim as object. The act of murder involved the destruction of the fused self and object. The violence may have had a narcissistic function in two ways. First, the rage was discharged against a fused self-object image. Second, the expression of the narcissistic rage restored the person to the state of infantile omnipotence. In this state, the adolescent murderer then becomes less vulnerable to blows to self-esteem. Sadistic fantasies have been described as having a narcissistic origin, and such fantasies were common to these adolescent murderers. Both sadistic fantasies and homicidal acts or explosively violent assaults can be understood as attempts at redress of a common narcissistic vulnerability. In tracing the growth of healthy narcissism and self-esteem regulation, Kohut 18 stressed the importance of the parents' availability for the essential self-enhancing mirroring process. Interference with this process through deprivation resulted in narcissistic rage. Narcissistic rage involved both a need for revenge and a persistent compulsion to pursue it. It is characterized by a "total lack of empathy for the offender. It explains the unmodifiable wish to blot outthe offense perpetuated against the grandiose self that the unforgiving fury arising when the control over the mirroring self-object is lost or when the omnipotent self-object is unavailable. 17.p. 386The omnipotence and grandiosity of the injured infantile self can be reaffirmed through sadistic fantasies. 32In the analysis of sadistic fantasies, two findings have been noteworthy. First, rage subsequent to an insult to the omnipotent self has a pervasive tendency to linger. Its retaliatory nature is often directed against a depriving mother image. Second, feelings of anxiety, helplessness, and inadequacy accompany the rage; hence, feelings tend to necessitate further reparation for lost self-esteem. Moreover, there is an aggressivization of the penis and an erotization of the
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whole body. 33 Such early disturbances in infantile narcissism, defined by Reich, occur before a stage of self-object differentiation. This produces a cathexis of the partial self and impaired capacity for later self-esteem regulation. Hence, people are not cathected as objects. In the adolescent murderer, there is a need for violent sadistic fantasies to be expressed overtly and a vacillation in self-regard from blithe omnipotence to depression and feelings of inadequacy. A frequently fantasized about violent fights and beatings, whereas B was preoccupied with fantasies of people being cut and bleed ing. Sexual ity and aggression become joined with the need for revenge. The need for revenge coincides with the need for the restoration of infantile omnipotence. It creates a disposition for the expression of violent homicidal rage. In sadomasochistic relationships, the sadist may gain a narcissistic satisfaction through identification with the pain of the victim or through a sense of omnipotent control over the victim. 34The same relationship may hold for the adolescent murderer. The expression of homicidal rage can restore the fragmented infantile grandiose self not only through discharge of destructive impulses but also through the reacquisition of a sense of omnipotent control. In a different context, Winnicott 3smaintained that the erotization of aggression can be a cause of compulsive sadistic tendencies in narcissistic personalities. Because of narcissistic disturbances, the adolescent murderer may be able to "feel real" when being destructive. When Freud alluded to the "narcissistic enjoyment" of destructiveness he paved the way for the scrutiny of the relationship between violent acts and the self or the ego. Although psychoanalysis or psychoanalytic psychotherapy has not been stressed with aggressive acting-out delinquents, it has been tried with some parameters. One approach has been the establ ishment of a preparatory phase of treatment which has as its principal goal development of transference to the analyst. 32 "The predominantly narcissistic quality of the delinquent's personality, his incapacity of loving . . . and the consequent absence of any spontaneous positive transference reaction, make it necessary thatthe analyst provoke or create the positive transference by active measures. ''3~, p" 99 This transference develops in the delinquent when the analyst has been experienced as an omnipotent being who is consistently interested in the patient's benefit. This is accomplished by not responding to the efforts to provoke the analyst and by limit-setting. The experience of those involved in treatment with the homicidal adolescents mentioned above suggests that a direct active approach can be fruitful, while concentrating on the development of a positive transference is not. Their extreme lack of impulse control and strong unconscious need to defeat the therapist work to prevent the establishment of a positive emotional relationship. The integration of a more-cohesive internalized self-structure and the development of firm controls to inhibit the
