Loneliness and Personality Pathology: Revisiting Kohut and Kernberg ()
1. Introduction
In this study, we attempt to illustrate and discuss loneliness in personality pathology by revisiting the psychoanalytic theories of Heinz Kohut and Otto F. Kernberg. These theories have largely contributed to the understanding and treatment of personality disorders and have many common features. Loneliness, as the painful state of being alone, is a fundamental human experience, although it has attracted research attention in the last few decades, and it is relatively less understood and interpreted at a theoretical level (for such classic studies, see Dolto, 1985 ; Klein, 1975 ; Fromm-Reichmann, 1990 ; Winnicott, 1965 ; see also Galanaki, 2014b, 2021, 2023 ). However, various qualities of loneliness seem to predominate in serious personality pathology and need further investigation. Psychoanalytic theories, in general, have the potential to offer insight into loneliness, thus generating research hypotheses and advances in clinical practice regarding this experience.
2. Kohut: Grandiose Isolation
The Austrian-born American psychiatrist and psychoanalyst Heinz Kohut (1913-1981) experienced isolation and a great sense of loneliness during his childhood due to the rare presence of his father and his intrusive and narcissistic mother. As a Jew, during his youth, he fled the Nazis and experienced marginalization and alienation, while also he did not identify with his Jewish origins. By introducing self-psychology, Kohut moved away from the Freudian tradition and received very strong criticisms that isolated him from the psychoanalytic community (Kohut, 1979; Strozier, 2001) . Furthermore, in one of his essays, he addressed the isolation of the field of psychoanalysis itself, in the sense of its poor integration with the university, the “community of scholars” (Kohut, 1975) . Therefore, it is no coincidence that Kohut elaborated on themes such as the narcissistic investment of the self and isolation.
2.1. The Human Presence of Selfobjects
In normal development, Kohut (1971) argued that primary narcissism during infancy meets the deficits of parental care, which cannot fully satisfy it. The child substitutes his/her traumatized omnipotence with a grandiose self and attributes the perfection to a wonderful, all-powerful object—essentially a transitional selfobject—which is the idealized parental imago (from the archaic mother-breast to the idealized oedipal parent) or resorts to fantasies, such as the imaginary playmate, who function as an alter ego.
After the disturbance of primary narcissism, the infant unconsciously attempts to rescue a part of the lost experience of omnipotence by creating the idealized parental imago. Kohut (1971) stated:
Since all bliss and power now reside in the idealized object, the child feels empty and powerless when he is separated from it and he attempts, therefore, to maintain a continuous union with it (p. 37, emphasis added).
It is evident that childhood loneliness may be a terrifying experience, characterized by fantasies of merging with the mother. However, this is a normal developmental phenomenon.
If the parents succeed in satisfying the child’s narcissistic needs selectively—that is, whenever necessary—and in an age-appropriate way, and if they adequately provide a responsive selfobject milieu, the grandiose self will unfold and gradually be neutralized. The small, inevitable disruptions of the mother’s empathy create the conditions in which the child internalizes this object (Kohut, 1977) . This means that the child will accept his/her limitations, abandon the grandiose fantasies, substitute them with ego-syntonic goals, derive pleasure from activities, and develop realistic self-esteem. This process usually takes place at the end of the oedipal period and the beginning of latency, when the idealized object becomes irretrievably lost. The child needs to experience a gradual disenchantment with the idealized object or form a more realistic image of that object. Because this disappointment is directly related (and coincides) with the oedipal phase, it leads the child, through the integration of the now modified parental images into his/her system of values and ideals, to the idealization of the superego. This is a developmental step of great significance because it protects the subject from the danger of narcissistic regression.
