Page 1

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CONTENTS I. INTRODUCTION

p. 3

II. FREUD

p. 6

a. Splitting of Consciousness

p. 8

b. The predominance of sexual factors in pathogenesis

p. 9

c. The working hypothesis of ‘neurosogenesis’

p. 10

d. The return of the repressed

p. 11

e. ‘Affect-trauma’ to the ‘topographical’ frame of reference

p. 12

i. Pathogenic heredity

p. 16

ii. The complemental series

p. 17

iii. Choice of neurosis

p. 18

f. ‘Topographical’ to ‘structural’ frame of reference

p. 20

i. The infantile roots of sexuality: neuropathic disposition p. 21 ii. The sociological significance of sexuality in pathology g. Freud’s metapsychology

p. 22 p. 22

i. Pregenital component instincts in the choice of neurosis p. 25 ii. The complemental series revisited

p. 26

iii. The pathogenesis of depression and aggression

p. 28

h. The tripartite model of the mind

p. 28

i. Oedipus

p. 29

III. MELANIE KLEIN

p. 30

a. Genealogy of Klein: Sadism, Aggression, Paranoia and Depression p. 36 IV. ANNA FREUD

p. 41


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V. PATHOGENESIS: CONTRASTING KLEIN WITH THE FREUDS p. 43 a. The Ego

p. 43

b. Differing opinions on the role and primacy of introjectionp. 45 c. Infantile neurosis or arrested development?

p. 46

d. The developmental-adaptive model of pathogenesis

p. 47

e. The role of the instincts in models of pathogenesis

p. 48

f. The Viennese Model

p. 49

g. The question of preoedipal predicates for pathology

p. 50

h. One-, two-, or three- person psychology?

p. 51

i. Shared and tacit acceptance of the complemental series

p. 52

j. The predominance of orality

p. 53

VI. CONTROVERSIAL DISCUSSIONS

p. 53

a. Unconscious phantasy: the battle lines are drawn

p. 55

b. Oedipus complex or Oedipus conflict

p. 56

c. The Kleinian victory?

p. 57

VII. CONCLUSION: The different pictures of the child

p. 59

VIII. RECAPITULATION

p. 60

IX. BIBLIOGRAPHY

p. 62

X. APPENDICES

p. 65

a. Appendix A

p. 65

b. Appendix B

p. 68


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A GENEALOGY OF PSYCHOANALYTIC THEORIES OF PATHOGENESIS: The Puzzle of Pathogenesis

“our need for a tangible…‘ultimate cause’ of nervous disorders will never be satisfied”1 I. INTRODUCTION Tracing the genealogical links of complementary, and at times fundamentally opposing models of pathogenesis within the psychodynamic field of inquiry should not be done without a propaedeutic expression of philosophical skepticism: that the validity of one model cannot completely rule out the validity of another. Contrary to the popular, but no less erroneous criticism of ‘discriminatory paralysis’, the skeptic’s suspension of judgement is subscribed to here, on the basis of a perspectival appreciation of the validity of multiple perspectives in an area of thought that is typically without huge contributions from empirical and thus objective verification. That said, this investigation into the dominant psychoanalytic models dealing with the puzzling problem of pathogenesis, intended to introduce the reader to a scholarly, if somewhat abbreviated history of Freud’s thought, and the thought of his successors, namely Melanie Klein and Anna Freud. There is a specific focus in this thesis on the developmental theories relating to infancy and their differences. Obviously, Freud’s thought evolved, as did Klein’s and his daughter’s, but this snapshot of the relevant concepts and theories within their different, yet complementary models of pathogenesis, aims to give the reader a broad and in depth look at the work of these pioneers. The context of this thesis is the burgeoning body of knowledge on the workings of the mind, and the process of pathological disturbance. Freud brings us to the notion of a splitting of consciousness in his early writings and highlights the predominance of sexual factors in pathogenesis. He 























































 1

Freud, S. (1926) Inhibition, Symptom and Fear. p. 221 in Freud, S. (2003). ‘Beyond the Pleasure Principle and Other Writings’. Translated by John Reddick. London: Penguin


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moves from a working economic hypothesis regarding the mechanism of hysterical pathology and places repression at the centre of his early formulations. There is a progression from affect-trauma to topographical and finally to structural conceptualizations of pathogenetic organization, traceable through the evolution of his thought. The role of heredity and a complemental series of relations between internal and external factors, discussed in the context of the choice of neurosis become central to Freud’s later model. The infantile roots of sexuality represent a neuropathic disposition for Freud. Later the sociological significance of sexuality in pathology constitute the final transition in Freud’s thought and led the way to a discussion of Freud’s metapsychology. The pregenital components in the choice of neurosis, the complemental series and an appreciation of depressive and aggressive pathologies led finally to Freud’ tripartite model of the mind, and the central inclusion of the Oedipus complex in his model. In Melanie Klein we see a more refined appreciation of sadistic impulses, alloyed with the erotic drives previously established in Freud’s metapsychology, and Klein concentrates her contributions around the role of aggression in paranoiac and depressive states of infancy that precede the classical notion of an Oedipus complex which sets her model out from those of the Freudians. Klein’s is a model that pays close attention to the unconscious phantasy underlying pathogenic states and object relationships. Genealogically speaking, it is fairly simple to trace the origins of her ideas on these themes to the already accepted psychoanalytic theory of her day. We then go on to describe in brief detail, the model of Anna Freud, focused as it was on a diagnostic and therapeutic atomisation of the complex interaction of progress and inhibition of development along several lines of development that include object relations as one among that the infant must go through on the path to maturation and adaptation. Anna Freud resists speaking of neurosis or pathology, like her father, before the establishment of the super-ego at the dissolution of the Oedipus complex. Comparing and contrasting Klein’s model with those of the Freudians, we begin to delineate some specific areas of dispute and others of agreement on the issue of pathogenesis. The role of the ego, the primacy of introjection, nosological distinctions


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between neurotic or developmental nomenclatures, metapsychological conceptions of the instincts, pregenital components, crude distinctions in the model’s inclusiveness of multiple psychologies, the use of complemental relationships and reference to fixation points in libidinal development, all contribute to this discussion and represent the major areas of divergence and similarity between the models discussed. Controversies leading to the trifurcation of the British Society take a penultimate place in this thesis, which reinforce the distinctions and comparisons made from primary sources. Unconscious phantasy demarcates the significant battle line between the conflicting schools and represent an issue that finds contradictory support and refutation in Freud’s original work: on this point, it is unclear who is more in line with Freud and who is not, since support can be found for both positions. Oedipal conflicts represent another dimension that appears equally unsettled in the genealogy, as both Klein and Anna Freud, believe they are staying true to Freud, and seem to fail to appreciate the complementarities of their ideas, in favour of using the differences as a launching pad for some of the most irremediable criticisms. Despite all the fuss, it can be concluded that Klein gained much ground during these discussions, leading to the modus

vivendi that constituted the partition of the British Society into three equally valid schools of thought. Each theorist built a different picture of the child, and found illuminating and at times, confusing pieces of the puzzle of pathogenesis. Only when looked at as a whole, can they be appreciated as delicately and mutually dependent components of a complicated and unsettled area of thought. With that said, we begin our journey into the landscape of psychoanalysis and its putatively primary goal, of understanding how, why and when things go awry in the mind leading to the suffering that psychoanalysts are so dedicated to holding to account and finding a remedy for. II. FREUD


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In 1885, Freud arrived at the ‘Salpêtriére’ in Paris2, where he studied under one of the greatest physicians, whose common sense was touched by genius. The young Freud had not met anyone with such an influence on his thoughts as Charcot3 who was renowned for his work into the organic causes of the status nervosi 4 in the field of neuropathology. By the time Freud was under his administration however, it was the psychopathology of hysteria and its treatment with hypnosis that had become the main subject of Charcot’s attention.5 From this modicum of biographical information, we not only perceive a hint of the influence that neuropathology was to have upon the young Freud, but we also discover that it was Charcot, and not Freud, who first attempted psycho-pathological paradigms for the understanding of nervous diseases. As Cuvier was to Paleontology, Charcot was to neuropathology, so said Freud in the obituary he wrote for his teacher in 1893. We are told that Charcot put clinical facts on a much higher pedestal than the ‘encroachments of theoretical medicine’6, which foreshadows Freud’s own preference and expertise in the clinical as opposed to the theoretical domain. It was a stroke of luck for neuropathology that Charcot was able to create nosological pictures through clinical observation whilst demonstrating that: “the same anatomical changes underlay the disease whether…a type or…a formes

frustes.”7 This ‘anatomical-clinical’ method of Charcot’s, in the field of organic nervous disease clearly paved the way for Freud to experiment with his ‘clinico-psychological’ method in the field of the psycho-pathology.8 Here, with the discovery of a new field 























































 2

Hospital for ‘incurables’ Professor of Clinical Neurology at Salpêtriére 4 Nervous disease 5 Freud, S. (1886) Preface to the Translation Of Charcot’s Lectures on the Diseases of the Nervous System. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. I (18861899): Pre-Psycho-Analytic Publications and Unpublished Drafts, 17-22. (hereon referred to as SE) 6 Freud confesses he provoked a favourite repartee of Charcot’s: Freud, S. (1893). Charcot. SE III (1893-1899): Early Psycho-Analytic Publications, 7-23. ‘La théorie, c’est bon, mais ça n’empêche pas d’exister’ (‘The theory is good but it doesn’t prevent things from existing’) Ibid. 7 Ibid. p. 13 8 Pathological anatomy serves neuropathology by demonstrating the presence of morbid change and establishing the localization of that change. Charcot, following in the footsteps of Türck and HitzigFritsch, ushered in a ‘new epoch’ in the enhanced localization of the nervous diseases, which has clearly been decisive in the evolution of the neurosciences and neuropsychology. This new epoch also must have contributed to Freud’s profound tendency to investigate the structure, function and location of the mental apparatus, neurotic disturbance and intrapsychic conflict respectively, within the agencies of the mind, which later became known as the ‘tripartite model’. 3


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of psychosomatic confluence, in the presentation of hysteria, the psychoanalytic science, took its first tentative steps: “if I find someone in a state which bears all the signs of a painful affect – weeping, screaming and raging – the conclusion seems probably that a mental process is going on…of which these physical phenomena are the appropriate expression.”9 Whereas healthy individuals were able to tell the physician about his torments, the hysterical patient was incapable of asserting such knowledge. The discovery of this psychosomatic mechanism and the assumption of a denial on the part of the hysteric, together with: “the many indications that the patient is behaving as though he does know about it”10 allowed Freud to propose the exploration of the patient’s life as a method by which an appropriate trauma from the past could be located and given pathogenic status in the origination of their hysterical symptoms. As a solution to the apparent lack of conscious knowledge regarding these pathogenic traumata, which were genetically linked to their hysterical output, Freud says: “the patient is in a special state of mind…his impressions or…recollections…are no longer held together by an associative chain, a state of mind in which it is possible for a recollection to express its affect by means of somatic phenomena without…the ego, knowing about it or being able to intervene to prevent it.”11 a. Splitting of Consciousness It is here, in solution to this ‘knowing yet not-knowing’ at the same time; this ‘blindsight of the seeing eye’ in his hysterical patients, that Freud is first known to have split consciousness into a system conscious (Cs), and a system unconscious (Ucs), which was to become a central tenet of his topographical phraseology. It was on this point that Freud differed most from Charcot, who treated hysteria as predominantly another subject of neuropathology; elaborating its nosographical and nosological 























































 9

Ibid. p. 19 Ibid. 11 Ibid. p. 20 10


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desiderata and showing that hysterical phenomena had their own ‘laws’ and ‘uniformities’. When it came to diagnosis, Charcot put forward the single factor of heredity as the

prima causa of hysteria, which he considered to be a form of degeneracy and a member of the ‘famille nèvropathique’. Such psychological reductionism did not, however, convince Freud. Reducing the plethora of causal factors to the role of incidental causes or ‘agents provocateurs’ and claiming biology as the sole source of neurotic disturbance left no room for psychological intervention or prevention. Nonetheless, Charcot’s employment of somnambulism and hypnosis in order to artificially reproduce hysterical paralyses proved: “…that [they]…were the result of ideas which had dominated the…brain at moments of a special disposition.”12 With this, the psychical mechanism of hysterical phenomena was, for the first time, within reach. The exclusively nosographical approach of the Salpêtriére had, however, reached its limits regarding what was now almost purely a psychological subject. Hypnosis, abjured by Bernheim (a pupil of Liébeault), as operating by means of suggestion called for a new methodology, which Freud was soon to forge from his growing and extensive clinical researches into the pathogenesis of psychical disturbance. 1893 also saw the publication of Freud and Breuer’s first collaboration, their ‘Preliminary Communication’, which contained the notable ‘working hypothesis’ on the psychical mechanism of hysterical phenomena. In a posthumously published draft version of the same work, Freud sketched what was to become a centrally significant hypothesis in his attempts at a psychoanalytical conceptualization of pathogenesis; the ‘complemental series’: “The hysterical disposition is therefore to be looked for where [hypnoid] states of this kind either appear spontaneously (from internal causes) or…produced by external

























































 12

Ibid. p. 22


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influences; and we may suppose a series of cases in which these two factors play a part

of varying importance.”13 Borrowing from Breuer, Freud discusses ‘hypnoid’ states, as examples of the splitting of consciousness, implied in the solution to the clinically perplexing hysterical ‘condition seconde’, which could explain the lack of conscious awareness of pathogenic traumata in hysterical patients.14 The splitting of consciousness by means of an effort of will was regarded as the manifestation of a pathological disposition, which is dissimilar to individual or hereditary ‘degeneracy’. b. The predominance of sexual factors in pathogenesis It was especially, sexual traumata, even at this early stage, that Freud believed to be decisive in the creation of such pathological dissociated states. Thus, ‘sexuality’ was already being given a prominent role in Freud’s pre-psychoanalytic attempts at a psychogenetic theory of hysteria. In order to explain the psychical mechanism of hysteria, Freud first had to lay down some fundamental precepts about mental economy, which he does in his draft by appealing to the ‘principle of constancy’. To wit: as a precondition of health, the nervous system seeks to keep constant, the sum of excitation in its functional relations by: “disposing associatively of every sensible accretion of excitation or by discharging it by an appropriate motor reaction”15. According to this theorem, hysterical attacks can be viewed as impressions, which have failed to achieve sufficient discharge. In their joint attempt at delineating the psychical mechanism of hysteria, Freud and Breuer draw our attention to an important notion of the ‘precipitating cause’ as: “the event, which provoked the first occurrence…of the phenomenon in question”16. We are 























































 13

Freud, S. (1940) Sketches for the ‘Preliminary Communication’ of 1893. SE I, 145-154. (p. 149) (My italics) 14 “we regard it as indispensable for the explanation of hysterical phenomena to assume the presence of a dissociation – a splitting of the content of consciousness”. Ibid. p. 151 15 Ibid. p. 153 16 Breuer, J. & Freud, S. (1893) On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication. SE II (1893-1895) pp. 1-17 (p. 2)