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youthful murderer from further violent aggression must be the two chief goals of therapy. The strategem of the therapists' mirroring the patients grandiosity to present a facsimileof the omnipotent partner21falls short of those therapeutic goals. In-depth follow-up studies of the ten adolescents in the study were impossible. Attempts at therapeutic change during their hospitalization provided generally poor results, but two aspects of their therapy bear repetition in work with other violent or homicidal adolescents. An active confrontational engagement of the patient is crucial in trying to make the overt expression of violence ego-dystonic and anxiety provoking. Group therapy was tried to that end at Queens Children's Psychiatric Center as an adjunct to individual therapy in some cases. The group process is useful in the attempt to disassociate heightened self-esteem from violent behavior. Overcoming resistance to general involvement in therapy remained an enormous obstacle with A and B, because violent assaultive behavior continued to be ego-syntonic. The need to address narcissistic disturbances in homicidal adolescents is also crucial. The active involvement of family members in family therapy provides some opportunity to alter the family framework within which narcissistic disturbances are perpetuated. The potential for future violent behavior is reduced if the therapist can work with the patient on the verbal expression of rage and in developing a more-substantial internal system for self-esteem regulation. The use of techniques to mobilize and heighten rage in transference, particularly paradigmatic techniques, 36could minimize the patient's behavioral expression of rage. Countertransference problems with homicidal adolescents are magnified by the almost automatic negative reactions they evoke and by fear of the therapist's own potential for rage and violence. On a lower order of priority, the generalized ego deficits present in both the murderers and delinquents need to be addressed. Primitive defenses, cognitive deficits, a lack of sublimations, and intolerance for minor insults all complicate the disturbance in self-esteem regulation. Ten adolescent murders were studied in terms of history, psychiatric and psychological evaluations, and psychotherapeutic treatment. Narcissistic disturbances, particularly an impaired capacity for self-esteem regulation and underlying narcissistic rage, were related to homicidal behavior. The youths' lack of concern for their victims and continued violence was explained on the basis of these factors. The homicidal assaults appeared to be multidetermined by early deprivation and disturbances in object relations that paralleled a lack of solidity of the self. The homicidal assaults were also related to the presence of dehumanization, loss of control and sadistic fantasies. It was proposed that violent acts, like sadistic fantasies, may restore omnipotence to the infantile self and thereby represent an attempt at reparation of the self. Treatment with these patients pointed to the need for a dual therapeutic focus on the evoca-
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tion of the patient's rage, so as to make overt violence dystonic, and on the presence of underlying narcissistic disturbances. The study underscores the need for broader investigations of a narcissistic function of violence or homicidal behavior. References
1. Freud, S. Civilization and its Discontents. In The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth. 1A. Freud, S. The Ego and the Id. In The Standard Edition of the Complete Psychological Works of Sigmund Freud. London: Hogarth. 2. Aichhorn, A. Wayward Youth. New York: Viking, 1935. 3. Glover, E. The Rootsof Crime. New York: International Universities Press, 1960. 4. Redl, F. Children Who Hate. New York: Macmillan, 1951. 5. Bandura, W. Adolescent Aggression: A Study of the Influence of Child Training Practice and Family Interrelationships. New York: Ronald Press, 1959. 6. Bender, L., and Curran, F. Children and adolescents who kill, J. Crim. Psychopathol., 1 (1940). 7. Bender, L. Aggression, Hostility and Anxiety in Children. Springfield: Charles C. Thomas, 1953. 8. Bender, L. Aggression in children. In S. Frazier (Ed.) Aggression. Baltimore: Williams & Wilkins, 1974. 9. Bender, L. Children and adolescents who have killed; Am. J. Psychiatry, 116(1959):510-513. 10. Bowlby, J. Child Care and the Growth of Love. London: Hogarth, 1953. 11. Reiner, B., and Kaufman, I. Character Disorders in Parents of Delinquents. New York: Family Service Association of America, 1959. 12. Easson, W., and Steinhilber, R. Murderous aggression by children and adolescents; Arch. Gen. Psychiatry, 4(1961). 13. Sargent, D. Children who kilI--A family conspiracy. Social Work, 13(1965):3542. 14. Berkowitz, D., Shapiro, R., Zinner, J., and Shapiro, E. Family contributions to narcissistic disturbances in adolescents. Int. J. Psychoanal. 1(1974):353-367. 15. Kohut, H. Forms and transformations of narcissism. J. Am. Psychoanal. Assoc. 14(1966):243-272. 16. Kohut, H. The psychoanalytic treatment of narcissistic personality disorders. Psychoanal. Study Child, 23(1968):86-113. 17. Kohut, H. Thoughts on narcissism and narcissistic rage. Psychoanal. Study Child, 27(1972):360-399. 18. Kohut, H. The Analysis of the Self. New York: International Universities Press, 1971. 19. Toch, H. An Inquiry Into the Psychology of Violence, Chicago: Aldine, 1969. 20. Johnson, A., and Szurek, S. The genesis of anti-social acting out in children and adults. Psychoanal. Q. 21(1952):323-343. 21. Aichhorn, A. The Narcissistic transference of the juvenile imposter. In O. Fleischmann, P. Kramer, and H. Ross (Eds.) Delinquency and Child Guidance: Selected Papersby August Aichhorn. New York: International Universities Press, 1964. 22. Greenacre, P. Trauma, Growth and Personality. New York: International Universities Press, 1950.