Kohut’s (1984) further elaboration (in his last book) on the notion of selfobjects has the potential to advance our understanding of loneliness in normal and pathological development. He distinguished three types of selfobjects: the mirroring selfobject, which accepts and confirms the child’s vitality and assertiveness; the idealized selfobject, which calms and uplifts the child, by enabling merger with greatness (i.e. idealized parental imago); and the alter ego or twin selfobject, which provides the child with the experience of human alikeness. These types of selfobjects correspond to three different qualities of transference during analysis. Kohut (1984: p. 200) considered that alter ego or twinship experience in normal development is for the child “a vague and pervasive sense of security as he feels himself to be a human among humans”. This state is established early in life as the child experiences the mere sustaining presence of parental or other figures. Kohut (1984) reported the case of a woman patient who, from her early childhood, had endless talks with her alter ego or twin selfobject, a “genie in the bottle”. She had invented this selfobject to combat her deep loneliness that resulted from the insufficient parental care and the loss of her beloved grandmother. In the analysis, she associated her captivated genie with a crucial memory of her simply being with her grandmother in the kitchen.
When idealizable parental imagos are available to the child during early development, then “optimally frustrating” selfobjects are created, which protect the child and later the adult from loneliness, while maintaining the cohesion, vitality, and harmony of the self. But if selfobjects are unable to respond appropriately, the child will struggle to find or create an alter ego or twin to compensate for this deficit. Kohut (1984) made a distinction between the archaic selfobjects, which are created early in life and are later present in disorders or in times of stress, and mature selfobjects, which he regarded necessary for our health throughout life. In any case, alter ego or twinship experiences were for him the expression of human alikeness, that, both in health and ill-health, reduces loneliness.
Moreover, early on, the child can enjoy aloneness that is not the result of the relinquishment of the selfobject or the love object, but a self-contained and creative state (Kohut, 2011a) —solitude is the term we usually employ for this state. Kohut argues that during childhood this type of aloneness is still under the shadow of autoerotism, narcissism, and object love, nevertheless it is observable and potentially beneficial. The main feature of alter ego or twin selfobjects, that is, their silent, sustaining presence, and their self-organizing function are what enable us to endure, and ultimately enjoy, our solitude.
2.2. Object Hunger as Quasi-Loneliness
In Kohut’s work, loneliness is not examined as a particular psychic phenomenon; it is not even defined. Yet, loneliness is implied in Kohut’s views on normal and pathological child development and, especially, in the context of the narcissistic personality disorder and its developmental antecedents.
The narcissistic personality disorder results when the grandiose self is not neutralized but persists because parents do not offer adequate selfobject experiences or do not help him/her to realize his/her limitations or because they disappoint him/her, and this is done not gradually but in a traumatic way. In all the above, parents lack empathy, or their empathy is deficient or unreliable for several reasons, such as the mother’s and/or the infant’s emotional coldness, the mother’s withdrawal from an unresponsive infant, etc. Thus, the idealized parental imago is not established and there is a hyper-cathexis of and fixation on the primary stages of the autoerotic body self and the archaic stages of the grandiose self.
A sense of grandiose self and the inability to form meaningful relationships with others are the main features of narcissistic personality disorder. Due to the experience of unrealistic grandeur, the subject dreads isolation, yet he/she needs this isolation to protect his/her personality, that is, to avoid the breakdown of the omnipotence and perfection upon which the self is built. Isolation poses obstacles to psychotherapy. Kohut (1971) highlighted this by quoting the following touching dream of a patient who had lost his mother early on and experienced an alternation of maternal substitutes after the first loss:
He dreamed that he was alone at his house, his fishing equipment by his side, looking out the window. Through the window he saw numbers of fishes swimming, big and little, and attractive, and he was yearning to go fishing. He realized, however, that his house was at the bottom of a lake and that as soon as he opened the window to fish the whole lake would flood the house and drown him (p. 307).
If the child experiences the traumatic loss of the idealized object (e.g. with the death of a parent) or a traumatic (severe and sudden or age-inappropriate) disappointment from it, then he/she will remain fixated on an archaic idealized figure, located in the intermediate area between self and object. The coherence of the self will suffer, the psychic structure of the subject will be deficient, he/she will experience not longing, but object hunger—except that the word “object” in this case does not have its real sense, because the subject does not love and admire objects for their characteristics but needs them to replace functions of his/her psychic structure that were not established in childhood. The subject yearns for constant approval, confirmation, and echoing. If these needs are not satisfied, narcissistic rage emerges (Kohut, 1977) . The early memories of frightening loneliness contain “near delusional mergings into others” (Kohut, 1971: p. 124) and may emerge in mirror, idealizing, or alter ego/twinship transference during the analysis of adults. Moreover, in the frequent hypochondriacal symptoms of adult narcissistic patients, we can discern the lack of protection and threat they experienced in their lonely childhood.