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reminded that the patient knows of no causal connection between the precipitating cause and pathological phenomena of their hysterical outbursts and therefore hypnosis is still implicated for the arousal of memories in treatment. The notion of psychical trauma acting like a foreign body: “which long after its entry…is still at work”17 echoes the medical language of neuropathology from whence Freud’s theories came. The presence of the requisite hypnoid states was claimed to predate the onset of illness and provide the fertile ground in which the traumatic affect sowed its pathogenic seeds in memory which grew later into the hysterical psychosomatic disturbances. Coming back to the ‘complemental series’, Breuer and Freud distinguished ‘dispositional hysteria’ from ‘traumatic neuroses’ (as extreme cases), between which a series of liabilities to dissociation and the affective magnitudes of trauma were thought to vary intensely. Taking leave of Charcot’s achievements, Breuer and Freud were keen to express that they had only enumerated the acquired forms of hysteria and the bearing of accidental factors on the neurosis, such as sexual traumata, and not, as their predecessor would have liked, the internal causes of the condition.18 c. The working hypothesis of ‘neurosogenesis’ In 1894, the origin of pathological ideas in new and different cases and a putative theory of defence, which would steer Freud further away from Charcot and Breuer, became the next challenge for the embryonic science of psychoanalysis. In this paper, ‘defence’, ‘conversion’, and ‘flight into psychosis’ make their first appearance and the importance of the part played by sexuality in pathogenesis continues to emerge. Freud presents his working hypothesis for the neuroses of defence, taking shape as an economic model, which contributes to psychoanalytic metapsychology: 























































 17

Ibid. p. 5 Illustrative of their theories regarding the pathogenesis of hysteria, Freud contemporaneously published the case history of ‘Katharina’, which succinctly verified many of the major postulates of the new theory. The deferred action of a pathogenic affect was supported in Katharina’s case by the fact that her symptoms occurred after the sexual trauma and after ‘an interval of incubation’. Charcot called this period of psychical working out ‘élaboration’. 18


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“in mental functions something is to be distinguished – a quota of affect or sum of excitation – which possesses all the characteristics of a quantity (though we have no means of measuring it), which is capable of increased displacement and discharge, and which is spread over the memory traces of ideas somewhat as an electric charge.”19 Further remarks on the neuro-psychoses of defence were published two years later in 1896a, incidentally the same year that Freud published a seminal paper on the role of heredity in the aetiology of the neuroses which begins to mark the end of the ‘affecttrauma’ frame of reference that dominates these pre-psychoanalytic investigations. d. The return of the repressed In 1896 also, Freud wrote ‘Draft K’ of the neuroses of defence, which is found in the extracts from Freud’s long-standing correspondence with Fliess. This letter introduced the content of Freud’s 1894 and 1896 papers dealing with the various types of neurotic disturbances he was becoming familiar with. Freud notes their similarities as pathological aberrations of normal psychical affective states20, which permanently damaged the ego, and he highlights the similarity of their precipitating causes as the ‘affective prototypes’ of these states. The psychoneuroses, we are told, had to fulfill two more causal preconditions of ‘sexuality’ and ‘infantilism’ in order to achieve differential diagnosis from the milder forms of the simple neuroses. Heredity came last on Freud’s list of preconditions: “in that it facilitates and increases the pathological affect”21, and in being the factor that determined: “the gradations between the normal and the extreme case”22. By this point, Freud did not agree with his teacher Charcot that heredity determined the issue of which neurosis was defensively employed23. 























































 19

Freud, S. (1894) The Neuro-Psychoses of Defence. SE III, p. 60 Conflict in hysteria; self-reproach in obsessional neurosis; mortification in paranoia and mourning in amentia. 21 Freud, S. (1892). Draft K The Neuroses of Defence from Extracts from the Fleiss Papers. SE I, p. 220 22 Ibid. 23 The choice of neurosis was not to come close to being solved until 1913, with the final explanation being offered after Freud had investigated the developmental stages of the libido and the concepts of 20


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Draft K deals with the curious possibility that a memory can release its pathogenic power post facto if puberty is interpolated between the original trauma and its repetition in memory; leading to an increased effect of the revival. Along these lines, Freud posits the necessary precondition for freedom from the neuroses of defence as the absence of any ‘considerable sexual irritation’ before puberty24. The cardinal deviation of the various psychoneuroses being dealt with by Freud at this time, is demonstrated by: “the way in which the repressed ideas return…the manner in which the symptoms are formed, and…the course taken by the illness. But the specific character of a particular neurosis lies in the fashion in which the repression is accomplished.”25 e. ‘Affect-trauma’ to the ‘topographical’ frame of reference Sandler et al., (1972) provide a useful division of the historical phases of psychoanalysis, which supports this discussion of the evolution of Freud’s thought. His pre-psychoanalytic and early psychoanalytic work is subsumed within the ‘affecttrauma’ frame of reference (1886-1897), his major psychoanalytic contributions between 1897-1923 form the ‘topographical’ frame of reference, and his final contributions of 1923-1939 take shape in the ‘structural’ frame of reference, which has by far outlived its predecessors. In addition to these broad divisions there were corresponding abandonments of certain theoretical and technical standpoints such as: the use of hypnosis, seduction theory, aggression as an ego-instinct etc, alongside an increasing tendency to reformulate the corpus of clinical and theoretical data of psychoanalysis within a metapsychological framework which attempted to consolidate the diverse perspectives within psychoanalytic psychology.26
































































































































































 fixation and regression were dealt with, metapsychologically, in Lectures 21 and 22 of Freud’s Introductory Lectures on Psychoanalysis. 24 “unpleasure…seems to be released by premature sexual stimulation…without which…a repression cannot be explained.” Ibid. p. 221 25 Ibid. p. 223 26 genetic, dynamic, structural, intrapsychic and developmental.


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The emphasis of the affect-trauma frame of reference was placed on: “external traumatic events as instigators of pathology, and on the role played by ‘charges of affect’ in normal and abnormal mental functioning.”27 During this phase, trauma, and its repression as causative in psychopathology, as well as the notion of ‘pent-up’ quantities of affect were all introduced into a burgeoning psychoanalytic vernacular. The concept of defence, also appears during this phase (although without the focus of what is defended against i.e., repression, not the repressed), and for the most part, these concepts have remained in psychoanalytic theory unchanged. Mental apparatus are characterised as: “a psychological organization, within which psychological processes occur…increasing in complexity during the course of development.”28 These apparatus function as: “a vehicle for adaptation to demands from both internal and external sources [where]…adaptation to experiences deriving

from external reality is emphasized.29” As the child develops, the ‘ego’ becomes differentiated: “on the basis of an interaction between biological needs (which create sums of excitation in the apparatus) and the external world (which produces substantially larger sums of excitation)”30: as ‘consciousness’ and as the agency performing defence. Freud posits a ‘constitutional disposition’ for the development of the ego. Importantly, the capacity for ‘splitting’ and the relegation of some content to the system unconscious arises alongside, and due to, the defensive function of the ego. Repression represented the first line of defence which, when unsuccessful, led to the damming up or strangulation of affect outside of consciousness and created ‘energic disequilibrium’. Substitution or displacement of incompatible ideas was another method discovered by Freud during this phase, as typical of obsessional pathology, and led to the characteristic ‘self-reproach’ now familiar in obsessional mechanisms. Transformation of affect, i.e., replacement of one affect for another, is the final method of defence attributable to this early phase of Freud’s work, and accounts: “for the 























































 27

Sandler, J, Holder, A & Dare, C. (1972) Frames of Reference in Psychoanalytic Psychology: IV. The affect-trauma frame of reference. British Journal of Medical Psychology, 45: 265-272 (p. 265) 28 Ibid. p. 266 29 Ibid 30 Ibid


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appearance of anxiety as a consequence of… ‘strangulated affect.’”31 Although defences were regarded as normal and fundamental to mental functioning, their excessive use was thought to lead to pathology. To sum up then, pathological processes, in the affect-trauma frame of reference, were seen as: “particular processes of adaptation to a disequilibrium in the mental apparatus caused by the existence of an intense charge of affective energy associated with certain ideas”.32 Whereby, the energy, if immune to normal processes of discharge, finds expression in psychological disturbance. Trauma is given its place as the prima causa of disequilibrium with particular emphasis on the occurrence of sexual traumata, which Freud thought, had a special affinity to the damming up of affect so crucial for psychopathological symptomatology. Here, repression dams up affect which finds ‘disguised and distorted’ expression in the form of a neurotic symptom. Formulations in the first phase: “represent a major attempt to explain the occurrence of pathological conditions…in terms of mental processes – psychological conflict, the effect of distressing or threatening affects, mental traumas and the psychological effect of sexual factors such as seductions, frustrations etc.”33 The common aspect of the neuro-psychoses of defence dealt with in the 1894 paper was that their symptoms all emerged through a psychical mechanism of unconscious defence; an attempt to: “repress an incompatible idea which had come into opposition to the patient’s ego.”34 Defence is seen as the ‘nuclear point’ in the psychical mechanism of the psychoneuroses in this psychological theory. Freud, in his further remarks places huge importance on the nature of these sexual traumas (actual

























































 31

Ibid. Ibid. p. 268 33 Ibid. 34 Freud, S. (1896) Further Remarks on The Neuro-Psychoses of Defence, SE III, p. 162 32


15


irritation of genitals, resembling copulation) and the period of life in which they necessarily occur (before puberty)35. Hereditary and constitutional predispositions also had a place in these preliminary theories of Freud’s, particularly in the ‘choice of neurosis’ which remained a central problem for him, long into his career: “It is the interaction of constitutional factors with the specific experiences of the individual which is regarded as important in determining the way in which the mental apparatus adapts to the forces acting on it, and whether or not pathological processes will ensue.”36 With his ‘Further Remarks’, the focus turns from repression to the repressed: a significant turning point for the history of psychoanalysis, emerging at the transition to the topographical phase. The topographical frame of reference gives a fuller appreciation of the role of internal forces and shifts the emphasis onto the role of the drives as opposed to the role of the trauma. It also introduces the emergence of new psychical mechanisms which were to play a very large part in Freud’s subsequent accounts of mental processes and therefore to the psychoanalytic theory of pathogenesis also. The importance of hereditary dispositions was thereby diminished by the predominance of the ‘accidental’ sexual factors enumerated by Freud. Auxiliary sexual traumas occurring after puberty were now conceived of as precipitating causes in that they: “arouse the memory-trace of…traumas in [earlier] childhood, which…lead to a release of the affect and to repression”37. A pre-existing susceptibility to a pathological reaction had, therefore, to be acknowledged and this indefinite neuropathic disposition amounted to the posthumous operation of sexual trauma in childhood. 























































 35

The upper limit below which sexual injury plays an aetiological role in hysteria is said to be between the 8th and 10th year; the lower limit being between the age of 1 and a half and 2 years (the ‘second dentition’ as referred to in The Aetiology of Hysteria, (1896) 36 Sandler, 1972… 37 Ibid. p. 165


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The deferred operation of these early traumata received treatment by Freud in his papers on heredity and aetiology in hysteria (published in the same year as these further remarks). The Fleiss letters (42, 46 & 52) also take on the problem of deferred action of repression and the ‘choice of neurosis’, with some illuminating chronological tables. Finally, the case of Katharina recapitulates much of Freud’s emerging theories of hysterical pathogenesis. 1898 marks the beginning of Freud’s explicit articulation of the topographical frame of reference and although only two years had passed since his last publication on psychopathology, Freud had begun his self-analysis and this led to the fundamental discovery of the Oedipus complex and the gradual recognition of infantile sexuality as a normal and universal fact. The affect-trauma frame of reference now closed, Freud suggests that the seeds of illness are acquired during childhood where the influence of sexual experiences leads to abnormal psychical reactions and to the emergence of psycho-pathological structures. The theory of the psychoneuroses was now based on the deferred nature of the effect of repression and the infantile state of the sexual apparatus and mental instrument. i. Pathogenic heredity ‘Heredity and the Aetiology of the Neuroses’ published in the same year as the aetiological investigation into hysteria (1896), officially closes the affect-trauma phase of psychoanalysis and repudiates Charcot’s nervous heredity account as being based on a ‘petitio principii’, which equally allowed for the possibility of acquired disorder: “powerful aetiological influences must be recognized whose collaboration is indispensable for the pathogenesis of certain illnesses which could not be produced by heredity alone.”38 To clarify, the pathogenic power of specific causes was believed to be accessory to that of heredity. Freud relays his own nosographical innovation for the description of 























































 38

Freud, S. (1896) Heredity and the Aetiology of the Neuroses. SE III pp. 141-156 (p. 143)


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pathogenesis by delineating three classes of pathogenic influences each differing in their importance and in the manner in which they relate to the effect they produce: The first of these influences are the ‘preconditions’, which are indispensable for the production of a disorder and equally present in many disorders. Second, are the ‘concurrent causes’, which share the character of the preconditions as functioning in the causation of disorder, but are not indispensable for the production of the disorder by themselves. Third, we come to the ‘specific causes’, which are as indispensable as the preconditions and limited in nature only by their determination of a specific disorder. The action of heredity is compared to that of a ‘multiplier’ within an electric circuit which: “exaggerates the visible deviation, but…cannot determine its direction.”39 ii. The complemental series The ‘complemental series’ is invoked once again (in 1896), with greater acuity, when Freud discusses the relations between heredity, the preconditions and the specific causes of neuroses and warns that: “one should not neglect the relative quantities…heredity and the specific causes can replace each other as regards to quantity.”40 Therefore, any lack of hereditary disposition is compensated for by a more powerful specific causation, and vice versa: this is the essential meaning of Freud’s complemental hypothesis. Concurrent causes take the form of auxiliary influences and include such irregular and unnecessary factors as emotional disturbance, physical exhaustion, acute illness, intoxicants, traumatic accidents and intellectual overwork, which at most: “render manifest a neurosis that has previously been latent.”41 These concurrent causes may replace the specific causes in respect of quantity, but they cannot replace it in its entirety.42

























































 39

Ibid. p. 146 Ibid. 41 Ibid. 42 “the nature of the stock cause which supervenes is a matter of complete indifference…The pathological effect will not be modified according to this variation; the nature of the neurosis will always be dominated by the preexisting specific cause.” Ibid. p. 148 40


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In his ‘The Aetiology of Hysteria’,43 we see Freud here formally surpassing Charcot’s thesis, establishing his psychological theory, appreciating the role of infantile sexuality and hinting at the possibility of phantasy and the co-operation of memory in hysterical phenomenology. Infantile sexual experiences became uniform pathogenic factors in the neuroses44 and with this, the ‘caput Nili’ in neuropathology was reached. In a further addition from 1924, Freud is keen to remind his readers that at the time of writing, he had still not freed himself from an overvaluation of reality and concomitant undervaluation of phantasy, even though we are able to trace the beginnings of a reversal of such valuations into this paper. In the treatise on the aetiology of hysteria, we find another reference to the elusive ‘complemental series’ when Freud says: “In the aetiology of the neuroses quantitative preconditions are as important as qualitative ones: there are threshold-values which have to be crossed before the illness can become manifest”45. iii. Choice of neurosis Though Freud did not regard this particular series as complete he was on the brink of discovering a new method of research which gave increasingly wider scope and access to fresh elements in the psychical field, i.e., unconscious, primary processes; lending hope of a better understanding of not just a few select instances, but to all functional psychic disturbances. The functional pathological modifications based on the disturbed economics of the nervous system are thus stated as the immediate cause of all the major neuroses, having as their common source the patient’s sexual life, which had hitherto been subordinate to hereditary factors and merely aligned with the concurrent causes of neuroses. Sexual influences were thereby elevated to the rank of specific causes and Freud found their ubiquity to be: “proof of a special causal relation

























































 43

Freud, S. (1896) The Aetiology of Hysteria ‘the contents of the infantile scenes turn out to be indispensable supplements to the associative and logical framework of the neurosis, whose insertion makes its course of development for the first time evident, or…self-evident.” Ibid. p. 204 45 Ibid. p. 209 44