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23. Blos, P. Adolescent concretization: A contribution to the theory of delinquency. In I. M. Marcus, (Ed.) Currents in Psychoanalysis, New York: International Universities Press, 1971. 24. Miller, O. and Looney, J. The prediction of adolescent homicide: Episodic dyscontrol and dehumanization. Am. J. Psychoanal. 34(I 974):I 87-I 98. 25. Menninger, K., and Maymon, M. Episodic dyscontrol: A third order of stress adaptation. Bull. Menninger Clin. 20(1956):153. 26. Blackman, N., Weiss, J., and Lamberts, J. The sudden murderer; Arch. Gen. Psychiatry 8(1963):289-294. 27. Reichard, S., and Tillman, C. Murder and suicide as defenses against schizophrenic psychosis. J. Clin. Psychopathol. 11 (1950):149. 28. Smith, S. The adolescent murderer. Arch. Gen. Psychiatry 13(1965):310-319. 29. Jacobson, E. The Self and the Object World. New York: International Universities Press, 1964. 30. Bromberg, W. A psychological study of murder. Int. J. Psychoanal. 32(1971):117-127. 31. Eissler, K. Ego psychological implications of the psychoanalytic treatment of delinquents. Psychoanal. Study Child 5(1950):97-121. 32. Bach, S., and Schwartz, U A dream of Marquis de Sade; J. Amer. Psychoanal. Assoc. 20(1972):451-474. 33. Reich, A. Pathologic forms of self esteem regulation. J. Psychoanal. Assoc. 15(1960):215-232. 34. Stollorow, R. The narcissistic functions of Masochism and Sadism; Int. J. of Psychoanal. 56(1975):441-448. 35. Winnicott, D. From Pediatrics Through Psychoanalysis. New York: Basic Books, 1975. 36. Spotnitz, H. Modern Psychoanalysis With the Schizophrenic Patient. New York: Grue & Shatton, 1969.
NARCISSISM AND THE SELF IN HOMICIDAL ADOLESCENTS James B. McCarthy Even where it emerges without any sexual purpose, in the blindest fury of destructiveness, the satisfaction of an instinct is accompanied by an extraordinarily high degree of narcissisticenjoyment.., owing to its old wishes for omnipotence. I Concern about homicidal and violent behavior in children and adolescents has been reflected in attempts to study them from statistical, developmental and psychodynamic points of view. In the Ego and the Id, IA Freud related criminal behavior in youths to a powerful sense of unconscious guilt which is primarily Oedipal in origin. He later stated in his preface to Aichhorn's WaywardYouth2that neither juvenile delinquents norcriminals havethe fully developed psychic apparatus that is essential for psychoanalysis. Glover 3saw delinquent criminal behavior as a series of hostile attacks on the environment that were motivated by the delinquents' strong unconscious need for punishment. A homicidal assault could thereby represent both an attack on unrecognized persecutors and a mechanism for the alleviation of guilt, as well as an unconscious demand for punishment. Another early psychoanalytic view of criminal behavior stressed anal character traits involving a spiteful rejection of societal norms and diminished superego control over id-derived antisocial activities. 4 Even though an inquiry into the personality construction of adolescents who commit violently assaultive acts is essential for treatment, little attention has been paid to the early pre-Oedipal predisposing events. Aside from the influence o f the sociocultural milieu of the youth gang, what are the psychic events that predispose an adolescent or child to overtly express a murderous rage? Of what importance can psychotherapy be in reducing the possibility that an adolescent who has murdered will commit further acts of violence? The purpose of the present paper will be to review the studies that bear light on this issue and to focus on early object relations phenomena. The relationship between narcissism and the self in violence-prone youngsters is particularly important in the formulation of treatment issues. Within the framework of a behavioral approach, adolescent aggression has been considered to be a learned response pattern to frustratation of nurturJames B. McCarthy, Ph.D., is PsychotherapySupervisor, Queens Children's Hospital, Bellerose, NY, and Clinical Psychologist in private practice. 19
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ance or dependency needs, s The influence of the interplay between parentchild interactions and organically based development was described by Lauretta Bender in a variety of studies of hospitalized children and adolescents who committed murders. ° In Aggression Hostility and Anxiety in Children 7 she commented on the frequency in the families of such youngsters of competition and rivalry among siblings for parental attention. In a review of 34 cases of hospitalized children in New York State who had committed murders, Bender noted severe early deprivation, schizophrenic signs in many of the cases, and a general absence of guilt about the murders. The children reportedly saw their homicidal acts as having been accidental, unexpected, or unintentionally fatal. Bender attributed the homicidal behavior to the disorganizing effect of environmental factors on patterned drive control. Among these groups of institutionalized children were psychopathic children who were characteristically aggressive and lacking in anxiety. Because they were deficient in thecapacity for identification or object love owing to the lack of an early relationship with a love object, their aggression was of a diffuse nature and the victim of their assaults had little value to them. 8 An earlier study of children who committed murder had also disclosed the presence of signs of organic brain disease, epilepsy, or schizophrenia. 