Interpreting Kohut’s views in the light of loneliness, we suggest that the subject with narcissistic personality disorder does not experience real loneliness, but a quasi-loneliness so to speak, precisely because he/she cannot experience real love for the object, even if we still call this object hunger “loneliness”—perhaps this is why Kohut usually speaks of isolation, not loneliness. After all, he argues that some of the most intense narcissistic experiences are related to objects which are either used in the service of the self or experienced as part of the self, and he does not consider any relationship with the object as the opposite pole of loneliness (Kohut, 1971) :
The antithesis to narcissism is not the object relation but object love. An individual’s profusion of object relations, in the sense of the observer of the social field, may conceal the narcissistic experience of the object world; and a person’s seeming isolation and loneliness may be the setting for a wealth of current object investments (p. 228).
This last observation implies that aloneness may also have beneficial functions. Indeed, toward the end of his life, as described previously, Kohut (1984: p. 200) re-defined the twinship experience, one of the main manifestations of selfobjects, as “confirmation of the feeling that one is a human being among other human beings” (see also Togashi & Kottler, 2015 ; VanDerHeide, 2012 ).
However, Kohut (1971) observed that, during periods of discovery, highly creative individuals (e.g. in art) need to come into close contact with an object (protector, mentor or judge) and experience it as an omnipotent figure with whom they can, even temporarily, merge—a selfobject, which is part of the self. Discoveries take the creative person far into lonely territories, previously unexplored by others, and make them feel excitement and fear at the same time. This transference of creativity is, according to Kohut (1971, 2011b) , a traumatic repetition of the early childhood fear of being alone, abandoned, with no support. This may explain the fact that the termination of analysis with narcissistic patients is usually evident as an increase in their creative activity. Besides, for Kohut (1977: p. 311) , “we cannot, by introspection and empathy, penetrate to the self per se; only its introspectively or empathically perceived psychological manifestations are open to us” (p. 311). This means that although the (potential) space between analyst and analysand alleviates loneliness, it also inevitably separates them.
3. Kernberg: Emptiness as the Essence of Loneliness
In addition to his clearly clinical orientation, the Austrian-born American psychiatrist and psychoanalyst Otto F. Kernberg (1928-) studied the development of object relations. Kernberg focuses on the nature and treatment of various forms of personality pathology, but he also often refers to their developmental antecedents and furthermore formulates a sequence of developmental stages of the self in relation to objects. His developmental insights are inspired by object relations theories, his clinical cases, and the processes of transference and countertransference. Therefore, his views can provide a deeper understanding of the developmental trajectory of loneliness and of its vicissitudes.
3.1. The Many Faces of Loneliness in Personality Pathology
Kernberg (1975) argued that mental health means two things: firstly, that by the end of infancy a clear self-object differentiation has been made and stable self-boundaries have been formed; secondly, that the good and bad image/representations of self and objects, in other words, the libidinal and aggressive drives towards self and objects, have been integrated. In mental disorders, however, things are different, as follows:
When, for various reasons, the normal relation between the self and the internal world of objects (the integrated object representations) is threatened, and what might be called an internal abandonment of the self on the part of internal objects or a loss of them occurs, pathological subjective experiences of a painful and disturbing nature develop. Among these experiences predominate a sense of emptiness and futility of life, chronic restlessness and boredom, and a loss of the normal capacity for experiencing and overcoming loneliness (p. 213).
In the above views, the belief that loneliness is an unavoidable human experience, which the mentally healthy person accepts and deals with effectively, is evident. However, in personality pathology, in which pathological narcissism is dominant, loneliness grows over the years because of the subject’s inability to form deep and mutual relationships with other human beings, in other words, because of the incapacity to love. Regarding sexual relations in particular, in some cases, these subjects seek psychotherapy because of their unbearable loneliness, whereas in other cases they resort to sexual promiscuity as a defense against terrifying aloneness—until this defense collapses because of the repetitions of disillusionment and the feeling of emptiness (Kernberg, 2023) . Emptiness takes on different qualities in serious personality disorders and exhibits a unique association with loneliness, as we shall see below.