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between the nature of the sexual influence and the pathological species of the neurosis”46, thus bearing on the problematic ‘choice’ of neurosis: “As regards nervous heredity…its presence is indispensable for severe cases…but…is unable to produce psychoneuroses if…precocious sexual excitation, is missing…the decision as to which…neurosis…will develop…is…decided by…a special characteristic of the sexual event in earliest childhood.”47 It was many years before any explicit statement of the relation between the succession of fixation points and the choice of neurosis would be published. However, Freud was able to promote the dictum that: “if the vita sexualis is normal, there can be no neurosis”48. Convenient as this causal mandate was, Freud’s views on normality and the content and causation of an abnormal sexual life were changing49. Hysterical symptoms were no longer seen as the direct derivatives of repressed memories of childhood experiences, but as symptoms of the childish impressions inserted into phantasies produced during puberty. His 1906 paper saw the first publication of the relative importance of traumatic experiences and unconscious phantasies in childhood (Letter 69, 1914, 1925). f. ‘Topographical’ to ‘structural’ frame of reference On the cusp of the final transition from the topographical to structural frame of reference, (in a 1922/1924 addition to his Three Essays) Freud clarifies that the origin of hallucinatory phenomena was found in experiences that were ‘analogous’ to childhood sexual traumata. Freud seems to view these phenomena as both ‘the return of the repressed’ and as: “consequences of a compromise between the resistance of the

























































 46

Ibid. p. 149 Freud, S. (1896) Heredity and the Aetiology of Hysteria, SE III, p. 156 48 Freud, S (1906) My Views on the Part Played by Sexuality in the Aetiology of the Neuroses. SE VII, pp. 269-279 49 “normality…[is the] result of the repression of certain component instincts and constituents of the infantile disposition and of subordination of the remaining constituents under the primacy of the genital zones in the service of reproduction.” Ibid. p. 277 47


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ego and the power of the returning repressed.”50 Thus solidifying the new interest in the contents of the repressed as opposed to repression per se. An important quote from these later additions highlights some of the continuity in Freud’s thought that persisted despite the various emendations that were to appear in the intervening years: “In each of…[the psychoneuroses], repression has been shown to be the nucleus of the psychical mechanism, and in each what has been repressed is a sexual experience in childhood”51 It is remarkable then, that despite a repudiation of the ‘seduction theory’ and the focus on repression, alongside the transition of not one but two frames of reference, the

dominance of the sexual factor in pathogenesis remained. The publicized investigations of this factor became the starting point for the topographical frame of reference and led to many new discoveries and formulations that would be maintained in psychoanalytic theory even to this day. i. The infantile roots of sexuality: neuropathic disposition Freud never completely repudiated the importance of sexuality or the infantile roots of sexuality, however, infantile sexual traumata were replaced with the ‘infantile roots of sexuality’ and therefore less emphasis was placed on accidental influences of sexuality, and constitutional-hereditary factors were no longer denied. Constitutional and hereditary factors superseded the accidental factors that Freud had previously struggled to establish as decisive in opposition to Charcot’s neurological thesis, which attributed sole causative discretion to heredity. What is new here, according to Freud is that on his theory: “the ‘sexual constitution’ took…[the] place of a ‘general neuropathic disposition”52, and that: “no experience could have a pathogenic effect unless it appeared intolerable to the subject’s ego and 























































 50

Ibid. p. 182 Ibid. 52 Freud, S (1898) My Views on the Part Played by Sexuality in the Aetiology of the Neuroses. SE VII pp. 275-276 51


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gave rise to efforts at defence”53, and this can be traced back to the assent of the topographical paradigm. This defence contained the ‘split in the psyche’ that is the

sine qua non of hysterical psychopathology, which was revealed in the affect-trauma paradigm. In this splitting of consciousness, repression is all-important: “in the course of development a spontaneous infantile sexual activity was often broken off by an act of repression…hysterics…fell ill as a result of the conflict between their libido and…sexual repression…[and] symptoms…[are] compromises between the two mental currencies.”54 Hysteria is therefore concerned with repressed sexuality and it is still the sexual component of the traumatic experience that produces pathology. The purely psychological concept of ‘defence’ is thus replaced by ‘organic sexual repression’, and neurotic symptoms now constituted sexual activity arising from normal or perverse components of sexuality. The constitutional sexual disposition of children is formally characterized as ‘polymorphously perverse’. Single pathogenic influences were scarcely sufficient in Freud’s view and a number of factors were required, which supported one another in the process of pathogenesis. The onset of illness was seen to be the result of a summation and: “necessary total of aetiological determinants”55, which could be completed from any station in the complemental series of accidental and constitutional influences: “the aetiology of the neuroses comprises everything which can act in a detrimental manner upon the processes serving the sexual function…noxae which affect the sexual function itself…other kinds of noxa and trauma which, by general damage to the organism…lead secondarily to injury to its sexual processes.”56 ii. The sociological significance of sexuality in pathology

























































 53

Ibid. p. 276 Ibid. p. 277 55 Ibid. p. 279 56 Ibid. 54


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The essence of neurotic illness now lay wholly in the disturbance of the sexual process and in 1908, Freud traced this disturbance to the ‘civilised sexual morality’ of his era where the individual’s innate constitution conflicts with the demands of civilization. We are here given an explicit statement about Freud’s conceptualization of the role of the environment in the process of pathogenesis. Specific forms of nervous illness could be typified as the injurious influence of civilization, reduced to the harmful suppression of the sexual life of civilized people, through the civilized sexual morality prevalent in them57. This process of suppression cannot, however, go on indefinitely and a certain amount of direct sexual satisfaction: “seems to be indispensable”58 for Freud. Deficiencies in the quanta of sexual satisfaction, which vary in individual cases, are frequented by phenomena, which lead to: “detrimental effects on functioning and…[the] subjective quality of unpleasure”59, and can therefore only be construed as ‘illness’.60 g. Freud’s metapsychology 1912 marks the publication of Freud’s influential discussion of the types of onset of neuroses in which he classifies both the internal and external precipitating causes of neurotic illnesses. Here, frustration takes a principal role, being what Strachey described as one of the: “most commonly used weapons in Freud’s clinical armory.”61 The discussion is continued in Lecture 2262 and the Wolf Man case63 contributes a type of onset resulting from narcissistic frustration, which is not dealt with here.64 Freud describes the: “changes to which conditions…[must yield] in order to bring 























































 57

Freud, S. (1908) ‘Civilised’ Sexual Morality and Modern Nervous Illness. SE IX (1906-1908) Ibid. p. 188 59 Ibid. 60 “The substitutive phenomena which emerge in consequence of the suppression of the instinct amount to what we call nervous illness…the psychoneuroses. Neurotics are the class of people who, since they possess a recalcitrant organization, only succeed, under the influence of cultural requirements, in achieving a suppression of their instincts which is apparent and which becomes increasingly unsuccessful.” Ibid. p. 190 61 Strachey, J. (1912) Editors Note to Freud, S. (1912) Types of Onset of Neurosis. SE. XII (1911-1913) pp. 227-238 (p. 230) 62 (Intro lectures) 63 Freud, S. (1918b) From the History of an Infantile Neurosis. SE XVII (1917-1919): An Infantile Neurosis and Other Works, 1-124 64 Freud, S. (1912) Types of Onset of Neurosis. SE. XII (1911-1913) pp. 227-238 58


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about the outbreak of a neurotic illness in a person with a disposition to it.”65 The precipitating causes enumerated here: “relate exclusively to the subject’s libido”66, which we are reminded, is considered decisive in the choice of health or sickness. The disposition to illness is traced into the development of the libido and the operative factors: “in that development to innate varieties of sexual constitution and to influences of the external world”67 that the infant experiences early on. The first apodictic precipitating cause dealt with by Freud in his 1912 paper is the external factor of frustration whereby health is dependent on the satisfaction of a need for love, by a real object in the world. Neurosis ensues when this object is withdrawn and no substitute takes its place. With external frustration, Freud believed fate to be the only curative possibility since only fate can: “offer the patient a substitute for the possibility of satisfaction which he has lost”68. It is this type of precipitating cause that belongs to the majority of neuroses where abstinence, representing the force of civilization on the ‘field of accessible satisfactions’, plays an important role: “Frustration has a pathogenic effect because it dams up libido, and so submits the subject to a test as to how long he can tolerate this increase in physical tension and as to what methods he will adopt for dealing with it.”69 The second precipitating cause, illustrated by Freud in 1912 are the internal difficulties that hinder an individual’s attempts to adapt to the demands of reality. Whereas the first precipitating cause amounts to the renouncing of satisfaction and an incapacity for resistance, this second precipitating cause involves the exchange of one kind of satisfaction for another and the breakdown that results from an internal inflexibility with regards to that change. Despite their differences, these types are not mutually exclusive and can be combined in the sense that frustration can result from the

























































 65

Ibid. p. 231 Ibid. p. 231 67 Ibid. 68 Ibid. 69 Ibid. p. 232 66


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incapacity to adapt to reality and reality can frustrate the satisfaction of the libido: frustration is, however, the common and more inclusive factor.70 A third type of precipitating cause is described by Freud as: “falling ill from an inhibition in development”71, which is essentially a dispositional determinant, considered in isolation: the libido remains attached to its infantile fixations and the reality demands of growing older cannot be met. The final precipitating cause Freud describes brings home the quantitative factor whereby spontaneous increase of libido experienced at critically important developmental landmarks such as puberty and menopause, lead to the pathogenic damming-up of libido. Such a dam of unsatisfied libido is known to precipitate regression and this factor is uniquely implicated in all the other factors mentioned: “The importance in the causation of illness which must be ascribed to quantity of libido is in…agreement with two main theses of the theory of the neuroses…that [they]…are derived from the conflict between the ego and the libido, and…that there is no qualitative distinction between the determinants of health and those of neurosis.”72 The healthy person is thus equally beholden to master the tasks of their developing libido as the neurotic person, and did so more successfully according to Freud. These four types of precipitating causes represent specific pathogenic constellations in economic terms: “the damming-up of libido, which the ego cannot…ward off without damage.”73 It is the economic factor that takes responsibility for pathogenesis since the allocation of endogenous or exogenous factors did violence to the psychoanalytic dictum that ‘the cause of the onset of neurotic illness in a particular psychic situation can be brought about in a variety of ways.’ Once again, a complemental series with ‘endowment’ on one end, and ‘chance’ on the other is adduced by Freud in 























































 70

“not one…is a pure example…rather, I find a portion of frustration operating alongside a portion of incapacity to adapt to the demands of reality; inhibition in development, which coincides…with inflexibilities of fixations…[and] the importance of quantity of libido must never be neglected” Ibid. p. 237 71 Ibid. 72 Ibid. 73 Ibid.


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contradistinction to a unitary causative thesis. Later in his introductory lectures, Freud will declare in a schematic abbreviation, ‘libidinal fixation’ as the internal predisposing factor and ‘frustration’ as the external and accidental predisposing factor.74 i. Pregenital components in the choice of neurosis In Freud’s 1913 paper on the disposition to obsessional neurosis, which tackled the problem of the choice of neurosis, of special importance is the notion of ‘pregenital organisations of the libido’. The section in the Three Essays dealing with pregenital libido organization was only added in 1915, and so, we find here the first appearance of the discussion of the component instincts. Strachey, once again, comes to our aid and neatly orders the publication of the successive pregenital organization of the libido: “auto-erotic stage, 1905 (…1899); narcissistic stage, 1911 (1909); anal-sadistic, 1913; oral stage, 1915; phallic stage, 1923.”75 In 1913, Freud still adhered to the division of pathological determinants into constitutional and accidental, although he now states that it is their combined operation that necessarily establishes the pathogenic effect. The choice of neurosis, Freud now believed, was determined by dispositional inhibitions in development and was: “independent of experiences which operate pathogenically”76, noting that: “The order in which the main forms of psycho-neuroses are usually enumerated…corresponds (…though not…exactly) to the order of the ages at which the onset of these disorders occurs”77

























































 74

Freud, S. (1916-17) Introductory Lectures in Psycho-Analysis (Part III) Lecture XXII Some Thoughts on Development and Regression – Aetiology. SE XVI, p. 346 75 Strachey, J. (1913) Editors Note to Freud, S. (1913) The Disposition to Obsessional Neurosis: A Contribution to the Problem of the Choice of Neurosis. SE XII (1911-1913) pp. 311-326. (p. 316) 76 Freud, S. (1913) The Disposition to Obsessional Neurosis: A Contribution to the Problem of the Choice of Neurosis. SE XII (1911-1913) pp. 311-326. (p. 317) 77 Ibid. p. 318


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From this new and enhanced view of pregenital sexuality, Freud was able to remark upon the: “extraordinary part played by impulses of hatred and anal-eroticism in the symptomatology of obsessional neurosis.”78 On this theory, activity is supplied by the common instinct of mastery, which includes sadism in the service of the sexual function, and the passive trend, fed by anal eroticism, which is implicated in the predisposition to homosexuality in men when the genital stage of organization has been achieved. Freud, felt so strongly about his burgeoning psychosexual theory that he wrote: “psychoanalysis stands or falls with the recognition of the sexual component instincts, of the erotogenic zones.”79 Hate becomes the precursor of love in the psychoanalytic theory of development80, which has monumental implications for theories of pathogenesis and particularly in reference to the work of Melanie Klein, who we will discuss imminently. ii. The complemental series revisited In a significant contribution to the notion of a complemental series, Freud clarifies that both endogenous and exogenous determinants in pathogenesis are indispensable, falling into a series where: “sexual constitution and experience…fixation of the libido and frustration”81 interact to the extent that when: “there is more of one there is less of the other.”82 In this lecture, Freud furnishes the relative tenacity or adhesiveness of the libido versus its plasticity, to trends and objects as a significant and independent variable in pathogenesis. His next lecture focuses on the paths of symptom-formation and here, infantile sexuality along with the abandoned component trends and objects of childhood are claimed as the activities and experiences containing the fixations necessary for the libido to break through the repressions. The fixation of the libido in adults, which represents the constitutional factor in aetiological equations, is divided 























































 78

Ibid. p. 321 Ibid. p. 322 80 “we might reasonably substitute the polarity of love and hate for the antithesis constituted by the two types of drives…Clinical observation, however, clearly shows us not only that hate is an unexpectedly regular accompaniment of love (ambivalence), and is very often its precursor in human relationships, but also that in certain circumstances hate changes into love, and love into hate.” Ibid. p. 325 81 Freud, S. (1916-17) Introductory Lectures in Psycho-Analysis (Part III) Lecture XXII Some Thoughts on Development and Regression – Aetiology, SE XVI, p. 347 82 Ibid. 79


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by Freud into an ‘inherited constitution’ and a ‘disposition acquired in early childhood’.83 Thus, a complemental relationship exists between the intensity and the pathogenic significance of both infantile and later experiences with ‘developmental inhibition’ and ‘regression’ as their respective extreme manifestations, and there is: “every degree of co-operation between the two.”84 It was of little importance to Freud, by this point, whether the childhood experiences constructed or remembered were real or imagined since phantasies correspond to psychical reality, which is the ‘decisive kind’ in pathogenesis. Specimens of the class of occurrences that recurred and were scarcely absent in neurotic case histories were observations of parental intercourse, seduction by an adult and the threat of castration. Seduction phantasies are reformulated as screen memories sparing the patient his shame from his early autoerotic enjoyment of masturbation. Sexual abuse was not wholly relegated to phantasy and was still felt by Freud to be essential and necessary for neurosis: resorting once again to the complemental relations between reality and phantasy in order to account for dual contributions of primal phantasy and primal experience in pathogenesis. iii. The pathogenesis of depression and aggression In his 1917 publication of ‘On Mourning and Melancholia’ Freud employs his illustrative schematisation of the pregenital stages of psychosexual development with precision and to great success: “we should not hesitate in seeing the oral phase of libido, which still belongs to narcissism, as one of the characteristics of melancholia.”85 The melancholic’s object-cathexis could be seen to have regressed to the stage of narcissistic identification and subordinated under the satisfying tendencies of sadism 























