9 Bowlby 1° stated that prolonged separation from the mother during the first few years of life is a primary cause of delinquent character formation. The prevalence of conscious and unconscious, overt or disguised parental messages to children to express themselves through violence is a consideration that follows from Reiner and Kaufman's 11investigation of character disorders in adolescence. Delinquent behavior in children may represent the fulfillment of unconscious parental needs arising from their own unresolved aggressive conflicts. Other investigators 12 have been able to confirm the role of family dynamics in contributing to assaults and murders by children. 13 In a recent study of the family system in the development of narcissistic disorders in adolescence, the severe disturbances in self-esteem in such adolescents was noted. Berkowitz et. al. TM attributed the fluctuations in selfesteem in these adolescents, and their vacillations from feelings of grandiosity to feelings of helplessness and inadequacy, to a narcissistic vulnerability. The essence of the narcissistic disturbance was the lack of an internal system for self-esteem regulation. Tape-recorded interviews and family therapy sessions provided firm clinical data that the parents used their adolescent children as objects for the regulation of their own tenuous self-esteem. The self of the child remained a continuation of the self-system of the parent. The family unit was a continuous interlocking system between parent and child, which fostered the maintenance of a precarious narcissistic equilibrium. The adolescent who develops in such a family constellation tends to remain tied to fulfilling parental expectations and dependent on the parents for his or her
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own continued self-esteem. He or she has really great difficulty in undergoing the separation phase of adolescence and in the emerging of an autonomous identity. The omnipotence and grandiosity of childhood narcissism does not become transformed or fully integrated with the ability for realistic appraisals of self and others. The central importance of underlying rage in narcissistic disturbances has been thoroughly discussed by Kohut 1~ and others in terms of its relation to self-esteem. 16 "The most violent forms of narcissistic rage arise in those individuals for whom a sense of absolute control over an archaic environment is indispensable because the maintenance of self-esteem--and indeed of the self--depends on the unconditional availability of the approving mirroring functions of an admiring self-object or on the ever present opportunity for a merger with an idealized one. '';7 The unavailability for the mirroring process of neglectful and rejecting parents has also been well-documented; 8 It is the central thesis of this paper that children and adolescents who murder are not merely lacking in impulse control, acting out of Oedipal guilt, or expressing poorly controlled rage. They are characterized by a vengeful narcissistic rage expressed through violent acts as attacks on a poorly integrated part-selfobject. Deprivation and rejection by early objects provide the framework for narcissistic disturbances in homicidal adolescents. Later parenting perpetuates their narcissistic vulnerability and feelings of shame and inadequacy. Acts of violent aggression and murder can represent not only expressions of rage, but also, simultaneously, a defensive response to lowered self-esteem and attempts at repair of the self. Violent acts by narcissistically vulnerable youths can also involve attempts at unconscious resolutions of trauma in early object relations. In a sample of adolescent murderers selected for study at Queens Children's Psychiatric Center, disturbances in self-esteem maintenance were common. These youngsters showed a propensity for narcissistic rage and vacillation between omnipotence and inadequacy, as well as a tendency to repeatedly act in a violent way. Their need for continued acts of violence marked a continuation of the same rage and a lack of repair of the self-structure. The personality characteristics of acting-out adolescents, in general, 19and of homicidal adolescents, in particular, 2° have been assessed by a variety of authors. 2~ A careful definition of delinquent adolescents' deficits emerges from the work of both Greenacre 22and Blos 23who both emphasize cognitive limitations. A predisposition to acting out exists in the distorted relationship of action to speech and thought. The expression of conflict through action, or perhaps violent assaults, becomes a substitute for the inner organization of experience. The expression of inner experience through articulate speech can be especially difficult for such a child. A selective superego deficit is common, together with a characteristic dependence on action as a replacement
