Beruflich Dokumente
Kultur Dokumente
HANDBOOK
OF PSYCHIATRY
VOLUME ONE
The Foundations of Psychiatry
e-Book 2015 International Psychotherapy Institute
ebooks@theipi.org
CONTRIBUTORS
PREFACE
PART I: History
Psychiatry From Ancient To Modern Times
The Personality
4
Infant Development
Cognitive Development
Adolescence
Adoption
Adjustment To Retirement
Old Age
A. Individual Psychology
B. Analytical Psychology
6
The Kleinian School
Social Work
8
CONTRIBUTORS
Ian Alger, M.D.
Individual Psychology.
Process.
10
School of Medicine, Washington, D.C.
and Letters.
Deceased.
Joseph L. Henderson
12
Assistant Clinical Professor of Neuro-Psychiatry, Stanford University Medical
School, California; President of the C. G. Jung Institute of San Francisco.
Missouri.
Worcester, Massachusetts.
Connecticut.
R. E. Money-Kyrle, Ph.D.
14
Clinical Professor of Psychiatry, Director of Psychiatric Residency Training,
and Director of Psychoanalytic Division, Department of Psychiatry, New York
Medical College, New York.
Missouri.
Paul Ricoeur
16
Professor and Chairman, Department of Psychiatry, Abraham Lincoln School,
University of Illinois, College of Medicine, Chicago, Illinois; Medical Director-
designate, American Psychiatric Association.
Cambridge, England.
York at Buffalo.
Late Fellow and Member of the Board of Directors, Association for the
18
Joseph B. Wheelwright, M.D.
Rockville, Maryland.
Philadelphia, Pennsylvania.
constantly enriched by these fields and many others, which all converge
toward a greater knowledge of man in health and mental illness.
When one looks at the first edition of this Handbook several thoughts
emerge: how much of its content has preserved its validity; how little is no
longer acceptable; but, most of all, how much is missing from it which we are
now in a position to include. And yet the initial two volumes of the first
edition appeared in 1959; the third in 1966. The time elapsed is short, but the
work done in the field in these intervening years is enormous. A new and
larger edition has thus become necessary. The success of the first edition, not
only in the United States but throughout the world, gave the inspiration and
provided the energy necessary for the preparation of this second edition.
When this new edition was planned it soon became evident that I could
no longer be the only editor, as I had been for the 1959-1966 edition. It is
increasingly difficult for one person to have the necessary competence in the
many areas of rapidly expanding psychiatry. The need for section editors
became a necessity. I am responsible for the planning, general organization,
20
and division of the work; but competent colleagues have joined me in editing
the various volumes. Only Volume One, “The Foundations of Psychiatry,” is
Reiser. Drs. Daniel X. Freedman and Jarl E. Dyrud have edited Volume Five,
dealing with “Treatment,” and Drs. David A. Hamburg and Keith Brodie have
recognized in the second. All orientations, all schools, all respectable methods
psychiatry the spirit of innovation and the state of flux of modern man. At the
toward consistency. Each author was requested to cover his special field; he
volumes differ from those of usual textbooks in being more complete, more
analytical, and more authoritative without reaching monographic
proportions. Except for Volume Six, no attempt was made to put emphasis on
The authors who were invited to participate in this project are in most
instances, the task of selecting the author was difficult because many people
had made important contributions in the same field. The search for
recognized authorities did not lead us to discriminate against young age.
whom we would have liked to have join us, could not participate because of
Repeating some of the words of the preface to the first edition, I wish to
say that this book is offered as representative of American psychiatry today.
22
no country other than the United States is there such willingness to listen to,
try out, and evaluate all theories, methodologies, and techniques, and to
absorb and find a place for all or many of them. We are also happy to have in
When the first edition was published, it was the first time that a work of
this kind appeared in the United States. It was also the first time that some of
the topics and issues appeared in a textbook of psychiatry published
anywhere. That this Handbook, within a short time, was imitated by other
editors in the United States and abroad was proof of its value and a source of
rejoicing for us. Perhaps this will happen again, as we hope that the
authors and do not necessarily represent those of the editors or the publisher.
On the other hand, the single contributors are not responsible for the general
editorial policies, with which, in a few instances, they may have disagreed.
As I have already mentioned, this first volume deals specifically with the
foundations of psychiatry. Foundations are of various kinds, and they will all
be represented in this book. They include the historical background, the very
basic notions from which the discipline emerges, the methodology with which
work.
people who, in various ways, have helped prepare this project. Their work
will unfold in these six volumes and will speak for itself. I shall mention only
that for many years the staff of Rasic Rooks has faithfully cooperated and
made it possible to transform into reality what was once only a hopeful
expectation.
SILVANO ARIETI
24
PART I
History
Introduction
present certain medical papers mention only the literature of the past five
years; the rest is almost as antiquated as Hippocrates. This being the case, one
may wonder about the interest of the history of psychiatry and inquire into its
meaning.
26
between an empirical body of knowledge and a scientific, experimental one?
Does psychiatry belong to medicine, or is it a science in its own right, or
perhaps no science at all? In order to solve such problems philosophical
cogitation is not enough: one needs a great deal of data, and these data can be
secured only through historical inquiry. However, this implies in turn that
a scientific methodology.
enough to say that there are wide gaps in our knowledge of Greco-Roman,
definitive, that any discovery can at any moment be displaced by a new one.
But we should not overlook another, complementary viewpoint: the progress
of today might also get lost through the regression of tomorrow. Science
implies not only a striving toward progress but also a constant effort to
maintain the permanent acquisitions of yesterday. These are two among the
fruitful lessons that a psychiatrist may learn from the history of science.
old, it is in a large measure the outcome of notions and procedures that are
perhaps as ancient as mankind itself. It would seem that from the beginning
among all populations of the earth a special attention was bestowed upon
possible ways. Many of them were treated in a downright inhuman, cruel way.
Some others were treated in a human but nonmedical way (for instance,
with the discarding of nonmedical ways of dealing with mental patients and
the perfecting of primitive healing procedures. The next step was the
temple healers) and also by lay healers. The third step was the foundation of a
rational medical art, severed from religion and superstition; this great
whatever its merits, the rational medicine of the Greeks and Romans still
28
foundation of a properly scientific medicine did not occur before the
seventeenth century, and that of psychiatry as a branch of medicine in its own
a matter will allow. It has been, indeed, a long way from nonmedical attitudes
killed shortly after their birth without further ado. Even among the culturally
enlightened Greeks such children were exposed in the wilderness. Among
certain Western and Central European rural populations there was a lasting
steal newborn children and replace them with their own ugly progeny.
Children believed to be changelings were often left without nourishment so
that they would die of hunger; this was no crime since these beings allegedly
Those senilely demented were often ruthlessly treated. Koty has shown
that among the populations of the earth certain peoples are kind and
considerate with old people and cripples; others harsh and cruel. But even in
the best case these individuals were likely to be sacrificed in the eventuality
of famine or other calamities.
the demoniac of Gadara described in the Gospel: he had been tied up several
times but had managed to break his chains and escape; he lived in tomb
vaults and frightened the surrounding population. When these psychotics
survive as vagrants and live off the charity of individuals and communities.
Accounts from the Renaissance period tell of “fools” roving from place to
place; in certain communities they were provided with some food or money
and gently led to the border; in other places they were driven away with a
whip; no doubt they paid a heavy toll in fatal illnesses or accidents. There are
also stories of “fools” being set in a little boat on the river, so that the stream
30
would drift them along to another place.
private home. Even after mental hospitals had been established, certain
catatonic woman had been confined by her respected and well-to-do family in
the plaything of children and adults, sometimes made the victims of practical
jokes or utilized for nefarious purposes. Philo tells the story of a lunatic who
lived in Alexandria in the first century A.D. and was the laughingstock of the
children. It happened that Herod Agrippa, king of the Jews and protected by
Emperor Caligula, visited Alexandria. A group of people of that city, out of
hatred for the Jews, staged an insulting mockery by bringing this “fool” into
the gymnasium, dressing him like a king, and greeting him with royal honors;
this was the onset of an anti-Jewish riot and pogrom. It would be easy to
been clear that the man suffered from delusions, the pharmacists of the town
prepared a poisonous beverage that the man drank together with his own
The worst fate was probably that incurred by the “furious,” the agitated
and aggressive psychotics. They usually were chained, sometimes with iron
fetters, or mercilessly beaten until they quieted down—that is, fell into
mattresses tightly bound with ropes, where they often died from choking.
He was imprisoned by his kindred and his feet put in the stocks. He asked for
a knife, and the servant who kept him did not dare to refuse his order.
Cleomenes then cut gashes in his flesh along his legs, thighs, hips, loins, and
his belly until he died. If this could happen to a king, one may imagine what
would be the condition of a commoner befallen with a similar condition.
they had been ordinary, nonpsychotic criminals. But the crime itself that
brought the man to trial was all too often the product of the patient’s
32
delusions, or of mass suggestion exerted upon him, if not of false accusations
and torture, as happened to thousands of unfortunate women during the
On the other hand, it could happen that the social response was
in many cultural settings. Certain mental patients were well cared for by the
community. Such was the kind attitude of the poor mountaineers in the high
condition that was endemic on these mountains until the middle of the
mental patients. In our own century did we not see the inmates of mental
Primitive Healing
Numerous skulls from the neolithic era show the marks of trepanning that
had been performed on living individuals and followed with cicatrization.
Since even in recent times the same operation was performed by medicine
few pictures of prehistoric art point to the existence of magic and wizards.
Such is the well-known picture of a sorcerer, his head adorned with deer’s
representation of a healer.
conducted, and of those that survived many retained only distorted remnants
of their former medical lore. However, the systematic study of primitive
34
distinguished several kinds of disease, of treatment, and of healer. Certain
conditions, obviously the effect of accidents, parasites, or poisons, suggested
this was demonological medicine. Natural medicine was the realm of the “lay
only healer but often a dreaded wizard and one of the leaders of his tribe,
along with the priest and the chief. He is a “man of high degree” (as Elkin
termed the Australian medicine man), and he has undergone a long and
difficult training that often includes the experience of an initiatory illness. His
personality is the principal agent of the cure, provided that the patient, the
healer himself, and the community are all convinced of his healing power.
recovery by the shaman, the intrusion of a supposed disease object and its
extraction, the intrusion of an evil spirit and its expulsion (mainly in the form
of exorcism), the breach of a taboo and its propitiation, the pathogenic effect
of magic and its cure through countermagic. These procedures are of great
dynamic therapies.
medicine man is the ancestor of the priest, who was the physician’s
antagonist for centuries. Thus, the discontinuous line of evolution led from
Around 4,000 B.C. the first kingdoms and empires were founded in Asia
and in Egypt. This implied the advent of a new type of social organization
36
with a large administrative system and of religions with colleges of priests
and elaborate rituals. The medicine man gave way to the priest, whereas the
lay healer became the physician, although the separation was not always very
sharp. For many centuries the healing priest and the physician lived side by
side, the physician more concerned with natural therapy (massage, dietetics,
hot baths, nonmagical drugs), and the priest with psychological healing.
The healing powers of the priest were enhanced by the fact that, in
and chief of ritual. Special honors were conferred upon him after his death;
later he was worshiped as a demigod; around 600 B.C. he had reached the
status of a god of medicine. Numerous wonderful cures were reported to
occur at his shrines, and it seems that a medical teaching was provided in his
great temple at Memphis. Until about 500 A.D. he remained one of the most
centuries later he was a god and numerous patients flocked to his shrines, the
highlight was the incubation, that is, the night of sleep in the sanctuary, either
on the ground or on a couch called the kline. Then the patient might
experience an epiphania (apparition of the god), or receive an oracle, or have
a therapeutic dream, that is, a specific kind of dream that would in itself bring
the cure. The cult of Aesculapius did not recede before the advent of rational
medicine. As time went on, the number of his shrines increased throughout
the Hellenistic and the Roman world, and for some time Aesculapius was a
great rival of Christ. After the triumph of the Church, patients sought healing
at the new Christian shrines. It is significant that in 1893 the skeptical Charcot
wrote a paper On Faith Healing, declaring that he had seen patients cured at
Lourdes after medical treatment had failed, so that the existence of powerful,
unknown healing agents must be assumed.
idea of sin; this was particularly marked in the Egyptian and Assyro-
Babylonian worlds. Healing could be obtained through confession,
38
propitiation, that is, reconciliation with the gods, and acceptance of the
cosmic order. Concepts of the nature of man, as taught by the priests, also
Man with His Soul, an Egyptian writing of about 2,000 B.C. that might be
considered the oldest known document on the psychology of suicide.
A decisive step in the history of medicine was taken with the rise of
in its terminology.
for about 25 centuries. In the same way as Greek priestly medicine was
dominated by the mythical figure of Aesculapius, Greek rational prescientific
All we know of Hippocrates (about 460 to 377 B.C.) is that he was one
dialect, and content. As Werner Jaeger says, “The result of one century of
research is that there is not one page in the Hippocratic collection which we
Singer’s words, “an idealized representation of what the Greek would wish his
physician to be.” Whereas the god Aesculapius stood high above mankind,
Hippocrates remained the more accessible figure of the “physician-
His figure, gaining in dignity what it loses in clearness, stands for all time
as the ideal physician. . . . Calm and effective, human and observant,
prompt and cautious, at once learned and willing to learn, eager alike to
get and give knowledge, unmoved save by the fear lest his knowledge may
fail to benefit others . . . incorruptible and pure in mind and body. ... In all
ages he has been held by medical men in a reverence comparable only to
that which has been felt towards the founders of the great religions by
their followers.
medical treatises, now lost, had been written. To quote Neuburger: “We stand
as in a devastated town, where only one building is extant, and we see only
the rough outline of the streets.” Among these schools the Cnidian strove to
diagnose diseases and localize their seats, whereas the school of Cos was
40
more concerned with the prognosis, with the organism as a whole within the
environmental setting, and with the concept of the “healing power of Nature.”
Throughout the whole Greek and Roman literature, mental disorders are
disorders with fever), mania (mental disorders with agitation without fever),
(in Greek, hystera, hence the adjective “hysterical” which meant “uterine” and
culture.
a rational medicine. However, we are still very far from the principles of
scientific medicine. Hippocratic thinking belongs to the pre-scientific level of
medicine. Robert Joly has shown conclusively how even the best treatises of
the Hippocratic collection are pervaded with “substantialism,” “numerology,”
four humors, the pneuma, the faculties of the soul, and organic localization.
These principles had to be correlated to each other and with the clinical
qualities. The two main polarities finally chosen were those of dry-moist and
warm-cold. Philosophers had also argued endlessly about the physical
as the fundamental elements water, air, fire, and earth. Similarly physicians
decided there were four humors of the human body: phlegm, blood, bile, and
“black bile.” Like the four elements, the four humors were correlated to the
imbalance from the excess of one of the humors. Thus, melancholy was
humors.
42
Meanwhile, primitive medicine’s concept of breath (or pneuma) as a
principle of life had found its way into philosophical medicine. Stoic
kinds of pneuma, physical, vital, and psychic, and interpreted certain diseases
main “souls” of the human psyche: vegetative soul (common to plants, animal,
and man), animal soul (common to animals and man), and rational soul
faculties). The use of this framework led to associating mental states with
over the animal soul by the rational soul. Certain mental conditions were
supposed to result from a deficiency of the rational soul (anoia).
Greek philosophers and physicians argued about the seat of the soul and
of its faculties. The ancients had thought that the diaphragm (phrenes) was
the seat of the soul, hence the word “phrenitis” for acute fever delirium (this
effort to integrate these various conflicting concepts and clinical pictures into
a coherent system.
Greek medicine gave to the world the ideal figure of the Father of Medicine,
In the Greek and Roman worlds there was no such thing as “psychiatry”
44
as we know it today, but only a few scattered elements of that which was to
become this science much later.
ours. The modern scientist starts with observation and quantification, draws
drew deductions that they extended with the help of analogies. Conflicting
and adopted by all scientists. Instead, there were a number of schools based
on particular philosophical systems, each one professing its own dogmatic
Hippocratic writings. Then in the fifth century B.C. Athens became the center
pupil Menon, of which fragments have survived. Diodes of Carystos, who was
associated with that school, was considered one of the greatest Greek
physicians; unfortunately his works are lost. However, his description of
that with these two physicians Greek medicine reached its highest scientific
level, even though their theories were not free from speculation. Undoubtedly
46
their works, had they survived, would hold great interest for the history of
neurology and psychiatry.
was represented mostly by Heraclid of Tarent. They were good clinicians who
strove to define diseases according to their seats and described them a capite
ad ealeem, that is, going from scalp and hair down to the heels and adding a
chapter for general diseases. Mental diseases were classified among the
diseases of the head, following those of the scalp and the skull. This type of
fashionable Greek physician and prolific writer who practiced in Rome. His
works have been lost. He seems to have been much interested in mental
treatment of mental diseases along the same lines as Asclepiades. Most of his
writings have perished, but something of his work is known thanks to a Latin
adaptation by Caelius Aurelianus.
flourished around 100 A.D. Aretaeus gave clear descriptions of the traditional
disease entities, phrenitis, mania, and melancholia, and mentioned that mania
and melancholia could turn into each other. This simply meant that a chronic
psychosis could begin or be interspersed with acute episodes.
Varro have perished, but we have the medical part of A. Cornelius Celsus’
suddenly pouring cold water over his head; however, rocking the patient in a
suspended bed was used in other eases.
The eclectic trend was personified by Claudius Galen (ca. 138-201 A.D.),
credited with writing about 400 treatises, of which about 80 are extant.
Because the works of the most prominent physicians before and after him
48
of the qualities, the humors, the pneuma, the “powers” of the soul, and the
localizations. Galen laid great emphasis on the doctrine of the four basic
humors, which had been much developed since the Hippocratic writers.
Disease resulted from the excess of one humor and the resulting dyscrasia
(imbalance), or from mixtures and alterations of the various humors, or from
the stomach or other organs to the brain. Galen’s humoral doctrine covers
diseases caused by the action of the two kinds of black bile. The Galenic
doctrine extended to the theory of drugs and their therapeutic indications.
forms of this condition: (1) general melancholia (from an excess of black bile
in the whole body), (2) brain melancholia (from an excess of black bile in the
brain), and (3) hypochondriac melancholia (from the ascension to the brain of
vicious vapors from the stomach). The author refers also to constitutional
melancholia, melancholia from a one-sided diet, from the “adustion” of yellow
of melancholia, one of them being lycanthropia, that is, the delusion of being
transformed into a wolf. This treatise standardized for the following fifteen or
Melancholy in 1621.
decline after Galen. This might partly be an illusion resulting from the fact
that the works of the most original minds of the following few centuries have
been lost. Posidonius (second half of the fourth century A.D.) seems to have
been eminent in the fields of neurological and mental diseases. But the Roman
Empire was crumbling under its inner weakness and the repeated assaults of
the barbarians, and medical progress was hampered. Thus, Galen was
resorted to as the infallible oracle who had said the final word about
medicine.
One may wonder to what extent the patients actually benefited from the
According to George Rosen, the family and friends of the Greek and Roman
customs, and the condition of the insane poor was extremely miserable.
50
There were apparently a few privileged forms of mental disorders. Plato
feigned madness of men such as Meton, Solon, and Brutus: it would seem that
Throughout the ancient world there were a few practices that could
Stoics learned the control of the emotions and practiced written and verbal
exercises in meditation. The Epicureans resorted to an intensive
unceasing effort to control one’s passions with the help of a wise mentor who
would point out one’s defects and dispense advice, then the gradual reduction
of one’s standard of living, attaining serenity and freedom from affects, until
one was able and ready to help others in a similar way.
word” among the ancient Greeks. There was a cathartic, a dialectic, and a
rhetorical use of the spoken word. One particular practice was the
have become literary classics, such as Plutarch’s Consolation to his wife for
the death of their child, or his Consolation to his friend Apollonius for the
death of his son. This kind of supportive psychotherapeutic intervention was
The Romans are credited with founding public hygiene. They devised
public medicine took place: there were town physicians paid by city
authorities and a rudiment of medical teaching. But their only hospitals were
slaves. Their moral callousness, their predatory economy, the use of vast
masses of miserable slaves, the cruel games of the circus, all these were the
care of the sick as a religious duty. Charity institutions and hospitals gradually
much of the philosophical and legal thinking, and the practice of religious
52
confession stimulated the development of introspection: this is well
illustrated by Saint Augustine’s Confession.
After the ruin of the ancient world, Greco-Roman culture split into three
parts: the Byzantine Empire, the Arabia, and Western Europe, each with its
vernacular language: Greek, Arabic, and Latin. Each developed its own
civilization and medical tradition, but they were bound by certain mutual
influences.
Although the barbarians had destroyed the Western Roman Empire, the
Eastern Roman (or Byzantine) Empire survived for ten centuries, and its
capital, Constantinople, became the cultural center of the world. In the sixth
founded, such as orphanages, homes for the aged, and hospitals, among which
were a few morotrophia for the mentally sick. Unfortunately we do not know
between the sixth and the fifteenth century. What could be the way of life of
charity of good people, being an object of ridicule, but enjoying the privilege
of telling the truth to anybody. The Greek medical tradition was prolonged by
analyzing role playing in the theater and in life and giving a psychology of
civilization in Asia Minor, Syria, and Egypt. Then, after the Arabs had
influence of the conquered countries, and by the late eighth century and
during the ninth century a brilliant Islamic civilization flourished in Baghdad,
Byzantines. But here, too, it is difficult to appraise the real originality of that
period. Out of a thousand books written by Arabian physicians, very few have
survived; among these few most either remained in manuscript or were not
Among the most outstanding names one should mention Rhazes (864-
925), a Persian distinguished in all fields of medicine. Among his many
54
treatises is one translated into English under the title, The Spiritual Physick of
Rhazes: a classification of psychopathological disorders is given, according to
the failure or excess in each one of the three “souls” (vegetative, animal, and
and physician, whose Canon of Medicine was used as a medical textbook for
centuries in the Islamic as well as in the Western European world. The Canon
are described in the traditional order “from head to heels,” mental diseases
being included in the chapter on head diseases. Arabian literature, like the
Byzantine, contains nonmedical works that are of interest for the psychiatrist,
for instance, books by the mystics, the moralists, the philosophers, books on
silk cushions, were nourished with the finest food, were treated with a
from the beauties of the town; their chains were gilded with gold and silver.
In sharp contrast with such a description, we read in a poem of Djelal-Eddin
(thirteenth century): “In the corner of a dungeon sat a raving insane; his neck
tied with a rope.” The French traveler Chardin, who visited Persia in the
seventeenth century, describes the moristan of Ispahan as a kind of cloister
around a garden; there were about 80 cubicles, but only seven or eight
lunatics, all of them in the most miserable condition, lying on straw, fettered
by arms, body, and neck. The staff consisted of one doctor, one pharmacist,
one molla (priest), one cook, one doorman, and one cleaner. Not much better
is the account given by Edward Lane of the moristan in Cairo in the middle of
the nineteenth century: there were two courts, one for male and one for
female patients. Around the first court were 17 very small cells with grated
windows. The patients were chained by the neck to a wall, had only straw to
sleep upon, and wore scarcely any clothing. It was customary for each visitor
to give them pieces of bread, so that as soon as they saw a stranger enter, they
made a great clamor. Obviously the Cairo moristan had declined since the
thirteenth century. Actually we know very little about the history and the
After the ruin of the ancient world, medicine in Western Europe was in a
56
precarious state. There was a long period of destruction and decline. The
meant had disappeared, the writings of ancient authors were lost, medical
to be placed above and before every other duty.” There were infirmaries in
inquiries. Not until our time, however, were they incorporated, as a section of
“pastoral psychology,” in the general body of psychiatry. On the other hand,
demonological concepts were taken for granted by the Church and accepted
also took place at the shrines of certain saints; patients could sometimes
remain there for a prolonged time; this was the origin of the psychiatric
thirteenth century.
schools. The thread with ancient Greco-Roman medicine was found again.
After the recovery of Galen’s works, his system became in its whole
complexity and artificiality the official doctrine of Western European
medicine.
Another great event took place in the thirteenth century. As in the first
centuries of Christianity, the cure of the sick was placed in the foreground of
Christian duties, and many hospitals were created. There are reports on
1367, and the plan of the older Spanish asylums copied the plan of the
Arabian moristans. The first one was opened in Valencia in 1407 under the
1481, and Toledo in 1483. Spanish historians, notably Juan Delgado Roig,
58
Psychiatry in the Renaissance Period
who dissected human bodies were unable to see anything except what Galen
and the Arabs had taught; the ability to perceive the anatomy of the brain as it
is, and not as one believes that it should be, appeared in the early 1500s
Italy, France, Belgium, and Holland. The death blow to Galenic anatomy was
given by Vesalius in 1543. The same transformation occurred in botany,
(which had been abolished since the fall of the Roman Empire) was
genocide took place in the Caribbeans and Central America, when judicial
torture was reinforced under the impact of resurgent Roman law, and when
illiterate, and the “fool.” But there was much interest in mental illness and in
Medical authors of the Renaissance are much better known than those
concept of moral insanity). One should also mention Jean Fernel in France,
literate world, and this may explain the great popularity of Robert Burton’s
60
character.
Sigerist says that “perhaps no one but a German can really understand him.”
country”; “Do not hold the effect of curses as nonsense, ye physicians, ye have
no inkling of the power and might of the will”; “The child needs no star or
planet: his mother is his planet and his star.” On the positive side are
Paracelsus’ teaching of a new pharmacology based on the use of mineral
effects of suggestion, his belief in the efficacy of healing springs, his interest in
minded persons (“Fools are our brethren; like us they were saved by Christ”).
Karl Sudhoff who published his extant works. But Paracelsus had already
become a legendary figure and was made the hero of novels and theatricals.
The (true or fictitious) story of his spectacular burning of Galen’s works on
the public place in Basel in 1527 acquired a symbolic value and was
paralleled with Luther’s burning of the papal bull on the public place in
Wittenberg. It is ironic that Basel, where Paracelsus had failed, was the home
of another medical reformer, Felix Platter (1536-1614), who carried out some
Platter’s life is better known than most physicians’ because he left his
his collections, and all of his writings. He studied medicine in Montpellier and
lived the rest of his life in Basel. He became a brilliant practitioner who was
his medical works Platter described diseases exclusively as he had seen them
in his practice, never quoting any author, never concealing his ignorance or
62
his doubts, and giving case histories of his own patients as illustrations. This
might seem a matter of course today, but at that time physicians used to
follow the descriptions of the old masters, with case histories borrowed from
the classics. As Paracelsus had done before him, Platter gave up the old
classification of diseases “from head to heels” and introduced a new principle.
natural science.
was a period of great suffering for the mentally ill. According to Walsh the
hospitals were much better and the insane more humanely treated in the
thirteenth century than later. Kirchhof writes that in the Middle Ages great
authorities.
The evil culminated with the witch psychosis of the sixteenth and
Inquisitors conducting witch trials, gives a sinister picture of the delusion; its
but a great many were normal individuals who accused themselves under the
Catholic alike. Among the few who dared openly to defend the incriminated
were victims of the demon rather than his allies. His book contains many
Those asylums for the humane treatment of the insane that had been
founded in Spain in the fifteenth century were isolated institutions, supported
suffered an acute psychotic episode and was treated in the local hospital with
merciless flogging. After his recovery he founded a hospital where patients
64
were treated humanely; he operated it with the help of a few volunteers. His
organization grew; after the founder’s death it was declared the Order of the
Hospitalers, and Juan Ciudad was canonized as Saint John of God. This Order
created and operated general and mental hospitals. All institutions of the
Order worked according to the same rules and were run by men trained at
the same place, so that experience could be collected and transmitted. These
institutions spread over Spain, Italy, France, and other countries. Later they
served as models to Philippe Pinel and Jean-Etienne Dominique Esquirol
when they devised modern mental hospitals. It is not surprising that the first
Cervantes’ Don Quixote. (Until then mental disease had often been described
in poetry, novels, or on the stage, but not the mental hospital.) In one episode
of the novel an inmate of the Seville asylum protests to the archbishop that he
is unduly retained, whereupon the archbishop sends his chaplain to examine
the patient. In Avellaneda’s continuation of the first part, Don Quixote is the
victim of numerous cruel practical jokes and is treacherously committed in
the Toledo asylum; the reader is left to suppose that he will stay there for the
rest of his life. This probably brought Cervantes to write the second part of
the novel: the hero recovers his sound mind on his death bed; far from being
just the victim of ridiculous delusions, Don Quixote now appears as a
took a long time until it extended to psychiatry. During the Renaissance man
had learned to perceive reality as it is and not as it should be; now man
attempted to fathom the depths of nature and elicit her laws. This implied the
the seventeenth and the eighteenth centuries. Among its theoreticians were
Francis Bacon and Descartes; among its pioneers Copernicus, Kepler, Galileo,
Newton, and Vesalius and Harvey in medicine. But new systems arose,
66
were correlated with disturbances of the nervous system; what was formerly
attributed to “black bile” began to be labeled as nervous ailments.
into psychiatry.
Among the new trends was that of the systematists. Sydenham had
emphasized that infectious diseases are specific entities: they exist in their
own right independently of the sick individuals they affect. Efforts were made
to work out an allover classification of diseases in natural species, genera, and
classes. The first attempt was probably that of Frangois Boissier de Sauvages
gathered from every possible source, even from travelers, so that the Malayan
“running amok” was incorporated into a European textbook. Boissier’s work
was far from being a tedious catalogue of diseases; there were lucid
introductions to the whole book and to each part; it was written in a clear and
flowing style and filled with interesting facts. No wonder it inspired a long
series of successors, among them the Swedish naturalist Carl Linnaeus, the
English physician William Cullen (who coined the term “neurosis”), and
more attentively for new diseases and facts and organizing material in a more
accurate and comprehensive way. It sufficed to replace the terms “classes,”
68
other men do. If he cannot take care of his property he is put under tutelage; if
its meaning of being assaulted by evil spirits and took on its present meaning.
La Mettrie, in his book, L’Homme machine (1748), contended that certain hard
individuals.
The concept of the unconscious (if not the term) appeared with
place Descartes told of his propensity for falling in love with cockeyed women
and how, thinking about it, he remembered that as a child he had been in love
with a young girl who had that defect; after he had understood the connection
his predilection disappeared. However, it did not occur to him nor to anybody
admonishments. There also were various other attempts. Diderot relates how
the wife of one of his friends was afflicted with the vapors (the fashionable
neurosis of eighteenth-century ladies). He advised the husband to simulate
the symptoms of his wife’s illness. The husband did so, and the wife, who was
very much in love with him, took so much care of him that she forgot her own
ailments and recovered.
priests. For a long time the only objective classifications and descriptions of
one of the first to use electricity as a therapeutic agent and had a profound
understanding of many emotional problems. The Quakers included the insane
70
mental institutions in Europe increased. They derived from two opposite
models: the prison and the monastery. Institutions of the incarcerative type
have been the subject of many descriptions. Who has not heard of the horrible
of the Age of Reason, that is, a reaction against “unreason”: since the sight of
the “fools” had become intolerable, they were hidden from the rest of
The other type of mental institutions derived from the monastery. Saint
about one of the institutions of the Order of the Hospitalers of Saint John of
God, the Charite of Senlis, not far from Paris. The archives of that institution
were preserved and utilized as the basis for an excellent monograph by Dr.
Helene Bonnafous-Serieux. The inmates were classified into four groups: the
their behavior the inmates were placed in one of three sections: the force
laid on the religious character of the institution, and inmates were invited to
join the morning prayers and Mass. Every new inmate was given a
pseudonym under which he was henceforth known; he had to wear a uniform
that was more religious than prisonlike in character. The “director of the
inmates” had a personal interview with each one of the inmates every day.
There was a library, but no work therapy. There was no question of chains,
whips, or cages and no demonology. Patients benefited from the medications
known at that time and from a kind of rational psychotherapy. The registers
show that many patients recovered, and it was reported that certain libertins
We thus see that by the end of the eighteenth century there existed a
small number of monastic institutions for a minority of privileged patients
and a concern for the disadvantaged and rejected members of the great
the state of the prisons all over Europe. Institutions were opened and
72
methods devised for the education of the blind, the deaf-mute, later of the
his life are covered with legend. For many years Pinel lived in Paris as a
medical journalist and translator with a small medical practice, working upon
The administration was in the hands of the “Governor” Pussin, an able man
who was much concerned with the welfare of the patients and had already
achieved several improvements. Pinel benefited from Pussin’s experience and
collaboration and gave his medical authority to the reforms. In 1795 Pinel
expounding a clear and humane system for the care of mental patients.
minded man with speech difficulties, but kind and good-humored. In later
years a number of young physicians became his enthusiastic pupils. Pinel
acquired the prestige of a hero: he had achieved his humane reforms in the
notorious Bicetre (also a prison and house of arrest for vagabonds) during the
legendary figure, and after his death he became the patron saint of several
With the nineteenth century began a new era of psychiatry. Within the
Attempts were made to give psychiatry a firm basis, either in brain anatomy
74
classification of mental diseases, and the devising of a “moral
therapy,” together with the study of brain anatomy.
The main feature of the period of asylum psychiatry was the appearance
of a new type of physician who devoted his whole time and activity to the
mentally sick. These men sought to found, operate, and reform “asylums”
satisfying the demands of science and humanity and open to all categories of
asylum statistics for the study of the causes, course, and prognosis of mental
disease. He proclaimed that “an insane asylum is a therapeutic instrument in
the hands of an able physician, and our most powerful weapon against mental
exerted by the patients upon each other and grouping them accordingly. He
wrote the first really scientific textbook on mental diseases, which was also
the first to have illustrations, a book remarkable for its style and clear clinical
Charite of the St. John of God Hospitalers. He visited every place where mental
specific mental disease with constant cerebral lesions. This encouraged the
alienists eagerly to study cerebral pathology with the hope of discovering
76
new specific entities. Their efforts, however, brought fewer rewards than did
they must constitute one identical condition. This discovery was published
delusions of persecution.
hashish (1845), showing that this drug produced a state of delusions and
hallucinations that—he believed —was for a few hours identical with the
manifestations of insanity and afforded an experimental approach to its
study. On this basis he came to consider the dream as the key to the
casts of their heads, investigated their lives and the lives of their parents and
ancestors. This was the basis for his theory of degeneracy. Degeneracy, Morel
said, was a gradual process; its manifestations became worse from one
automatically ended the process. But Morel also discussed the ways of
Morel also introduced the psychiatric use of etherization, that is, studying a
background, had undergone its own evolution. It seems that the German
asylum tradition issued more from the prison than the monastery, and this is,
French alienists based their nosology on the empirical study of clinical cases,
their German colleagues often tried to isolate abstract types deduced from a
78
psychological origin and treatment of mental illness).
Among the Physiker were Johannes Friedreich, also known as one of the
first historians of psychiatry, and Maximilian Jacobi, author of a treatise on
The Psychiker took over from Stahl the notion of the role of emotions in
the etiology of mental illness. Each one of them developed his own views
about the human mind and the nature of mental illness with great originality
role of “sin” (in modern language, guilt feelings) in psychopathology; he, too,
the relationship between anxiety and frustrated drives, and he described the
masked manifestations of sexuality among psychotic patients. All these men
Ludwig Kahlbaum (1828-1899), who spent his career in remote asylums and
whose publications were ignored for a long time. His main contribution to
psychiatry was his descriptions of hebephrenia and catatonia (the former
delegated to his collaborator, Ewald Hecker, in 1871; the latter in his own
dementia praecox.
In Belgium Joseph Guislain taught that almost all mental diseases had
emotional causes and were rooted in an all-pervading, underlying feeling of
In England William Tuke’s pioneer work in the “Retreat” near York was
pursued by descendants and their collaborators. One of the latter, M. Allen,
founded his own institution at High Beach and wrote a highly instructive
account of his therapeutic methods. To give only one instance: patients with
80
violent agitation, accompanied by an attendant, were sometimes allowed to
ramble about and scream in a forest for a whole day, with a subsequent
Physiology and Pathology of the Mind (1867) with a chapter about the
would take into account the “plan of development” of the mind (in the animal,
the infant), the study of its “degeneration” (in the dream, delirium, insanity),
and of its “progress and regress” throughout history.
is often found between the theoretical views of the alienists and the real state
of their mental hospitals, as pictured by visitors. The term “moral treatment”
used to treat delusional patients with icy cold showers until they came to
recognize their “errors”; he called that method “moral treatment.”
around the use of “magnetic sleep,” later called hypnosis. Mesmer, Puysegur,
was to achieve important creative work in a mental asylum. For that reason
clinic, a threefold institution for treatment, teaching, and research. For some
reason German psychiatry outdistanced France around i860 (with the
exception of the field of neuroses), but as time went on, psychiatry became
more international.
worked with a team of collaborators and pupils and was provided with well-
82
German university psychiatry. Possessing an eclectic mind, he introduced
Herbart’s psychological concepts into psychiatry, but his contention that
“mental diseases are brain diseases” was taken as a slogan by the adherents
associative organ and the soul as being “the sum of all possible associations.”
Only the most elementary mental functions are localized in the cortex, he
said; the higher ones, including consciousness, are products of the associative
activity. Unfortunately these men and many of their colleagues fell into “brain
mythology,” the tendency to explain all mental phenomena in terms of real or
sixth edition of his textbook (1899) he defined the two great endogenous
anatomy but shifted toward a dynamic concept of the mind. Among his pupils
were Eugen Bleuler and Adolf Meyer. Eugen Bleuler (1857-1930) sought a
degeneracy so widely that this diagnosis covered almost the whole realm of
psychiatry. His fame, however, was the result of his clinical studies on
alcoholism. But the main French contribution to psychiatry was the work of a
Bemheim (1840-1919). These two men gave the official stamp of approval to
the use of hypnosis, thus making it a respectable procedure, though their
84
theoretical concepts and therapeutic use of the phenomenon differed widely.
A large part of the teaching of the old magnetists and hypnotists was
symptoms resulting from the loss of a higher function and positive ones
neurasthenia by means of rest, isolation, feeding, and massage. After the turn
of the century the main American contribution to psychiatry came from Adolf
become sciences in their own right. Thus, the field of sexual pathology had
of biological medicine, but when sociologists and lawyers joined his group the
attempts, however, were short-lived. The first man who undertook to build a
new dynamic psychiatry was Pierre Janet (1859-1947). Janet was able to
every phenomenon of the mind. But whereas Janet had kept closely within the
bounds of traditional psychiatry, Freud and the founders of the newer
86
dynamic schools openly broke with official medicine.
organization of a new type that had no parallel in modern times, that is, a
close, tightly structured organization with its official doctrine and rules for
cultural life. Some of its adherents had the feeling that the history of
psychiatry was now divided in two periods: before and after Freud.
psychiatry. Among Freud’s disciples were orthodox and deviant groups. Both
Alfred Adler (1870-1937) and Carl Gustav Jung (1875-1961) developed a
the individual’s striving for superiority versus his community feeling. Jung’s
of psychiatry. This was a manifestation of a new trend that could be called the
“psychiatric explosion.”
From that time on, the field of psychiatry continually expanded. Former
branches became autonomous disciplines (for instance, child psychiatry,
88
sexual psychopathology, clinical criminology), and new branches were
founded. Among the latter were genetics (Rüdin, Luxemburger), biotypology
community psychiatry.
(Egas Moniz), and last but not least, the pharmacotherapy of mental diseases
various methods of behavior therapy. Not less numerous are the varieties of
group therapy, therapeutic communities, and psychodrama.
Meantime, the traditional principles that had ruled psychiatry for a long
time were shaken. Henri Ey had warned that the boundless expansion of
proclaim that mental illness does not exist; what is called by that name is
nothing but the artificial product of social repression; psychiatric treatment is
mental hospital can never cure a patient but only make his condition worse;
“antipsychiatry.”
and reminds one of what Bachelard once wrote: “All scientific knowledge
must be, at every moment, reconstructed. ... In the work of science only, one
can love that which one destroys; one can continue the past while denying it;
90
Bibliography
Ackerknecht, E., “Problems of Primitive Medicine,” Bull. Hist. Med., 11:503-521, 1942.
_____, A Short History of Psychiatry, rev. ed., Hefner, New York, 1968.
Alexander, F., and Selesnick, S., The History of Psychiatry, Harper & Row, New York, 1966.
Campbell, D., Arabian Medicine and Its Influence in the Middle Ages, 2 vols., Kegan Paul, London,
1926.
Delgado Roig, J., Fundaciones psiquiatricas en Sevilla y Nuevo Mundo, Editorial Paz Montalvo,
Madrid, 1948.
De Morsier, G., Essai sur la genese de la civilisation scicntifiquc aetuelle, Georg, Geneve, 1965.
Ellenbercer, H., The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry,
Basic Books, New York, 1970.
Harms, E., Origins of Modern Psychiatry, Charles C Thomas, Springfield, Ill., 1967.
Hunter, B., and Macalpine, I., Three Hundred Years of Psychiatry, Oxford University Press, New
York, 1963.
Jackson, S. W., “Galen—On Mental Disorders,” J. Hist. Behav. Sci., 5 365-384, 1969.
Joly, B., Le niveau de la science hippocratique, Les Belles Lettres, Paris, 1966.
Karcher, J., Felix Platter, Lebensbild des Basler Stacltarztes, Helbling & Lichtenhahn, Basel, 1949.
Laignel-Lavastine, M. and Vinchon, J. Les maladies de l’esprit et leurs mediccins du XVIe au XIXe
siècle, Maloine, Paris, 1930.
Lechler, W. H., Neue Ergebnisse in der Forschung uber Philippe Pinel, Diss med., Munich, 1960.
Leibrand, W. Heikunde, Eine Problem-geschichte der Medizin. K.A. Freiburg, Munich 1953.
_____, and Wettley, A., Der Wahnsinn Geschichte der abendlandischen Psychopathologie, Alber,
Frieburg, 1961.
Lesky, E., Die Wiener medizinische Schule im 19. Jahrhundert, Graz, Bohlau, 1965.
Neuburger, M. Handbuch der Geschichte der Medizin, 3 vols., Fischer, Jena, 1902–1905.
Semelaigne, R., Les Pionniers dc la psychiatrie frangaise, 2 vols., Bailliere, Paris, 1930-1932.
_____, A History of Medicine, 2 vols., Oxford University Press, New York, 1951, 1956.
92
Singer, C., A Short History of Medicine, Clarendon Press, Oxford, 1928.
Sudhoff, K., Essays in the History of Medicine, Medical Life Press, New York, 1926.
areas are not sharply outlined, and, moreover, most of its particular concepts
and aims are exceedingly difficult to trace accurately in terms of their
chronological appearance.
considerable extent by the current cultural conditions of its locality and time.
94
span of time indicated by the title of this chapter, one must resort to a
condensed style of communication. The topic includes more than a hundred
years, during the early parts of which are revealed only a few records of basic
later years.
Since the aim in this chapter is to indicate some of the most important
can find pioneers, men whose energy and curiosity were so great as to lead
them to devote their lives to the promotion and extension of knowledge
beyond the existing outposts of what was accepted and practiced. Benjamin
American psychiatry. Although at this time Rush was only 38 years old, he
was already a very famous physician. He had been a precocious student,
having graduated from the New Jersey College (now Princeton) at the age of
who was one of the most famous professors of medicine of his time, with an
importance, and the causes of mental disorders were within the individual,
that is, endogenous. Insanity was a pathological condition of the mind and not
some force entering from without, and, therefore, its expressions should be
interpreted in the light of normal psychological functions. His First Lines of the
influence on Rush’s subsequent career, which was thus oriented in the theory
and therapy then prevalent in Scotland and England.
Dr. Rush, equipped with a keen mind and the best training available at
the time, attacked the problems of mental disorder, a subject that was
infiltrated with superstition and ignorance as well as characterized by neglect
96
psychiatry in America. This book, published in 1812 under the title Medical
Inquiries and Observations upon Diseases of the Mind, remained the only
American book of its kind for 70 years.1
“to obviate these evils of the ‘strait waistcoat’ and at the same time to obtain
all the benefit of coercion.” These instruments, which were certainly rough on
the patient, were decidedly “shock” measures—a form of shock therapy, and,
like all shock therapies including the modem ones, were interpreted as
effecting cures.
Benjamin Rush was one of the earliest, if not the first, to recommend
medical historians, he did for America what Pinel and Esquirol did for France.
His biographers are in accord that he, like many originators and creators, was
anyone who did not agree with his theories and practices, and at times
Had Benjamin Rush had a successor akin to his own spirit American
psychiatry may have had the lead over the European and its actually
colonial development. It took a hundred years before the step towards a
culture for responsible life began to assert itself. ... I do not know what the
names and teachings of the immediate successors were. . . . Psychiatry may
see the influence of the 1840’s in J. P. Gray.28
other countries than it has here in America, but there were some important
significance. For example, the old San Hipolito, established in Mexico in 1566
by the philanthropist Bernardo Alvares, was the first hospital in the Americas
for the study and care of mental disorders and, of course, one of the earliest
for this purpose in the whole world. At first this institution was not devoted
the increase in the number of these cases made it necessary to restrict the
98
It was nearly 200 years before the first institution to care for the
followed by a few other public and private institutions. In 1773 the first
Williamsburg, Virginia, then the capital of the colony. For half a century
and at the end of another 50 years a separate building was constructed for
them. The Blooming- dale Asylum was another of the early institutions for the
mentally disordered. It was opened in the New York City area in 1821 as a
separately managed hospital, although it had its beginnings in the earlier
founding of the New York Hospital. It continues today in White Plains, New
the country. From 1893 to 1921 it was known as the American Medico-
In their day the “original thirteen” made a lot of psychiatric history, both
America and in Europe, and a prolific writer. He was one of the most eminent
State Hospital for the Insane at Augusta, Maine, and later of the famous Butler
100
1863 and was interested particularly in the relationship between legislation
and mental disease. As a matter of fact, the first book in the English language
concerning forensic psychiatry was published by Ray in 1838; this book made
medicolegal matters. The title of this book was Treatise on the Medical
Jurisprudence of Insanity. It was used as an authoritative text for court work
whose influence for the better understanding and care of the mentally sick
was widespread. He wrote lucidly on such diverse subjects as cholera,
anatomy at the College of Physicians and Surgeons in New York City. In 1842
he was appointed superintendent of the State Lunatic Asylum at Utica, New
York, the first New York State public institution for the mentally disordered.
training center for medical superintendents. His book entitled Remarks on the
Influence of Mental Cultivation upon Health had a remarkably wide American
school in this country, and it was certainly one of the very early additions of
Massachusetts.
European psychiatry of the day, introducing new ideas from Germany and
treatise entitled The Curability of Insanity. He had a critical mind and a far-
reaching vision, recommending small hospitals for intensive treatment and
separate ones for the incurable patients. He was also an early advocate of
a position that he held for 43 years during which time he was a progressive
advocate of many reforms in the care and therapy of mental patients and
102
served as an active participant in community affairs.
that for at least 50 years the “Kirkbride type” of hospital building was
type” buildings are still in active use today in the older mental hospitals. Dr.
Earl Bond4 has written a most informative book, Dr. Kirkbride and His Mental
organization of a mental hospital, the Ohio State Asylum for the Insane. He
became its first superintendent in 1838 and remained at this post for 12
practice and also became physician at the Ohio Institute for the Blind.
Although Dr. Awl possessed keen mental abilities, he wrote very little on
mental disorders. He devoted much time and thought to the organization of
the state asylum and the institute for the blind, and was concerned with the
organization of the Ohio Medical Society.
was in general practice for a time in New Hampshire, and also served in the
state legislature, as well as participating in establishing the State Asylum at
description of a form of acute mania, which was named after him (Bells
disease). During his active professional lifetime he received many awards and
honors and was a participant in a variety of local and national civic activities.
He was the only one of the “original thirteen” to have served in the Civil War,
during which he died, in 1862, in an army camp near Washington, D. C., where
he was a medical inspector.
John S. Butler (1803-1890), after receiving his medical degree from the
patients. In 1843 Dr. Butler was electcd superintendent of the Bctreat for the
Insane at Hartford, Connecticut, to succeed Dr. Amariah Brigham, who had
gone to Utica, New York. Dr. Butler remained at the Betreat for nearly 30
104
years after retirement from hospital service.
where he gradually built up a specialty of treating the mentally ill to the point
hospital was successful despite the prejudice extant against private mental
institutions. The hospital burned down in 1853 and was not rebuilt; however,
School in 1828, and in 1830 was appointed resident surgeon at the United
years. In 1834, being keenly interested in the theories of Gall and Spurzheim,
started a private practice in Boston in 1840, and two years later he became
and consultant in medicine and surgery in various other hospitals in the city.
Hudson, New York, in 1797 at the age of 20. He apparently never attended a
functioned successfully until his death. From the historical fragments that
have been recorded about his life and ideas, one may assume that he was
progressive in thought, was accepted as an authority by his contemporaries,
Staunton, Virginia, his native town, and at the age of 26 was appointed
physician to the Western Lunatic Asylum of Virginia. Dr. Stribling left very
little published work, but he was an able clinician and was one of the early
advocates of training for attendants, of prompt treatment for acute cases, and
of occupational therapy.
he was made the first superintendent of the Williamsburg Asylum, which had
been established many years before (1773)- He was an unusually erudite man
who read many languages and was thus able to bring important psychiatric
106
all of what was known of mental disorders. Other books and many articles
came from his pen, and, although his life span was comparatively short, his
was a powerful influence for progress since he advocated the proper keeping
of records, the performance of autopsies, the value of research, and the need
for changes in the legal aspects of psychiatry. He utilized in his hospital
American Institutions for the Insane, six were in charge of state institutions,
five directed incorporated hospitals, and two were the proprietors of private
hospitals. From the intelligence of this remarkable group of men and the
examples they set in their respective areas have developed many of our
modem attitudes and endeavors in the specialty. At the time they formed
their national association, European psychiatry, although still relatively
psychiatry, for many years after 1841, was Dorothea Lynde Dix (1802-1887)
Boston. This remarkable woman, a retired schoolteacher, became “shocked”
by how she saw mental patients cared for in certain places, where they were
locked up in filthy cells and were not only neglected but often treated brutally
with having been directly responsible for creating or extending the facilities
of a total of 32 hospitals. In this country 20 states built or enlarged mental
hospitals as a result of her personal efforts. The Government Hospital for the
Insane (now St. Elizabeths Hospital) in Washington, D.C., is among those that
New York City in 1876, with 16 members present. Dr. George M. Beard (1839-
1883) presented a paper entitled “The Influence of Mind in the Causation and
Cure of Disease and the Potency of Definite Expectation.” This paper was
theologians.”
108
influence of any other agency than some land of emotion. Mental qualities,
like drugs, could neutralize therapeutics and they could also increase the
effect of drugs. Fear, terror, anxiety and care, grief, anger, wonder and
replied that he had not implied that psychotherapy was new, but that it had
not been carried out in a systematic manner by the profession. Although there
was much vigorous critical discussion and skepticism, the brilliant Beard,
pioneer in the field, defended his position with confidence and ability. When
neurologist, also taught psychiatry and wrote a book, Insanity in Its Medical
Relations, that came into active use as a text. Dr. Spitzka, in 1883, published
the Manual of Insanity, which included about all that was known and taught of
the subject. Although the term “paranoia” (which means “mental disorder” in
the original Greek) was introduced into medicine by Vogel in 1764 after
which it had rather widespread applications, it was Dr. Spitzka of New York
increased and enriched the whole field. He was a systematizer who, following
ideas. Kraepelin had a large amount of clinical and laboratory material with
which to work, and he made his studies according to the natural history
disorders on which some basis for prognosis, therapy, and prevention could
be ascertained. He was after the causes, the course, and the outcome of
mental disorders with reference to any pathological lesions and processes,
and he was interested in any mental trends and clinical pictures that tended
to terminate in various degrees of deterioration.
110
languages. The English translation of the book changed the whole aspect of
classification of mental disorders in America. His outstanding contributions to
clinical descriptions of the psychoses can still be read with a great deal of
About one year after the birth of Kraepelin, a man was bom who was not
only to revolutionize psychiatry but to influence the philosophic thought of
interest in neurology, Freud went to Paris to study under Charcot, who was
the outstanding clinical neurologist of his day, and who had developed a
and to the phenomena of the unconscious. Freud had replaced hypnosis with
Freud’s technique made it possible, for the first time, for a physician to
obscure to everyone involved. For a number of years Freud worked alone, but
later, when he was well on his way to success despite the great amount of
in the list of his special pupils, supporters, and co-workers. Among these are
Karl Abraham, Sandor Fer- enczi, Carl Jung, Alfred Adler, Wilhelm Stekel, Otto
Jung, Adler, Rank, and Stekel later developed some special modifications
modifications were not really psychoanalytic and were of such a nature that
they necessitated his breaking off professional relationship with these
112
Harry Stack Sullivan among others in this country.
that practically everything that Freud wrote has at one time or another been
translated into the English language, but in those earlier years America
Smith Ely Jelliffe and William A. White, both of whom were outstanding
reveals a considerable diversity of trends, but in the main they fall into two
the superego, the material gained by hypnosis, and the pregenital infantile
frustrations are the principal topics, and (2) that which attempts to adapt
114
psychiatry, and philosophy. Following services as a pathologist in the state
hospitals of Kankakee, Illinois, and Worcester, Massachusetts, he became
director of the New York State Psychiatric Institute on Wards Island where, as
early as 1906, he was working on his concept of integration with the total
individual as a unit. From the beginning he emphasized the pathological
Meyer had brought social work into psychiatry as early as 1904, but in 1912 it
was Southard who expressed clearly the social aspects of psychiatry and
author, was published in 1922 after Southard’s death. This book dealt with
social case work, presenting 100 case histories together with a classification
of social divisions of evil. In 1919 he said, “Social psychiatry is far from the
whole of mental hygiene, for mental hygiene includes also the far more
difficult and intriguing topic of the individual as related to himself and his
organ processes.” Here is reflected the keen interest he always had in the
organic reactions of the body and brain, which were the principal foci of his
original researches.
of Therapy and Practice of Physic at the University of Vermont. Dr. Isaac Ray
also wrote a book ten years later entitled Mental Hygiene. He defined it as the
art of preserving the health of the mind, and he emphasized that all methods
of preserving mental health came under it. However, many years were to pass
before the mental hygiene movement became a force for psychiatric progress.
In 1908 Clifford Beers published his book, The Mind That Found Itself, which
116
Adolf Meyer and others, the National Committee for Mental Hygiene
was organized in 1908. Dr. Meyer suggested the name “mental hygiene” for
this committee, which has now been renamed the National Committee for
Mental Health. It began with twelve charter members, among whom were
Peterson; the famous psychologist, William James; and the Johns Hopkins
The chief aims of the Committee were clearly stated: (1) to work for the
protection of the mental health of the public; (2) to strive to raise the
standard of care for the mentally ill and for those in danger of becoming
mentally disordered; (3) to promote the study of all types of mental illness
prevention; (4) to obtain from every available source reliable data regarding
methods of dealing with mental disorders; (5) to enlist the help of the federal
A. White, among others, basing their teachings on the concept that mental
symptoms are the expressions or symbols of meanings that are obscure and
hidden in the unconscious, made a widespread impact on psychotherapeutic
practice, which proceeded along the lines of what could be learned from a
study of what was going on in the deeper recesses of the patient’s mind.
contributing a number of concepts of his own, was the Boston psychiatrist Dr.
Abnormal Psychology. His famous case of a girl with multiple personality was
studied for over seven years and published in 1908 under the title
118
special group of students in what he termed “phyloanalytie” investigations of
human behavior and social adjustment. He stressed the defensive distortions
tensions.
of the psychiatric and neurologic fields. His concepts of integration and his
among the subjects with which he enriched the literature. The work of Harry
consideration but did not develop or emphasize in the same way. The basis of
Freud thought. Sullivan organized and published the journal called Psychiatry,
which still serves as a useful medium for psychiatric thought.
tissue of patients dying of general paresis, thus proving that this mental
disorder was precipitated by a form of syphilis. Following this laboratory
drugs used for syphilitic disorders, but without marked success. In 1918
Julius Wagner von Jauregg (1857-1940) of Vienna announced his now well-
known malarial therapy for general paresis. This treatment, strikingly
general use, and the first to apply it in America was the staff of the St.
Elizabeths Hospital in Washington, D.C., from which the first paper in English
During World War I psychiatry was brought more prominently into the
medical specialties. At the beginning of the war the government called upon
the National Committee for Mental Hygiene for aid, and this organization was
exceedingly fortunate to obtain and recommend the services of Dr. Thomas
to the efficiency of the armed services by recognizing and treating the war
neuroses. Salmon and his associates in the Army, with its numerous civilian
120
as well as military personnel problems, were instrumental in pointing out the
may be pointed out that what he did for the Army has stood the test of time,
as his methods are still more or less in force and, in the minds of some, are
still the best available, having been so proved in World War II and in the
Korean campaign.