 83

“The assertion that the libidinal cathexis (and therefore the pathogenic significance) of infantile experiences has been largely intensified by the regression of the libido is undoubtedly correct, but it would lead to error if we were to regard it alone as decisive.” Freud, S. (1916-1917) Introductory Lectures on Psycho-Analysis, Lecture XXIII The Paths to the formation of symptoms pp. 358-377 (p. 363) 84 Ibid. p. 364 85 Freud, S. (1917) On Mourning and Melancholia. In Freud, S. (2005). ‘On Murder, Mourning and Melancholia’. Translated by Shaun Whiteside. London: Penguin pp. 203-218 (p. 210)


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and hatred where the conflict of ambivalence and ascetic hostility the ego applies to itself lead to a characteristic fear of impoverishment traceable to the context of analeroticism. Freud lists the loss of the object, ambivalence and the regression of the libido into the ego as the three preconditions for melancholia. h. The tripartite model of the mind 1923 marks the end of the topographical frame of reference and the start of a new appreciation of structural dynamics in the development of the personality and pathology. Two significant papers were published in this year. ‘The Infantile Genital Organisation (An Interpolation into the Theory of Sexuality)’ posits the primacy of the phallus in the infantile genital organization, which renders the notion of a castration complex intelligible86, and ‘The Ego and the Id’, in which Freud builds on his analysis of melancholia as a resurrection of a lost love object within the ego: “Where…compelled to give up a sexual object, there is not uncommonly a compensatory process in the form of that particular ego-alteration…’erecting the object within the ego’, just as occurs in melancholia…this surrogation process…introjection, which is a form of regression to the mechanism of the oral phase.”87 Conversion of a sexual object cathexis into an ‘ego-alteration’ enables the ego to grab hold of the reigns of the id, so to speak. By introjecting the object, the ego is able to offer itself as a love object to the instincts and thus subsidise the id’s loss. We are hereby led to the origins of the superego: it is the sequel to the primary identifications that the young infant made and these impressions are so pervasive due to their internalization; they become, so to speak, ideal egos to which the infant aspires. With the introduction of this third agency of mind, Freud’s structural and tripartite model of the mind was complete, and although certain topographical referents remained 























































 86

Freud, S. (1923) The Infantile Genital Organisation (An interpolation into the Theory of Sexuality). SE XIX (1923-1925): The Ego and the Id and Other Works, pp 139-146. 87 Freud, S. (1923) The Ego and the Id. Ibid. p. 120


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clinically and theoretically salient, the third and final phase of Freud’s psychoanalysis was initiated. i. Oedipus The Oedipus complex, for Freud, once dissolved results in the latency period in his psychosexual theory of development and its sequelae include the super-ego and: “the erection of ethical and aesthetical barriers in the ego”88. According to Freud, all three of the major neuroses begin with the destruction of the Oedipus complex, and it is fear of castration arising in the id that leads to the ego’s resistance and therefore to neurotic symptomatology. This stands in opposition to Klein’s thesis that pre-oedipal conflicts along paranoid and depressive lines, can contribute as much to the infantile neurosis as the later Oedipal conflicts, and in fact, represent their precursor in developmental history. Nevertheless, Freud believed that intra-uterine life and earliest infancy represented a more definite continuum: “than the…caesura of…birth…might lead us to suppose.”89 It is in this initial phase of childhood that the danger of psychic helplessness befits most accurately90; the next danger becomes the loss of the loved-object in the pregenital phase of early childhood, followed by the fear of castration in the phallic phase and finally the fear of the super-ego during latency. We are to remember that these danger-situations and ‘fear-determinants’ can co-exist and trigger their pathogenic effects in a deferred manner. Having thus located the precursor of all adult neuroses in the childhood of his patients Freud was forced to accept that the infantile neurosis was a normal process of maturation. All children had to relinquish the fear-determinants and danger situations that correspond to definite stages in their development and only lost their importance with the dissolution of the Oedipus complex and the establishment of the super-ego. The abrupt cessation of sexual life during latency and its resurrection and continuation at puberty is considered by Freud at this point to have massive 























































 88

Ibid. Ibid. pp. 206-207 90 “The biological factor thus produces the first danger-situations in each child’s life and generates the need to be loved – a need that stays…throughout…life.” Ibid. p. 223 89


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pathogenic significance due to the ego’s defensive remonstrations of infantile sexuality and their risk of being dragged back into those ‘paradigmatic impulses’ when revived later on. Freud calls this the ‘second phylogenetic factor’ and this represents, to him, the most direct cause of neurosis. In his addenda to the 1926 paper, Freud makes some conclusive remarks on ‘Fear, Pain and Sorrow’ in relation to his previous discussion into the perplexing phenomena of mourning and melancholia, and we find here, the perfect place to begin our discussion of Melanie Klein’s model of pathogenesis. III. MELANIE KLEIN Freud characterizes maternal absence as the first traumatic situation, when the mother is needed by the infant to gratify some need (feeding, affection, cleaning). This fear-determinant equates with the loss of the loved-object in toto and does not refer to the loss of love per se. This part object-loss is only dimly perceived by the infant as such; as the terror of dissolving or disintegrating, or the ‘nameless dread’ and refers to a need state of frustration and non-gratification, corresponding in Kleinian metapsychology, to the ‘paranoid-schizoid position’. With the progression into an understanding that the mother can be present, but angry, the loss of the object’s love becomes: “the new and far more constant danger and fear-determinant”91 which typifies Klein’s ‘depressive position’ and involves a transition from part-, to wholeobject relations and to a general increase of concern for the loved object as an independent object. Klein gives an elaborate account of both the genesis of psychotic anxiety in infancy and the commensurate phantasies, of a sadistic nature, that preponderate at different stages of libido development, highlighting primitive and psychotic mechanisms that were previously inaccessible to analytic treatment or understanding: Klein propounds a theory of the infant defending itself against the terrors of retaliatory persecution, from objects in the external world, and later from internalised imagos of 























































 91

Ibid. pp. 137-138


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these objects92. Klein’s infant avails itself of several mechanisms, which become accessible at varying points during growth and correspond to ego-development as well as to the principal phantasy material unfolding from the drives at that time. Klein details the concatenation of ‘anxiety-situations, anxiety-contents and defencemechanisms’, which progress from part paranoid to whole-depressive- and finally to manic-positions, though in her scheme movement is not unidirectional and the infant (and the adult) has recourse to previous liabilities once they have been achieved. The ability of the ego to manage the barrage of excitation and damming-up of instinctual energy stemming from the non-gratification of part-objects in the external world, and later from the drives, determines the fluctuation from paranoid-to-depressive and from depressive-to-manic positions. Klein’s paranoid-schizoid model of pathogenesis demands that we ask about the nature of what the infant’s ego is defending itself against. It cannot be the loss of the mother since this fear-determinant is only operative in the later depressive position and can be likened to the fundamental mechanism of melancholia93 in that it involves whole-object relations, which according to Klein develop around the time of weaning. In the paranoid-position, the anxiety-situation of non-gratification is the object of fear and this is generated by maternal absence.94 Denial of the ‘good breast’ leads to a heightened object-cathexis to the ‘bad breast’, which is attacked, in phantasy, with the full gamut of sadistic measures that are available to the infant during this paranoidschizoid moment: “because the baby projects its own aggression on to these objects…it feels them to be ‘bad’ and not only in that they frustrate its desires: the child conceives of them as 























































 92

Klein, M. (1935) ‘A Contribution to the Psychogenesis of Manic-Depressive States’ International Journal of Psycho-Analysis, 16: 145-174 p. 150 93 Freud and Abraham had previously described melancholia as the ‘loss of the loved object’, which results in the object being installed within the ego. The point of reference here is melancholia in adult patients but in the Kleinian scheme the loss of the loved object occurs at the stage of sadism where cannibalistic phantasies predominate (in the earliest oral stage of infancy) and pertains to a time in egodevelopment when only part-objects are perceived (i.e. the good and the bad breast): the loss of the whole object (qua Mother) can only be felt fully when the whole object is perceived. 94 The mother’s breast is the prototypic good and bad part-object. The gratifying breast is thought to be the object of love and care in the infant’s phantasies, whereas the denying breast becomes the object of the infant’s destructive tendencies (sadism)


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actually dangerous—persecutors who it fears will devour it, scoop out the inside of its body, cut it to pieces, poison it.” 95 In this primary phase the infant is assumed to hold omnipotent beliefs about the success of its sadistic attacks, confirmed as they are when the mother is absent or returned in the mien of the bad mother (or denying breast) and this results in the dread of persecution against its ego. Klein thinks of this ‘persecution anxiety’ as the consequence of the concomitant frustration of ambivalence between love and hate that the sadistic tendencies let loose in the infant’s inner world. This basic ambivalence of feeling is first directed against the infant’s frustrating part-object, the denied breast, and later against a whole ‘mother object’. According to Klein, these part and whole objects are phantasied as seeking revenge against the infant’s ego or the objects installed therein and are thus felt to be persecutory. ‘Paranoid-schizoid’ anxiety-contents embrace the internalised persecutors which the young ego attempts to efface through projection, but it cannot obliterate the dread of these internal persecutors, thus the ego: “marshals against the persecutors inside the body the same forces [of sadistic aggression] as it employs against those in the outside world”96. It is these anxiety contents and mechanisms of defence, resorted to at this early stage of the ego’s development and in regard to the status of partial objectrelationships and phantasies forthwith, that in Kleinian thought are consigned as the basis of paranoia and as representing the fixation-point in the disturbance of severe psychosis. When full identification with the mother-as-a-whole becomes possible, which signals the ascent of the depressive position, the internal imagos split and approximate ever closer to reality97. The ambivalence of love/hate in object-relationships becomes more integrated and the dread of persecution of the ego transforms into the dread of 























































 95

Ibid. p. 145 Ibid. pp. 145-146. 97 “I have explained that, gradually, by unifying and then splitting up the good and bad, the phantastic and the real, the external and the internal objects, the ego makes its way towards a more realistic conception both of the external and the internal objects and thus obtains a satisfactory relation to both” Ibid, p. 151 96


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persecution of the internal ‘good’ mother, whose paradigm was the imago of the satisfying breast. In the depressive position, Klein says that the preservation of the good internalized object is tantamount to preservation of the ego.98 The ‘depressive-position’ ushers in a weakening of oral fixations and their corresponding phantasies (biting, chewing, etc). Klein plots the depressive position at around the time that the infant is weaned and thus suffering increasing frustration and non-gratification. When a whole object-relationship to both a good and bad mother has been assimilated: “the libidinal urges increase; he develops a greedy love and desire to devour this object and the mechanism of introjection is reinforced.”99 Such repetitive incorporation of the good object, Klein thinks is: “partly because he dreads that he has forfeited…[her] by his cannibalism…and partly because he fears internalized persecutors against whom he requires a good object [mother] to help him.”100 Therefore, repetitive introjection of the ‘good’ composes the reality-testing of the depressive position, i.e., repeated attempts at disproving the omnipotent fear that the object has been annihilated through the infant’s phantasied sadism or cannibalistic absorption. Hence, the depressive-position requires a strong force of love and concern for the mother as well as a need to take her inside. The characteristic defence of the paranoid-schizoid position, i.e., obsessive phantasied expulsion, indicates, however paradoxically, that the internal world of the infant is not a consistently safe resting place for the infant’s internalized imagos.101 Depressive introjection surpasses the paranoid projection, but the infant has already relinquished his power to protect the objects within his emergent ego, otherwise, why would there be the need to send them out in order to protect them from the disintegration? It is the realization of this ‘psychic helplessness’, in the face of the bleak dilemma between 























































 98

“at this stage of development the unification of external and internal, loved and hated, real and imaginary objects is carried out in such a way that each step in that unification leads again to a renewed splitting of the imagos. But as the adaptation to the external world increases, this splitting is carried out on planes which gradually become increasingly nearer and nearer to reality. This goes on until love for the real and the internalized objects and trust in them are well established. Then ambivalence, which is partly a safeguard against one’s own hate and against the hated and terrifying objects, will in normal development again diminish in varying degrees.” Ibid. p. 173 99 Ibid 100 Ibid 101 Ibid


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an excessively hostile inner world or an equally hostile outer world, that leads to an anxiety that both Klein and Freud understood as psychologically justified and fundamental to the melancholic’s response to the ‘loss of the loved object’. Therefore, anxiety-contents of the depressive position are typified by the fear of the loss of the loved mother. Dread of this loss: “becomes a perpetual source of an anxiety lest the real mother should die”102, and any fraction of a ‘real’ loss, however temporary, correlates to the dread that the inner mother has been lost also. The depressive divorce between good and bad imagos is not as pronounced as it is in the paranoid position, though an identifiable cleavage does still exist: hatred is expressed against the frustrating, non-gratifying mother-imago whilst love and reparative tendencies are expressed towards the satisfying, gratifying one. It is not only the infant’s recalcitrant sadism that imperils its imagos, but his love too, closely connected at this stage to devouring (the breast-feeding situation). Klein says that: “every access of hate or anxiety may temporarily abolish the differentiation [between good and bad] and thus result in a ‘loss of the loved object”103. To recap: “in the first few months…paranoid anxieties related to the ‘bad’ denying breasts…are felt as external and internalized persecutors. From this relation to partobjects…springs…the phantastic and unrealistic nature of the child’s relations to all other things: parts of it own body, people and things around it, which are at first but dimly perceived.”104 Klein portrays the very young infant’s inner object world as inclusive of both the gratifying and persecuting fragments of the real world in which it exists. As internal imagos approximate more closely to reality, through the ever-refining operation of splitting, the whole mother and then other whole objects in the world are perceived less and less dimly. In the paranoid-schizoid position, when sadism is at its zenith in Klein’s model, the infant’s emotional and libidinal fixation to the breast evolves into an 























































 102

Klein, M. (1935) ‘A Contribution to the Psychogenesis of Manic-Depressive States’ International Journal of Psycho-Analysis, 16: 145-174, p. 148 103 Ibid. p. 149 104 Ibid. p. 170


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emotional and libidinal attachment to the mother as a person and, critically, the basic ambivalence of feeling between love and hatred is integrated as both feelings are directed towards the same object. For Klein, it is this ‘basic ambivalence of feeling’ that results in the: “deep and disturbing conflicts”105 constituting the depressive position.106 a. Genealogy of Klein: Sadism, Aggression, Paranoia and Depression. In a chapter regarding the relations between obsessional neurosis and the early stages of the super-ego in Klein’s 1932 publication107, we find evidence of the wide-reaching scope of her theories which touched firmly on the ground of some of the fundamental landmarks of psychoanalytic metapsychology: Freud’s tripartite model of the mind; neurosis; normal development etc. Citing from Freud’s 1913 paper, Klein illuminates her complex views on the infantile operation of sadism.108 For Klein then, the epistemophilic instinct is not only linked with sadism but is rooted firmly within the sadistic tendencies of infancy. Appealing to the work of Abraham: that the epistemophilic instinct arises at the inception of the Oedipus conflict and serves the oral-sadistic trends of the young ego, Klein embellishes the affinity her theories have to her forefathers’ in a footnote to her 1931.109 























































