Narcissism, Freud, and the Future of Psychotherapy – A conversation with Elizabeth Lunbeck, Historian of Psychological Sciences

SPEAKERS

Elizabeth Lunbeck, Jennifer Berglund

 

Jennifer Berglund 00:04

Welcome to HMSC Connects! where we go behind the scenes of four Harvard museums to explore the connections between us, our big, beautiful world, and even what lies beyond. My name is Jennifer Berglund, part of the exhibits team here at the Harvard Museums of Science and Culture, and I'll be your host. Today, I'm speaking with Elizabeth Lunbeck, a historian of gender, as well as the psychological sciences, including psychoanalysis and psychiatry. We've been working with her on a new exhibit on Freud, which was recently released online. I'm talking with her today about that work, as well as her other fascinating insight into narcissism and politics, and the recent shift in psychotherapy to the virtual space caused by the pandemic. Here she is. Elizabeth Lunbeck, welcome to the show.

 

Elizabeth Lunbeck 01:11

Well, thanks for having me. I'm pleased to be with you.

 

Jennifer Berglund 01:17

You have spent years studying narcissism, something you started investigating long before it began dominating the headlines four years ago. What about the topic first interested you? And describe how it's changed or influenced American culture since the 2016 election.

 

Elizabeth Lunbeck 01:38

So I first became interested in narcissism when I wrote my first book because a category that was of interest to me when writing about psychiatry was the category of psychopathic personality. So we're all familiar now with the term psychopath and sociopath. This term was brought into professional discourse into psychiatry in the late 19th, early 20th century, as a way to describe people who, as it was said, didn't fit the normal categories of disease, like they could be excessively problematic, but also really successful. Narcissism, like psychopathic personality, is what's called a personality disorder. It was a kind of leftover category from my first book, and my first teaching job was at the University of Rochester where Christopher Lasch taught. He was a colleague of mine. And he wrote a very influential book in 1978, published in 1978, called The Culture of Narcissism. I was very interested in this category, both within psychiatry and psychoanalysis, and in the larger culture. It's a really hard category to take the measure of. Narcissism, the term as it's used, encompasses what we consider to be some of the worst human qualities--the tendency to devalue people to destroy them to be full of rage, and so on, so the sort of major sins, as well as it can encompass, describe, account for some of our better qualities. To put an evaluative matrix over it, I think you have to have a concept of healthy narcissism or self esteem to account for ambition, drive, to accomplish something in the world, to do good in the world. If you don't have enough self-feeling, you don't have the wherewithal to go out and put yourself out there in the world, so it compresses both ends of the kind of spectrum of human behavior, and that is incredibly confusing.

 

Jennifer Berglund 03:46

Yeah, yeah, so you're saying, like, all of us, hopefully, to some extent, have a little bit of it, you know, and that we have drive and self esteem to accomplish things in our lives.

 

Elizabeth Lunbeck 03:56

Right. So narcissism, as well as referring to what is in the psychiatrists DSM, Diagnostic and Statistical Manual, as a disease category of narcissistic personality disorder. It also refers to a quantity of self feeling, roughly to self esteem. So, we all know, or the culture tells us that it's okay to have some self esteem, that we need self esteem, to feel good about ourselves and to be able to accomplish anything, to get out of bed in the morning. So, narcissism is both a quantity of self feeling that is kind of neutral, and a disease category that is widely condemned, so it's very confusing in that way, and it goes to the heart of questions about who we are, like, are we at base selfish, envious, self-referential self-centered people? Or are we altruistic, capable of doing good in the world, of caring about our fellow creatures. It encompasses all of this, so that's not something I decry. It is that way. It's a very protean category, but it leads to lots of confusion in the public sphere, when it gets out there, when it's unleashed onto the culture, it's very confusing. So, for example, people have a very hard time conceiving that there could be anything positive about narcissism, and it's been widely condemned, but I don't think you can account for much of what we do without looking at the positive valence of narcissism. That's really hard to do. And the other thing that's hard is that it's a paradoxical concept that to take the disease category, or character type, the extremely destructive narcissist can be an incredibly attractive character to many people. That's really hard to get your head around.

