PSYCHE, 1967, Jg. 21, Ausgabe 10-11

Comments on the psychoanalytic psychology of adaption, with special reference to the role of affects and the representational world
In this paper the view is put forward that the ultimate criterion on which the ego bases its adaptive manoeuvres is its conscious or preconscious awareness of the feeling-states which are an integral part of the representational world. It is suggested that all ideational content in the representational world can only develop and carry meaning for the ego by virtue of its (genetic and functional) connection with feeling-representations. The aim of adaption can be regarded (directly or ultimately) as the need to maintain a certain state of the representational world. The ultimate criterion with regard to adaption is the gaining of what the authors have (in previous publications) referred to as the affective state of well-being which accompanies inner states of dynamic equilibrium. The drives are the main disruptors of these states, but this view implies a shift of emphasis from the concept of energetic homeostasis as a regulatory principle to a principle of progressive adaption based on the regulation of feeling-states. Here the authors distinguish sharply between the »feeling« aspects of affect and somatic discharge aspects. While many workers have placed emphasis on the latter, it is the authors' view that it is the maintenance of what might be called a »feeling« equilibrium which is of prime significance in moment-to-moment adaption. Discharge processes acquire significance to the ego only insofar as their ideational representations are consciously or unconsciously linked with feeling-representations. Finally, the concept of a well-being principle is discussed in relation to Freud's pleasure-principle;

The paper discusses the variation, dictated by his personality, in the manner of each psychoanalyst's understanding of his patients, and the relationship of this variation to the theory of psychoanalytic technique. Psychoanalytic psychology is considered to have justified its claim to be scientifically based 'by the production of covering laws. At the same time the law of overdetermination implies a clinical method in some ways antithetical to the usual method of science. The psychoanalyst has not only to test unitary explanations of multiple phenomena; he also has to select from multiple explanations of individual phenomena by complex acts of assessment. This involves the operation of his value systems. The influence of the character-structure of the psychoanalyst has received little detailed consideration in the theory of psychoanalytic technique. His difficulties are largely assessed in terms of the theory of counter-transference, a concept which classically implies the eruption of the derivatives of the Id. It is analogous to the concept of the patient's resistance, which had a wider applicability before the advent of the analysis of defences. An attempt is made to illustrate the need for increased recognition of the influence on the psychoanalytic transaction of the structure of the ego in analyst and patient.

1. Zu depressiven Reaktionen neigen Personen, die eine narzißtische Disposition in dem Sinne besitzen, daß sie keine stabile Bindung zwischen Selbst und Ideal-Selbst entwickelt haben, vielmehr zur Aufrechterhaltung ihres »narzißtischen Gleichgewichtssystems« auf die Realpräsenz des das Ideal- Selbst repräsentierenden Ideal-Objektes angewiesen sind. Sie entwickeln aus Angst vor dem Verlust dieser Beziehung zwanghafte Verhaltensformen, das sind anankastische Züge. Werden sie am gelebten Vollzug eines derartigen Abwehrstils behindert, dann resultieren prädepressive Zustandsbilder im Sinne der »Inkludenz« und »Remanenz« (H. Tellenbach, l. c.). 2. Das das depressive Symptom auslösende Ereignis ist der »Verlust« des Ideal-Selbstes13, präziser gesagt der Verlust des Ideal-Charakters dieser Struktur. 3. Eine depressive Psychose wird manifest, bzw. wird vom Bewußtsein ek-sistiert, wenn das verlorene Ideal-Selbst durch bestimmte Triebmechanismen und Regressionen entwertet und in dieser entwerteten Form im Selbst aufgenommen wird — der »psychotische« Mechanismus sensu strictiori —, wobei jetzt die Beurteilung und Verurteilung der so entstandenen Ausgangslage durch Über-Ich-Strukturen — Bestandteil der »neurotischen« Persönlichkeitsstrukturen — erfolgt. Letztere müssen zur Ausbildung gekommen sein, bevor die aus der Klinik bekannte depressive Symptomatik überhaupt entstehen kann. Kleinkinder, die die ödipale Phase noch nicht erreicht und keine Über-Ich-Struktur entwickelt haben, sind deshalb nicht in der Lage, echte depressive Merkmale zu bilden. 4. Verlust und Entwertung des Ideal-Selbsts und gleichzeitige Aufnahme des entwerteten Ideals im Selbst sind die Korrelate der von Binswanger erkannten Fusion von Protentio und Retentio, in der die Bedingung der Möglichkeit für die melancholische Veränderung der Zeitigung zu sehen ist. 5. Eine differentielle Diagnose zwischen reaktiver, neurotischer und »endogener« Depression ergibt sich aus der Analyse der Bedingungen des Ideal- Selbst-Verlustes. Durch äußere Gewalt herbeigeführte Verluste, wie auch durch neurotische Konflikte veranlaßte, erlangen Tiefenwirkung nur, können nur dann psychotisches Ausmaß gewinnen, wenn das narzißtische Regulationssystem instabil geblieben war. »Rein endogene« Depressionen entstehen dann, wenn »somatische« Bedingungen die positiv affektive (libidi- nöse) Bindung an das Ideal-Objekt, i. e. seine Repräsentanz aufheben.