This was the pioneer child guidance clinic, although the term was not coined
until 1922. The Boston Psychopathic Hospital, opening in 1912, accepted
children from the first, as did the Phipps Psychiatric Clinic in Baltimore where
Allentown State Hospital in Pennsylvania was also a pioneer in this field, with
a clinic under way in 1915. Child guidance clinics developed rapidly in other
cities and areas under such well-known specialists as Lawson Lowrey (1890-
and distribution, as the needs for the study and correction of the behavior
between the brain and mental diseases, was appointed special pathologist at
the Government Hospital for the Insane (now St. Elizabeths Hospital). He was
the first fulltime pathologist in a mental institution in America (at least I can
part of the state hospital system. Located at first in New York City with Dr. Ira
122
of Adolf Meyer, August Hoch (1868-1919), and George Kirby (1875-1935). In
1929 the old institute was replaced by a modern building constructed as a
unit in the Columbia Presbyterian Medical Center and named the New York
State Psychiatric Institute and Hospital. During the past 60 years this institute
has been unique since it has been supported for the sole purpose of research.
workers. With these beginnings acting as stimuli, there have been many
an example of the progress that may be expected with the growth of research
interests and financial aid.
medicine” has been known for at least 100 years, but in the sense of the
modem clinical application and theories in psychopathology and medical
expressions of nervousness that are found here only: and the relative
124
recommended complete rest as the cure. From the general interest in so-
called functional disorders came one of the special roots now known as
psychosomatic medicine.
the years despite the fact that there have been outstanding pioneers with
constructive concepts and writings. Beginning with Isaac Ray’s book in 1838,
psychiatry and the law and recommendations for dealing with these
procedures.
In the field of clinical psychology the use of the Rorschach and other
projective techniques became established and were freely applied to
of hospital patients and of the child guidance field, and in interpreting the
begun in the United States with the opening of the Pennsylvania Hospital in
equipment “to employ such Persons as may be capable of using the same.”
Activities ranging from music, games, and arts and crafts to industrial or
126
two more training centers were functioning. Three other schools, originated
during World War I to train “reconstruction aides” for Army hospitals,
continued to grow and were among those accredited in 1938 by the American
As late as the 1930s it was advocated by many that psychiatry was not a
science but an art, since the personality of the psychiatrist bulks so large in
the practice of mental medicine, and psychiatry could never free itself from its
school” was developing, and by 1937 it had the following characteristics, most
The American school had started to use the new shock therapies that
composite eclecticism, but it was beginning a positive frontal attack upon the
problems of mental medicine that was new, frank, and critical. It advocated
treating all behavior, thought, and feeling of an individual as real or actual
notably larger since earlier strong prejudices against them had subsided
considerably. It is a matter of interest to note that in 1890 a law was passed
by the New York State legislature authorizing the appointment of at least one
woman physician in each state hospital. Obviously we have come a long way
during the last half century. The lack of sufficient knowledge of mental
hygiene and the psychic components of disease on the part of the general
128
practitioners and the lack of proper psychiatric information among the clergy
and the population in general were also well recognized, and movements
In recent years, and particularly since World War II, more adequate
methods and techniques suitable for attacking vital problems have appeared
and are still in various stages of evolution. In scrutinizing the past in an
science of man, one should remember that each worker, regardless of his
Bibliography
1. Ackerly, S., “Thirty Years of Child Psychiatry,” Am. J. Psychiat., 210:567, 1953.
4. Bond, E. D., Dr. Kirkhride and His Mental Hospital, Lippincott, Philadelphia, 1947.
6. _____, “Therapeutic Forces in Early American Hospitals,” Am. J. Psychiat., 113:407, 1956.
7. Braceland, F. J., “Kraepelin: His System and His Influences,” Am. J. Psychiat., 113:871, 1957.
9. Collier, G. K., “History of the Section on Convulsive Disorders and Related Efforts,” Am. J.
Psychiat., 101:468-471, 1945.
10. Deutsch, A., The Mentally Ill in America: A History of Their Care and Treatment from Colonial
Times, Doubleday, New York, 1937.
11. Diamond, B. L., “Isaac Ray and Trial of Daniel MeNaugton,” Am. J. Psychiat., 112:651, 1956.
12. Drukurs, R., and Corsini, R., “Twenty Years of Group Therapy,” Am. J. Psychiat., 110:567, 1954.
13. Ebaugh, F. G., “The History of Psychiatric Education in the United States from 1844 to 1944,”
Am. J. Psychiat., 101.151-160, 1945.
14. Farr, C. B., “Benjamin Rush and American Psychiatry,” Am. J. Psychiat., 101:1-15, 1945.
15. Hadden, S. B., “Historic Background of Group Psychotherapy,” Int. J. Psychother., 5.162-168,
1955.
16. Hall, J. K., et al. (Eds.), One Hundred Years of American Psychiatry, Columbia University Press,
New York, 1944.
17. Haskell, R. H., “Mental Deficiency over a Hundred Years,” Am. J. Psychiat., 101: 107-118, 1945.
19. Kanner, L., “The Origins and Growth of Child Psychiatry,” Am. J. Psychiat., 101: 139-143. 1945.
20. Karwin, E., “Contribution of Adolf Meyer and Psychobiology to Child Guidance,” Ment. Hyg.,
29:575, 1945.
21. Lazell, E. W., “The Group Treatment of Dementia Praecox,” Psychoanal. Rev., 8: 168-179, 1921.
130
Progress,” M. Ann. District of Columbia, 24:469-477, 542-550, 1955.
23. Lewis, N. D. C., “Review of the Scientific Publications from St. Elizabeths Hospital During the
Past 100 Years,” M. Ann. District of Columbia, 25.143-147, 1956.
25. _____, Hubbard, L. D., and Dyar, E. G., “Malarial Treatment of Paretic Neurosyphilis,” Am. J.
Psychiat., 4:175, 1924.
27. Meyer, A., “Objective Psychology or Psychobiology with Subordination of the Medically
Useless Contrast of Mental and Physical,” J.A.M.A., 65:860-862, 1915.
29._____, “Thirty-Five Years of Psychiatry in the United States and Our Present Outlook”
(Presidential Address, American Psychiatric Association), Am. J. Psychiat., 8:1,
1928.
30. Moreno, S. R., “History of First Psychopathic Institute of the Great American Continent,” Am. J.
Psychiat., 99:194, 1942.
31. Oberndorf, C. P., “Psychiatry at Ward’s Island 40 Years Ago,” Psychiat. Quart., suppl., 24:35,
1950.
32. Riese, W., “An Outline of History of Ideas in Psychotherapy,” Bull. Hist. Med., 25:5, 1951.
33. Ruggles, A. H., “Clifford Beers and American Psychiatry,” Am. J. Psychiat., 101:98- 99. 1945.
34. Russell, W. R., “From Asylum to Hospital–A Transition Period,” Am. J. Psychiat., 101:87-97,
1945.
35. Shryock, R. H., “The Psychiatry of Benjamin Rush,” Am. J. Psychiat., 101:429-432, 1945-
37. Sterns, A. W., “Isaac Ray: Psychiatrist and Pioneer in Forensic Medicine,” Am. J. Psychiat.,
101:573, 1945.
38. Stevenson, G. S., “The Development of Extramural Psychiatry in the United States,” Am. J.
Psychiat., 101.147-150, 1945.
39. Stone, S., “Psychiatry in New Hampshire, First 100 Years,” New Eng. J. Med., 228: 595, 1943-
40. Thompson, G., “The Society of Riological Psychiatry,” Am. J. Psychiat., 111:389, 1954.
41. Tucker, B. R., “Development of Psychiatry and Neurology in Virginia,” Virginia Med. Month.,
69:480, 1942.
43. Walker, W. B., “Medical Education in the Nineteenth Century,” J. Med. Educ., 31: 765, 1956.
44. Wittels, F., “The Contribution of Benjamin Rush to Psychiatry,” Bull. Hist. Med., 20: 157-166,
1946.
45. Zilboorc, G., “Eugen Bleuler and Present-Day Psychiatry,” Am. J. Psychiat., 119: 289-303, 1957.
Notes
[1] Benjamin Rush is also claimed by professional chemists as the “Father of American Chemistry” on
the basis that he was the first professor of chemistry in America, his post being the
College of Philadelphia (1769-1789).
132
Chapter 3
George Mora
three decades is not an easy task, especially in view of the great deal of
progress made in this field since the end of World War II, of the difficulties
progress.
psychiatry has gained acceptance in the overall realm of medicine and, even
more, in the American culture by and large. Psychiatry has now reached the
point of being able to look comfortably at its present situation and to draw
appeared.
134
the mind”—that find antecedents in similar episodes in the past.
fields of psychiatry, included in the first edition of this Handbook, have been
omitted. Also, in discussing specific points, full source information has not
been provided in the text or in the bibliography, as this will be done in the
following chapters of this work.
Shortly after the first edition of this Handbook was published in 1959,
an important document.
impetus toward moral treatment in the first part of the nineteenth century,
followed by the emphasis on institutionalization of a large number of
mentally ill in isolated settings in the second part of the century. The
In the late thirties early attempts were made to improve the treatment
around that time helped to focus attention once again on psychotic patients
and on organic psychopathology and research in general; in the two previous
escape the Nazi persecution of the Jews, new impetus was given to individual
136
problems: syndromes of acute breakdown in relation to combat, a large
number of inductees rejected for psychiatric reasons, and rehabilitation of
Act (1946) leading to the creation of the National Institute of Mental Health
(1949)—for research, training, and assistance in developing mental health
In 1955 the Mental Health Study Act was passed, providing for the
creation of the Joint Commission on Mental Illness and Health. This
five years of intensive work produced the above- mentioned Action for Mental
Health, essentially geared to shift the emphasis from institutional to
throughout the entire nation. Finally in 1965 funds for staffing these centers
were allocated through an amendment to the act.
138
of scientists having different ideas and biases. Moreover, most of the research
tends to be supported by the federal government, which relies on a relatively
small number of experts, who are inclined to favor certain projects and
equipped settings. The typical pattern has been for American research teams
however, the issue of research has become more complex than ever as the
result of the upsurge of community psychiatry, which requires a difficult type
dimensions and not immune from ethical and political pressures. The fear of
losing the uniqueness of the doctor-patient relationship, so close to the core
140
“supernormality,” that is, “expansion of consciousness” achieved with the
help of certain drugs, has been brought forward. Although most psychiatrists
the same time, trying to find what is common. Some years ago H. Ellenberger
pointed to the biases of psychiatric nosology in terms of the nature and kind
of classifications, the concept of nature, the projection of intellectual
schemata, and the unconscious position of the researcher. Yet the history of
Psychiatric Association.
In the light of all this the Diagnostic and Statistical Manual of Mental
is uncertain what future awaits bold new attempts (such as New Approaches
142
mental patients (Malz- berg in New York, Dayton in Massachusetts), to
particular ethnic groups (Eaton and Weil on the Hutterite), to samples of
the Institute of Living in Hartford, Conn., in 1962, have later been used in
other places (New York State Department of Mental Hygiene, New York State
has put it, if the computer takes over, the psychiatric role may be “reduced to
machine-processed data of being pushed around like pawns on a chessboard
of science.
Psychopathology
The biological trend in psychiatry, which had been prominent in the late
nineteenth century, gained momentum again at the end of World War II, for
example, the founding of the Society of Biological Psychiatry. Among the main
research themes were: stress reactions in Air Force servicemen (R. Grinker
and J. Spiegel), theory of emotions (J. Papez), visceral brain (P. MacLean),
reticular system (G. Moruzzi and H. Magoun), theory of cell assembly (D.
Hebb), stimulation of cerebral cortex (W. Penfield), functions of the frontal
lobes (J. Fulton), “stress syndrome” and “general adaptation syndrome” (H.
144
psychopharmacology in the fifties, which represented a return to the
philosophy of biological psychiatry. Of the many topics mention should be
made here at least of: the genetic role of the DNA molecule and the
phenomena in EEG and of REM signs in sleep and dreaming; clinical aspects of
functions of lymbic and reticular systems, of the temporal lobe, and of the
neurotransmitters in psychiatric syndromes and in relation to chemotherapy;
one disregards Freud’s prediction that the ultimate cause of mental disorders
will be found one day in biological processes, the fact remains that nowadays
and Public Policy of the National Academy of Science and the Problems and
“negative” (that is, interfering with such behavior) from time to time.
In this country from the forties on, many studies have been devoted to
“separation anxiety”; Hans Selye has described the above- mentioned “stress
146
the basis of experimental studies on gastric secretion; others (D. Funkenstein)
have differentiated unexpressed anger (anger-in) from expressed anger
neuroses.
which from a defense may turn into a symptom (K. Horney). Finally the
matter what perspective one adheres to, anxiety remains a highly complex
by W. Fischer.
be established beyond doubt when the first edition of this Handbook was
beginning with the Greeks, running through the Romantics in the early
nineteenth century, and leading to study of hypnosis by the French schools in
Yet in the last decade or so the advocates of the unconscious have found
themselves on the defensive. Supporters of the new “behavior therapy” and of
other related approaches question, not the validity of the notion of the
unconscious, but its relevanec for psychiatric treatment, which they view as
tradition that can be traced back to ancient Middle East cultures, the Greeks,
148
and the Middle Ages. Such a tradition was given scientific form for the first
time in Freud’s Interpretation of Dreams (1899), which, by introducing a new
(Hartman and Kris); attempt to unify past and future in the light of ego
existence (existentialists).
sleep (E. Aserinsky and N. Kleitman) and their relation to EEG patterns and
eye movements (REMPs) and nonrapid eye movements (N- REM), instinctual
sleep and the connection between dreaming and psychotic states), while at
dreams. As a result, dreams are seen today from the threefold perspective of
especially concerned with the first of these three aspects. Many interesting
points are discussed in the literature of the last two decades, such as Fromm’s
Forgotten Language, Boss’s The Analysis of Dreams, Tauber and Green’s Pre-
logical Experience, Bonime’s The Clinical Use of Dreams, French and Fromm’s
Dream Interpretation, and Hall and Van de Castle’s The Content Analysis of
Dreams.
the early times on, in the literary as well as in the figurative fields. This is true
even during periods of severe sexual repression, such as in the Middle Ages,
when sex aberrations were expressed in the context of the witchcraft mania.
Early in our century Freud and his disciples faced the manyfold
150
verbal technique. Thus for the first time the centuries-old intuitions
concerning the relationship of sexuality to psychopathology were given
model of the progression from the oral to the anal to the genital stage has
remained valid to our day, though modified by some: for example, Alexander
has attributed the sexual urge of adults to the surplus of energy after growth
even the validity of a notion as basic as that of the oedipal complex came to be
questioned.
sexual behavior of the male (1949) and of the female indicating a wide range
of sexual activity in the American culture; the bold methodological approach
the psychological rather than from the moral perspective; finally the rapid
reassessment of the role of the female vis-a-vis that of the male in this country
as well as in other Western nations.
The various concepts listed in the heading of this section have come to
acquire significance as the result of revisions of traditional Freudian notions
According to Arieti, this new orientation has the following background: the
pioneering eighteenth-century writings on prelogical thinking by the Italian
152
In the past some attempts had been made to establish a relationship
and other human expressions (for example, by the Swiss A. Storch). However,
traditionally the emphasis has been on the study of the content rather than
fully.”
and Creativity in Health and Mental Illness,™ he has described the fundamental
Schizophrenia
Schizophrenia has remained to the present the most studied, yet the
whether the emphasis is put on its difference from neurosis or, conversely, on
twins carried on at the New York Psychiatric Institute by F. Kallman and then
by J. Rainer, have thrown some light on this issue, at least in terms of a
154
midfifties, following the introduction of chemotherapy, resulting in a variety
of studies and hypotheses (disturbance of the catecholamines, faulty
“secondary classes” (that is, the secondary process of the Aristotelian logic).
Examples of such primary thinking are the spontaneous productions of
process rather than from their difference from the normal process of
thinking.
In recent years many studies in this country have focused on the issue of
on the so-called Palo Alto group (G. Bateson, D. Jackson, J. Haley, and J.
Weaklan) has concentrated on the “double-bind” theory of schizophrenia,
based on the ambiguous message that the schizophrenic receives from his
schizophrenic patients.
have had considerable resonance in this country (so to justify their mention
here). Laing’s interests have shifted from the phenomenological discussion of
the inner process of schizophrenia (The Divided Self, 1960), to the dynamics of
the communication patterns (The Self and Others, 1961; Sanity, Madness and
156
schizophrenic into society (The Politics of Experience, 1967; The Politics of the
Family, 1969).
Depression
famous paper on “Mourning and Melancholia” (1917), until in the forties the
normal depressive position in the earlier stages of life never had too much
type” of depression, in which there is a loss of the “dominant other,” that is, of
the idealized parental figure toward whom the patient is dependent.
the intrapsychic; thus they remain quite vulnerable to the loss of sources of
self-esteem.
received a great deal of attention along with the biochemical and the dynamic
Bethesda, Md.
Psychosomatic Medicine
158
In the thirties a number of psychoanalysts “rediscovered” the centuries-
old belief in the influence of the mind upon the body in the wake of Freud’s
matter how meaningful the study of psychological factors has been (such as
the correlation between dreams and the biological phases of the menstrual
Deutsch’s On the Mysterious Leap from the Mind to the Body, A. Garma’s Peptic
internists, and behavioral scientists; and (2) the various theoretical models of
The study of the life and work of Freud has continued to be the subject
160
of a number of studies in the last two decades, typically the three-volume
monograph by E. Jones completed in 1957. Such a monograph typified the
unconsciously gave a prophetic character. Since then, with the help of newly
published material—such as Freud’s correspondence with some pupils and
have arisen concerning Freud’s academic career and his involvement in the
suicide of V. Tausk, author of the classical paper on the “influencing machine”
in schizophrenia (1919).
opening the new field of psychohistory. This has signified a new advance in
Clinical Developments
The most important event in the history of psychoanalysis has been the
shift of emphasis from the unconscious to the ego (mainly A. Freud’s The Ego
and the Mechanisms of Defense and H. Hartmann’s Ego Psychology and the
Dumbar, Thomas French, and Roy Grinker for psychosomatic medicine; Felix
162
Gerald Pearson, and Emmy Sylvester for emotional disturbances in childhood;
Erich Lindemann and Nathan Ackerman for family dynamics; Frieda Fromm
Kubie, Bertrand Lewin, Sandor Lorand, Karl and William Menninger, Herman
Nunberg, Clara Thompson, Gregory Zilboorg, and many others for various
clinical matters.
Psychosomatic Medicine (1948) for its many innovating techniques, and Our
Age of Unreason and Western Mind in Transition, dealing with broad cultural
issues; his various papers collected under The Scope of Psychoanalysis (1961)
The emphasis on the ego that became prominent in the forties left
defined it as the balance of ego autonomy from the id and ego autonomy from
the environment. The adaptive point of view was integrated with the genetic
mastering the apparatus of internal and external motility and the perception,
Other theoretical developments deal with the role of the somatic ego
related to the body image, the concepts of “ego strength,” of “area of the ego
formation of the ego. All this has come to signify historically a rapprochement
between psychoanalysis and genetic psychology, this latter represented
for American psychiatry in the last two decades coincidentally with the
advent of ego psychology, leading to attempts to compare psychoanalysis
164
with the school of Geneva (P. Wolff, J. Anthony, and others).
Aside from this the main innovation consists of the concepts developed
in this country by the Danish-born and Viennese-trained E. Erikson, a highly
creative personality imbued with literary gifts. Erikson views the personality
represent the best example of an entire historical period viewed in the light of
and Life Cycle, 1959; Insight and Responsibility, 1964; Identity: Youth and
Crisis, 1969), all stemming from his basic Childhood and Society (1950), he has
brought to the fore the identity crisis of adolescence in American society and
the basic stages of the life cycle. These latter (in succession “hope,” “will,”
“basic virtues,” can be easily connected with the fundamental “virtues” of the
Judeo-Christian tradition. His views on adolescence have come to be very
by the important volume The Person by T. Lidz) and transcends the field of
psychoanalysis proper, so one may justifiably question whether Erikson
established by Freud.
the one hand, and of the social sciences, on the other hand, is being
recognized. The American Academy of Psychoanalysis, established about 15
years ago, has represented this new trend, as evidenced by the proceedings of
166
drives of the ego, and the isolation of the psychotherapeutic relationship with
only as they are in relation to each other within a specific space-time field”
(Grinker, 1968).
Research
some of the classical findings by the early psychoanalysts. Among the first
168
in the Report of the Ad Hoc Committee on Central Fact Gathering of the
When the first edition of this Handbook was published in 1959, this
following the high peak it reached in the mid-fifties. This is reflected in the
sufficiently proven, has become increasingly critical, and attempts are made
and the Downstate Medical Center in Brooklyn) and of the exclusion of lay
analysts from official recognition (with the exception of very few, such as E.
While for many years, as it will be shown in the next section of this
official position of the psychoanalytic group, today the main issue concerns
170
psychoanalysis is dying, as some sensational journalistic reports seem to
Aside from some basic notions presented early in his career and
of the Swiss Carl Gustav Jung (1875-1961) has received very little notice here.
One reason is that his pupils, being of non-Jewish extraction, did not have to
emigrate to this country. Particularly ignored is his late production, which has
very palatable to the pragmatic American mind. Despite the availability of his
main writings in this country for many years (and the current publication of
his complete works by the Bollingen Foundation), Jung’s ideas have found
circles.
the Society for Individual Psychology. In this country, aside from a few pupils
Other well-known analysts who worked in this country for many years
172
the controversial “discovery” of “orgone” energy as the basis of life.
Abraham), on the crucial role of the introjection of “good” and “bad” objects,
and on a normal “depressive position” early in life have been considered too
overdetermined by the American mentality concerned with environmental
exception of Sullivan, were European-born, their work has taken place almost
exclusively in this country. They have all been influenced by the Swiss-born
Adolf Meyer (1866-1950), the founder of the school of psychobiology, which
influences at variance with the rigid aspect of Freud’s doctrine of the instincts
and of family dynamics (for example, the dominant male role). Her
explanation of neurosis as “moving toward,” “moving away,” and “moving
174
personality (that is, stages of libido, oedipus complex) and elaborated notions
based on various modalities of experiencing interpersonal relationship
Also geared to the general public are the many volumes of the German-
born Erich Fromm (b. 1900), in the past associated with the William Alanson
paid tribute to both Freud and Marx, have an appealing and engaging style,
but are rather peripheral to the central theme of psychiatry proper. The same
can be said of the philosopher Herbert Marcuse (b. 1898), whose humanistic
defenses of man from the Marxist perspective have been taken as a symbol by
Existentialist Schools
developed mainly in Europe, it is important to state that, like the rest of this
chapter, this presentation deals exclusively with the American developments
of its main tenets. The matter is complicated by the vagueness of the core and
boundaries of existential psychiatry, which inherently defies any attempt at
of human existence from the Greeks on, tends to become significant at times
of general insecurity and weakening of social institutions, leading to a defense
Europe and W. James in this country) have been well established and
176
awareness of new social dimensions (poverty, alienation, racial conflicts, and
so forth), existential psychiatry came to the fore in the mid-fifties. Various
Today, a decade later, it safely can be said that the original impetus of
Lexington, Ky., for more than two decades, have received very little notice. It
appears that the reaction of many disenchanted with the traditional American
style of life has taken the form of “irrational” group expressions (such as the
common two main aspects: (1) their appearance in the last two decades or so,
in response to dissatisfaction with current concepts of human behavior as not
relevant to the new needs of man’s changing role under the pressure of
without escaping from the world, to the point of constituting a sort of “new
utopia” (W. Boguslaw). Also two of them, ethology and structuralism, are of
European origin and based on innate and congenital postulates; the other
two, general system theory and ecology, are of American origin and based on
environmental and behavioristic postulates.
178
Unified Theory of Human Behavior), by K. Menninger (The Vital Balance, a new
classification of mental disorders based on this theory), by S. Arieti (who has
presented in the recent volume General Systems Theory and Psycluatry, edited
by W. Gray, F. Duhl, and N. Rizzo. Ecology, rapidly seen as important for
Levi-Strauss ) is still too new for its relevance for psychiatry to be seen, but it
has definite connections with psycholinguistics, communication theory, and
popular in the last ten years. From the historical perspective of this chapter,
to the preeminence of community psychiatry and the definition of its core and
In regard to the first point, throughout history the mentally ill have been
Foucault, and others) have attempted to investigate the social and cultural
nineteenth century to the recognition of the value of treating the patient in his
differentiated from social psychiatry. This latter, first defined in this country
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sociocultural (A. Leighton), transcultural (E. Wittkower), ecological (J.
Ruesch) and interdisciplinary (N. Bell and J. Spiegel) aspects. In general, the
also due to the different ethnic, cultural, and religious backgrounds of various
public health and has achieved recognition especially through the many
studies published by G. Caplan, who is responsible for the subdivisions of
community psychiatry: opening of outpatient clinics for adults and then for
psychiatric disorders and the need for a national program to adequately face
general hospitals (which now number more than 30,000); foundation of the
National Institute of Mental Health in 1949, which, under the long leadership
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study The Mental Hospital (1954), carried out at Chesnut Lodge in Rockville,
Md.; this received ample recognition and was followed by others (for
example, From Custodial to Therapeutic and The Patient and the Mental
programs were approved (first in New York State in 1954), and the annual
Governors’ Conference on Mental Health offered the impetus for passing
adequate legislation. As a result of the Mental Health Study Act of 1955, the
Joint Commission on Mental Illness and Health was established under the
leadership of K. Appel and L. Bartcmeier to make an assessment of the system
of treatment and care of the mentally ill, identify needs, and propose
recommendations.
At the end of five years of work the Commission’s Chairman J. Ewalt and
collaborators found that the 13,000 psychiatrists then available were largely
community mental health and relying on the help of other professionals and
nonprofcssionals; (2) opening of many new facilities, such as clinics,
for Mental Health, nine other books were published on the following topics:
approach was to convert large state hospitals into units of no more than 1,000
patients and to provide a mental health clinic for each 50,000 people.
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Congressmen J. Priest, O. Harris, and J. Fogarty, and A. Ribicoff, then Secretary
of Health, Education, and Welfare), proposals to implement the
Significant impetus toward the success of this endeavor was provided by the
inauguration of a wholly new emphasis and approach to care for the mentally
ill—which will return mental health to the mainstream of American medicine,
people. Any center had to offer five types of services: inpatient, outpatient,
signed by President Johnson in 1965 to provide federal funds also for staffing.
By 1970 more than 400 centers were in operation: some received
construction grants, others staffing grants or both. The NIMH budget for that
billion.
Historically services for the mentally ill have developed according to the
order followed in the above heading. Mental hospitals first appeared at the
end of the eighteenth century in the process of differentiating the mentally ill
from all other outcasts of society; the philosophy of “moral treatment” based
nineteenth century; later on, with the arrival of many immigrants and the
expansion of the frontier, the mentally ill were increasingly institutionalized
in large state institutions (many built under the impetus of D. Dix’s crusade)
Around the second decade of our century, under the influence of several
reached the point of neglect and despair, as portrayed in The Shame of the
States by A. Deutsch and in The Snake Pit by M. Ward.
186
Only in the mid-fifties two concomitant developments, the introduction
the delivery of services to mental patients. The first important step in this
and then in this country: “day hospitals” for patients not needing full
“unit” in the state hospital to facilitate contacts with their community. All
these pioneering endeavors came to be named the “open-door policy” (M.
Jones), that is, a shift from a custodial to a therapeutic setting and from a
the flexible approach both of the hospital and of the community, as quite often
family. Worth mentioning also is the significant role that private mental
hospitals (about 170 caring for almost 17,000 patients and involved in the
above-mentioned developments.
The literature on all these events is quite extensive. Among the most
valuable works are The Therapeutic Community by M. Jones, The Psychiatric
Hospital as a Small Society by W. Caudill, Day Hospital by B. Kramer, The
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be traced back to the convergence of various movements of social work,
voluntary agency, welfare programs, settlement houses, and others early in
this century. The original philosophy of these clinics was eclectic and
total of 373 in 1935) served patients discharged from mental hospitals, and
most of them were located in the five states of New York, Massachusetts,
and sophisticated patients whose values were similar to that of the staff,
while the contact with community agencies and schools became negligible.
therapy.
Centers of America) are far from over. One of the sharpest critics, G. Albee,
has written that “the psychiatric clinics in the United States are treating the
wrong people; they are using the wrong methods; they are located in the
wrong places; they are improperly staffed and administered; and they require
institution.”’
(adolescents, alcoholics, drug addicts, etc.), are developed; efforts are made to
open clinics in rural areas and in Midwestern and Southern states with the
substantial help of public moneys and, to a less extent, of insurance coverage.
The main issue remains the identity of the outpatient clinic vis-a-vis the
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ambivalence: on the one hand, the nostalgic feeling toward the traditional
small clinic whose staff was quite involved with the patients; on the other
Community mental health centers, being only less than a decade old, are
difficult to assess from the historical perspective. The complexity of any one
difficulty.
Yet ten years from Action for Mental Health, some trends concerning the
that the great expectations raised initially that this movement would
constitute a “third” (N. Hobbs) or a “fourth” (L. Linn) psychiatric revolution
are not accepted by many. At best it is accepted that this movement helped
is not a panacea for gigantic social problems, from the Vietnam War to drug
addiction to changes in the traditional values of this country (J. Seeley). Too
conservative groups have seen the mental health movement as a plot against
patriotism by government infringement on the mental health of the citizens.
this movement has been characterized as “a retreat from the patient” (L.
Kubie), and a strong defense of the “medical” (that is, “dyadic”) model of the
doctor-patient relationship over the “social” model has been voiced by some
192
(R. Kaufman, L. Kolb).
All this should not deter anyone from recognizing the moral
implications of a movement that, in line with the American democratic
community mental health center; the new pattern of cooperation with social
local, state, and federal agencies; and last but not least, the more accepting
attitude toward mental illness by many segments of the population.
Thus far most of the impetus toward community psychiatry has taken
recession and other social problems of this country indicates that local
community mental health movement. How this will affect the success of this
movement in the long run remains to be seen.
Therapy
viewed from the perspective of the theory of mind and body prevailing in
each culture at a particular period. In the Western tradition the centuries- old
194
mental functions and the treatment of neurotic disorders. The
psychodynamic trend has persisted to our days, although organic theories of
the mind became prominent again in the thirties in connection with the
While all this justifiably has aroused in many the urge to reach a new
unitary concept of body and mind, the orientation of most psychiatrists with
Organic Therapies
Shock Therapies
The notion that sudden and unexpected events (such as a loud noise, an
unpredictable shower, or a fall into the water) may alter the mental status of
convulsions in Rome. The first two moved to this country shortly thereafter,
had been largely missing in the psychodynamic schools, both in the patients
and in the professionals. After the wave of enthusiasm shock therapies came
to be limited mainly to electric shock, because of its easy use and safety, and
to the treatment of forms of depression. The efforts of many to find the
Also limited have been the technical improvements, such as use of anesthesia
and various substances to achieve relaxation. Worth mentioning also are the
and dependence on the staff coupled with symbolic death and rebirth. In the
196
Procedures in Psychiatry by L. Kalinowski and P. Hoch, continually brought
up-to-date.
Psychosurgery
from the alleged possession by evil spirits was extensively practiced. Surgical
medicine, while, later on, caution prevailed in connection with the discoveries
of the delicate functions of the central nervous system.
between cortical and subcortical functions on the basis of data obtained from
ablation of frontal lobes in monkeys (J. Fulton, C. Jacobsen), from
religious groups, from the Catholic Church to Soviet Russia, have condemned
psychosurgery on moral grounds. The controversies about psychosurgery
recently some of these issues have been raised again in connection with the
Psychopharmacology
“drugs of the mind” has brought forward many similarities between them and
a variety of drugs employed in magic-religious ceremonies of healing in
198
later on by opium, bromides, chloral hydrate, paraldehyde, and finally
barbiturates. Mescaline was isolated in 1896 by the German L. Levvin (who
published a famous book on the drugs of the mind) " and later synthetized,
and its hallucinogenic effects were described in the German literature in this
century.
early in the fifties. This opened the way to a great step forward in psychiatry,
that is, to a more optimistic view of mental illness on the part of professionals
and patients and ultimately of the community. In rapid succession a number
200
the interplay of pure research and the interests of supporting drug
companies, legal aspects in various nations, and the continuity of the tradition
(mainly LSD 25) in the treatment of mental disorders and especially about the
power of some drugs to enlarge the field of consciousness and provide new
philosophical and religious insights are unrealistic. Concretely many use
much more enlightened attitude toward mental illness on the part of many
general practitioners and other physicians and especially the general
population at large.
Psychological Therapies
The innovation that has taken place recently consists in the new
methodological approach toward such healing practices by researchers well
nonphysical events (that is, power of devils or ancestors and action of words
and deeds) or events attributed to the person himself (that is, disregard for
certain taboos). Also in the last decade or so, methods of psychological
healing stemming from the Greek tradition and their relation to present
methods have been made the subject of thorough studies by W. Riese, P. Lain
202
Ehrenwald’s notion of “doctrinal compliance” to explain the tendency of the
therapist to fit everything into his own system. Moreover, the boundaries of
success of nondy- adic modalities, such as family and group therapy, but by
the spread of new approaches, from brief therapy and crisis intervention to
therapists.
resulting from the urge toward action brought forward by the pressing social
Individual Psychotherapy:
Psychoanalytic Psychotherapy and Psychoanalytically Oriented Psychotherapy
other schools.
204
Aside from the loose distinction of deep versus superficial, insight versus
supportive, verbal versus active therapy, descriptions have been offered of
movement. At the moment the attempts to graft them on a broader and more
Hypnosis
hypnosis, traceable to Mesmer and, further back, to the Greeks and preliterate
cultures, were illustrated by some.
It is well known that Freud rejected hypnosis after a few years and that
its use for anesthetic and surgical purposes, introduced in the mid-nineteenth
century, was soon forgotten, also as a result of the theatrical use of hypnosis.
Only in the forties, following some pioneer work by C. Hull (Hypnosis and
Suggestibility, 1933) was hypnosis scientifically investigated by M. Erickson,
206
World War II. Eventually the Society for Clinical and Experimental Hypnosis
(1949) and later the American Society of Clinical Hypnosis, which publishes
In recent years the theories of play acting to please the hypnotist (M.
therapist (M. Gill and M. Brennan) have been postulated. Also the connection
between hypnosis and depth and extension of the field of consciousness
achieved through the use of particular drugs (LSD 25, mescaline, and others)
well established.
Client-Centered Therapy
Among the various schools of psychotherapy the only one with a fully
American origin was developed by the psychologist Carl Rogers (b. 1902) first
therapist, who continually reflects his feelings toward his client. Historically
the lay analyst Otto Rank early in the century advocated the analysis of the
treatment for young and sophisticated clients suffering from problems rather
than definite clinical entities (thus nonpatients in the medical sense); on the
other hand, Rogers and his pupils have done important research on
Group Psychotherapy
resulting from the loss of the support provided by each society from which
the immigrant groups came. Moreover, in the European societies centuries-
208
decline of the sources of support provided by traditional values, today’s man
tends to feel alienated, or “other-directed” in the sense of Ries- man (The
New York City area, the “impromptu theater” by J. Moreno also in New York
(already practiced in Vienna early in our century). While these various groups
were composed for different reasons and the emotional outlet was only
mirror, double, and role reversal), practiced by J. Moreno, all in the New York
City area.
group dynamics able to offer a much needed scientific basis to the field of
group psychotherapy. Since then this field has acquired a more stable image
with the help of professional meetings and journals, especially Group
selecting proper patients, and in structuring the role of the leader in the
formation of groups. '‘ However, some basic issues, such as the conceptual
are still clouded by uncertainty. In recent years the rise of all kinds of new
groups (from Alcoholic Anonymous to encounter groups, sensitivity training,
Family Therapy
Family therapy, scarcely mentioned in the first edition of this work, has
become prominent in the last dozen years, to the point of being considered as
the treatment of choice by some. For the historian the reason for this rapid
210
success, over and above the field of psychiatry, has to be found in family
therapy’s attempt to strengthen an institution that traditionally has
and that is now affected by some basic problems: decrease of family ties,
virtual loss of the extended family, and rise of the divorce rate.
family process either at the research level (J. Spiegel, J. Bell, and others) or
from the practical perspective (G. Bateson, D. Jackson, and V. Satir of the so-
called Palo Alto Group, which has published Family Process since 1962; T. Lidz
dynamics and role, the sociological approach, and the cultural dimension; this
be a cause of concern for many. The historical consideration that the family
has remained a landmark in all cultures at all times may help overcome this
psychotherapy.
Behavior Therapy
Behavior therapy is so recent that it was not even mentioned in the first
edition of this work. In a matter of a few years this school has gained a great
deal of interest, if not of acceptance, partially as a result of the caustic
212
The foundations of behavior therapy have to be related to the two
theory, respectively. The first school is identified with the Russian I. Pavlov
(1849-1936), who derived some of his concepts from his fellow countryman I.
clinicians, notably W. Gantt (b. 1893), who studied under him in Russia and
translating animal into human behavior, that is, to make the higher nervous
activity relevant to clinical issues. The other school of reinforcement theory
fifties, is especially identified with the work of the psychiatrist J. Wolpe (b.
1915), first at the University of Witwatersrand in South Africa and then at
Some reasons for the success of behavior therapy are the dissatisfaction
with psychodynamic therapies, its apparent measurability consonant with the
214
the future.
psychoses was rejected almost universally (K. Abraham was perhaps the only
exception) on the basis that the patient was unable to develop a transference
neurosis.
Md., on the basis of his interpersonal theory of behavior. While his empirical
efforts influenced many in this country and in Europe, his theoretical
introduced by J. Rosen, first in New York City and then at the Institute for
disturbed communications between the patient and his family (G. Bateson, D.
sound research.
the focus on this approach is new, its use in some cases goes back to Freud
216
himself (particularly in the famous treatment of the conductor Bruno Walter)
and to some of the early psychoanalysts. Alfred Adler practiced short-term
Psychoanalysis.
dehumanizing forces, and their modest view of the role of the therapist as a
218
(H. Schulz-Henke and W. Reich) and the American concept of the “self” (G.
Mead), in a number of popular books illustrated the clinical implications of
self, self-image and relationship of the self to others on the basis of the
is quite limited.
The main thrust of the cognitive and volitional school, a new trend
that affects are not major agents in human conflicts and in conscious and
except the most primitive are consequent to meaning or choice. In their turn
they generate new meanings and choice.” In essence primary consideration is
given here to the cognitive dimension in its relation both to conflict and
creativity in the light of its unique importance for the human condition.
called parent, adult, and child) are combined in the different forms of basic
human interactions.
Psychotherapeutic Borderlines:
Sensitivity Training, Encounter, and Marathon Groups
220
The various movements listed in this section are quite recent and all of
American origin. Their rapid success in some quarters, mainly outside the
and alienation felt by many; paradoxically these feelings are reinforced by the
relationship.
effort, supported by the Gould Academy in Bethel, Maine, resulted the work of
the National Training Laboratories. Eventually in the fifties the emphasis
transitional nature of their methods based on the “here and now”; their
appeal mainly to sophisticated people (not “patients”) of the East and West
Coast; the call for “honesty” on the part of every participant and leader (and
surface through these sessions; and consequently the ethical aspect of the
leader’s responsibility.
emphasizing the unity of body and mind and grouped under the term of
Gestalt therapy. Common to all of them (initiated by the neo-Reiehian A.
Lowen with his bioenergetie group therapy) is the postulate that release of
a variety of ways.
took into consideration the body as well as the mind, as pointed out in some
222
Zen Buddhism). Those therapeutic methods, however, represented an
expression of their own culture, while the methods described in this section
civilization.
Research in Psychotherapy
has already been made in some scattered passages in this chapter. However,
Two points stand out, in some way related to each other. In the first
attitude may have been due to a number of reasons: the discouraging number
of variables intervening in the psychotherapeutic process; the lack of
and technique.” The few issues dedicated to this topic by the American Journal
of Psychotherapy, the small monograph Psychotherapy and the Dual Research
Tradition (1969) by the Group for the Advancement of Psychiatry, and the
224
may, however, change in the future in connection with some developments:
the decrease of the omnipotent image of the therapist and of the charismatic
to measurement; and the overall political and social situation, which calls for
a more thorough justification of the use of public funds in the field of mental
health, even in psychotherapy.
Milieu Therapy
mentally ill in any institutional setting may have been overlooked, but it has
certainly been present from early times on. Evidence of the importance of
latter part of the century, the environment became more custodial and
impersonal.
The advent of the psychodynamic approach did not alter this situation
country, while reducing the omnipotent role of the therapist to more modest
Jones in England and The Mental Hospital (1954) by Stanton and Schwartz,
Much effort has been made to prove the underlying assumption that a stable
free areas of the ego and adaptation (H. Hartmann), in terms of clarification
and learning of roles (T. Parsons, G. Mead), on the basis of the notion of the
field of forces (K. Lewin’s “lifespace”), and from the overall perspective of
Western democratic society. Up until now the best attempt to conceptualize
the therapeutic areas of the environment remains Ego and Milieu Therapy by
226
milieu will increasingly be considered as an open system from the viewpoint
of the general systems theory and will be concretely affected by the
Psychiatric Education
apprenticeship for medicine men have been in use from earliest times (for
today’s psychotherapists.
A. Meyer (who first developed there his “life chart” of the individual
model of the Kaiser Wilhelm Institute for Psychiatry in Munich, the so-called
Kraepelin Institute.
Since then much has happened in the field of psychiatric training in this
and outpatient facilities with the help of private foundations (especially the
228
Psychiatry in Medical Education, and H. Witmer, who published Teaching
Psychotherapeutic Medicine).
World War II, by emphasizing the great need for psychiatry, led to a vast
early fifties on, such a program has been undertaken almost exclusively by
the National Institute of Mental Health through its division of training and
manpower. By the time the First Conference on Psychiatric Education was
by the Group for the Advancement of Psychiatry (1948) had identified the
the decline of the psychoanalytic movement and the parallel rise of the
In the last two decades most of psychiatric training has taken place with
the support of the federal government: the original program of NIMH began
with a little more than 200 grants annually and now is in the realm of 10,000.
This has had, on the one hand, the advantage of fostering a certain degree of
interfering with the aim of making psychiatry available even in less populated
230
vastness of each new field of psychiatry, such an ambitious program can be
realistically carried on in very few places.
the appealing volume Man, Mind and Medicine, edited by the distinguished
surgeon, Oliver Cope), only slow gains toward the acceptance of psychiatry
have been made thus far among the already established professionals. The
psychiatry, which has become the third largest specialty. Also a cause of
concern is the shortage of psychiatrists actively involved in research, in spite
232
The future of psychiatric education, though promising in terms of
Health. This may result in a broader support of training at the state and local
the moment, the following remarks are the result of a broad perusal of
Even a succinct discussion of the above points calls, however, for some
toward the mentally ill in our country from the almost exclusive perspective
of psychoanalysis up until recently. Finally, parallel to the spread of the
234
approaches to mental illness and its treatment carried on in other countries
Concomitant with this has been a better definition of the three growing
In spite of the tendency toward the spread of Western practices all over
discussion is divided into: (1) countries of the Western tradition, that is,
China, and some others; and (3) international psychiatry. The developments
of psychiatry in these various countries will be presented essentially in their
On the one hand, in view of the different ethnic, cultural, economic, and
political aspects of the many countries of the Western tradition, it is
unitary form. On the other hand, the interchange of ideas and people among
To begin with, a few main aspects stand out clearly on the basis of some
others. There are many similarities between British and American trends, at
236
finally the interest in experimentally testing the above methods by
interdisciplinary teams of scientists. The main difference between Great
Britain and the United States consists, of course, in the uniformity of the
ethnic and cultural scene of the former vis-a-vis the racial and social
pluralism of the latter, with definite repercussions on psychiatry. This is
approaches.
the rational tradition (derived from Leibnitz and Kant), which has resulted in
a more philosophical view of mental life; the persistent concern with the
“whole man,” which stems from the Greek tradition and which is somehow
psychiatric theory and practices into definite “schools,” each one led by an
significant change after World War II; such an influence persisted in regard to
States: (i) moral treatment in the early nineteenth century; (2) organicistic
philosophy in the late nineteenth century; (3) psychoanalytic influence in the
in the last two decades. For the purpose of this chapter the discussion will be
necessarily limited to this last point, as advances in chemotherapy have
238
already been discussed above, also from the international perspective.
“open-door policy” in mental hospitals, on day hospitals (J. Bierer), and on the
were the uneven and loose systems of training, the lack of systematic support
for research even to dedicated scientists, the resistance of professionals to
more tolerant attitude toward the mentally ill on the part of society, which is
schizophrenic”).
“moral treatment” and the movement of “no restraint” in the early nineteenth
240
Klein and even to follow ideas put forward by C. Jung. The trend of
organicistie psychiatry has remained very strong, however, in line with the
Among the most prominent psychiatrists are (or have been) D. Henderson, D.
psychiatry: in 1948 the National Mental Health Service Act placed the care
and treatment of the mentally ill under the Ministry of Health on a regional
basis; the Mental Health Act of 1959 removed any legal distinction between
very limited.
psychology (A. Binet), and social psychology (E. Durkheim and others) were
directly as well as P. Janet (1859-1947 ). Through Janet and some of his early
disciples the psychoanalytic movement developed on a limited scale, also
with the support (in contrast to the belief of many) of some progressive
French Psychoanalytic Society, led by D. Lagache and J. Lacan; the latter is the
author of a famous paper (1953) in which he identified the structure of the
influences (J.-P. Sartre). In recent years the two psychiatrists J. Delay and H.
Ey, both authors of many publications aiming at the integration of organic and
242
arrondissement in Paris). The new trend of structuralism—mainly
in Paris were held both the First International Congress of Child Psychiatry
(1937) and the First World Congress of Psychiatry (1950).
Belgium, the country where family care of the mentally ill was continued
Querido).
the Aryan race. In the thirties for a few years the Berlin Psychoanalytic
244
the contributions to ethology by K. Lorenz and others (N. Tinbergen, C.
Schiller, H. Hass ), and the recent studies dealing with sociological (including
Adorno in this country and then in Germany (especially his study on the
appeared there.
Psychology, 1845) and, later on, studies by the organicistic school (T. Meyncrt,
R. Krafft- Ebing) received impetus through the renown of the medical school
of Vienna and the extension of the Austrian empire. For the past two decades
have been the subject of many studies in the United States. In Austria,
pupils from Austria (as well as the sympathizer P. Sehilder, whose studies on
Bleuler. There A. Meyer received his first psychiatric training before moving
associations early in this century); and H. Rorschach developed his test that
soon became known the world over. Aside from Jung’s followers such as C.
Meier, C. Kereny, and others, gathered around the Jung Institute in Zurich and
the so-called Eranos meetings in Ascona, worth remembering are the names
246
Oberholzer (who moved to New York City, where he introduced the
Storch, has been applied first by M. Seehe- haye with her technique of
“symbolic realization” and then by C. Müller in Bern and by the Italian-born G.
view of the stability of the social situation and the long-term absence of great
military conflicts, research on hereditary factors in mental illness has
health.
Italy, Spain, and Portugal are presented together here because of close
ethnic, religious, and cultural affinities that justifiably can be extended to
psychiatry. In these countries care of the mentally ill has had an illustrious,
the Nobel Prize winner C. Golgi and the pathographic studies by C. Lombroso
248
University of Rome S. De Sanctis’s notions on child psychosis (Dementia
by U. Cerletti and L. Bini in the late thirties was applied everywhere. Recently
through a long period of decline. Only at the beginning of this century ample
system by Ramon y Cajal and his school. In recent years psychodynamic and
existentialist concepts have gained momentum there (J. Lopez-Ibor, R. Sarro),
and psychiatry has been given more recognition, as evidenced by the Fourth
psychiatry, and the interchange of professionals has always been very high
(for example, C. Farrar from Toronto was for many years editor of the
the British association, gained autonomous status in the fifties. It has been
heavily influenced by Catholic philosophy in the French province of Quebec
(for example, by K. Stern in his The Third Revolution and by N. Mailloux at his
orders have taken care of institutionalized mental patients for the past two
centuries. Academic psychiatry has been particularly cultivated in Toronto
(W. Penfield, H. Jasper, F. Gibbs, E. Gibbs, and H. Selye, who described the
example, through the report More for the Mind published in 1963 by the
Canadian Mental Health Association under the leadership of J. Griffin) to
250
Association (founded in 1951), has already led to considerable progress in
has been operating under A. Stoller since 1955), while relatively few take part
Psychotherapy).
Israel, a small and young nation, offers a great deal of interest for
Russia, and E. Neumann of the Jungian school. Since its founding Israel has
become a fertile ground for psychiatry in three main areas: (1) coping with
geographical and cultural situation, economic and social level in each country,
in addition to the unstable political scene. Yet certain common trends can
in the mid-nineteenth century, later on the German tradition, and after World
War II on the American tradition; in many countries methods of indigenous
252
Inter-American Council of Psychiatric Associations—including the American,
the Canadian, and the Latin American Associations—have led to rather
meager results thus far. In general, most of the broad long-range projects
initiated in Latin America tend to achieve limited results because of social and
political difficulties.
World War II. From the psychiatric perspective two main areas are thus
institutional settings, and others are connected with the Puerto Rican
LaFuente, J. Velasco Alzaga, and others) and in psychoanalysis (E. Fromm has
introduced in the past (mainly by J. Matte-Blanco and C. Nassar), after the rise
to power of the leftist government of the physician S. Allende, who was
254
psychodynamic notions were introduced first by H. Delgado and later by C.
Seguin and where an Institute of Social Psychiatry was founded in 1967 at the
University of San Marcos in Lima, the oldest medical school in the American
continent.
psychiatry. More recently impetus for psychiatry has been provided in Sao
Paulo by A. Pacheco e Silva.
other immigrants in the late forties. All this overshadowed the fact that
concepts. Among the professionals recognition has been won by A. Garma for
for the mentally ill throughout the whole country, was founded in 1957.
Russia and the communist countries offer a rather complex and varied
doctrine. ”
been found that Russia has developed a network of services for mental
patients, first at the level of the polyclinic (one for every 5,000 people), then
256
the neuropsychiatric dispensary (one for every 500,000 people), and finally
the district mental hospital, in all of which extensive work on prophylaxis,
diagnosis, and rehabilitation takes place. Such work is possible because of the
large number of physicians (more than 600,000 mostly women), nurses, and
medical technicians (that is, paraprofessionals, called “feldshers”) available in
system), " with the consequent complete absence of the collateral fields of
clinical psychology and social work, the limited research facilities (mainly at
two centers in Moscow and Leningrad), and the recently established
interested attitude in this country for two reasons: from the perspective of
services for the mentally disturbed at the community and district level. Aside
Russia because of the reasons mentioned above, in spite of the efforts made
which had a long tradition in each one of them. In Poland much of the care for
the institutionalized mentally ill is still in the hands of Catholic orders, while
in Bulgaria and Runumia, as in the rest of the communist countries, systems
258
From an overall historical perspective—and taking into consideration
of the Far Eastern tradition can roughly be divided into three types: (1) those
that developed as part of the British Commonwealth (India, Ceylon, etc); (2)
practices and Western concepts (Japan, Philippines, Taiwan); (3) and those in
Psychiatric Society. Today there are about 200 psychiatrists for a population
German school, while, in general, the attitude toward the mentally ill was
rather punitive or neglectful (with some exceptions, such as the system of
community care practiced at Iwakura, near Kyoto). In the late twenties the
ambivalence toward Western progress, admired but also hated (J. Moloney’s
Understanding the Japanese Mind, 1954). Around the same time the so-called
Morita therapy (named after the Tokyo psychiatrist S. Morita) was
260
psychodynamic schools. Regardless of differences in orientation, the
individual; disregard for Tao may cause an imbalance between the two basic
forces Yin and Yang, to which are subjected the various organs and channels
connecting the inside to the periphery and the five constituents of the body,
that is, earth, fire, water, wood, and metal. Since early times (such as in The
Yellow Emperor’s Classic of Internal Medicine, about 1,000 b.c.) the treatment
flow of Yin and Yang along the proper channels. In the coastal cities of Canton,
Shanghai, and a few others, Western practices were introduced a century ago
mainly by American missionaries, so that the few psychiatrists came to be
Since the communists took over in 1949, psychiatry has come to be seen from
Psychiatry and the Chinese Neurological and Psychiatric Journal came into
existence, psychiatric training was introduced in all 50 medical schools, and
and Western practices from the mid-sixties on), milieu therapy focused on
group sessions directed toward ideological discussions has received the
various points have many implications for mental health from the Western
262
Psychiatry at the International Level
culture that has taken place during the period considered in this chapter,
disorders in other countries has come from the rapidly increasing contacts
among people of different nations since the end of World War II and, even
more, from the rise of many independent nations in the Afro-Asian areas.
In connection with this latter event governments all over the world are
The role of the United States has been so prominent in helping these various
governments in this endeavor as to justify the separate presentation of this
the basis of recent studies (such as the comprehensive survey by A. Kiev): the
scientific approach attempts to explain how, folk attitudes why (e.g., influence
or delusions) and the form (e.g., unusual syndromes due to altered states of
depending on the social expectation of the role played by the mentally ill (G.
alcoholism, homosexuality) and occur more often than others (e.g., frequent
acute schizophrenic breakdown versus rare depressive conditions in Africa);
are based on a mixture of exorcism, drugs, and particular rituals, such as the
interpretation of dreams; rapid social changes occurring mainly in Afro-Asian
countries tend to result in stress that facilitates the rise of messianic and
superstitious cults.
where hospital facilities are rare, life expectancy is shorter, and migrations as
well as political and social conflicts (urbanization, industrialization, etc.) are
264
frequent. It also becomes understandable why in many countries the
Congress in Mental Health), the World Federation for Mental Health, under
the dedicated leadership of few professionals (first the British J. Rees, then
of mental hygiene.
juvenile delinquency (by L. Bovet, 1951) on maternal care and mental health
was elected the first president. Through the dedication of many psychiatrists
(mainly the French J. Delay, H. Ey, and P. Sivadon, the Spanish J. Lopez-Ibor,
the Swiss M. Bleuler, the British D. Leigh and J. Wing, and the American H.
Tompkins, D. Blain, and F. Braceland), it has fostered the dissemination of
subjects.
266
Psychiatry has been edited by J. Aronson in New York City since 1963, while,
among the developing nations, the periodical Pstjchopathologie Africaine has
responsibility toward all the citizens of the nations. For the historian it is
important to determine the main currents that have created this situation,
268
increasingly important role at the international level, first through research
matters on the part of this country can be traced back to the establishment of
National Association for Mental Health, 1909), which organized the First
committees), aside from the substantial support given to the United Nations.
the end of the war, with the help of various organizations, a good number of
some of them eventually settled permanently in this country. In the sixties the
majority of the foreign physicians in training came from developing Far
Eastern nations (India, Korea, Philippines); in fact, during the academic year
America has a commitment to developing countries to help train staff for their
own programs.
riots, and the Poor People’s March), and some important judicial and political
education, President Johnson’s War on Poverty, etc.), this country has become
aware, as never before, of large areas of poverty and deep racial and social
conflicts. As a result of this new awareness, the community mental health
movement, discussed in detail in another section of this chapter, has been
taking place.
270
S. Minuchin, F. Riessman, and others), assessing community-based facilities in
some areas (for example, in a section of New York City by L. Kolb and
In view of all this, the situation of psychiatry in many other parts of the
world, where poverty and social conflicts are endemic, has become quite
fifties, psychiatry in practically all the rest of the world was seen as inferior to
movement of the sixties, systems of care and treatment of the mentally ill
This ranges from a more tolerant attitude toward the mentally disturbed by
toward prevention and help to many more people throughout the country.
youth revolt to drug abuse ) and toward worldwide cooperation (e.g., in space
exploration and in ecological projects) cannot but affect also the field of
psychiatry.
modes of help” (that is, community mental health) in eras of social reforms,
may be debatable. The fact remains, however, that historically a definite
change is taking place in the role of psychiatry from the viewpoint of the
psychiatric profession itself, of the patient, and of the public at large.
272
1958) is being challenged by the notion that there are few differences
between psychoanalysts, psychiatrists, psychologists, and social workers (W.
Strauss, 1964), quite often in a rather narrow way (W. Freeman, 1968). In
reality the first two models are the most pervasive, while thus far community
action has not attracted many, as shown in the thorough study by A. Rogow.
