WOMAN: That was amazing !! I’ve never had sex like that before !!

MAN: What can I say? It’s part of my pathology !!


A man with an adrenal disorder produced too much testosterone.  To the man, it seemed like a blessing.  He could have sex five times a day!  He was unaware that too much testosterone can lead to serious health problems.  He was unaware that his pleasure was rooted in a disorder.

Be that as it may.

I started work with a new psychotherapist about three weeks ago.  My last session on Monday (May 1, 2017) raised concerns.

We talked about my grandiosity:

I’m grandiose.  I like to think about winning a Nobel Prize, 1/ for example.

How do you feel about that?

I’m OK with my grandiosity.  In fact, I like to think about getting a telephone call from the Nobel Prize Committee and making plans to fly to Sweden to pick up my prize.

So, you’re OK with your grandiosity.

We talked about my paranoia:

I think I’m under surveillance by my former employer.

How do you feel about that?

I like it.  I mean, that was one of the biggest law firms in the country, in the world.  So it makes me feel special that they took such an interest in me.

So it sounds like you’re fine with your grandiosity and you’re fine with your paranoia.  So why are you in psychotherapy?

Paranoia and grandiosity are symptoms of deep and disturbing problems.  The psychological test report traced my paranoia back to child abuse.  (“[A]bout half of [the researchers’] 46/64 (4=psychopathic deviance, 6=paranoia) adolescent sample reported having been beaten with a strap”).

My grandiosity can be traced back to disturbances in my relationship with my mother — namely, her failure to provide appropriate narcissistic mirroring (that’s what Kohut would say).

Persistent failure of selfobjects to empathically respond to the child’s mirroring and idealizing needs, that is, failure to mirror the child’s grandiose self or to foster the child’s idealizations, can cause developmental fixation on an immature self.  Kohut suggested that “early disturbances in the mother-child relationship (due to emotional coldness of the mother, the absence of consistent contact with the mother, the baby’s congenital emotional coldness, the mother’s withdrawal from an unresponsive baby, etc.)” can result in a fixation on “the archaic (pre) stages of the grandiose self” or “a failure in the establishment of an idealized parent imago.”  Healthy ambitions and attainable ideals would not become established in the personality.  Moreover, narcissistic needs would remain immoderate (and the self precarious) if internal-self-esteem regulating and anxiety-reducing structures did not develop.  Persistent “selfobject failures” on part of the parents, that is, “a lack of mirroring, a lack of alter-ego support, or an unavailabilty of idealizable selfobjects” would cause “fragmentation, weakness, or disharmony of the self.”

This is what gets me about cognitive therapy.  It tries to put a positive spin on things that should not get a positive spin.  If a patient feels fine with symptoms that are rooted in personality pathology, maybe that’s an important part of the problem.

I would wonder about a Holocaust survivor who actually enjoys dandelion soup !!



1/ In 1966 Helen Tartakoff introduced a nosological entity, the “Nobel Prize complex,” to apply to people who have in common many of the following characteristics: They are preoccupied with the achievement of diverse ambitious goals, which may include, for example, the wish to become President, to attain great wealth, to be a social leader, or to win an Oscar. Many are intellectually or artistically gifted and possess charismatic qualities that others admire. They are often firstborn and frequently only children. They adopt an all-or-nothing attitude toward their aspirations. They are hypersensitive to disappointments in life, particularly to lack of recognition, and may become depressed and develop psychosomatic symptoms at the time of real or fantasized disappointment. They unconsciously look upon psycho-therapeutic treatment as a magical cure and expect to be rewarded during their treatment with the same applause they received from their mothers.