Rage

Aggression and Transference in Severe Personality Disorders

by Otto F. Kernberg, M.D.

Function of Rage

The earliest function of rage is the effort to eliminate a source of irritation or pain. Rage is thus always secondary to frustration or pain, although the intensity of the rage response may depend upon temperamental features. A second function of rage is to eliminate an obstacle or barrier toward gratification. Here the dynamics are more complex: an obstacle has to be eliminated to reach a fantasied or real source of gratification. This is the prototype for a third, higher developmental level function of rage, namely the elimination of a bad object, that is, a supposedly willful source of frustration standing between the self and the gratification of a need.

At a still more advanced developmental level, the wish is no longer to destroy the bad object, but to make it suffer: here, we are definitely in the complex developmental area in which pleasure and pain combine, sadism expresses a condensation of aggression with pleasure, and the original affect of rage appears transformed into hatred with new, stable, structural characteristics. At a further level of development, the wish to make the bad object suffer shifts into the wish to dominate and control the bad object in order to avoid fears of persecution from it; now obsessive mechanisms of control may psychopathologically regulate the suppression or repression of aggression. Finally, in sublimatory aspects of the aggressive response, the search for autonomy and self-affirmation, for freedom from external control, reflects characteristics of the original, self-affirmative implications of rage.

Hatred, I propose, is a complex, structured derivative of the affect rage that expresses several wishes: to destroy a bad object, to make it suffer and to control it. In contrast to the acute, transitory and disruptive quality of rage, it is a chronic, stable, usually charac-terologically anchored or structured affect. The object relationship framing this affect expresses concretely the desire to destroy or dominate the object. An almost unavoidable consequence of hatred is its justification as revenge against the frustrating object; the wish for revenge is typical of hatred. Paranoid fears of retaliation also are usually unavoidable accompaniments of intense hatred, so that paranoid features, a wish for revenge, and sadism go hand in hand.

One complication of hatred derives from the fact that very early frustration and gratification are experienced as stemming from the same source. Hence, the obstacle to gratification is the origin of that gratification, which brings us to the psychopathology of envy. I am referring to Klein's (1957) explanation of envy as a major manifestation of human aggression. Very early frustration-in Klein's terms, the absence of the good breast-is experienced by the baby as if the breast withheld itself, with an underlying projection into the breast of the baby's aggressive reaction to that frustration. The baby's aggression takes the form of greedy wishes to incorporate. The frustrating breast is experienced as greedily withholding itself. Here lies the origin of envy, the need to spoil and destroy the object that is also needed for survival and, in the end, the object of love.

The clinical study of patients with narcissistic personality disorder regularly reveals both unconscious and conscious envy as a major affective expression of aggression. As we move from the better functioning narcissistic pathology to severe narcissistic personality disorders with overt borderline functioning, that is, with generalized lack of impulse control, of anxiety tolerance and of sublimatory channeling, the intensity of aggression mounts, reaching a maximum in the syndrome of malignant narcissism. At times, the intensity of hatred is such that it results in a primitive effort of denial of hatred by means of the destruction of all awareness of the affect, a transformation of aggressive affects into action or acting out; in addition to defending against the subjective awareness of the affect, the action obliterates ordinary cognitive functioning. These developments characterize the syndrome that Bion (1957) described as constituted by arrogance, curiosity and pseudo stupidity: here envy and hatred become almost indistinguishable.

Most patients with severe histrionic, hysteroid or borderline personality disorder, and with severe self-destructive, self-mutilating, suicidal, and/or antisocial trends always also evince strong elements of envy within the context of intense activation of hatred. On the other hand, what might be called the "purest" manifestation of hatred-with relative absence of envy per se-may be seen in patients who were physically traumatized or victims of sexual abuse or incest.

The greater the envy, the more is an actual perception of the envied or hatefully envied person as one who possesses qualities that are highly desirable or "good." In other words, the object of hatred is experienced as an object that in some ways possesses the goodness and values that the patient misses and desires for himself. This development does not take place when pure hatred is directed at an object perceived as a dangerous, sadistic enemy. Hatred aims at the destruction of a source of frustration perceived as sadistically attacking the self; envy is a form of hatred of another perceived as sadistically or teasingly withholding something highly desirable. Typically, although not always, patients with severe narcissistic pathology have a history of a relationship with a parental figure who seemed to be operating as a good enough parent, but who had an underlying indifference toward the patient and a tendency to narcissistically exploit the patient.

Dr. Kernberg is associate chairman and medical director of New York Hospital-Cornell Medical Center, Westchester Division; professor of psychiatry at Cornell University Medical College; and tutoring and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research.

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