 105

Ibid “In the normal course of events the ego is faced at this point of its development—roughly between four to five months of age—with the necessity to acknowledge psychic reality as well as the external reality to a certain degree. It is thus made to realize that the loved object is at the same time the hated one, and in addition to this that the real objects and the imaginary figures, both external and internal, are bound up with each other…The first important steps in this direction occur, in my view, when the child comes to know its mother as a whole person and becomes identified with her as a whole, real and loved person” Ibid. pp. 170-171 107 Klein, M. (1975; 1932) The Psycho-Analysis of Children, NY: Delacorte Press. 108 “At the same time as it wants to force its way into its mother’s body in order to take possession of the contents and to destroy them, it wants to know what is going on and what things look like in there. In this way, its wish to know what there is in the interior of her body is equated in many ways with its wish to force a way inside her, and the one desire reinforces and stands for the other. Thus the instinct for knowledge becomes linked at its source with sadism when it is at its height, which makes it easier to understand why that bond should arouse feelings of guilt in the individual.” Klein, M (1975; 1932) pp. 173-174 109 Referring to her 1930 paper Klein says: “The view put forward there is in agreement with Abraham’s theory that in paranoiacs the libido has regressed to the earlier anal stage; for the phase of development in which sadism reaches its height begins, in my opinion, with the emergence of the oral-sadistic instincts and ends with the decline of the earlier anal stage…In this way Abraham’s theory would be 106


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Hanna Segal states that: “Klein’s work confirmed Freud’s discoveries about infantile sexuality and aggression”110, although Klein: “emphasized much more the role of aggression in children.”111 It is possible to trace Klein’s study of aggression to her 1930 paper on symbol formation112, where she scrutinizes the phantastical nature of the anxieties connected to the child’s aggressive impulses. Her account of these phantasies relates closely to the fear-determinants elucidated by Freud113. Klein, herself references the seminal ‘Beyond the Pleasure Principle’ 114, which admittedly contains so many links as to demand a genealogy of its own. The contents, and references contained therein, as well as to the other formative thesis of Freud’s, ‘The

Ego and the Id ’ in 1923, leave no shadow of a doubt that Klein was strongly influenced by the ideas within both of these Freudian texts. Evidence of this link in Klein is apodictic from 1930 onwards. Notwithstanding, traces of these influences can be identified in Klein’s earliest works:
































































































































































 extended in two directions. In the first place we see what an intensive co-operation of the various instruments of the child’s sadism there is in this phase, and especially, besides his oral sadism, what enormous importance attaches to his hitherto little recognized urethral-sadistic tendencies in reinforcing and elaborating his anal-sadistic ones. In the second place, we get a more detailed understanding of the structure of those phantasies in which his anal-sadistic impulses belonging to the earlier stage find expression” Ibid. pp. 238-239 110 Klein, M. (1998). ‘Love, Guilt and Reparation’ and other works 1921-1945’. London: Vintage. p. ix 111 Ibid. p. x 112 Ibid. Chpt XIII ‘The Importance of Symbol-Formation in the Development of the Ego’ (1930) pp. 219-235 113 “The child expects to find within the mother (a) the father’s penis, (b) excrement, and (c) children, and these things it equates with edible substances. According to the child’s earliest phantasies (or ‘sexual theories’) of parental coitus, the father’s penis (or his whole body) becomes incorporated in the mother during the act. Thus the child’s sadistic attacks have for their object both father and mother, who are in phantasy bitten, torn, cut or stamped to bits. The attacks give rise to anxiety lest the subject should be punished by the united parents, and this anxiety also becomes internalized in consequence of the oralsadistic introjection of the objects and is thus already directed towards the early super-ego. I have found these anxiety-situations of the early phases of mental development to be the most profound and overwhelming. It is my experience that in the phantasied attack on the mother’s body a considerable part is played by the urethral and anal sadism which is very soon added to the oral and muscular sadism. In phantasy the excreta are transformed into dangerous weapons: wetting is regarded as cutting, stabbing, burning, drowning, while the faecal mass is equated with weapons and missiles. At a later stage of the phase which I have described, these violent modes of attack give place to hidden assaults by the most refined methods which sadism can devise, and the excreta are equated with poisonous substances.” Ibid. p. 219 114 Freud, S. (1926) in Freud, S. (2003). ‘Beyond the Pleasure Principle and Other Writings’. Translated by John Reddick. London: Penguin


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In 1929115, she posits the central place that sadism will take in the hitherto unformulated Kleinian metapsychology: the personification of beneficent and malevolent forces in six-year-old Erma’s play offered telltale signs of the sadistic phantasies that Klein inferred as underlying them.116 That same year117, Klein suggests that the breast-feeding situation instigates oral-sadism118, in this case typified by phantasies of smashing, tearing and striking with swords.119 In 1928, the connection between epistemophilia and sadism as characteristic of the earliest stages of what she termed the Oedipus conflict had already been instituted120, and it was this universal connection that for Klein was invaluable to the total development of the infant’s mind. To wit: oedipal tendencies arouse the infant’s curiosity, initially with the mother’s body, or parts thereof121 at the anal-sadistic libido-position. Thus interpolating the notions of appropriating or possessing the contents of the mother’s body as characteristic of the sadistic phantasies experienced at this stage, Klein highlights the significance of a very early maternal identification. Pre-Kleinian analysis had neglected this significant early identification and this very point was soon to become a centrepiece to the Kleinian model of pathogenesis. Earlier still, 1923122 Klein attributes the inhibition of symbolism to primarily libidinal

and aggressive sources.123 From this metapsychological milestone, the focal conflict in 























































 115

Chpt X ‘Personification in the Play of Children’ (1929) pp. 199-210 in Klein, M. (1998). ‘Love, Guilt and Reparation’ and other works 1921-1945’. London: Vintage 116 “Often Erma herself played the part of the child. Then the game generally ended up in her escaping the persecutors (on these occasions the child was ‘good’), becoming rich and powerful, being made queen and taking a cruel revenge on her persecutors. After her sadism had spent itself in these phantasies, apparently unchecked by any inhibition (all this came about after we had a done a good deal of analysis), reaction would set in the form of a deep depression, anxiety and bodily exhaustion. Her play then reflected her incapacity to bear this tremendous oppression, which manifested itself in a number of serious symptoms” Ibid. p. 200 117 Ibid. Chpt XI ‘Infantile Anxiety-Situations Reflected in Work of Art and in the Creative Impulse’ (1929) pp. 211-218 118 “The oral frustration which turns the indulgent ‘good mother’ into the ‘bad mother’ stimulates his sadism.” Ibid p. 214 119 Klein equates these weapons and attacks to the child’s primary sadism: “which he employs [with] his teeth, nails, muscles and so on.” Ibid. p. 212 120 As opposed to the later inception proposed for Freud’s Oedipus Complex. 121 The child’s sexual theories, or phantasies at this stage include an assumption, not so far from the actuality, that the mother’s body is the locus of the complete remit of sexual processes and sexual development. 122 Chpt III ‘The Role of the School in the Libidinal Development of the Child’ (1923) in Klein, M. (1998). ‘Love, Guilt and Reparation’ and other works 1921-1945’ London: Vintage


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the mind becomes a conflict between the forces of love and hate, libido and destruction, Eros and Thanatos, and these notions gain an increasing importance in the Kleinian oeuvre as it develops: yet more evidence of Klein’s close affinity with Freud. Keeping her theories in line with the developmental stage theories of her predecessors, Klein says: “That period of the phase…which, in my view, forms the basis of paranoia, would occur, therefore, at a time when the earlier anal stage is in the ascendant.”124 Thus reinforcing her thesis from 1930 where, with the aid of Freud and Abraham, the fixation point for paranoia is: “situated…in the phase when sadism is at its height.” (i.e., the paranoid-schizoid position.) In Klein the ‘loss of the loved object’ constitutes: “a failure to maintain the identification with both the internalised and real loved objects [and] may result in the psychotic disorders of the depressive states…mania, or…paranoia.”125 By 1940, she describes the depressive position as melancholia in statu nascendi126, and the dread of losing both parents at this stage is thought to emerge in the Oedipus situation, which arises from the very first frustrations of the breast-feeding situation where oral fixations and anxieties predominate. Sadistic phantasies, now directed towards a larger diversity of whole objects (father, siblings etc.), are attacked within the mother’s body and increase the potential for the infant to experience loss and guilt.127 Klein attributes the discovery of the role of introjection in the work of mourning and melancholia to Freud, who introduced the super-ego into his structural theory on the basis of such an appreciation. Here, the super-ego can be seen as the establishment of 






























































































































































 123

Klein’s views on aggression correspond to Freud’s post-1920 works where the death-instinct is introduced as a metapsychological remedy to the growing disparities, inaccuracies and discontinuities in classical Freudian theory. Freud was preoccupied with the dialectic between ego- and sexual- drives prior to his introduction of narcissism (1914) which somewhat contradicted this duality. The ego-drives were now seen to arise out of a narcissistic libido-cathexis. By 1920, in ‘Beyond the Pleasure Principle’, Freud re-introduces this dualism as between a tension between Eros and Thanatos. 124 Ibid. pp. 238-239 125 Klein, M. (1935) ‘A Contribution to the Psychogenesis of Manic-Depressive States’ International Journal of Psycho-Analysis, 16: 145-174 p. 174 126 Klein, M. (1940) ‘Mourning and its Relation to Manic-Depressive States’ International Journal of Psycho-Analysis, 21; 125-153, pp. 126-127 127 “The sorrow and concern about the feared loss of the ‘good’ objects, that is to say, the depressive position, is, in my experience, the deepest source of the painful conflicts in the Oedipus situation, as well as in the child’s relations to people in general. In normal development these feelings of grief and fears are overcome by various methods.” Ibid


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the parents within the ego.128 The important point for Klein is that the sufferings in adult melancholia (conflict, remorse, guilt) are connected to the ego’s relation to its internal imagos, which are already operative in the baby. Rado’s 1928 paper is also called upon to fortify Klein’s views on the nature and content of the infantile depressive-position. There, he elaborates the mechanism of melancholia in such a way as to compound Freud’s views and pave the way for what Klein was to contribute soon after. Tracing the string of ideas of ‘guilt —atonement—forgiveness’, squarely into the: “sequence of early infancy: rage, hunger, [and] drinking at the mother’s breast”129, Rado saw melancholia as an extensive loss of relation to reality and as an almost total subordination of the ego to the ‘unrestrained tyranny’ of a sadistic critical agency.130 Melanie Klein, in a fiercely imaginative way, laid the ground upon which psychoanalysis became astute to the inherent complications and sadistic phantasies connected to the earliest psychotic mechanisms which predate the level of egoorganisation, forwarded as being the outcome of the dissolution of the Oedipus complex in Freud. It is this central issue of ego-organisation where Klein differs most with Freud. Freud considered that the formation of the super-ego was a consequence of the passing of the Oedipus complex, resulting in the ‘latency’ period. Klein, however, saw the very first introjections of even part-objects as being constitutive of development of the super-ego and thus presented the much younger infant, in her theories, with many more dynamic processes of defence and structuration than Freud was able to do impute (this perhaps by virtue of Klein’s vastly superior experience with 























































 128

“the processes of introjection and projection from the beginning of life lead to the institution inside ourselves of loved and hated objects, who are felt to be ‘good’ and ‘bad’, and who are interrelated with each other and with the self: that is to say, they constitute an inner world. This assembly of internalized objects becomes organized, together with the organization of the ego, and in the higher strata of the mind it becomes discernible as the super-ego.” Ibid. pp. 145-146 129 Ibid. p. 427 130 “the melancholiac…feels guilty because by his aggressive attitude he has himself to blame for the loss of the object…this confession of guilt by the ego is modeled on infantile prototypes and its expression is strongly reinforced from infantile sources…It has its origin in the sadistic trend of hostility to the object, which has already shown its force in the ambivalent character of the love relation… The repentant ego desires to win the forgiveness of the offended object and, as an atonement, submits to being punished by the super-ego instead of by the object. In the undreamed-of harshness of the super-ego the old tendency of hostility to the object is expending its fury on the ego, which is thrust into the place of the hated object.” Rado, S. (1928). ‘The Problem of Melancholia.’ International Journal of PsychoAnalysis, 9: 420-438. pp. 429-430


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young children and infants). On this point, it is interesting to note that in the beginning, Klein avowed to stay loyal to Freud and his theory of the Oedipus complex. As time goes by, however, we can notice an increasing trend in Klein’s clinical work to tackle earlier and earlier disturbances in younger and younger patients. It certainly aided the acceptance of Klein’s theories that she implicitly and explicitly adhered to the Freudian sequence of infantile psycho-sexual development and she somewhat depends on her familiarity with Abraham’s authentication of the Freudian theory of sexuality in order to overlay her ‘positions’ on top of these ontological developments. The mother-infant dyad (and the implicit sensitivity to the environment) becomes centrally significant to the psycho-analysis of children thanks to Klein and this influenced a paradigmatic shift in psychoanalytic work that has remained unmatched in the British Society for over half a decade.131 IV. ANNA FREUD In 1936, Anna Freud published ‘The Ego and the Mechanisms of Defence’, from which her loyalty to her father’s former hypotheses and her recapitulation of classical psychoanalytic theory can be appreciated. She atomises the various different defence mechanisms employed by the ego in specific psychopathological entities and stimulated renewed interest in the study of early parent-child relationships and their role in the process of pathogenesis, which for Anna Freud, is closely linked to factors affecting normal growth and ego-development as well as the ego’s ability to resolve conflicts.132 Anna Freud’s model of pathogenesis focuses much more than either her father’s or Klein’s on the establishment of a detailed developmental view of normal development 























































 131

Klein synthesises Freud, Abraham, Rado, Schmideberg and Laforgue to name but a few, in her metapsychological quest and her ideas remain unavoidably poignant today. This is reflected in the fact that hers is one of two aligned perspectives upheld within British psychoanalysis and has a strong basis in much of the non-aligned, independent work since undertaken by Winnicott. 132 Freud, A. (1936) The Ego & The Mechanisms of Defence. (Revised Ed. 1968). London: Hogarth.