 

Jennifer Berglund 05:52

I mean, case in point, what we've been dealing with the last four years, which is something that you have been looking at. Talk about narcissism in the context of Trump.

 

Elizabeth Lunbeck 06:04

Okay, so first, to be clear, I'm not diagnosing him and kind of clinical sense, but he does conform, as many have pointed out, to all the descriptive categorizations in the DSM, the Diagnostic and Statistical Manual, and he conforms in a psychoanalytic sense to what we, if we met someone like this, we would say, narcissistic personality. So, just to be clear on that. I think if we look at the last couple days and what's happened with the impeachment, the submissiveness of certain Republicans to Trump, even though he lost the election, he lost Georgia for the Republicans, he's not a winner. But yet, certain people are caught in his grip still. So, how do you account for that? Now I'm not, there's lots of political considerations and so on, I'm only talking about the psychological, that kind of extreme submissiveness to someone who is so destructive is a problem worth thinking about. So let's go back. Why was Trump, why is Trump so attractive is a question that I think narcissism can help illuminate. I think he has both the positive and the negative, the sort of deficits in the capabilities in a very narcissistic character. I actually think he has many gifts. I don't want to be misunderstood. I think he has many political gifts. I am not a supporter by any means, but he is to those who fall under his spells and incredibly compelling, charismatic politician. He has a very strong following that we'll see how it plays out. We can't predict the future, and if he doesn't have an organization, if he doesn't have the office of the presidency, which surrounds him with the pertinences of state, if he doesn't have that, will the 74 million stay with him? We don't know that. That said, he came to us from being a television celebrity. He has a kind of aura, a glitter, that many people find irresistible. But it's not just that. I think to go to the more negative qualities that also I think constitute some of his appeal, we're all aware, we've seen people interviewed saying Trump says what I can't say, or he says what I feel. I think Trump manages to inhabit a kind of every man personality while also appearing as a sort of royal figure. He voices opinions that many people find outrageous--racially outrageous, sexually provocative, misogynist, and so on. He tries them out at his rallies, he kind of throws them out and sees how people respond, and the crowd goes wild. So he's voicing what in a psychoanalytic sense would be called primitive, that is early, unfiltered opinions, sentiments that many people feel but have learned to not either acknowledge or voice, and he comes along and says all these completely outrageous things, and throughout his presidency, there was this interesting dance with the media. Like every day, there would be articles Trump's a narcissist, he did this and the other, is this it? And the hope would be raised. Oh, finally that'll be it. But it was never it. You know, the next day would be another provocation. So a psychoanalytic theory would be that his internal processes, you know, what's going on inside him, his angers, resentments, sense of entitlement and so on, speak to people who would like to be able to live out that on a larger than life stage in a way that he does. So the common understanding of this is, well, if Trump's a narcissist, then it must be that he succeeds because he's speaking to a nation of narcissists. I would say, That's not a very strong argument. I would want to put a little twist in that, and say that he's very good at speaking to those whose sense of narcissism efficacy in the world has been wounded. So if we talk about the dispossessed and his appeal to the dispossessed, and I know it's not just to the dispossessed. Many fairly well off people, people have done well in life, support him. But if we think about the dispossessed, these are people whose dreams have been stymied or shattered, who aren't able to live out life on that big stage as they might have in their imaginations, or what they envisioned for themselves. Their towns have been destroyed by the flight of capital, promises have been made to them by the government of a future that they can't have. That's called narcissistic wound in a clinical sense, they're suffering from narcissistic wounds. Well, someone whose own narcissism has been under assault is particularly vulnerable to the entreaties of someone whose narcissism seems to be flowering, and in this magnificent way that Trump's has. That would be my argument. And I think we need to have an understanding of this phenomenon that is rooted in people's emotions, because otherwise, there's nothing rational about the connection to a leader like Trump. There's been a lot of work done on narcissistic leaders in the world of business and their appeal, but also their danger, you know. So, we have two realms, sort of the political realm, the realm of leadership in the corporate world in which this figure, the narcissist, is particularly attractive, but also very dangerous. Steve Jobs is often invoked as the exemplary narcissist, someone who has a change the world personality, as Freud put it, dreams big.