Claims of psychoanalytic contributions to community action (in D. Milman
of the Joint Commission of Mental Health of Children) are far from being
substantiated.
how a person finds a psychiatrist (Harper’s, 1960). The results of his own
research (with Hollingshead, 1959), that low-income people tend to receive
study by J. Myers and L. Beam (1968). There is a need for studies along the
all pointing to the fact that the majority of people tend to turn for help to
become the third most frequent choice of specialty by young physicians after
medicine and surgery, and there has been massive federal support of training
the values of the professionals and their allegiance to their own values.
274
assumed that values were not relevant to psychiatry. This notion was later
challenged by many who became aware of the unconscious identification of
the patient with the therapist’s own values. In the fifties, during the short
Psychotherapy, 1962).
In the last decade the main issue in regard to values has shifted from
The fact that many of these latter problems transcend the boundaries of
our nation should not deter American psychiatrists from meaningful
the position officially taken by the Group for the Advancement of Psychiatry
children, by M. Dumont (The Absurd Healer, 1969), by R. Leifer (In the Name
of Mental Health, 1969), and by others on the uncertain role of the
psychiatrist at present are expressions of this trend. Also notable are the
liberal attitude of some psychiatrists toward the use of drugs and toward
violence and current president, A. Freedman, has been elected with the
support of the Committee for Concerned Psychiatrists, a newly formed group
276
All this points to the fact that in a matter of a few years a generation gap
who still control many academic positions, and many socially committed
psychiatrists. Certainly, on the one hand, the latter should realize that
(1971).
Association, society, rather than the patient, appears to be sick today. Yet the
irrational expressions of many, up to despair, should not deter us from
reason: “Sooner or later,” he concluded, “the soft voice of reason will be heard
once again.”
Alan Gregg, a great mentor of our profession, on the occasion of the centenary
“Psychiatry, along with the other natural sciences, leads to a life of reason. .
interest in history may be essential for the rise of a new humanism to which
Bibliography
bibliography:
1. Well-known books are cited in the text only, together with the
name of their authors. They are not listed in the bibliography
because the complete reference is given in other chapters
dealing specifically with the topic to which the book refers.
278
c. Specific articles that historically represent the beginning of a
new field.
1971. Menninger, K., A Guide to Psychiatric Books in English, 3rd ed., Grune &
Ackerknecht, E., Medicine and Ethnology: Selected Essays, Johns Hopkins Press, Baltimore, 1971.
_____ , A Short History of Psychiatry, 2nd ed., Hafner, New York, 1968.
Albee, G. W., “A Specter Is Haunting the Out-Patient Clinic,” in Tulipan, A. B., and Feldman, S.
(Eds.), Psychiatric Clinics in Transition, Brunner-Mazel, New York, 1969.
Alexander, F., and Ross, H. (Eds.), Twenty Years of Psychoanalysis, Norton, New York, 1953.
_____, Eisensteix, S., and Grotjahn, M. (Eds.), Psychoanalytic Pioneers, Basic Books, New York, 1966.
_____, and Selesnick, S., The History of Psychiatry, Harper & Row, New York, 1966.
Alinsky, S., “The War on Poverty-Political Pornography,” J. Soc. Issues, 21.41-47, 1965.
Allport, G. W., “European and American Theories of Personality,” in David, H. P., and Von Bracken,
Alt, H., and Alt, E., Russia’s Children, Bookman Associates, New York, 1969.
Altschule, M. D., Roots of Modern Psychiatry: Essays in the History of Psychiatry, Grune & Stratton,
New York, 1957.
American Journal of Psychiatry, Centennial Anniversary Issue, 1844-1344, Washington, D.C., 1944.
Ansbacher, H. L., “Alfred Adler: A Historical Perspective,” Am. J. Psychiat., 127-777-782, 1970.
_____, and Ansbacher, R. R. (Eds.), The Individual Psychology of Alfred Adler, Basic Books, New
York, 1956.
Arieti, S., “Conceptual and Cognitive Psychiatry,” Am. J. Psychiat., 122:361-366, 1965.
_____, The Intrapsychic Self: Feeling, Cognition, and Creativity in Health and Mental Illness, Basic
Books, New York, 1967.
_____, “New Views on the Psychodynamics of Schizophrenia,” Am. J. Psychiat., 124:453-458, 1967.
_____, “The Psychotherapeutic Approach to Depression,” Am. J. Psychother., 16: 361-366, 1962.
_____, “Some Elements of Cognitive Psychiatry,” Am. J. Psychother., 21:723- 736, 1967.
_____, “The Structural and Psychodynamic Role of Cognition in the Human Psyche,” in Arieti, S.
(Ed.), The World Biennial of Psychiatry and Psychotherapy, Vol. I, pp. 3-33, Basic
Books, New York, 1970.
280
_____, The Will to Be Human, Quadrangle, New York, 1972.
Aronson, J., and Field, M. G., “Mental Health Programming in the Soviet Union,” Am. J.
Orthopsychiat., 34:913- 924, 1964.
Aserinsky, E., and Kleitman, N., “Regularly Occurring Periods of Eye Motility and Concomitant
Phenomena during Sleep,” Science, 118:273-274, 1953.
Auerbach, H., “The Anti-Mental Health Movement,” Am. J. Psychiat., 220:105-112, 1963.
Auerswald, E., “Interdisciplinary versus Ecological Approach,” Fam. Process, 7: 202-215, 1968.
Auster, S. L., “Impressions of Psychiatry in One Russian City,” Am. J. Psychiat., 124:538-542, 1967.
Ayd, F. J., and Blackwell, B. (Eds.), Discoveries in Biological Psychiatry, Lippincott, Philadelphia,
1970.
Babayan, E. A., “The Organization of Psychiatric Services in the USSR,” Int. J. Psychiat., 1:31-35,
1965.
Bach, G. E., and Illing, H., “Historische Perspektive zur Gruppenpsychotherapie,” Zeitschrift für
Psycho-somatische Medizin, 2:132-147, 1956.
Bandler, B., “The American Psychoanalytic Association and Community Psychiatry,” Am. J.
Psychiat., 124:1037-1042, 1968.
Bandler, S., “Current Trends in Psychiatric Education,” Am. J. Psychiat., 127: 585-590. 1970.
Barahal, H. S., “Resistances to Community Psychiatry,” Psychiat. Quart., 45: 333-347, 1971.
Barton, W., “Historical Perspective in the Delivery of Psychiatric Services,” in Stokes, A. B. (Ed.),
Psychiatry in Transition, 1966-1967, pp. 3-18, University of Toronto Press, Toronto,
1967.
_____, “Prospects and Perspectives: Implications of Social Change for Psychiatry,” Am. J. Psychiat.,
125:147-150, 1968.
_____, Farrell, M. J., Lenehan, F. T., and McLaughlin, W. F., Impressions of European Psychiatry,
American Psychiatric Association, Washington, D.C., 1961.
Baruk, H., La psychiatric frangaisc de Pinel a nos jours, Presses Universitaires de France, Paris,
1967.
Bateson, G. (Ed.), Perceval's Narrative: A Patient's Account of His Own Psychosis, 1830-1832,
Stanford University Press, Stanford, 1961.
Becker, R. de, The Understanding of Dreams: Their Influence on the History of Man, Hawthorn, New
York, 1968.
Bell, N. W., and Spiegel, J. P., “Social Psychiatry: Vagary of a Term,” Arch. Gen. Psychiat., 14:337-
345, 1966.
Bellak, L., “The Role of Psychoanalysis in Contemporary Psychiatry,” Am. J. Psychother., 24:470-
476, 1970.
_____, “Some Personal Reflections on European and American Psychiatry,” in Beliak, L. (Ed.),
Contemporary European Psychiatry, pp. vii-xxvi, Grove Press, New York, 1961.
Belloni, L., “Dall’elleboro alia reserpina,” Archivio di psicologia, neurologia e psichiatria, 17:115-
148, 1956.
Bemporad, J. R., “New Views on the Psychodynamics of the Depressive Character,” in Arieti, S.
(Ed.), The World Biennial of Psychiatry and Psychotherapy, Vol. I, pp. 219-243, Basic
282
Books, New York, 1971.
_____, and Muller, C., “Switzerland,” in Beliak, L. (Ed.), Contemporary European Psychiatry, pp. 325-
359, Grove Press, New York, 1961.
Benne, K. D., “History of the T-Group in the Laboratory Setting,” in Bradford, L. P., Gibb, J. R., and
Benne, K. D. (Eds.), T-Group Theory and Laboratory Method: Innovations and Re-
Education, Chap. 4, John Wiley, New York, 1964.
Bennett, C. L., and Gruenberg, E., “A Substitute for Clinical Thinking,” Int. J. Psychiat., 9:621-627,
1970.
Berman, G., “Mental Hygiene in Latin America,” in Shore, M. J. (Ed.), Twentieth Century Mental
Hygiene, pp. 403- 428, Social Sciences Publishers, New York, 1950.
_____, La salud mental y la asistencia psiquiatrica en la Argentina, Paidos, Buenos Aires, 1965.
Bernard, V. W., “Interracial Practice in the Midst of Change,” Am. J. Psychiat., 128: 978-984, 1972.
Bernfeld, S., “Freud’s Scientific Beginnings,” in Lorand, S. (Ed.), The Yearbook of Psychoanalysis,
Vol. 6, pp. 24- 50, International Universities Press, New York, 1950.
Binger, C., Revolutionary Doctor: Benjamin Rush, 1746-1813, Norton, New York, 1966.
Binswanger, L., Being-in-the-World: Selected Papers, Basic Books, New York, 1963.
Blain, D., Potter, H., and Salomon, H., “Manpower Studies with Special Reference to Psychiatrists,”
Am. J. Psychiat., 116:791-797, 1960.
Bleuler, E., Dementia Praccox or the Group of Schizophrenias, International Universities Press,
New York, 1950.
Bleuler, M., “Conception of Schizophrenia within the Last Fifty Years and Today,” Proc. Roy. Soc.
Mecl., 66:945-952, 1963; repr. in Int. J. Psychiat., 1:501-523, 1965.
_____, “Research and Changes in Concepts in the Study of Schizophrenia, 1941-1950,” Bull. Isaac
Ray Med. Lib. (Providence, R. I.), 3.1-132, 1955.
Blum, R. H., et al., Society and Drugs, 2 vols., Jossey-Bass, San Francisco, 1970.
Bockoven, S., Moral Treatment in American Psychiatry, Springer, New York, 1963, 2nd ed., Moral
Treatment in Community Mental Health, Springer, New York, 1972.
Boguslaw, W., The New Utopians, Prentice-Hall, Englewood Cliffs, N.J., 1965.
Bohannan, P. (Ed.), African Homicide and Suicide, Princeton University Press, Princeton, 1960.
Bonaparte, M., The Life and Works of Edgar Allan Poe, Imago, London, 1949.
Bond, E., Dr. Kirkbride and His Mental Hospital, Lippincott, Philadelphia, 1947.
Booth, G., “Values in Nature and Psychotherapy,” Arch. Gen. Psychiat., 8:22-32, 1963.
Si. Boss, M., Psychoanalysis and Daseinsanalysis, Basic Books, New York, 1963.
284
Bostock, J., The Dawn of Australian Psychiatry, Australian Medical Association, Mervyn Archdall
Medical Monograph Number 4, Sidney, 1968.
Boyeras, R. (Ed.), R. D. Laing and Anti-Psychiatry, Harper & Row, New York, 1971.
Braceland, F., “Biological Research Developments in Psychiatry,” in Talkington, P. C., and Bloss, C.
L. (Eds.), Evolving Concepts in Psychiatry, pp. 52-64, Grune & Stratton, New York,
1969.
_____, “Historical Perspectives of the Ethical Practice of Psychiatry,” Am. J. Psychiat., 126:230-237,
1969.
Brand, J. L., “The National Mental Health Act of 1946: A Retrospect,” Bull. Hist. Med., 39:231-245,
1965.
_____, “The United States: A Historical Perspective,” in William, R. H., and Ozarin, L. D. (Eds.),
Community Mental Health. An International Perspective, pp. 18-43, Jossey-Bass, San
Francisco, 1968.
Bhody, E. B., “Cultural Exclusion, Character and Illness,” Am. J. Psychiat., 122: 852-857.
_____ , (Ed.), Mental Health in the Americas, Report of the First Hemisphere Conference,
Washington, D.C., American Psychiatric Association, 1969.
_____, “Psychiatric Education in the Americas,” Am. J. Psychiat., 127:1479- 1484, 1971.
Brofenbrenner, U., Two Worlds of Childhood: U.S. and U.S.S.R., Russell Sage Foundation, New York,
1970.
Brosin, H. W., “The Changing Curriculum,” in Stokes, A. B. (Ed.), Psychiatry in Transition, 1966-
1967, pp. 39-55, University of Toronto Press, Toronto, 1967.
Brothers, C. R. D., Early Victorian Psychiatry, 1835-1905, Mental Health Authority, Melbourne,
1962.
Brown, B. S., “Psychiatric Practice and Public Policy,” Am. J. Psychiat., 125: 141-146, 1968.
Brown, J. A. C., Freud and the Post-Freudians, Penguin Books, Baltimore, 1961.
Brown, N., Life against Death: The Psychoanalytic Meaning of History, Wesleyan University Press,
Middletown, 1959.
Brozek, J., and Slobin, D. I., Psychology in the USSR: An Historical Perspective, International Arts
and Science Press, White Plains, N.Y., 1972.
Brun, R., General Theory of Neurosis., International Universities Press, New York, 1951.
Cahnman, W. J., and Boskoff, A. (Eds.), Sociology and History: Theory and Research, Free Press,
New York, 1964.
Caldwell, A. E., Origins of Psychopharmacology: From CPZ to LSD, Charles C Thomas, Springfield,
Ill., 1970.
Cameron, D. E., “The World Psychiatric Association,” Am. J. Psychiat., 12,3:1439- 1441, 1967.
Caplan, R. (in collaboration with Caplan, G.), Psychiatry and the Community in Nineteenth-Century
286
America, Basic Books, New York, 1969.
Carmichael, H. T., “Perspectives on the American Board of Psychiatry and Neurology,” Arch. Gen.
Psychiat., 8:405- 417, 1963.
Carothers, J. C., The African Mind in Health and Disease: A Study in Ethno-psychiatry, World Health
Organization, Geneva, 1953.
Carp, E. A. D. E., The Affective Contact, Proceedings of the International Congress for
Psychotherapeutics, Leiden, Sept. 5-10, 1951, Strengholt, Amsterdam, 1952.
Castelnuovo-Tedesco, P., The Twenty-Minute Hour: A Guide to Brief Psychotherapy for the
Physician, Little Brown, Boston, 1965.
Caudill, W., and Doi, L. T., “Psychiatry and Culture in Japan,” in David, H. P. (Ed.), International
Trends in Mental Health, pp. 97-108, McGraw-Hill, New York, 1966.
_____ , and Schooler, C., “Symptom Patterns and Background Characteristics of Japanese
Psychiatric Patients,” in Caudill, W., and Lin, T. (Eds.), Mental Health Research in
Asia and the Pacific, pp. 114-147, East-West Center Press, Honolulu, 1969.
Cerletti, U., “Italy,” in Beliak, L. (Ed.), Contemporary European Psychiatry, pp. 185-216, Grove
Press, New York, 1961.
_____ ,“Old and New Information about Electroshock,” Am. J. Psychiat., 107:87-94, 1950.
Chin, R., and Chin, A. S., Psychological Research in Communist China: 1949- 1966, MIT Press,
Cambridge, 1969.
Clark, D. H., Monro, A. B., Sainsbury, P., and Dicks, H. V., “The British National Health Service and
Psychiatry,” Am. J. Psychiat., 125:1218-1238, 1969.
_____, “Psychiatrists and Psychoanalysts on War,” Am. J. Psychother., 19:540- 557, 1965.
Clinard, M. B., Sociology of Deviant Behavior, Rinehart & Co., New York, 1957.
Colby, K. M., An Introduction to Psychoanalytic Research, Basic Books, New York, 1960.
Congress Report of the 2nd International Congress for Psychiatry, Zurich, 1-7 September 1957, 4
vols., Füssli, Zurich, 1959.
Connery, R. H. (Ed.), The Politics of Mental Health, Columbia University Press, New York, 1968.
Cope, O., Man, Mind and Medicine: The Doctor’s Education, A Chairman’s View of the Swampscott
Study on Behavioral Science in Medicine, 23 Oct-4 Nov. 1966, Lippincott,
Philadelphia, 1968.
Costigan, G., Sigmund Freud: A Short Biography, Macmillan, New York, 1965.
Cowen, E. L., Gardner, E. A., and Zax, M., Emergent Approaches to Mental Health Problems,
Appleton-Century-Crofts, New York, 1967.
Crisis in Child Mental Health: Challenge for the 1970’s, Report of the Joint Commission on Mental
Health of Children, Harper & Row, New York, 1970.
Dain, N., Concepts of Insanity in the United States, 1789-1865, Rutgers University Press, New
Brunswick, 1964.
288
_____, Disordered Minds: The First Century of Eastern State Hospital in Williamsburg, Va., 1766-
1866, University of Virginia Press, Charlottesville, 1971.
Daniels, D. N., Gigula, M. F., and Ochberg, F. M., Violence and the Struggle for Existence, Little,
Brown, Boston, 1970.
David, K., “Mental Hygiene and the Class Structure,” Psychiatry, 1:55-65, 1938.
Davidson, H. A., “The Image of the Psychiatrist,” Am. J. Psychiat., 122:329-334, 1964.
Davies, J., Phrenology, Fad and Science, Yale University Press, New Haven, 1955.
Day, M., “The Natural History of Training Groups,” Int. J. Group Psychother., 17: 436-446, 1967.
Dean, S. R., “Is There an Ultraconscious beyond the Unconscious?” J. Canad. Psychiat. A., 15.57-62,
1970.
Delay, J., The Youth of Andre Gide, University of Chicago Press, Chicago, 1963.
Delgado, J. M. R., Physical Control of the Mind, Harper & Row, New York, 1969.
Denko, J. D., “How Preliterate Peoples Explain Disturbed Behavior,” Arch. Gen. Psychiat., 25:398-
409, 1966.
_____, “The Role of Culture in Mental Illness in Non-Western Peoples,” J. Am. Med. Women’s A.,
19:1029-1044, 1964.
Deutsch, A., The Mentally Ill in America, 2nd ed., Columbia Univerity Press, New York, 1959.
Devereux, G., “Cultural Factors in Psychoanalytic Therapy,” J. Am. Psychoanal. A., 1:629-655, 1953.
_____, “Cultural Thought Models in Primitive and Modem Psychiatric Theories,” Psychiatry,
21:359-374, 1958.
Devoto, A., La tirannia psicologica. Studi di psicologia politico, Sansoni, Florence, 1960.
Dicks, H. V., Fifty Years of the Tavistock Clinic, Routledge & Kegan Paul, London, 1970.
Dienelt, K., From Freud zu Frankl, Osterreichischer Bundesverlag fiir Unrerricht, Wissenschaft
und Kunst., Vienna, 1967.
Dorner, K., Burger und Irre. Zur Sozialgeschichte und Wissenschaftsoziologie der Psychiatric,
Europaische Verlaganstalt, Frankfurt am Main, 1969.
Douglas, M. (Ed.), Witchcraft, Confessions and Accusations, Tavistock Publications, London, 1970.
Dreikurs, R., “Early Experiments with Group Psychotherapy,” Am. J. Psychother., 13:882-891,
1959.
_____, and Corsini, R., “Twenty Years of Group Psychotherapy,” Am. J. Psychiat., 110:567-575, 1954.
Dunham, W., “Community Psychiatry: The Newest Therapeutic Bandwagon,” Arch. Gen. Psychiat.,
22:303-313, 1965.
Ebaugh, F. G., “The Evolution of Psychiatric Education,” Am. J. Psychiat., 126:97-100, 1969.
Ebin, D. (Ed.), The Drug Experience, Grove Press, New York, 1961.
Ehrenwald, J., From Medicine Man to Freud: An Anthology, Dell, New York, 1956.
290
_____, Psychotherapy: Myth and Method. An Integrative Approach, Grune & Stratton, New York,
1966.
Ehrhardt, H., Ploog, D., and Stutte, H. (Eds.), Psychiatric und Gesellschaft, Huber, Beni, 1958.
Eissler, K. R., Goethe: A Psychoanalytic Study, 2 vols. Wayne State University Press, Detroit, 1963.
_____ , Leonardo da Vinci: Psychoanalytic Notes on the Enigma, International Universities Press,
New York, 1962.
_____, Sigmund Freud und die Wiener Universitdt, Bern and Stuttgart, 1966.
_____, Talent and Genius: The Fictitious Case of Tausk contra Freud, Quadrangle, New York, 1971.
Ekstein, R., and Wallerstein, R. S., The Teaching and Learning of Psychotherapists, 2nd ed., Basic
Books, New York, 1972.
Ellenberger, H., “A Comparison of European and American Psychiatry,” Bull. Menninger Clin.,
19:43-52, 1955.
_____, The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry, Basic
Books, New York, 1969.
_____, “La psychiatrie Suisse,” Evol. Psychiat., 16:321, 619, 1951; 17:139, 369, 593. 1952; 18:298,
719, 1953.
_____ , “Les illusions de la classification psychiatrique,” Evol. Psychiat., pp. 221- 242, 1963.
Erikson, E. H., “Autobiographic Notes on the Identity Crisis,” Daedalus, 99:730- 759, 1970.
_____, “On the Nature of Psycho-Historical Evidence: In Search of Gandhi,” Daedalus, 97:695-730,
1968.
_____, “Psychoanalysis and Ongoing History: Problems of Identity, Hatred and Non-Violence,” Am.
“Evaluation of the Results of the Psychotherapies,” Second and Third National Scientific Meetings
of the Association for the Advancement of Psychotherapy, Am. J. Psychother., 20:1-
202, 1966.
Evans, R. I., R. F. Skinner: The Man and His Ideas, Dutton, New York, 1968.
Ewalt, J. R., and Ewalt, P. L., “History of the Community Psychiatry Movement,” Am. J. Psychiat.,
126:43-52,
_____ , Schwartz, M. S., Appel, K. E., Bartemeier, L. H., and Schlaifer, C., “Joint Commission on Mental
Illness and Health,” Am. J. Psychiat., 116:782-790, 1960.
_____ , “Trends and Progress in French Psychiatry,” J. Clin. & Exper. Psychopath., 15:1-8, 1954.
Eysenck, H. J. (Ed.), Behavior Therapy and the Neuroses, Pergamon Press, New York, 1960.
Faber, M. D., The Design Within: Psychoanalytic Approaches to Shakespeare, Science House, New
York, 1970.
Fanchamps, A., “Des drogues magiques des Azteques a la therapie psycholytique,” Acta
Psychotherapeut., 10:372-384, 1962.
Farau, A., Der Einfluss der osterreischen Tiefenpsychologie auf die amerikanische Psychotherapie
der Gegewart, Sexl, Vienna, 1953.
Farber, M., The Foundation of Phenomenology, Harvard University Press, Cambridge, 1943.
Feldman, P. E., “The Personal Element in Psychiatric Research,” Am. J. Psychiat., 113:52-54, 1956.
Felix, R. H., “The Image of the Psychiatrist: Past, Present and Future,” Am. J. Psychiat., 121:318-
292
322, 1964.
_____, Mental Illness: Progress and Prospects, Columbia University Press, New York, 1967.
Fermi, L., Illustrious Immigrants: The Intellectual Migration from Europe, 1930-1941, University of
Chicago Press, Chicago, 1968.
Fernandez-Marina, R., “The Puerto Rican Syndrome: Its Dynamics and Cultural Determinants,
Psychiatry, 24:47-82, 1961.
Field, M. G., “Approaches to Mental Illness in Soviet Society: Some Comparisons and Conjectures,”
Soc. Problems, 7:277-297, 1960.
_____, “The Institutional Framework of Soviet Psychiatry,” J. Nerv. & Ment. Dis., 138:306-322, 1964.
_____, “Psychiatry and Ideology: The Official Soviet View of Western Theories and Practices,” Am. J.
Psychother., 22: 602-615, 1968.
Foster, E. B., “The Theory and Practice of Psychiatry in Ghana,” Am. J. Psychother., 16:7-51, 1962.
Foucault, M., Madness and Civilization: A History of Insanity in the Age of Reason, Pantheon Books,
New York, 1965.
_____, The Order of Things: An Archaeology of the Human Sciences, Pantheon Books, New York,
1971.
Frank, J. D., Persuasion and Healing: A Comparative Study of Psychotherapy, Johns Hopkins Press,
Baltimore, 1961.
_____, Sanity and Survival: Psychological Aspects of War and Peace, Random House, New York,
1967.
Franks, C. M., Behavior Therapy: Appraisal and Status, Chap. 1, McGraw-Hill, New York, 1970.
Freedman, A. M., “Historical and Political Roots of the Community Mental Health Centers Act,”
Am. J. Orthopsychiat., 37: 487-494, 1967.
Freedman, W., The Psychiatrists, Personalities and Patterns, Grune & Stratton, New York, 1968.
Freud, A., “Clinical Studies in Psychoanalysis (Research Project at the Hampstead Child Therapy
Clinic),” Proc. Roy. Soc. Med., 51;937-974, 1958.
Freud, E. L. (Ed.), The Letters of Sigmund Freud and Arnold Zweig, Harcourt, Brace & World, New
York, 1970.
Freud, S., The Freud Journal of Lou Andreas-Salome, ed. by Leavy, S. A., Basic Books, New York,
1964.
_____, The Origins of Psychoanalysis. Letters to Wilhelm Fliess, Drafts and Notes: 1887-1902, Basic
Books, New York, 1954.
_____, Psychoanalysis and Faith: The Letters of Sigmund Freud and Oskar Pfister, ed. by Meng, H.,
and Freud, E. L., Basic Books, New York, 1963.
_____, A Psycho-Analytic Dialogue: The Letters of Sigmund Freud and Karl Abraham, 1907-1926, ed.
by Abraham, H. C., and Freud, E. L., Basic Books, New York, 1965.
Fried, M., “Effects of Social Change on Mental Health,” Am. J. Orthopsychiat., 34:3-28, 1964.
Fromm, E., Suzuki, D. T., and De Martino, R., Zen Buddhism and Psychoanalysis, The Zen Studies
Society, New York, 1960.
294
Fromm-Reichmann, F., “Notes on the History and Philosophy of Psychotherapy,” in Fromm-
Reichmann, F., and Moreno, J. L. (Eds.), Progress in Psychotherapy, pp. 1-23, Grune &
Stratton, New York, 1956.
Funkenstein, D. H., “A New Breed of Psychiatrist?” Am. J. Psychiat., 124:226- 228, 1967.
Furman, S. S., Community Mental Health Services in Northern Europe, Great Britain, Netherlands,
Denmark and Sweden, PHS Pub. No. 1407, U.S. Government Printing Office,
Washington, D.C., 1965.
_____, “Obstacles to the Development of Community Mental Health Centers,” Am. J. Orthopsychiat.,
37:7 58-765, 1967.
Galdston, I., “Community Psychiatry, Its Social and Historic Derivations,” J. Canad. Psychiat. A.,
10:461-473, 1965
_____ (Ed.), The Interface between Psychiatry and Anthropology, Brunner Mazel, New York, 1971.
Gantt, W. H., Pickenhain, L., and Zwingmann, C. (Eds.), Pavlovian Approach to Psychopathology:
History and Perspectives, Pergamon, New York, 1970.
Garber, R. S., “The Presidential Address: The Proper Business of Psychiatry,” Am. J. Psychiat.,
128:1-11, 1971.
Gay, F. P., The Open Mind: Ernest Southard, 1876-1920, Normandie House, Chicago, 1938.
Ghougassian, J. P., Gordon W. Allport’s Ontopsychology of the Person, Philosophical Library, New
York, 1972.
Gill, M., “The Present State of Psychoanalytic Theory,” J. Abnorm. & Soc. Psychol., 58:1-8, 1959.
Gitelson, M., “On the Identity Crisis in American Psychoanalysis,” J. Am. Psychoanal. A., 12:451-
476, 1964.
Glasscote, R. M., et al., The Community Mental Health Center: An Analysis of Existing Models,
American Psychiatric Association, Washington, D.C., 1964.
Glickhorn, J., and Glickhorn, R., Sigmund Freuds Akademische Laufbahn im Lichte der Dokumente,
Urban & Sclnvarzenburg, Vienna, 1960.
Glueck, B. C., Jr., and Stroebel, C. F., “The Computer and the Clinical Decision Process. II,” Am. J.
Psychiat., 225, Suppl. 1-7. 1969.
Goble, F. G., The Third Force: The Psychology of Abraham Maslow, Grossman, New York, 1970.
Goffman, E., Asylums: Essays on the Social Situation of Mental Patients and Other Inmates,
Doubleday, New York, 1961.
Goldman, G., “Retrospect and Prospect: Review and Evaluation of Developments at Columbia
Psychoanalytic Clinic,” in Goldman, G. S., and Shapiro, D. (Eds.), Developments and
Psychoanalysis at Columbia University, pp. 335-347, Proceedings of the 20th
Anniversary Conference, Psychoanalytic Clinic for Training and Research, Columbia
University, October 30, 1965, Hafner, New York, 1966.
Gorman, II., “Soviet Psychiatry and the Russian Citizen,” in Freeman, H. (Ed.), Progress in Mental
Health, pp. 85-98, Proceedings of the Seventh International Congress on Mental
Health, Grune & Stratton, New York, 1969.
Gorman, M., Barton, W. E., Visotsky, H. M., Sirotkin, P., Miller, A. D., Bazelon, D. L., and Yolles, S. R.,
“Impressions of Soviet Psychiatry,” Am. J. Psychiat., 125:638-674, 1968.
Gottschalk, L. A., and Pattison, E. M., “Psychiatric Perspectives on T-Groups and the Laboratory
296
Movement: An Overview,” Am. J. Psychiat., 126:823-839, 1969.
Greenfield, N. S., and Lewis, W. C. (Eds.), Psychoanalysis and Current Biological Thought,
University Wisconsin Press, Madison, 1965.
Greenson, R. R., “The Origin and Fate of New Ideas in Psychoanalysis,” Int. J. Psychoanal., 50:503-
516, 1969.
Grene, M., Approaches to a Philosophical Biology, Basic Books, New York, 1965.
_____ , “The Continuing Search for Meaning,” Am. J. Psychiat., 127:725-731, 1970.
_____, “Emerging Concepts of Mental Illness and Models of Treatment: The Medical Point of View,”
Am. J. Psychiat., 125:865-876, 1969.
_____ (Ed.), Mid-Century Psychiatry: An Overview, Charles C Thomas, Springfield, Ill., 1953.
_____, “Psychiatry Rides Madly in All Directions,” Arch. Gen. Psychiat., 10: 228-237, 1964.
_____, “The Sciences of Psychiatry: Fields, Fences and Riders,” Am. J. Psychiat., 122:367-376, 1965.
_____, Werble, B., and Drye, R. C., The Borderline Syndrome: A Behavioral Study of Ego-Functions,
Basic Books, New York, 1968.
Group for the Advancement of Psychiatry, Clinical Psychiatry: Problems of Treatment, Research
and Prevention, Science House, New York, 1967.
_____, The Field of Family Therapy, Report #78, New York, 1970.
_____, The Recruitment and Training of the Research Psychiatrist, Report #65, April 1967.
_____, “The Social Breakdown Syndrome: Some Origins,” Am. J. Psychiat., 123: 1481-1489, 1967.
Gruhle, H. W., Verstehen und Einfuhlen, Gesammlete Schriften, Springer, Berlin, 1953.
_____ , Jung, R., Mayer-Gross, W., and Muller, M., Psychiatric der Gegemcart, 3 vols., Springer, Berlin,
1961-1967.
Grunebaum, G. E. von, and Caillois, R. (Eds.), The Dream and Human Societies, University of
California Press, Berkeley, 1966.
Guerra, F., The Pre-Columbian Mind, Seminar Press, New York, 1971.
Hadfield, J. A., Introduction to Psychotherapy: Its History and Modern Schools, Allen & Unwin,
London, 1967.
Hale, N. G. Jr., Freud and the Americans: The Beginnings of Psychoanalysis in the United States,
1876-1917, Oxford University Press, New York, 1971.
Hall, J. (Ed.), One Hundred Years of American Psychiatry, Columbia University Press, New York,
1944.
298
Halleck, S. L., The Politics of Therapy, Science House, New York, 1971.
Hamburg, D. A., et al., “Report of the Ad Hoc Committee on Central Fact-Gathering Data of the
American Psychoanalytic Association,” J. Am. Psychoanal. A., 15: 841-861, 1967.
Hanselmann, H., and Simon, T. (Eds.), Bericht über den 1. lnternationalen Kongress für
Heilpadagogik, Leemann, Zurich, 1939.
Hare, E. H., and Wing, J. K. (Eds.), Psychiatric Epidemiology, Proceedings of the International
Symposium Held at Aberdeen University, July 22-25, 1969, Oxford University
Press, New York, 1970.
Hass, H., The Human Animal: The Mystery of Man’s Behavior, Putnam’s, New York, 1970.
Havens, L., “Main Currents of Psychiatric Developments,” Int. J. Psychiat., 5:288- 345, 1968.
Hayes, E. N., and Hayes, T. (Eds.), Claude Levi-Strauss: The Anthropologist as Hero, MIT Press,
Cambridge, 1970.
Hein, G., “Social Psychiatric Treatment of Schizophrenia in the Soviet Union,” Int. J. Psychiat.,
6:346-362, 1968.
Hobbs, N., “Mental Health’s Third Revolution,” Am. J. Orthopsychiat., 34:822- 833, 1964.
Hoch, P. H., and Polatin, P., “Pseudoneurotic Forms of Schizophrenia,” Psychiat. Quart., 23:248-
255, 1949.
_____, and Arnold, O. F., “Germany and Austria,” in Beliak, L. (Ed.), Contemporary European
Psychiatry, pp. 43-142, Grove Press, New York, 1961.
Horwitz, W. A., Polatin, P., Kolb, L. C., and Hoch, P., “A Study of Cases of Schizophrenia Treated by
“Direct Analysis,” Am. J. Psychiat., 114:780-783, 1958.
Hudges, R. W., et al., “Psychiatric Illness in a Developing Country: A Clinical Study,” Am. J. Pub.
Health, 60:1788- 1805, 1970.
Hughes, H. S., “Emotional Disturbance and American Social Change, 1944-1969,” Am. J. Psychiat.,
126:21-28, 1969.
Hunter, R., and Macalpine, I., Three Hundred Years of Psychiatry, 1535-1960, Oxford University
Press, London, 1963.
Jackson, B., “The Revised Diagnostic and Statistical Manual of the American Psychiatric
Association,” Am. J. Psychiat., 127:65-73, 1970.
Jaco, E. G., The Social Epidemiology of Mental Disorders, Russell Sage Foundation, New York, 1960.
Jacobs, H., Western Psychotherapy and Hindu-Sadhana, International University Press, New York,
1961.
Jacobs, L., and Kotin, J., “Fantasies of Psychiatric Research,” Am. J. Psychiat., 128: 1074-1080, 1972.
Jahoda, M., “The Migration of Psychoanalysis: Its Impact on American Psychology,” in Flemming,
D., and Bailyn, (Eds.), The Intellectual Migration: Europe and America, 1930-1960,
pp. 420-445, Harvard University Press, Cambridge, 1969.
_____, “Traditional Healers and Other Institutions Concerned with Mental Illness in Ghana,” Int. J.
300
Soc. Psychiat., 7: 245-268, 1961.
Janet, P., The Major Symptoms of Hysteria, Fifteen Lectures Given in the Medical School of Harvard
University, Macmillan, New York, 1907.
Jones, E., The Life and Work of Sigmund Freud, 3 vols., Basic Books, New York, 1953-1957.
Jung, C. G., Memories, Dreams, Reflections, Basic Books, New York, 1963.
_____, The Psychology of Dementia Praccox, Journal of Nervous Disease Pub. Co., New York, 1909.
Kalinowsky, L. B., “Practices of Psychiatry in the Communist Countries of Eastern Europe,” Am. J.
Psychother., 16:301- 307, 1962.
_____, and Phillips, J. S., “Behavior Therapy: A Panacea for All Ills or a Passing Fancy?” Arch. Gen.
Psychiat., 114-128, 1966.
Kanner, L., “Autistic Disturbances of Affective Contact,” Nerv. Child, 2:217-230, 1943.
Kaplan, B. H. (Ed.), Psychiatric Disorder and the Urban Environment: Report of the Cornell Social
Science Center, Behavioral Publications, New York, 1971.
Kardiner, A., and Preble, E., They Studied Man, Seeker & Warburg, London, 1962.
Karlen, A., Sexuality and Homosexuality: A New View, Norton, New York, 1971.
Kaufman, M. R., “Psychiatry: Why ‘Medical’ or ‘Social’ Model?” Arch. Gen. Psychiat., 17:347-360,
1967.
Kelman, H., “The Changing Image of Psychoanalysis,” Am. J. Psychoanal., 26: 176, 1966.
Kepecs, J. G., “Psychoanalysis Today: A Rather Lonely Island,” Arch. Gen. Psychiat., 18:161-167,
1968.
Kiell, N., Psychiatry and Psychology in the Visual Arts and Aesthetics, University of Wisconsin Press,
Madison, 1965.
Kiev, A. (Ed.), Magic, Faith and Healing: Studies in Primitive Psychiatry Today, Free Press, New
York, 1964.
_____, Psychiatry in the Communist World, Science House, New York, 1968.
Klagsbrun, S. C., “In Search of an Identity,” Arch. Gen. Psychiat., 16:286-289, 1967.
Klapman, J. W., Group Psychotherapy: Theory and Practice, Ch. 1, Grune & Stratton, New York,
1947.
Kline, N. S., “The Organization of Psychiatric Care and Psychiatric Research in the Union of Soviet
Socialist Republics,” Ann. N.Y. Acad. Sci., 84.: 147-224, 1960.
Kluckhohn, C., “The Influence of Psychiatry on Anthropology in America during the Past One
Hundred Years,” in Hall, J. K. (Ed.), One Hundred Years of American Psychiatry, pp.
589-617, Columbia University Press, New York, 1944.
Kolb, L., “The Institutes of Psychiatry: Growth, Development and Future,” Psychol. Med., 1:86-95,
1970.
302
_____, “The Presidential Address: American Psychiatry, 1944-1969 and Beyond,” Am. J. Psychiat.,
126:1-10, 1969.
_____, “Soviet Psychiatric Organization and the Community Mental Health Center Concept,” Am. J.
Psychiat., 123:433-440, 1966.
Koran, L. M., “Psychiatry in Mainland China: History and Recent Status,” Am. J. Psychiat., 128:970-
978, 1972.
Kraepelin, E., One Hundred Years of Psychiatry, Citadel, New York, 1962.
Kranz, H., and Einrich, K., Psychiatric im Uebergang, Thieme, Stuttgart, 1969.
Krapf, E. E., “The Work of the World Health Organization in the Field of Mental Health,” Ment.
Hyg., 44:315-338, 1960.
_____, and Moser, J., “Changes of Emphasis and Accomplishments in Mental Health Work, 1948-
1960,” Ment. Hyg., 46:163-191, 1962.
Kris, E., Psychoanalytic Explorations in Art, International Universities Press, New York, 1952.
Kubie, L. S., “Pitfalls of Community Psychiatry,” Arch. Gen. Psychiat., 18:257- 266, 1968.
_____, “The Pros and Cons of a New Profession: A Doctorate in Medical Psychology,” Tex. Rep. Biol.
& Med., 12:125-170, 1954.
_____, “The Retreat from Patients,” Arch. Gen. Psychiat., 24:98-106, 1971.
Kumasaka, Y., “Iwakura: Early Community Care of the Mentally Ill in Japan,” Am. J. Psychother.,
21:666-675, 1967.
Lachman, J. H., “Swedish and American Psychiatry: A Comparative View,” Am. J. Psychiat.,
126:1777-1781, 1970.
Lain Entralco, P., Doctor and Patient, McGraw-Hill, New York, 1969.
_____, The Therapy of the Word in Classical Antiquity, Yale University Press, New Haven, 1971.
Lambo, T. A., “Experience with a Program in Nigeria,” in William, R. H., and Ozarin, L. O. (Ed.),
Community Mental Health. An International Perspective, pp. 97-110, Jossey-Bass,
San Francisco, 1968.
_____, “Patterns of Psychiatric Care in Developing African Countries: The Nigerian Village
Program,” in David, H. P. (Ed.), International Trends in Mental Health, pp. 147-153,
McGraw-Hill, New York, 1966.
_____, “Socioeconomic Change, Population Explosion and the Changing Phases of Mental Health
Programs in Developing Countries,” Am. J. Orthopsychiat., 36:77-83, 1966.
Langfeldt, G., “Scandinavia,” in Beliak, L. (Ed.), Contemporary European Psychiatry, pp. 217-279,
Grove Press, New York, 1961.
Laubscher, B. J. F., Sex, Custom and Psychopathology, Routledge & Sons, London, 1937.
Laughlin, H. P., “Psychiatry in the United Kingdom,” Am. J. Psychiat., 126:1790-1794. 1970.
Lazure, D., “Politics and Mental Health in New China,” Am. J. Orthopsychiat., 34:925-933. 1964.
304
Lebensohn, Z. M., “Impressions of Soviet Psychiatry,” Arch. Neur. Psychiat., 80: 735-751, 1958.
Lefkbre, L. B., “The Psychology of Karl Jaspers,” in The Philosophy of Karl Jaspers, pp. 467-497,
Tudor, New York, 1959-
Leigh, D., The Historical Development of British Psychiatry, Pergamon, London, 1961.
Leighton, A. H., Prince, T., and May, R., “The Therapeutic Process in Cross-Cultural Perspective: A
Symposium,” Am. J. Psychiat., 124:1171-1183, 1968.
Lemon, R., “Psychiatry: The Uncertain Science,” Saturday Evening Post, 241: 37-54, 1968.
Lenz, H., Vergleichende Psychiatric. Eine Studie über die Bezichung von Kultur, Soziologie und
Psychopathologie, Maudrich, Vienna, 1964.
Leo, J., “Psychoanalysis Reaches a Crossroad,” New York Times, August 4, 1968.
Levine, M., and Levine, A., A Social History of Helping Services: Clinic, Court, School and Community,
Appleton-Century-Crofts, New York, 1970.
Lewin, L., Phantastica, Narcotic and Stimulant Drugs, Kegan Paul, London, 1931.
Lewis, A., “Empirical or Rational? The Nature and Basis of Psychiatry,” Lancet, 2:1-9, 1967.
_____, “Great Britain,” in Beliak, L. (Ed.), Contemporary European Psychiatry, pp. 145-183, Grove
Press, New York, 1961.
_____, “Problems Presented by the Ambiguous Word ‘Anxiety’ as Used in Psychopathology,” The
Israel Annals of Psychiatry and Related Disciplines, 5: 105-121, 1967. Reprinted in
Int. J. Psychiat., 9:62-79, 1970.
Lidz, T., “Adolf Meyer and the Development of American Psychiatry,” Am. J. Psychiat., 123:320-
332, 1966.
_____, and Edelson, M. (Eds.), Training Tomorrow’s Psychiatrist, Yale University Press, New Haven,
1970.
Lin, T., “Community Mental Health Services: A World View,” in William, R. H„ and Ozarin, L. O.
(Eds.), Community Mental Health: An International Perspective, pp. 3-17, Jossey-
Bass, San Francisco, 1968.
_____, et al., “Psychiatric Training for Foreign Medical Graduates: A Symposium,” Psychiatry,
34:233-257, 1971.
Lindeman, E., “Psychosexual Factors as Stress Agents,” in Tanner, J. (Eds.), Stress and Psychiatric
Disorders, Blackwell, Oxford, 1960.
Linn, L., “The Fourth Psychiatric Revolution,” Am. J. Psychiat., 124:1043-1048, 1968.
Lokwenbehg, R. D., “Karl Jaspers on Psychotherapy,” Am. J. Psychother., 9:502- 513, 1951.
Lopez Ibor, J. J. (Ed.), Proceedings of the Fourth World Congress of Psychiatry, 4 vols., Excerpta
Medica, Amsterdam, 1968.
Lopez Pinero, J. M., Origines historicas del concepto de neurosis, Industrias Graficas ECIR, Valencia,
1963.
_____, and Morales Meseguer, J. M., Neurosis y psicoterapia: Un estudio historico, Espasa-Calpe,
Madrid, 1970.
Lustic, B., Therapeutic Methods in Soviet Psychiatry, Fordham University (Monographs in Soviet
Medical Sciences, No. 3), New York, 1963.
Luthe, W., “Autogenic Training: Method, Research and Application in Medicine,” Am. J.
Psychother., 17.174-195, 1963.
Lynn, R., “Russian Theory and Research on Schizophrenia,” Psychol. Bull., 60:486-498, 1963.
306
McGlashan, A. M., and Reeve, C. J., Sigmund Freud: Founder of Psychoanalysis, Praeger, New York,
1970.
McKnicht, W. K., “Historical Landmarks in Research on Schizophrenia in the United States,” Am. J.
Psychiat., 114: 873-881, 1958.
McNeil, J. N. M., Liewellyn, C. E., and McCollough, T. E., “Community Psychiatry and Ethics,” Am. J.
Orthopsychiat., 40:22-29, 1970.
Madison, B. Q., Social Welfare in the Soviet Union, Stanford University Press, Stanford, 1968.
Mahler, M. S., “On Child Psychosis and Schizophrenia: Autistic and Symbiotic Infantile Psychoses,”
in The Psychoanalytic Study of the Child, Vol. 7, pp. 286-305, International
University Press, New York, 1952.
Manuel, F. E., “The Use and Abuse of Psychology in History,” Daedalus, 100: 187-213, 1971.
Marcuse, H., Eros and Civilization: A Philosophical Inquiry into Freud, Beacon Press, Boston, 1955.
Margktts, E. L., “Historical Notes on Psychosomatic Medicine,” in Wittkower, E., and Cleghorn, J.
(Eds.), Recent Developments in Psychosomatic Medicine, pp. 41-69, Lippincott,
Philadelphia, 1954.
_____, “The Reintegration of Psychoanalysis into Psychiatric Practice,” Arch. Gen. Psychiat., 3-569-
574. 1960.
Marshall, H., Dorothea Dix: Forgotten Samaritan, University of North Carolina Press, Chapel Hill,
1937.
Marwick, M. (Ed.), Witchcraft and Sorcery: Selected Readings, Penguin, Baltimore, 1970.
_____ (Ed.), Youth: A Transcultural Psychiatric Approach, Grune & Stratton, New York, 1969.
May, A. R., “Development of Mental Health Services in Europe,” in Freeman, (Ed.), Progress in
Mental Health, Proceedings of the Seventh International Congress on Mental
Health, pp. 77-84, Grune & Stratton, New York, 1969.
May, R., “Historical Roots of Modern Anxiety Theories,” in Hoch, P. H., and Zubin, J. (Eds.), Anxiety,
Proceedings of the 39th Annual Meeting of the American Psychopathological
Association, pp. 3-16, Grune & Stratton, New York, 1950.
Mazlish, B. (Ed.), Psychoanalysis and History, Prentice-Hall, Englewood Cliffs, N.J., 1963.
Medvedev, Z. A., and Medvedev, R. A., A Question of Madness, Alfred A. Knopf, New York, 1971.
Meier, C. A., Ancient Incubation and Modern Psychotherapy, Northwestern University Press,
Evanston, 1967.
Menninger, K., “Hope” (The Academic Lecture), Am. J. Psychiat., 116:481-491, 1959.
_____ , (with Mayman, M., and Pruyser, P.), The Vital Balance, Viking, New York, 1963.
Mental Health Education: A Critique, Pennsylvania Association for Mental Health, Philadelphia,
1960.
Mering, O. von, and Kasdal, L. (Eds.), Anthropology and Behavioral and Health Sciences, University
of Pittsburgh Press, Pittsburgh, 1970.
Meyer, A., “Organizing the Community for the Protection of Its Mental Life,” Survey, 34-557-560,
1915.
Meyerhoff, H., “On Psychoanalysis and History,” Psychoanal. & Psychoanalyt. Rev., 49:2-20, 1962.
308
Middleton, J. (Ed.), Magic, Witchcraft and Curing, The Natural History Press, Garden City, N.Y.,
1967.
Miller, M. H., Whitaker, C. A., and Fellner, C .H., “Existentialism in American Psychiatr. Ten Years
Later,” Amer. J. Psychiat., 125.1112-1115, 1969.
Mischler, E. G., and Waxler, N. E., “Family Interaction Processes and Schizophrenia: A Review of
Current Theories,” Int. J. Psychiat., 2:375-413, 1966.
Mitchell, W. S., “Address before the 50th Annual Meeting,” J. Nerv. & Ment. Dis., 21:413-437, 1894.
Mitscherlich, A., Society without the Father: A Contribution to Social Psychology, Basic Books, New
York, 1969.
Mittel, N. S., “Training Psychiatrists from Developing Nations,” Am. J. Psychiat., 126:1143-1149,
1970.
Mora, G., “The Historiography of Psychiatry and Its Development: A Re-Evaluation,” J. Hist. Behav.
Sci., 2:43-52, 1965.
_____, “The History of Psychiatry: A Cultural and Bibliographical Survey,” Psychoanal. Rev. 52:299-
328, 1965.
_____, “The History of Psychiatry: The Relevance for the Psychiatrist,” Am. J. France, Paris, 1961.
_____, and Brand, J., Psychiatry and Its History: Methodological Problems in Research, Charles C
Murphy, G., and Murphy, L. (Eds.), Asian Psychology, Basic Books, New York, 1968.
_____, and _____ (Eds.), Western Psychology, Basic Books, New York, 1969.
Myers, J. M., “The Image of the Psychiatrist,” Am. J. Psychiat., 222:323-328, et son public, Presses
Universitaire de Psychiat., 126:957-967, 1970.
National Institute of Mental Health, The Nation's Psychiatrists, Public Health Service Pub. #1885,
Chevy Chase, Md., 1969.
Nayes, E. J., and Nayes, T. (Eds.), Claude Levi-Strauss: The Anthropologist as Hero, MIT Press,
Cambridge, 1970.
Nelson, B. (Eds.), Freud and the 20th Century, Meridian Books, New York, 1957.
_____, “Self-Images and Systems of Spiritual Directions in the History of European Civilization,” in
Klausner, S. Z. (Ed.), The Quest for Self-Control: Classical Philosophies and Scientific
Research, pp. 49-103, Free Press, New York, 1965.
Nunberg, H., and Federn, E., Minutes of the Vienna Psychoanalytic Society, vol. 1, 2906-2908, vol. 2,
290,9-2922, International University Press, New York, 1962, 1967.
Nittin, J., Psychoanalysis and Personality, Sheed & Ward, New York, 1962.
Orgler, H., Alfred Adler: The Man and His Work, Liveright, New York, 1963.
310
Ortigues, M. C., and Ortigues, E., Oedipe Africain, Plon, Paris, 1966.
Osborn, R., Freud and Marx: A Dialectic Study, Gollanez, London, 1937.
Ostow, M., “Psychoanalysis and Ethology,” J. Am. Psychoanal. A., 8:526-534, 1960.
Papanek, H., and Papanek, E., “Individual Psychology Today,” Am. J. Psychother., 25:4-26, 1961.
_____, Paumelle, P., and Lebovici, S., “An Experience with Sectorization in Paris,” in David, H. P.
(Ed.), International Trends in Mental Health, pp. 97-108, McGraw-Hill, New York,
1966.
_____ , and William, R. H., “Issues on a Pilot Program” (Paris) in William, R. H., and Oxarin, L. O.
(Eds.), Community Mental Health: An International Perspective, pp. 157-166, Jossey-
Bass, San Francisco, 1968.
Payne, T. R., S. L. Rubinstein and the Philosophical Foundations of Soviet Psychology, Humanities
Press, New York, 1968.
Pichot, P., “France,” in Beliak, L. (Ed.), Contemporary European Psychiatry, pp. 3-39, Grove Press,
New York, 1961.
Pollock, H. M. (Ed.), Family Care of Mental Patients: A Review of Systems of Family Care in America
and in Europe, State Hospital Press, Utica, N.Y., 1936.
Pomeroy, W. B., Dr. Kinsey and the Institute of Sex Research, Harper & Row, New York, 1972.
_____ , New Paths in Biology, Harper & Row, New York, 1964.
Premier Congres Mondial de Psychiatric. Compte Rendus des Seances (18-27 Septembre, Paris), 7
vols., Hermann, Paris, 1952.
Proceedings of the Brief Psychotherapy Council, Institute for Psychoanalysis, Chicago, 1942, 1944,
1946.
Proceedings of the International Conference on Mental Health, London, 1948, Lewis, London,
1949.
Proceedings of the Third World Congress of Psychiatry (Montreal, 4-10 June 1961), 3 vols.,
University of Toronto Press, Toronto, 1963.
“The Psychiatrist, the APA and Social Issues: A Symposium,” Am. J. Psychiat., 128:677-687, 1971.
Querido, A., “Early Diagnosis and Treatment Services: Elements of a Community Mental Health
Program,” in Proceedings of a Round Table at 1955 Annual Conference, Milbank
Memorial Fund.
_____, “Mental Health Programs in Public Health Planning,” in David, H. P. (Ed.), International
Trends in Mental Health, pp. 32-54, McGraw-Hill, New York, 1966.
Rabkin, R., “Is the Unconscious Necessary?” Am. J. Psychiat., 125:313-319, 1968.
Rangell, L., “Psychoanalysis: A Current Lock,” Bull. Am. Psychoanal. A., 23: 423-431, 1967.
_____, “Psychoanalysis and Neuropsychiatry: A Look at Their Interface,” Am. J. Psychiat., 127:125-
312
131, 1970.
_____, Organization and Pathology of Thought, Columbia University Press, New York, 1951.
Rascovky, A., “Notes on the History of the Psychoanalytic Movement in Latin America,” in Litman,
R. E. (Ed.), Psychoanalysis in the Americas: Original Contributions from the First Pan-
American Congress for Psychoanalysis, pp. 289-299, International Universities
Press, New York, 1966.
Redlich, F. C., “Research Atmosphere in Departments of Psychiatry,” Arch. Gen. Psychiat., 4:225-
236, 1961.
_____, and Pepper, M., “Are Social Psychiatry and Community Psychiatry Subspeciality of
Psychiatry?” Am. J. Psychiat., 124:1343-1349, 1968.
_____, and Pines, M., “How to Choose a Psychiatrist,” Harper Magazine, 220:33- 40, 1960.
Reich, I. O., Wilhelm Reich: A Personal Biography, Saint Martin’s Press, New York, 1970.
Reich, W., The Mass Psychology of Fascism, Farrar, Straus & Giroux; New York, 1970.
Rennie, T. A. C., “Social Psychiatry: A Definition,” Int. J. Soc. Psychiat., 1:5-13, 1955-
Repond, A., “Mental Hygiene in Switzerland,” in Shore, M. J. (Ed.), Twentieth Century Mental
Hygiene, pp. 383-402, Social Sciences Publishers, New York, 1950.
Ricouer, P., Freud and Philosophy: An Essay on Interpretation, Yale University Press, New Haven,
1970.
Rieff, P., Freud: The Mind of a Moralist, Viking, New York, 1959.
_____, The Triumph of the Therapeutic: Uses of Faith after Freud, Harper & Row, New York, 1966.
Riese, W., The Legacy of Philippe Pinel, Springer, New York, 1969.
_____, “Phenomenology and Existentialism in Psychiatry. An Historical Analysis,” J. Nerv. & Ment.
Dis., 132:469-484, 1961.
Roazen, P., Brother Animal: The Story of Freud and Tausk, Alfred A. Knopf, New York, 1969.
Robbins, L. L., “A Historical Review of Classification of Behavior Disorders and One Current
Perspective,” in Eron, L. D. (Ed.), The Classification of Behavior Disorders, pp. 1-37,
Aldine, Chicago, 1966.
Robert, M., The Psychoanalytic Revolution: Sigmund Freud’s Life and Achievement, Harcourt, Brace
& World, New York, 1966.
Rogers, R. R., “The Emotional Climate in Israel Society,” Am. J. Psychiat., 128: 987-992, 1972.
Rollins, N., “Is Soviet Psychiatric Training Relevant in America?” Am. J. Psychiat., 128:622-627,
1971.
314
Roman, P. M., “Labeling Theory and Community Psychiatry (The Impact of Psychiatric Sociology
on Ideology and Practice in American Psychiatry),” Psychiatry, 34:378-390, 1971.
Romano, J., “The Teaching of Psychiatry to Medical Students: Past, Present and Future,” Am. J.
Psychiat., 126:1115-1126, 1970.
Rome, H. P., “Psychiatry and Foreign Affairs: The Expanding Competence of Psychiatry,” Am. J.
Psychiat., 125:725-730, 1968.
_____, et al., “Psychiatry Viewed From the Outside: The Challenge of the Next Ten Years,” Am. J.
Psychiat., 123:519-530, 1966.
