Criticism in the Self, Brain, Relationships, and Social Structure: Implications for Psychodynamic Psychiatry.

An integrative-psychodynamic theory of criticism in self and relationships is presented (Shahar, 2015). My theoretical starting point is the tension between Authenticity (A; our inherited potential, tantamount to Winnicott's True Self) and Self-Knowledge (SK; what we [think] we know about ourselves). Self-criticism, a formidable dimension of vulnerability to a wide array of psychopathologies, is construed as a distorted form of self-knowledge, reducing internal confusion at the expense of widening the gap between A and SK. Amalgamated by a genetic and neuroanatomic makeup, criticism of the self quickly translates into criticism-based interpersonal exchanges across the life span, culminating in an Axis of Criticism (ACRIM). A psychodynamic-integrative psychotherapy of malignant criticism in self and relationships is described. The article is concluded with some broad reflections on the implication of this work to the theory development and therapeutic action.