 

Jennifer Berglund 12:21

Visionary.

 

Elizabeth Lunbeck 12:22

A visionary who sees things that no one else could and is extremely attractive in that way. But there's mountains of evidence that he didn't treat subordinates very well. He lashed out at people so very full of rage, destructive, those those sort of negative narcissistic traits. Now in his case, it's likely that the more destructive elements will be forgotten because he created a wildly successful company as well as products that we all use, so my guess is that over time, the negative aspects of his personality will recede. I would say you have to have narcissistic capabilities to lead anything, you know, anything large. Every leader of the United States recently has been branded a narcissist. Bush was a narcissist because he had no empathy. That was the claim. Obama was a narcissist, because he used the word "I" too many times, but I think there's something about the charisma. You don't get to be a leader of a country like the United States without having a fair amount of charisma. Bill Clinton had charisma in spades, I would say, and he sort of performed empathic relationships constantly, he would say, you know, "I feel your pain." That was kind of like a signature line of his, "I'm very empathic." So, I think narcissism, in the business world, it is seen as necessary, kind of the sine qua non of leading a company now. It's expected that leaders will be narcissists, and the task is to make sure that they're not destructive narcissists, but that they are what's called productive narcissists, and I think to harbor the ambition and to act on it to rise to the level of President of the United States, you have to have some measure of narcissism. Even Joe Biden, even though he presents himself as sort of no nonsense, straightforward, you know, he's a politician. He knows how to play to the crowd. I don't see destructive narcissism in him, but I'm just going on what I read in the papers, and no specific diagnostic claims being made here. But you have to have a certain sense of mission, of kind of the historical moment being there to kind of gather up in your person the wishes and dreams and desires of a people to lead to rise to the level of leader, and I think any political leader who is successful has to have that. And I think it's a capability. I think it's a real capability. I mean, there's something about usually man, man and moment, sort of being there at the right moment. But it's not just luck. People who have no charisma, which is, by the way, a relational quality, it's not something you have, it's your ability to convince others that there's something special about you. You can take courses in how to increase your charisma. I haven't seen courses in how to increase your narcissistic quotient, but this, maybe they're out there. Maybe some entrepreneur will come up with them. But, you know, there is something in this indefinable quality of charisma. It is not just a personal quality, it is a capability that allows you to speak, to connect, in a very direct way to followers because there's no leader without followers.

 

Jennifer Berglund 15:59

Since the beginning of the pandemic, in-person psychotherapy has been unavailable to many patients. So, psychiatrists have begun seeing patients virtually. How did this overnight shift change psychotherapy, and do you think that change will last?

 