Rosen, G., Madness in Society: Chapters in the Historical Sociology of Mental Illness, University of
Chicago Press, Chicago, 1968.
Rosen, J. N., “The Treatment of Schizophrenic Psychosis by Direct Analysis,” Psychiat. Quart.,
21:117-131, 1947.
Rosenberg, M., and Ericson, R. P., “The Clinician and the Computer: Affair, Marriage or Divorce?”
Am. J. Psychiat., 125: Suppl. 28-32, 1969.
Rossi, A. M., “Some Pre-World War II Antecedents of Community Mental Health Theory and
Practice,” Ment. Hyg., 46:78-98, 1962. Reprinted in Bindman, A. J., and Spiegal, A. D.
(Eds.), Perspectives in Community Mental Health, Aldine, Chicago, 1969.
Rothman, D. J., The Discovery of the Asylum: Social Order and Disorder in the New Republic, Little,
Brown, Boston, 1971.
Rubin, B., “Community Psychiatry: An Evolutionary Change in Medical Psychology in the United
States,” Arch. Gen. Psychiat., 20:497-507, 1969.
Ruesch, J., “Social Process,” Arch. Gen. Psychiat., 15:577- 589, 1966.
_____, “The Trouble with Psychiatric Research,” Arch. Neurol. & Psychiat., 77: 93-107, 1957.
Russell, W., The New York Hospital: A History of the Psychiatric Service, 1771-1936, Columbia
Ryan, W., “Community Care in Historical Perspective,” Canada’s Mental Health, 17: Suppl. 60,
1969.
Sabshin, M., “The Anti-Community Mental Health Movement,” Am. J. Psychiat., 125.1005-1012,
1969.
_____, Diesenhaus, H., and Wilkerson, R., “Dimensions of Institutional Racism in Psychiatry,” Am. J.
Psychiat., 127: 787-793, 1970.
Sackler, A. M., et al. (Eds.), The Great Physiodynamic Therapies in Psychiatry, Harper, New York,
1956.
Sager, C. J., “The Development of Marriage Therapy: An Historical Review,” Am. J. Orthopsychiat.,
36:458-467, 1966.
Sargant, W., Battle for the Mind, Doubleday, New York, 1957.
_____, “Psychiatric Treatment Here and in England,” Atlantic Monthly, 214:88- 95, 1964-
Scheidlinger, S., “Group Psychotherapy in the Sixties,” Am. J. Psychother., 22: 184, 1968.
Schlessinger, N., “Supervision of Psychotherapy: A Critical Review of the Literature,” Arch. Gen.
Psychiat., 15.129-139, 1966.
Schoenwald, R., Freud, the Man and His Mind, 1856-1956, Alfred A. Knopf, New York, 1956.
316
Schofield, W., Psychotherapy: The Purchase of a Friendship, Prentice-Hall, Englewood Cliffs, N.J.,
1964.
Sears, R. R., “Survey of Objective Studies of Psychoanalytic Concepts,” Soc. Sci. Res. Comm. Bull.,
No. 51, 1945.
Secuin, C. A., “The Theory and Practice of Psychiatry in Peru,” Am. J. Psychother., 18:188-211,
1964.
Sells, S. B. (Ed.), The Definition and Measurement of Mental Health, U.S. Department of Health,
Education and Welfare, Washington, D.C., 1968.
Sethi, B. B., Sachdev, S., and Nag, D., “Sociocultural Factors in the Practice of Psychiatry in India,”
Am. J. Psychother., 19:445-454, 1965.
_____, Thacore, V. R., and Gupta, S. C., “Changing Patterns of Culture and Psychiatry in India,” Am. J.
Psychother., 22:46-54, 1968.
Shakow, D., and Rapaport, D., The Influence of Freud on American Psychology, International
Universities Press, New York, 1964.
Sloane, R. B., “The Converging Paths of Behavior Therapy and Psychotherapy,” Am. J. Psychiat.,
125:877-885, 1969.
Smartt, C. G. F., “Mental Maladjustment in the East African,” J. Ment. Sci., 102: 441-466, 1956.
_____, and Ahrenfeldt, R. H. (Eds.), Mental Health in a Changing World, Vol. 1, Lippincott,
Philadelphia, 1965.
_____, and _____ (Eds.), Mental Health in Contemporary Thought, Vol. 2, Lippincott, Philadelphia,
1967.
_____, and _____ (Eds.), Mental Health in the Service of the Community, Vol. 3, Lippincott,
Philadelphia, 1967.
Spiegel, J. P., “Psychosocial Factors in Riots: Old and New,” Am. J. Psychiat., 125:281-285, 1968.
Spiegelberg, H., The Phenomenological Movement, 2 vols, 2nd ed., Nijhoff, The Hague, 1969.
Spitz, R. A., and Wolf, K. M., “Anaclitic Depression: An Inquiry into the Genesis of Psychiatric
Conditions in Early Childhood,” in The Psychoanalytic Study of the Child, Vol. 2, pp.
313-342, International Universities Press, New York, 1946.
Stein, M., “Psychiatrist’s Role in Psychiatric Research,” Arch. Gen. Psychiat., 22: 481-489, 1970.
Sterba, R., “A Case of Brief Psychotherapy by Sigmund Freud,” Psychoanal. Rev., 35-75-80, 1951.
Stewart, W. A., Psychoanalysis: The First Ten Years, 1888-1898, Macmillan, New York, 1967.
Stierling, H., “Bleuler’s Concept of Schizophrenia: A Confusing Heritage,” Am. J. Psychiat., 123:996-
1001, 1967.
Stoller, A., “Public Health Aspects of Community Mental Health” (Australia), in William, R. H., and
318
Ozarin, L. O. (Eds.), Community Mental Health, An International Perspective, pp. 123-
139, Jossey-Bass, San Francisco, 1968.
Storch, A., The Primitive Archaic Forms of Inner Experiences and Thought in Schizophrenia,
Nervous and Mental Diseases Publishing Co., New York, 1924.
_____, The Primary World of Senses, Free Press, New York, 1963.
_____, and Griffith, R. M. (Eds.), Phenomenology of Memory, Duquesne University Press, Pittsburgh,
1970.
Strauss, E., et al.(Eds.),Psychiatric Ideologies and Institutions, Free Press, New York, 1964.
Strupp, H. H., and Bergin, A. E., “Some Empirical and Conceptual Bases for Coordinated Research
in Psychotherapy: A Critical Review of Issues, Trends and Evidence,” Int. J.
Psychiat., 7:18-90, 118-168, 1969.
Suk Choo Chang, “The Cultural Context of Japanese Psychiatry and Psychotherapy,” Am. J.
Psychother., 19:593-606, 1965.
Szasz, T. S., The Myth of Mental Illness, Harper, New York, 1961.
Techniques and Statistics in the Evaluation of the Results of the Psychotherapies, Proceedings of the
First National Scientific Meeting of the Association for the Advancement of
Psychotherapy, Am. J. Psychother., 18: Suppl., 1964.
Temkin, O., “The History of Classification in the Medical Sciences,” in Katz, M. J., Cole, J. O., and
Barton, W. E. (Eds.), The Role and Methodology of Classification in Psychiatry and
Psychopathology, Proceedings of a Conference in Washington, D.C., November
1965, Department of Health, Education and Welfare, Washington, D.C., 1968.
Tinterow, N. M., Foundations of Hypnosis: From Mesmer to Freud, Charles C Thomas, Springfield,
Ill., 1970.
Torhey, E. F., “Emergency Psychiatric Ambulance Services in the USSR,” Am. J. Psychiat., 128.153-
157, 1971.
Tourney, G., “History of Biological Psychiatry in America,” Am. J. Psychiat., 12 6:29-42, 1969.
Treffert, D. A., “Psychiatry Revolves as It Evolves,” Arch. Gen. Psychiat., 17: 72-94, 1967.
Tsung-Yi, L., “Community Mental Health Services: World View,” in William, R. H., and Ozarin, L. D.
(Eds.), Community Mental Health: An International Perspective, pp. 3-17, Jossey-
Bass, San Francisco, 1968.
Vail, D. J., Mental Health Systems in Scandinavia, Charles C Thomas, Springfield, Ill. 1965.
Veith, I., Hysteria: The History of a Disease, University of Chicago Press, Chicago, 1965.
_____, “Psychiatric Nosology: From Hippocrates to Kraepelin,” Am. J. Psychiat., 114-385-391, 1957.
Velasco-Alzaga, J. M., La salud mental en las Americas, Scientific Publications No. 81, pp. 8-28, Pan
American Health Organization, Washington, D.C., 1963.
Viet, J., Les methodes structural isles dans les sciences sociales, 2nd ed., Mounton, The Hague, 1969.
Vogel, E., “A Preliminary View of Family and Mental Health in Urban Communist China,” in
320
Caudill, W., and Lin, T. (Eds.), Mental Health Research in Asia and the Pacific, pp.
39.3-404, East-West Center Press, Honolulu, 1969.
Volmat, R., and Wiart, C. (Eds.), Art and Psychopathology, Proceedings of the Fifth Congress of the
International Society of Art and Psychopathology, Paris, June 7-10, 1967, Excerpta
Medica Foundation, Amsterdam, 1969.
Vygotsky, L. S., The Thought and Language, MIT Press, Cambridge, 1962.
Waggoner, R. W., “The Future of International Psychiatry,” Am. J. Psychiat., 126: 1705-1710, 1970.
Wallerstein, R. S., “The Challenge of the Community Mental Health Movement to Psychoanalysis,”
Am. J. Psychiat., 124: 1049-1056, 1968.
_____, “The Current State of Psychotherapy: Theory, Practice, Research,” J. Am. Psychoanal. A.,
14.,183-225, 1966.
Ward, C. H., “Psychotherapy Research: Dilemmas and Directions,” Arch. Gen. Psychiat., 10:596-
622, 1964.
_____, and Rickels, K., “Psychiatric Residency Training: Changes over a Decade,” Am. J. Psychiat.,
123:45-54, 1966.
Wasson, R. G., Soma: Divine Mushrooms of Immortality, Harcourt, Brace & World, New York, 1969.
Wasson, V. P., and Wasson, R. G., Mushrooms, Russia and History, 2 vols., Pantheon, New York,
1957.
Watts, A. W., Psychotherapy East and West, Pantheon, New York, 1961.
Weinberg, A. A., Migration and Belonging: A Study of Mental Health in Israel, Nijhoff, The Hague,
1961.
Weinberg, S. K. (Ed.), The Sociology of Mental Illness: Analyses and Readings in Psychiatric
Sociology, Aldine, Chicago, 1967.
Weinshel, E. M., et al., “The Changing Identity of the Psychiatrist in Private Practice: A
Symposium,” Am. J. Psychiat., 126: 1577-1587, 1970.
Weiss, E., Sigmund Freud as a Consultant, Intercontinental Medical Book Corp., New York, 1970.
Weitbreght, H. J., Psychiatric in der Zeit des National-sozialismus, Hanstein, Bonn, 1968.
Wells, H. K., Pavlov and Freud, 2 vols., International Publishers Co., New York, 1956.
Wender, P. II., “Dementia Praecox: The Development of the Concept,” Am. J. Psychiat., 119:1143-
1151, 1963.
Whittington, H., “The Third Psychiatric Revolution, Really?” Comm. Ment. Health J., 1:73-80, 1963.
Whyte, L., The Unconscious before Freud, Basic Books, New York, 1960.
Wild, J., “William Janes and Existential Authenticity,” J. Existentialism, 5:244-256, 1965.
Wilder, J., “Alfred Adler in Historical Perspective,” Am. J. Psychother., 24:450- 460, 1970.
Winn, R. B. (Ed.), Psychotherapy in the Soviet Union, Philosophical Library, New York, 1961.
Wittels, F., Freud and His Time, Liveright, New York, 1931.
322
Wittkower, E. D., “Transcultural Psychiatry,” Arch. Gen. Psychiat., 13:387-394, 1965.
_____, “Transcultural Psychiatry in the Caribbean: Past, Present and Future,” Am. J. Psychiat.,
127:162-166, 1970.
Yang, C. K., The Chinese Family in the Communist Revolution, Harvard University Press, Cambridge,
1959.
Yates, A. J., Behavior Therapy, Ch. 1, John Wiley, New York, 1970.
Yolles, S. F., “Past, Present and 1980: Trend Projections,” in Beliak, L., and Barten, H. H. (Eds.),
Progress in Community Psychiatry, vol. 1, pp. 3-23, Grune & Stratton, New York,
1969.
Zegans, L. S., “An Appraisal of Etliological Contributions to Psychiatric Theory and Research,” Am.
J. Psychiat., 124:729-739, 1967.
_____, “The Soviet Psychiatrist: His Relationship to His Patients and to His Society,” Am. J. Psychiat.,
123:440-446, 1966.
_____, “Russian Psychiatry: Its Historical and Ideological Background,” Bull. N.Y. Acad. Med.,
19:713-728, 1943.
Zubin, J. (Ed.), Field Studies in the Mental Disorders, Proceedings of the Conference sponsored by
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PART II
Basic Notions
Alfred H. Rifkin
take the measure of. We do not ordinarily consider assessing fields like
the scope of psychiatry, to fix the proper limits of its concern, to determine
the nature of the problems to which it should address itself, and to study the
conceptual and technical tools fashioned for the solution of problems. What is
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criteria for health or illness, the “cure” rate achieved by different treatments,
aided by the powerful tools of mathematics, were the first to emerge from
and their treatment. Today there are hardly any remnants of the great
versus allopathy. But it was not until 1824- 1825 that J. F. Herbart, a
the burdens of the past are evident in this title. It was several decades later
are no longer urgent issues, but psychogenesis, the modern descendant of the
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psychiatry. Deeply rooted schisms abound that are not differences in
conceptualization.
selective rather than exhaustive. Ideally it should deal with trends and lines of
identify central themes and problems, and the strategies devised to explore
them.
Schools of Thought
The first matter that calls for attention and appraisal is the prominence
of schools of thought. There are many lines of cleavage that take on the
symptom elimination, the medical model versus game theory and social
absolute sense; it merely becomes more plausible and perhaps more useful as
such form and content that it may be refuted by some crucial observation.
The problem for psychiatry is that these conditions are difficult to fulfill. On
330
Concerned as it is with disorders of human behavior, psychiatry must
deal with the vast array, to apply the available modes of reasoning and
also limiting. Applying Sapir’s viewpoint we may posit that each school of
interpretation.
encompasses at one and the same time the scientific study of man on the
biological level, the psychological study of the individual, and the sociological
and anthropological study of human groups on a small and large scale. Not
only is psychiatry concerned with these various levels of integration, but also
332
of the subject matter within manageable bounds, but at the same time
characterizes the current era makes it less and less possible for any one
articles, and books are more often group undertakings. On the other hand,
At the very least the results should include mutual enrichment of information,
viewpoints. The disciplines may be using different terminology for the same
between social class status and symptom patterns. Such studies usually fall
334
within the newly delineated fields of psychosomatic medicine and social
psychiatry.
mind to body” and the reverse. Two major theoretical formulations have
or the need to communicate). Placing the “psycho” first seems to have meant
for most users of the term that the psychological state is primary or causal.
Recent findings and more detailed analysis indicate that the interrelationship
complex. Human survival requires that societal forms be consistent with basic
into cultural institutions. There are evidently many ways in which these
needs can be met. The most direct formulations focus on ways in which
step direct, one step indirect, two step direct, and two step indirect. Even this
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are many interweaving processes and variables that operate to a greater or
change versus stability, definition versus ambiguity of role, and others. The
interactions.
it appears that genetic factors are significant in this disorder and may consist
stressful, however, depends largely on the life history and experiences of the
is based on previous experience, role within the family and within the
the organ and cellular level, its extent determined in part by genetically
distinct ways. (1) They form the dictionary with which an individual
threat, ie, stress, it constitutes for him. (2) Their residue determines the
quantity and style of defenses and coping abilities with which the
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identifications, and the pattern of perceptions and coping mechanisms
associated with one’s location in the social class matrix. (3) Prior
CNS structure, ie, neonatal anoxia causing minimal brain changes that later
For the purposes of this general assessment it is not necessary to review the
evidence for or against the various aspects of Pollin’s thesis. Admittedly some
different levels are not posed against one another as competing etiologies but
are woven into a coherent whole. The concept of stress provides the
possibly relevant factors are made to vary one at a time. Twin studies are an
twin pairs have been noted repeatedly along with many similarities. Pollin
cites a twin pair only one of whom was schizophrenic. From an early age
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differences between identical twins, Pollin and his co-workers point out that
may evoke different treatment from the parents. Throughout life there is a
systems of factors that vary and interact in many different ways. Any
“other things being equal.” Since other things cannot ordinarily be taken as
other than those under investigation within some limit of allowable error. In
portion of the network are associated with changes in other portions, and
such problems may be approached comes from the field of economics. In this
area, because numerical measures are available for many variables, complex
for defining cause and effect. The procedures are formidable, but in principle
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behavior of the real economic system even though the available information
probability.
will produce measurable change in the system. In practice this will mean that
social class etiologies. Knapp proposes a similar framework for the etiology of
many quarters and ranges from mild criticism to outright rejection. The
sharpest attack comes from Szasz, who denies there is any mental illness,
suggesting, instead, that there are only “problems of living,” which are moral
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and ethical, not medical. Similar criticisms of the medical model are voiced by
Adams, Albee, Becker, Laing, Leifer, Sarbin, Scheflen. Somewhat less stringent
criticism is offered by Cowen, Ellis, Mowrer, Reiff. Virtues and drawbacks are
Goffman, Scheff, Spitzer and Denzin. Rejoinders to Szasz and the criticisms of
correspond to a set of events or things in the real world. If this model is well
and draw conclusions that might not be feasible with the real system in the
the degree of correspondence between its elements and the “real” system in
the external world. Valid conclusions can be drawn only to the extent of such
correspondence. In other respects the model may not behave like the “real”
model to reality must remain within these limits. Several steps may be
involved in using models. Light may first be compared with (modeled by)
revolving around a nucleus after the fashion of the solar system. Then a
rotating bodies.
346
It is clear that the medical model being criticized is not of this formal
involved. The challenge is to the medical model. Is there such a model, one
theories about causes and what the process consists of have reflected the
natural spirits, vital spirits, and animal spirits that survived through the
seventeenth and eighteenth centuries there were several medical models: (1)
(3) vitalism—the living body is governed by special laws of its own, not those
pathology and the role of microorganisms became the medical model of the
latter half of the nineteenth century. Subsequently other facets were added:
348
emphasis has been shifting to neoplasia, to “wear and tear”—the processes of
it would seem to be merely that the processes and mechanisms of illness are
The major criticisms of the medical model are directed against specific
2. The locus of the disorder is within the affected person, and the
because the real locus of the disorder may be, and usually is,
independence or autonomy.
350
model fosters conformity and stifles originality and
creativity.
medical model requires vast numbers of highly trained personnel to deal with
existing problems. Adequate care for all who need it cannot be attained
Leifer and Szasz carry the argument further. In their view a psychiatric
victimized while the power and prestige of the psychiatrist are enhanced.
mental illness. His experience is that at best mental illness is a metaphor that
defects. But the term “disorders of the mind” refers to a false substantive,
are significant but not crucial. Psychiatry may be quite adequately defined
without reference to mind, and many textbooks do not use the term, or if they
the organism rather than a metaphysical entity. Although Szasz states that he
352
entity and thus appears to resurrect the philosophical dilemma.
cannot “have” a mental disease in the sense that one can “have” diabetes. (The
quotation marks indicating special meaning are terms of the critics.) The
disease does not. What is at issue is the meaning of terms like “have, entity,”
hypothetical property separate and apart from the tangible and experiential
certain characteristics. A class name is neither real nor unreal; it may be more
places him in the class of individuals who show certain defining biochemical
characteristics. The class falls within the larger class of diseases, which are
included, although the nature and basis of the discomfort or impairment are
the mechanisms of the signs and symptoms are characteristics added to the
was recognized as a disease and named 011 the basis of one of its
conspicuous and easily observable features long before there was any
354
descriptions had to be revised and new classifications added to accommodate
newly acquired knowledge. Some behavioral aberrations that are today called
mental diseases were recognized and described as far back as the period of
ideology. If statistical, then the distribution of any trait will have extremes,
extensive writings of Szasz and the other critics of the medical model reveals
several additional elements implicit in the argument. The most important one
general thesis. Only certain aberrations are labeled in any particular culture.
In Szasz’s view the problem of mental illness is the right to be different in the
face of societal demands for conformity. This view involves at least two
further assumptions: (1) social roles and behavior are imposed against an
considers irrational.
356
tradition of individuality and freedom of expression. It takes advantage of the
vexed even those who accept the concept. It invokes images of arbitrary and
psychiatrists.
abnormality in the medical model. Mere deviation from norms does not
constitute disease; rather it calls for attention and further investigation into
the significance of the deviation. The precision associated with bodily disease
Norms for judgment are not different in principle from those applied in many
probabilities that particular levels of blood sugar will be associated with the
may fall into the area of uncertainty. The final judgment is made on the basis
indicators and with due regard for background factors such as culture.
schizophrenia any more than it would take all elevations of blood sugar as
358
even approved, the occurrence of hallucinations will not necessarily indicate
pathology even though in specific instances the case may be borderline. The
describing individuals who exhibit minor deviations and give little evidence
alterations. On the other hand, psychiatry is for the most part concerned with
changes have as yet been found despite many investigations. Invoking the
separate from, the physiological level. The nonreductionist position can only
that two plus two equals five. The error may be due to ignorance or mental
defect. Suppose these causes are excluded and the error persists for reasons
comprise the full description of the error within the appropriate level of
360
possible to resolve the reductionist objection and arrive at physiological
patients. No doubt there are physicians and patients about whom these
would be required than is now offered by the critics. As the matter stands, the
physicians, and they “depend” on his technical knowledge and skills. But
“orders” and “depend” in this context do not have the pejorative meaning
Mowrer suggests that the concept of sin has been too hastily excluded.
Better sin than sickness in his view. If the responsibility for sin is
those now under care. Presumably he anticipates that they can all be returned
362
psychoanalysis he names autonomous psychotherapy. Most of the other
day and night hospitals, behavioral and conditioning therapies, and a variety
mental disorder.
is too one-sided and premature a view to serve as the basis for professional or
public policy in the mental health field. In any event the personnel and
financing required would hardly be less than under the medical model.
The most general alternative to the medical model is the social model,
which attributes the major portion of mental illness to the impact of social
than with caring for those now afflicted, although there is reasonable ground
rehospitalizations.
364
the medical model? What is the medical model? On the whole it appears that
the medical model is whatever critics attribute to it. The model used by most
psychiatrists accepts the notion that the disability of the mental patient is real
and represents a dysfunction, but is not specific about the nature of the
and will probably turn out to be a complex network of factors. The medical
model does not require that treatment be directed internally even if the
are matters for investigation. Given the present state of knowledge, most of
bound, and difficult, what can be said of the future? Probably the surest
plans for the future are necessary, and some risk must therefore be
in this section depart from the customary style of handbooks and use the
pronoun “I.” I will attempt to anticipate the future in three time spans—near,
delivery.
health care to all segments of the population under some form of insurance.
366
At this time there is some official hesitation about providing psychiatric
services because of the anticipated high costs. Ways will have to be devised to
care will be provision of a full range of services and employment of all forms
to the least expensive treatments. The aim must be to provide a basis for
has followed economic lines. Only when the various modalities are available
indications for each modality. Evaluation of formal treatments will also have
Theory must play a dual role. On the one hand, theory must supply clues
for new approaches. These, in turn, will modify and enrich theory. The
outcome should be in the form of “unified” theories, drawing upon all levels of
challenge to the medical model. The overall impact of this trend has been to
move psychiatry away from the rest of medicine. The outcome will depend on
368
other. The results of this competition will not emerge early, carrying the issue
into the intermediate time span. In the meantime there will be mounting
their investigations.
fragment rather than to unify the mental health field. Specialization, I believe,
institutes would be the base for both clinical and research activities and
should be located within a university that has a medical school. The core of
work, that is, the disciplines most closely involved in treatment. Each institute
should also be a major center for research and should include departments of
would help minimize the current coolness between clinicians and researchers
370
so often encountered. The department of psychiatry would still be concerned
and would centralize and coordinate the delivery of services and evaluation
of efficacy.
requires separate attention. If both the medical school and the behavioral
psychiatry from the rest of medicine will be minimized. But I also foresee
specialization and the need for integration. Several medical schools have
preclinical sciences and basic general clinical training in the first two to two-
and one-half years. The student can then choose a track leading toward
interested medical students would have early access to all the disciplines
could at the same time maintain their connection with the rest of medicine.
Other students in the behavioral sciences institute might find their primary
base in one of the related disciplines and take clinical work in the psychiatry
track. The content of the M.D. degree may also change. Ph.D.’s arc now
granted in a specific discipline. The trend toward earlier and more intensive
gynecology and obstetrics—or perhaps the M.D. will be the basic medical
information.
372
These changes in medical education will certainly not be completed in
the immediate future, but will extend into the intermediate time span.
efficiency and the roles of the various professionals should have been
least to the point that men will be able to live harmoniously with other men. I
to be the ease, I do not doubt that ways will be found to improve the genetic
stock of the race. When all this has been done, then perhaps psychiatrists will
no longer be concerned with mental diseases but only with problems of living.
Bibliography
Adams, H., “Mental Illness or Interpersonal Behavior,” Am. Psychol., 19.191-197, 1964.
Albee, G., “Emerging Concepts of Mental Illness and Models of Treatment: The Psychological Point
_____, “The Relation of Conceptual Models to Manpower Needs,” in Cowen, E., Gardner, E., and Zax,
Ando, A., Fisher, F., and Simon, H., Essays on the Structure of Social Science Models, MIT Press,
Cambridge, 1963.
_____, “Relationships between Psychology and Psychiatry: The Hidden Issues,” Am. Psychol, 11:99-
374
105, 1956.
Avnet, H., Psychiatric Insurance, Group Health Insurance, Inc., New York, 1962.
Begelman, D., “Misnaming, Metaphors, the Medical Model and Some Muddles,” Psychiatry, 34:38-
58, 1971.
Bell, N., “Models and Methods in Social Psychiatry,” in Zubin, J., and Freyhan, F. (Eds.), Social
Brown, B., and Long, E., “Psychology and Community Mental Health: The Medical Muddle,”
_____, and Ochberg, F., “The Medical Muddle,” Int. J. Psychiat., 9:22-25, 1970-1971.
Cohen, L., “Health and Disease: Observations on Strategies for Community Psychology,” in
Cowen, E., “Emergent Approaches to Mental Health Problems,” in Cowen, E., Gardner, E., and Zax,
Crowley, R., “The Medical Model in Psychoanalysis,” in Masserman, J. (Ed.), Science and
Psychoanalysis,Vol. 12, pp. 1-11, Grune & Stratton, New York, 1968.
Davidson, H., “The New War on Psychiatry,” Am. J. Psychiat., 121:528-548, 1964.
Davis, K., “The Application of Science to Personal Situations: A Critique of the Family Clinic Idea,”
Deutsch, F., On the Mysterious Leap from the Mind to the Body, International Universities Press,
Ellis, A., “Should Some People Be Labeled Mentally Ill?” J. Consult. Psychol., 31: 435-446, 1967.
Glaser, F., “The Dichotomy Game: A Further Consideration of the Writings of Dr. Thomas Szasz,”
Goffman, E., Asylums: Essays on the Social Situation of Mental Patients and Other Inmates,
Grinker, R. R., Sr., “Emerging Concepts of Mental Illness and Models of Rx: The Medical Point of
Halleck, S. L., The Politics of Therapy, Science House, New York, 1971.
376
Herbart, J. F., Cited in Boring, E., A History of Experimental Psychology, Appleton-Century-Crofts,
Jahoda, M., Current Concepts of Positive Mental Health, Basic Books, New York, 1959.
John, E. R., “Where is Fancy Bred?” in M. Hammer, et al. (Eds.), Psychopathology, John Wiley, New
York, 1972.
Kaufman, M. R., “Psychiatry: Why ‘Medical’ or ‘Social’ Model,” Arch. Gen. Psychiat., 17:347-361,
1967.
Knapp, P., “Revolution, Relevance and Psychosomatic Medicine: Where the Light Is Not,”
Leifer, R., “The Medical Model as Ideology,” Int. J. Psychiat., 9:13-21, 31-35, 1970-1971.
Leighton, A., “Psychiatric Disorder and Social Environment,” in Bergen, B. J., and Thomas, C.
1970.
Mowrer, O. H., “ ‘Sin’ the Lesser of Two Evils,” Am. Psychol., 15:301-304, i960.
Nagel, E., The Structure of Science, Harcourt, Brace & World, New York, 1961.
Offer, D., and Sabshin, M., Normality, Basic Books, New York, 1966.
Parsons, T., “Definitions of Health and Illness in the Light of American Values and Social
Structure,” in Jaco, E. G. (Ed.), Patients, Physicians and Illness, Free Press, Glencoe,
1958.
Philips, D. L., “Identification of Mental Illness: Its Consequences for Rejection,” Com. Ment. Health
J.,3:262-266, 1967.
_____, “Rejection: A Possible Consequence of Seeking Help for Mental Disorders,” Am. Sociol. Rev.,
28:963-972, 1963.
Pollin, W., “The Pathogenesis of Schizophrenia,” Arch. Gen. Psychiat., 27:29-37, 1972.
_____, and Stabenau, J. R., “Biological, Psychological and Historical Differences in a Series of
—332, 1968.
378
Reiff, R., “Mental Health Manpower & Institutional Change,” in Cowen, E., Gardner, E., and Zax, M.
Reiss, S., “A Critique of Szasz’s ‘Myth of Mental Illness,’ ” Am. ]. Psychiat., 128: 1081-1086, 1972.
Sander, F., “Some Thoughts on Thomas Szasz,” Am. ]. Psychiat., 125:1429-1431, 1969.
Sarason, I., and Ganzer, V. J., “Concerning the Medical Model,” Am. Psychol., 23:507-510, 1968.
Sarbin, T. R., “On the Futility of the Proposition That Some People Be Labeled ‘Mentally Ill,’ ” J.
_____, and Juhasz, J., “The Historical Background of the Concept of Hallucination,” J. Hist. Behav. Sci.,
3: 339-357, 1965.
Scheff, T. J., “Role of the Mentally Ill and the Dynamics of Mental Disorder: A Research
Scheflen, A. E., “An Analysis of a Thought Model Which Persists in Psychiatry,” in Bergen, B. J., and
Spitzer, S., and Denzin, N., The Mental Patient—Studies in Social Deviance, McGraw-Hill, New York,
Szasz, T. S., The Ethics of Psychoanalysis, Basic Books, New York, 1965.
_____,The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, Hoeber-Harper, New
York, 1961.
Thorne, F. L., “An Analysis of Szasz’s ‘Myth of Mental Illness,’ ” Am. J. Psychiat., 123: 652-656,
1966.
Turner,R. J., and Cumming, J., “Theoretical Malaise and Community Mental Health,” in Cowen, E.,
Gardner, E., and Zax, M. (Eds.), Emergent Approaches to Mental Health Problems,
Weiner, H., “Some Comments on the Transduction of Experience by the Brain: Implications for
380, 1972.
380
Chapter 5
John D. Rainer
In no branch of medical science have there been more rapid, more significant,
and more fascinating advances in recent years than in the understanding and
psychiatric disorder.
evolution, and the human gene pool. Meanwhile, clinicians have become more
drugs. All of these developments have opened the borders on the map
psychiatry.
the United States oversimplified views of one side or the other prevailed, with
382
in the transfer of psychoanalysis from Europe before and after World War II,
the attention of Freud and Ernest Jones to inborn differences was largely
the major psychoses were reported by Rosanoff, and Pollock and Malzberg in
the attempt to assess the genetic contribution, but it was the publication in
family study, and in 1946 of his paper “The Genetic Theory of Schizophrenia,”
based on his New York State twin investigation, that for a while divided and
During his influential career Kallmann devoted his attention to many areas,
including schizophrenia, manic-depressive psychosis, homosexuality, mental
the social. The psychiatric status of the organism at any given time is defined
metabolites; brain and nervous system; infectious and toxic agents and diet;
parents, families, groups, and society. In the largest sense the aim of
psychiatric genetics as a scientific approach is to understand and control the
behavior.
384
individual, are environmentally induced gene mutations or chromosome
At the other extreme on the scale of time and number, the mechanisms
and negative selective forces in the environment, the workings of chance, and
the complexity of the genetic structures of the individual and the population,
presented.
behavior problems and character disorders that would require for their
neurotic disease, and who spoke of primary congenital variations in the ego
and he felt that twin studies might throw light on the possible substitution of
one trait for another. Genetics may thus act as a unifying principle in future
386
children, found them to be as important as maternal attitudes in shaping
sleep, feeding, and sensory responses, activity and passivity, motor behavior,
and specific reaction patterns. Thomas, Chess, and Birch have identified nine
the first two years. These are activity level, rhythmicity, approach-
moment of conception and prenatal and perinatal influences come into play
the ulcer studies both neonates and healthy older persons were noted to vary
in the degree of secretion of pepsinogen, as measured in urine and blood; this
duodenal ulcer, but none of those in the hyposecretor group did. In Mirsky’s
needs that are insatiable by the average good mother; the mother is therefore
perceived as rejecting, the dependent wishes persist, and they can be revived
in later life when fears of the loss of security are mobilized by environmental
eczema differed from those who did not in a congenital predisposition and in
the infants who would develop eczema in the second six months of life
showed a heightened set of responses at birth in the area of cutaneous
388
reflexes. Psychologically their absence of eight- month anxiety meant to Spitz
anxiety and repressed hostility on the part of their mothers. The mothers did
not like to touch their child or care for them, deprived them of cutaneous
contact, and therefore refused to gratify the very need that already at birth
had been shown to be increased in this group of infants. The pathways to the
actual somatic lesion are again not clear, but the model for interaction
provides the new kind of dynamic role for genetics in psychiatric thought.
of the century established the fact that single hereditary traits are determined
by paired particles (later called genes) that are unchanged throughout life,
independently separate during gamete formation, and are transmitted via the
ovum and sperm respectively to combine again in the zygote. The sum total of
associated with the action of that gene. On the other hand, each parent may
may exhibit traits intermediate to those associated with the homozygote for
either gene, or he may display the same trait as a homozygote, in which case
lethal, will usually have a pathological effect expressed against the genetic
pedigrees in the direct line of descent through the affected parent in each
generation, appearing in approximately 50 percent of that parent’s offspring.
Recessive traits require inheritance from both parents, who, since they are
usually heterozygotes, are rarely affected themselves. A child of two
“carriers,” for a given gene are relatively frequent in the population, the
chance of two such individuals mating under conditions of random choice is
much less common; when the gene is rare, many of such matings will be
Since a gene produces a given trait only via a long series of steps that
390
may be modified at every level by both prenatal and postnatal environmental
forces and requirements, as well as by the action of other genes, the effects
effect of many genes, either all having minor intermediate effect (multifactor
inheritance), or modifying the effect of single major genes.
For a half century this empirical body of knowledge was related to what
was known of chromosome structure and processes of cell division, to inborn
and cytology. For some time it had been known that the genetic material
chains are twisted about each other, forming a double helix. To each sugar is
on the other, there is a hydrogen bond linkage that may only take place
between either adenine on one chain and thymine on the other, or guanine on
one and cytosine on the other. A DNA molecule may consist of thousands of
such nucleotide linkages. Replication of the DNA molecule during cell division
complementary to the original half chain. There result two double helical
The importance of the base sequence in the DNA molecule was soon
realized, as the process of protein manufacture by the cell was elucidated. In
very schematic form the code represented by the sequence in the double helix
the sequence of amino acid assembly into a polypeptide chain. In this process
specialized molecules of soluble or transfer RNA (sRNA) carry one by one in
bases that code for one amino acid alone. Once formed, the chain assumes the
392
Mutation
light of the above scheme, they arise from a change in the nucleotide
sequence in the DNA, an error during replication possibly resulting from the
action of certain chemicals or from radiation. This change will affect the
must exist some method of control or regulation. With every cell containing
the same genes, some of these must be inactive, their message never
and other products is regulated at any given time according to the needs of
the entire organism. There are various theories to account for such control.
Jacob and Monod have studied the action in bacteria of regulator genes whose
given enzyme acts, or the end product of such action. In this operon theory
genes are responsive to their surroundings; this is the most basic example of
the process of interaction so central to the modern conception of genetics. In
Human Cytogenetics
chromosomes in man was 48. It was known that females had two X
394
chromosomes and males one X and one Y, but by analogy with drosophila
maleness was thought to be due to the presence of only one X chromosome,
Examining neurons of the cat, they found, in some animals only, a densely
membrane. It was soon realized that it was female cats that demonstrated
about one in 40 cells in females and in less than one in 500 cells in males.
Because of its shape, this small lobe was called a “drumstick.”
Since the sex chromatin body was found in females, who have two X
was established that a Barr body consists of all or part of one X chromosome,
each cell takes place early in the development of the female embryo.
smears made of oral mucosal cells. After swabbing the inside of the cheek
gently with a gauze pad, the roughened surface is scraped with the edge of a
narrow metal spatula. The buccal material is spread onto a glass slide, which
It was not long before the process of “nuclear sexing,” as it was then
called, was applied to certain cases of human infertility and abnormal sexual
nuclear chromatin body. Such females tend to be of short stature and sexually
396
arms are often present. Occurring with an estimated frequency of 0.2 to 0.3
per 1,000 females, Turner’s syndrome may include slight intellectual
one in 500 male births, it accounts for about 1 percent of male mentally
a better source of cells in the process of mitotic division, the stage in which
the chromosomes are distinguishable. Treatment with colchicine arrested
dividing cells in this stage, and the use of hypotonic solutions swelled the
before final staining of the cells in slide preparations. Photography under the
oil immersion lens revealed the chromosomes as X-shaped bodies, each
skin biopsy material and bone marrow, these techniques have been variously
modified and at present are applied most practically to lymphocytes of
peripheral blood.
by antibiotics. After three days of incubation at 37°C, they are ready for
harvesting after being arrested at the cell division stage by adding colchicine
or a derivative of it. The addition of hypotonic sodium citrate solution is
398
In 1956 these new techniques resulted in the demonstration of 46
them, and to enlarge, cut out, pair, and mount them in order of decreasing
and by the position of the constriction called the centromere, the point at
which the two parts of the dividing chromosome still remain joined. The
line with the system proposed at the Denver meeting, the description of the
chromosomes is as follows:
position.
chromosomes.
400
Group 19-20. (F) Short chromosomes with approximately median
centromeres.
and in Paris in 1971, with the aim of increasing the accuracy of chromosome
Chromosomal Abnormalities
and clinical syndromes. The first group of these abnormalities arose from the
separating, each one going into a separate sperm cell (in the male), or into the
ovum and polar body, respectively (in the female), they both go into the same
gamete, producing two kinds of abnormal gametes, those with two
chromosomes of a given pair and hence with one chromosome too many, or
with none of that pair and hence one too few. When united with a normal
sperm or ovum, such a gamete yields a fertilized ovum (zygote) with either 47
or 45 chromosomes in all. Similar processes of nondisjunction at an early
cleavage stage of the zygote, resulting in cells with even more than 47
are formed, each one of which perpetuates its line, giving rise to individuals
with cells of two or more types. This phenomenon is known as mosaicism.
402
per cent, foreshadowed an early germinal, possibly a chromosomal, defect as
the responsible agent. Early in 1959 tissue culture methods showed that
only one is present, the individual is normal. In the latter case, however, he or
she may be a “carrier,” that is, may bear affected children, by producing a
From a practical point of view the translocation mechanism for producing this
greater than for any other woman of the same age (1 in 600 altogether, up to
higher risk (about 10 percent) of having a second affected child, apart from
that of having children who are carriers. If the father has the translocation,
are rare in live-born infants and usually result in early death. One of the
chromatin patterns, it was not long before the techniques of studying human
404
sex chromosomes being missing. The resulting sex chromosome constitution
was first called the XO condition, “O” indicating simply the absence of a
phenomenon may yield sperm cells having both X and Y (XY) with 24
necessary and sufficient for maleness, since the XO individual is female with
only one X chromosome but no Y, while the XXY, possessing two X
pictures that have been reported. Nondisjunction during later cell divisions
after the zygote is formed may produce such abnormalities as XXXY or XXXXY
deficiency) and many varieties of mosaicism. It has been estimated that one in
diagnosis and counseling, its value in unraveling the processes of gene action
is only beginning to be exploited. For one example, the correlation of specific
406
distinguish nosological subgroups in major diagnostic categories.
schizophreniclike behavior.
degrees of eunuchoid habitus and weak libido, low marriage rate, often
mental deficiency, and personality disorders ranging from inadequate
have been found in clinics and hospitals are often mildly retarded and socially
withdrawn; they seem to be found more often than expected in mental
body defects play any role in the extra X syndromes described above, they do
not seem to result in any disturbance here, for these girls and women have
been described as resilient to adversity, stable in personality, and maternal in
temperament. They are not mentally retarded except in some nonverbal skills
especially since the frequency of XYY males in the total population is not yet
accurately known.'" Fluorescent staining techniques in buccal epithelial cells
should be able to provide better data both on the incidence of the karyotypic
408
some of these men are usually passive, withdrawn, inadequate, and docile,
but under stress they may exhibit impulsive behavior. There is also
imbalance and mental symptoms may one day elucidate some of the genetic
mechanisms in behavior disorders. An analogy has been provided in studies
Pedigree Method
Census Method
with that in the general population. A number of pitfalls must be avoided. The
the desired categories must then be located and diagnosis made. Since one is
interested not in the incidence (new cases) or even the prevalence (total
cases) but rather in the expectancy rate (cases that may arise during the
lifetime of the relatives), it is necessary either to wait for many years or more
practically to apply a correction method. A simplified method often used is
410
relatives in this category, but rather that number diminished by all of those
who have not reached the earliest manifestation age and half of those still
representing the expectancy of developing the given condition for those who
will live through the manifestation period. This figure can then be compared
with risk figures for other groups of relatives and for the general population.
The latter have been determined in many cases by total or sample population
studies, or by studies of the relatives of control patients.
twins, those derived from a single fertilized ovum that has split and
developed as two separate individuals (“identical,” monozygotic, or one-egg
twins) and those derived from two ova, fertilized by two different
twins). In the first case the twins are always of the same sex (barring a rare
sex chromosome loss early in embryonic division, which may result in a pair
syndrome). On the average dizygotic twins are one-quarter of the time both
twins are born with the same genotype; dizygotic twins are as similar
genetically as any pair of sibs.
In the twin family method the index cases are twins. Expectancy rates
partners of the same sex, dizygotic twin partners of opposite sexes, full sibs,
half sibs, and step sibs. This method provides a graded series of genetic
relationships and a differently graded series of environmental ones; the
extent to which the risk in the various categories of relatives corresponds to
the genetic similarity bears a relation to, or is a measure of, the genetic
412
but such pairs who also present a particular syndrome are rare.
monozygotic and dizygotic pairs, and the diagnosis of zygosity and that of
twins, at least those of the same sex, has been questioned; yet observation of
twins and their families has often shown similar family dynamics and role
assignment—twin dependency, parental need to distinguish, and so forth—
with both types of twins. Indeed, monozygotic twins are often more disparate
in size and vigor at birth than dizygotic ones. Finally it should be realized that
it is not necessary to have 100 percent concordance in monozygotic twins to
the dizygotic rates, monozygotic concordance rates of under 50 per cent, for
dissimilar twins studied by Rainer, Mesnikoff, Kolb, and Carr. Obtaining data
each parent about the sex of the expected child; (2) the attitude of the parents
toward the twins’ birth; (3) the family significance of the naming, both as
established before birth and as modified by the birth of the twins; (4) the
features to the parents and the extended family; (7) the effect of such bodily
distinctions on the differential mode of mothering for each twin; (8) the
differing object relations of the twins from birth onward; (9) the attitude of
each twin to his body and to his self, as perceived and as seen ideally; (10) the
414
fantasy life of the twins, particularly in the sexual area; and (11) the superego
birth, and the occurrence of petit mal seizures in one twin at the age of three.
It was suggested that these early events may have set a double pattern—
focusing of the mother’s concern on one twin as being psychiatrically and
child’s part, which helped him to strengthen his control and responsibility
over himself. As in all of these studies, similarities in underlying personalities
as to physiological differences.
development.
perinatal, and postnatal interactions. The pathways are labyrinthine that lead
in twins from the identical molecular structures that constitute the genic
the dynamic process at nodal points may lead to wide phenotypic divergence.
Preconceived ideas on the locus of such nodal points should be regarded with
may arise not only from postnatal influences on the twins but also in the
prenatal stages of development. Infant, childhood, adolescent, and adult
Adoption Studies
416
biological parents, while others have compared biological and adoptive
parents and other relatives of affected adopted children. Some of the findings
in these kinds of studies are discussed in Volume Three, Chapter 25, of this
Longitudinal Studies
affected parents may be followed, comparing them with their sibs and with
protective factors.
gene if it appears to stem from a locus on the same chromosome with, and at
a given distance from, the locus of another known gene. In principle linkage is
depression and color blindness, occurring in the same family, may be found
usually together or usually separately.
genetic basis; if, however, there are strong differences in prevalence that are
determined by cultural and environmental factors and that are not due to
418
differences in diagnostic procedures, the genetic contribution, although it
may still be present, will be more difficult to detect.
Schizophrenia
For over 40 years family and twin studies, studies of adopted children,
hereditary basis for schizophrenia. From the point of view of the present
seems to vary with the severity of the illness and to bear a relation to newly
delineated clinical types; and the fourth is the emergence of longitudinal
of fertile marriages and higher overall reproductive rates; therefore, the need
Affective Disorder
Studies of families and twins have played an important role in both the
Kraepelin observed large numbers of relatives who had the same illness, but
he did not find an increase in dementia praecox among these relatives. In
most European and American populations the general rate for manic-
depressive psychosis varies between 0.4 percent and 1.6 per cent, though in a
few special situations, such as isolated populations, rates of as low as 0.07
has been consistently observed. In the case of parents, sibs, and children of
manic-depressive index cases, the expectancy rates are much higher, with a
studies. With both parents affected, the morbidity risk in children has been
found to be as high as 40 per cent.
In the largest twin family study that has been reported, Kallmann
manic-depressive psychosis varied from 16.7 percent for half sibs to 22.7 and
420
25.5 percent for sibs and two egg co-twins, respectively, and 100 percent for
one egg cotwins. Parents of index cases showed a rate of 23.4 percent. Since
only patients admitted to a mental hospital, and hence the most severe cases,
were included as index cases, the apparently perfect concordance rate of 100
percent for one-egg twins was considered an artificial maximum value. Other
two subgroups, bipolar illness with periods of mania, and unipolar illness
these two groups have shown different morbidity risk in relatives, with the
bipolar cases showing more genetic loading than the unipolar cases or than
the earlier combined groups. A 34 percent risk was found, for example, in the
first-degree relatives of bipolar patients studied by Winokur. Moreover, both
bipolar and unipolar illness have been found in the first-degree relatives of
bipolar cases, while families of unipolar probands have shown only unipolar
illness.
These data seem to indicate that bipolar and unipolar illness are
different with regard to their genetic component, although the nature of the
genotype of the unipolar relatives found in bipolar families remains in
atypical forms. Some studies have divided the group according to time of
onset, with earlier onset associated with more severe genetic loading, later
onset with a negative family history; while others have classified patients on
the basis of their response to pharmacological treatment. In the latter
between patients and affected family members who respond only to MAO
inhibitors and those who respond only to tricyclic antidepressants. Similar
422
The X-linked hypothesis is based on the observation of an excess of
females in the sex ratio of manic-depressive illness and the rarity of father-to-
by the New York study of persons totally deaf since birth or early childhood.
Although the prevalence of affective illness did not differ from that among the
normal hearing population, there was a decrease in symptoms of guilt and
closely with the group of schizoid personality traits than with manic-
Criminality
selectivity and heterogeneity; they tended to show high concordance rates for
been described with divergent overt histories, and it would seem to be more
appropriate to study specific personality traits leading to a life of crime rather
than criminal behavior itself. The current status of the role of chromosomal
424
intelligence than any other aspect of behavior genetics; the value of early
childhood education, the nature of learning, the problem of underprivileged
groups, and innumerable school policies have become involved with this
issue. The question often narrows down to one of priorities in making very
practical decisions. Underlying much of the divergence of conclusion is the
yet what factors are measured by the various tests, or how their results are
made by the study of a group of 33 pairs of twins discordant for early total
deafness. In these pairs the verbal IQs showed significant difference that
disappeared in the performance scales. The role of emotional factors in
formulations.
In the field of mental defect some of the data are more clear-cut. Mental
deficiency syndromes based on specific gene mutations and chromosomal
consider that polygenic inheritance is responsible for most of the rest, with
they conclude that five-sixths of persons in the given lower IQ range have had
at least one parent or an aunt or an uncle similarly retarded.
group of persons still living at 90 years and above and the other a random
group of individuals. The sum of the ages at death of the six immediate
ancestors of the index cases was significantly greater in the longevous group
than in the comparison group.
426
been that conducted in the Department of Medical Genetics of the New York
State Psychiatric Institute since 1945 by Kallmann and various colleagues and
started with 1,603 twin index cases over the age of 60 and followed the
mortality patterns of 584 pairs where both twins qualified as index cases. The
length of time between the death of the first twin and the death of the second
twin has been consistently greater in the dizygotic pairs than in the
monozygotic pairs. These studies also confirmed the relationship between the
mean life span of the twins and their sibs and the age of death of their
parents. The investigators felt that life span potential was demonstrated to
have a genetic basis that could be assumed to follow the multifactor type of
inheritance. Also studied were intrapair differences in psychometric test
scores, which were larger for dizygotic than for monozygotic twins. There
with survival.
loss was found in the aged women but not in the aged men. The chromosome
of overall chromosome loss than young males, the chromosomes that were
chromosome loss was found in the women who had organic brain syndrome
Intersexual Conditions
428
changes. Most hermaphrodites with both testicular and ovarian tissues are
found to have normal karyotypes, although some are mosaics. A few
What one can say is that the chromosomal pattern determines the
determining genes are probably on the X chromosome and may also exist on
female determiners tend to exert such a strong influence that the individual
develops as a female.
Male Homosexuality
on the finding of a greater proportion of males among their sibs than would
birth order and a high maternal age, with a variance in the latter as great as
430
Kallmann’s investigation of a series of male twins with homosexuality
expected on the basis of Kinsey’s statistics for the general population. In the
apparatus. Not ruling out the possibility that some male homosexuals,
generally put aside this special explanation, along with other theories of
single-factor causation, in favor of a range of genetic mechanisms capable of
that during an earlier period (1916) I was less cautious and believed, on
pretending to be an expert in this field I should like to point out that what
has been previously said about gynecomastia (an inherited change in the
mammary gland the brain would be the end organ (italics added).
interaction in the organism from its earliest origin and with its genetic
potentialities.
biological basis for the usual heterosexual choice, for example, may provoke
432
intromission in heterosexual contact, with more of the “satisfactions which
intromission may bring”; (3) olfactory and other anatomical and physiological
characteristics differentiating the sexes; and (4) the conditioning effect of the
nature; (2) to feel and recognize satisfaction and success; and (3) to utilize
sex.
responsible for homosexuality may operate on the rates and extent of the
The plan used in observing those few one-egg twin pairs found with one
of the developing character structure and the most sensitive periods at which
they can be affected, it is obvious that many more cases must be studied
434
before any detailed interactional synthesis can be achieved.
Genetic Counseling
From the clinical point of view the final common pathway for the
planning and population growth, and concerns with birth control, voluntary
sterilization, genetic diagnosis by amniocentesis, abortion, and adoption
have special skill in assessing the emotional aspects of the search for genetic
coming for help, and the impact of the information provided. Many persons
accept misinformation and superstition if it is in accordance with their wishes
or fears. Some couples look for reasons to avoid marriage and parenthood,
while others who have had an affected child seek to alleviate their shame or
public responsibility. With proper concern the growing body of scientific and
psychiatrists may participate in the social planning that lies ahead as well as
discharge their duty to foster responsible parenthood and genuinely healthy
Bibliography
Altshuler, K. Z., “Personality Traits and Depressive Symptoms of the Deaf,” in Wortis, J. (Ed.),
Angst, J., and Perris, C., “Nosology of Endogenous Depression, A Comparison of the Findings of
Two Studies,” Archiv für Psychiatrie und Zeitsclirift für die Gesamte Neurologic,
210:373-386, 1968.
Asano, N., “Clinico-Genetic Study of Manic-Depressive Psychoses,” in Mit- suda, H. (Ed.), Clinical
436
Barr,M. L., and Bertram, E.G., “A Morphological Distinction between Neurons of the Male and
_____, and Hobbs, G. E., “Chromosomal Sex in Transvestites,” Lancet, 1:1109–1110, 1954.
Bartalos, M., and Baramki, T. A., Medical Cytogenetics, Williams & Wilkins, Baltimore, 1967.
Benjamin, J. D., “Some Comments on Twin Research in Psychiatry,” in Tourlentes, T. T., Pollack, S.,
Bleuler, M., and Wiedemann, H. R., “Chromosomengeschlecht und Psychosexualitat,” Archiv für
Blum, J. E., Jarvik, L. F., and Clark, E. T., “Rate of Change on Selective Tests of Intelligence: A
Special Regard to Schizophrenia and Mental Deficiency,” Acta Genet., 4:1-139, 1953.
_____, Fraccaro, M., and Lindsten, J., “Cytogenetical Observations in Mongolism,” Acta
Paediatrica,48:453-468, 1959.
Carr, A. C. (Ed.), The Prediction of Overt Behavior through the Use of Projective Techniques, Charles
Series, 2, 1966.
Comfort, A., “Sexual Selection in Man—A Comment,” Am. Naturalist, 93:389- 391, 1959.
Court Brown, W. M., Males with an XYY Sex Chromosome Complement,” J. Med. Genet., 5:341–359.
1968.
Edwards, J. H., Harnden, D. G., Cameron, A. H., Crosse, V. M., and Wolff, O. H., “A New Trisomic
Erlenmeyer-Kimling, L., and Hirsch, J., “Measurement of the Relations between Chromosomes and
438
_____, Nicol, S., Rainer, J. D., and Deming, W. E., “Changes in Fertility Rates of Schizophrenic
Ford, C. E., Jones, K. W., Polani, P. E., et al., “A Sex-Chromosome Anomaly in a Case of Gonadal
Gottesman, I. I., and Shields, J., “A Polygenic Theory of Schizophrenia,” Int. J. Ment. Health, 1:107-
115, 1972.
Hartmann, H., “Comments on the Psychoanalytic Theory of the Ego,” in Essays on Ego
_____, “Psychiatric Studies of Twins,” Jahrbücher für Psychiatric und Neurologie, 50, 1934, and 51,
1935.
Hecht,F.,Wyandt, H. E., and Erbe, R. W., “Revolutionary Cytogenetics,” New Eng. J. Med., 285:1482-
1484, 1971.
Hopkinson, G., “A Genetic Study of Affective Illness in Patients over 50,” Brit. J. Psychiat., 110:244-
254, 1964.
Jacob, F., and Monod, J., “Genetic Regulatory Mechanisms in the Synthesis of Proteins,” J. Molec.
Biol.,3:318-356, 1961.
Jacobs, P. A., Baikie, A. G., Court Brown, W. M., MacGregor, T. N., MacLean, N., and Harnden, D. G.,
“Evidence for the Existence of the Human ‘Super- Female,’ ” Lancet, 2:423-425,
1959.
_____, _____, ______, and Strong, J. A., “The Somatic Chromosomes in Mongolism,” Lancet, 1:710,
1959.
_____ , and Strong, J. A., “A Case of Human Intersexuality Having a Possible XXY Sex-determining
440
Jarvik, L. F., Altshuler, K. Z., Kato, T., and Blumner, B., “Organic Brain Syndrome and Chromosome
_____, Kallmann, F. J., Falek, A., and Klaber, M. M., “Changing Intellectual Functions in Senescent
_____, and Kato, T., “Chromosome Examinations in Aged Twins,” Am. J. Human Genet., 22.562-572,
1970.
Jones, E. “Mental Heredity,” in Essays in Applied Psychoanalysis, Vol. 1, Hogarth, London, 1951.
Kallmann, F. J., “Comparative Twin Study on the Genetic Aspects of Male Homosexuality,” J. Nerv.
_____, “Genetic Factors in Aging: Comparative and Longitudinal Observations in a Senescent Twin
Population,” in Hoch, P., and Zubin, J. (Eds.), Psychopathology of Aging, Grune &
______, “Genetic Principles in Manic-Depressive Psychosis,” in Hoch, P., and Zubin, J. (Eds.),
1971.