In depressive personality disorder, the feeling of emptiness resembles loneliness, in Kernberg’s (1975) view. However, there is a difference. Loneliness involves longing for objects, whose presence and love are necessary to the subject, but are not available. In contrast, in depressive disorder, the subject unconsciously experiences guilt, suffers a severe attack from the superego, and believes that he/she is not worthy of love and appreciation, therefore he/she is doomed to be alone. At a deeper level and in the most severe cases, the subject’s fantasies determined by his/her sadistic superego have destroyed the internal objects, leaving the subject essentially alone in a loveless world.
In schizoid personality disorder, unlike depressive disorder, the feeling of emptiness cannot be accompanied by loneliness, since the subject is alienated from relationships and this distance does not allow him/her to experience the emotions that usually arise in these relationships. The feeling of emptiness here is more bearable than in depressive disorder. We would add that the schizoid may not experience loneliness, but he/she is aware of the distance from others—we would suggest that he/she has an acute awareness of existential loneliness.
Restlessness and boredom characterize emptiness in narcissistic personality disorder. Satisfying relationships with significant others and an appreciation of ideals outside of ourselves (e.g. science and truth, aesthetics and art, religion, and moral values) enrich our lives. But the subject with an unnaturally grandiose sense of self does not invest in these values in a normal way and his/her life becomes impoverished. Kernberg (1975) claims that this feeling of emptiness is the opposite of loneliness, because people with narcissistic disorder do not experience longing or know what it means to have an important relationship with another person and lose it (this view is very close to Kohut’s view).
Elaborating further on the feeling of emptiness and its relation to loneliness, Kernberg (1975) considers that this feeling lies in the middle between, on the one hand, longing, sadness, and loneliness arising from the hope for re-establishing relationships with others and, on the other hand, the psychotic fusion of the good self-image with the good object-image, which occurs when the loss of the good object relation cannot be tolerated.
In the case of borderline personality disorder, the mother (or her substitute) is not available from the beginning of life, does not satisfy her child’s needs, and thus in the inner psychic life of the child a chronic dissatisfaction and discomfort for this person and for the relationship with her is established. The basic ego disturbance is its failure to construct a strong image of the fused self-object or a good internal object. Severe frustrations from the first years of life interfere with the formation of this image, as the child is unable to deal with his/her unconscious aggressive impulses towards the thwarting object, with the result that these impulses predominate and cannot be integrated into a single self-image. Because these very opposite states cannot be synthesized without giving rise to unbearable anxiety and guilt, which endanger the good representations of self and object, the defense mechanism of splitting is set in motion, by which the two opposites are kept separately. Kernberg (1975) states:
Clinically, the child who is going to become a borderline patient, lives from moment to moment, actively cutting off the emotional links between what would otherwise become chaotic, contradictory, highly frustrating and frightening emotional experiences with significant others in his immediate environment (p. 165).
Pathological narcissism, which is present in all personality disorders, is likely to ensue when parental figures do not provide warmth, although they function in an apparently well-organized family, but express indifference and explicit or covert aggression. In other cases, the child is used by parents, in a cold and hostile way, to satisfy their narcissistic needs, especially when the child happens to have a gift or talent. To face this unbearable reality of relationships, the child unconsciously resorts to the defense of fusion of the ideal self, the ideal object, and the actual self into an inflated self-concept. This state, however, goes hand in hand with the destruction of the internal and external objects. The child develops into an adult who has great difficulty in keeping memories not only of the real persons of his/her past, but also of his/her own experiences with these persons and fears dependence on others because this dependence is experienced as exploitation and evokes hate and envy.