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and this can be expressed with reference to her major diagnostic contributions (Diagnostic Profile and Developmental Lines).133 Her developmental view of pathogenesis involved the assessment of psychological normality or pathology in terms of maturity along several lines of development such as the drives, the superego and object relations. Each line is evaluated in order to formulate a picture of the normal and pathological processes at work in the child. According to Miss Freud, the most severe pathology stems from early failure to thrive psychologically due to either constitutional or early-acquired traumatic defects in the sensory or intellectual functions of the ego; environmental failure such as maternal absence or inadequacy; or overwhelming trauma at transitional moments in development. For Miss Freud, psychopathology is best understood in terms of psychogenetic and psychodynamic deviations from normal development. In the Anna Freud’s model, ‘internal disharmonies’ come about if the drives and the ego develop at different rates or with different strengths. Disharmonies are resolved via compromises, which resemble neurotic symptomatology and lay the ground for future neurotic development. Disharmony also leads to conflict, which in turn causes pathology. Anna Freud’s thesis that conflict has a role in all aspects of development emphasizes an approach to psychic life based on classical metapsychology and psychoanalytic observations of the structure, organization and functioning of every aspect of the personality; where psychic functioning is seen as a complex, constantly shifting dynamic and economic system. Such an expanded view of conflict, as pertaining to the constantly shifting equilibrium in all aspects of psychic functioning includes both inter-systemic and intra-systemic conflicts and reflects the vast order of complexity that we are faced with when trying to get to grips with the puzzle of pathogenesis. Freud’s ‘complemental series’ does justice to the complexity and multiplicity of factors involved in pathogenesis and we can see his daughter’s model as an extension of such a series, in infinitely more detail. Her ‘Developmental Lines’ refer to surface 























































 133

See Appendices A and B


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phenomena and are not metapsychological concepts as such, however, the imbalances in the underlying agencies of the mind are described in the developmental lines. Miss Freud, of course, prefers not to talk of pathology and pathogenesis but rather of interferences with optimal development and her developmental lines illuminate the potentialities for this development. Miss Freud’s principal legacy, according to Abrams and Solnit is in the: “blending of innovative perspectives into the established facts and theories of psychoanalysis”134 and her major contributions are considered to be important anchoring points for analytic clinicians. Miss Freud was keen to show that psychoanalysis and developmental psychology shared a common locus. In the field of attending to changes in functions, structures and organisations within the mind it bolsters her thesis of developmental lines that they have relevance to the assumptions and postulates of developmental psychology and the determination of normal and abnormal behaviour: a fortification not present in the Kleinian model. V. PATHOGENESIS: CONTRASTING KLEIN WITH THE FREUDS a. The Ego All theories of pathogenetic processes depend largely on a coherent theory of the ego and its development as well as its functions, organization, differentiation from the other agencies of the mind, and of course, the conflicts obtaining therein, which cause, in Anna Freud’s terminology, ‘disequilibria’, and become decisive in the expression of pathology. In psychoanalytic theory, an individual’s character is attributed to their ego and the coordinating and integrating tendencies of that agency, commonly known as the synthetic function. Clearly, these theses stem from the dominance of a structural theory of mind such as the tripartite model. Hartmann135 opined that there 























































 134

Abrams, S. & Solnit, A. (1998) Coordinating Developmental and Psycho-Analytic Processes: Conceptualising Technique. Journal of the American Psycho-Analytic Association, 46:85-103 135 Hartmann, H. (1950) Comments on the Psycho-Analytic Theory of the Ego. Psycho-Analytic Study of the Child, 5: 74-96


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is considerable wealth of reliable and systematic information about how the ego is molded under the impact of reality and the instinctual drives and by its defensive activity in both directions as well as how it develops alongside progressive object relationships, expressing the ineluctable influence of the environment on even these most internal factors. Anna Freud and her immediate coterie did not ignore the role of object relationships in development or pathogenesis, however, object relationships assume but one line of development amongst a myriad of other lines that receive an equal portion of the analyst’s attention. Crucially the Viennese subscribe to a Freudian timetable with regards to the emergence of complete object relationships and do not interpret the existence of such relationships as early as the Kleinians. Ego-development is a definite system in metapsychology and the establishment of secondary process thinking is critical for it.136 The ego becomes implicit in discussions of pathogenesis since it is the agency of defence against the disequilibria and conflict that cause pathological mechanisms to operate. Much like pathology, the ego develops in response to inherited characteristics and their interaction and to the influences of the drives and of outer reality. Anna Freud is often contrasted with Klein on the basis of several fundamental divergences in their theories and models of development and pathogenesis. Klein grants pathogenic supremacy to the mechanisms of introjection and projection which, according to her, exist from the very beginnings of life and contribute to the very building-up of ego agency (including the earlier formation of the super-ego). Miss Freud, on the other hand covers the whole plethora of defence mechanisms available to the young child, throughout childhood, and critically demands the utilization of verbalization in her analyses, in order to corroborate psychoanalytic formulations that

























































 136

Ibid


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may or may not become therapeutically efficacious; placing a deliberate constraint on the age at which analysis is viable.137 In 1929, Miss Freud was already disseminating her pro-pedagogical approach to the treatment of oedipal/post-oedipal aged patients, using the notion of the super-ego and its incomplete development as a guide to her developmental approach. By 1936, with the publication of her seminal text, Miss Freud had abandoned the chronological pursuit in favour of studying: “in detail the situations which call for defensive reactions”138. Holding the superego to be the root of all neurotic disturbance, allowed for a greater prophylactic approach to the neuroses. Therefore the avoidance of: “everything which may contribute to the formation of a superego of excessive strictness”139, through gentle educational methods, tolerance towards the instincts and adequate outlets for aggressiveness, were proposed as prerequisites for health and development: anything contravening these allowances contributed towards pathology in Miss Freud’s view. Her pedagogical approach, now firmly established, centres our investigations around an area of great disparity with the Kleinian school: “When the ego has taken its defensive measures against an affect for the purpose of avoiding unpleasure, something besides analysis is required to undo them, if the result is to be permanent. The child must learn to tolerate larger and larger quantities of unpleasure without immediately having recourse to his defensive mechanisms…theoretically it is the business of education rather than of analysis to teach him this lesson.”140

























































 137

“According to the…English school, introjection and projection, which in our view should be assigned to the period after the ego has been differentiated from the outside world, are the very processes by which the structure of the ego is developed but for which differentiation would never have taken place. These differences…bring home to us the fact that the chronology of psychic processes is still one of the most obscure fields in analytic theory.” Freud, A. (1936) The Ego & The Mechanisms of Defence. (Revised Ed. 1968) pp. 52-53. London: Hogarth; and: “English school…maintain that in the earliest months of life, before any repression has taken place, the infant already projects its first aggressive impulses and that this process is of crucial importance for the picture which the child forms of the world around him and the way in which his personality develops.” Ibid (pp. 122-123) 138 Ibid. p. 53 139 Ibid. p. 56 140 Ibid. pp. 64-65


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b. Differing opinions on the role and primacy of introjection. It is not that Miss Freud discounts the role of introjection and projection in her model, but these mechanisms are not granted the same pathogenic significance as they are in Klein. In Anna Freud’s view, they are but two of the ten mechanisms available to the ego at different points during its development; employed defensively to ward off conflict and thus impede the progression of pathological symptoms. In her discussion of identification with the aggressor, Miss Freud details her version of events whereby: “A child introjects some characteristic of an anxiety object and so assimilates an anxiety experience which he has just undergone. Here, the mechanism of identification or introjection is combined with…impersonating the aggressor, assuming his attributes or imitating his aggression, the child transforms from the person threatened to the person who makes the threat.”141 According to Miss Freud, the introjection of an external criticism and the concomitant threat of punishment for the offense: “have not yet been connected up in the patient’s mind”142. Thus, internalization leads almost simultaneously to the defensive projection of guilt. Arrested development at this preliminary stage of superego development (identification with the aggressor) leads to a failure of internalization and: “indicates an abortive beginning in the development of melancholic states”143. We can contrast this view, with the Kleinian notion of paranoid projection of malevolent part-objects and criticisms being surpassed only by the reintrojection of benevolent whole objects and reassurances that constitute the fading of paranoid-schizoid sadism and the ascent of depressive concern for, and reparative tendencies toward, both internal and external love objects. Anna Freud’s ‘abortive beginnings of melancholic states’ would correspond with a fixation in paranoidpsychotic states for Klein. 























































 141

Ibid. p. 113 Ibid. pp. 118-119 143 Ibid. pp. 119-120 142


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c. Infantile neurosis or arrested development? Just as Klein believed her depressive position to be a universally experienced phenomenon of the infantile neurosis144, Anna Freud, too, saw that: “in the minds of little children urgent instinctual demands conflict with acute objective anxiety, and the symptoms of the infantile neurosis are attempts at solving this conflict”145. The infantile neurosis is thus instantiated as a normal aspect of every individual’s development, in mutual agreement with Herr Freud. The content and the age at which the conflictual tendencies of the infantile neurosis present themselves, however, was a point of stark divergence between Miss Freud and Mrs. Klein. Klein focused on the unconscious phantasies involved in the projective and introjective mechanisms of pre-genital phases of infancy, although she in no way ignored the role of the environment in the production and content of these internal phantasies. Miss Freud, on the other hand concentrated her efforts more broadly and developmentally and tried to show how adaptations to both the outer world and instinctual drives could result in a variety of defensive operations and lead to a greater variety of developmental disharmonies and disequilibria.146 d. The developmental-adaptive model of pathogenesis In her, ‘Indications for Child Analysis’ (1945) Freud reiterates her developmentaladaptive model and makes it clear that it is the ability to develop and not remain fixed 























































 144

Klein believed that every child passed through ‘phases of grave abnormality (psychotic states, depressions) in infancy, and that “normal development in later stages can be best safeguarded by early analysis, by analyzing the psychotic residues of the earliest stage whenever…circumstances permit.” Freud, A. (1969) Indications for Child Analysis & Other Papers 1945-1956. London: Hogarth (p. 10) 145 Freud, A. (1936) The Ego & The Mechanisms of Defence. (Revised Ed. 1968). London: Hogarth (p. 143) 146 In the Vienna School the application of child analysis was restricted to the most severe cases of infantile neurosis “which every child experiences at one time or another before entering the latency period. With all other children, the application of analytic knowledge to their educational handling may prove sufficient to guide them through the intricacies of their instinctual and emotional development.” Freud, A. (1969) Indications for Child Analysis & Other Papers 1945-1956. London: Hogarth (p. 10)


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at some stage of development before the conclusion of the maturation process that becomes impaired through pathogenesis. Such maturational impairment calls for immediate action and knowledge of the severity of the infantile neurosis is accessed: “according to the degree to which it prevents the child from developing further.”147 Anna’s is characteristically akin to her father’s model, and thus much broader than that of Klein’s.148 Where Klein seems to give, perhaps excessive, weight to the pathogenic part played by aggression in the development of pathology, Miss Freud grants it a necessary, though not sufficient role in the understanding of normal and abnormal development. Aggression as the expression of the destructive instinct in the psychoanalytic theory of the drives, is traced back to Freud’s seminal work ‘Beyond the Pleasure-Principle’ (1920), where aggression as an ‘ego-instinct’ is abandoned in favour of the Eros/Thanatos distinction. At this point, the development of aggression was understood as being: “inseparably bound up with the developmental phases of infantile sexuality.”149 Such a modification amounted to a new metapsychological framework for Freudian psychoanalysis which had implications for general psychology in the sense that the erotic and destructive drives are alloyed ab initio and directed towards the infant’s earliest love objects (primarily the mother). e. The role of the instincts in models of pathogenesis At this juncture, a further fundamental disparity can be revealed between the Viennese and British Schools, spearheaded as they were, by Freud and Klein respectively. The controversy centres on the conflict between these two biological forces (sexuality/life/Eros, and aggression/death/Thanatos). The question for Anna Freud 























































 147

Ibid. p. 18 “[in] neurotic conflict the libido flows backward (regression) and attaches itself once more to earlier libidinal wishes (fixation point), in order to avoid anxiety that has arisen on a higher level of sexual organization. The ego of the child thus finds itself confronted with primitive desires (oral, aggressive, anal), which it is not prepared to tolerate. It defends itself against the instinctual danger with the help of various mechanisms (repression, reaction formation, displacements, etc.), but if such a defence is unsuccessful, neurotic symptoms arise which represent the gratification of the wish, distorted in its forms by the action of the repressive forces. While these symptoms persist, they are the central expression of the child’s libidinal life.” Ibid. p. 20 149 Ibid. p.57 Notes on Aggression (1949[1948]) 148


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is whether or not this conflict creates a: “basic ambivalence of feeling”150, and if this ambivalence is of vital pathogenic significance. Klein answers in the affirmative in both instances and recognized that: “a love object is in danger of being attacked or destroyed by virtue of being loved”151. Whereas Anna Freud not agree that two opposing instinctual forces are in themselves sufficient to produce mental conflict or pathology.152 f. The Viennese Model Miss Freud adheres to two general propositions regarding pathogenesis. Firstly that: “Increased frustrations of essential libidinal wishes…abnormally increases the child’s aggressive reaction to…normal and inevitable deprivations…from birth”153, where the agents of frustration are: “unloving, forbidding, [or] rejecting…parents”154. Secondly that: “lack of steady love relationships in early childhood…by internal or external factors…gives rise to states of emotional starvation with consequent…stunting of…erotic development”155, where the loss of parents or traumatic weaning constitute precipitating causes and importantly, where: “normal fusion between the…urges cannot take place…aggression manifest[s]…as pure, independent destructiveness.”156 These two propositions alongside the conviction that pathogenesis is caused primarily by conflict and that: “health or illness is decided…by the solutions…which the…ego adopts to solve the discord”157, constitute the essentials of Anna Freud’s theoretical model of developmental pathogenesis. This model draws heavily on Freud’s notions of the economics of the libido, frustration, a complemental relation between internal 























































 150

Ibid. p. 69 “When the loved object is no longer merely a part…[object] (such as the…breast) but a whole human being…the infant feels guilt with regard to his destructive fantasies. This produces feelings of depression which are lessened only when reparative and restitutive ideas appear and bring relief…‘the depressive position’, an essential feature in emotional development” Ibid (My Italics) 152 “It is only the growth of…(the ego) which results in the gradual integration of all instinctual strivings, and…may lead to clashes and realization of incompatibility between them…conflicts and guilt feelings consequent on them presuppose…a specific comparatively advanced stage in ego development.” Ibid. p. 70 153 Ibid. p. 71 154 Ibid. 155 Ibid. 156 Ibid. 157 Psychoanalysis and Genetic Psychology (1951[1950]). Ibid. p. 130 151


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and external factors, precipitating causes and the fusion of the drives which evolved during transition of psychoanalytic thought from the ‘affect-trauma’, to ‘topographical’, and finally to the ‘structural’ frame of reference. By 1952, Miss Freud was attempting to fill in the gaps in her theories that were visible due to its disparity with Kleinian theory. The development from part to whole object relationships, according to the Viennese, was determined by a decrease in the urgency of the drives, which at first sight does not contradict Klein’s thesis since the capacity to be alone and tolerate longer periods of frustration is characteristic of the depressive position. However, the metapsychology behind Anna Freud’s portrayal is clearly more in line with traditional Freud, than that underlying Klein’s.158 The focus here is on the quantitative aspects of the economy of the pleasure-principle and there is no reference whatsoever to the sadistic currents of the aggressive drive, which in Klein typify the qualitatively expressed movement from the paranoidschizoid position (‘dominated by the pleasure-principle’) to the depressive position (reality-principle and ‘ego-control’). There is also no reference to the content of the underlying pathogenic phantasy activity that we find so richly elaborated in Klein, because, the Viennese fundamentally refute the pathogenic significance, let alone the possibility for clinical verification, of such phantasies. g. The question of preoedipal predicates for pathology In her contribution to the discussion of the problem of infantile neurosis, Miss Freud asserts that psychoanalysis is concerned with: “the earliest possible pathogenic influences, which date back to the child’s first years”159. She admits that she had never had a predilection for the study of this ‘darkest of all ages’, preferring instead the study of phases of development: “where assumptions can be checked against verbalized 























































 158

“[the] impact of…drives, or…needs which represent them, is most imperative…while the infant is under the full impact of his needs…dominated by the pleasure-principle – he demands…immediate satisfaction…[an] object which fails…cannot be maintained…and is exchanged for a more satisfying one. The needs have to lesson in strength, or…brought under ego-control, before nonsatisfying (…absent) objects can retain their cathexis.” Ibid. p. 234 159 Ibid. Problems of Infantile Neurosis: Contribution to the Discussion (1954) p. 328