Kay, B., “Observations on the Natural History and Genetics of Old Age Psychoses, A Stockholm
Kinsey, A. C., Pomeroy, W. B., Martin, C. E., and Gebhard, P. H., Sexual Behavior in the Human
Kolb, L. C., Rainer, J. D., Mesnikoff, A., and Carr, A., “Divergent Sexual Development in Identical
Kolodny, R. C., Masters, W. H., Hendryx, J., and Roro, G., “Plasma Testosterone and Semen Analysis
Kraepelin, E., Manic-Depressive Insanity and Paranoia, E & S Livingstone, Ltd., Edinburgh, 1921.
Lang., T., “Die Homosexualitat als Genetisches Problem,” Acta Geneticae Medicae et Genellogiae,
9:370-381, i960.
442
Larsson, T., and Sjogren, T., “A Methodological, Psychiatric, and Statistical Study of a Large
89, 1954.
Lejeune, J., Gautier, M., and Turpin, R., “Etude des chromosomes somatiques de neuf enfants
Leonhard, K., Aufteilung der Endogenen Psychosen, Akademie Verlag, Berlin, 1959.
Loraine, J. A., Adamapoulos, D. A., Kirkham, K. E., Ismail, A. A. A., and Dove, A., “Patterns of
Lyon, M., “Sex Chromatin and Gene Action in the Mammalian X-Chromosome,” Am. ]. Human
Genet.,14:135-148, 1962.
Mendlewicz, J., Fieve, R. R., Rainer, J. D., and Fleiss, J. L., “Manic Depressive Illness: A Comparative
Study of Patients With and Without a Family History,” Brit. J. Psychiat., 120:523-
530, 1972.
Mirsky, I. A., “Physiologic, Psychologic and Social Determinants of Psychosomatic Disorders,” Dis.
Money, J., “Hormonal and Genetic Extremes at Puberty,” in Zubin, J., and Freedman, A. M. (Eds.),
National Institute of Mental Health, Report on the XYY Chromosomal Abnormality, U.S.
Nielsen, J., Jensen, L., Lindhardt, H., Stottrup, L., and Sondergaard, A., “Chromosomes in Senile
Pare, C. M. B., “Homosexuality and Chromosomal Sex,” J. Psychosom. Res., 1: 247-251. 1956.
_____, and Mack, J. W., “Differentiation of Two Genetically Specific Types of Depression by
Patau, K., Smith, D. W., Therman, E., et al., “Multiple Congenital Anomaly Caused by an Extra
Pearl, R., and Pearl, R. DeW., The Ancestry of the Long-Lived, Johns Hopkins Press, Baltimore,
1934.
Pearson, P. L., Borrow, M., and Vosa, C. G., “Technique for Identifying Y Chromosomes in Human
444
Perris, C., “Abnormality on Paternal and Maternal Sides: Observations in Bipolar (Manic-
1971.
Plunkett, E. R., and Barr, M. L., “Testicular Dysgenesis Affecting the Seminifuous Tubules,
Polani,P. E., Briggs, J. H.,Ford, C. E., et al.,“A Mongol Girl with46 Chromosomes,” Lancet, 1:721-724,
i960.
_____, Hunter, W. E., and Lennox, B., “Chromosomal Sex in Turner’s Syndrome with Coarctation of
Pollin, W., and Stabenau, J. R., “Biological, Psychological, and Historical Differences in a Series of
Pollock, H. M., Malzbf.rg, B., and Fuller, R. G., Heredity and Environmental Factors in the Causation
N.Y., 1939.
1958-
Rado, S., “Adaptational Psychodynamics: A Basic Science,” in Psychoanalysis of Behavior, Grune &
_____,“An Adaptational View of Sexual Behavior,” in Hoch, P. H., and Zubin, J. (Eds.), Psychosexual
_____,“Hedonic Control, Action-Self, and the Depressive Spell,” in Depression, Proceedings of the
1969.
_____, Abdullah, S., and Jarvik, L. F., “XYY Karyotype in a Pair of Monozygotic Twins: A 17-Year
_____, Mesnikoff, A., Kolb, L. C., and Carr, A., “Homosexuality and Heterosexuality in Identical
Raphael, T., and Shaw, M. W., “Chromosome Studies in Schizophrenia,” J.A.M.A., 183:1022-1028,
446
1963.
Redding, A., and Hirschhorn, K., “Guide to Human Chromosome Defects,” Birth Defects Original
Reed, E. W., and Reed, S. C., Mental Retardation: A Family Study, W. B. Saunders, Philadelphia,
1965.
Reich, T., Clayton, P., and Winokur, G., “Family History Studies: V. The Genetics of Mania,” Am. ].
Rosanoff, A. J., Handy, L. M., and Plesset, I. R., “The Etiology of Manic-Depressive Syndromes with
_____, Handy, L. M., Plesset, I. R., and Brush, S., “The Etiology of So-Called Schizophrenic Psychoses
1934.
Rosenthal, D. (Ed.), The Genain Quadruplets, Basic Books, New York, 1963.
______, Genetic Theory and Abnormal Behavior, McGraw-Hill, New York, 1970.
Salzberger, R. M., and Jarvik, L. F., “Intelligence Tests in Deaf Twins,” in Rainer, J. D., Altshuler, K.
Z., and Kallmann, F. J. (Eds.), Family and Mental Health Problems in a Deaf
Slater, E., “Birth Order and Maternal Age of Homosexuals,” Lancet, 1:69—71, 1962.
_____, “The Inheritance of Manic-Depressive Insanity,” Proc. Roy. Soc. Med., 29: 981-990, 1936.
_____, “Psychiatric and Neurotic Illnesses in Twins,” Medical Research Council, Special Report Series
_____, and Cowie, V., The Genetics of Mental Disorders, Oxford University Press, London, 1971.
_____, Maxwell, J., and Price, J. S., “Distribution of Ancestral Secondary Cases in Bipolar Affective
Spitz, R. A., The First Year of Life, pp. 224-242, International Universities Press, New York, 1965.
Stenstedt, A., “Involutional Melancholia,” Acta Psychiatrica Scandinavica, Suppl. 127, 1959.
_____, “A Study in Manic-Depressive Psychosis: Clinical, Social and Genetic Investigations,” Acta
Thomas, A., Chess, S., Birch, H. G., Hertzig, M., and Korn, S., Behavioral Individuality in Early
448
Tjio, J. H., and Levan, A., “The Chromosome Number of Man,” Hereditas, 42: 1-6, 1956.
Tompkins, G. M., and Martin, D. W., “Hormones and Gene Expression,” Annual Rev. Genet., 4:91-
106, 1970.
Vartanyan, M. E., and Gindilis, V. M., “The Role of Chromosomal Aberrations in the Clinical
Watson, J. D., Molecular Biology of the Gene, W. A. Benjamin, New York, 1970.
_____, and Crick, F. H. C., “The Structure of DNA,” Cold Spring Harbor Symposia on Quantitative
Wilkins, L., Grumbach, M. M., and Van Wyk, J., “Chromosomal Sex in Ovarian Agenesis,” J. Clin.
Winokur, G., and Clayton, P., “Family History Studies: 1. Two Types of Affective Disorders
Separated According to Genetic and Clinical Factors,” in Wortis, J. (Ed.), Recent Adv.
Notes
[1] Subsequent investigations revealed that satellites are carried by all the acrocentric chromosomes,
except the Y, although they cannot always be seen; therefore, the use of satellites to
450
Chapter 6
The Personality
Joseph F. Rychlak
This chapter will be limited to the strictly psychological views of personality,
as opposed to the more properly psychiatric theories. All theories must deal
review five such points of relevance before moving on to see how they have
been answered by theorists interested in the question, “What is man?”
What Is a Cause?
the material cause. In describing a chair we can say that we know it is a chair
because like most chairs it is made of wood, or metal, or the like. Another
cause of the chair is the fact that it was assembled by someone or something
(a machine). This Aristotle termed the efficient cause. Chairs also meet our
Finally Aristotle noted that there is often a purpose in events, a “that for
the sake of which” something like a chair is made to come about. The “sake”
and so forth. Of course, the chair docs not itself decide to “come about.” It is
the human being who obtained the wood (material cause) and made it
cause) so that he might live more comfortably (final cause) who may be said
way of opposition. Just as to know “left” is to know “right,” so, too, did men
like Socrates and Plato assume that all meanings were at some point united
by arguing that when one begins in error he ends in error. One cannot extract
452
truthful conclusions from premises that are false to begin with, dialectically
or otherwise. Only through premises of a “primary and true” or factual nature
Although Aristotle wanted to move the scientist out of his armchair into
the world of facts, he was not above employing final causes in his description
of nature. For example, in hisPhysics Aristotle theorized that leaves exist for
the “purpose” of providing shade for the fruit on trees (pp. 276-277). In
time the natural scientist has made conscious effort to explain events in only
material and/or efficient cause terms, with modest use of formal causality,
but no use of the final cause.
John Locke then followed in this British empiricist tradition to say that
framing in meaning “from above.” Whereas Locke felt that we could not—as
human beings— subdivide, frame, or invent one “new” simple idea in mind,
thought man could and often did see the opposite implication of these
Lockean inputs. This led to alternative implications for meanings were again
taken as bipolar, and hence man could be said to influence his relationship to
structures or, in the case of mentality, “inputs.” This placed the theoretical
account at a “third person” or extraspective perspective. The extraspectionist
writes his theory about “that, over there,” the object or organism under
454
written. The introspectionist writes about “this, over here,” the individual or
subject under study in a “personal” way. In this case a more Kantian
of view” for the sake of which (final cause) an organism may be said to
behave. This shift in theoretical perspective is probably the main alteration in
The final aspect of knowledge that science was to affect has to do with
the other hand, science was to raise the status of validating evidence. In the
events that have been designed to test a prediction about the effect of one
been the focal point for these interplaying vehicles for the exercise of
evidence.
who tried to find his way within the strictures of a demonstrative science that
did not quite meet his theoretical needs. Freud is the father of modern
unconscious, directing man from out of a region of wishes and desires, was
are crazy quilt patterns of contradiction and inconsistency. Freud made man
456
carried meaning, and even more complexly, such meanings werealways
repressed!
Freud began writing his ill-fated Project for a Scientific Psychology. This is the
clearest Lockean formulation in all of Freud, but one that he could not
ideas and counter wills (pp. 117-128), in the ill-fated Project he was to speak
whereas the latter are on the side of efficient and material causes. Fliess had
pushed Freud over the line to scientific respectability, but within three
months’ time Freud could honestly say to his friend: “I no longer understand
the state of mind in which I concocted the psychology [the Project]” (p. 134).
What Freud did do in time was to introduce his libido theory, as a kind
of efficient cause (thrust) and possibly material cause (does libido “exist?”)
appellation he identified with “sophist.” But anyone with the proper grasp of
history can see that he made his energies behave dialectically. Drive power
always issues from a dialectical ploy of some sort, oriented teleologically for
goals in conflict (lust versus propriety, and so on), and then rephrased in
Lockean substrate energies, Jung moved his concept of libido even more
147). Jung also clearly recognized that his therapeutic approach was
dialectical in nature (p. 554). Adler was to prove the most teleological of the
this movement was always fixed by some goal (telos) as embodied in a life
plan, prototype, or life style (formal causes that, when exercised, permitted a
“that for the sake of which” purposiveness in Adlerian thought). Let Adler
retained a healthy respect for the tough-minded approach to theoretical
458
the dialectical ploy (p. 145).
It was Sullivan more than any other person who shifted the locus of
psychoanalysis to an interpersonal rather than an intrapersonal frame of
of behavior are the most compatible of all analytical formulations with the
In more recent years Arieti has attempted to offset the heavy reliance of
self” conceptions to say that man is what his environment makes him, Arieti
stated flatly that “the self is not merely a passive reflection” (p. 370). Psychic
identities are not tabula rasa, but rather the individual has a certain cognitive
contribution to make to his ultimate personality. Thus we find in Arieti a
of symbolic organization.
There are many other theorists who might be cited in this tradition,
such as Horney, Fromm, Rank, and so forth, but we must refer the reader to
the other chapters of this volume for a more thorough coverage of such views.
We wish now to move into another major tradition having implications for
theories of personality.
twentieth century, this theory was never popular as a formal position in the
validity—for this client, and quite likely for all humans as well. Unfortunately,
as events were to demonstrate both within and without the analytical camp,
them, and clients to be healed by the knowledge so garnered. If they all work
equally well to heal, which “insight” is the “true” one, reflecting what is
460
actually taking place in the personality—a Freudian’s, Jungian’s, Adlerian’s, or
Sullivanian’s?
argued that not until a behavioral phenomena had been traced back to
“simple forces” (Helmholtz) and “motion” (Wundt) could it be said that a
complete account of its nature was rendered (Cassirer, pp. 86, 88). We can
see here the substrate efficient cause “reduction” that had been the hallmark
of sound science since the days of Bacon. It remained for John B. Watson to
“natural science” description and press them upon the study of man in his
school of behaviorism. Here was a “truly scientific” rendering of human
activity, one that academic psychology could embrace and further through
experimentation.
the behaviorist puts in front of him always is: Can I describe this bit of
behaviorists we stand “over here” and describe the behavior of others “over
there” in efficient cause terms. There is no attempt to speculate about the
final causation are literally impossible in the behaviorist’s world view. All that
variable and dependent variable) with his theoretical terms (stimulus and
response.) The world of reality is “out there,” and the behaviorist makes no
bones about his job being that of mapping it “as discovered.”
differed over the years. Watson relied upon Pavlov’s conditioned reflex and
physical process. This theory has been termed a “drive reduction” view, based
awareness, much less intentionality. Indeed, when he voiced his initial call for
behaviorism in 1913, Watson made it clear that this approach “recognizes no
dividing line between man and brute” (p. 158). This resulted in an entirely
mechanical conception of human behavior, with reflexes being combined a la
Lockean building blocks into habits, and congeries of habits leading to higher
level behaviors at the social level (not unlike the Sullivanian conception
462
referred to above). But nowhere was there the dialectical clash, the internal
psychoanalysis.
extraspective theory. Tolman, for example, drew inspiration from the Gestalt
theorists and proposed that animals (including man) approached life in terms
of a Kantianlike sign-gestalt (p. 135), which acted as a sort of road may along
expectancies. We see here more of a mixed model and the hint of final
causality, although Tolman formally rejected teleology in the best tough-
the fact that it reduces anxiety over the short run tends to maintain it (see
over a log (operant response) and is rewarded thereby with a rich lode of
he once said to Evans: “I don’t see any reason to postulate a need anywhere
along the line. . . . As far as I’m concerned, if a baby is reinforced by the sound
empirically pure.
464
cyberneticist that man has any other than a demonstrative power of reason.
Yet, as Freud properly grasped, whereas the Ten Commandments fed into a
into a man would of necessity teach him “ten possible sins!” But in Skinner’s
world not only are all such one-sided “controls” possible, but also they are
desirable and of the essence of existence. For that is the nature of behavior; it
cause predictability. The trick is to find how best to direct this flow of impetus
Wundtian and the behavioristic formulations led to that moved men like
Kohler, Koffka, and Wertheimer to found a reactionary form of scientific
approach they termed Gestalt psychology. This school took root about the
century. But the Gestaltists were not the only voices rising in opposition to
natural science descriptions of man. Throughout the 1920’s, 1930’s, and
1940’s, and particularly following World War II, a rising tide of criticism was
science theory applied to man somehow robs him of that spontaneous sense
terms of our causes, Kant was saying that material causation was always
dependent upon an assumption that “things are really there, even though all I
can know about palpable events is what my senses tell me.” And when we
now consider the objectivities of natural science, it is obvious that they all
rely on a kind of “inter- subjective agreement” between individuals who are
themselves functioning within their own, private, subjective phenomenal field
466
extraspective validation. Building on the theme of alienation first introduced
by Hegel, and then popularized in the writings of Kierkegaard, the
existentialists argue that man has been alienated from his true (phenomenal)
such a variant form of scientific method. Although he worked to lay down the
principle of just how this method might be conceived, the actual process was
never crystallized.
bias, even in the sense of presuming that certain experience is normal, other
abnormal, and so forth (p. 110). Hallucinations are thus phenomenally as true
experience for the individual and in this way come to see his reality (dasein)
based upon intersubjectivity, and doubtless the resultant account leaves out
much that is rich in a subjective sense, validating evidence does at least point
to objective generalizations. With nothing else to go on, the scientist can state
over the details of “what do we know about phenomenon X?” And this has
been the great indictment of phenomenological efforts. Not that they are
not the least of the reasons that he found it so difficult settling disputes with
students and colleagues can be traced to the exclusive reliance that clinical
that behaviorism has on academia never really permitted this more Kantian
psychology, but the truth is that it makes rather frequent rebounds under the
guise of so-called cognitive psychology. The Gestaltists, too, were advocates of
468
phenomenology, which Koffka once essentially defined as the attempt “to look
naively, without bias, at the facts of direct experience” (p. 73). Gestalt
psychology is best known for its supposed attempt to prove that “the whole is
greater than the sum of its parts.” What has not often been made clear is that
this conception of the relations between the “one” and the “many” has
Rychlak, pp. 257-267). And invariably over the course of the centuries it was
the more idealistic, dialectically oriented philosopher who argued this point.
Plato, for example, viewed knowledge as “one,” as having “many” facets, but
contradictions thus implied, the student (and teacher) could arrive at a higher
state of totality (synopsis, later “synthesis” a la Hegel).
Gestaltists did show again and again that man contributes something to
and thought that make certain “total organizations” likely to result in one
taking place “over here,” as an observer looking out onto the world studies his
own processes. Their behaviorist counterparts found this sort of talk almost
spiritual, harking back to the Middle Ages. There was a certain truth in this, of
course, because the major factor of a “totality” is that it has organization; that
is, it is a formal cause. And, assuming now that the individual may be said to
behave “for the sake of’ this total experience rather than simply responding to
inputs, it follows that we begin taking on the meaning of a final cause in our
issues separating behaviorists from Gestaltists have never been made clear.
Often ad hominerm have been substituted for rational discourse, and nowhere
Having now reviewed the three major intellectual traditions that have
470
the formal outlooks of academicians, it will be clear to the reader that
that these constructs were directed at some clearly philosophical issue, such
as determinism versus teleology. A theorist’s name and his major construct
Sheldon’s “Morphogenotype”
about man that dates back through Kretschmer, Lomboroso, and others to the
Lockean model. The point here is that “genes” are “primary and true” items of
descent of man. At least there has been no deity teleology or natural teleology
at work. Whether there has been a human teleology— and how this is to be
(muscles, bones, blood vessels, etc.) layers of the developing organism. The
in every human form, and Sheldon has devised a series of ratings to score
individuals along these “primary components of physique.”
competition, and the leader role); and cerebrotonia (people with restraint in
472
established that endomorphy was related to viscerotonic personality
tendencies, ectomorphy to cerebrotonic traits, and mesomorphy to
explication of the human pattern, but neither does it presume to explain all
studied his school books because his parents showed him love and gave him
financial rewards for good grades, the mature adult can in fact acquire along
the way a love of knowledge per se. The “conditioning” process of earlier
years is not irrelevant to the now functionally autonomous motivation, that is,
the basic drive reductions (the physical caressing from parents) as so-called
But Allport was trying in his own way to break personality description
behavior” (p. 295). Note the tie given here to the physical structure of the
central nervous system (material cause). A trait is a formal cause notion, since
Allport was thus hoping to point out that man’s behavior is not blindly
474
habitual, responsive to stimulus input only, but also to some degree self-
directing and stylized. Man could behave “for the sake of” an interest, a
fascination, a freely operating desire that he had learned over time was
development over the course of life. One can learn a good deal about the
cannot learn why the French value one style of living while the Italians
evolving across time. And to immerse oneself in the first five years, as Freud
had done, or to believe that only through base reinforcement does man find
the motivation to approach life, as Watson had done, was for Allport a
common error in theoretical formulation. Man can be functionally
Murphy’s “Canalization”
events (efficient causes). But these movements were simply preparatory; they
oriented the animal for eventual gratification that was itself more in the
the restaurant waitress approaches our table to take our order, there are
various mechanical, unthinking conditioned responses that we make in
ordering our meal; for example, we arrange our plate and table utensils, tap
nervously on the menu, and so forth. But the consummatory act, the goal of
170). One can see here an effort to bring some modicum of “that for the sake
of which” into personality theory. As Allport would have it, man passes
476
demonstratively “input” with experience, but he has this capacity to evaluate
satisfaction. At some point the taking delight begins selectively to direct what
so forth. Murphy thus did not deny the behavioral findings of the rat
laboratory. He simply wished to point out that there was more to human
behavior than this routine, blindly repetitive series of responses. Choice and
more physical terms than either Allport or Murphy. The behaviorists had
referred to needs as specific tissue deprivations of some sort, as in the case of
hunger or thirst. Murray was to broaden the scope of this term, using it much
as Allport had used traits to include the purely psychological aspects of
a force in the brain region that organizes behavior in a directional sense (p.
achievement might well find that there are forces in his experience that
The typical fashion in which people go about meeting their needs in the
face of counteracting pressures from their life’s milieu Murray called the
thema. This entire theoretical account is essentially an analogy from Murray’s
projective test, the Thematic Apperception Test (TAT). In the same way that
the clinician analyzes a “hero” figure in a TAT story, so, too, does the
level of satiation or deprivation, and the life circumstances (press) that faced
him. The highly affiliative person, for example, after a period of time in which
478
hierarchical arrangement—from lower-level, simple stimulus-response
connections, to higher-level complexities of a more global nature (we see here
arguing that certain needs were prepotent (overriding force) to other needs.
Such needs demand answering in the “now”; they dominate our brain process
of behavior will be undertaken to seek the goal that can satisfy the condition
Since the need concept is now a psychological one, we can say that
“wishes” or “cathexes” are regnant brain processes. The man under regnant
without actually making it seem that way, because all needs are either given
at birth in physical constitution or they are “learned” (input influences a la
Lockean model) over the years of development. Hence the image of man here
is more introspective than classical behaviorism would have it, but we still do
not find that heavy aura of the “internal world” that Freud and Jung provide
us with. Murray has milked the dialectical side of man out of his theory. Man
implication, and thence directs himself via a true choice to some alternative
from physicochemical forces in the brain, forces that have been planted there
by nature or by the social milieu. What quasi- dialectical clash there is takes
place between these internal forces (needs) and the external counterforces in
the milieu (press). But man qua man is not “in the middle” as Freud believed
theory of a Hullian cast with the insights of the consulting room and thereby
unite psychology in a way it had never been united previously. Since
translation could have been performed on Adler, Jung, Sullivan, and so forth.
But Freud was selected, and the procedure adopted was to rewrite Freudian
cause) that preceded it. Freud’s sexual concept is interpreted as such a drive.
480
There are basic drives (such as pain) and drives of a secondary cast, which
can be easily attached (learned) to stimuli that do not ordinarily bring about a
drive having the properties of fear, except that in the case of anxiety the
source of the threat is vague (p. 63). We fear a train bearing down on us, but
we are anxious knowing why. The point of importance for learning theory,
relation to the elevator stimulus. Hence the next time we face an elevator
situation we will be sure to flee in order to reduce the anxiety that has once
again mounted due to inexplicable reasons.
proved very popular because, just like Murray’s regnancies, we have reduced
the Freudian dualisms of mental events versus bodily drives to a single, hence
monistic, formulation. This is all very much in the traditions of natural
science, and the essence of this tactic is to say that a physically based drive
(material cause) brings about and sustains behavior (efficient cause) entirely
fact that he has not paid sufficient attention to his life circumstances in the
knew what it was about the elevator that actually set off his fear (a loud noise,
a frightening passenger, the fact that he was being taken to the dentist, and so
forth). So far as learning theory is concerned, the actual reason for the
symptom is unimportant, or at least quite secondary to the fact that a
In the first place Freud’s concept of repression was not one of a passive
unconscious mind, according to Freud, knew only too well what it feared or
lusted or hated. Second, Freud definitely did not want anxiety to take over the
motivation properties of the personality structure. That was the job of libido
—an entirely mental construction of force or drive. This is why he stressed
that only the ego could experience anxiety! As is well known, Freud relegated
anxiety to an instrumental role as a warning sign (pp. 57-59). The warning to
482
consciousness in neurotic anxiety was something to the effect: “watch out,
your lustful desire for mother and your wish to kill father is going to pop up
here in a moment and then you will have consciously to admit that you are a
rapacious, incestuous pig and murderer.” The conscious aspect of the ego is
“inoculated” with a modicum of anxiety so that, rather than consciously
not to avoid anxiety, but to avoid the awareness of their completely psychic,
unacceptable intentions!
Hence the wedding of Freudian and behavioral theory must and has
altered the image of man being described. Theorists are dualists (mind-body)
for reasons, and when one alters the necessary teleological implications of
Fliess, his “natural science conscience,” and he gave the Lockean model a
sincere effort in theProject. But he could not forego the meanings he was
laudable efforts as only partially successful, through no real fault of their own.
precedence over and hence enter into) others. The unique twist that Cattell
gives to the Lockean model is that he sees both surface and source traits in
lying beneath. Source traits, on the other hand, “promise to be the real
structural influences underlying personality” (p. 27). Thus by using the trait
designation Cattell captures a formal cause meaning, but his “source”
What one must do to jump the gap between a surface and a source trait
484
finds in this way a common “factor” accounting for various overt
This collection of source traits (universal index) can then be applied by the
psychologist much as the chemist makes use of his periodic table of elements.
The specifics of just how personalities got to be the way they are “now”
constituted would depend upon the typical “input” notion (efficient cause) of
Skinner s “Contingency”
needs, wishes, aspirations, intentions, and so on, Skinner argued that only
those responses that “operate” on the environment to bring about rewarding
and virtually all of human responding is of this nature. Skinner termed this an
If we know this, then we can easily predict what behavior it will emit, for
behavior is always under the control of some class of empirically
this area to rank him at the very top of contributors to the study of
of man’s behavior is that the environment and not man is the selective agent
what used to be dealt with by the concept of purpose. The purpose of an act is
the consequences it is going to have” (Evans, p. 19). We find here an almost
486
startling preempting of the final by the efficient cause meaning. Through
viewing man exclusively on extraspective terms, and fixing on the
form of efficient cause control over it. But what if the organism “over there” is
considered introspectively and judged to behave “for the sake of” personally
held intentions, after all? What if, in the case of man, rather than his being
awareness on the part of the subject. This could easily be taken as evidence in
support of a final cause view of behavior, with the response- reinforcement
contingency interpreted as “that advantage, clue, goal, or plan for the sake of
which” behavior is acquired and perpetuated. Yet such questions are not
view because what is fixed upon is only the flow (impetus, efficient cause) of
events across time. This is taken as “behavior.” Just so long as it can be shown
Rotter’s “Expectancy”
but in accounting for the continuing influence that an organism (rat, man) has
upon his experience, Tolman was to speak of what have ever since been called
to begin responding even before they see their reward (reinforcement), said
Hull. Anthropomorphizing, we might say that the dog “knows” his dinner is
488
waiting ahead, for he salivates noticeably and breaks into a more rapid run as
he sees his master’s house ahead. But actually the dog anticipates nothing at
all. He has simply been trained to respond to certain “antedating” cues, so that
over time his salivation response began moving ahead in time, from his food
dish, to the door leading from outdoors, to the silhouette of the entire house
Hull was the behaviorist to develop this line of theory most creatively,
and he was obviously trying to account for what in other contexts might be
human behavior based on what has since been called the level of aspiration.
Adler made no bones about this being a teleological conception, claiming that
people laid down a definite plan (prototype, fife plan) “for the sake of which”
was also teleological, but he was not quite so outspoken because he was
trying to meet some of the natural science objections to final cause
description.
level is crushed with a grade of B, whereas the child expecting C’s is elated
of reinforcement value to say, for example, that even some things that are
easy to attain in life are not valued. If we wish to predict behavior we must
know not only what the person is expecting, but how much he values that
which is upcoming. The child who docs not value education will give little
perspective, and his account is far less mechanistic than the classical
behaviorist’s, Rotter’s psychology remains heavily Lockean in tone. He is
490
Kantian approaches we now turn to.
a view of the life space, or the total psychological environment that each of us
aspiration) that attracted him. Other goal regions might repel the individual
(negative valence), and it is the sum total of all the field forces (efficient
causes) entering into an overall pattern (Gestalt, formal cause) that led to
behavior (locomotion) within the life space. Hence behavior was directed, and
organized subportion of the entire life space. Motions within the field
(efficient causes) can be induced by any portion of this life space.
tied to man’s image. The life space is, of course, a derivative concept of the
on the “other side” of the phenomenal life space. Such influences on behavior
as the fact that a path under our foot is slippery, or a roof over our head leaks
membrane the life space (formal cause) interacted with such foreign hull
were called for and mutually altering the status of the foreign hull by
reciprocal influences.
492
seen in George A. Kelly’s “Psychology of Personal Constructs.” Unlike Rotter,
who viewed expectancies as past input influences based upon a
construed experience rather than passively took it in. For Kelly an expectancy
is to be thought of in terms of both a formal and a final cause meaning. It is a
stylized meaning through which or “for the sake of which” the individual
advances on life daily. Of course, Kelly’s actual term is that of the personal
construct rather than the expectancy. Just as Kant had argued that freely
created thought is dialectical in its essence, so, too, did Kelly view the process
commonality of events that he has observed recurring over time, he must also
negate some other aspect of that recurring experience. To say “Redheads tend
elements of experience into similarities and contrasts (p. 62). The products of
thought, or constructs, state in either clear or highly nebulous terms how
“two elements are similar and contrast with a third” (p. 61). Constructs are
working hypotheses, predictions, appraisals, and even pathways of
that behavior. The philosophy that expresses a strong faith in man’s capacity
Constructs can also be objective in that many men can understand the
to identify the constructs of his clients Kelly formulated the “Role Construct
Repertory Test,” or, more simply, the “Rep Test.” A role construct is one that
comparing how various figures in his life (mother, father, best friend, admired
teacher, disliked associate, and so forth) were like and yet different from a
third figure, Kelly was able to fashion a list of core personal constructs that he
then used to see the world from his client’s eyes. “How are your mother and
ex-girlfriend alike, and yet different from your wife?” This would be a typical
example of the way in which role constructs are evoked. The individual is free
to select his own terms. Kelly devised a nonparametric procedure for factor
analyzing these many different constructs to find the very heart of the
494
individual’s construct system. This idiographic manner of factor analyzing
data is quite different from that of Cattell’s, and the image of man that results
nomothetic approach.
to-higher needs that rest upon one another, yet are fundamentally
independent of each other. Maslow thus picks up the conception of need
necessities. Physiological needs lie at the base of the hierarchy of needs, with
higher-level needs such as love, esteem, the need to grow and self-actualize
coming into the organization as kind of emergents. The important point is
that one cannot find the meaning of higher-level needs by reducing them to
evolutionary processes of nature, so, too, does Maslow rely upon this tactic to
modify the Lockean hierarchy that held that the lower levels constitute higher
levels and to know the latter we must deal with the formed. This is a clear
Lockean thought while striving to retain continuity with the physical aspects
that there was a “growing tip” to the advance of organismic life (natural
teleology). If we want to get a sense of the higher life that evolution is making
possible, we should investigate our more self-actualized human life histories.
Maslow did just that, isolating the factors of important historical figures like
than other people. They are more decisive and can take a stand with greater
confidence, for they are prepared to name what is right and what is wrong
about life. They have a childlike simplicity and usually admit their lack of
knowledge in an area of what is clearly their expertise. Though very confident
496
they are humble and more open in their general approach to others. Without
exception they have some worthy task to which they commit themselves
and gives them a sense of fulfillment even though it is not always easy or
pleasurable to accomplish. They are, above all, spontaneous and creative in
their behavior, willing to “be themselves” for they lack pretense and
defensiveness. Mas- low coined the term Eupsychian to describe the society
that a group of such self-actualized individuals would form if left to their own
devices—say, on a secluded island. Presumably the society would reflect their
common tendencies: a biological utopia of our very best, the “growing tip”
Piaget’s “Schemata”
the basis of reflexive activity, as when the infant first employs his sucking
limited due to the lack of language. One sees here a decidedly introspective
formulation of what is a formal cause term (schema, pattern). The nature of
various schemata into more and more meaning. The child begins to notice
and suck other objects—his fingers, a blanket, and so forth—coming to
The essence of Piagetian motivation theory is that the child and then the
Piaget’s empirical work has involved the study of maturing children, tracing
the child is anthropomorphic. The child perceives natural events of all sorts,
including rain, wind, and so on in terms of intentions and willful acts. The five
year old says that the sun’s rays push the wind into activity or organize the
clouds to look pretty. Only by about age eight or ten does the child completely
divest the physical world of human qualities and view it in purely physical,
498
mechanical terms. Piaget called this early phase “precausal” thinking, but we
It is well and good for science to lay down its principles of explanation,
“primitive,” but does this change what is taking place? The child does, after
all, experience intentionality phenomenally. Who is to say that this experience
causes that propel the individual through his phenomenal field are being
R. Rogers.
construct, which is similar to, although more subjective than, Lewin’s life
his sensory feelings as he does by way of his conscious symbols. Indeed, says
Rogers, there is “a discriminating evaluative physiological organismic
summarizes it: “The suggestion is that though modern man no longer trusts
religion or science or philosophy nor any system of beliefs to give him values,
he may find an organismic valuing base within himself which, if he can learn
again to be in touch with it, will prove to be an organized, adaptive, and social
approach to the perplexing value issues which face all of us” (p. 441).
500
science to define him or to control him. To be what Rogers calls the fully
must trust to his feelings and to the feelings of others. Science may tell the
person that he is under the control of outwardly determined natural laws, but
what does he subjectively perceive (phenomenally) if not a sense of personal
concern with group encounter based on this naturalistic ethic. The point of
sensitivity training is to make one aware of his personal contributions to the
pattern of natural feelings very similar to others, the individual can drop the
facades of social niceties and the masks of social defenses. The person as
enacted in overt behavior can become “one” or congruent with the feeling
tones he has been ignoring or denying in the past. With everyone in the group
100 percent in tune with their sincere feelings, a higher level of phenomenal
living is achieved.
In one sense Rogers has avoided the dualism of mind-body in his uniting
the body. Material causes (feelings) somehow clue us to what is “best” (final
genuinely, in time behaviors would seek their level. The bully would
acknowledge his hostility and the coward would express his fears in a way
never before possible. The result would be a more genuine, sincere, fully
that all theorists in this line are clearly Kantian, that they take on some such
“spectacles” notions as Binswanger’s world designs, Kelly’s constructs, or
Piaget’s schemata. Actually there are positions that are not this easy to
classify within the phenomenological camp. Medard Boss is an excellent case
classical Kantian views are “endowed” by the world designs that frame in
experience. For Boss, on the other hand, Dasein is always “disclosed.” Boss
502
liked to speak of it as luminating or shining forth, disclosing itself to man’s
experience something that is not part and parcel of that experience, much in
the way that science presses its arbitrary efficient causes onto teleological
mind can create “a position.” But when Hegel now took this to be “the”
undermine the pat, the set, the rigid certainties of contrived experiences.
What it seeks is “pure” experience, as immediately luminated to the mind’s
It should be clear now that the reason it was impossible to write this
among people. This would make it predominantly a “formal cause” term. Such
styles are usually first identified in terms of the “total” person, so that the
personality scheme is likely to begin as a typology. We study individuals and
and anality in other and then all people “more or less.” This is not to say that
trait theories cannot begin as such; it is to suggest that the usual historical
504
solution here is to fall back on genetic-hereditary explanations, as in the
morphogenotype of Sheldon. There is almost no rebuttal to this proclamation
that people differ because they are born that way. Enlarging upon this we can
say that people differ because they have different needs, or that their needs
(instincts, drives, etc.) have been differentially met. We can now extend this
to in- elude learned needs, and even Rotterian expectancies that serve to
merely differential controls being exerted on the basic organism that itself
follows common (basic) laws. Needs are reinforcers when met, and insofar as
the term “personality” has any meaning at all, it refers to the habit hierarchy
are prompted by one’s culture, social group, and so forth. In the final analysis
every behaviorist psychologist is a social psychologist. Cattell’s test-based
laboratory psychologists, who have moved away from the more classical
captured in efficient cause terms, such as the S-R construct. But what of the
style of such behaviors? And how much influence docs the individual himself
have on this styling of his personal behavior?
Those theorists who reject the more passive, Lockean conceptions of the
human condition argue that behavior is also shaped by the individual, who
lifetime. Man is a potentially higher animal for some (Maslow), and hence we
can not find his unique humanity in the reductive common substrate of a
lower form of behavior. The phenomenologists and existentialists take this a
good deal further, and staunchly defend the thesis that only man can be the
And here it would seem that, by science’s own standards, if the world of
506
surely see in every attempt to account for human behavior a kind of teleology
being espoused; or at least a good deal of theoretical effort put into a
substitute for this kind of description. Continuing in this vein, it would seem
that man responds to his past antecedents? Does not learning fashion his
present behavioral predilections? Without denying the fact of antecedent
events we must point out that antecedents can be such things as the Adlerian
“life plans,” which are, when put into effect, done so “for the sake of” their
intended goals. But are these not simply mediators, plans themselves put into
the so-called human being just as mediating stimuli are programmed into a
rat? The final rejoinder here is: “No, not if meanings are bipolar and man as a
human animal can reason dialectically. If this is true then that state of 100 per
cent control from outside the organism that theorists like Skinner speak
about is flatly impossible.” Hence the heuristic device that a theorist must fall
back on at some point if he is to ascribe humanity to man is the dialectic. One
So, in closing this chapter, it would be our argument that the term
“personality” is superfluous without the predicate assumptions of a humanly
conformed to, and premised upon. Here again the reader is under the
persuasion—not the control—of a neo-Kantian theorist. He can reason to the
come up with an alternative that will best suit him. But if he can do that, he
can also “be” a distinct, unique person. Terms used to describe him in these
creative efforts are properly thought of as personality concepts.
Bibliography
Adler, A., The Education of Children, Allen and Unwin, London, 1930.
_____., The Practice and Theory of Individual Psychology, Littlefield, Adams, & Co., Totowa, N.J.,
1968.
Arieti, S., The Intrapsychic Self: Feeling, Cognition and Creativity in Health and Mental Illness, Basic
381,1968.
508
Aristotle, “Topics,” and “Physics,” in Hutchins, R. M. (Ed.), Great Books of the Western World, pp.
Bacon, F., “Advancement of Learning,” in Robert M. Hutchins (Ed.), Great Books of the Western
Boss, M., Psychoanalysis and Daseinsanalysis, Basic Books, Inc., New York, 1963.
Cassirer, E., The Problem of Knowledge, Yale University Press, New Haven, 1950.
Cattell, B. B., Personality: A Systematic, Theoretical, and Factual Study, McGraw- Hill, New York,
1950.
Dollard, J., and Miller, N. E., Personality and Psychotherapy: An Analysis in Terms of Learning,
Evans, B. I., B. F. Skinner: The Man and His Ideas, Dutton, New York, 1968.
Freud, S., The Ego and the Id, and Other Works in Strachey, J. (Ed.), Standard Edition, Vol. 19,
_____., The Origins of Psycho-Analysis, Letters to Wilhelm Fliess, Drafts and Notes: 1887-1902, Basic
Goble, F., The Third Force: The Psychology of Abraham Maslow, Grossman Publishers, New York,
1970.
Husserl, E., Phenomenology and the Crisis of Philosophy, Harper & Row, New York, 1965.
_____., Psychology and Religion: West and East, Pantheon Books, New York, 1958.
Kelly, G. A., The Psychology of Personal Constructs, Vols. 1 & 2, Norton, New York, 1955.
Koffka, K, Principles of Gestalt Psychology, Harcourt, Brace & Co., New York, 1935.
Kohler, W., The Task of Gestalt Psychology, Princeton University Press, Princeton, 1969.
Marrow, A. J., The Practical Theorist: The Life and Work of Kurt Lewin, Basic Books, New York,
1969.
510
Maslow, A. H., Motivation and Personality, Harper & Row, New York, 1954.
Morgan, C. D., and Murray, H. A., “A Method for Investigating Phantasies,” Arch. Neurol, ir
Mowrer, O. H., “A Stimulus-Response Analysis of Anxiety and Its Role As a Reinforcing Agent,”
Murphy, G., Personality: A Biosocial Approach to Origins and Structure, Harper, New York, 1947.
Murray, H. A., et al., Explorations in Personality, Oxford University Press, New York, 1938.
Piaget, J., The Child’s Conception of Physical Causality, Kegan Paul, London, 1930.
_____., The Origins of Intelligence in Children, International Universities Press, New York, 1952.
_____., “The Process of the Basic Encounter Group,” in Hart, J. T., and Tomlinson, T. M. (Eds.), New
Directions in Client- Centered Therapy, pp. 292-313, Houghton Mifflin, Boston, 1970.
_____., “Toward a Modern Approach to Values: The Valuing Process in the Mature Person,” in Hart,
Rotter, J. B., Social Learning and Clinical Psychology, Prentice-Hall, Englewood Cliffs, N.J., 1954.
Rychlak, J. F., A Philosophy of Science for Personality Theory, Houghton Mifflin, Boston, 1968.
Sheldon, W. H., with Stevens, S. S., and Tucker, W. B., The Varieties of Human Physique: An
Skinner, B. F., Beyond Freedom and Dignity, Alfred A. Knopf, New York, 1971.
Sullivan, H. S., The Interpersonal Theory of Psychiatry, Norton, New York, 1953.
Tolman, E. C., Purposive Behavior in Animals and Men, Appleton-Century-Crofts, New York, 1960.
_____., “Psychology as the Behaviorist Views It,” Psychol. Rev., 20.158-177, 1913.
512
Wiener, N., The Human Use of Human Beings, Houghton Mifflin, Boston, 1954.
Wolpe, J., Psychotherapy by Reciprocal Inhibition, Stanford University Press, Stanford, 1958.
Donald A. Bloch
Introduction
This chapter will consider the relationship between a set of events usually
technical skills from play therapy, group therapy, and psychodrama, with
more recent additions from the encounter and training group fields. On the
and, more recently, from cybernetics, general systems theory, linguistics, and
kinesics. While the family field has burgeoned in the last two decades as a
514
therapeutic and social movement, it is conceptually diverse and varied. As to
practice, there are no generally accepted standards of certification or
accreditation, and there is no national organization of family therapists;
departments of psychology.
present the main elements of this array. In doing so we will focus on the
following issues:
not limited to, the nuclear family. The psychiatrically relevant family may be
defined along two principal dimensions, structure and function. By the first
term we refer to the structural units of the family held in any given instance to
phenomenon.
the family from culture to culture, from science to science, within any single
516
necessarily expresses the ad hoc nature of present psychiatric studies of the
family. Target symptoms, syndromes, attitudes, or traits are used as the
unit may shift according to the purpose of analysis.” It follows that the
psychiatrically relevant family should be thought of as a distinctive social unit
that may or may not overlap other defined families. Legal, sociological, and
practitioner.
The starting place for most definitions is the nuclear family[1] (often
referred to as the isolated nuclear family); that is, biological parents and
new families of their own. Although this is what is most often referred to as
in many instances, since it may not conform to the group actually dealt with
by clinicians; it does not take into account the wide variation in family and
household composition, even in Western industrial societies; nor does it
psychosocial time probably extends backward for four generations and into
the future for three generations. Even for the neonate the family extends
backward in time; there is a specific familial inheritance that is part of the
psychosocial matrix into which the new human is born. Naturally the more
remote in time, the less influential persons and events are; death and other
dislocations alter or obliterate their idiosyncratic influence, and they are
matrix that family themes, myths, identity positions, conflicts, and defensive
positions are elaborated and synthesized. In connection with the temporal
aspect of the family, its constantly changing character over time must be
mentioned. Not only does the family have a past and a future, but also it is
518
The most common subunit of the family of clinical interest is the marital
pair. Without regard to the nature of the presenting problem, the husband
and wife are most often apt to be considered as the primary unit of interest. If
the group is enlarged, one child may be added, usually the identified patient,
or the entire nuclear family may be included. Astute clinicians are sensitized
to the defensive exclusion of a particular family member, often one child, from
the therapeutic enterprise on the grounds that this person does not need to
be involved, or will be damaged by exposure to secret or painful material, and
family” all members of the household; practically this often indicates who is
where cultures do not adhere to the nuclear model, and in situations where
other persons have been regular and meaningful members of the household
(a housekeeper or maiden aunt, for example).
Kin other than the nuclear family are often considered as important and
within the bounds of relevance. Most commonly the parents and the siblings
of the parents of the nuclear family are included. Many theories of
extended kin articulation with nuclear families. In the first two, extended
conflict; here the dynamics of intergroup relations are dealt with. In the
second dimension the extended families act as screens for the projections of
that extends the concept of relevance to other systems with which the family
interacts and of which it is a part. The important instances of this are network
therapy and ecological therapy. In the first instance relevance is extended to
include members of the social networks of which the family is a part; friends,
with the therapist to consider the psychiatric problems of one member of that
520
social institutions that are believed to have power or to provide an important
maintenance function for the family, such as the school, hospital, court, and
family system, but also in relation to its external boundary with other natural
social institutions.
disorder and the family into several distinctively different categories. Each of
these categories suggests a differing causal or etiological connection between
may be some shifting back and forth between orientations. Nevertheless, the
positions are distinctively different; those preferring one view are unlikely to
vacate it easily.
family members or its health practices—a brain tumor, for example. There is
The ability of the family to cushion the blows of adversity upon its
may impinge upon a family as crises that are dealt with successfully. A death
of the family healing its own members and protecting its own structure in the
nephew to visit him. Barely able to speak, the dying man asked the physician
in his presence to inform the wife and only daughter that his condition was
hopeless. For the first time they were able to openly weep together and begin
family could be used to help heal the nuclear family by facilitating available
522
restitutive processes.
Some of the complexities of this model can be seen when one considers
how psychiatric disorder itself is to be understood. Is it a stress upon the
accidental, to arise endogenously in the patient, and, in its own turn, to pose
problems for the family growing out of the need to manage the ensuing
difficulties. The era of modern clinical study of the family began when this
between family issues and psychiatric matters has been carried out in terms
of a model of linear causality. The underlying assumption is that a sufficiently
attitudes, traits, or practices can be located, most often in the mother, that
cause this. The earliest versions of such studies indicted a blend of physical
and social heredity as being pathogenic; for example, Dugdale’s study of the
in this field. Excellent reviews are to be found in Spiegel and Bell and Aldous
and Hill. More recently Walter and Stinnett reviewed the literature of the
1960’s on parent-child relationships. They found “a distrust of simplistic
children may produce impaired functioning in their parents, rather than the
other way around. The authors note a shift in the studies reviewed from an
They find that boys seem to be more susceptible than girls to parental
524
and creative thinking. Poor parent-child relations on the other hand, are
related to aggressive, antisocial behavior, and a tendency for children to be
social development.”
The principal feature of the model being used is that a parental trait or
mother and child, and dealt with as if it existed in isolation and caused the
pathological response to appear in the child.
illness in the child, it is reasonable to hope that one can discover these wrong
attitudes and, having discovered them, teach parents how to do better. Out of
such hopes has grown the broad field of parental attitude and child
development research, as well as the influential child study movement in the
an active social influence, this movement seems to be reducing its impact. The
straightforward quantification.
field, and investigators and theorists alike have attempted to use the language
and Cottrell, Handel, Handel and Hess, Hare, et al., Parsons and Bales, Spiegel,
and Spiegel and Klyckhohn may be mentioned as seminal. The field is vast,
and it is only possible here to indicate the general direction research and
theorizing takes.
526
the society (role) and/or to difficult and conflicting patterns of cultural
prescription (value).” At the same time the cultural patterns of childrearing
authors’ view is that the family mediates these constraints and that
individuals are “in some sense trapped by the conflicting tenets of these two
The predominant analytic model here is sociological; the family for the
emphasis on role and value conflict and the use of a learned socialization
on this subject Greek culture and the historical development of the modem
view, the author uses such terms as penis envy and castration anxiety to
indicate these needs and points out how the specific interaction within Greek
and social positions. Identity is defined in terms of both self-identity, that is,
how the person views himself, and the objective public identity, that is, how
528
developed based on the degree to which there is compatibility between
experience and subidentities. Thus the effeminate husband may be expected
newborn child may act as a stabilizer, or may tip the balance toward
instability, because his presence “requires the development of new sub-
The family as acculturator may induct its members into roles, value
systems, and perceptual-cognitive modes that deviate from those of the larger
culture. The dominant culture may define these deviant ways as “sick,”
in the controversy over the Moynihan Report. This report contended that an
important proportion of black families were enmeshed in a particular version
with male impotence and extrusion from the family. This was related to the
systematic attack on the masculine role in the black family in slavery, with the
further the position of the black male, with the consequence that a vicious
and perdurable” white family unrelated to class and culture; that even if there
were it is questionable if it should serve as a paradigm, or if it “actually
Aside from the substantive merits of these arguments one must note the
functioning.
comes from general systems theory. Originally this approach was developed
uniquely suited to dealing with living systems. To think of the family in this
way is to ask how it can be conceptualized as a set of structures organized so
530
as to maintain patterned integrated functioning of the entire system.
Roy R. Grinker, Sr., notes that “general systems theory includes concepts
family, in this sense, is an open system in that there are transactions across its
Among these social institutions would be other parts of the larger kin
and sex splits, among others. In all of these instances the same principles of
calls it, has been a conceptual tool of considerable importance to the clinician
in the field of family studies. It serves as a reliable guide to understanding
identity positions that must be filled in the family. Speck notes that when a
suicidal patient gives up his self-destructive ideation, his role in the family
532
be filled by the mate, matrices that have developed in the context of the
describe therapy in terms of the transaction of two family systems, that of the
terms, between the new pair formation of therapist and patient and mate
selection.
have approached the issue in ways that reflect their personal biases,
Schizophrenia
that has led other investigators to search for a unitary cause for this “disease,”
syndrome.
relations, above all that with the mother.” Davis attempts to get at the oedipal
contribution to the etiology of schizophrenia in males. In acute schizophrenic
breakdown he claims that anxiety arises out of the relationship with the
mother and “the illness begins when a change in this relationship increases
The most important studies of this genre are those of the Lidz group at
534
families with schizophrenic young adult members. Middle-class families were
chosen for study so as to avoid the effects of social disorganization under
economic stress. There were many clinical contacts with the families and with
kin, friends, servants, and so on. In addition to clinical interviews at home and
conflict, and beset by role uncertainties by family members other than the
patient.”
fact that these women were “paired with husbands who would either
acquiesce to any irrational and bizarre notions ... or who would constantly
battle with and undermine an already anxious and insecure mother.”
The fathers in half the families were described as paranoid, “paired with
for a variety of reasons. The suggestion is that if they had married more
supportive wives, they might have done better as fathers and husbands. The
Lidz group’s findings seem comparable with those of Cheek, who says, “The
profile of the father of the schizophrenic differed less from that of the father
parental sex roles in the family.” However, he notes, “Our study does not tell
us whether or not this distortion of parental roles has been a cause of, or a
families are “beset by chronic strife and controversy, primarily between the
parents. . . . The parents undermine each other’s worth, despising each other
children.
The second type of family they describe is the skewed family, which
may be peaceful on the outside, but where the peace is maintained because
a female becomes schizophrenic, they note, among other things, that same sex
siblings seem to be more disturbed than opposite sex siblings. Three issues
536
appear to be critical: “(1) the faulty model for identification provided by the
parent of the same sex as the patient; (2) the impediments to proper
parental interaction; and (3) the failure of the parents to maintain proper
the cardinal functions of the family,” and in a series of cases they illustrate the
failure to accomplish this in the mother-daughter relationship. In these
families this failure increased the insecurities of the child, who focused on a
thought disorder, they say, “We are following the hypothesis that the
complete her frustrated life. She demands the impossible from him, feels only
nor is there any exit from this because of the qualities of the father.
The Lidz group speaks of folie a famille where the life of the family
centers around the distorted beliefs of one parent, usually the father, and
lives according to a social pattern quite different from the larger social
context. The parents hold a rigid and fantastic conception of the environment
and the family into which the children must fit without regard to reality or
their own needs. These parents are described as being “impervious,” unable
to hear the child’s emotional needs, and, in general, much given to projective
identification, the attribution to the child of the parental needs, principally in
Lyman Wynne and his co-workers set themselves the formidable task of
whole.” They build their theory on the need of all humans to be related and on
the striving to develop a sense of personal identity. The attempt to deal with
538
differentiation of the identities of the persons in the relation.” The essential
difficulty in differentiation of identity characterizing the schizophrenic is put
at all costs since it is the most severe threat in these families. Thus, in terms of
mutuality.
and fragility. The authors emphasize the role rigidities of these families as
well as the absence of imaginative play or affective release in the interactions
extremely difficult for the members of these families to distinguish the family
boundary. The term used for this by Wynne is “the rubber fence,” an
this regard it is possible to see the similarities between the Lidz and Wynne
the subjective experience of the therapist in direct work with these families
540
Wynne and Singer attempt to relate schizophrenic thinking disorders to
internalized in the same form into the ego structure of the growing offspring.”
When the Rorschach and TAT tests of the parental pair were compared, blind
ranking of these tests showed high correlation with the diagnosis of the child.
the child’s pathology. Thus on the TAT parents of autistic children “have clear
Laing has advanced the view that pathology lies, as it were, in the eye of
the beholder. As he sees it, this is true for individual psychopathology, and
Laing emphasizes that mystification is both an act and a state and points out
that the person being mystified may not know it or feel it. It is a process
operating within the family (and elsewhere for that matter) in which the
person is systematically forced to deny data from one realm in the interest of
Schatzman. In this paper the Schreber case, which played a key part in the
development of Freudian psychoanalytic theories of paranoia, is reviewed,
542
with emphasis on the use of mystification to cover over deeply conflicted
issues in the relationship between Schreber and his father. Schatzman
concludes that Schreber was indeed persecuted by his father and mystified in
addition, by being told the persecution was loving. His delusions then
represented an effort to make sense out of this total configuration.
that learning occurs in a context that has formal characteristics and that this
Bateson says, “Even more shocking is the fact that there may be infinite
with the possibility that “in human relations another sort of complexity may
be generated; e.g., messages may be emitted forbidding the subject to make
the meta-connection.”
level, which conflicts with the first. It is essential that the “victim” also be
prevented from escaping from the field. The authors suggest that an
individual repeatedly exposed to this mode of communication will suffer a
meaning to the mother, which arouses her anxiety . . . when she is in danger of
intimate contact with the child. 2. The mother’s way of denying this anxiety
544
example, that the person is not really the source of the message, that the
words are action and not really the message, that the receiver is not really
accepting being governed by other people and that this, in turn, destroys
relationships.
transcripts of the tests done in the homes were studied by raters who did not
know the families. The results “indicate the communication and interaction
way from these patterns in families whose class background is similar, but
fathers and affectionate mothers. It often seemed as if these husbands did not
strong ties with their wives. This led to frequent neglect, increasing with the
DuPont and Grunebaum point out that paranoid women tend to marry
men who are walled off, passive, and unable to express hostile or erotic
feelings. In some instances the wife’s psychosis is precipitated by the
546
husband’s reduction in sexual activity. They point out that the husband’s
“eagerness to reunite with his wife and to exclude others was reflected in his
failure to support her therapeutic alliance with her psychiatrist and his failure
to consider divorce.”
Phobias
The case of “little Hans,” first published by Freud in 1909, presaged later
the agency of his father, of whom Freud says, “the special knowledge, by
means of which he was able to interpret the remarks made by his five-year-
old son, was indispensable . . . and (treatment was possible) . . . because the
events occurring elsewhere in the family system. Here the identified patient is
easy fatigability, and suicide threats. The precipitating event of her illness was
her father’s involvement with the wife of a business friend; the friend had on
and psychopathology.
present in other members of the family, often a husband or wife. As Fry has
observed, “The spouses of the patients in this group . . . are typically
resembling, if not identical to, the symptoms of the patient. Usually they are
anxious patient, even though the patient does not need or wish it.
Fry also notes, as does Carek and Miller, that symptoms seem to break
out at a point when the spouse has some change— usually for the better—in
his life; there is a constant dual supervision and control, and the couple are
frequently held together by the symptoms.
548
inadequately resolved dependency relationship to their mothers, with intense
repressed resentments.” In turn, their own children are pulled into a pattern
disciplinarian, frustrates the child, she arouses his rage.” The child’s rage
toward the mother is inhibited and the teacher becomes the phobic object. In
about the specificity of interaction in the child’s involvement with the school.