Identity diffusion, which results from the failure of integration of whole object relations, as the main manifestation of personality pathology, aggravates the sense of inner fragmentation and alienation. Moreover, failure in identity formation is linked with failure in the expansion of self in time and space, as the identifications with the past and the future generations are weak or nonexistent. Kernberg (2012) speaks of the destruction of time in narcissistic patients, which is linked with repetition compulsion, failure of the depressive position and the normal mourning, and establishment of an isolated grandiose self who strives for constant admiration and not for good internalized object relations. In later life, narcissistic patients frequently experience shrinkage of time (“lost time”) and a fear of death which is associated with infantile memories of abandonment and loneliness. This is how the feeling of emptiness arises. The subject has lost the opportunity to construct his/her own history and embed it into the history of his/her culture. When Kernberg (1975: p. 219) writes that “the experience of emptiness represents an opposite pole from that of the feeling of loneliness”, we think that he obviously means real loneliness, that is, that kind of experience that retains hope and the possibility of genuine relationships with others and of living a life full of meaning.
The antecedents of personality pathology are to be found in the disruption of the primary mother-child relationship and of the family structure in general—and not, as Kernberg (1975) categorically argues, in the “age of alienation”, that is, in the changes that have occurred in recent decades at the social and moral level. These disorders concern the intrapsychic structures that determine human interactions and human capacity to relate deeply to others.
3.2. Mature Love as the Opposite of Loneliness
The patient’s defensive denial of hatred and envy towards the analyst, and the accompanying guilt, to maintain this relationship and be protected from intolerable loneliness is, according to Kernberg (2023) , what accounts for many cases of interminable analysis. Indeed, Kernberg regarded loneliness as the force that produces “secondary gain” and a negative therapeutic reaction: the patient devalues the therapist to avoid dependence but denies guilt for this aggression to protect his/her grandiose self from complete isolation.
In the transference, these narcissistic patients can sometimes (not always) work through their aggression and achieve the capacity for mature love (Kernberg, 2023) . Describing briefly the five stages of normal development of internalized object relations and discussing what should be the desired outcome of this developmental course, he writes the following for the final stage, which he calls consolidation of superego and ego integration and may also be regarded as the end-point of psychotherapy (Kernberg, 1976) :
A harmonious world of internalized object-representations, including significant others from the family and immediate friends but also a social group and a cultural identity, constitutes an ever-growing internal world providing love, reconfirmation, support, and guidance within the object relations system of the ego. Such an internal world, in turn, gives depth to the present interaction with others. In periods of crisis, such as loss, abandonment, separation, failure, and loneliness, the individual can temporarily fall back on his internal world; in this way, the intrapsychic and the interpersonal worlds relate to and reinforce each other (p. 73).
Mature love presupposes that the individual is able to form and retain images of those persons who have previously provided him/her with love and comfort and to reactivate these images in his/her fantasy when this is necessary—as in cases where loneliness arises. In other words, the self can, as Kernberg (1976) argues adopting Erikson’s (1950) term, derive basic trust from good internalized object relations of the past. Basic trust results from the early internalization of a reliable, need-satisfying representation of the mother, associated with a lovable, satisfying representation of the self. But even in cases where human development has followed a normal course, it takes a lifetime to reach such a state. Therefore, we suggest that the search for the optimal way to deal with loneliness is also a lifelong endeavor.
Furthermore, Kernberg (1995) sees loneliness as having a crucial role in mature sexual love. He regards this type of love as characterized by the contradiction between the awareness of separateness from the beloved and the sense of transcendence, of being one with them. This happens because in sexual passion, although there is a crossing of self-boundaries (i.e. merger, as in orgasm), the separate identity and its awareness are maintained. The painful awareness of separateness and of the frailty of all relations is what fuels loneliness, which, in turn, may lead to transcendence. In this way, loneliness is conceptualized as longing for union with the other—and union with the world at large (e.g. nature, art)—while at the same time, it leads to “the painful and yet strangely gratifying acceptance” (Kernberg, 1976: p. 227) of the inherent unintelligibility, distance, and self-containment of this outer world. Thus, in our view, Kernberg seems to conceptualize loneliness as a powerful motive for sexual love and as a great paradox (see Galanaki, 2014a for an analysis of the many faces of the loneliness paradox).