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for verbalized thought. Greenacre depicts the delinquent acting-out in terms of manifest versus latent action themes. The latent meaning of a violent or delinquent act involves the consolidation of affective experience. The reliance on action is closely tied to difficulty in problem solving and concretization of thought. Rather than struggle with frustration and conflict, the delinquent typically acts out. The environment becomes only a medium for tension regulation, and other people become merely sources of need satisfaction. On an object-relations level there is a primitive continuation of partial objects. Integration of experience remains prelogical and marked by the tendency to act out rather than to reflect, assimilate, and respond. The acting-out of the delinquent can be seen as being defensive. Just as conflict resolution through acting-out emerges as a consistent pattern in delinquents, violent or homicidal acting-out can be understood in similar terms. Vacillations in self-esteem and limitations in self-esteem maintenance contribute to making viOlence ego-syntonic. A recent attempt by Miller and Looney 24to categorize murder syndromes among adolescents highlights their loss of control and their tendency to dehumanize their victims. Dehumanization involves a pathological projection of some split-off, unacceptable part of the self onto the other person. When it occurs, reality testing suffers to some degree, and the victim, who may represent an image of the depriving mother, loses his or her humanity. Menninger 2sfirst introduced the concept of episodic dyscontrol and defined it as momentary marked lapses of control that inhibit further decompensation in a disintegrating personality structure. The most-dangerous adolescents were either: first, those subject to marked episodic dyscontrol, who also showed total dehumanization of victims, or, second, those who showed partial dehumanization, with the aggressive eroticization of part objects. The former group of murderers were narcissistic omnipotent personalities for whom violence was ego-syntonic. Their capacity for dehumanization was the feature that distinguished them from merely assaultive adolescents. The latter group committed homocide when partial dehumanization occurred during a period of dyscontrol. They all revealed murderous fantasies that clearly indicated a mixture of sexuality and destructive aggression. The low-risk group (of partial dehumanizers) needed support and encouragement from external sources--i.e., the youth gang--in order to commit murder. This notion of violence as a defense against further ego-disruption is congruent with the findings of Blackman 26and those of other researchers.27In over 40 cases of people without any history of previous aggressive antisocial acts, murder was done impulsively without any apparent motive. Blackman assembled a personality profile of these cases which revealed them to be dependent, schizoid, or borderline schizophrenic males with weak masculine sexual identification who were easily provoked into rage. The
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murders they committed followed periods of profound struggle against dependency, feelings of helplessness, and impeding psychotic episodes. In a very detailed study of adolescent murders, Smith ~8 studied eight murderers ranging from age 14 to 21 and found a pattern of ego weakness, susceptibility to loss of control, and a character structure traceable to early oral deprivation. These adolescents' histories revealed: oral incorporation fantasies, an infantile clinging to love objects, and early disruption in family relationsh i ps. Edith Jacobson29portrayed the parents' role as one of aid ing the child's ego development by assisting in the neutralization of sexual and aggressive energies. The unavailability of the parents of adolescent murderers intensifies these youngsters' superego deficits. The superego of the adolescent murderer allows for eruptions of rage and limitations in avenues for its expression. When disappointment or frustration unleashes a primitive infantile rage in such adolescents, there seems to be a sudden loss of ego-object differentiation. Homicide is then a multidetermined response to the fear of being destroyed. 3° Smith's findings and the data below both support Eissler's view 31that aggression stems from anxiety and panic in the delinquent adolescent. The panic occurs because of a fixation atthe phase of infantile omnipotence. The clinical insights in this paper rely on interviews conducted by and data collected by Dr. Donn Winn of Queens Children's Psychiatric Center in 1975. Ten inpatient adolescents who had committed murder were compared in terms of early history, symptoms, and psychopathology. They included nine males and one female, aged 12 to 16 years. Nine of the adolescents had been deserted by one or both parents. The parents had either left their families permanently or were absent from the home for long durations owing to prolonged psychiatric hospitalization. Nine of the