1. The tendency for depressive reactions is dependent on a narcissistic disposition. Such patients are lacking stable ties between the self and the ideal self; their "narcissistic balance" rests on the actual presence. of the idealized object representing this ideal self. For fear to lose this relationship they develop compulsive patterns of behaviour and whenever they are obstructed in the realization of their defences they show pre-depressive mental states with symptoms, which Tellenbach calls »includence« and »remanence«. 2. The precipitating event is the loss of the ideal self or better, loss of the ideal character of this structure. If the idealized object is completely de-cathected schizophrenic states are ushered in. 3. A depressive psychosis becomes manifest when the lost ideal self has been depreciated and re-accepted in this degraded form into the self. This is the psychotic mechanism sensu strictiori. The situation is then evaluated or better, censured by structures within the superego- components of the neurotic personality. These structures must have emerged before.the depressive symptomatology can become manifest. 4. Loss and depreciation of the ideal self and the simultaneous acceptance of the defaced ideal into the self are the correlates of a fusion of »protentio« and »retentio« postulated by Binswanger; this is the pre-condition for the melancholic's impaired sense of time. 5. A differential diagnosis distinguishing between reactive-neurotic and endogenous depression can be made on the grounds of the conditions responsible for the loss of the ideal self. Loss from external causes or loss resulting from a neurotic conflict will, however, deteriorate into a psychotic state only if the narcissistic regulation has already previously been instable. »Purely endogenous« depressive states may be dependent on the existence of (postulated) »somatic« conditions dissolving the affective (libidinal) tie with the object-ideal, i. e. its psychic representation.

The paper reviews a nurober of psychosomatic concepts or »models« of the pathogenesis of ulcus ventriculi et .duodeni. The sequence of research is marked by the gradually increasing insight gained into the psychodynamic factors participating in the development of the symptoms. Obviously such »models« cannot be dispensed with both for diagnosis and for a scientific classification of the clinical findings. The syndrome of ulcer is taken for an example on which to demonstrate two different phases of chronification: (1) Chronification on the basis of unsolved and for the patient unsolvable conflicts. The interlaced pathopsychological and pathophysiological processes, however, are still reversible. (2) Chronification accompanied by serious lesions of the organ. Here the psycho-somatic interrelations are disrupted; secondary somato-psychic phenomena (e. g. pain) have taken the lead. In the first phase of chronification the state asks for an early therapy aiming at the psychopathological factors; in the second phase somatic therapy, e. g. surgery, has to be envisaged. The psychological meaning an intervention like gastrectomy will have for the patient is discussed.

Stimulated by Willi Hoffer's contributions to this theme in reference to early infant observation (hand; mouth and ego integration) the case history of a woman with strong mood swings is elaborated upon. In her depressive phases the ego is threatened with disintegration owing to a breakdown of functions. manifested mainly in her hands and her being flooded by her impulse life of a negative sort. In her phases of recovery the first outward sign of improvement is usually a successful attempt to acquire a new artistic technique, a skill in her hands, lessened fear of her aggressive mouth and a capacity for perceiving shapes, colours, textures which inspire her imagination to constructive work. This process of finding has been linked with Willi Hoffer's ideas on the importance of the hand and has also been used to refer to the work on infant research by Anna Freud, D. W. Winnicott, Michael Balint, John Bowlby and Melanie Klein.

This paper presents some of the difficulties which have arisen in connection with the integration of the clinical concept of transference into psychoanalytic metapsychology. The extension of the concept by Freud himself has presented us with subsequent conceptual problems, and definitions given by later workers have failed to clarify the situation. An examination of child psychoanalytic material recorded in the Hampstead Index shows that many different phenomena ( e. g. the various forms of externalization, transfer of authority of the superego introjects, displacements and extensions of other relationships, the emergence of »character« attitudes in the analytic situation, the »working alliance«, etc. cannot be distinguished sharply from transference or transference neurosis, particularly if the concept of transference is applied in a broad sense. The conclusion is drawn that what emerges as the various forms of transference in the analytic situation are phenomena which, from a metapsychological point of view, represent the different dimensions of relationships in general. lt is suggested that the closer study of all these dimensions may in turn be rewarding from the point of view of understanding the complex relationships which occur in the psychoanalytic situation and which are normally subsumed under the broad heading of transference.

Nach zusammenfassender Darstellung der Theorie der Konversion werden psychoanalytische Auffassungen über die Entwicklung der weiblichen Sexualität diskutiert. Das Problem der weiblichen Kastrationsangst wird anhand einer Literaturübersicht dargestellt. Durch eine Krankengeschichte werden folgende theoretische Gesichtspunkte kasuistisch erläutert: A. Verschiebung von unten nach oben, B. Schwangerschafts- und Geburtsfurcht als unbewußte Kastrationsangst, C. Schwangerschaftsangst und ödipaler Kinderwunsch, D. Präödipale Angstbedingungen.

A synopsis of the theory of conversion is given and the psychoanalytic opinions on female sexuality and its development are discussed. A specific presentation of female castration fear is attempted on the background of the existing literature on that problem. As an illustration, a case history is given and the following points elaborated: A. Displacement upward; B. Conception and delivery fears as unconscious expressions of castration anxiety; C. Conception fear and oedipal wish for a child; D. Pre-oedipal sources for anxiety.

Es wurde einleitend das Beispiel einer klinischen Beobachtung aus der alltäglichen Praxis mitgeteilt. Hauptziel dieser Arbeit war es jedoch, dem Forscher Willi Hoffer Dank abzustatten und die heutigen Studierenden daran zu erinnern, wie eng Hoffers theoretische Ableitungen mit den Beobachtungen aus nächster Nähe, die er beschreibt, verknüpft sind.

I have given an introductory specimen of clinical observation arising out of today's practice. My main aim, however, is to pay tribute to the man Willi Hoffer and to remind students of his descriptions of close observations along with his theoretical deductions.