4. Conclusion: The Need for Genuine Intimacy and for Real Loneliness
In Émile, in which we find numerous references to solitude, as either the painful or the beneficial state of being alone, Rousseau (1974) discusses human imperfection and weakness, considering that this is what makes us social beings. The echo of Freud’s (1957: p. 85) dictum, “In the last resort we must begin to love in order not to fall ill, and we are bound to fall ill if, in consequence of frustration, we are unable to love” is present in the following passage—or better we should say that the echo of Rousseau’s words is present in Freud’s text, perhaps in the work of Kohut and Kernberg as well:
Man’s weakness makes him sociable. Our common sufferings draw our hearts to our fellow creatures; we should have no duties to mankind if we were not men. Every affection is a sign of insufficiency; if each of us had no need of others, we should hardly think of associating with them. So our frail happiness has its roots in our weakness. A really happy man is a hermit; God only enjoys absolute happiness, but which of us has any idea what that means? If any imperfect creature were self-sufficing, what would he have to enjoy? To our thinking he would be wretched and alone. I do not understand how one who has need of nothing could love anything, nor do I understand how he who loves nothing can be happy (p. 182).
There are many differences between the theories of Kohut and Kernberg. For example, whereas for Kohut, narcissistic and borderline personality disorders are different from each other, for Kernberg, narcissistic disorder is a subtype of borderline personality organization. However, there are also some points of convergence that are relevant to the conceptualization of loneliness. In both theories, narcissism, as a sense of omnipotence and as the maintenance of identification with the object, protects the infant from the frightening sense of being alone, weak, and helpless. Regarding the pathology of narcissism, in both theories, it is conceptualized as the outcome of disturbances in early object relations. Parents either inflated the infant’s narcissism by diminishing frustrations and discouraging reality testing, or prematurely and abruptly disrupted the infant’s omnipotence by their absence, inadequacy, or hostility. Another common point in the theories of Kohut and Kernberg is that the subject with a narcissistic personality disorder does not experience real loneliness. He/she vacillates, on the one hand, between omnipotence, absolute self-sufficiency, and the denial of dependency on objects, and, on the other hand, deep isolation accompanied by an intense feeling of inner emptiness and futility. This vacillation is evident in the analytic situation, in the transference itself, and distinguishes narcissistic personality pathology from other mental disorders—and this is another point of convergence between the two theories (although there are differences between them regarding the quality and use of transference).
The denial of the need for relationships, for mature dependence, acts as a defensive protection of an extremely vulnerable internal world from the first years of life and is expressed as the subject’s tendency to literally withdraw from the external world. At the same time, however, the subject denies absence as well as the fact that objects have their own, separate existence. He/she needs “nourishing” relationships, which is why he/she will unconsciously make narcissistic object choices, to deal with his/her dreadful loneliness. Sooner or later, however, the object of identification, an imperfect being, fails to live up to the subject’s unrealistic standards. As a result, the subject experiences uncontrollable rage and deep despair at the object’s lack of understanding and empathy. He/she feels like “the last man on earth” and “all alone in the world”, since no one understands and can help him/her. He/she has used up others, they are now useless to him/her, and he/she feels used up too. He/she feels unlovable and unable to love.
The subject’s anger and despair at the object’s unresponsiveness express the former’s inability to experience and communicate real loneliness in the context of an interpersonal relationship characterized by genuine intimacy, because this intimacy has not been achieved. The only exception is perhaps the talented narcissistic subject, who makes others the companions of his/her isolation in his/her personal self-sufficient universe, because, sometimes facilitated by the social conditions, he/she manages to transform isolation into art, discovery, and creation. The price, however, that the talented narcissistic individual is likely to pay is psychosomatic exhaustion caused by the defense of compulsive production, which temporarily fills the void and feeds the illusion of intimacy.
We cannot extend our hands to our true selves, but only to our image or idol, Martin Buber (1964) argued. However, the monologue is often disguised as dialogue. In this case, the soliloquist holds his/her mirror and so he/she walks, even in areas, such as that of love, which are the areas of the most profound dialogue. Vast desolation is the certain result of this life attitude. We can ultimately extend our hands only toward another human being.