ten had histories of transient psychotic schizophrenic episodes and extensive histories of fighting, antisocial behavior, and in several cases, fire-setting. Their victims ranged in age from younger children to peers, adults who were strangers or neighbors; and in one case, a youngster murdered his mother. A lack of concern for the victims was generally noted, together with a fear of punishment or retal iation, rather than remorse or guilt. A, an only child, is now a 17-year-old boy who stabbed his mother to death a year after a period of hospitalization for assaultive behavior. After the death of his father at age 12, A's mother became increasingly ambivalent and seductive to him. A showed no overt symptoms of psychosis, but exhibited both borderline and psychopathic features and had a long history of violent, antisocial behavior. He was subject to feelings of inferiority and inadequacy to which he responded by assaultive behavior with littleor no provocation. In spite of dull normal intelligence and a third-grade reading level, he fantasized that he would become a world-famous archeologist. Poorly controlled rage,
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dehumanization and the potential for violent acting out permeated A's test materials. His self-esteem was enhanced prior to hospitalization by constantly carrying a knife and encouraging other boys to engage in violent antisocial acts. His productions showed: an ego-syntonic need for violent behavior, a lack of concern for the consequences of his actions, and a pervasive poorly controlled rage. B is a 1 7-year-old girl who was hospitalized during a psychotic episode after committing homicide. She stabbed an older female neighbor after a minor argument in which the woman criticized her. B was an out-of-wedlock child who lived with her mother and had little contact with her father. Depressed and isolated throughout her early childhood, B became outwardly aggressive and provocative after puberty. B feared men and women. These fears stemmed from projected fears of her own rage (which was directed against herself and her mother). Her dependency needs augmented her unconscious image of her mother who was herself psychopathic, depressed, and unavailable. Her need to protect and maintain a positive idealized maternal image played a dynamic role in her depression and outbursts of aggressive behavior. Whenever B was slighted or insulted in an argument, the need to express her violent aggressive feelings became powerful. The neighbor's criticism dealt a severe blow to her self-esteem and became a triggering mechanism for her highly charged, internalized attacks against the combined image of herself and her mother. B was severely depressed for four months following the homicide and presented a high suicide risk. After the acute phase of her schizophrenic episode and a period of ego reintegration, B was able to verbalize highly charged patterns of thinking and ambivalence towards her mother. When less-defensive with her therapist, she talked about a series of fantasies that centered around two sets of themes: "people jumping out of windows" and "people bleeding, being cut up." However, her character structure and paranoid suspiciousness made progress in therapy quite limited. Once her defensive network was reconstituted after her schizophrenic episode, her suspiciousness and need to defend herself against her female therapist created a therapeutic impasse and a barrier to emotional growth. Mental status interviews and psychological tests administered to these youngsters confirmed the presence of narcissistic disturbances and narcissistic rage. Early psychic events and "cumulative trauma" contributed to the narcissistic disturbances. Evidence of a schizophrenic process or organic impairment was not generally related to the homicidal behavior. These homicidal youngsters did show both primitive object'relations and vacillations in the sense of self-worth from infantile omnipotence..to profound feelings of inadequacy. Projective test protocols contained evidence of both episodic dyscontrol and dehumanization. On the Rorschach test, for exam-
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pie, several youngsters repeatedly saw statues in human-like movement instead of popular human-movement responses. Their vacillations in selfesteem can be understood in terms of what Kohut described as the lack of integration between the "grandiose self" and the "idealized parental image. ''~8 Their lack of cohesion of the self was illustrated by the use of splitting concretization and a generally primitive level of defenses. All of the ten patients showed a lack of concern for the victim after the murder and a tendency to contin ue the overt expression of violence. Aside from the specific dynamic conflicts which triggered off their homicidal assaults, narcissistic rage was at the intrapsychic core of their violent acts. Blows to their selfesteem assaulted their grandiosity and triggered off a powerfully destructive rage. In my view, their expression of the homicidal rage can be understood as an attempt at reparation of the self. Its expression affirmed a sense of reality and restored