ISBN 978-1-913494-00-1, £12.99, Phil Mollon

If one ignores the first twenty pages of Mollon’s narcissistic journey which are somewhat splintered, coded and unbecoming, along with the book’s final two words (“acupoint tapping”), then one is rewarded with a rich array of melodic language, case studies and ADHD/borderline personality disorder/narcissism insight. A gentler introduction would have prompted more loyalty and curiosity, certainly in this reader, and an overreliance on the writings of Heinz Kohut does beg the question: Why not just dive into those very works, The Analysis of the Self and The Restoration of the Self? But on reflection, even though I agree and disagree with Mollon’s thoughts in equal measure, there is much to be admired.

Narcissistic illness takes three forms, we are told: egocentricity/sense of entitlement/distorting reality; deficits in the structure of the self; and defensive retreat. Or, put in plainer terms: thinking only of oneself/excessive self-love; preoccupation with image; and the inability to relate or consider another’s thoughts. Clients are seemingly perpetrators, victims or both – some desperately caught between the protected, “prescribed path [and] realm of approval” of parents or significant others and the vulnerable, creative freedom/autonomy of real adulthood.

Mollon makes us think: Do we all impose our identity on those around us – particularly those close – to a degree? Do we fade in and out of expecting certain behavioural patterns from our children, partner, friends, colleagues and acquaintances and thus touch the narcissistic light in some regard? The “illusory nature of the self” is asserted in the blurb of Pathologies. And inside the book, the emphasis is on the true self as an “unknown evolving self”. This, I have great difficulty with. True is certainly a definitive word, but it also rides pillion with “our innermost design” and “the basic agenda of the nuclear self” which Mollon evidently lauds or at least acknowledges as early as page 25.

So bits of the book fight with each other. But such disturbance mimics its subjects and is inevitable given the heedful and delicate nature of figuring out humans in distress. If I was to say I’m a stockbroker, novelist, journalist and counsellor, then what would you honestly expect from me given the shrewd, nihilistic, critical, compassionate and perhaps incompatible mix of such professions? Such an analogy lies at the heart of Pathologies, for self, relationships and history invariably define us, or rather our “neurological temperament” and “the attuned responsiveness of others”.

Indeed, ‘selfobject’ – Mollon’s keyword throughout Pathologies – which effectively means the unconscious experience of self in relation to objects and thus has us inextricably bound to the ‘I’ in relation to the ‘Other’ we happen to be connecting with , would suggest that the self does constantly shift, but surely our core remains consistent courtesy of our values and desires.

Many brilliant expressions and phrases light up this work: psychic murder syndrome, nostalgia for lost infantile narcissism, primitively engulfed in our companions’ opinions of us, sending the over-powerful superego-ego mother to hell, using the other as a vessel for projected feelings of weakness, left brain tyranny, vicarious introspection (empathy) and psychic bleeding (little resilience).

It is, however, Mollon’s underscoring the belief that therapy is a process of self-exploration which I consider to be the salient juncture in the book. A typical diagnosis of BPD indicates inconsistent presentation (sometimes calm, at other times chaotic) and ADHD sufferers are said to prefer conflict to boredom. But at least both of these classes present. Are we as therapists often too mute or muffled or inarticulate in explaining exactly what it is that we do? I say this because abrupt therapeutic conclusions (example: pg.125) litter counselling publications and a client becoming ‘aware’ of what affects his mental health does not equate to moving forward.  

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This review was first published in Private Practice, December 2020 issue, © BACP