More respect for the neurotic process: comments on the problem of narcissism in severe psychopathology, especially the addictions.

In dealing with and writing about psychopathology and psychodynamics, there has been in the past 20 years an increasing shift towards stressing their closeness to the psychoses and emphasizing the archaic nature of the inner processes. With that there has developed a special regard for a "defect psychology." This change has had momentous implications for the attitude towards patients and the treatment approach. The discussions about such changes center on the concept of narcissism. The paper advocates, in contradiction to these moves, the continued use of the model of conflict theory and, hence, a consistent focus on the defenses in psychotherapy and psychoanalysis, with all that this specifically entails for the treatment and understanding of the addictions, as illustrated by four case vignettes.