Pathological Accommodation

"Pathological accommodation" is a term I first encountered through the readings of Bernard Brandchaft and the theories of intersubjectivity. I find this concept transformative to the work I do; it seems to apply to virtually every patient I've encountered (as well as most people I've known in my personal life). I feel compelled to write this at this time, as this subject follows naturally from my previous post about narcissistic mothers.   

At its basic core is the idea that children who are unable to develop authentic selves due to the various barriers put upon them by their parents learn that they must contort themselves into a false self or risk losing the ties to the parent(s) to whom they are most closely attached. This accommodation can manifest in one of three ways. The child who does not want to lose his bond to his caregiver learns to sacrifice parts of himself in order to preserve that bond. Alternatively, a child may decide that she will hold fast to her true self at all costs, only to find herself isolated and alienated from her caretakers. Finally, some children oscillate between these two poles, enacting an ambivalence in which they play the dutiful, obedient child at times and fiercely cling to their own wishes at others. In contrast to a healthy development in which the child is allowed to develop a true self and also maintain a secure positive attachment to one's parents, children who grow up being pathologically accommodating find themselves in a no-win situation, either sacrificing key parts of their identity or losing their close ties to the parents that are so important to them.

Most of the patients I've encountered fall into this first category. They come to me having lived their lives hiding parts of themselves and working hard to be the "good" boy or girl they believe they are supposed to be. They go through life accommodating others at all costs, and the price they pay is incredible unhappiness for having to squelch parts of themselves and contort themselves into who they think others want them to be. These people aim to please, though often while feeling deep-seated resentment and rage for having to do so. Most of the gay men and women I've treated learned to hide their sexual orientation at a young age because they were taught that it was "bad" and "unacceptable." Even more insidiously, most people are taught that their internal world of feelings -- particularly their anger -- is something dangerous, threatening, shameful, or wrong that is to be avoided at all costs. When one learns to split off their feelings instead of learning that all feelings are a healthy part of what makes us human, it becomes impossible to live fully and authentically. 

An intersubjective therapist is trained to look for how these issues show up in the therapeutic relationship. We must expect that the ways our patients have learned to conduct their relationships up until coming to us will also play out in the relationship that develops between therapist and patient. Thus, patients often behave like dutiful students, wanting to do what's "right" for my sake. Others act out by experiencing me as their parent who places demands on them and then they rebel by missing sessions, coming late, not paying on time, or engaging in risky behaviors outside of therapy. It is crucial to track the interactions in the therapeutic relationship so as not to ignore or dismiss these enactments and to not repeat perpetuating the unhealthy relational dynamics established in childhood. When we can speak to what's happening in our relationship and shed light on how the patient may be pathologically accommodating the therapist, then we have a chance to alter these patterns and allow for an alternate positive relational experience in which the patient (maybe for the first time) can learn to have a healthy relationship where she can bring herself fully into the room and be accepted  unconditionally. 

In future posts I will elaborate on some of these ideas -- such as the crucial role that anger plays, the power that shame wields, and the specific ways that people may act out in response to believing that they cannot express themselves authentically. For clinicians interested in learning more about pathological accommodation, I recommend the collection of Brandchaft's essays entitled Toward an Emancipatory Psychoanalysis. 

Children of Narcissistic Mothers

I am astonished by the number of patients I have treated who are children of one or two narcissistic parents. Though we often associate narcissism with males, in most of the cases I've witnessed, it is the mother who appears to be the narcissist. The world of entertainment fascinates us with such women. There's a dramatic example in the cult movie Mommie, Dearest. And one review of a Broadway revival of the musical Gypsy described the stage mother Rose who is determined to see her daughters achieve the success she never did as "the mother who is always there when she needs you." While these make for titillating enjoyment and these characters are extreme examples of narcissistic mothers, both based on actual autobiographies, in my practice the children of such mothers are anything but fodder for amusement.