The minimum systems model seems to include the child at an interface
He relates this to the mother’s inability to establish close contact with the boy,
Psychosomatic Disorders
life. The connection has been made, for example, in certain cases of severe
childhood asthma. Purcel, etal., note, “It is clear that substantial numbers of
distinguish the two groups. An imaginative procedure was used, whereby the
child stayed physically in his own home although all parental and sibling
figures were removed, and a substitute parent was provided. The carefully
there is some unique connection between family patterns and such disorder.
Although research in this area has been relatively unproductive thus far, it is
our conviction that several modes of investigation will fuse in the near future
to improve our understanding of these relationships. Specifically it seems
reveal the subtle modes whereby families teach somatic responses to their
members.
550
Titchener, in a case study of a family in which one son developed
relations were not only formed in the binary mother-child symbiosis, but
constituting the field in which his personality developed.” Jackson and Yalom
Learning Difficulties
prevented the boys from adequately identifying with their fathers or from
Similarly Miller and Westman noting that the mothers in these families
exercise the real power, “postulate that parents and children resist change in
Delinquency
for instance, and B (a message about Message A) from mother.” He notes the
pair threatens a series of punishments as the consequence for not obeying his
Addictive States
Ewing using concurrent group therapy for wives and husbands, notes
accept her own dependent needs. One case is described in which there is a
constant interplay between the husband’s drinking bouts and the wife’s
Homosexuality
552
Bieber, et al. conducted a study of 206 male psychoanalytic patients, of
whom 106 were homosexuals. Brown’s findings in his study of Air Force
confirmed here as well. The authors consider, too, the “triangular system,”
involving both parents and the son. The basic mode of analysis consists of
family systems, noting their transactional nature. Thus Goldberg and Mudd
individual and his spouse.” Essentially the threats and plans are seen as a
spotlight the apartness each member of this family felt in this inability to
communicate with one another in a helpful or constructive way.”
family must recognize the influence on this issue of the rapid process of social
change presently characteristic of the family in the Western world. As
vantage point, i.e., bias, from which a psychiatric judge views phenomena
determines the meaning of the behaviors being assessed. Also the very
554
confidently to assume that he knows the directions family life should take; yet
it is not possible for him to abandon or deny his own value systems since they
other than his own. The white view of the black family is notably deficient in
this regard, as is that of the male psychiatrist judging the “proper” role for
women.
any way from the broad processes at work to create change in society at
large. A few of the more important of these processes may be noted. First,
there is the rapid change in the status of women vis-a-vis men. Associated
with this are profound revisions of the ideal and normative expectations of
premarital sexual liaisons are openly accepted in many quarters, and the age
Adolescents and youth are expected to have active sexual lives prior to
marriage, while the sexual needs and capabilities of the aged are better
are more common, and the birth rate has recently dropped (1972) to the
lowest point in U.S. history, a rate approximating that needed to achieve the
556
longevity, produced many serious problems of social isolation in the aged.
The primary breakdown in ties to kin networks results in an epidemic
group and multilateral marriages, have been impressed with the large
with the small number actually doing so. Despite this it seems certain that the
family of the future, and thus the psychiatrically relevant family of the future,
will refer less often to the modal nuclear family of the past and with
important in terms of the generational model that family psychiatry has found
to be so helpful, the natural social system into which a person is born, the
natural social system in which he lives his adult life and procreates, and the
natural social system in which his children (if any) live their lives, all will be
Bibliography
Ackerman, N. W., “Adolescent Problems: A Symptom of Family Disorder,” Fam. Process, 1:202-
213, 1962.
_____., Psychodynamics of Family Life, Diagnosis and Treatment in Family Relationships, Basic
_____., Beatman, F. L., and Sherman, S. (Eds.), Exploring the Base for Family Therapy, Family Service
Alanen, Y., “Some Thoughts on Schizophrenia and Ego Development in the Light of Family
Aldous, J., and Hill, B., International Bibliography of Research in Marriage and the Family 1900—
Attneave, C. L., “Therapy in Tribal Settings and Urban Network Intervention,” Fam. Process,
8:192-210, 1969.
558
Bailey, M. B., “Alcoholism and Marriage,” Quart. J. Stud. Alcohol., 22:81-97, 1961.
Bateson, G., “The Biosocial Integration of Behavior in the Schizophrenic Family,” in Ackerman, N.
W., Beatman, F. L., and Sherman, S. (Eds.), Exploring the Base for Family Therapy,
_____., “Minimal Requirements for a Theory of Schizophrenia,” Arch. Gen. Psychiat., 2:477-491,
1960.
Bateson, G., Jackson, D. D., Haley, J., and Weakland, J., “Toward a Theory of Schizophrenia,” Behav.
Sc.,1:251-264, 1956.
Baxter, J. C., “Family Relations and Variables in Schizophrenia,” in Cohen, I. M. (Ed.), Psychiatric
Research Report No. 20, American Psychiatric Association, Washington, D.C., 1966.
Becker, J., “ ‘Good Premorbid’ Schizophrenic Wives and Their Husbands,” Fam. Process, 2:34-51,
1963.
Behrens, M., Rosenthal, A. J., and Chodoff, P., “Communication in Lower-Class Families of
Bell, J., The Family in the Hospital, National Institute of Mental Health, Chevy Chase, Md., April
Bell, N., “Extended Family Relations of Disturbed and Well Families,” Fam. Process, 1:175-193,
1962.
_____., and Vogel, E. S. (Eds.), A Modern Introduction to the Family, Free Press, Glencoe, 1961.
Bieber, I., et al. (Eds.), Homosexuality: A Psychoanalytic Study, Basic Books, New York, 1962.
Billingsley, A., Black Families in White America, Prentice-Hall, Englewood Cliffs, N.J., 1968.
Boszormenyi-Nagy, I., and Framo, J. L. (Eds.), Intensive Family Therapy: Theoretical and Practical
Brodey, W., “Image, Object and Narcissistic Relationships,” Am. J. Orthopsychiat., 31:69-73, 1961.
Brown, D. G., “Homosexuality and Family Dynamics,” Bull. Menninger Clin., 27: 227-232, 1963.
560
Bruch, H., “Psychological Aspects of Obesity,” Psychiatry, 10:373, 1947.
Buck, C. W., and Ladd, K. L., “Psychoneurosis in Marital Partners,” Br. J. Psychiat., 3:587-590, 1965.
Buell, B., et al., Community Planning for Human Services, Columbia University Press, New York,
1952.
Burgess, E. W., “The Family and Sociological Research,” Soc. Forces, 26:1, 1947.
_____., “The Family as a Unity of Interacting Personalities,” The Family, 7:3, 1926.
Bursten, B., “Family Dynamics, The Sick Role, and Medical Hospital Admissions,” Fam. Process,
4:206-216, 1965.
Carek, D. J., Hendrickson, W. J., and Holmes, D. J., “Delinquency Addiction in Parents,” Arch. Gen.
Chance, E., “Measuring the Potential Interplay of Forces within the Family dining Treatment,”
Cheek, F., “Family Interaction Patterns and Convalescent Adjustment of the Schizophrenic,” Arch.
_____., “The Father of the Schizophrenic: The Function of a Peripheral Role,” Arch. Gen.
Psychiat.,13:336-345, 1965.
Columbia University Council for Research in the Social Sciences, New York.
Cleveland, E. J., and Longaker, W. D., “Neurotic Patterns in the Family,” in Leighton, A. H., Clausen,
J. A., and Wilson, R. N. (Eds.), Explorations in Social Psychiatry, Basic Books, New
York, 1957.
Constantine, L. L., and Constantine, J. M., “Group and Multilateral Marriage: Definitional Notes,
Cottrell, L. S., “New Directions for Research on the American Family,” Soc. Casework, 34:54, 1953.
Counts, R., “Family Crisis and the Impulsive Adolescent,” Arch. Gen. Psychiat., 17:64-74, 1967.
Davis, D. R., “The Family Triangle in Schizophrenia,” Br. J. Med. Psychol., 34: 53-63, 1961.
Dugdale, R. L., The Jukes: A Study in Crime, Pauperism, Disease and Heredity, Putnam, New York,
1910.
DuPont, R., and Grunebaum, H., “Willing Victims: The Husbands of Paranoid Women,” Am. J.
Psychiat.,125.151-159, 1968.
Easson, W. M., and Steinhilber, R. M., “Murderous Aggression by Children and Adolescents,” Arch.
562
Ehrenwald, J., “Neurosis in the Family: A Study of Psychiatric Epidemiology,” Arch. Gen. Psychiat.,
3:2,32-242, 1960.
Eisenstein, V. (Ed.), Neurotic Interaction in Marriage, Basic Books, New York, 1956.
Erlich-Amitai, H. S., and Bloch, D. A., “Two Families: The Origins of a Therapeutic Crisis,” Fam.
Ewing, J. A., Long, V., and Wenzel, G. G., “Concurrent Group Psychotherapy of Alcoholic Patients
Ferber, A., Kligler, D., Zwerling, I., and Mendelsohn, M., “Current Family Structure,” Arch. Gen.
Psychiat.,16:659-667, 1967.
Ferreira, A. J., “The ‘Double-Bind’ and Delinquent Behavior,” Arch. Gen. Psychiat., 3:359-367, 1960.
_____., and Winter, W. D., “Family Interaction and Decision-Making,” Arch. Gen. Psychiat., 13:214-
223, 1965.
Fisher, S., and Mendell, D., “The Communication of Neurotic Patterns over Two and Three
Psychiatry,21:133-140, 1958.
Fleck, S., “Family Dynamics and Origin of Schizophrenia,” Psychosom. Med., 22: 333-344, 1960.
_____., Lidz, T., and Cornelison, A., “Comparison of Parent-Child Relationships of Male and Female
Bull.,66:214-227, 1966.
Foote, N., and Cottrell, L. S., Identity and Interpersonal Competence: New Directions in Family
Framo, J. L., “The Theory of the Technique of Family Treatment of Schizophrenia,” Fam.
Process,1.119-131, 1962.
Freud, S., “Analysis of a Phobia in a Five-Year-Old Boy,” in Collected Papers, Vol. 10, pp. 5-149,
_____., “Fragment of an Analysis of a Case of Hysteria,” in Collected Papers, Vol. 7, pp. 7-124,
Friedman, A. S., “Delinquency and the Family System,” in Poliak, O., and Friedman, A. S. (Eds.),
564
Family Dynamics and Female Sexual Delinquency, Science & Behavior Books, Palo
Fry, W. F., Jr., “The Marital Context of an Anxiety Syndrome,” Fam. Process, 1: 245-252, 1962.
Gehrke, S., and Kirschenbaum, M., “Survival Patterns in Family Conjoint Therapy,” Fam. Process,
6:67-80, 1967.
Getzels, J. W., and Jackson, P. W., “Family Environment and Cognitive Style: A Study of the Sources
of Highly Intelligent and of Highly Creative Adolescents,” Am. Sociol. Rev., 26:351-
359, 1961.
Glick, I., and Haley, J., Family Therapy and Research—An Annotated Bibliography, Grune &
Goddard, H. H., The Kallikak Family: A Study in the Heredity of Feeble-Mindedness, Macmillan, New
York, 1912.
Goldberg, M., and Mudd, E., “The Effects of Suicidal Behavior upon Marriage and the Family,” in
Goldfarb, W., “The Mutual Impact of Mother and Child in Childhood Schizophrenia,” Am. J.
Boston, 1969.
Greig, A. B., “The Problem of the Parent in Child Analysis,” Psychiatry, 3:539, 1940.
Grotjahn, M., Psychoanalysis and the Family Neurosis, Norton, New York, 1960.
Grunebaum, M. G., Hurwitz, I., Prentice, N. M., and Sperry, B. M., “Fathers of Sons with Primary
Haley, J., “Experiment with Abnormal Families,” Arch. Gen. Psychiat., 17:53-63, 1967.
_____., “The Family of the Schizophrenic: A Model System,” J. Nerv. & Ment. Dis., 129:357-374,
1959.
_____., “Observation of the Family of the Schizophrenic,” Am. J. Orthopsychiat., 30;460-467, 1960.
_____., “Speech Sequences of Normal and Abnormal Families with Two Children Present,” Fam.
Process,6:81-97, 1967.
_____., and Hoffman, L., Techniques of Family Therapy, Basic Books, New York, 1967.
Handel, G., “Psychological Studies of Whole Families,” in Handel, G. (Ed.), The Psychosocial Interior
566
of the Family, Aldine, Chicago, 1967.
_____., (Ed.), The Psychosocial Interior of the Family, Aldine, Chicago, 1967.
_____., and Hess, R. D., “The Family as an Emotional Organization,” Marriage & Fam. Living, 28:99-
101, 1956.
Hare, A. P., Borgatta, E. F., and Bales, R. F. (Eds.), Small Groups—Studies in Social Interaction,
Henry, J. “Family Structure and the Transmission of Neurotic Behavior,” Am. J. Orthopsychiat.,
21:800,1951.
Hilgard, J., and Newman, M., “Parental Loss by Death in Childhood as an Etiological Factor among
Hill, R., “A Critique of Contemporary Marriage and Family Research,” Soc. Forces, 33:268, 1955.
_____., “Methodological Issues in Family Development Research,” Fam. Process, 3.186-206, 1964.
Hoover, C., “The Embroiled Family: A Blueprint for Schizophrenia,” Fam. Process, 4:291-310,
1965.
Jackson, D. D. (Ed.), The Etiology of Schizophrenia, Basic Books, New York, 1960.
_____., and Yalom, I., “Family Research on the Problem of Ulcerative Colitis,” Arch. Gen.
Psychiat.,15:410-418, 1966.
Jensen, G. D., and Wallace, J. G., “Family Mourning Process,” Fam. Process, 6: 56-66, 1967.
Johnson, A. M., Falstein, E. I., Szurek, S. A., and Svendsen, M., “School Phobia,” Am. J.
Orthopsychiat.,11:702, 1941.
Kafka, J. S., “Critique of Double Bind Theory and Its Logical Foundation (an Alternative
Katz, M., “Agreement on Connotative Meaning in Marriage,” Fam. Process, 4: 64-74, 1965.
Kempler, W., Iverson, R., and Beisser, A., “The Adult Schizophrenic Patient and His Siblings,” Fam.
Kysar, J. E., “Reactions of a Professional to Disturbed Children and Their Parents,” Arch.
568
_____., “Mystification, Confusion and Conflict,” in Boszormenyi-Nagy, I., and Framo, J. L. (Eds.),
_____., and Esterson, A., Sanity, Madness and the Family, Vol. 1, Families of Schizophrenics,
_____., Phillipson, H., and Lee, A., Interpersonal Perception—A Theory and a Method of
Leichter, H. J., “Boundaries of the Family as an Empirical and Theoretical Unit,” in Ackerman, N.
W., Beatman, F. L., and Sherman, S. (Eds.), Exploring the Base for Family Therapy,
_____., “Resolution of Intrafamilial Role Conflict in Families of Schizophrenic Patients. II. Social
Levy, D. M., Maternal Overprotection, Columbia University Press, New York, 1943.
Levy, J., and Epstein, N. B., “An Application of the Rorschach Test in Family Investigation,” Fain.
Lidz, R., and Lidz, T., “Homosexual Tendencies in Mothers of Schizophrenic Women,” J. Nerv. &
Lidz, T., Cornelison, A., Fleck, S., and Terry, D., “Intrafamilial Environment of Schizophrenic
Patients. II. Marital Schism and Marital Skew,” Am. J. Psychiat., 114:241-248, 1957.
_____., “Schism and Skew in the Families of Schizophrenics,” in Bell, N. W., and Vogel, E. F. (Eds.),
Loveland, N. T., Wynne, L. C., and Singer, M. T., “The Family Rorschach: A New Method for
Lu, Y.-C., “Contradictory Parental Expectations in Schizophrenia,” Arch. Gen. Psychiat., 6:219-234,
1962.
570
_____., “Mother-Child Role Relations in Schizophrenia: A Comparison of Schizophrenic Patients
Machotka, P., Pittman, F. S., and Flomenhaft, K., “Incest as a Family Affair,” Fam. Process, 6:98-116,
1967.
McCord, W., Porta, J., and McCord, J., “The Familial Genesis of Psychoses,” Psychiatry, 25:60-71,
1962.
Malmquist, C., “School Phobia: A Problem in Family Neurosis,” J. Am. Acad. Child Psychiat., 4:293-
319, 1965.
Meissner, W. W., “Family Dynamics and Psychosomatic Processes,” Fam. Process, 5:142-161,
1966.
Meyers, D., and Goldfarb, W., “Studies of Perplexity in Mothers of Schizophrenic Children,” Am. J.
Miller, D. R., and Westman, J. C., “Family Teamwork and Psychotherapy,” Family Process, 5:49-59,
1966.
_____., “Reading Disability as a Condition of Family Stability,” Fam. Process, ,3:66-76, 1964.
Miller, H., and Baruch, D. W., “Psychosomatic Studies of Children with Allergic Manifestations. I.
Minuchin, S., Montalvo, B. Guerney, B. G., Rosman, B. L., and Shumer, F., Families of the Slums: An
Exploration of Their Structure and Treatment, Basic Books, New York, 1967.
Mishler, E. G., and Waxler, N. E., “Family Interaction Processes and Schizophrenia,” Int. J.
Psychiat.,2:375-430, 1966.
Morris, G., and Wynne, L., “Schizophrenic Offspring, Parental Styles of Communication,”
Mowrer, H. R., “Alcoholism and the Family,” J. Crim. Psychopath., 3:90, 1941.
Murrell, S., and Staghowiak, J., “Consistency, Rigidity, and Power in the Interaction Patterns of
10:373-395, 1971.
Novak, A. L., and van der Veen, F., “Family Concepts and Emotional Disturbance 148. in the
1970.
572
Otto, H. A., “Criteria for Assessing Family Strength,” Fam. Process, 2:329-338, 1963.
Parsons, T., and Bales, R. F., Family Socialization and Interaction Process, Free Press, Glencoe,
1955.
Paul, N. L., and Grosser, G. H., “Family Resistance to Change in Schizophrenic Patients,” Fam.
Process,3:377-401, 1964.
_____., “Operational Mourning and Its Role in Conjoint Family Therapy,” Com. Ment. Health, 1: 339-
345, 1965.
Perry, S. E., Silber, E., and Bloch, D. A., Children in a Disaster: A Study of the 1953 Vicksburg
Pittman, F., Langsley, D., and DeYoung, C., “Work and School Phobias: A Family Approach to
Purcel, K., et al., “The Effect on Asthma in Children of Experimental Separations from the
Rabkin, L. Y., “The Patient’s Family: Research Methods,” Fam. Process, 4.105-132, 1965.
Rabkin, R., Inner and Outer Space, Norton, New York, 1970.
Rashkis, H., “Depression as a Manifestation of the Family as an Open System,” Arch. Gen. Psychiat.,
19:57-63, 1968.
Reiss, D., “Individual Thinking and Family Interaction. I. Introduction to an Experimental Study of
_____., “Individual Thinking and Family Interaction. II. A Study of Pattern Recognition and
_____., “Individual Thinking and Family Interaction. III. An Experimental Study of Categorization
_____., “Individual Thinking and Family Interaction. IV. A Study of Information Exchange in
574
Fam. Process, 10.1-36, 1971-
Richardson, H. B., Patients Have Families, Commonwealth Fund, Harvard, Cambridge, 1945.
Rosenthal, A. J., Behrens, M. I., and Chodoff, P., “Communication in Lower Class Families of
Ruesch, J., and Bateson, G., Communication, the Social Matrix of Psychiatry, Norton, New York,
1951.
Schaffer, L., Wynne, L. C., Day, J., Ryckoff, I. M., and Halperin, A., “On the Nature and Sources of the
45, 1962.
Schatzman, M., “Paranoia or Persecution: The Case of Schreber,” Fam. Process, 10:177-212, 1971.
Sluzki, C., “Transactional Disqualification: Research on the Double Bind,” Arch. Gen. Psychiat.,
16:494-504, 1967.
_____., and Veron, E., “The Double-Bind as a Universal Pathogenic Situation,” Fam. Process, 10:397-
411, 1971.
Sonne, J. C., Speck, R. V., and Jungreis, J. C., “The Absent-Member Maneuver as a Resistance in
Speck, R. V., “Family Therapy of the Suicidal Patient,” in Resnick, H. L. P. (Ed.), Suicidal
_____., and Attneave, C. L., “Network Therapy,” in Haley, J. (Ed.), Changing Families, Grune &
Speer, D. C., “Family Systems: Morphostasis and Morphogenesis, or ‘Is Homeostasis Enough?’ ”
Spiegel, J. P., “A Model for Relationships among Systems,” in Grinker, B. B. (Ed.), Toward a Unified
_____., and Bell, N. W., “The Family of the Psychiatric Patient,” Am. Hbk. Psychiat., 1:114-149, 1959.
576
_____., and Klyckhohn, F. R., Integration and Conflict in Family Behavior, Report No. 27, Group for
Stachowiak, J., “Decision-Making and Conflict Resolution in the Family Group,” in Larson, C., and
Strean, H. S., “A Family Therapist Looks at ‘Little Hans,’ ” Fam. Process, 6:227-234, 1967.
Terrill, J. M., and Terrill, R. E., “A Method for Studying Family Communication,” Fam. Process,
4:259-290, 1965.
Thomas, A., “Simultaneous Psychotherapy with Marital Partners,” Am. J. Psychother., 10:716,
1956.
_____., and Sillen, S., Racism and Psychiatry, Brunner/Mazel, New York, 1972.
Titchener, J. L., Riskin, J., and Emerson, R., “The Family in Psychosomatic Process: A Case Report
1960.
Tomas, W., The Family Constellation: Its Effects on Personality and Social Behavior, Springer, New
York, 1969.
Vassiliou, G., “Milieu Specificity in Family Therapy,” in Ackerman, N. W. (Ed.), Family Therapy in
Vogel, E. F., “The Marital Relationship of Parents of Emotionally Disturbed Children: Polarization
Vogel, E. F., and Bell, N. W., “The Emotionally Disturbed Child as the Family Scapegoat,” in Bell, N.
W., and Vogel, E. F. (Eds.), A Modern Introduction to the Family, Free Press, Glencoe,
1960.
von Bertanlanffy, L., General System Theory, George Braziller, New York, 1968.
_____., and Rapoport, A. (Eds.), General Systems Yearbook of the Society for General Systems
Research,Vols. 1-16, Society for General Systems Research, Washington, D. C., 1955-
1971.
Wahl, C. W., “Antecedent Factors in Family Histories of 392 Schizophrenics,” Am. J. Psychiat.,
110:668, 1954.
Walter, J., and Stinnett, N., “Parent-Child Relationships: A Decade Review of Research,” J. Marriage
578
Watzlawick, P., “A Review of the Double Bind Theory,” Fam. Process, 2.132-153, 1963.
_____., Beavin, J. H., and Jackson, D. D., Pragmatics of Human Communication, Norton, New York,
1967.
Jackson, D. D. (Ed.), The Etiology of Schizophrenia, Basic Books, New York, 1960.
_____., and Fry, W. F., “Letters of Mothers of Schizophrenics,” Am. J. Orthopsychiat., 32:604-623,
1962.
Weblin, J., “Communication and Schizophrenic Behavior,” Fam. Process, 1:5— 14, 1962.
Welldon, R. M. C., “The ‘Shadow of Death’ and Its Implications in Four Families, Each with a
Wellisch, D. K., Gay, G. R., and McEntee, R., “The Easy Rider Syndrome: A Pattern of Hetero- and
1970.
Westlund, N., and Palumbo, A. Z., “Parental Rejection of Crippled Children,” Am. J.
Orthopsychiat.,16:271, 1946.
Wynne, L. C., Ryckoff, I. M., Day, J., and Hirsch, S. I., “Pseudo-Mutuality in the Family Relations of
_____., and Singer, M. T., “Thought Disorder and Family Relations of Schizophrenics. I. A. Research
1963.
Zilbach, J. J., “Crisis in Chronic Problem Families,” in Belsasso, G. (Ed.), Psychiatric Care of the
Zuk, G. H., “On the Pathology of Silencing Strategies,” Fam. Process, 4:32-49, 1965.
_____., “On the Theory and Pathology of Laughter in Psychotherapy,” Psychotherapy, 3-97-101,
1966.
Notes
[1] In general terms family is a biopsychosocial system found in all cultures that acts: (l) to reproduce
other families (Families reproduce reproductive units, namely families. It is the human
biopsychosocial system that uniquely recruits new components by biological means, i.e.,
sexual reproduction); (2) to nurture and acculturate young humans; and (3) to care for
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Chapter 8
Introduction
Why has the study of normality and health been a relative newcomer to
teacher have had difficulty in recognizing the normal. Recently there has been
all behavior whether pathological or not. Reference to the normal also gives
behavior. That is not to say, however, that the concept of normality is a clear
and concise one. On the contrary, the concept is ambiguous, has a multiplicity
hospital wards into the community, they began to come into contact with
segments of the population not previously seen in their more traditional role
consultation, where they are called upon to make decisions about who is
healthier rather than about who is too sick for various positions. Interest in
582
conceptual issues related to normality and mental health. We cannot provide
a definitive answer to the question, “What is mental health or normality?”
since such an answer must eventually evolve out of new research and new
so that together they represent the total behavioral and social science
approach to normality. The four perspectives are (1) normality as health, (2)
normality as utopia, (3) normality as average, and (4) normality as process.
correlates with the traditional model of the doctor who attempts to free his
patient from grossly observable signs and symptoms. To this physician the
its simplest form this perspective is illustrated by Romano, who states that a
healthy person is one who is reasonably free of undue pain, discomfort, and
disability.
that harmonious and optimal blending of the diverse elements of the mental
when they grapple with a complex problem such as their criteria of successful
treatment. This approach can be dated directly back to Freud who, when
584
psychology (for example, Rogers).
the bell-shaped curve. This approach conceives of the middle range as normal
and both extremes as deviant. The normative approach that is based on the
statistical principle describes each individual in terms of general assessment
and total score. Variability is described only within the context of groups and
not within the context of one individual. Although this approach is more
than in the past. Not only do psychiatrists utilize results of IQ tests, Rorschach
tests, or T.A.T. but they also construct their own tests and questionnaires.
Conceptually the normality as average perspective is similar to Kardiner’s
developing model personalities for different societies, one assumes that the
typologies of character can be statistically measured.
theory (Von Bertalanffy Gray, Duhl, and Rizzo) further stressed the general
system over time. The integration of the variables into the system and the
Silber, et al., White, Cox, Heath, Westley and Epstein. There have been very
586
normality as process perspectives. In the section below we have chosen two
research strategies that illustrate the usefulness of the latter two perspectives
The overall aim of the Modal Adolescent Project has been to study
(Offer and Diesenhaus) was within one standard deviation from the mean in
nine out of ten scales. As such it was our aim to study one population of
average students by eliminating both extremes; the disturbed adolescent as
well as the teenager who functions on a superior level. Since the above study
was undertaken in two suburbs of Chicago, the adolescents represent average
part of a data pool that will give scientists a better understanding concerning
At the onset of our project we wanted to select our modal group from
the widest possible spectrum of teenagers living in a particular community, so
class populations but, nevertheless, represented the full range of the middle
typical teenagers have, the way they cope with them, and the reasons behind
their successes and failures in the coping process. Our findings are
summarized below:
588
school the father is seen as reliable and the mother as
understanding. The adolescents feel closer emotionally to
the mother. After high school the subject gets closer
emotionally to the father.
maladaptation.
590
assumes the continuity of change in behavioral patterns. While this particular
perspective has been espoused by many mental health professionals on a
verbal level, the empirical evidence supporting this understanding has been
longitudinal study.
Hoffman, and their colleagues in the area of family adaptation to the fatal
behavior arc being investigated. Their method is similar to the one utilized by
Vaillant in his 30-year follow-up study of healthy adults. The central question
is what were the contributing factors that helped bring about successful
sample of parents and their children from the initial communication about
the fatal illness up to, and in some cases following, the death of the child. To
carry on such studies is in itself a most formidable task considering its
extreme poignancy. Indeed, recent work by Paykel has indicated that the
investigations in this area with the realization that much can be learned by
studies of a normative population undergoing stress of high intensity over a
substantial period of time.
From the very beginning the observers were impressed with the wide
exact criteria for successful coping with this dreadful stress remain to be
worked out, the research team has focused upon the modal processes of
592
adaptation in their sample. Examination of the data after two and a half years
of observations indicated that each set of parents had to cope with the
4. To cherish and cling to the leukemic child and yet to allow the child
to separate from them and continue to grow.
5. To invest in the leukemic child and yet to invest also in the child’s
siblings.
9. To focus on the immediate crises and yet to plan for the future of
the family.
5. Anticipatory mourning.
Each of the above adaptational tasks was further analyzed into its various
components, and efforts were made to follow these adaptational subtasks
throughout the course of the child’s illness and even beyond the death of the
child.
594
empirically from the data as a series of adaptive part-processes interwoven
and reached prominence earlier in the child’s illness while others peaked in
the latter stages of the disease. The part-processes emerging from qualitative
adaptation to fatal childhood illness. However, other authors have not treated
the course of parental anticipatory mourning as a total process, nor have they
described the progression of each of its part-processes and their dynamic
mourning.
596
Normality and health have often been associated with terms such as
that these concepts, like normality and health, are complex theoretical
constructs that have not been adequately explained on the basis of any past
or present single theory or hypothesis. One of the major problems that has
plagued investigators in the behavioral sciences has been the great difficulty
clusters of traits and behavior that describe the variety of healthy or normal
populations. (See, for example, Silber, et al., Grinker, et al., White, Heath,
West- ley and Epstein, Cox, Offer, Beiser, and Vaillant).
coping abilities. (See, for example, Grinker and Vaillant.) A recent review by
and health and normality. Here again the stronger (or healthier) the ego the
easier it is for the individual to adapt to his internal as well as to his external
environments.
that a large variety of stimuli from either the external environment or the
598
to study the coping behavior of people from a psychological point of view. The
individualized response, which is based on constitutional, experiential,
familial, social, and cultural factors, is not uniform. Hence the 20 universal
what causes one person to be unable to cope (for example, death of a close
relative or friend) at a particular time will not necessarily cause the same
have not been too successful in the past in predicting who will cope
outlined by Hamburg. The physiological system that has been activated by the
parents in acute stages of grief is not intrinsically different from the system
less specific. Hamburg and Adams state that there are basically four stages in
relieving stress of major proportions: “1. Personality attributes that tend to
are erected to protect the person against the upsurge of powerful aggressive
and sexual instinctual demands from within and to protect him from undue
pressure from without. From this perspective the best way to study coping is
by observing populations that are experiencing stressful reactions in highly
conflictual situations.
Erikson presents human growth from the point of view of conflict, crisis,
and stress: “For man, in order to remain psychologically alive, constantly
eight specific crisis periods one can study the human condition better because
both the potential for growth and the emergence of pathological defense
600
mechanisms are more evident. It remains unclear whether Erikson extends
the crisis periods to include all substages or phases of the eight crisis periods.
The concepts that delineate the beginning and end of each crisis period have
not as yet been operationally defined. Erikson assumes that crisis, like stress,
of parental values, but rather through conflicts or minor issues that have been
endowed with major importance for the adolescent’s own growth and
development. At least in the modal adolescents the reactions do not give rise
to the storm and stress described by investigators studying intensive
abilities are often inadequate, and hence they commonly seek help in the
psychiatrists’ offices. The adolescents who cope successfully with the period
are an enigma to many clinicians. We need new terminology that will describe
the nuances in coping behavior and that will take into account the
602
Returning full circle now to our original question: What is normality and
system that we call an individual, a person will have developed a coping style
the psychological system that an individual erects in order to cope with crisis,
stress, and everyday life will by and large remain relatively constant through
life, since the repertoire of adaptive mechanisms, including defenses, is
relatively fixed in early childhood. Some individuals will undergo Sturm und
Drang at every major crossroad through the life cycle. Others will go through
life with little turmoil. We postulate that the healthier individuals will have a
variety of coping techniques available to them, will have a larger array of
defenses at their disposal, will utilize the more adaptive and object-seeking
defenses, and will show more flexibility in dealing with internal as well as
external events. Whether the ones who show less overt (behavioral) turmoil
are the ones who are optimally healthier cannot be determined without
individual, the family, the group, and the society. Only then can it be fully
understood.
of this goal.
604
There is another reason why normality will emerge as a central
their borders, and they will cooperate with investigations that facilitate such
evaluation.
They have demonstrated the feasibility of such studies and have also
have seen in the past decade a dramatic increase in investigators studying the
Bibliography
Beiser, M., “A Psychiatric Follow-Up Study of ‘Normal’ Adults,” Am. ]. Psychiat., 127: 1464-1473,
606
1971.
Binger, C. M., Ablin, A. R., Feuerstein, R. C. Kushner, J. H., Zoger, S., and Mikkelson, C., “Childhood
Leukemia: Emotional Impact on Patient and Family,” New Eng. J. Med., 280:414-
418, 1969.
Bolmax, W. M., “Theoretical and Empirical Bases of Community Mental Health,” Am. ]. Psychiat.,
Bozeman, M. F., Orbach, C. E., and Sutherland, A. M., “Psychological Impact of Cancer and Its
Treatment, III. The Adaptation of Mothers to the Threatened Loss of Their Children
Cox, F. D., Youth into Maturity, Mental Health Materials Center, New York, 1970.
“The Definition and Measurement of Mental Health: A Symposium,” National Center for Health
Erikson, E. H., Identity: Youth and Crisis, Norton, New York, 1968.
Freud, A., Normality and Pathology in Childhood, International Universities Press, New York,
1965.
Friedman, S. B., Chodoff, P., Mason, J. W., and Hamburg, D. A., “Behavioral Observations on Parents
Futterman, E. H., and Hoffman, I., “Shielding from Awareness: An Aspect of Family Adaptation to
_____., and _____., “Crisis, Adaptation and Anticipatory Mourning in Families with a Leukemic Child,
in Anthony, E. J. and Koupernik, C. (Eds.), The Child in His Family, Vol. 2, pp. 127-
_____., _____., and Sabshin, M., “Parental Anticipatory Mourning,” in Schoenberg, B., et al.
1972.
Glaser, B. G., and Strauss, A. L., Time for Dying, Aldine, Chicago, 1968.
Gray, W., Duhl, F. J., and Rizzo, N. D., General Systems Theory and Psychiatry, Little, Brown, Boston,
1969.
Grinker, R. R., Sr., “Brief Impressions of the Conference on Coping,” paper presented at the
608
_____., Towards a Unified Theory of Human Behavior, Basic Books, New York, 1956.
_____., with Grinker, R. R., Jr., and Timberlake, J., “A Study of ‘Mentally Healthy’ Young Males
Grinker, R. R., and Spiegel, J., Men under Stress, Blakiston, Philadelphia, 1948.
Hamburg, D. A., “A Perspective on Coping,” paper presented at the Conference on Coping and
_____., and Adams, J. E., “A Perspective on Coping Behavior,” Arch. Gen. Psychiat., 18:277-284,
1967.
Hamovitch, M. B., The Parent and the Fatally III Child, Delmar Publishing Co., Los Angeles, 1964.
Hoffman, I., and Futterman, E. H., “Coping with Waiting,” Comprehensive Psychiat., 12:67-81, 1971.
Jahoda, M., Current Concepts of Positive Mental Health, Basic Books, New York, 1958.
Jones, E., Cited in Birnbach, M., Neo-Freudian Social Philosophy, Stanford University Press,
Stanford, 1961.
_____., “The Concept of a Normal Mind,” in Papers in Psychoanalysis, Williams & Wilkins, Baltimore,
Kagen, J., and Moss, M. A., Birth to Maturity: A Study in Psychological Development, John Wiley,
Kaplan, A., “A Philosophical Discussion of Normality,” A.M.A. Arch. Gen. Psychiat., 17:325-330,
1967-
Kardiner, A., The Individual and His Society, Columbia University Press, New York, 1939.
Kellam, S. G., and Schiff, S. K., “The Origins and Early Evolution of an Urban Community Mental
_____., and _____., “The Woodlawn Mental Health Center: A Community Mental Health Center
Lazarus, R. S., Averill, J. R., and Option, E. M., Jr., “Assessment of Coping,” paper presented at the
Mechanic, D., Mental Health and Social Policy, Prentice-Hall, Englewood Cliffs, N.J., 1969.
Natterson, J. M., and Knudson, A. G., “Observations Concerning Fear of Death in Fatally Ill Children
610
and Their Mothers,” Psychosom. Med., 22:456-465, 1960.
Offer, D., The Psychological World of the Teen-ager: A Study of Normal Adolescent Boys, Basic
_____., and Diesenhaus, H., “The Self-Image Questionnaire for Adolescents,” Special Publication,
Chicago, 1969.
_____., and Sabshin, M., Normality: Theoretical and Clinical Concepts of Mental Health, Basic Books,
Paykel, E. S., “Life Events and Acute Depression,” paper presented as part of a symposium on
“Separation and Depression: Clinical and Research Aspects” at the Annual Meeting
Richmond, J. B., and Waisman, H. A., “Psychological Aspects of Management of Children with
Rogler, L. H., and Hollingshead, A. B., Trapped: Families and Schizophrenia, John Wiley, New York,
Romano, J., “Basic Orientation and Education of the Medical Student,” J.A.M.A., 143:409, 1950.
Sabshin, M., “The Boundaries of Community Psychiatry,” Soc. Service Rev., 40:3, 246- 254, 1966.
_____., “Toward More Rigorous Definitions of Mental Health,” in Roberts, L. M., Greenfield, N. S.,
Silber, et al., “Adaptive Behavior in Competent Adolescents,” A.M.A. Arch. Gen. Psychiat., 5:359–
365, 1961.
Srole, L., et al., Mental Health in the Metropolis, McGraw-Hill, New York, 1962.
Vaillant, G. E., “Theoretical Hierarchy of Adaptive Ego Mechanisms,” A.M.A. Arch. Gen. Psychiat.,
24:107-118, 1971.
Von Bertalanffy, L., General Systems Theory, George Braziller, New York, 1968.
Weinshel, E. M., “The Ego in Health and Normality,” J. Am. Psychoanal. A., 18: 682-735, 1970.
Westley, W. A., and Epstein, N. B., Silent Majority, Jossey-Bass, San Francisco, 1970.
612
Symposium on Motivation, pp. 97- 138, University of Nebraska Press, Lincoln, 1960.
Zinberg, N. W., and Kaufman, I., Normal Psychology of the Aging Process, International Universities
Notes
[1] (1) Separation from parents in childhood; (2) displacement by siblings; (3) childhood experiences
of rejection; (4) illness and injuries in childhood; (5) illness and death of parents; (6)
severe illnesses and injuries of the adult years; (7) the initial transition from home to
school; (8) puberty; (9) later school transitions, for example, from grade school to junior
high school to college; (10) competitive graduate education; (11) marriage; (12)
pregnancy; (13) menopause; (14) necessity for periodic moves to a new environment;
(15) retirement; (16) rapid technological and social change; (17) wars and threats of
Since the early 1950’s maturity as a term and a concept has come into
from the tacit assumption that everybody—professional and lay people alike
—knows what is meant by the term. The seeming general agreement about
614
meaning may well arise out of the vagueness of the concept itself and the
characteristic of any emerging concept and its lexicon, which will in time give
immaturity. Both concepts have come into rapid currency because they seem
serviceability of the idea and the terminology has thus led to an accretion of
meaning that makes for a certain level of communication. Indeed, maturity
has become an allpurpose word, vague enough to fit into any context where a
and unproductive, socially adjusted and maladjusted. And when these words
are used by the teacher, counselor or therapist they carry the same weight of
approbation and disapprobation as the earlier good and bad,” and constitute
a code as specific as that they have replaced. If she is right, certain moral
either feel it is inadvisable to tell parents the hard truth or are themselves
very unclear about what ails a failing or near failing pupil. In this situation
teacher regards the child as unsatisfactory. In what ways and to what degree
and with what hope of change for the better are often obscure to teacher and
parent alike.
Preoccupied with pathology, psychiatry has until quite recently directed its
developing at a very rapid pace, nursery school teachers long ago saw that
616
separate components. Important and perceptive as its work has been, Early
Childhood Education has remained for the most part a self-contained applied
field. So-called basic research and theory building has been on the whole left
become a topic to be researched. Heath who has produced one of the more
In fact, the findings, not only of Heath but also of the body of empirical
research on psychological maturity —scant though that research is—are in
substantial agreement about the manifest traits and behavior of the so-called
Even while the loose and sometimes confused use of the terminology of
idea and the terminology. The significant point is that in its present use
psychological maturity is a concept relatively new to science. While it
unquestionably has a legacy from moral philosophy and religion, that rigor is
supports the totality of growth, but does not accept the notion that poor
health forecloses the possibility of mature personality. The quality has been
studied almost exclusively by using subjects who are intellectually well
endowed, highly educated, and well above the poverty line economically; but
the certainty remains in the minds of expert and laity alike that many
individuals only moderately bright, poorly educated, and in the lower ranges
holds that mature persons are clearly aware of reality and that they do not
run head on to violate it, though they do what they can to shape it to positive
ends. Reaching out in trust and warmth to other persons, they are able to give
and accept affiliation. Being essentially at peace with themselves, they are
618
attentive to the needs, joys, and griefs of others. Enjoying productivity, they
work in accordance with their gifts and tend to grow steadily toward higher
It may be that the aptitude to achieve the somatic, psychic, social unity
possibility of an overall effective level of being that satisfies the criteria of the
reality-oriented, productive, and loving way of life is achieved by persons who
have relatively little to work with. How such individuals cope with their
problems so formidable that the hurdles in work with the highly endowed are
undertaken in this chapter must perforce deal with the research and
almost exclusively upon adult subjects, most of them in their twenties and
thirties when full biological and social maturation has presumably been
years following the war brought a succession of studies (Barron, Bond, Brown
Cox Sanford Terman), all of them beamed upon the adult years. On exploring
what was essentially uncharted territory, these investigations had to adapt
would produce relevant data. As publication dates show, much of this work
seem to begin de novo. It is captious to complain that studies did not at this
early stage build one upon another. Timing and differences in research
situations and resources as well as various aims made replication either
independently pursued and from different starting points came out with
620
severity of the stresses encountered by presumably mature young subjects in
their later experience. Some of the stresses were environmental and could be
the psychologically mature subject was the ability to recover from stress.
The steps by which the “righting” comes about are of particular interest.
Cox, for example, found that continuing in an accepted role was supportive as
was the less tangible framework implicit in a self-ideal. Ruff’s work with the
astronauts revealed that their command of specific skills that gave them a
From all the in-depth research on criterion groups comes evidence that
mature people are sensitively aware of the persons and events around them
and recognize and accept the claim of others upon them. The mature
individual is usually in harmony with people and with the basic institutions of
his society; but if his own value system and his own clear sense of what he is
and what he wants to become run counter to the ideas and events he
pursued with satisfaction to himself and for the enrichment of his society.
The strong and resilient people who have been subjects are given
different titles or names appear to carry essentially the same content and will
fact the subjects of this particular part of the literature have been biologically
Although the major research efforts have not denied the possibility that
there is such a thing as psychological maturity before and after the
blossoming of the early adult years, they have either not entertained the idea
use of the term and the idea of mature and immature levels of development in
the growing years make imperative the recognition that there is not one but
many levels of maturity—each appropriate to particular points in the life
cycle.
622
labels began to appear, research in developmental psychology had produced
a vast body of information about infants and young and school age children
who were functioning in accord with their good potential. Terman and
years, but one of the significant by-products was just that. Contrary to belief
current at the time that highly intelligent individuals were physically puny,
socially withdrawn, and emotionally unstable, the gifted children were found
modes that much more recent research has found in adults who meet criteria
Retrospectively it seems clear that these children were working and loving in
can be attained early in life but that moves unceasingly toward later revisions
maturity derives.
the concept of maturity. On the one hand, psychoanalysis, and the elaboration
of its theory in ego psychology, has traced affective and intellectual growth
toward full stature. On the other hand, more recently the psychology of
cognition in children has become a powerful influence on the way maturity is
conceptualized. Its single most significant thrust has been its explication of
the orderly progress of the genetically rich but cognitively naive infant
measure remain, separate despite the urgent need on the part of psychiatry,
psychology, and education for a synthesis. Such a synthesis is by no means in
the immediate offing, but the theories, empirical investigation, and expository
624
Leading the way for psychoanalysis, Hartman, as early as 1939, declared
imagination, and maturity. “I think,” he wrote again in 1964, “we have the
right to assume that there are, in man, inborn apparatuses which I have called
ego and their maturation constitute one foundation of the relation to reality.
Among these factors originating in the hereditary core of the ego, there are
those which serve postponement of discharge, that is, which are of an
derive from the conflicts between the ego and id, not all ego activities are
devoted to such struggles. The ego is able to achieve on its own strength and
to secure those achievements against reversibility.
theory in those circles and may eventually make synthesis possible. It is,
child psychologists can approach the theory with lessened wariness. Erikson
accepts the psychosexual stages of historical psychoanalysis and traces
When the individual falters on one step in the process, all that follows is in
eventually is able to deal effectively with the id and superego, and at the same
time attain mastery of relevant actualities of existence, constitutes, he says,
life cycle. These polarities state the central problem whose solution at each
The polarity of basic trust versus basic mistrust in the early months of
life is followed by autonomy versus shame and doubt in early childhood. In
turn, the polarities of industry versus inferiority, identity versus diffusion,
the last decade of the experimental impulse in child psychology and the rise
626
of the conditioning therapies take the science in a direction that seems for the
and like-minded psychologists have been doing. The new research differs
markedly from the laboratory work with infants and children before the
the late 1920’s, when his interest was first aroused by the ways in which
maturation, of discovery and learning on the part of the infant and young
child.[2] Equally important for both theory and practical affairs is his
demonstration that cognitive mastery awaits both the biological maturation
accessible to the developing organism by its own maturing structures and the
The somewhat cool reception accorded Piaget’s early work in the United
States seems to have been due to his overreliance upon verbal responses
from child subjects whose ideation, American psychologists believed, was far
more sophisticated than their language could express. Piaget himself now
concedes the point. The further fact that most of his work was available only
in French limited his hearing in America. His later studies, now translated, on
his own three young children and his ingenious experiments with larger
628
This formulation actually constitutes a fresh statement of the vexing
constitution nor upon socially proffered nurture, but upon some as yet
The importance of Piaget’s work for therapy, teaching, and social policy
maturation is invariant, Piaget is less positive about what happens in the long
run when there is a time lag in attaining any given level of growth. He
surmises, however, that there is an optimal rate of progress from stage to
stage. If the organism is delayed in a new phase, the ability to achieve the next
Piaget is, of course, concerned with the theory of cognition, but the
principles and the stages he delineates also have applicability to treatment
situations. The capacity to think, transpose, understand, and generalize can
be, and indeed are, fruitfully adapted to the affective sphere. Thinking
abstractly is supportive of the reorganization not only of cognition but also of
630
intellectual maturation might be accelerated in extremely bright children by
“forced feeding” appears to him ill- considered, and he sounds a warning on
cognitive factor is a critical issue. As Heath points out, “A theme that weaves
systems of the concept of stages— each resting upon that which goes before
paths. The fact that one system has addressed itself primarily to the affective
sphere and the other to the cognitive makes the parallelism the more
interesting.
development. This idea has grown out of the mental measurement movement.
thinking. Perhaps the most important of its working postulates is the use of
been strongly practical, even though important theories about the nature of
ability based upon statistical manipulation of test scores have been a notable
spin-off. Self-psychology, on the other hand, has been very largely theoretical
personality employ psychological tests. It is true also that the notion of the
MMPI and several of the projective techniques have been used by self, or ego,
researchers sufficiently sophisticated in these methods to use them
632
effectively. (See especially Barron, Heath). It is probably not unduly
pessimistic to say, however, that the clear delineation of norms for overall
psychological maturity, and the measurement of self or ego strength, are still
Age-Appropriate Maturity
Early in this century Alfred Binet developed the seemingly simple, but
chronological age, and that within broad limits his performance at any given
age must be evaluated by comparing it with that of other children of the same
life age. This device, later extended, with certain technical modifications by
other workers, to adult subjects (Wechsler, and the testing programs of the
armed services in World War I and World War II), has led to the elaboration
The age-appropriate idea leads at once to the proposition that the status
middle years of adult life. It is true, of course, that almost without exception
supernormal persons has only fairly recently attracted research talent. It can
The point of view advanced in this chapter is that for each age span
rapid growth of the biological basis of the person increases and elaborates the
634
new adaptation. Furthermore, at certain critical junctures accelerated
alterations of overt behavior and inner growth are required. Separation
experiences occurring in new contexts at different points in the life cycle, the
action. Similarly in the decades following the middle years, receding physical
resilience, the withdrawal in retirement of the social consensus concerning
the individual’s meaning and worth, and the loss of significant others make
unprecedented demands.
maturity this is especially true. Equally true is the fact that only if
being in phase with chronological age at that time of life depends upon
soundness of body. This is especially true in the early stages of extrauterine
life when the infant’s grasp upon his world can be secured only by his contact
with the space, sounds, touch, smells, and temperature of that world.
The interaction of the growing infant with his milieu in reaching toward
comprehension of his world has been richly documented over the last
but a few from an innumerable list. The most favored approach to the study of
maturation in the growing years has been the naturalistic or genetic one.
Using longitudinal methods with fairly small groups, and cross-sectional
the like from birth through adolescence. Norms of growth have been
identified at closely spaced points along the continuum of chronological age
636
with a competence that will probably never be excelled. From the normative
As noted above, Jean Piaget has infused the genetic approach with new
gives his work a theoretical and philosophic depth and breadth scarcely
The importance of the infancy and early childhood work for our
understanding of the maturation of the total person can scarcely be
overstated. From the earliest baby biographies down to the present, these
emotional, and intellectual factors. Since World War II a series of studies have
highlighted the blighting effect upon the growing organism where resources
for wholesome growth are not available. The benchmark studies of Ribble
and Spitz were followed by numerous investigations that sustained the early
finding that infants deprived of ongoing contact with supportive emotional
between the infant and his caretaker. Acting as a mother surrogate with a
finding is in line with that of others who report that language acquisition is
especially retarded by the absence of stimulation. Her experiment gives,
however, the positive side of the coin in demonstrating that the introduction
must be—an oral being, since to fail in the task of sucking, as some newborns
with seriously impaired nervous systems do, is to incur grave hazard to life
638
itself. Rut as Erikson has pointed out, the infant takes in much more than
physical nurture in this oral stage. He knows the world and interprets it in
will have come to terms with society’s initial interference with his reflexive
and instinctual life and begun to channel and control his intense loves and
hatreds.
has laid the foundations for identification and social feeling. His control of his
own body, his command of information and skills, his growing awareness of
the “rules” and expectations of society, as well as his capacity for satisfaction
this point his faith in the world and his confidence in his own powers ready
him for the further complications of life beyond the reach of his mother’s arm.
are by no means asexual and that interest in sex and sporadic sexual activity
are neither perverse nor abnormally precocious. However, the most telling
self as a member of small and larger social groups. The opposed polarity,
inferiority, is expressed in failure to achieve these goals. As teachers know,
lag in the mastery of the various forms of symbolic learning does not merely
constitute inconvenient deficits in the tools of school work. Such lacks are felt
by the child and the society as deficits in the individual himself. The shock
waves of these failures, reverberating into every aspect of the child’s life,
that the young person “keep up” and remain close to suitably advanced school
achievement.
time, educators lean upon age and grade norms where these are available, as
they are for most school subjects. The dangers inherent in the rigid use of
640
norm tables in dealing with individuals who differ markedly from the
fortunately well known today. At the same time humane use of norms as
to keep the realities of the child’s school situation in view. School learning is,
In the more subtle matter of becoming the sort of person the family, the
school, and the society demand, landmarks are far more vague. There are no
quantified norms for being an acceptable boy or girl, a normative son or
daughter, a good team member. Although rarely spelled out, standards are
how to act and what roles to carry out. The histories of adults studied as
notably mature reveal that these men and women were capable
schoolchildren, not only successful in school learning but also in the varied
and more inclusive roles and functions of their personal lives. There is little
solid evidence on whether children who fail badly over an extended period in
the tasks of latency can later achieve a high level of personal integration. We
do know that adults who have been studied in criterion groups have not been
choices made at this point are, happily, more reversible in the United States
than in most societies, but even here the child must begin to think with a time
what he does not do—in his school tasks can be recouped only by unusual
awareness of his correct role has been emphasized since early childhood. In
Western cultures, however, equalizing of opportunities and diversification in
sociological roles has in the last half century tended to focus attention upon
the physical aspects of her femininity along with all its implications for
emotional and sociological specialization. While physical maturation is less
formidable.
642
Both male and female must now relinquish old certainties and
until now taken for granted. As this evaluation goes on the youth retires into
his inmost self, questioning what he is really like and what he may become.
This state of affairs is reflected in his Rorschach protocol, which now shows a
clique serves as a kind of public relations agent for the adolescent while he, at
his deepest levels, goes into executive session with himself. Meanwhile,
observing the social scene, seeking clues about himself in the ways his fellows
relate to him, trying out attitudes and roles in which he only half believes, he
adolescent that anything may seem possible to him. Fantasy and enthusiasm
together with his newfound powers to entertain the hypothetical entice him
at times beyond himself. The line between adolescent dreams and unreality
Erikson sees as the critical task the securing of the emerging identity
one is and where he shall stand. For the adolescent whose self-revision is
already creating so many inner uncertainties, the chaotic social scene
indicates, by individuals who are able to preserve continuity with the past self
while reorganizing and revising standards and goals in terms compatible with
the realities of their present situation and with what the society beyond the
With the upsurge of genital capacity young persons who have come
successfully now turn toward members of the opposite sex for recognition
unreservedly in trust to another, is the critical next step for the genitally
mature. By the end of the adolescent years the emotionally mature man and
woman are able to enter into faithfulness in love and the competence in work
more explicitly researched than that in any other period. The qualities of
644
set forth in psychological test terms and in verbal descriptions by a number of
investigators (Barron, Bond, Brown Cox, Golden, Heath, Hooten, Sanford,
other human encounters, about the personality of the mature adult are found
scattered through the literature of personality theory. (Note particularly
noted in the first section of this chapter, fully support Freud’s surmise that in
adequacy of her subjects in the five spheres she deemed most important:
functioning that this study revealed, her findings agree with Heath’s that
experiences and their use of them to reach still higher levels of personality
The capacity to love deeply is not, as we have seen, reserved to the span
beyond adolescence. But during the adult years it takes on greater depth and
opens realms of feeling and action new even to those who have been able to
love sincerely and securely in childhood and youth. Maslow found such
limited number of other investigations that have inquired into the nature of
a long series of studies, beginning with the cross- sectional research of Jones
646
and Conrad and culminating in the standardization of the Wechsler-Bellevue
Test of Adult Intelligence, the curve of growth from childhood to late adult life
the curve reaches its highest point in the early twenties, then enters upon a
plateau that it maintains with relatively minor loss for two or three decades.
Thereafter, the curve declines, reaching at length in the late sixties and early
seventies the level attained by the average 14 year old. When the total score
was analyzed and subtest scores scrutinized, it was found that the decline
associations and those calling for rapid eye-hand coordination lose ground
early and at a relatively rapid rate; abstract thinking, particularly as
years on the same subjects did not yield falling scores. The earlier results
seem to have been produced in part at least by an artifact of poorer schooling
in older subjects. Yet when younger subjects today whose schooling is more
recent and presumably more adequate are compared with older subjects, the
young still outscore the older.
the closing years of life, there is very little solid evidence. Much is written and
said about the unhappy plight of the very old—their loneliness, their sense of
when these supports are withdrawn, as they inevitably are for most of the
lifetime, can sustain and carry the individual onward to some hitherto
unattained upland? Few psychological and social questions press so urgently
also in advanced age, men and women can be restored and maintained in
648
supports emotional health and, indeed, the totality of the person.[6]
Erikson believes that the later years offer the opportunity for the fully
individual may arrive at wisdom that maintains and conveys the integrity of
with the gift of responsible renunciation, some old people can envisage
human problems in their entirety.” Such old people can, he says, “represent to
the coming generation a living example of the ‘closure’ of a style of life.” Such
challenge science. Genetic endowment and the stage of physical and cognitive
growth, together with the input from the environment, set limits. The level of
the needs and purposes of the total organism. The synthesizing of resources,
many levels of thought and action in their totality are known as integration.
The tendency or entity that makes integration possible appears to have its
origins early in the life process. Since it unquestionably makes its appearance
soon after birth and since its mode of relating to experience shows a certain
consistency even then, it is surmised that this embryonic tendency toward a
unique style may have an hereditary core. This entity, which becomes clearer
accumulate, is referred to by some theorists as the self. Others call it the ego.