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material”160. Unable, however, to withstand the trend of interest in ever-earlier events in the infant’s life, Miss Freud tries to restore ‘puberty’ to its legitimate place, as the phase in which early disturbance reaches its full pathogenic force: an attempt that reinforces her loyalty to her father’s classical model of oedipal and post-oedipal pathology. Like Freud, Anna preferred not to use the term neurosis before the decisive structural divisions between ego and id are established i.e., before conflict is fully internalized qua the superego. This preference contains a veiled criticism of the Kleinian model where pathological states are imputed into the earliest stages of predifferentiated development. Miss Freud agrees that the first year is the time when the first object relationships are formed and maintained and she correlates Hartmann’s notion of a ‘lack of object constancy’ with Klein’s ‘part-object’ schemata. The Viennese, however, were dissatisfied with the British emphasis on the object, favouring the picture of the child as dominated by needs and libidinally cathected to: “the moment of blissful satisfaction, not the object.”161 On this point, another obscure difference emerges between the two schools and relates to the crude distinction of a one-person, twoperson, or three-person psychology that broadly categorises the models of pathogenesis we have covered. h. One-, two-, or three-person psychology? Freud’s original work is often called an internalist model of a one-person psychology; it is what goes on within the infant that is salient, the environment and other people only play a role insofar as they are represented within the mind. Clearly, this is an inadequate summary of Freud, especially since his ‘complemental series’ is much more multiply determined, but for the sake of clarity, we will follow this crude thread. If Freud’s is a one-person psychology, then his daughter’s is clearly a two-person psychology, where she gives much greater emphasis to the role of the mother against

























































 160 161

Ibid Ibid. p. 344 (My Italics)


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the background of spontaneous developmental forces active in the child.162 Klein’s then would be a richer and more descriptive one-person-psychology, with elements of a two-person psychology, since the mother and her presence or absence is critical in her model of pathogenetic states. Klein’s borders on a three-person psychology since the father and his role, in phantasy and in regard to the primary object of the mother, is also implicated in the contents of these pathogenic states. In this sense, Klein’s could be seen as a more comprehensive theory accounting for a more theoretically expedient array of internal and external factors. i. Shared and tacit acceptance of the complemental series In discussing the different models designed to solve the problem of how far inherent tendencies towards normality can be thwarted by environmental conditions in pathogenetic processes, the good old Freudian notion of a complemental series has superior explanatory power. Involving both internal and external factors, which mutually compensate one another, the complemental series remains a vital piece of the puzzle of pathogenesis and in some shape or form, is resorted to in both Klein and Miss Freud’s models. We can see elements, references and even diagnostic versions of it in his daughter’s work163, and we can infer its essential components in Klein’s, fairly balanced, portrayal of both internal and external events although Klein does not go to the lengths of diagnostic profiling.164 j. The predominance of orality

























































 162

“the mother is not responsible for the child’s neurosis, even if she causes ‘chaotic’ development…By rejecting and seducing she can influence, distort and determine development, but she cannot produce either neurosis or psychosis.” Ibid. p. 349 163 See Appendix A for a more detailed illustration of Miss Freud’s Diagnostic Profile, which atomises Freud’s complemental series for classification purposes 164 “There is thus a constant interaction between the early development of relations to the internal and external world. This complex interplay includes the foundations of the infant’s object relations as well as his sublimations. All these processes…presuppose not only a complexity of emotions and a rich phantasy life, but also methods of the ego in dealing with them.” Klein, M. (1944) ‘The Emotional Life and Ego-Development of the Infant with Special reference to the Depressive Position’. In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. (p. 784)


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Miss Freud’s 1966 paper discussing the widening scope of psychoanalysis in the 1920s highlights an almost irremediable nexus of complaint between her model of pathogenesis and that of the Kleinians’. The complaint orbits around the overwhelming importance granted to orality and the events of the oral stage of infantile psychosexual and psycho-aggressive development in the Kleinian model. The Viennese, of course, in loyal conformity to Freud, observe, putatively more empirically: “the main features of the superego and character formation as well as the roots of mental illness”165 in the phallic-oedipal phase and on this point, there is little harmony between the two schools. VI. CONTROVERSIAL DISCUSSIONS King and Steiner (1991) point out that psychoanalysis is not a closed system. It is bound to confront new observations, which cannot always be accounted for with existing theory and therefore new hypotheses must be put forward. How these hypotheses are assessed and whether they are included in the general body of knowledge were some of the questions the Controversial Discussions of 1940-1946 dealt with in regard to Klein’s theories and clinical findings. Anna Freud’s work was already well established within the ‘general body of knowledge’ of psychoanalysis. Klein’s work, however, was being questioned in its adherence to classical Freudian theory and criticized as being a departure from traditional Freud on a number of counts. Despite an overwhelmingly positive reception by her English colleagues in her early days as a practising analyst, Klein found herself, during the war years, having to defend her ideas painstakingly, against an onslaught from the Viennese who had mostly found refuge in England from the Nazi campaign, which surely had an exacerbating influence on the discussions as a whole and the tensions therein. As we have already mentioned Klein was prepared to interpret the negative material and aggressive impulses of her patients: “without the customary nurturing of the

























































 165

Freud, A. (1966) A Short History of Child Analysis. Psycho-Analytic Study of the Child 21: 7-14 (p. 10)


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positive affects…without which it was…held…psychoanalysis could not proceed”166. Klein formulated her ideas descriptively, not conceptually: whereas the metapsychology of classical theory involves hard conceptual work167, Klein’s descriptive approach facilitated a rapid understanding of her patient’s material. Klein’s view of early development and the genesis of psychic functioning had consequences for technique that were believed to be inconsistent with psychoanalysis ‘as known’ to the Freudians. Klein, however, correctly maintained that she was well grounded in Freud and merely extended and developed his ideas. To Klein’s defence Paula Heimann contributed a seminal paper that tried to explain how: “Acceptance of the theory of the death instinct brings about a different approach to the manifestations of destructiveness, the interplay of love and hate…to all psychological phenomena, from that obtaining when psychical conflicts are not traced back to an antithesis as final and cardinal as that of these inherently conflicting primal instincts.”168 Therefore, in the Kleinian model, the infantile system is by its nature, instinctually conflicted ab initio, and the Kleinian approach to the negative transference rests on a different basis in light of this theory, leading to a fuller appreciation of projection and persecution symptoms. Freud and Abraham were both aware of aggressive and instinctual manifestations, though the aggressive trend was not investigated to the extent of the libido. Klein did not discover these processes, though she concluded that the destructive impulses behaved exactly as the libidinal ones, highlighting how they could be deflected outwards and focusing on the sadistic elements of bodily functions and the sadistic relation to satisfying objects.

























































 166

King, P. & Steiner, R. (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. pp. 18-19 167 See Appendix A 168 Heimann, P. (1943) Some Aspects of the Role of Introjection and Projection in Early Development. In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. (p. 512)


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a. Unconscious phantasy: The battle lines are drawn Reading Steiner’s background to the debates, the Viennese rejection of the primary pathogenic role of unconscious phantasy in the first months is paramount because acceptance of it would imply a rudimentary ego and system of defences, which would, controversially, precede repression (in contradistinction to the cornerstone of the Freudian model of pathogenesis). Such early unconscious phantasy production also implied a rudimentary sense of the reality-principle and the still dominant pleasureprinciple, all of which sounded obscure and uncanny to the traditional Freudians. Nonetheless, to the majority, especially within Britain: “Klein had come to very precise, even if still fluid views about the precocious genesis and phantasmatic nature of the primitive superego and on the nature of the sense of guilt, and above all on the fundamental role played by…the ‘depressive position’ in the development of the child”169 Her stress on the constitutional factors: “in regard to both libidinal and destructive impulses”170 went down well in Britain, notwithstanding her already widely accepted notions of the inner world. Still, Klein was not immune to her criticisms from the Viennese, as we see from the discussion of Isaac’s contribution to ‘The Nature and Function of Phantasy’ to which Miss Freud reproached: “early phantasies…frequently described in Kleinian theory are violently aggressive…[and] logical to…analysts who are convinced of the preponderance of the death instinct at the beginning of life…[but] questioned by those to whom the libidinal impulses seem of overwhelming importance for this time of life.”171

























































 169

King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. (p. 254) 170 Ibid. p. 256 171 st 1 Series of Scientific Discussions: 4th Discussion of Scientific Controversies (April 7th, 1943) – Contribution to discussion on Isaac’s paper ‘The Nature and Function of Phantasy’. In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. (p. 424)


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Isaacs responds in the next discussion, that Klein gives equal importance to erotic and destructive instinctual drives and reminds the audience that Klein is not departing from Freud on this count.172 b. Oedipus complex or Oedipus conflict Yet another outstanding arena of debate between the Kleinian and Freudian models is insofar as Klein detracts from the pathogenic primacy of the Oedipus complex in favour of preoedipal stirrings, which is rebuffed by Isaacs, when she says: “Klein, so far from lessening the importance of the Oedipus complex, extends its sphere since…she sees it in action over a greater period of time and influencing a greater variety of phenomena in development.”173 In her memorandum of the same year, Anna Freud still maintained that the importance of pre-verbal phases in Klein’s model of pathogenesis, left all other sources to dwindle.174 Responding in her own memorandum in 1943, Klein makes clear the fact that early analyses (from the age of two and up) allowed for a new understanding of the earliest object relationships and of the origin of anxiety, guilt and conflict. These had already had a demonstrable influence on adult technique, were rooted in Freudian thought and allowed for a fuller understanding of other emotions as well. For Klein, the extensive analysis of the phantasy life and of the unconscious generally, as well as of the defence mechanisms and the ego, i.e., the whole personality, was not incompatible with the full psychoanalysis of the libido, indeed, she felt it to be a condition for it. In Klein, anxieties stirred by destructive impulses influence the libido and the vicissitudes of the libido are only fully comprehensible in relation to the early

























































 172

“Glover…pointed out…[that in] the earliest theories…libidinal factors predominated, yet in later years Freud came increasingly to recognize and emphasise ‘the general importance of hate, aggression, and destructive impulses in ego-development.’ This was also true of Abraham.” 5th Discussion (May 19th, 1943). In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. (p. 443) 173 Ibid. p. 448 174 Ibid. pp. 631-632


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anxieties with which they are bound. This approach to anxiety and guilt remains a distinctive guiding principle in the Kleinian model. c. The Kleinian Victory With the publication of her expert re-synthesis of previously seminal contributions, in the following year, Klein described the infantile depressive position as: “a system of feelings, phantasies, anxieties, and defences arising in the first year of life”.175 Leaving no doubt on where she differed from Miss Freud. Klein claims to have secured her theory of the psychogenesis of depression, firmly within the psychoanalytic canon, through her analyses of children from 21 months and by comparison with adult material (normal and abnormal), which was all checked by direct observation of infants and older children. Such an early onset of pathogenic states was untenable according the Viennese, who only recognized melancholic states after the dissolution of the Oedipus complex, or in later admissions by Miss Freud herself, in the third year (itself a departure from traditional Freudian theory). In dealing with the origins of anxiety and guilt, Klein comes to two conclusions, supported, as they are by Herr Freud. First is that unsatisfied libidinal excitation in young children is what transforms into anxiety and second, that: “the earliest content of anxiety is the infant’s feeling of danger lest his needs should not be satisfied because mother does not return.”176 Abraham is brought in here, being the pioneer who pointed out the confluence of anxiety and cannibalistic urges. This confluence became critical for Klein in recognizing the aggressive source of anxiety.177 Klein’s tendency towards aggression can be traced back to her 1929 paper, which illustrates an extreme case of:

























































 175

Klein, M. (1944) ‘The Emotional Life and Ego-Development of the Infant with Special reference to the Depressive Position’. In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 19411945. Routledge: London. (p. 752) 176 Ibid p. 758 177 “His hypothesis that guilt arises in the ego’s struggle to overcome the cannibalistic impulses…implies a sense of guilt at a very early stage of development.” Ibid. p. 759


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 “pathological effects of the anxiety aroused by the destructive impulses in the infant, and concluded that the earliest defences of the ego…[are] not directed against the libido but against the anxiety aroused by aggressive impulses and phantasies.”178

Klein’s concept of the infantile depressive position therefore finds its theoretical basis in: “Freud’s and Abraham’s discoveries of the factors underlying melancholia and normal mourning…the essential part introjection plays in melancholia…[where the] object…installed within the ego…[is] bound to miscarry if the cannibalistic impulses…are excessive, and…leads to illness.”179 Klein’s contention was that the infant: “experiences feelings akin to mourning, and that these feelings arise from…fear of destroying and so losing his loved and indispensable object”180. Having thus located the first important pathogenic fixations for melancholia in infancy (weaning) Klein goes on to explain how: “young children develop phantasies and anxieties…in content identical with the conscious and unconscious phantasies and anxieties of adult psychotics”181. It is the analysis of these phantasies that marks Klein’s as a model of consciousness perpetually influenced by emotions and wish-fulfillment. Klein was lauded for her discovery of the fixation point for all the psychoses, since this was something pre-Kleinian psychoanalysis was ill equipped to do. Such fixations were considered to be normal in infancy but became pathological if they were maintained or regressed to in later years. VII. CONCLUSION: The different pictures of the child Miss Freud’s ‘Diagnostic Profile’ best encapsulates her view of the child. As a systematic assessment of childhood pathology, it contains a:

























































 178

Ibid. Ibid. p. 767 180 Ibid. 181 Ibid. p. 769 179


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 “picture of…[the] child against…[a] background of developmental norm[s] into which

the state of his inner agencies…various functions, conflicts, attitudes and achievements have to be fitted.”182 Her notion of ‘Developmental Lines’ is not a theoretical abstraction but a conceptualization of historical reality conveying a picture of achievements and failures in personality development.183 A further, and centrally significant diversion of opinion between Miss Freud and Klein, appears when we appreciate that under the Viennese model, the child analyst is beholden to distinguish between neurotic-developmental disorders where the ego plays a vital pathogenic role, and ‘deficiency illnesses’ where pathological distortions are traced back to some external agent considered essential for normal growth. In light of this distinguishing feature, Klein’s model could be seen only to approach these ‘deficiency illnesses’, since pathogenic primacy is given to the role of introjected and projected imagos in the unconscious phantasy of the preverbal child. Klein does not distinguish between neurotic-developmental and deficiency pathologies although she does have room in her theory for pathologies based on maltreatment, and she is able, where Miss Freud is not, to extend analysis into the realm of psychotic, as distinguished from neurotic, pathogenesis. It is perhaps on this point that the two thinkers claim their unique, yet not incompatible, territory. Klein’s is a picture of early object relationships, emotions and conflicts, which shape and colour the development of the Oedipus conflict. Various situations and relationships in the infant’s history are set against a backdrop of sexuality, symptoms, character and emotional attitudes. Destructive impulses are directed against the loved object during breast-feeding and weaning and cause anxiety and guilt. Klein finds support for her elevation of the breast-situation to primary pathogenic status in Herr Freud’s: “unobtainable prototype of…sexual satisfaction”184, and it is here that she extends Freudian notions of hallucinatory wish-fulfillment into the indispensable notion of phantasy. Without phantasy, there is no pathology in Klein’s view: 























































 182

Freud, A (1963). The Concept of Developmental Lines. Psycho-Analytic Study of the Child 18: 245265. 183 Appendix B contains an abbreviated example of a developmental line that is pertinent to this thesis. 184 Freud, S. (1916-17) Introductory Lectures on Psycho-Analysis p. 314


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hallucination compensates for the painful absence of instinctual gratification. Unconscious sexual theories constitute inherent phantasies, which relate to both external and internal objects and this explains how the inner world can become so terrifying to the infant, as anxiety lest the internal objects retaliate against the sadistic attacks, becomes multiplied. VIII. RECAPITULATION In genealogical terms, we began with Freud’s broad developmental approach to the formation of ‘energic disequilibrium’ and later his theory of the psychoneuroses went on to include the important notion of the deferred action of pathogenic sexual traumata. Freud’s model of pathogenesis explicates the functional pathological modifications based on the disturbed economics of the nervous system caused by these sexual traumata. The choice of neurosis, for Freud, depended primarily on the ‘causal relation between the nature of the sexual influence and the pathological species of the neurosis. Repression takes a nucleic role in Freud’s predominantly sexual model of pathogenesis. In his later works, Freud included the civilized sexual morality of his era to have an exacerbating effect on the vulnerability to pathological manifestations. The thread of pregenital sexuality and its significance in pathogenesis is initiated by Freud and runs through the entirety of Klein’s publications. The plasticity or rigidity of the libido in its relation to objects is also a central theme in Klein, that we find delineated by Freud as a significant and independent variable in his model of pathogenesis. We cannot forget the complemental series and its explanatory power in all the models mentioned heretofore, and Freud’s prowess at identifying divisible constitutional factors such as inherited constitution and acquired dispositions, remains a guiding principle in his daughters contributions to the classical canon. In addition, Freud introduces the necessity of the Oedipus complex; the moratorium in sexual life during latency and its re-emergence during puberty, as massively significant in his model of pathogenesis, he called this, the ‘second phylogenetic factor’ and claimed it to be the most direct cause of pathology that he had discovered.