Elizabeth Lunbeck 16:17

Those are great questions. You know, it's been absolutely striking how quickly the pivot happened. So, everything shut down around March 15, in 2020, and within, I don't know, a month, maybe, or even less, psychotherapy went online through Zoom or other platforms, or back to talking on the phone. This for many years, traditionally, has been seen as a poor substitute for being in the room with someone because the point of being in the room with someone was that you could pick up on all kinds of emotions, affects, gestures, facial expressions, and so on that conveyed important clinical information about the patient or the clients state that you couldn't get if you weren't in the room with them. Well, once it became no longer possible to be in the room, people pivoted very quickly of necessity. But now there's an interesting argument going on about whether this will last and about whether there are not, in fact, advantages to not being in the room. Such as, you know, I've heard clinicians talking about being able to see the patient in their natural setting--in their home in their bedroom. The downside of that is some have had to see patients hiding in their bathrooms or in their closets when they can't get privacy that's necessary, or for, just in practical terms, you don't have to get in your car or get on the subway to get to your appointment, you just log on, so it's a big time saver. Some people miss the kind of transition of the ritual of getting to the office and leaving the office as kind of spaces to enter a different space. As virtual psychotherapy very quickly replaced in-person psychotherapy, it suddenly became the new norm, and all the talk about it being a second class form of relationship seemed to drop away. So this is very interesting because for, I don't know, 100 years, the in-person has been seen as the gold standard. And that's no longer the case. So will it last? I don't know. My guess, and maybe I'm just an optimist about people's relational desires and capabilities, is that people will want to see each other once restraints are lifted, and that includes many people might want to see their therapist in person. Those who suffer from social anxiety, or are very isolated emotionally might prefer the lesser barrier that virtual psychotherapy is organized around. So, it might be easier to connect through the safety of a screen for some people than it was to actually get out and go to an office, but we won't know until it actually happens how things will shake out, so there's a lot of futurology about what's going to happen, not just about psychotherapy, but will people want to go back to the office and so on. But no one can predict the future reliably. People are charging a lot of money and making a lot of money predicting the future. I don't know what the future of psychotherapy holds. I just don't know. We don't know how we'll react once we're set free. There's speculation anywhere from another roaring 20s where we'll be out partying all the time to we'll be happy to sit in our offices at home cut off from all human contact and continue working through the screen forever. So, probably something in-between will be what actually happens, but I think psychotherapy is an interesting test case for is this something that we can do without the actual presence of the other? And what does it mean to be in relation with someone when they're pixels on a screen.

 

Jennifer Berglund 20:30

So you've been working with us on a new online exhibit about Freud. Explain the concept behind the exhibit and the significance of visual representation in Freud's work.

 

Elizabeth Lunbeck 20:42

So, the concept behind the exhibit is to look at drawings, representations, made by Freud and some by others in the history of psychoanalysis, and to gather together some material to actually focus on that dimension of Freud's entire opus. We had to switch, obviously, to going online with the pandemic hitting. The exhibit was originally planned to be an actual exhibit in a museum. That won't happen. That said, there have been, thanks to some of the work done by the museum staff, there are some advantages to doing it this way in that we have a number of interactive images that probably would not have been developed in this way for an actual exhibit that you went to walk in on your two feet, and so on. So that's been a really pleasant surprise, some beautiful work done by the museum people, just wonderful. What interests me in the exhibit is to watch Freud wrestling with how to represent on paper, or imprint, internal mental processes and structures. Now, we take this for granted now. Take the example of the ID, the ego and the superego, the ego being our sort of sense of who we are in the world, what we know about ourselves, the Id being this repository of dark, forbidden desires, unconscious thoughts, and the superego roughly corresponding to our conscience. You can go on Google Images and come up with hundreds of images of the Id, the ego and the superego, usually the superego is up top, the ego is in the middle, and then there's this vast kind of roiling underside, or underbelly to the self. People have used the iceberg metaphor or portrayal, sort of the bit that's we can see, the bit we can't see, the sort of conscious life, unconscious, they don't really line up all that well, and in fact, that's a problem for wrestled with because there are parts of our ego that we're not aware of. But we're all familiar with this representation. Well, this is something that Freud struggled with. How do I represent this in a way that people can understand it? And he came up with a very nice image, which is the image that's basically all over the internet. The exhibit starts with him dissecting eels. He was a neuroscientist. He was dissecting eels in the early years of his medical career, and we can follow him as he attempts to provide maps of what he is hypothesizing exists inside of us. No one has seen an ego. No one has seen an Id. Yet we all talk about these things as if they are real. And I don't mean just clinicians, it's out there. There's so much talk about the id and the ego out in the public realm. We assume these that have kind of some substantive material existence, they do as representations, but if you get five therapists a room, they will disagree about the borders between id, ego, superego. So it's not that you can open up the person post mortem and draw this overlay. So, this is what I'm interested in, and this is the kind of struggle to represent internal processes. How do dreams happen? What is repression? How does that work? So Freud uses very vivid scene setting to talk about these, for example, a famous image of material from the Id, or from the unconscious, would be someone lecturing in a hall and there's a man outside banging on the doors, "let me in let me in let me in!" So, the conscious versus the unconscious, the inadmissible to consciousness material, he paints a kind of word picture of that, but the imagery conveys it parsimoniously in a way that's readily apprehensible. We tend to think then, "oh, it's real." But we have to remind ourselves that it's a representation. So I'm really interested in the materiality of the imagery, and I think the show does a really wonderful job of focusing on that and bringing that to our attention.