Although the terms are not synonymous, both designate a central, powerful
to the nature of this unifier and undertakes to spell out its dimensions and the
conditions of its development.
significant return to a topic that the science largely abandoned after 1890 or
650
means that there is in some quarters less disposition than formerly to treat as
what might be called a supervising entity. For him the self was only the sum
resisted this view, insisting that a unifying principle held the parts together
and was the overriding phenomenon (Allport), but they fought a losing battle.
Uneasiness among the proponents of the new theory and methodology may
have arisen, Allport surmises, out of their fear that psychology would excuse
itself from its chosen tasks by assigning what was not readily understood in
analytic theory.
being a point of view and a body of research that bears directly upon the idea
phenomenon as the self and to ask what a mature self is like. In his 1955
said that many psychologists “had commenced to embrace what two decades
ago would have been considered a heresy. They have reintroduced self and
ego unashamedly and, as if to make up for lost time, have employed ancillary
self- imposed restrictions of their predecessors and have been able to assert
that an indispensable something was missing from the positivists’ account of
the human psyche. Whether the new work on the self takes theory beyond the
point where the road forked in the nineteenth century remains to be seen.
community turned away from the molecular approach, they returned to the
652
understanding of the self.
activities and developing values, but also standing apart from and regarding
uncertainty about the self is so widespread. It may well be, as Erikson has
suggested, that uncertainty about identity is endemic in our time. On every
hand are heard reports of young people who are vague and bewildered. They
“do not know who they are” or what they are all about. The drug culture
appears to be one of the malignant symptoms of the confusion. In the idiom of
pretty clear about where he wants to go and about how his gifts are matched
to the journey. Very early he develops a life style that he maintains over time,
undertaking those inner revisions and those manipulations of milieu that
enable him to realize his own potential and to use environmental givens
that “the mature and productive individual derives his feeling of identity from
the experience of himself as the agent who is one with his powers.” Lecky
positive ways depends upon the quality of the brain. He goes on to say,
however, that intelligence alone does not account for ego strength. No less
important are flexible controls that use repression selectively but at the same
time keep the person “optimally open to experience.” On the basis of his data
654
on personal soundness in a criterion group of graduate students, he
“They are sound largely because they bear with their anxieties, hew to a
To recognize and even to describe the mature self is not the same as
judgments of maturity in selfhood. Yet most of the studies also report that
or several of these supports (Barron, Bond, Cox, Heath). Cox found that, in
general, the more numerous the misfortunes and deprivations the greater the
This agrees with the findings of the large sample study of Langner and
long ago proposed that the ego grows through frustration and denial. Na-
gera, following the path laid out by Sigmund and Anna Freud, asserts that
of the newborn infant. Such frustrations,” he adds, “are inevitable even in the
to absorb it, and if, as in the case of institutionalized infants, the deprivation is
extreme, development is blocked.
Some years ago Claparede inquired where subjects felt the self to
reside: in the right hand, in the viscera, in the center of the forehead, behind
656
the eyes, and so forth. This somewhat whimsical approach no longer engages
psychology. The notion of body image, however, is influential in clinical
practice and has inspired substantial research (Albee and Hamlin, Berman,
believed to be an expression of the total self, with the inner sense of one’s
Allport proposes what he calls the “proprium” to include all the regions
of our life that we regard as peculiarly ours and reviews those aspects of
personality that make for inward unity. In his eightfold schema of the
proprium[7] he gives special priority to the bodily sense. The centrality of the
body in psychological health is affirmed by all investigators. If psychological
maturity is conceived—as we do here—to be expressed by the relationship
between chronological age and psychic development, the bodily basis for the
self is especially important. During the growing years rapid and continuous
however, does healthy physical change disturb the self. On the contrary,
and elaborate the infant self. During the latency years the self is supported
In the beginning, as work with infants shows, the bodily self is learned.
The way in which the young child discovers that the boundaries of his body
have special relevance to all the rest of him and establishes his physical
how his infant son learned by biting his fingers painfully that they belonged to
the nearer parts of him. Later when the baby was standing in his crib, Preyer
asked him to “give the shoe”—which lay on the crib beside the child. The little
son complied. A moment later, Preyer, preparing to put the shoe on the child,
requested, “Give me the foot.” The child’s response was to stoop and tug at his
own foot in the same way he had reached for and lifted the shoe. At this point
the knowledge that the foot belonged to the self in a way quite different from
the shoe had not been mastered.[8] Preyer reported a series of explorations
the little boy made discovering the outlines of his own head, the difference
between his hand and the tray of his high chair. Fifty-five years later, Piaget’s
published studies of his three young children gave an account of the
emergence of the idea of the object as a continuing entity apart from the
perceiver. He concludes that the notion of the self as an object among objects
was one of the achievements of the sensorimotor period.
658
The awareness that oneself is not merely one other object but has a
special status is also attained in the early months of life. The toddler
gives clear indication that the baby in the mirror is himself. This may come
before he has enough language to express his understanding verbally, but his
self-conscious little smile and his gestures make his meaning unmistakable.
Thus, for a child even as young as this, one of the most complicated
phenomena of psychic life has come into being (Stutzman). For a child at this
Recent research has inquired into the very earliest appearance of the
style that will become the self. Mahler traces the gradual emergence of the
individual from the autistic shell by which the newborn has been sheltered
from excessive stimulation into “a protective but also receptive and selective
positively cathected stimulus shield” that envelops a child-mother unity in the
early normal symbiosis. After the healthful and necessary symbiotic stage is
past, the infant gradually becomes aware, from two to nine months old, of the
world outside the protecting shell and can attend increasingly to the world
about him. The “holding behavior” of the mother, so indispensable for the
protection of the neonate and young infant, can now loosen as the infant
becomes ready to “hatch” from the symbiotic orbit smoothly and gradually
without undue strain on his own resources. During the early infancy period a
the child gradually alters his behavior in a characteristic way. His emergent
mode, Mahler writes, grows out of his own endowment and the mother-child
individual. In the mutual cuing of mother and child the groundwork is laid for
child to readiness for both physical and psychic distance from the mother.
This stage is reached when ego functions have reached a fairly advanced
stage and, equally important, when he has attained the level of object
constancy in which the object is intrapsychically available. His memory of the
mother, his cognitively held assurance of her existence and availability even
when she is physically invisible, sustains him in his separateness. Clearly the
timing of this maturation cannot be dated precisely, for the intricate network
of competencies that enable the child, or older person, to exist without panic
is made up of many strands and can be weakened by the failure of any one of
them. Yet some children exhibit very early in life—even in infancy—an
660
apparently an original given. A strong core of self thus seems present almost
at birth.
clarity of self are apparent. The three year old with a firmly developed self can
tolerate brief separation from his mother without great anxiety and, in
achieved inner cohesiveness, is able to grasp the opportunities offered by the
nursery school. As he advances into the school years, his life style is
developed identity, is modified to include awareness that the self has at its
functions, and social roles call for reorganization of the existing self. Evidence
on adult life for periods as long as 15 to 20 years indicates that the level of
which life style remains essentially unchanged over the entire life span is still
to be determined, but the evidence from longitudinal work encourages the
hypothesis that those who have over the years been mature personalities will
be so to the end (Cox)
purposes here are the ideas expressed by self- or ego identity, self-esteem,
makeup, the notably healthy individual is clearer about his identity and
and mature subjects and found the mature better able to withstand
disturbing evidence.
terms of his genetic idiom and also in terms of the responses he gets from
others. Soon after extrauterine life begins the child identifies the self as male
or female, and later still as a good or poor game participant, as a quick or slow
family, race, social and national group. Only much later does he grow into his
662
To be sure, there are certain normal and inevitable crises in the life
cycle that shake identity. These are known to be associated with puberty,
One of the tests of maturity is the way the assurance of what one really is
holds up.
the social self.[9] In health the self is not wholly dependent upon the way one
is conceptualized by others, but there is evidence that in the mature person
there is congruencc between what one feels himself to be and how he believes
others view him. Furthermore, he is pretty accurate in his estimate of the way
Self-Esteem
human relationships is said to have its roots in love of self. This sentiment is
peace with the self (Cox, Fromm, Heath, Maslow). Pride in achievement,
conviction of one’s worth, and confidence that one is worthy of love enable
the individual to extend the largesse of his disinterested care beyond the
oneself does not go hand-in- hand with smugness. Rather this attitude might
be likened to that of the good strict parent described by Susan Isaacs—
accepting and warm but not uncritical nor negligent about responsibility and
Self-Ideal
personality: “It is readily apparent that the ideal of who one might or desires
to be or become has important bearing on one’s feeling about who one is.”
The self-ideal by definition reaches outside of and beyond the achieved state
664
excellence, to strength, to saintliness is to claim kinship with these qualities
and to borrow some of their effulgence. At the same time, unless there is
intention and effort toward bringing the ideal self to reality, the ideal can
possibly attain that they neutralize the pull of the goal (Cox). However, in
realistic and responsible persons, from childhood onward the idea of what
one wishes and tries to become exercises significant influence and is, indeed,
as most nearly universal and timeless: firm anchorage in reality, warmth and
work suited to ability, responsibility toward the small and the large social
group, secure sense of self, development of a value system, and resilience
under stress.
Bibliography
Albee, G. W., and Hamlin, B. M., “Judgment of Adjustment from Drawings: the Application of
Allport, G. W., Becoming: Basic Considerations for a Psychology of Personality, Yale University
_____, The Individual and His Religion, Macmillan, New York, 1950.
_____, Pattern and Growth in Personality, Holt, Rinehart and Winston, New York, 1961.
Anastasi, A., Psychological Testing, 3rd ed., Macmillan, New York, 1963.
Anderson, H. H. (Ed.), Creativity and Its Cultivation, Harper & Row, New York, 1959.
Anderson, T. B., and Olsen, L., “Ideal Self and Occupational Choices,” Personnel & Guidance J.,
44:171-176, 1965.
Arieti, S. (Ed.), American Handbook of Psychiatry, 3 vols., Basic Books, New York, 1959, 1966.
666
Barron, F., Creativity and Psychological Health, Van Nostrand, New York, 1963.
_____, Personal Soundness in University Graduate Students: An Experimental Study of Young Men in
Bayley, N., “Development of Mental Abilities,” in Mussen, P. H. (Ed.), Carmichael’s Manual of Child
Bennett, V. D., “Combinations of Figure Drawing Characteristics Related to the Drawer’s Self
Berman, S., and Laffal, J., “Body Type and Figure Drawing,” J. Clin. Psychol., .9-368-370, 1953.
Bond, E. D., “The Student Council Study: A Preliminary Report,” Am. J. Psychiat., 107:271-273,
1950.
_____, “The Student Council Study: An Approach to the Normal,” Am. J. Psychiat., 109: 11-16, 1952.
Bowlby, J., Attachment and Loss, Vol. 1, Basic Books, New York, 1969.
_____, Child Care and the Growth of Love, 2nd ed., Penguin Books, Harmondsworth, England, 1968.
_____, “Personality, College Environment, and Academic Productivity,” in Sanford, N. (Ed.), The
Buhler, C., The First Year of Life, John Day, New York, 1930.
Butler, R. N., “Aspects of Survival and Adaptation in Human Ageing,” Am. J. Psychiat., 123.; 1233-
1243, 1967.
Cabak, V., and Najdanvic, R., “Effects of Undernourishment in Early Life on Physical and Mental
Carmichael’s Manual of Child Psychology, Vol. 1, John Wiley, New York, 1970.
Casler, L., “The Effects of Extra Tactile Stimulation on a Group of Institutionalized Infants,” Genet.
Claparede, E., “Note sur la localisation du Moi,” Arch, of Psychol., 19: 172-182, 1924.
Cox, R. D., “The Normal Personality: An Analysis of Rorschach and Thematic Apperception Test
668
Responses of a Group of College Students,” J. Projective Techniques, 20:70-77, 1956.
_____, “Verbal Expression of Level of Aspiration as a Defense Against Anxiety,” Unpublished case
study of Robert.
_____, Youth into Maturity, Mental Health Materials Center, New York, 1970.
Dunn, H. L., “Dynamic Maturity for Purposeful Living,” Geriatrics, 21:205-208, 1966.
Elkind, D., Children and Adolescents: Interpretative Essays on Jean Piaget, Oxford University Press,
Elkisch, P., “Children’s Drawings in a Projective Technique,” Psychol. Monog., 58, 1945.
Erb, E. D., and Hooker, D., The Psychology of the Emerging Self: An Integrated Interpretation of
Erikson, E., Childhood and Society, 2nd ed., Norton, New York, 1963.
_____, Growth and Crisis in Healthy Personality, Monograph 1, Vol. 1, Psychological Issues,
of Infancy and Childhood, Josiah Macey, Jr., Foundation, New York, 1953.
Flavell, J. H., The Developmental Psychology of Jean Piaget, Van Nostrand, Princeton, 1963.
Freud, A., “The Concept of Developmental Lines,” in The Psychoanalytic Study of the Child, Vol. 18,
_____, The Ego and the Mechanisms of Defense, International Universities Press, New York, 1946.
Freud, S. (1923), The Ego and the Id, Norton, New York, 1960.
Fromm, E., Man for Himself, Rinehart & Co., New York, 1947.
Gesell, A. L., and Amatruda, C. S., Developmental Diagnosis, 2nd ed., Holber, New York, 1960.
Golden, J., Mandel, N., Glueck, B. C., Jr., and Feder, Z., “Summary Description of Fifty Normal White
670
Gorney, J. E., and Tobin, S. S., “Experiencing among the Aged,” Proceedings of the 20th Annual
Greenacre, P., “Early Physical Determinants in the Development of the Sense of Identity,” J. Am.
Gurin, G., Veroff, J., and Feld, S., Americans View Their Mental Health, Basic Books, New York,
1960.
Harris, D. B., Childrens Drawings as Measures of Intellectual Maturity, Harcourt Brace World, New
York, 1963.
Hartman, H., “Comments on the Psychoanalytic Theory of the Ego,” in The Psychoanalytic Study of
the Child, Vol. 5, pp. 74–96, International Universities Press, New York, 1950.
_____ (1939). Ego Psychology and the Problem of Adaptation, International Universities Press, New
York, 1958.
_____, “Psychoanalysis and Developmental Psychology,” in The Psychoanalytic Study of the Child,
Heath, C. W., What People Are: A Study of Normal Young Men, Harvard University Press,
Cambridge, 1946.
Hollingworth, L., Children above 180 IQ. Stanford Binet, World, New York, 1942.
Hooten, E., Young Man, You Are Normal: Findings from a Study of Students, G. P. Putnam’s Sons,
Inhelder, B., and Piaget, J., The Growth of Logical Thinking from Childhood to Adolescence, Basic
Jahoda, M., Current Concepts of Positive Mental Health, Basic Books, New York, 1958.
Jones, M. C., “Psychological Correlates of Somatic Development,” Child Dev., 36: 899-911, 1965.
Kohlberg, L., and Kramer, R., “Continuities and Discontinuities in Childhood and Adult Moral
672
Kotkov, B., and Goodman, M., “The Draw-a-Person Tests of Obese Women,” J. Clin. Psychol., ,9:362-
364, 1953.
Langer, J., “Werner’s Theory of Development,” in Mussen, P. H. (Ed.), Carmichael’s Manual of Child
Langner, T. S., and Michael, S. T., Life Stress and Mental Health: The Midtown Manhattan Study, Vol.
Lidz, T., The Person: His Development throughout the Life Cycle, Basic Books, New York, 1968.
1969.
Lynd, H. M., On Shame and the Search for Identity, Science Editions, New York, 1961.
McGraw, M. B., Growth: A Study of Johnny and Jummy, Appleton Century, New York, 1935.
1949.
MacKinnon, D. W., “The Highly Effective Individual,” Teachers College Record, 61:367-378, 1960.
Maddox, G. L., “Disengagement Theory: A Critical Evaluation,” The Gerontologist, 4:80-82, 103,
1964.
_____, “Fact and Artifact: Evidence Bearing on Disengagement Theory from Duke Geriatrics
Mahler, M. S., On Human Symbiosis and the Vicissitudes of Individuation, Vol. 1, International
Maslow, A. H., Motivation and Personality, Harper & Row, New York, 1954.
_____, “Self-actualizing People: A Study of Psychological Health,” Personality, Symposium No. 1, 11-
34, 1950.
_____, Toward a Psychology of Being, 2nd ed., Van Nostrand Reinhold, New York, 1968.
Modell, A. H., “Changes in Human Figure Drawings by Patients Who Recover from Regressed
674
Murray, H. A., Explorations in Personality: A Clinical and Experimental Study of Fifty Men of College
Mussen, P. H., Conger, J. J., and Kagan, J., Child Development and Personality, 3rd ed., Harper &
Nagera, H., Early Childhood Disturbances, The Infantile Neuroses and Adulthood
Nass, M. L., “The Superego and Moral Development in the Theories of Freud and Piaget,” in The
Psychoanalytic Study of the Child, Vol. 21, pp. 51-68, International Universities
Neugarten, B. (Ed.), Personality in Middle and Late Life, University of Chicago Press, Chicago,
1968.
Olim, E., “The Self-Actualizing Person in the Fully Functioning Family: A Humanistic
Piaget, J. (1937), The Construction of Reality in the Child, Basic Books, New York, 1954.
_____ (1936), The Origins of Intelligence in Children, International Universities Press, New York,
1952.
_____ (1947), The Psychology of Intelligence, Harcourt Brace World, New York, 1950.
Pratt, K. C., “The Organization of Behaviour in the New Born Infant,” Psychol. Rev., 44:470-490,
1937.
Preyer, W., The Mind of the Child, Pt. I, The Senses and the Will, Appleton, New York, 1888.
_____, The Mind of the Child, Pt. II., The Development of the Intellect, Appleton, New York, 1893.
Provence, S., and Lipton, R. C., Infants in Institutions, International Universities Press, New York,
1962.
Rabinowitz, M., “The Relationship of Self Regard to the Effectiveness of Life Experiences,” J.
Rheingold, H. L., “The Effects of Environmental Stimulation upon Social and Exploratory
Rheingold, H. L., Gewirtz, J. L., and Ross, H. W., “Social Conditioning of Vocalization in the Infant,”
676
Rhudick, P. J., and Gordon, C., “Test-Retest I.Q. Changes in Bright Ageing Individuals,” Proceedings
_____, The Personality of the Young Child, Columbia University Press, New York, 1955.
_____, “Toward a Theory of Creativity,” in Anderson, H. H. (Ed.), Creativity and Its Cultivation,
Rubin, I. M., “Increased Self-Acceptance: A Means of Reducing Prejudice,” J. Pers. & Soc. Psychol.,
5:233-238, 1967.
Ruff, G., and Sheldon, J. K., “Adaptive Stress Behaviour,” in Appleby M. H., and Trumbull, R.
Sanford, N. (Ed.), College and Character, John Wiley, New York, 1964.
_____, “Personality Development during the College Years,” J. Soc. Issues, 12:1–70, 1956.
Santostefano, S., “Relating Self-Report and Overt Behaviour: The Concept of Levels of Modes for
Schilder, P., Image and Appearance of the Human Body, Kegan Paul, London, 1935.
Scott, J. P., “The Genetic and Environmental Differentiation of Behaviour,” in Harris, D. B. (Ed.),
Shinn, W. M., The Biography of a Baby, Houghton Mifflin, New York, 1900.
Smedslund, J., “The Effect of Observation on Children’s Representation of the Spatial Orientation
Spitz, R. A., The First Year of Life: A Psychoanalytic Study of Normal and Deviant Development of
Smith, M. B., “Mental Health Reconsidered: A Special Case of the Problem of Values in
Srole, L., Langner, T., Michael, S. T., Opley, M. K., Marvin, R., and Thomas, A. C., Mental Health in the
Metropolis: The Midtown Manhattan Study, Vol. 1, McGraw-Hill, New York, 1962.
678
Stewart, R. A., “Transcendence of Opposites,” Psychology, 6:62-64, 1969.
Stutzman, R., Mental Measurement of Preschool Children with a Guide for the Administration of the
Taft, J., The Dynamics of Therapy in a Controlled Relationship, Dover, New York, 1962.
_____, “Physical Growth,” in Mussen, P. H. (Ed.), Carmichael’s Manual of Child Psychology, Vol. 1,
Terman, L. M., and Oden, M. H., The Gifted Child Grows Up: 25-Year Follow- up of a Superior
_____, The Gifted Group in Mid-life: 35-Year Follow-up of the Gifted Child, Stanford University Press,
Stanford, 1960.
Tippet, J. S., and Silfer, E., “Autonomy of Self Esteem: An Experimental Approach,” Arch. Gen.
Van Den Deale, L., “A Developmental Study of the Ego Ideal,” Genet. Psychol. Monog., 18.191-256,
1968.
Vispo, R. H., “On Human Maturity,” Perspectives Biol, & Med., 9:586-602, 1966.
Baltimore, 1958.
Werner, H., Comparative Psychology of Mental Development, International Universities Press, New
York, 1948.
_____, “The Concept of Development from a Comparative and Organismic Point of View,” in Harris,
1957.
White, S., “The Learning Theory Approach,” in Mussen, P. H. (Ed.), Carmichael’s Manual of Child
Witty, P., (Ed.), The Gifted Child (American Association for Gifted Children) Heath, Boston, 1951.
Wolff, K., “Personality Type and Reaction toward Ageing and Death: A Clinical Study,”
Geriatrics,21.189–192, 1966.
Wohlwill, J. F., and Lowe, R. C., “An Experiment Analysis of the Development of the Conservation
Ziller, R. C., and Grossman, S. A., “A Developmental Study of the Self-Social Constructs of Normals
680
_____, _____, Hagey, J., Smith, M., and Long, B. H., “Self Esteem: A Self- Social Construct,” J. Consult. &
Bentz, V. J., “A Test-Rerest Experiment on the Relationship between Age and Mental Ability,” Am.
Owens, W. A., “Age and Mental Abilities: A Longitudinal Study,” Genet. Psychol. Monog., 48:3-54.
1953.
Notes
[1] The work of Heinz Werner, though in many ways paralleling that of Piaget, has until recently been
less well known. His theory of mental development evolved over 40 years ago into an
ongoing change. His teaching at Clark University profoundly influenced his students.
[2] Stimulus-response learning theory and methodology have produced a vast literature that bears a
controlled stimuli stands, however, in sharp contrast to the genetic approach, which has
psychology is illuminating.
topics are dealt with more appropriately in another chapter of the handbook.
[3] The neglect of the retarded by psychiatry is currently being remedied to some degree by the
and the multifaceted program of the National Association for Retarded Children have
undertaken the habilitation—as distinct from rehabilitation—of this group and will
probably continue to do so under comprehensive mental health care with more adequate
[4] Psychology as a science has shown marked reluctance to study tender, affiliative relationships.
Allport notes that Ian Suttle sees this as a “flight from tenderness” spurred by the fear of
have found love relationships to be a central theme in the lives of their subjects.
[5] Research on very vigorous physical exercise by subjects in their eighties has produced very
[6] Note particularly such people as Pablo Casals and Picasso in the arts, Hilda Smith in public service,
682
[7] Allport’s eightfold schema for the proprium—or the self—includes the following: bodily sense, self-
identity, ego enhancement, ego extension, rational agent, self-image, propriate striving,
[8] A series of baby biographies and other less extensive reports touch upon these same phenomena,
although few prior to Piaget have clone so with details as telling as Preyer’s.
[9] Identity is regarded by some investigators to be so deeply related to social factors that it has no
existence apart from them. They see it as a personal-social phenomenon. This would lead
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Chapter 10
Theodore Lidz
The psychodynamic understanding of the personality and its disorders rests
heavily upon the study of the life cycle. The commonalities and similarities in
the course of all lives make possible the generalizations and abstractions
necessary for the scientific study of the personality. Although no two persons
are identical and no life stories are the same, the basic themes are limited and
it is the variations upon them that are infinite and inexhaustible. Behind their
individual uniqueness all persons are born with physical endowments that
are essentially alike and with similar biological needs that must be met. Like
all living things, they go through a cycle of gestation, maturation, maturity,
decline, and death. In common with all humans, each individual starts life
totally dependent on others and remains immature and dependent for many
years, during which he forms intense emotional ties to those who nurture him
—bonds that must be loosened sufficiently to enable him to live without them
and to form new meaningful relationships. He requires many years not only
to mature sexually and physically but also to learn the adaptive techniques he
collaboration with others, upon thought and foresight, and upon his ability to
change his environment to meet his needs. Alone among animals he is aware
of death and his position in his course from birth to death. Man’s life is never
static, for the passage of time of itself changes his functioning. Each phase of
the life cycle brings new potentialities and closes off old ones; the opportunity
and challenge must be met and surmounted for the individual to be prepared
for the next phase.
The development of the personality and the course of the life cycle
proceed phasically, not at a steady pace. The child goes through periods of
relative quiescence during which his progress seems slight and then
potentialities, provides new areas to explore, and sets new tasks that require
the acquisition of new skills and abilities to master. Thus, the ability to walk,
which must await maturation of the infant’s nervous system as well as
sufficient practice, changes the limits of the child’s world and his perspective
gains new opportunities to explore and learn, but he also requires more
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delimitation from those who take care of him. Similarly the hormonal shifts
that precede and accompany the advent of puberty will move the child into a
new phase of his life by rapidly altering his size and contours and by initiating
The phasic nature of the life cycle derives from several interrelated
factors.
Physical Maturation
organism. The infant cannot become a toddler until the pyramidal tracts in
the spinal cord that permit voluntary discrete movements of the lower limbs
become functional around the tenth month. Even after maturation allows the
adequately before they can be combined with others and incorporated into
organism initiate new phases in the life cycle. The metamorphosis of puberty
that ushers in adolescence provokes changes without regard to prior
life.
The Society
The roles the society establishes for persons of various ages set
expectations that promote shifts in ways of living. The time of weaning and
such as rescinding areas of independence to care for and consider the needs
of a spouse or a child. Yet for a society to remain viable, the roles and
expectations it establishes must be compatible with a person’s abilities and
needs at each phase of life. A child is moved into the role of schoolchild, with
its many demands and privileges, at the age of five or six partly because
primary socialization is usually completed and partly because his cognitive
Not only does the individual move into age- appropriate roles, but time
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brings changes in physical makeup that require changes in attitudes, as when
a person reaches middle life and realizes his life is approaching a climax, or
strengths. It is clear that a child who does not gain adequate autonomy from
his mother prior to going to school will have difficulties in attending school,
learning, and relating to peers, but failures are usually partial and not
need to meet the new challenges that are inherent in the life cycle. The
crises. Similarities exist in the ways in which different people meet similar
developmental problems, and there is likely to be something repetitive about
the ways in which the same person surmounts certain crises in his life.
Often there is a pause or delay before the child finds the confidence to
attempt to face the strange needs of a new phase in his life. The need for
emotional security sets limits on the pace of development. He is often prey to
new skills and situations and the child wishes to emulate parental figures,
become more grown up, and achieve greater independence; but the new
situations and demands bring insecurity, failures create frustrations, and
The anxieties that are aroused can lead the child to seek the security of
may need to be checked from the unrestrained use of new capacities as when
he begins to walk or when he first matures sexually, but at other times he may
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to leave the familiar and protected home to attend school. Developmental
hazards exist on both sides; too much support may leave the child overly
dependent and fearful of venturing forward; too little can leave the child
developmental phase leaves the child unprepared to move forward into the
next phase. The child gives up, or more commonly he moves ahead in some
areas and remains stuck in others. He squanders energy in coping with old
problems instead of moving on. A child who has never felt adequately secure
at home continues to seek maternal protection and affection when his peers
are secure with one another. Such arrests are termed fixations. Movement
developmental process, for every child will regress at times in order to regain
they are not simply temporary expediencies. The child remains improperly
prepared to meet the developmental challenges of the next phase of the life
for the stimulation of new experiences, by his drives, by needs for the
affection and approval of his parents, by desire to go along with his peers, by
the yearning of his body for another, by the needs of survival, by the roles
provided by society, by the desire for progeny, and by other such influences.
The life cycle has been divided into stages or phases somewhat
is considerable overlap in where the dividing lines are placed. The description
and study of the salient features of these stages have evolved largely from
other chapters, only Erikson’s and Piaget’s approaches will be discussed here.
692
Adhering to a more classical psychoanalytic framework than Sullivan,
psychosocial task of each phase that the individual must surmount in order to
be properly prepared to meet the opportunities and tasks of the next stage.
He also went beyond the traditional psychosexual phases that end with the
upon the specific developmental tasks of each stage and examining how
differing societies help the individual to cope by providing essential care,
vital needs and to keep him comfortable, the basic psychosocial task of the
oral phase concerns the achievement of a basic trust in others and also in the
self, with failures leading to varying degrees of basic mistrust; the “basic”
conveys that the trust is not conscious but blends into the total personality
this phase, the child properly gains a lasting sense of autonomy; on the other
hand, failure to achieve self-control often leads to a pervasive sense of doubt
and shame. The resolution of the oedipal conflict during the phallic phase
leads to a heightening of conscience; it is the time, too, when the child needs
to develop the prerequisites for either masculine or feminine initiative or
become prey to a deep and lasting sense of guilt. In the latency period the
child starts school where he finds that gaining admiration, approval, and
affection depends upon achievement, and now he must acquire a capacity for
industry or become subject to a pervasive sense of inferiority. Then, instead
the sameness and continuity of one’s meaning for others. If this cannot be
attained the person is subject to identity diffusion. Then, after the young adult
has achieved a sense of identity, he can move to relate to another with true
intimacy and have the concomitant capacity to distantiate the self from
persons or forces whose essence is dangerous to his own; failure to gain the
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phase of adult life has as its critical issue the interest in producing members
of the next generation and guiding and laying foundations for it; that is, a
phase. The final phase of the life cycle concerns the achievement of mature
dignity and integrity through maturely accepting “one’s own and only life
cycle” and taking responsibility for how it has turned out, whereas despair
involves the feeling that this one chance has been wasted and, in essence, has
been worthless.
critical issues of each developmental phase sharpen his emphasis upon the
need to cope with tasks rather than simply to pass through a phase without
suffering traumata that cause fixations. Still, the critical issues selected
studies of the child’s moral development have also provided new insights.
abilities through the constant process of adaptation of the existing state of the
organism to new experiences. The child cannot utilize experiences that his
cognitive schema are not yet ready to assimilate. The foundations for
experiencing emerge step by step through the expansion and reorganization
to react to and utilize more complex experiences. The process is a very active
one in which the organism is, so to speak, ever reaching out to incorporate
child and adolescent regard the world and can think about it at each stage of
development.
Piaget has divided cognitive development into four major periods, each
696
reflex movements through the time when the child uses internalized visual
and motoric symbols to invent very simple means of solving problems. In the
preoperationalperiod, which lasts until about the time the child enters school,
the child becomes capable of using symbols and language. He will not yet
have the ability to adapt what he says to the needs of the listener, to note
moves beyond his static ways of thinking as he gains experience and as words
begin to symbolize categories. The period of concrete operations
approximates the “latency” period, lasting from about the start of schooling to
the onset of puberty. The child now possesses a coherent cognitive system
with which he can understand his world and into which he can fit new
Still, dividing the life cycle into a series of rather natural phases permits the
Infancy
The period of infancy approximates the first fifteen months of life when
the baby is almost completely dependent upon others to care for his essential
needs, to provide a sense of security and the stimulation required for his
phase” emphasizes that the infant’s life centers upon taking in nutriment
through sucking but also that his emotional well-being rests upon the
within him, he will have established at the core of his being a basic trust in the
world and those who inhabit it. It is upon this trust in others that confidence
in himself and in his capacities to care for himself will later develop. Still, a
698
great deal more than gaining a sense of basic trust and a satisfaction of oral
needs must take place if the infant is to develop properly. These are a very
long fifteen months during which the child undergoes a greater physical and
period. Indeed, there are profound differences between the first and second
halves of infancy. During the first half, particularly during the first four
months, the baby’s physical maturation is of dominant importance, and the
but such needs cannot be neglected during the second half of infancy without
from those who raise him, the child will complete most of his sensorimotor
development to gain increasing control over his movements, to differentiate
The Toddler
As the baby begins to walk and talk, he enters the new phase in which
the crucial problems involve the imbalance between his newfound motor
skills and his meager mental capacities. He is impelled to use his new abilities
own safety. Because of his limited verbal and intellectual capacities reasons
cannot be explained to him, and the baby is only beginning to tolerate delays
and frustrations. The delimitations and the increasing expectations for self-
control almost inevitably lead to some conflict with the nurturing persons
and who cannot tolerate disorder can easily instill a pervasive sense of guilt
or shame. The struggle over conformity often focuses upon bowel training
and thereby can involve anal erotic fixations. During this period the child
requires subtle guidance in the complex process of acquiring language and a
trust in the utility of language. Now the child is also gaining a firm sense of
being a boy or a girl, and after the age of three the child’s gender identity
and depressive disturbances. When the child is about three years old, the
between his motor skills and his ability to comprehend and communicate
700
verbally. If progress through the period has gone well, he is ready to gain a
more definite autonomy from his mother and find his or her place as a boy or
Some time around the age of two and a half or three, the child ceases to
relationship with his mother, but now the erotic aspects of the relationship
must be frustrated to enable the child to gain a more realistic and less
egocentric grasp of his place in his mother’s life. The transition depends
partly upon his mother’s ability gradually to frustrate her child’s attachment
to her, but also upon other changes that are taking place. This phase is critical
member of the family, and be prepared to invest his energies and attention in
his mother, develops hostile feelings toward his father, and fears reciprocal
rescinding his primacy with his mother and seeking instead to become a man
like his father, a person capable of gaining the love of his mother. The girl, in
love object within the family in her father and forms a close attachment that
will be rescinded about the time of puberty. The child is now gaining the
experience as well as the cognitive tools he needs for improved reality testing,
and an important aspect of the period is the differentiation of fantasy from
reality. He also properly gains a trust in the utility and validity of verbal
directives. By the age of five or six the child will have gained considerable
organization of his personality, and the major lines of his future development
will have been laid down—his ways of relating to others and reacting
emotionally, having been patterned within his family setting. The resolution
of the oedipal situation terminates early childhood, and the precise manner in
few years the child has taken a giant step toward becoming an independent
and self- sufficient person even though he has done so through appreciating
The Juvenile
702
goes off to school, where he will be judged by his achievements rather than by
neighborhood peer group, where he must also find his place on his own. As
Erikson has noted, unless the child now gains a sense of industry, he can
develop pervasive feelings of inferiority and inadequacy. The trait of industry
in this time of life. A sense of belonging develops, the feeling that one is an
accepted integral part of the group as contrasted with the feeling of being an
outsider; it is a sense that not only concerns social ease as contrasted with
social anxiety, but ultimately affects the person’s identification with the
society in which he lives and his commitment to its values and ethics, as
contrasted with a deep- seated feeling of alienation. It is now that a sense of
crystallize in reaction to the way his teachers and peers relate to him. At
about the time the child enters school, there is a notable shift in his cognitive
considers this time of life as the latency period, it is apparent that these early
the home into the broader world of the schoolroom and his peer groups.
Adolescence
the difficult process of gaining freedom from the earlier repressive ban upon
sexual expression while redirecting his choice of love objects outside of the
family circle. During these years his cognitive capacities change, and he enters
Piaget’s stage of formal operations; he becomes capable of using
propositional logic, can think about concepts abstracted from reality, and is
704
system rather than simply by interpersonal relationships and the values
stemming from them. At the start of adolescence the individual is still a child
at play, dependent on his parents and with an amorphous future; at the end
he becomes responsible for himself, the direction his life will take is fairly
well settled, and his personality has gelled into a workable integrate. As
the attainment of an ego identity, but usually, particularly for a girl, the
attainment of an ego identity also requires the gaining of a capacity for
intimacy.
and conformity, revolt from parental standards and authority and conformity
when delimitation is required as the young person seeks to find and define
his own identity and when cravings for intimacy with a specific individual
become important.
phase in the life cycle, but the course of the life cycle varies with the social
and cultural setting. Aries has pointed out that during the Middle Ages
childhood stopped at the age of six or seven. Adolescence may not have been
common early in this century. Among many preliterate peoples the child
rapidly changing world has created new developmental problems for some
Youth includes the period that usually has been included as part of late
adolescence and early adult life. It concerns the tensions between the self and
which he has been raised as well as upon the ethical standards he embraces.
706
The period is marked by a struggle against acceptance of a conventional way
life that will make one an adult. The dangers quite clearly lie in the extremes
The young adult is at the height of his physical and mental vigor, and his
energies and interests can now be directed beyond his own growth and
ready to establish a new interdependence with another person and to find his
place in the social system. Now commitments are made, and if a person
cannot make them he will lack the opportunity of being meaningful to others
and having others become meaningful to him. Occupational choice and
marital choice, if not made previously, are critical issues, and both will greatly
social roles and patterns for living; and by determining the sort of persons
with whom one spends much of his life, it markedly influences values and
and supports and upon whom one can rely because the well-being of each
partner is bound up with the fate of the other. Marriage also helps individual
standards with a person raised in another family. Marriage not only tests the
success of the earlier oedipal transition but also many other facets of the
developmental process.
Parenthood
The position of parenthood in the life cycle is not fixed, but for most it
more or less completed. Spouses are transformed into parents and their
marriage into a family. The birth of the first child often alters their life
patterns and perspectives more than had their marriage. The person who
by the act of creativity. Women, in particular, now feel fulfilled, for to many
708
bearing, and nurturing children and strong cultural directives had added
central matter that provides meaning and balance to her life; and for many
years her child or children will be a prime focus in her life. The birth of a child
also brings increased self-esteem and sense of responsibility to the father.
shared interest and identification, but he can also be a divisive influence, and
separating force. For those who have achieved the necessary capacities, the
new responsibilities are offset by the fulfillment that comes with experiencing
the other side of the parent-child relationship; the self-realization that derives
from being needed and loved by a child to whom the parent is so very
important; and the constant renewal that comes with the changes in the
offspring.
only life is passing—the gratifications attained from marriage and career, and
an assessment of prospects for the future. The turn into middle life involves a
demarcated shift in life roles, although awareness of wear and tear on the
among peers influences the state of mind. The new phase starts with a
persistent awareness that it will soon be too late to attempt to change one’s
course through life. For women in particular middle age may start when the
but she is usually well into middle age when it occurs. A sense of integrity
comes with the feeling that a life has been meaningful, that relationships with
those who are significant are happy. A negative balance sheet can lead to
changes in career or marital partners and frantic efforts for sexual
of achieving goals. As the person passes over the peak, he finds himself one of
the older, responsible generation. Accepting responsibilities that one has
and disillusion that often leads to resentments toward those who seem to
have frustrated.
Old Age
710
Currently old age is somewhat arbitrarily considered to start at about
the age of sixty- five, the time when most men retire from an active
burdensome. It is, or should be, a period of surcease from striving and a need
those upon whom he must depend. In some respects there is a reversal of the
diminish.
It is useful to consider three phases of old age even though not all
persons go through them. The elderly person is not greatly changed from
middle life and considers himself capable of taking care of himself and his
him dependent upon others and he is considered senescent. The final phase,
which many are spared, is senility, when the brain is no longer sufficiently
Death is the end of the life cycle and an inevitable outcome that brings
closure to every life story. Because man is aware of this eventuality from an
early age, it profoundly influences how he lives his life. The desire for some
type of continuity into the future is pervasive, but the ways of seeking some
those who have obtained some wisdom in the process of reaching old age,
death often assumes meaning as the proper outcome of life. It is nature’s way
of assuring much life and constant renewal. Times and customs change but
the elderly tire of changing; it is time for others to take over, and the elderly
Panphasic Influences
that are not phasic. Children usually have the same parents throughout the
first decades of their lives, and the parents’ personalities and their ways of
712
relating to each other as well as to the child pervade all phases of the child’s
can affect the individual throughout all developmental stages. Some of these
Bibliography
Benedek, T., “Parenthood as a Developmental Phase: A Contribution to the Libido Theory,” J. Am.
Erikson, E., “Growth and Crises of the ‘Healthy Personality,’ ” Psychol. Issues, Vol. 1, No. 1,
Flavell, J., The Developmental Psychology of Jean Piaget, Van Nostrand, Princeton, N.J., 1963.
Freud, S. (1905), “Three Essays on the Theory of Sexuality,” in Strachey, J. (Ed.), Standard Edition,
Parsons, A., and Milgram, S.), Basic Books, New York, 1958.
Keniston, K., “Youth: A ‘New’ Stage of Life,” Am. Scholar, 39:631-654, 1970.
Parsons, T., “The School Class as a Social System: Some of Its Functions in American Society,” in
Piaget, J., Judgment and Reasoning in the Child (Tr. by Warden, M.), Harcourt Brace, New York,
1928.
_____, The Moral Judgment of the Child (Tr. by Gabain, M.), Free Press, Glencoe, 1948.
Sullivan, H. S. (1946-1947), The Interpersonal Theory of Psychiatry (Ed. Perry, H., and Gawel, M.),
Notes
this book
714
Chapter 11
The Family:
The Developmental Setting
Theodore Lidz
Studies of personality development and maldevelopment have been seriously
impeded by a dearth of understanding of the central role of the family in
directing the developmental process. The critical early stages of the life cycle,
upon which all later development and the stability of the personality rest,
take place in the nidus of the family. The stability and satisfaction of the lives
of most adults depend greatly upon their marital and parental transactions
within their families of procreation. A very large proportion of the work in
his interpersonal relationships and his own evaluation of himself. The various
childhood phases of the life cycle unroll favorably or unfavorably not so much
Because the family is ubiquitous it has, like the air that we breathe, been
very much taken for granted and many of the vital functions it subserves have
been overlooked. Indeed the human being is so constructed that the family is
augmenting his inborn adaptive capacities. Man, after all, is virtually unique
conditions. Many of his critical adaptive techniques are not inborn; he is born
with a unique brain that permits him to acquire language and thereby to
acquire from those who raise him the instrumentalities that his society has
developed for coping with the environment and for living with one another.
which he grows up. The human mechanisms for survival and adaptation are
716
vastly different from those possessed by any other organism, and we can
Everywhere the family must meet two requisites: the biological nature
and needs of man, and the requirements of the particular society in which it
exists and which it subserves by preparing children to live in it. Thus,
wherever families exist they will have certain essential features in common
the needs of a specific society. In this chapter, I shall seek to designate the
essential functions of the family, particularly for childrearing, and the
is the basic social system that mediates between the child’s genetic and
cultural endowments, provides for his physical needs while instilling societal
techniques, and stands between the individual and society, offering a shelter
against the remainder of society. Because the child must remain dependent
whom his well-being is as important as their own. His dependency upon them
and his prolonged attachment to them provide major motivations and
directives for his development. As the family forms the earliest and most
pervasive influence that encompasses the still unformed infant and small
down within the family. These family patterns and the child’s reactions to
them become so thoroughly incorporated in the child that they are difficult to
This difficulty greatly complicates the study of the child’s physical and
personality development. Later influences will modify those of the family, but
they can never undo nor fully reshape these early core experiences.
subserves essential needs of the spouses and of the society. It not only fills a
vital societal need by carrying out the basic enculturation of its children, but
the family also constitutes the fundamental social unit of virtually every
society: it forms a grouping of individuals that the society treats as an entity;
some; and it provides roles, status, motivation, and incentives that affect the
718
family completes and stabilizes the lives of the spouses who formed it. These
three sets of functions of the family—for the society, for the parents, and for
simultaneously fill these three functions without radical change in our social
structure and probably not without grave consequences. It is even highly
separately at all except under very special circumstances, but must be fused
in the family. Nevertheless, these functions can also conflict, and some conflict
can obviously conflict with the needs of both the spouses and children, as
when the husband is taken from the home into military service.
essential to examine briefly why people marry and form new families. Such
when the value of the family is being challenged as part of the broader
questioning of existing institutions and mores. Although people marry for
within his family of origin. Minimally some degree of frustration must occur
because he cannot become a parent with the prerogatives of parenthood and
relationships. Within his natal family, however, he has enjoyed the security of
afforded by a union in which his well-being and needs are again of paramount
importance to another—and in marriage the spouses’ well-being and security
The division of the human species into two sexes has created another
major impetus for marriage. Men and women are drawn together not only by
sexual impulsions but also because the two sexes complement one another in
720
many different ways. Males and females are subjected to gender-linked role
training from earliest childhood, which gives them differing skills and ways of
relating to people and regarding the world even if such differences are
to divide the tasks of living and to complement and complete one another as
In a marriage the husband and wife can assume very differing types of
role relationships and find very diverse ways of achieving reciprocity with
satisfactory than separating. The variant ways in which marital couples live
together are countless. However, when the birth of a child turns a marriage
into a nuclear family, the spouses’ ways of relating to one another must not
only shift to make room for the children, but limits are also set upon how they
can relate to one another if they are also to provide a proper developmental
setting for their children.
influence of other persons and other situations upon the two marital
the characteristics of all true small groups, of which it is the epitome: the
requires each member to give some precedence to the needs of the group
over his own desires; it has a tendency to divide up into dyads that exclude
others from significant relationships and transactions. These and still other
promote the essential unity and to minimize divisive tendencies. The family,
moreover, is a very special type of group with characteristics that are
determined both by the biological differences of its members and also by the
certain requirements.
Generational Differences
722
members of each have different needs, prerogatives, obligations, and
functions in the family. The parents who have grown up in two different
families seek to merge themselves and their backgrounds into a new unit that
satisfies the sexual and emotional needs of both and helps bring completion
to their personalities in a relationship that seeks to be permanent for them.
to take cognizance of an alter ego. Wishes and desires of a spouse that can be
set aside must be differentiated from needs that cannot be neglected.
tasks of living and childrearing. They are properly dependent on one another,
so that the children can develop, serving as guides, educators, and models for
their offspring even when they are unaware of it. As objects of identification
and as basic love objects for their children, how the parents behave and how
they interrelate with one another, and not simply what they do to and for
living and in socialization within the family and are properly dependent upon
their parents for many years, forming intense bonds to them while
developing through assimilation from the parents and the introjection of their
characteristics. Yet the children must so learn to live within the family that
generation.
Gender Differences
makeup and is related to the nurturing of children and the maintenance of the
home needed for that purpose, which has led women to have a particular
Intrafamiliar Bonds
The family relationships are held firm by erotic and affectional bonds.
724
the erogenous gratification from parental figures that properly accompanies
nurturant care must be progressively frustrated lest the bonds to the family
become too firm and prevent the child’s investments of interests, energy, and
The family forms a physical and emotional shelter for its members
within the larger society. However, the family must reflect and transmit the
systems of meanings and logic, its ethos and ethics, to assure that the children
will be able to function when they emerge from the family into the broader
society.
them, set requisites for the parents and for their marital relationship if the
family they form is to provide a suitable setting for the harmonious
development of their offspring and for directing their development into
trauma, or some flaw in maternal nurturance during the early years of his
development. The child requires positive direction and guidance in a suitable
have largely been overlooked because they have been built into the
institutions and customs of all workable societies and particularly into the
family, which has everywhere knowingly or unknowingly carried out the task
of shaping the child’s development. The family fosters and organizes the
child’s development by carrying out a number of interrelated functions,
which I shall consider under the headings of nurture, structure, and enculture.
Nurture
The parental nurturant function must meet the child’s needs and
development. This is the one function of the family that has been specifically
726
recognized by most developmental theories. As it has been the focus of
intensive study, it does not require elaboration here. It concerns the nature of
the nurturance provided from the total care given to the newborn to how the
opportunities for the child to utilize new capacities as they unfold. Proper
becomes a toddler and cannot be fully guarded from the dangers in his
erotized attachment during the oedipal phase. However, unstable parents and
grossly incompatible parents are often disturbing influences throughout all of
the child’s developmental years, and such panphasic influences are often
more significant in establishing personality traits or disturbances in children
usually the primary nurturant figure to the child, particularly when the child
care, her relationship with the child does not transpire in isolation but is
influenced by the total family setting. The mother’s capacity to care for her
her children as well as by her husband’s relationship with each child. The
quality and nature of the nurture that a child receives profoundly influences
his emotional development. It affects his capacities to differentiate from the
mother and the emotional context of his relationships to others; it affects his
properly been paid to the parental nurturant activities and how profoundly
they influence the development of a person; but they are but one aspect of
728
what a child requires from his parents and his family.
Structure
Although the family organization differs from one society to another and with
social class and ethnic group within a society, it seems likely that the family
everywhere follows certain organizational principles both because of its
and tends to provide an area free from conflict into which the immature child
can develop, and directs him or her to grow into the proper gender identity,
which forms the cornerstone of a stable ego identity. While all groups require
unity of leadership, the family contains two leaders—the father and the
the required coalition that permits unity of leadership. We may hazard that in
order for the family to develop a structure that can properly direct the
integration of its offspring, the spouses must form a coalition as parents,
As has been noted, all small groups require unity of leadership, but the
family has a dual leadership. The mother, no matter how subjugated, is the
the support essential for carrying for example, can better delimit her erotic
investment in the small child to maternal feelings when her sexual needs are
being satisfied by her husband. The family is less likely to break up into dyads
that create rivalries and jealousies if the parents form a unity in relating to
their children; and, particularly, a child’s tendency to possess one or the other
parent for himself alone—the essence of the oedipal situation—is more
readily overcome if the parental coalition is firm and the child’s egocentric
fantasies are frustrated and redirected to the reality that requires repression
married couple, then the child, who is provided with adult models that treat
one another as alter egos, each striving for the partner’s satisfaction as well as
for his own, is very likely to grow up valuing marriage as an institution that
730
The child properly requires two parents: a parent of the same sex, with
whom he can identify and who forms an object of identification to follow into
adulthood, and a parent of the opposite sex, who serves as a basic love object
and whose love and approval is sought by identifying with the parent of the
same sex. However, a parent fills neither role effectively for a child if
their children despite marital discord and to some extent even despite
separation; they can agree about how children should be raised and support
their spouses to the children as worthwhile persons and as good parents even
the other parent or in seeking to bridge the gap between them, rather than
utilizing his energies for his own development. Sometimes the child becomes
a scapegoat with his problems magnified into the major source of dissent
between the parents, and he comes to feel responsible for their difficulties. A
child may willingly oblige and assume the role of villain in order to mask the
parental discord, thereby retaining the two parents he needs. The child may
also be caught in an impossible situation in which any attempt to please one
achieve a coalition, there are many ways in which the child becomes subject
The division of the nuclear family into two generations lessens the
danger of role conflict and furnishes space free from competition with a
parent into which the child can develop. The generational division is a major
factor in providing structure to the family. The parents are the nurturing and
dependency to be able to utilize his energies in his own development, and his
personality becomes stunted if he must emotionally support the parents he
parents than between parent and child. However, the situation is complicated
properly exists between the mother and each preoedipal child and by the
slow differentiation of the child from his original symbiotic union with his
mother. The generational division aids both mother and child to overcome
the bond, as is essential to enable the child to find a proper place as a boy or
girl member of the family and then to invest his energies in peer groups and
732
schooling, as well as in gaining his own identity. The generation boundaries
can be breached by the parents in various ways, such as by the mother failing
to establish boundaries between herself and a son; by the parent using a child
other, the child can seek to widen the gap between his parents and insert
himself into it; and by finding an essential place in completing a parent’s life
completion. The resolution of the oedipal situation thus depends for its
proper completion upon having a family in which the parents are primarily
reliant upon one another or at least upon other adults. Further, if a parent
feels excluded by a child, the child’s fears of retribution and retaliation may
not be simply projections of his own wishes to be rid of a parent, but may
together with the ensuing role conflicts can distort the child’s development in
a variety of ways, some of which have already been indicated. The child’s
proper place within the family is invaded; rivalry with parents absorbs
completing the life of another rather than with his own development.
stable ego identity; and of all factors entering into the formation of
Confusions concerning sexual identity and dissatisfactions with one’s sex can
contribute to the etiology of many neuroses and character disorders as well
linked attributes simply by being born a boy or girl, but through gender role
allocation that starts at birth and then develops through role assumptions
the parents’ sex-linked roles obviously distort the child’s development, either
when they are in the sexual sphere, as when a parent is overtly homosexual,
or when they concern the divisions of tasks in maintaining the family. While it
734
is clear that a child whose father performs the mothering functions, both
tangibly and emotionally, while the mother supports the family will usually
family. As Parsons and Bales have pointed out, a cold and unyielding mother
is more deleterious than a cold and unyielding father, whereas a weak and
ineffectual father is more damaging than a weak and ineffectual mother." Still
father may be more deleterious to a son who must overcome his initial
identification with his mother, as well as his early dependency upon her, to
gain security in his ability to provide for a wife and family. Although the
The child’s identification with the parent of the same sex is likely to be
seriously impeded when this parent is unacceptable to the other whose love
learn that masculinity will evoke rebuff from her, and fears of engulfment or
castration by the mother become more realistic sources of anxiety than fears
of retaliatory rejection or castration by the father.
secure gender identity, such as when parents convey the wish that the boy
had been born a girl or vice versa, or the need to avoid incestuous
The relationship between the family structure and the integration of the
security of sexual identity, the transition through the oedipal phase, the
736
parents can form an adequate coalition, maintain proper boundaries between
the generations, and provide appropriate gender role models by their
behavior, conflicts and role distortions will interfere with the proper
The proper enculturation of the child within the family may be more
how the child learns basic roles and institutions through interactions
The form and function of the family evolves with the culture and
subserves the needs of the society of which it is a subsystem. The family is the
first social system that the child knows, and simply by living in it he properly
gains familiarity with the basic roles as they are carried out in the society in
which he happens to live: the roles of parents and child, of boy and girl, of
man and woman, of husband and wife. He also learns how these roles of the
family members interact with the broader society. Whereas roles are
The child also learns from his intrafamilial experiences about a variety
marriage, economic exchange, and so forth; and societal values are inculcated
acceptable and unacceptable means of achieving such goals. Within the family
role definitions, and patterns of interrelationship enter into the child through
the family behavior far more than through what he is taught or even what the
738
parents consciously appreciate.
techniques to its offspring and must rely upon schools and other specialized
and games, as well as many less tangible matters such as status hierarchies,
religious beliefs, ethical values and behavior that are accepted as divine
commands or axiomatically as the only proper way of doing things and are
in the inculcation of both techniques and values because the totality of the
enculturation process depends so greatly upon it. After the first year of life
greater or lesser extent upon language; and the collaborative interaction with
others, which is so critical to human adaptation, depends upon the use of a
shared system of meanings. Indeed, the capacity to direct the self, to have any
ego functioning at all, depends upon having verbal symbols with which one
irrevocable action. As virtually all intact children learn to speak, we are apt to
foundation in the language of the culture is among the most crucial tasks
carried out by the family.
vagueness, in accord with how effectively and consistently the proper usage
of words gains objectives for the child. The process depends upon reciprocal
interaction between the child and his tutors, the consistency among his
teachers, the cues they provide, the words to which they respond or remain
Many other factors are also involved in the child’s attainment of language, but
it is clear that the family plays a very important part in the process. The
740
categorizing of experiences through the abstraction of common attributes, the
by grasping the critical attributes designated by the word are essential for
capable of surviving are relatively limited, but every viable society develops a
set of instrumental techniques and institutions that take the infant’s essential
needs into account and modify the environment to the child’s capacities.
Then, very largely through the use of language, the child learns the culture’s
drive impulsions. Further, the world in which he lives, the behavior of others,
and his own needs gain some degree of order and predictability through the
we begin to note that the parents of such persons are usually obsessional
themselves, unable to tolerate direct expressions of hostility in themselves or
in their children. They are very likely to teach the use of isolation, undoing,
their children.
Such obsessional parents are likely to use rigid bowel training and to
limit the young child’s autonomy and thus foster ambivalence, stubbornness,
shame, and undoing defenses in many ways other than simply through the
way they direct the child’s bowel training.
Conclusions
742
Personality development cannot be properly studied or understood
abstracted from the family matrix in which it takes place. The major foci of
guided by the dynamic organization of his family, which channels his drives
and directs him into proper gender and generation roles. The child must grow
into and internalize the institutions and roles of the society as well as identify
with persons who themselves have assimilated the culture. The child acquires
and through finding reciprocal roles with them. His appreciation of the worth
and meaning of both social roles and institutions is markedly affected by the
manner in which his parents fill their roles, relate to one another, and behave
in other contexts. The perceived reliability of the verbal tools that are
necessary for collaboration with others and for thinking and self-direction
depend greatly upon the tutelage within the family and on the parents’ styles
emphasis upon what parents should or should not do to the child, for the
child, and with the child in each phase of his development has often led to
neglect of other more significant familial influences. Who the parents are;
how they behave and communicate; how they relate to one another as well as
Bibliography
Bateson, G., Jackson, D., Haley, J., and Weakland, J., “Toward a Theory of Schizophrenia,” Behav.
Hartmann, H. (1939), Ego Psychology and the Problem of Adaptation, International Universities
Lidz, T., The Family and Human Adaptation, International Universities Press, New York, 1963.