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Anna Freud, staying true to her classical lineage, runs with much of what is laborious and complex in her father’s models, and develops her own, developmental view of normal development, with which she could measure and compare pathological sequences of events along developmental lines; expressed diagnostically with her Developmental Profile. Her language is typically Freudian, but unique to her own affinity with other disciplines. Her model focuses on conflict within different structures of the mind, and required, the dissolution of the Oedipus complex and the super-ego to be in place, before she would speak of pathology. On this point, she differs with Klein, who came to intricate and fluid conclusions about the early development and phantastical contents of a more primitive super-ego that neither of the Freuds had intuited. Refining her attention on the operation of guilt and of course the ‘depressive position’, Klein’s model seems to allow for an earlier appreciation of the significant processes of mind, in the problem of pathogenesis. So from Freud’s broad developmental approach, to his daughters diagnostic profile and finally to Klein’s depressive position, it would be difficult to isolate any one model from the other, since they are all so firmly rooted in the history of psychoanalytic thought. Influenced by Charcot and Breuer, Freud eventually established a broad developmental model of the process of pathogenesis in adults, hinting somewhat at their precursors in infancy. He paved the way for both his daughter and Klein, to build upon what they could learn from that, and to some extent, their work complements each other because of their shared and tacit adherence to many fundamental psychoanalytic tenets. Where they differ however, it is still possible to trace their ideas into Freud, sometimes into the same papers and even the same quotes, but their interpretations are what lead them away from each other’s viewpoints. All models of pathogenesis owe much of their success to this genealogical heritage in Freud. Anna’s and Klein’s are just two such models, particularly complicated to sketch without risk of misunderstanding. This attempt to draw links from their models to Freud’s after what can only be described as an abbreviated history of Freud’s evolution as a theorist, is hoped to have been successful by virtue of the volume of research covered. A broad view of the development of psychoanalytic theories of pathogenesis has been traced with attention to detail where necessary in


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order to bring out the important elements in this puzzle we have been teasing over: the puzzle of pathogenesis. IX. BIBLIOGRAPHY 1.

Freud, S. (1926) Inhibition, Symptom and Fear in Freud, S. (2003). ‘Beyond the Pleasure Principle and Other Writings’. Translated by John Reddick. London: Penguin

2. Freud, S. (1885) The Origins of Psychoanalysis: The Fleiss Letters (Nov, 24th) 3. Freud, S. (1886) Preface to Charcot’s Lectures on the Diseases of the Nervous System. The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. I (1886-1899): Pre-Psycho-Analytic Publications and Unpublished Drafts, 17-22 4. Freud, S. (1883) Charcot. SE III (1893-1899): Early Psycho-Analytic Publications, 7-23. 5. Freud, S. (1940) Sketches for the ‘Preliminary Communication’ of 1893. SE I, 145-154. 6. Breuer, J. & Freud, S. (1893) On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication. SE II (1893-1895) 7. Freud, S. (1894) The Neuro-Psychoses of Defence. SE III (1893-1899) 8. Freud, S. (1892). Draft K. The Neuropsychoses of Defence from Extracts from the Fleiss Papers. SE I. 9. Sandler, J, Holder, A & Dare, C (1972) Frames of reference in psychoanalytic psychology: IV. The affect-trauma frame of reference. British Journal of Medical Psychology, 45: 265-272 10. Freud, S. (1896). Further Remarks on The Neuro-Psychoses of Defence, SE III 11. Freud, S. (1896). The Aetiology of Hysteria, SE III 12. Freud, S. (1896). Heredity and the Aetiology of the Neuroses. SE III 13. Freud, S. (1911) Two Principles of Mental Functioning. SE XII 14. Freud, S. (1911). The Schreber Case. SE XII


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 15. Freud, S. (1906). My Views on the Part Played by Sexuality in the Aetiology of the Neuroses. SE VII 16. Freud, S. (1898). Sexuality in the Aetiology of the Neuroses. SE IX 17. Freud, S. (1908) ‘Civilised’ Sexual Morality and Modern Nervous Illness. SE IX (1906-1908) 18. Strachey, J. (1962) Editors Note to Freud, S. (1912) Types of Onset of Neurosis. SE XII (1911-1913) 19. Freud, S. (1916-1917) Introductory Lectures on Psycho-Analysis, SE XVI 20. Freud, S. (1918) From The History of an Infantile Neurosis. SE XVII

21. Freud, S. (1912) Types of Onset of Neurosis. SE XII 22. Strachey, J. (1913) Editor’s Note to Freud, S. (1913) The Disposition to Obsessional Neurosis: A Contribution to the Problem of the Choice of Neurosis. SE XII 23. Freud, S. (1913) The Disposition to Obsessional Neurosis: A Contribution to the Problem of the Choice of Neurosis. Ibid. 24. Freud, (1917). Mourning and Melancholia. SE XIV 25. Freud, (1923) The Ego and the Id. SE XIX

26. Klein, M. (1935) A Contribution to the Psychogenesis of Manic-Depressive States. International Journal of Psycho-Analysis, 16: 145-174 27. Klein, M. (1975; 1932). The Psycho-Analysis of Children. NY: Delacorte Press 28. Klein, M. (1998). ‘Love Guilt and Reparation’ and other works 1921-1945. London: Vintage 29. Freud, S. (2003). Beyond the Pleasure Principle and Other Writings. Translated by John Reddick. London: Penguin 30. Klein, M. (1940) Mourning and its Relation to Manic-Depressive States. International Journal of Psycho-Analysis, 21: 125-153 31. Rado, S. (1928). The Problem of Melancholia. International Journal of Psycho-Analysis 9: 420-438 32. Freud, A. (1936). The Ego and the Mechanisms of Defence. (Revised Ed. 1968). London: Hogarth


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 33. Abrams, S. & Solnit, A. (1998) Co-ordinating Developmental and Psychoanalytic Processes: Conceptualising Technique. Journal of the American Psychoanalytic Association, 46: 85-103 34. Hartmann, H. (1950) Comments of the Psychoanalytic Theory of the Ego. Psychoanalytic Study of the Child, 5: 74-96 35. Freud, A. (1969) Indications for Child Analysis & Other Papers 1945-1956. London: Hogarth 36. Klein, M. (1944) The Emotional Life and Ego-Development of the Infant with Special Reference to the Depressive Position. In King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 1941-1945. Routledge: London. p. 784 37. Freud, A. (1966) A Short History of Child Analysis. Psychoanalytic Study of the Child, 21:7-14 38. King, P. & Steiner, R. (Eds.). (1991). The Freud-Klein Controversies 19411945. Routledge: London. 39. Heimann, P. (1943) Some Aspects of the Role of Introjection and Projection in Early Development. In King & Steiner. Ibid (p. 512) 40. 1st Series of Scientific Discussions: 4th Discussion of Scientific Controversies (April 7th, 1943) – Contribution to discussion on Isaac’s paper ‘The Nature and Function of Phantasy’. In King, & Steiner. Ibid. p. 424 41. 5th Discussion (May 19th, 1943). In King. & Steiner. Ibid. p. 443 42. Freud, A. (1963) The Concept of Developmental Lines. Psychoanalytic Study of the Child. 18:245-265 43. Freud, A. (1962). Assessment of Childhood Disturbances. Psycho-Analytic Study of the Child. 17: 149-158


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X. APPENDICES a. Appendix A: Freud, A. (1962). Assessment of Childhood Disturbances. Psycho-Analytic Study of the Child. 17: 149-158 The diagnostician’s task, according to Anna Freud, is to ascertain where a child stands on the developmental scale (age-adequate/retarded/precocious) and “to what extent…observable internal and external circumstances and existential symptoms…interfere…with the possibilities of future growth.”185 In order to place the child correctly on a scale of normal or pathological development, the analyst requires a ‘comprehensive metapsychological picture of the child’. This metapsychological framework is provided by Miss Freud as the ‘Developmental Profile’, which breaks diagnostic thinking into its constituent parts. The profile is drawn up at preliminary, treatment and terminal diagnostic stages providing a tool for the completion and verification of diagnosis and an instrument to measure the efficacy of results of treatment. The profile is initiated by the ‘referral symptoms’ of the child. It continues with investigation into the family background and history with an enumeration of significant environmental influences and proceeds to the internal picture (structure of the personality; dynamic interplay within the structure; economic factors concerning drive activity; the relative strength of the id and ego forces; adaptation to reality and genetic assumptions). Below is a paraphrased version of Miss Freud’s abbreviated draft Diagnostic Profile: Diagnostic Profile (Draft) I – Reasons for referral (arrests in development, behavioural problems, anxieties, inhibitions, symptoms) II – Description of the child (personal appearance, moods, manner) III – Family Background and personal history IV – Possibly significant environmental influences V – Assessment of development of: A) Drive i) Libido (Examine and State) a) phase of development, sequence and phase dominance, regression or maintenance (oral, anal, phallic, latency, pre-adolescent, adolescent) b) libido distribution (self and world cathexes) 























































 185

Freud, A. (1962) Assessment of Childhood Disturbances. Psycho-Analytic Study of the Child. 17: 149-158 (p. 149)


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 c) object libido (level and quality of object-relationships: narcissistic, anaclitic, constancy, preoedipal, oedipal, postoediapal) according to age. Regression or maintenance, whether object relationships correspond with phase of development. ii) aggression (examine expressions available to the child) a) according to their quantity (presence or absence in manifest picture) b) according to their quality (correspondence with level of libido development) c) according to their direction toward either object world or self.

B) Ego and Superego a) examine and state the intactness or defect of ego apparatus, serving perception, memory, motility etc. b) examine and state the intactness or otherwise of ego functions (memory, realitytesting, synthesis, control of motility, speech, secondary processes) looking out for deficiencies. Note unevenness in levels reached. IQ tests. c) examine in detail the status of the defence organization: whether defence employed against drives, or drive activity and instinctual pleasure; whether defences are age adequate, primitive or precocious; use of many defence mechanisms or excessive use of one (balance of defence mechanisms); efficacy in dealing with anxiety (equilibrium, disequilibrium, lability, mobility or deadlock within the structure; object dependency or independence of defence (superego development) d) secondary interference of defence activity with ego achievements (price paid for upkeep of defence organization) C) Total Personality (Lines of development and Mastery of tasks) “Under the influence of external and internal factors these lines of development may proceed at a fairly equal rate, i.e., harmoniously, or with wide divergences of speed, which may lead to many existent imbalances, variations and incongruities in personal development.”186 VI – Genetic Assessments (regression and fixation points) a) manifest behaviour allowing conclusions as to the underlying id processes undergone repression and modification and left imprint b) fantasy activity (Cs and Ucs) betrays pathogenically important parts of developmental history c) symptomatology (surface-depth relations firmly established) (two types of regression – temporary and permanent, spontaneously reversible or irreversible – needs distinguishing to indicate therapeutic efficacy) 























































 186

Ibid. p. 153


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VII – Dynamic and Structural Assessments (conflicts) Examine conflicts and classify as: a) external conflicts between the id-ego agencies and object world (fear of object world) b) internalized conflicts between ego-superego and id after the ego agencies have taken over and represent to the id the demands of the object world (guilt) c) internal conflicts between insufficiently fused or incompatible drive representatives (unresolved ambivalence, activity versus passivity, masculinity versus femininity, etc) According to the predominance of any of the three types, it may be possible to arrive at assessments of: 1) the level of maturity (relative independence of child’s personality structure); 2) the severity of his disturbance; 3) the intensity of therapy needed for alleviation or removal of disturbance VIII – Assessments of Some General Characteristics: Possible significance for predicting the chances for spontaneous recovery and reaction to treatment. Examine: a) b) c) d)

frustration tolerance sublimation potential overall attitude to anxiety (defence based on phobic countercathexes) progressive developmental forces versus regressive tendencies (economic relations)

IX—Diagnosis Reassemble the items above and combine in a clinically meaningful assessment number of categorisations: 1) In spite of manifest behavioural disturbances, personality growth essentially healthy, falling within the range of “variations of normality”; 2) Existent pathological formations (symptoms) of transitory nature – byproducts of developmental strain; 3) Permanent regressions (more permanent symptom-formation and impoverishing effects on libido progression, crippling effects on ego-growth) According to the location of fixation points and the amount of ego-superego damage. Character structure/symptoms of neurotic, psychotic or delinquent nature; 4) Primary deficiencies of an organic nature or early deprivations which distort development and structuralisation and produce retarded, defective and nontypical personalities;


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 5) Destructive processes at work (of organic, toxic, psychic, known or unknown origin) effecting disruption of mental growth.

b. Appendix B Freud, A (1963). The Concept of Developmental Lines. Psycho-Analytic Study of the Child 18: 245-265 Prototype of developmental line: From Dependency to Emotional Self-reliance and adult object relationships: 1) Biological unity between mother-infant couple (Subdivided into autistic, symbiotic and separation-individuation phases with significant danger points in each) 2) Part-object, need fulfilling, anaclitic relationship, based on urgency of child’s bodily needs and drive derivatives 3) Object constancy (positive inner image, maintained irrespective of dissatisfaction and frustration) 4) The ambivalent relationship of the preoedipal, anal-sadistic stage 5) Object-centred phallic-oedipal phase 6) Post-oedipal latency period (lessening of drive urgency, transformation of libido to ‘others’) 7) Pre-adolescent prelude to the ‘adolescent revolt’ (return of earlier ambivalence/need-fulfillment/part-object) 8) Adolescent shedding of infantile ties (genital supremacy) Infringements of biological mother-infant tie: (1) ‘Separation anxiety’ (Bowlby, 1960); (2) Failure of mother in need-fulfillment/comfort-giving = breakdowns in individuation; (4) Unsatisfactory libidinal relations to unstable or otherwise unsuitable love objects during anal-sadism will disturb the balanced fusion between libido and aggression. Give rise to uncontrollable aggressivity, destructiveness etc. Average normality equates to a close correspondence between growths along individual developmental lines. Harmonious personality development equates to corresponding levels of development along various lines. Irregular patterns in growth, lagging behind, imbalance between lines determined differentially by innate and environmental reasons and their interactions. The id endows the maturational sequences in development of libido and aggression


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The ego endows the innate tendencies of organization, defence and structuralisation, quantitative differences of emphasis on progress in one direction or another. Accidental environmental influences: •

Parental personality/ideals/actions

Family atmosphere

Cultural setting

Maternal depression

Disequilibrium between developmental lines becomes pathogenic agent where imbalance is excessive. Moderate disharmony produces variations of normality.


A Genealogy of Psychoanalytic Theories of Pathogenesis: The Puzzle of pathogenesis  

Masters Dissertation Distinction piece

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