 

Jennifer Berglund 25:21

You mentioned that these images, these representations of the id, ego, superego from Freud have been part of the public consciousness since his day. Do you see that as problematic?

 

Elizabeth Lunbeck 25:35

No. You know, there was a big debate around the Millennium, "Is Freud Dead?" There was a Newsweek had a cover, Time had a cover. And my answer is, yes, he died in 1939, but no, you will never really kill him off because Freudianism, sort of basic tenets of Freudianism, have become accepted in the culture at large. Think of the Freudian slip, you know that you say something that comes out wrongly, people call it a Freudian slip. Well, that refers to this notion of unconscious process. We think things are going on inside of us of which we are not fully aware, and can't control. That's widely accepted. That's a kind of basic Freudian way of looking at ourselves. The idea that we do things that are not in our best interest over and over, that we recreate scenes, or that we reenact scenes from our earlier years is another Freudian idea that I think is very hard to shake. And you can see this in a pop way in the sort of idea that people marry their parents.

 

Jennifer Berglund 26:54

I've totally married my father, by the way, and it's funny, it's funny, because I tell my husband that, you know, like, I get exasperated, sometimes, and I'm like, "Oh, I married my father." And he goes, "no, I married your father."

 

Elizabeth Lunbeck 27:08

Oh, interesting twist on that

 

Jennifer Berglund 27:13

I know, it is an interesting twist, but he's kind of right too..

 

Elizabeth Lunbeck 27:16

So, I think that's a kind of a nice, very concise and readily apprehensible instance of a pretty sophisticated psychoanalytic idea, which is that we are fated, in some kind of tragic way, to reenact the relationships that we have with other people throughout our lives, or the idea of transference. Transference in psychotherapy refers to the way that patients tend to make the therapist into figures that have not everything to do with a therapist. That idea is, pretty much you can see it in kind of pop agony columns. So, I meet this new person, I find myself treating them this way, and then the advice giver is like, maybe that has something to do with the way you were raised, or the way your parents treated you, that we don't approach other people as blank slates, or, as they objectively are, but rather, we bring to them our experience of them, all of our past experience. And so the sense, I don't know if people felt it, but sometimes of deja vu, I've met this person before. So there's many roughly Freudian, or psychoanalytic, I would say, ideas out there in the culture, that are pretty useful for ways of understanding our experience. I'm not so interested in the minutiae of Freudian doctrine. Where do we see that? Is it right or wrong? There's very healthy and vigorous debate within psychoanalysis and psychiatry about all of this. There has been for decades, and people fall on various places of the spectrum from quite orthodox Freudian to very revisionist, or even non analytic sort of going into the realm of CBT, or cognitive behavioral therapy. So, that to me is less interesting than the survivals, and I will say, the setting is one thing that has survived until now, and is in question, which would be the two people in the room being able to say anything to each other. So what is the room going to consistent in going forward?

 

Jennifer Berglund 29:42

Elizabeth Lunbeck, thank you so much for being here. This has been fascinating.

 

Elizabeth Lunbeck 29:45

Well, thank you, Jennie. It's been a great conversation, and I really enjoyed the opportunity.

 

Jennifer Berglund 29:56

Today's HMSC Connects! Podcast was produced by me, Jennifer Berglund and the Harvard Museums of Science and Culture. Special thanks to Elizabeth Lunbeck and the History of Science Department for their wisdom and expertise. Please check out our new online exhibit, "The Interpretation of Drawings: Freud and the Visual Origins of Psychoanalysis", which you can find a link to in the description of this episode. And thank you so much for listening. If you like today's podcast, please subscribe on Apple Podcasts, Spotify, Podbean, or wherever you get your podcasts. See you in a couple of weeks!