The child of a narcissistic mother is often put into the role of a "self-object function" for the mother. Whereas in a healthy mother/child relationship the mother is tasked with meeting the needs of her child, the scenario is flipped with a narcissistic mother and the child is treated as an extension of her. Everything becomes viewed through the lens of how the child can serve the mother's needs or how the child's behavior wounded the mother.  Thus, if the child makes any move to separate from the mother and form an authentic identity of her own, this is unconsciously perceived as a threat to the mother. Normal developmental milestones such as puberty, adolescence, going to college, turning 21  and becoming an adult, and forging relationships, getting married, and starting one's own family are all potential threats or "narcissistic injuries." Similarly, if the child chooses to forge a unique identity and follow his own path, one that may differ from the mother's ideas of what the child should do, this may be taken as a direct attack on the mother. I've known patients whose mothers reacted negatively when the individual began a normal sexual exploration as a teenager, when the child moved away from home for school or work, when he announced plans for marriage, or when she announced that she was pregnant. These mothers are incredibly needy themselves and they are turning to their children to fill the expansive gulf of neediness they experience because they are unable to rely on themselves to do so and they most likely did not have adequate parenting in their childhood in which their own emotional needs could be met. 

Narcissism in a parent can take different forms. In some instances, the patient has a mother who martyrs herself, acting as a helpless victim and seeing herself as utterly selfless for the sake of her children and others. Yet this is far from unconditional and often the child experiences an enormous amount of guilt-tripping, with the mother making it clear that the child has disappointed her deeply. In some cases, this takes the form of a mother who suffers from a chronic illness, such as fibromyalgia or acute asthma. Far from being a victim, this mother can actually wield a great deal of power and control with her illness, holding her family members hostage and at her mercy. Once again the child's needs are sacrificed for the sake of the mother's "emergency." Other narcissistic parents may abuse alcohol or other substances in an attempt to fill the profound void they feel inside. Such a parent can hardly be relied upon to be responsible and consistently available for one's child. Often the child develops into a "parentified child," reversing roles with her own parents and having to learn to take care of her own needs as best as she can. Being age inappropriate, she cannot adequately function as a parent to herself, and she often is excessively harsh with herself and her siblings and may hold herself up to unreasonable standards. 

Sometimes the father in these scenarios is also a narcissist, pairing with the mother in using his children for his own purposes. More often, I have found the fathers to be emasculated men who cannot provide an adequate buffer to protect the child from the mother's unreasonable demands. They may appear rather passive, relinquishing their own authority as having equal responsibility in parenting their children, instead meekly backing their wives up and going along with their wishes so as to avoid a storm. The children become the true victims here, unable to defend themselves and unable to turn to their father to be the strong buffer they need him to be. 

The stage is set for this perfect storm. Children of narcissistic mothers, more often than not, find themselves in a no-win situation. There is no chance for a healthy development. Either he can squelch parts of himself and contort himself into the son he believes his mother wants him to be, or he can choose to assert his independence at the great risk of forever severing his bond to his mother. There doesn't appear to be a path in which this child can both develop an authentic identity and maintain a close connection to his mother. The fear of becoming an authentic self that is not reliant on the mother for survival may manifest itself as dependency. The child may have learned that she cannot survive without her mother. She remains anchored to her mother for guidance and direction. The mother's own neediness gets projected onto the child, and the child ends up believing that he is the needy one who is unable to be a self-sufficient adult. He may continue to prove how helpless he is by engaging in acting out behaviors such as financial irresponsibility, sexual promiscuity, and substance abuse to confirm his mother's view. In fact, this child is terrified of separating from his mother because to do so risks losing her entirely. 

I suppose it is not surprising that my caseload consists primarily of these children of narcissists, rather than the parents themselves. One of the hallmarks of a personality disorder is how entrenched it is, and a person with a true narcissistic personality disorder externalizes all his problems and does not take responsibility for any of his egregious actions. Remember, the narcissistic mother firmly believes that it is her child who has wronged her and is at fault for whatever problems ensue. Children of narcissistic mothers who find the strength to engage in psychotherapy have the opportunity to become aware of how profoundly their mother's behavior has impacted them and over time can work toward separating from this mother and genuinely forging an authentic identity of one's own. Even initiating the process of therapy is a step toward  greater empowerment and becoming a self-sufficient adult.