infantile omnipotence. These adolescents' lack of concern for their victims stemmed not simply from a psychopathic lack of guilt, but a dehumanization of the victim as object. The act of murder involved the destruction of the fused self and object. The violence may have had a narcissistic function in two ways. First, the rage was discharged against a fused self-object image. Second, the expression of the narcissistic rage restored the person to the state of infantile omnipotence. In this state, the adolescent murderer then becomes less vulnerable to blows to self-esteem. Sadistic fantasies have been described as having a narcissistic origin, and such fantasies were common to these adolescent murderers. Both sadistic fantasies and homicidal acts or explosively violent assaults can be understood as attempts at redress of a common narcissistic vulnerability. In tracing the growth of healthy narcissism and self-esteem regulation, Kohut 18 stressed the importance of the parents' availability for the essential self-enhancing mirroring process. Interference with this process through deprivation resulted in narcissistic rage. Narcissistic rage involved both a need for revenge and a persistent compulsion to pursue it. It is characterized by a "total lack of empathy for the offender. It explains the unmodifiable wish to blot outthe offense perpetuated against the grandiose self that the unforgiving fury arising when the control over the mirroring self-object is lost or when the omnipotent self-object is unavailable. 17.p. 386The omnipotence and grandiosity of the injured infantile self can be reaffirmed through sadistic fantasies. 32In the analysis of sadistic fantasies, two findings have been noteworthy. First, rage subsequent to an insult to the omnipotent self has a pervasive tendency to linger. Its retaliatory nature is often directed against a depriving mother image. Second, feelings of anxiety, helplessness, and inadequacy accompany the rage; hence, feelings tend to necessitate further reparation for lost self-esteem. Moreover, there is an aggressivization of the penis and an erotization of the
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whole body. 33 Such early disturbances in infantile narcissism, defined by Reich, occur before a stage of self-object differentiation. This produces a cathexis of the partial self and impaired capacity for later self-esteem regulation. Hence, people are not cathected as objects. In the adolescent murderer, there is a need for violent sadistic fantasies to be expressed overtly and a vacillation in self-regard from blithe omnipotence to depression and feelings of inadequacy. A frequently fantasized about violent fights and beatings, whereas B was preoccupied with fantasies of people being cut and bleed ing. Sexual ity and aggression become joined with the need for revenge. The need for revenge coincides with the need for the restoration of infantile omnipotence. It creates a disposition for the expression of violent homicidal rage. In sadomasochistic relationships, the sadist may gain a narcissistic satisfaction through identification with the pain of the victim or through a sense of omnipotent control over the victim. 34The same relationship may hold for the adolescent murderer. The expression of homicidal rage can restore the fragmented infantile grandiose self not only through discharge of destructive impulses but also through the reacquisition of a sense of omnipotent control. In a different context, Winnicott 3smaintained that the erotization of aggression can be a cause of compulsive sadistic tendencies in narcissistic personalities. Because of narcissistic disturbances, the adolescent murderer may be able to "feel real" when being destructive. When Freud alluded to the "narcissistic enjoyment" of destructiveness he paved the way for the scrutiny of the relationship between violent acts and the self or the ego. Although psychoanalysis or psychoanalytic psychotherapy has not been stressed with aggressive acting-out delinquents, it has been tried with some parameters. One approach has been the establ ishment of a preparatory phase of treatment which has as its principal goal development of transference to the analyst. 32 "The predominantly narcissistic quality of the delinquent's personality, his incapacity of loving . . . and the consequent absence of any spontaneous positive transference reaction, make it necessary thatthe analyst provoke or create the positive transference by active measures. ''3~, p" 99 This transference develops in the delinquent when the analyst has been experienced as an omnipotent being who is consistently interested in the patient's benefit. This is accomplished by not responding to the efforts to provoke the analyst and by limit-setting. The experience of those involved in treatment with the homicidal adolescents mentioned above suggests that a direct active approach can be fruitful, while concentrating on the development of a positive transference is not. Their extreme lack of impulse control and strong unconscious need to defeat the therapist work to prevent the establishment of a positive emotional relationship. The integration of a more-cohesive internalized self-structure and the development of firm controls to inhibit the
