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Dr. James Masterson, expert on personality disorders; at 84

By Margalit Fox
New York Times / April 20, 2010

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NEW YORK — Dr. James F. Masterson, an internationally recognized psychiatrist who helped inaugurate a new approach to the study and treatment of personality disorders, including narcissism, died April 12 from complications of pneumonia. He was 84 and lived in Rye, N.Y.

A trained psychoanalyst, Dr. Masterson was an authority on narcissistic and borderline personality disorders. At his death, he was clinical professor emeritus of psychiatry at Weill Medical College of Cornell University.

He was also the founder and director of the Masterson Institute for Psychoanalytic Psychotherapy. Established in 1977, the institute offers psychoanalytic training at its headquarters in Manhattan, its West Coast branch in San Francisco and, via the Internet, locations around the world.

Personality disorders affect millions of people in the United States alone. Patients with narcissistic personality disorder can be grandiose, attention-seeking, and demanding. Those with borderline personality disorder tend toward self-destructiveness, manipulativeness, and flash-flood anger.

Dr. Masterson was one of the first people to bring the psychoanalytic approach known as object relations theory to bear on the study of personality.

In so doing, he helped widen the lens through which personality disorders are viewed beyond the classical Freudian one that analysts had favored for decades.

“The enormous contribution he made was in the understanding of personality disorders and the evolution of personality per se,’’ Allan N. Schore, a psychoanalyst and neuroscientist at the University of California, Los Angeles, said. “He really helped psychiatry shift to offer more complex, more effective models in the treatment of personality disorders.’’

Most closely associated with the British psychoanalysts Donald Winnicott and Melanie Klein, object relations theory centers on infants’ early attachment to their mothers. This attachment is vital, the theory holds, so vital that disruptions can cause psychological disturbances later on.

Object relations theory was primarily meant to explain human behavior. But in work he began in the mid-20th century, Dr. Masterson came to believe that it also held the key to personality, in particular the origin and treatment of personality disorders. (The psychoanalysts Heinz Kohut and Otto F. Kernberg also played seminal roles in applying the object relations model to the realm of personality.)

Classical Freudianism roots personality disorders in the Oedipal period, roughly between the ages of 4 and 6. Applying the object relations model, Dr. Masterson placed the roots even farther back, between about 18 months old and 36 months old.

“The pre-Oedipal disorders, which include all the personality disorders by definition, are much more concerned with the issue of maternal availability,’’ Judith Pearson, director of the Masterson Institute’s East Coast division, said Thursday.

“In the Oedipal phase, the conflict really includes the child’s rivalry with the same-sex parent for the love of the opposite-sex parent.’’

With its emphasis on the Oedipal, the Freudian approach was ill suited to treating personality disorders, Dr. Masterson argued. He maintained that these disorders crucially involve the conflict between a person’s two “selves’’: the false self, which the very young child constructs to please the mother, and the true self.

“The psychotherapy of personality disorders,’’ Pearson explained, “is an attempt to put people back in touch with their real selves.’’

Dr. Masterson, whose work also encompassed the neurobiology of personality disorders, was the author of many books. Among them are “The Search for the Real Self’’ and “The Psychiatric Dilemma of Adolescence.’’

Dr. Masterson became so well known as an expert on narcissism that he sometimes attracted patients for whom only a high-profile therapist would do — in other words, narcissists.

In the 1980s, after The New York Times cited him as an authority on the disorder, he received a dozen calls from people wanting treatment.

Too busy to accept new patients, Dr. Masterson referred the callers to his associates. As The Times reported in 1988, not a single one made an appointment.