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youthful murderer from further violent aggression must be the two chief goals of therapy. The strategem of the therapists' mirroring the patients grandiosity to present a facsimileof the omnipotent partner21falls short of those therapeutic goals. In-depth follow-up studies of the ten adolescents in the study were impossible. Attempts at therapeutic change during their hospitalization provided generally poor results, but two aspects of their therapy bear repetition in work with other violent or homicidal adolescents. An active confrontational engagement of the patient is crucial in trying to make the overt expression of violence ego-dystonic and anxiety provoking. Group therapy was tried to that end at Queens Children's Psychiatric Center as an adjunct to individual therapy in some cases. The group process is useful in the attempt to disassociate heightened self-esteem from violent behavior. Overcoming resistance to general involvement in therapy remained an enormous obstacle with A and B, because violent assaultive behavior continued to be ego-syntonic. The need to address narcissistic disturbances in homicidal adolescents is also crucial. The active involvement of family members in family therapy provides some opportunity to alter the family framework within which narcissistic disturbances are perpetuated. The potential for future violent behavior is reduced if the therapist can work with the patient on the verbal expression of rage and in developing a more-substantial internal system for self-esteem regulation. The use of techniques to mobilize and heighten rage in transference, particularly paradigmatic techniques, 36could minimize the patient's behavioral expression of rage. Countertransference problems with homicidal adolescents are magnified by the almost automatic negative reactions they evoke and by fear of the therapist's own potential for rage and violence. On a lower order of priority, the generalized ego deficits present in both the murderers and delinquents need to be addressed. Primitive defenses, cognitive deficits, a lack of sublimations, and intolerance for minor insults all complicate the disturbance in self-esteem regulation. Ten adolescent murders were studied in terms of history, psychiatric and psychological evaluations, and psychotherapeutic treatment. Narcissistic disturbances, particularly an impaired capacity for self-esteem regulation and underlying narcissistic rage, were related to homicidal behavior. The youths' lack of concern for their victims and continued violence was explained on the basis of these factors. The homicidal assaults appeared to be multidetermined by early deprivation and disturbances in object relations that paralleled a lack of solidity of the self. The homicidal assaults were also related to the presence of dehumanization, loss of control and sadistic fantasies. It was proposed that violent acts, like sadistic fantasies, may restore omnipotence to the infantile self and thereby represent an attempt at reparation of the self. Treatment with these patients pointed to the need for a dual therapeutic focus on the evoca-
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tion of the patient's rage, so as to make overt violence dystonic, and on the presence of underlying narcissistic disturbances. The study underscores the need for broader investigations of a narcissistic function of violence or homicidal behavior. References
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23. Blos, P. Adolescent concretization: A contribution to the theory of delinquency. In I. M. Marcus, (Ed.) Currents in Psychoanalysis, New York: International Universities Press, 1971. 24. Miller, O. and Looney, J. The prediction of adolescent homicide: Episodic dyscontrol and dehumanization. Am. J. Psychoanal. 34(I 974):I 87-I 98. 25. Menninger, K., and Maymon, M. Episodic dyscontrol: A third order of stress adaptation. Bull. Menninger Clin. 20(1956):153. 26. Blackman, N., Weiss, J., and Lamberts, J. The sudden murderer; Arch. Gen. Psychiatry 8(1963):289-294. 27. Reichard, S., and Tillman, C. Murder and suicide as defenses against schizophrenic psychosis. J. Clin. Psychopathol. 11 (1950):149. 28. Smith, S. The adolescent murderer. Arch. Gen. Psychiatry 13(1965):310-319. 29. Jacobson, E. The Self and the Object World. New York: International Universities Press, 1964. 30. Bromberg, W. A psychological study of murder. Int. J. Psychoanal. 32(1971):117-127. 31. Eissler, K. Ego psychological implications of the psychoanalytic treatment of delinquents. Psychoanal. Study Child 5(1950):97-121. 32. Bach, S., and Schwartz, U A dream of Marquis de Sade; J. Amer. Psychoanal. Assoc. 20(1972):451-474. 33. Reich, A. Pathologic forms of self esteem regulation. J. Psychoanal. Assoc. 15(1960):215-232. 34. Stollorow, R. The narcissistic functions of Masochism and Sadism; Int. J. of Psychoanal. 56(1975):441-448. 35. Winnicott, D. From Pediatrics Through Psychoanalysis. New York: Basic Books, 1975. 36. Spotnitz, H. Modern Psychoanalysis With the Schizophrenic Patient. New York: Grue & Shatton, 1969.