Lidz, T., Cornelison, A., Terry, D., and Fleck, S., “The Transmission of Irrationality,” in Lidz, T.,
Fleck, S., and Cornelison, A., Schizophrenia and the Family, International
744
Parsons, T., and Bales, B., Family, Socialization and Interaction Process, Free Press, Glencoe, 1955.
Sapir, E., Selected Writings of Edward Sapir in Language, Culture and Personality, University of
Singer, M., and Wynne, L., “Thought Disorder and Family Relations of Schizophrenics: III.
_____, and _____, “Thought Disorder and Family Relations of Schizophrenics: IV. Results and
Whorf, B., Language, Thought, and Reality: Selected Writings of Benjamin Lee Whorf (Ed. by
Carroll, J.), M.I.T. and J. Wiley & Sons, New York, 1956.
Wynne, L., and Singer, M., “Thought Disorder and Family Relations of Schizophrenics: I. A
_____, and _____, “Thought Disorder and Family Relations of Schizophrenics: II. A Classification of
Infant Development
David E. Schecter
considerations, especially with the realization that the needs of child, youth,
and childrearing structures (the daycare center, the kibbutz, the commune), it
is more important than ever to understand the nature of the infant and his
tube. For practical purposes we will assume that the family—or a variant
thereof—is still viable and still a rather universal matrix in which children are
746
broken down to varying degree in the Western nuclear family, with an
ensuing search for new forms of childrearing that may be adaptive to a
problems connected with child and adolescent rearing, with life style, and
with basic value orientation.
wide range of adaptability, the issues of “health” and adaptation are closely
there are many routes toward this behavioral end. One end of the spectrum
would rely on providing a milieu that encourages self-control by example and
encouragement as well as by a clear setting of limits; the other direction
shaming. Although the surface behaviors in each instance may have a similar
caretakers who have a high stake in the infant’s growth and development.
Traditionally the family has been entrusted with the functions of fostering the
child’s biological, social, and cultural development. This implies that from the
the parents.
748
intense inner struggle to establish his—or her—own sense of identity.
Simultaneously a need develops for a relatively enduring, intimate
ego boundaries. The latter is experienced not only during sexual excitement
and orgasm but in the not infrequent expectation that the one partner have
identical wishes, tastes, and values as the other. With the relative sense of
for the cyclical moving toward and away from one another in any intimate
relationship.
can potentially come to signify an intrusion into the new unit. At the very
least, even when the pregnancy and newborn are consciously and
new homeostasis in the new family unit. The- capacity for the dyad to grow
into a relatively harmonious triad is one of the essential developmental tasks
pregnancy and infancy set up new strains in both parents. Aside from the
have studied in weekly observation for the first two years of life, we have
being excluded.[3]
settings, one would suspect that there may be a widespread incidence of new
families suffering in a quiet spirit of desperation. [4]
750
whole other side to the Oedipus-type myths that Freud did not emphasize.
This perspective involves predictions that the newborn (son) would preempt
and perhaps kill the father of the new family. This prophecy of the Delphic
kingdom.[5]
The observations that a father may feel that his wife has “the inside
track” with their son and that the mother feels despairing about her lack of
abundance to provide for both child and husband should not obscure the fact
that these conflicts are often resolved in a positive direction; the couple
transcends its former structure to make room for—and, indeed, feel enriched
by—the common pleasures and tasks involved in the child’s growth. With this
in which one’s potency and surplus vitality is expressed in the sharing of the
care and concern for another whose importance is experienced as at least
The many variables that are involved in the adequate growth of a family
respond to. The work of Bridger, Birns, Chess, Thomas, et al., and Escalona
parents will evaluate the infant’s progress and their own worth and
“goodness” as parents.[6]
the intensity of parental expectation and hope for their infant’s achievements
in accordance with a kind of idealized developmental schedule. If one of these
goals—for example, to be independent, to play by himself, to reach and grasp
mounting family tensions, whose origins the parents would soon become
unaware of in the complex mesh of secondary interpersonal stress. We
observed a two-month-old infant with colic shrieking for relief, but when his
mother carried him “too long” in order to soothe him she was accused by her
husband— and eventually accused herself—of “spoiling” the child. The fear of
spoiling the infant proved quite prominent in a number of parents and was
one of the sources of doubt and dulling of spontaneity in the parents’
752
attitudes toward their child. Behind the issue of spoiling is a fear of inducing
old infant was spanked by her father because she “refused” to go to sleep; on
another occasion, using unfamiliar strident vocal tones and threatening facial
gestures, her mother severely reprimanded her when the infant’s protruding
withhold bodily contact with the baby by propping the bottle during most
feedings. We must emphasize that although these were not the most sensitive
of parents, they were also not too unrepresentative in many respects of what
we saw in lower-class and lower-middle-class homes.[8]
readiness for certain masteries. Spock has written about how critical the
period of five to six months is for the development of increasing autonomy
and self-reliance through the potential mastery of cup feeding at this time.
much earlier than the classic autonomy phase usually ascribed to the infant in
his second and third year of life. Even though we were impressed with the
754
toward an optimal balance of interdependence and autonomy.
Of all the developments in the first year of life, that of the human bond
between the infant and his caretaker—or caretakers—is probably the most
fateful for his future life. We have presumed that the unfolding of the child’s
the first social relationships. I have avoided the use of the word “mother”
here, lest we assume that it is only with one’s actual mother that the primary
social bonds can be formed. Originally psychological, including
There are several types of theories concerning the process by which the
child becomes socially related. One type is concerned with the formation of
anaclitic in its nature since it “leaned on” what he then referred to as the self-
preservative ego instincts. The object of the sucking drive was seen as the
breast—the social bond to mother being developed largely through the
seeking tendency in the infant from the time of birth. Bowlby postulates
visual and locomotor), crying, and smiling. Bowlby himself stresses that his
theoretical model was intended to retain but update Freud’s original schema
756
responses at different developmental stages. The controversy that has ensued
impossible to separate out the primarily innate from the experiential since
early infantile experience tends to become organized and patterned, and
Nevertheless, this does not rule out the fact that certain maturations must
occur before certain kinds of experience can be undergone and organized by
the infant. Many ethologists have largely abandoned the idea of an entirely
That the oral and feeding experience of the infant constitutes one of the
important basic roots of social attachment is not in question. However,
historically, because of the obvious power of the sucking drive and its crucial
connection with satisfaction of hunger and with survival itself, it was seen as
example, that mothers who respond to their child’s cry and discomfort almost
exclusively by offering the breast or the bottle condition their infants in such
a way that oral craving is experienced and oral satisfaction may be more
usually sought out when distress is felt.[11]
758
than feeding as an antecedent to social attachment, I believe this is a false
kind of distinction because this type of competitive choice between these two
intensity of oral drive and the pleasure experienced in close physical contact
authors concluded that the noncuddlers were not suffering primarily from
four day olds; Fantz described more prolonged visual fixation upon more
complex visual patterns as against simpler ones in the early days and weeks
of infancy.
with scrambled features in infants from one to six months. Spitz and Ahrens
in separate, very detailed analyses were able to demonstrate that the infant
two eyes and later becoming more differentiated to include the mouth. A
that as early as the third week in the infant’s life the specifically human
stimulus of a high-pitched voice elicits a smile more consistently than any
other stimulus at that time. The voice also served to reduce the infant’s
760
nodding face, with accompanying musical vocalizations—that is, with the
cumulative potency of various modalities.
equipped innately with the capacity for a smiling response, a capacity that is
social traumata and deprivation of varying degree, nature and culture seem to
guarantee reciprocal responsiveness by the fact that healthy adults, especially
By five to seven months the infant who is being enjoyed by his parents
spends a good part of his day in social interactions involving mutual regard,
By the end of the first half year of life, mother and infant have developed
excite him to the point of painful stress. Some of the variables involved in a
systematic study of the patterns of reciprocity include: the infant’s and
mother’s sensitivity and activity levels, their initiatory tendencies, mother’s
762
need to dominate rather than facilitate her infant, the nature of her
personification of her infant (is he to be docile or actively initiatory), mother’s
anxiety level, her fear of “spoiling” the child through play, and so on. A
The maternal variables are stressed here for the moment, since social
based needs (hunger, cold, sleep). She functions as a protector from excessive
hungry, cold, wet, or in pain. With this realization develops a new sense of
“social potency” and trust that is qualitatively different from urgent need
tension relief. The child can now obtain not only reduction of tension but also
absorption of the two partners—a kind of sacred ritual that one dare not
with the infant, the latter gains a new degree of human status, now being
perceived as a psychological and social as well as physiological being. At the
same time a new kind of parental pride appears; the mother’s self-esteem is
validated by her feeling that she has succeeded in helping her baby become
socially human. It is at this point in development that fathers—often for the
In this sense we can see that mutual playfulness is a model of freedom and
764
response, the child is freed to “be alone in the presence of mother,” as
Winnicott states it, a phase that prepares him for separations from mother’s
physical presence for longer periods without undue anxiety. This is a crucial
one of the first qualities of a relationship to fall away is playfulness since this
quality of parenting but also the individual characteristics of the infant that
reactions and from them draw inferences about qualities and levels of social
group—may be operating at a given time and also at what level a person may
have been arrested in his development. Such knowledge will allow for a
reconstructive viewpoint in attempts at individual and social change. If we
know there tends to be a relatively invariant sequence of stages A, B, C, D in
modeled largely on the issue of conflict, without too much regard for the
structural elements of personality that are needed for a certain level of
interpersonal behavior and conflict. For a person who has not achieved the
capacity for close specific social attachment in infancy, one would not expect
to find the higher level oedipal-type conflicts that already presume a capacity
766
for specific social attachment.
infancy.
768
had developed this relationship of confidence to the mother
by age three months and 56 per cent at age six months. (His
study did not go beyond eight months.) Yarrow concluded
that the development of confidence in the mother is not
simply a maturationally determined development, but
undoubtedly influenced by many environmental as well as
idiosyncratic factors, including the patterns of maternal care,
“such as the depth of the relationship, the consistency with
which mother responds to the child as well as the general
level of predictability of the environment based on recurring
and predictable sequences of gratification.”
that would indicate the mother is represented mentally and invested with
intense affect.[21]
The child, for example, will call for his mother by whatever “call sounds”
he has developed to summon her to himself; when she is absent he will
verbally refer to her or to her possessions and he will miss her grievingly.
Even nonverbally, his beginning dramatic play indicates that he is developing
the capacity to mentally represent himself and mother in a mobile symbolic
act—for instance, when he places a doll to sleep during a play sequence. His
mental operations have progressed beyond immediate imitation to what
Piaget calls deferred imitation, and then to the formation of more lasting
identifications with the mother. Evidence for these identifications are
(Schecter).
During the second year of life, the child’s very special relationship to the
mother, in a nuclear family, becomes increasingly complex and elaborated.
The child shares his inner and outer world with his mother, verbalizing
fantasies and fears, bringing her objects, naming them, and expecting an
770
affirming response from her. Even as the child increasingly individuates, he
becomes capable of sharing a rather private world—a shared “mythology”—
in the sense that there are idiosyncratic words for special objects; there are
verbal, musical, that is, play involving almost every modality. This is probably
multiple child caretakers—that a single person is not necessarily the first step
the possibility that intensive early mothering may have been a prerequisite to
the broadening of specific attachment. In most cases (62 per cent) fathers
were found to be specific objects of social attachment after the onset of the
phase of specific attachment. In fact, for 4 per cent of the infants in their
sample, the father was the only specific object of attachment at seven months.
intense attachment being shown to the principal object person, who is not
772
Origins of Infantile Anxiety
Rank’s idea of the birth trauma in a far more sophisticated form, it is still
of life adds a new variable both to the predisposition and to the idea of actual
infancy that it may be more fruitful to describe the various critical periods of
its development— leaving open the theoretical question of what constitutes
mothering in protecting the infant from this new source of stimulation might
contribute to the subsequent predisposition to anxiety. The relatively
undifferentiated negative affect expressed upon being left alone can be seen
crucial familiar element. We have noted, for example, that some infants
respond with a look of apprehension at the appearance of a smiling, nodding
the facial gestalt, such as the placing of pads over the eyes, the forbidding
to have particular significance for the infant; this fits with Wolff’s observation
that the infant tends to search out the eye area and make eye-to-eye contact
774
before smiling at the presentation of a face.[26] These signs of increasing
separation anxiety, namely, the fear of object loss. Benjamin found that
although stranger and separation anxieties are related dynamically and even
anxiety can occur whether or not the mother is present, whereas separation
reactions occur in the absence of the mother whether or not anyone else is
present. Moreover, the average and peak time of onset are different for each
Aside from its own intrinsic significance, this description of the reaction
Various observers have noted, for example, that a baby would suffer feeding
disturbances when fed by mothers who were high-strung and excitable while
accepting the same formula from another feeder. It is our hypothesis that
familiar and strange by her infant. We assume that from his very early
discriminations of familiar persons as well as from familiar ways of being
handled the baby comes to learn and anticipate behavioral signs connected
with “good mothering.” These signs probably include cues from all the
various sense modalities. When the mother is anxious her facial configuration
strident, her handling becomes less graceful and smooth, and it is conceivable
that there may be olfactory- sensitive changes in her odors as well. We
776
ridden no’s. At such times parents become aware of a momentous change in
anxiety in clashing with the child’s real or imagined “will.” Sullivan and other
analysts suggest that “good” and “bad” feeling experiences become organized
most powerful means through which socialization may then take place.
available for exploration. Aside from the practical aspects involved in this
function, the parent mediates for her child the new and strange objects,
sounds, and people in the environment. We see the origins of what might be
called the “magical blessing” when mother, for example, allays the child’s fear
of receiving and exploring a new toy from a stranger by simply handling the
toy and offering it to the child herself. One has the impression that by such
the environment. She does this, in part, by helping the child cope with the
frighteningly strange aspects of his world in ways that allow them to be
778
attachment behavior toward her—as if the child had selectively lost interest
in the mother. If there is a series of losses of mothering figures, the child will
commit himself less and less to each succeeding figure and will develop
widespread human crises of our time since the relation between such defects
From the work of Spitz, Bowlby, and more recently Tennes and Lampl,
who is disappearing through the door. When active attempts at mastery arc
overt separation, one can postulate the importance of these reaction patterns
can occur when a mothering figure is physically present but not adequately
stimulating or responsive.[31]
available. Even though human development does not seem to proceed in the
rather rigidly defined “critical periods” seen in various other animals,
nevertheless, there would seem to be optimal periods during which certain
experiences are most productive to the cognitive and social-affective
780
The direction of psychic development in infancy is from symbiotic
higher level of reciprocity. There are signs of a dawning sense of self in the
first year of life as the infant remembers and anticipates experience and
comes to discriminate his self, his mother, and others. As maturation and
strivings. It is through decision making, goal setting, and goal mastery that the
age. By this time the infant has begun to share his experience with his parents
who are—if all is going well—delighted with his humanoid capacities to walk,
talk, and begin to communicate his needs and experience.
groundwork for shame and doubt. The infant and toddler becomes all too
aware that a socially disapproved act will bring a disapproving signal or more
subtly, but not less potently, a withdrawal of parental behaviors that have the
power to reduce anxiety and induce security. In the child’s new stage of
becomes crucial that his induction into the social world proceed with a net
balance allowing for zestful enjoyment of activity, mastery, autonomy, and
Bibliography
599-633, 1954.
Ainsworth, M., et al., “Deprivation of Maternal Care: A Reassessment of Its Effects,” Public Health
Aldrich, R., “Preface,” in Hellmuth, J. (Ed.), The Exceptional Infant, Vol. 1, Brunner/Mazel, New
York, 1967.
782
Balint, M., Primary Love and Psychoanalytic Technique, Liveright, New York, 1953.
Barsch, R., “The Infant Curriculum—A Concept for Tomorrow,” cites Casler, L., “The Study of the
York, 1967.
_____, “The Innate and the Experiential in Development,” in Brosin, H. (Ed.), Lectures in
_____, “Some Developmental Observations Relating to the Theory of Anxiety,” J. Am. Psychoanal.
A.,9:652-668, 1961.
Bettelheim, B., The Children of the Dream, Macmillan, New York, 1969.
Birch, H., “Malnutrition and Early Development,” in Grotberg, E. (Ed.), Day Care: Resources for
_____, and Gussow, J., Disadvantaged Children: Health, Nutrition and School Failure, Harcourt
Birns, B., “Individual Differences in Human Neonates’ Responses to Stimulation,” Child Dev.,
36:249-256, 1965.
Blanck, R., and Blanck, G., Marriage and Personal Development, Columbia University Press, New
York, 1968.
Bowlby, J., Attachment and Loss, Vol. 1, Basic Books, New York, 1969.
_____, “Grief and Mourning in Infancy and Early Childhood,” in The Psychoanalytic Study of the
_____, Maternal Care and Mental Health, 2nd ed., Monograph Series No. 2, WorldHealth
_____, “The Nature of the Child’s Tie to His Mother,” lnternat. J. Psychoanal., 39: 35:373, 1958.
Bridger, W., Birns, B., and Blank, M., “A Comparison of Behavior Ratings and Heart Rate
Brody, S., Patterns of Mothering, International Universities Press, New York, 1956.
_____, and Axelrad, S., Anxiety and Ego Formation in Infancy, International Universities Press, New
York, 1970.
784
Bruch, H., and Touraine, G., “Obesity in Childhood: The Family Frame of Obese Children,”
Caldwell, B., “The Effects of Infant Care,” in Hoffman, M., and Hoffman, L. (Eds.), Child
Development Research, pp. 9-89, Russell Sage Foundation, New York, 1964.
Chess, S., Thomas, A., Birch, H., et al., Behavioral Individuality in Early Childhood, New York
Coleman, R., Kris, E., and Provence, S., “The Study of Variations of Early Parental Attitudes,” in The
Psychoanalytic Study of the Child, Vol. 8, International Universities Press, New York,
1953.
Deutsch, M., et al., The Disadvantaged Child, Basic Books, New York, 1967.
_____, “Identity and the Life Cycle,” Psychol. Issues, 1:1, 1959.
Escalona, S., “Emotional Development in the First Year of Life,” in Senn, M. (Ed.), Problems of
Infancy and Childhood, Josiah Macy, Jr., Foundation, New York, 1953.
_____, “Feeding Disturbances in Very Young Children,” Am. J. Orthopsychiat., 15:76, 1945.
_____, “Patterns of Infantile Experience and the Developmental Process,” in The Psychoanalytic
Fantz, R., “The Origin of Form Perception,” Scientific American, 204:66-72, 1961.
Fraiberg., S., “Libidinal Object Constancy and Mental Representation,” in The Psychoanalytic Study
of the Child, Vol. 24, International University Press, New York, 1969.
Edition, Complete Psychological Works, Vol. 29, p. 169, Hogarth, London, 1964.
_____(1905), “Three Essays on the Theory of Sexuality,” in Strachey, J. (Ed.), Standard Edition, Vol.
Fromm, E., The Forgotten Language, pp. 196-231, Rinehart, New York, 1951.
Galenson, E., “A Consideration of the Nature of Thought in Childhood Play,” in McDevitt, J., and
786
Goldfarb, W., “Variations in Adolescent Adjustment of Institutionally-Reared Children,” Am. J.
Greenacre, P., “The Biological Economy of Birth,” in The Psychoanalytic Study of the Child, Vol. 1,
Kleeman, J., “The Peek-a-Boo Game,” inThe Psychoanalytic Study of the Child, Vol. 22, International
Levy, R., “Tahiti, Sin and the Question of the Integration between Personality and Sociocultural
Lichtenberc,, P., and Norton, D., “Cognitive and Mental Development in the First Five Years of
Life,” pp. 83-98, National Clearinghouse for Mental Health Information, Maryland,
1970.
Mahler, M., On Human Symbiosis and the Vicissitudes of Individuation, International Universities
_____, “On the Significance of the Normal Separation Individuation Phase,” in Schur, M. (Ed.),
Drives, Affects, Behavior, Vol. 2, pp. 161-169, International Universities Press, New
York, 1965.
Mason, W., “Early Social Deprivation in the Non-Human Primates: Implications for Human
Mead, M., “A Cultural Anthropologist’s Approach to Maternal Deprivation,” in Ainsworth, M., et al.
Moss, H., “Sex, Age and State as Determinants of Mother-Infant Interaction,” in Chess, S., and
Thomas, A. (Eds.), Annual Progress in Child Psychiatry and Child Development, pp.
Murdock, G., “The Universality of the Nuclear Family,” in Bell, N., and Vogel, E. (Eds.), A Modern
Murphy, L., The Widening World of Childhood, Basic Books, New York, 1962.
Nagera, H., Early Childhood Disturbances, The Infantile Neurosis and the Adult
788
Disturbances,International Universities Press, New York, 1966.
Piaget, J., The Construction of Reality in the Child, Basic Books, New York, 1959.
_____, Play, Dreams and Imitation in Childhood, Routledge Kegan Paul, London, 1962.
Pines, M., “Infants Are Smarter than Anybody Thinks (A Report on Some of the Work of Jerome
Bruner, Harvard University Center for Cognitive Studies),” New York Times
Provence, S., and Lipton, R., Infants in Institutions: A Comparison of Their Development with Family
Reared Infants during the First Year of Life, International Universities Press, New
York, 1952.
Prugii, D., and Harlow, R., “Masked Deprivation,” in Ainsworth, M., et al. (Eds.), Deprivation of
1962.
Rheingold, H., “The Modification of Social Responsiveness in Institutional Babies,” Monog. Soc.
_____, Gewirtz, J., and Ross, W., “Social Conditioning of Vocalizations in the Infant,” J. Comp. Physiol.
Thomas, A. (Eds.), Annual Progress in Child Psychiatry and Child Development, pp.
Schachtel, E., Metamorphosis, pp. 48-49, Basic Books, New York, 1959.
Schaffer, H., and Emerson, P., “The Development of Social Attachments in Infancy,” Monog. Soc.
_____, and _____, “Patterns of Response to Physical Contact in Early Human Development,” J. Child
Schecter, D., “Identification and Individuation,” J. Am. Psychoanal. A., 16:48-80, 1968.
_____, “The Oedipus Complex: Considerations of Ego Development and Parental Interaction,”
_____, and Corman, H., “Some Early Developments in Parent-Child Interaction,” 1971 (unpublished
mss.).
790
Schneirla, T., and Rosenblatt, J., “Behavioral Organization and Genesis of the Social Bond in
Spitz, R., The First Year of Life, International Universities Press, New York, 1965.
_____, “Hospitalism: A Follow-up Report,” in The Psychoanalytic Study of the Child, Vol. 2, p. 113,
_____, “An Inquiry into the Genesis of Psychiatric Conditions in Early Childhood,” in The
Psychoanalytic Study of the Child, Vol. 1, International Universities Press, New York,
1945.
_____, No and Yes, p. 54, International Universities Press, New York, 1957.
_____, “The Smiling Response: A Contribution to the Ontogenesis of Social Relations,” Genet.
Spock, B., “The Striving for Autonomy and Regressive Object Relationships,” in The Psychoanalytic
Study of the Child, Vol. 18, International Universities Press, New York, 1963.
between a Mother and Her 3 ½ Month-Old Twins,” J. Am. Acad. Child Psychiat.,
Sullivan, H., The Interpersonal Theory of Psychiatry, Norton, New York, 1953.
Tauber, E., and Koffler, P., “Optomotor Response in Human Infants to Apparent Motion: Evidence
Tennes, K., and Lampl, E., “Defensive Reactions to Infantile Separation Anxiety,” J. Am. Psychoanal.
A.,27:1142-1162. 1969.
Weisberg, P., “Social and Non-Social Conditioning of Infant Vocalizations,” J. Child Dev., 34:377-
388, 1963.
Winnicott, D. (1958), “The Capacity to Be Alone,” in Winnicott, D., The Maturational Processes and
Wolff, P., “Observations on the Early Development of Smiling,” in Foss, B. (Ed.), Determinants of
_____, and White, B., “Visual Pursuit and Attention in Young Infants,” ]. Child Psychiat., 4, 1965.
Yarrow, L., “The Development of Focused Relationships during Infancy,” in Hellmuth, J. (Ed.), The
792
Notes
[2] For discussions of parenthood that include developmental and intergenerational points of view, see
[3] The observations referred to above have been written up in an unpublished manuscript, “Some
“Studies in Ego Development” at the Albert Einstein College of Medicine (New York) and
was made possible by Grant #HD 01155-01 provided by the National Institute of Child
[4] The public health possibilities in helping newly developing families are enormous, although
complex. One can imagine parent and child caretaker groups being formed under skilled
leadership on a widespread basis with the function of helping parents with problems
that have been considered unique, unshareable, and taboo. If we can further develop the
professional knowledge and skills in this area of family development, such feelings can
emerge step by step from considerations of the practical matters of infant rearing to the
[5] We presume that common myths are part dramatization and part “answer” to certain universal
human concerns. Although Laius’s action can be linked to his jealous, “immature,”
authoritarian character, there is yet another side to his mythic action that functions as a
cultural expression of the incest taboo. In ontogenetic terms this taboo expresses the
This type of analysis of the Oedipus myth reveals another motive for Oedipus’s
death wish, namely, one of revenge against the father authority whose son’s growth was
viewed as an unpardonable threat to the father’s exclusive power and possessions. For a
further discussion of the “triangular” parental affects in the preoedipal phase, see
Fromm's presentation of the issue of authority in the oedipal complex and my own
[6] There is more than analogy to the above model in the major transference elements that are brought
into the psychotherapeutic situation. The therapist is frequently cast in the role of magic
helper by the patient, but he has also been cast into this role—in varying degree—by his
mutual needs between therapist and patient constitute a major part of the work of
family development in infancy, we will see that there is probably not a single dimension
some depth. Hence an understanding of infancy and its salient developmental issues
[7] The whole problem of child abuse (including the “battered child syndrome”) can only be mentioned
here. The rage leading to violence has been connected by the attacking parents to the
inability—as they perceive it—to bend the will of the child to obedience. It is not only the
794
child’s actual autonomous, defiant, or negativistic behavior that provokes attack but
and defiant.
[8] We had less opportunity to observe upper- middle-class and upper-class families.
[9] Coleman, Kris, and Provence have described in some detail how parental attitudes and unconscious
fantasies are continuously influenced by the child’s growth and development. More
recent research, for example, Moss, has been even more specific about the fact that
different variables such as sex, age, and “state” contribute to the shaping of maternal
response.
[10] See R. Levy’s exposition of the proposition of the inevitability of guilt provocation in Western
cultures, which are constantly aspiring to new standards, thus making it very unclear
[11] Psychoanalysis has systematized the positive and negative oral character traits that presumably
derive from the period of infancy. Oral optimism is seen as a consequence of having been
adequately gratified in this area. On the other hand, such traits as excessive longing and a
compulsive need for acquisition and intake of various kinds have been seen as
consequences of either overly or underly gratified oral experience. There are as yet no
to indicate whether there is a definite relationship between oral patterning and such
smoking.
alter their rate of sucking (for example, to suck in longer bursts “to produce” a clearer
focus in a projected picture). Moreover, by reversing the conditions the infant can even
learn to desist from sucking on his nipple in order to obtain a consequently clearer
picture. This kind of work is indicative of the tremendous range of learning that begins to
take place in the early weeks of life—even in an area as “drive-oriented” as the oral zone.
[12] This is the kind of individual difference that is most important to psychiatry and psychotherapy
because we tend to assume that people have more or less the same degree and quality of
need in various modalities, be they oral or contact stimulation. The fact of individual
the formation and maintenance of the social bond throughout the life cycle. Witness the
individual alienation—in the encounter group phenomena and the “human potential
movement.”
[13] D. Stern discovered through a film microanalysis that by the age of three months stable patterns of
eye-to-eye contact and eye aversion between mother and infant have already been
developed and tend to remain stable for a number of months thereafter. If this work is
validated, the implications seem far-reaching for the understanding of the patterning of
better understood through the microsignaling visual “ballet” that Stern describes as
occurring between mother and child. More speculatively, patterns of visual aversion may
796
also constitute one of the first anlagen of later classical ego defenses, including denial
and possibly repression. Stern’s later work appeared after this chapter was written.
[14] Several workers have experimentally demonstrated that one can reinforce the infant’s smiling
response by responding to his smile with a smile, or tend to extinguish the smile by
failing to respond to it. Rheingold and Weisberg similarly demonstrated that an infants
[15] See the classic studies of Spitz, Bowlby, Goldfarb, and the more recent observations of Provence
[16] See Kleeman’s excellent description and analysis of this particular form of play. Kleeman does not
reduce peekaboo to the mastery of separation anxiety or to tension reduction, but sees it
also in its own right as a “form of interaction, play, a social game pleasurable to infant
and adult.” This kind of playful interpersonal exchange can often take precedence over
[17] We suggest the hypothesis that with deprivation of relatively enduring reciprocal social
relationships, including playfulness, children and adults will appeal for response by re-
creating and communicating the urgent need tensions that had been successful in
bringing about a response. Hence, hunger, pain, and later in life various expressions of
activity can be understood, at least in part, as an appeal for responsiveness that has hail
the formation of culture. I have elaborated on the theme of social playfulness elsewhere,
stressing the quality of lack of immediate purposiveness, which frees the partners to
improvise and explore new forms of action, symbolism, and relatedness. The structural
development of play in infancy has been studied by Piaget, and more recently a
[19] A fuller discussion of “masked deprivation” is included in the section of this chapter titled
[20] The criterion used by these authors to assess the level of achievement of specific social
attachment to the mother was that of protest upon separation from her. The assumption
here was that the infant had a need for proximity, at least on a visual level; when he
suffered a cutoff of such visual contact, he expressed his protest in affecto-motor sounds
[21] Reconstructive data derived from psychiatric and psychoanalytic histories indicate that the
mental health. Whether there is a “critical period” for its achievement and whether there
is the possibility for compensation are discussed under the topic “Separation and
Individuation.” Many psychiatric disturbances are associated with the failure to develop
Sullivan refers to them—derive in large part from a failure to achieve a level of object
798
constancy with one or more significant persons early in life, for a complex variety of
reasons. The achievement of object constancy can be unstable and—as we know from
[22] Some other important findings that are relevant to contemporary issues involving new forms of
child- rearing include the following: (l). High intensity of attachment correlated with the
what is cause and what is effect, since certain individual differences in babies may
demand higher levels of stimulation. (2). High intensity of attachment also correlated
with mothers who respond quickly to demands. Again, the nature and intensity of infant
as vice versa. (3). High intensity of attachment was found mostly in families with fewer
caretakers.
The “selection” of the infant’s principal object of attachment correlated closely with
the particular adult’s responsiveness to the infant’s crying and with the amount of
interaction between the significant adult and the child. The authors concluded that the
who will offer relevant stimuli, especially socializing and caretaking functions in the
widest sense.
For a discussion of these issues from a cultural anthropological point of view, see
Mead Spiro, and Bettelheim, who have studied new forms of multiple caretaking; the
infants.
[24] More recent work is revealing that perceptual discrimination of the mother—if not the specific
social attachment to her—is developed in the early months of life. The fact that
caretakers would appear to be interchangeable does not contradict the observations that
[25] The experimental observations noted here have not been carried out systematically on a
sufficiently significant number of infants to allow any solid conclusion about how
[26] H. S. Sullivan took pains to point out the understandably magical significance that many people —
most particularly schizophrenics—attribute to the power of the eyes, to being looked at,
and, we would add, to intense eye-to-eye contact. One of the most comprehensive
reviews of the significance of early eye-to-eye contact has been written by Robson. The
[27] Compare Schaffer and Emerson’s apparently opposite but differentiating results, presumably due
to the use of slightly different criteria for each form of anxiety. Yarrow reserves the term
“stranger anxiety’’ for those infants who manifest active protest or withdrawal.
[28] The psychotherapist has a similar task in fostering the patient’s movement from the familiar and
800
“embedded” (Schachtel) into new areas of experience that had been avoided because of
their association with anxious affect. The therapist in this sense is also a mediator who
looks with the patient into dark, unknown, dissociated areas and through the therapeutic
alliance gradually helps to detoxify both the traumatic and untried areas of living.
[29] M.S. Mahler has made a significant contribution to the process of separation-individuation.
[30] See the classic work of Spitz and Provence and Lipton. The latter authors found that some of the
still revealed serious ego deficiencies such as an incapacity for delay, failure in
social relationships.
[31] We note in our discussion that hypotheses concerning character development have proceeded
largely from research connected with trauma and psychopathology. This is due, in part,
to the fact that as yet there are few direct observational longitudinal studies reported in
emphasize that with deprivational and traumatic experience, defensive patterns are
coping capacities and “ego strength.” There are, of course, many other sources of
identification and a whole range of coping mechanisms and ego defenses. See Nagera,
heavily to ego development. The whole topic of learning and cognition will be considered
[32] For a discussion of attempts at compensatory work with deprived children, see Lichtenberg and
Norton’s review of the research literature and Deutsch’s The Disadvantaged Child. For a
more extensive review of the effects of maternal deprivation, see Ainsworth’s work.
malnutrition.
Caldwell offers an excellent broadly ranging review of the entire subject of infant
care.
802
Chapter 13
John A. Sours
beginning of creeping and crawling movements, and extend to the third year,
when the child has developed the motor skills, language, cognitive activities,
and defenses sufficient for separation-individuation and the autonomy
During the anal-muscular phase the child grows from lap babyhood to
and guilt. The erogenous zone has shifted from the mouth to the anus-rectum
his own identity in the family group. The child acquires a sense of autonomy
to combat his sense of doubt and shame. His physical, psychological, and
social dependency, however, fosters doubts about his capacity and freedom to
assert himself. His urge to prove muscular strength and mobility is ever
present. It is hard for him to stay in one activity or space. He wants to explore
controlling his anal and urinal sphincters. His diet has been changed so that
only with his hands, but also with his mouth, eyes, and sphincters. His
How is this concept acquired? Spitz has suggested that the sign of negation
evolves from the neurophysiological rooting reflex. At six months visual and
muscular coordination makes rooting unnecessary for sucking. Sucking is
804
then changed to withdrawal and refusal when the child is sated. At 15 months
the motor behavior has taken on an ideational content. Then the head
affirmative gesture is different. Head nodding is not derived from rooting. The
young infant’s neck muscles are not strong enough for extension. From three
to six months of age the infant is able to support his head. Visual orientation is
then possible. The affirmative head nodding is based on the vertical approach
movement of the head to the nipple. The affirmative nodding retains its
negative is acquired.
to her baby who is slow to wake up for feeding as stubborn. She sees her child
as resistive to being fed. Stranger anxiety at eight months may be confused
independence through rejection of the offered spoon are seen. The child can
also spit out food he does not like, an early manifestation of the development
Negativism appears when the child feels a need for protecting this
reflex in the gamma afferent loop systems. At 12 months the child is able to
months to walk awkwardly. His new locomotion gives him a great deal of
pleasure but also causes conflicts and struggles with his parents. The
maturation of motor function seems independent of learning and experience.
and allows him to start using secondary process thinking and expression.
Under one year he has used principally vowels. From one to two years he
switches more to consonants and begins using single words and some
grammatical structure. The vowel- consonant reversal after age one occurs
806
attainment of erect posture. Language development is fostered by secondary
reward and generalization learning. Identificatory learning is also important
child and the mother. Reward and punishment are critically involved in this
behavioral acquisition. Many children, however, are not trainable until one
and a half to two years. And frequently children are not dry at night until well
The child begins to play at age two, but shows little interest in
reciprocal play and affiliation with his peers. Later he is able to play
cooperatively in the preschool period from three to five years. In his play he
manipulates objects and is able to affect changes in his world. From walking,
By six months the child tries playing with many playthings in his
reproducing the mother’s body and providing a transitional object for the
assimilate the anxiety of object loss. Such symbolic play expresses separation
from and retrieval of the mother. In the toddler stage movable toys with
strings extend this separation play. In addition, the toddler uses socially
acceptable substances for symbolic excrement play involving filling,
The use of symbols with no fixed meaning and the lack of negation are aspects
the toddler is ready to assume control of his sphincters. At the same time the
give up pleasurable retention and elimination, as well as play with the feces.
She cannot control his sphincters as she controlled his rhythmic nutritive and
non-nutritive needs. She now has to negotiate with the child by pleading,
begging, and cajoling. This interaction, once thought to be the most important
808
aspect of toddlerhood before the separation-individuation subphases were
recognized, is still central to this phase of development.
evacuation. He may retain to defy the mother, an act that may mark the onset
incur the mother’s pleasure. He may let go to defy the mother. Soiling and
smearing are hostile acts and are often precursors to anal, urethral, and
phallic profanity. The child may urinate and move his bowels to please his
parents. The feces may be regarded by the child as valuable possessions, his
own creation. The mother may regard the feces as a laudatory product or, on
the other hand, as dirt and filthiness. Frequently both attitudes are expressed
at one time or another. The child may view defecation as getting rid of
something bad or dangerous.
to the powerful stream. This play may evoke envy in little girls. If a child is
frustrated too much by toilet training, his frustration may result in chronic
to confusion about whether the fecal mass or the genitals are dropping off
during defecation.
development of anal erotism and body awareness. Anal erotism refers to the
drive qualities of the anal phase of development when the erogenous zone
has shifted to the anus and rectum. The erotism is experienced during
Stimulation of the mucus membranes lining the anus and rectal canal leads to
erotism. The pleasure is autoerotic. In this way the child negotiates with the
mother over sphincter control so that the erotism becomes object related.
possess.
Freud first referred to the anal phase in a letter to Fliess in 1897. Freud
history. In the 1905 edition of the “Three Essays” Freud described excitation
of the anal zone. He indicated that children enjoy anal erotogenic stimulation
in holding back stools to the point where the accumulation results in a violent
derived from stimulation of the anal zone. In his paper on “Little Hans” he
referred to Hans’s fantasy of taking big children to the toilet to make them
810
“widdle” and to “wipe their behinds.” Freud felt that the fantasy indicated that
Little Hans had been looked after as an infant in much the same way and this
Little Hans had been a child who enjoyed retaining his feces so that he could
enjoy “a voluptuous sensation from their evacuation.” In his paper on
the act of defecation), as well as the child’s unwillingness to comply with the
mother’s wishes. Later he indicated that anal erotic aims are unserviceable
culturally and must undergo sublimation. Later in the analysis of the “Rat
Man” Freud revealed ways in which anal erotism appeared in the man’s
illness. For the “Rat Man” the rat had many meanings such as money, worms
that bury in the anus, and dirty animals feeding upon excrement. In
primacy of the genital zones has not yet been established. He believed that the
component instincts that dominated the pregenital organization of sexual life
are the anal erotic and sadistic ones. He also indicated the mechanism of
reaction formations against anal erotic and sadistic impulses and the
erotic stages.
active and passive. Activities are supplied by instinctual mastery. The passive
trend “is fed by anal erotism whose erotogenic zone corresponds to the old
undifferentiated cloaca.” In “Three Essays” Freud stated that “the activity is
put into operation by the instinct for mastery through the agency of the
somatic musculature; the organ which, more than any other, represents the
passive sexual aim is the erotogenic mucus membrane of the anus. Both of
between the ideas of feces, child, and penis. He later elaborated on this in his
study of the “Wolf Man” who preferred copulation from behind and was
attracted to the female buttocks, all part of his anal erotic disposition. And in
“Three Essays” Freud further elaborated on the unconscious meaning of feces,
suggesting that they are at first for a child a “gift” and later acquire the
meaning of “baby,” one of the sexual theories of children. In his study of the
“Wolf Man” Freud also concluded that the fecal mass stimulates the
erotogenic mucus membranes of the male and is the active organ just as the
penis stimulates the vaginal mucus membrane. In this sense the fecal mass
812
acts as though it were a forerunner during the cloacal period. Freud felt that
giving up feces was a prototype of castration, the first time a child is made to
part with a piece of his body in order to gain the love of an object. Feces, baby,
penis thus all form a unity, “the little ones” that can become separate from
one’s body.
In another paper Freud remarked that the child must dccide between a
narcissistic and an object-loving attitude. As he makes the choice of autoerotic
satisfaction and becomes defiant, his attitude comes from his narcissistic
carried over to the eathexis of the penis. He further remarked that fantasies of
in the vagina occurs later and springs from anal erotic sources. He quoted
Andreas-Salome, who referred to the vagina as “taken on lease” from the
Thus Freud viewed the anal phase as the second phase of libidinal
may continue to play a large part in his life and produce various warped
defense mechanisms.
representational world also contains the child’s own body sensations as part
of parental authority.
814
intelligence the toddler’s representational world arises. Piaget has described
this process over a period of some years.
continue through the first year. A fatigued and satisfied infant goes to sleep
until hungry and restless. If not immediately fed, he then begins sucking his
finger, which gives him experience in eye and mouth activity, the basis of
primary circular reactions. This activity leads to tension reduction by mental
images that are satisfying for a while until hunger increases, and the infant
cries and becomes more restless. The mother then responds with milk. The
infant then lies in an alert, active state, playing and exploring to the point that
he again becomes fatigued and falls asleep. Thus the sleep-waking cycle is
Whenever the infant’s oral needs are satisfied, the baby uses
During the first two years of life the child goes through six stages of
levels. At the biological level there are physiochemical incorporations into the
The mind incorporates ideas about the external world and products of mental
grasping. These reflexes are the building blocks to intelligence. At this stage of
development the baby is able to differentiate the nipple from the blanket. He
816
pattern of behavior is called a schema, which may be a mental experience and
At the second stage the primary circular stage (one to four months) the
mother and visually pursues her. The sensory stimuli in his environment
provide the aliments for activity. The human face is a visual schema. The
leads to new accommodations. The child is now able to grasp what he sees. He
now is capable of intersensory coordination, but he is still not able to identify
cover, the toy is totally lost to him. The image is no longer a stimulus when
the object is gone.
The third stage is the secondary circular reaction (four to eight months).
It is the first time the infant performs an intentional act. The baby acts upon
things and uses relationships as a means toward an end. For instance, he will
grasp a suspended rattle, strike it, or swing it. If he is supine he will swing at
the rattle rather than grasp it. He will practice with pleasure. He may make
the rattle swing by shaking the crib. Thus the schemata are reciprocally
assimilated. In following the mother, the baby will use these gestures to
perpetuate a variety of spectacles. He may induce another person to make the
cover, the baby will look for it as an extension of his own visual environment,
or he will look into the adult’s hand. There is now some kind of permanence
of images for him at this stage. Space has become a function of the images of
prehension and motor activity; which exist in a trajectory of visual and motor
example, if an object is hidden, he will remove the object with one motion and
then take hold of it with another. He has the capacity to keep in mind his goal.
push the adult’s hand away. Signs and symbols indicate specific events. At this
stage the infant will turn toward the sound of footsteps. He will explore
818
At the next stage, tertiary circular reactions (12 to 18 months), the baby
unfamiliar situations not only by using schemata acquired earlier but also by
producing familiar results. If he has a new toy, he will feel it, pick it up, drop it.
His interest is taken up with what is new and different about the toy. He may
also, for instance, take a ball and roll it and delight with the new activity he
has given the object. He will search for novelty and be overjoyed if he finds an
entity that can be made to do different things. He may use a stick or string to
bring things nearer. Spatial and causal relations are extended. For instance, if
a ball is hidden at point A, he will find it. If the ball is then hidden successively
under B, C, and D, he will go immediately to D. He is able to take into account
dimension, qualities, spatial, temporal, and causal relations, even when the
objects are no longer perceived. Thus the child has attained conceptual object
constancy. He forms mental representations that include the object not only
circumstances. External objects are identical to the self, separate from the self
and his actions, regardless of how displaced or hidden. The child will search
for hidden objects or displacements not visible to him. He is able to imagine
At the end of the 24 months the child enters a new phase of intelligence.
He has left the sensorimotor stage of intelligence and is now in the period of
820
of conceptual organization that takes on stability and coherence by series of
first three years of life. Many of her concepts relate to or interdigitate with
those of Piaget and Sandler. She has helped develop the view of the life cycle
symbiotic mother and negotiating the eternal longing for the actual or
fantasized “ideal state of self”—a symbiotic fusion with the “all-good”
symbiotic mother, who at one point in infancy is part of the self, as the core to
at first through the help of the mother and later through the development of
maternal gratification.
inside and outside are experienced together. At this point the infant has
barrier and protects the child from premature phase-specific strain. The
symbiosis is an hallucinatory somatopsychic omnipotent fusion with the
necessary that displacement of libido take place from the inside to the outside
of the body.
demarcation of the representation of the body ego from the symbiotic matrix.
self boundaries. The infant begins to develop an inner sensation for the core
of the self. Feelings of the self form the beginnings of a sense of identity. The
sensoriperceptive organ further demarcates the self. Object relations start to
822
develop as the infant differentiates from the mother-infant dual unity and
enters a normal phase of human symbiosis. There then is a transition from lap
The process of growing away from the baby- mother symbiosis involves a
The first phase, differentiation, takes place from four to five months of
age at the peak of symbiosis. In the symbiotic months the infant comes to
identify the mother as the specific object toward whom he forms a specific
bond. The symbiotic unit is created through entero-proprioceptive and
expands his perception beyond the symbiotic orbit and fosters a perceptual
mother’s face and body, which he explores with his available sensory
Brody calls this activity “customs inspection.” He attempts for the first time to
break away from his passive lap babyhood. He does this in miniscule ways by
pushing back from his mother’s hold, sliding down her lap, and sitting at her
feet, all providing him with increasing distance from the mother and new
views of the maternal object. As he sees new objects distinctly different from
anxiety is manageable.
some degree. The second phase occurs from seven to ten months and lasts up
to fifteen to sixteen months of age. Activity in this period justifies dividing this
phase into two parts: (1) the early phase, which overlaps differentiation and
is marked by the infant’s early ability to push away physically from the
mother through crawling, righting himself, and climbing, yet at the same time
holding on; and (2) the practicing phase proper, which is characterized by
free, upright, bipedal locomotion. The child’s increasing awareness of
Because of his new relationship with the mother he can now look
824
beyond her at other human and inanimate objects. He can play with toys of all
sorts and explore them with his eyes, nose, hands, and mouth. One or more of
mother are used to assuage anxiety during her absence at night. During this
phase of development the infant must move and explore. As he does so he
makes brief sorties away from the mother, returning periodically to “home
subphase there are brief periods of separation anxiety. The infant tries not to
lose sight of his mother. Much depends on the mother’s comfort in seeing the
child moving away from her. Walking has for the mother, as for the child, an
enormous symbolic meaning. If she is able to believe that the child is capable
of moving progressively away from her, she contributes to his feeling of
safety, and perhaps as Sandler has indicated, he gives up some of his magical
Libidinal cathexis goes into the service of the growing autonomous ego and
its functions. The child appears to be ecstatic with his new faculties and the
relationship with his new faculties and world is also a defensive maneuver to
avoid absorption into the mother’s protective sphere. The toddler has now
actively, as she eventually catches him and reminds him of her potential
moods become, as Mahler has phrased it, “low-key” only when he is aware
that the mother is absent. His motility diminishes as docs his interest in his
attention, which has been called “imagining.” The low-keyness has been
into tears. When he is reunited with the mother, his low-keyness diminishes.
Mahler believes that such behavior results from the child’s effort to hold onto
a state of mind that Joffe and Sandler have termed the “ideal state of self.”
becomes much more active with the mother. He now wants his mother to
826
share with him all his new skills and experiences. Mahler has referred to this
interaction of the toddler with the mother, most markedly evident in both
vocal and nonvocal communication, as well as symbolic play. The toddler now
becomes apparent to the toddler that the world is not quite his oyster; he
realizes that he must learn to cope with increasing independence even though
omnipotence. One finds the child now actively wooing his mother; this is
often perplexing to her because he should now be more independent and self-
even if the child does return to woo her, to view the child as increasingly
independent and separate. In the third subphase individuation proceeds very
and uses a number of ploys to avoid separation from the mother. He finds that
provide the same sense of satisfaction and well-being that they used to. The
junior toddler realizes and must accept that his parents are separate
individuals with their own individualistic tendencies and interests. He is
forced to give up the delusion of his own omnipotence and grandeur. This
Mahler has termed the rapprochement crisis, the crossroad where three basic
anxieties of early childhood come together: namely, the fear of object loss, the
fear of loss of love, and signs of castration anxiety. It is the crossroad between
individuation.
beginning the child is gradually able to accept once again separation from the
that had begun during the third subphase develops very rapidly during the
fourth phase and replaces to some degree gestural language, affective motility
and primary process language. In this regard the mother must often play
along with the toddler, providing him with secondary process language and
ways of viewing the world. In addition, the toddler in this subphase shows a
more constructive and purposeful type of play, often associated with fantasy,
828
role playing, and make-believe. The child is increasingly interested in adults
other than the mother. His sense of time develops along with a capacity to
available to him as a love object. Now separation and individuation are more
closely connected to developmental processes. Yet if development is
Oral, anal, and early genital forces and conflicts are found at the time of
the rapprochement crisis. Symbiotic omnipotence must be renounced in the
zonal points. Awareness of bowel and urinary sensations during the toilet
training process can heighten the child’s reaction to the discovery of
partly because of his lesser importance during the early infancy months. The
baby’s relationship with the father begins during the symbiotic phase, as
manifested in the infant’s smiling response to the father. At this time the
father becomes somewhat familiar to the infant and is no longer just an object
toward whom he may experience stranger anxiety. From the very beginning
of infancy the infant is more reactive to the mother and even to siblings than
to the father. In the differentiation subphase attachment to the father occurs,
at which time the father is truly the second parent. The father is now the
more interesting object, in space away from the mother and readily available
for exploration. The infant’s elevated mood seen during this period is most
conspicuous with the father, with whom exuberant play takes place.
It has been observed that girls attach themselves to the father earlier
than boys and are more cautious with strange men and with all unfamiliar
people. Boys are able to approach male objects earlier, a fact probably related
to their greater interest in distance, space, and inanimate objects. Even at the
age of two years girls tend to be passive in seeking affection from the father
and his substitutes. Boys, on the other hand, are more distant and show a
Toward the end of the practicing subphase toddlers seek out the
830
attention of more than one adult. Children of this age are quite competitive,
manifesting considerable envy and aggression toward one another.
Competition toward the father is not evidenced at this point, but the child’s
powerful parent. This image of the father may be essential for the attenuation
parental objects, which provide the necessary triadic elements for the
Oedipus complex.
anatomical sex differences. They suspect that there is at this time an increase
in endogenous genital sensations, associated with bowel and bladder activity,
that is probably independent of toilet training. They suggest that this part of
separation-individuation be considered an early genital phase, necessary for
some children who have not formed stable body schema. Castration anxiety is
or birth defects or have lost a parent. Their observations come from nursery
school experiences, but analytic child and adult data also indicate much the
the self, with depressive mood and collapse of self-esteem. Castration anxiety
weakens ego functions and brings about inhibition of curiosity and play.
Studies of the early genital phase indicate that children are well aware
upon the child by the parents, with the expressed aim of giving the child
autonomy, but at the same time making the child struggle for independence.
The toddler’s sexual curiosity, interest, and activities are also typical of this
period and have strong influence on the entire toilet training process.
832
Castration reactions at this phase can disrupt toilet training and, if part of the
rapprochement crisis, deflate the child’s selfesteem at a time when he is
already bereft with the loss of his omnipotence and the uncertainty about the
presence and availability of his mother. With dissolution of the toilet training
routine, the child is put into a further crisis with the mother and is more apt
constancy, the child enters firmly into the triadic world of his family. Growth
Bibliography
Abelin, E. L., “The Role of the Father in the Separation-individuation Process,” in McDevitt, J. B.,
and Settlage, C. F. (Eds.), Separation-individuation, pp. 229-252, International
Universities Press, New York, 197i-
Abraham, K. (1921), “Contribution to the Theory of Anal Character,” in Abraham, K., Selected
Papers on Psychoanalysis, pp. 370-393, Hogarth, London, 1948.
Baldwin, A. L., Theories of Child Development, Jolm Wiley, New York, 1967.
Bell, A., “Some Observations on the Role of the Scrotal Sac and Testicles,” J. Am. Psychoanal. A.,
9:261-286, 1961.
Blos, P., On Adolescence: A Psychoanalytic Interpretation, Free Press, New York, 1962.
Brackbill, Y. (Ed.), Infancy and Early Childhood, Free Press, New York, 1967.
Cameron, N., Personality Development and Psychopathology, Houghton Mifflin, Boston, 1963.
Erikson, E., Childhood and Society, pp. 182-218, Norton, New York, 1950.
Fenichel, O., The Psychoanalytic Theory of Neurosis, Norton, New York, 1943.
Ferenczi, S., “The Ontogenesis of the Interest in Money,” Selected Papers, Vol. 1, pp. 319-331.
Flavell, J. H., The Developmental Psychology of Jean Piaget, pp. 83-142, Van Nostrand, New York,
1963.
Fraiberg, S., “Libidinal Object Constancy and Mental Representation,” in The Psychoanalytic Study
of the Child, Vol. 24, pp. 9-47, International Universities Press, New York, 1969.
Freud, A., The Ego and the Mechanism of Defense, Hogarth, London, 1936.
_____, Normality and Pathology in Childhood, International Universities Press, New York, 1963.
_____, “Observations on Child Development,” in The Psychoanalytic Study of the Child, Vol. 6, pp. 18-
30, International Universities Press, New York, 1951.
_____ (1908), “Character and Anal Erotism,” in Strachey, J. (Ed.), Standard Edition, Vol. 9, pp. 167-
176, Hogarth, London, 1961.
_____ (1913), “The Disposition to Obsessional Neurosis,” in Strachey, J. (Ed.), Standard Edition, Vol.
12, pp. 322-326, Hogarth, London, 1961.
_____ (1918), “From the History of an Infantile Neurosis,” in Strachey, J. (Ed.), Standard Edition,
Vol. 17, pp. 3-124, Hogarth, London, 1961.
_____ (1923), “The Infantile Genital Organization of the Libido,” in Strachey, J. (Ed.), Standard
834
Edition, Vol. 19, pp. 141- 48, Hogarth, London, 1961.
_____ (1926), “Inhibitions, Symptoms and Anxiety,” in Strachey, J. (Ed.), Standard Edition, Vol. 20,
pp. 77-178, Hogarth, London, 1961.
_____, “The Interpretation of Dreams,” in Strachey, J. (Ed.), Standard Edition, Vol. 5. pp. 354-356,
Hogarth, London, 1961.
_____ (1905), “Jokes and Their Relation to the Unconscious,” in Strachey, J. (Ed.), Standard Edition,
Vol. 8, pp. 3-249, Hogarth, London, 1961.
_____, “New Introductory Lectures on Psychoanalysis,” in Strachey, J. (Ed.), Standard Edition, Vol.
22, pp. 3-250, Hogarth, London, 1961.
_____ (1909), “Notes upon a Case of Obsessional Neurosis,” in Strachey, J. (Ed.), Standard Edition,
Vol. 10, pp. 133-330, Hogarth, London, 1961.
_____ (1917), “On Transformations of Instinct as Exemplified in Anal Erotism,” in Strachey, J. (Ed.),
Standard Edition, Vol. 17, pp. 125-134, Hogarth, London, 1961.
_____ (1903), “Three Essays on the Theory of Sexuality,” in Strachey, J. (Ed.), Standard Edition, Vol.
7, pp. 123-248, Hogarth, London, 1961.
Galenson, E., “A Consideration of the Nature of Thought in Childhood Play,” in McDevitt, J. B., and
Settlage, C. F. (Eds.), Separation-individuation, pp. 41-59, International Universities
Press, New York, 1971.
Greenacre, P. “The Childhood of the Artist: Libidinal Phase Development and Giftedness,” in The
Psychoanalytic Study of the Child, Vol. 12, pp. 47-72, International Universities
Press, New York, 1957.
_____ , “Perversions: General Considerations Regarding Their Genetic and Dynamic Background,”
in The Psychoanalytic Study of the Child, Vol. 23, pp. 47-62, International
Universities Press, New York, 1968.
Henscher, J. E., A Psychiatric Study of Fairy Tales, Charles C Thomas, Springfield, Ill., 1963.
Joffe, W. G., and Sandler, J., “Notes on Pain Depression and Individuation,” in The Psychoanalytic
Study of the Child, Vol. 20, pp. 394—424, International Universities Press, New
York, 1965.
_____, and _____, “Some Conceptual Problems Involved in the Consideration of Disorders of
Narcissism,” J. Child Psychother., 2.-5 2-71, 1967.
Lenneberg, E., Biological Foundation of Language, pp. 127-142, John Wiley, New York, 1967.
Mahler, M. S., “On the First Three Subphases of the Separation-individuation Process,” Int. J.
Psychoanal., 53:333-338, 1972.
_____, and Furer, M. “Observations on Research Regarding the Symbiotic Syndrome of Infantile
Psychosis,” Psychoanal. Quart., 29:317-327, 1960.
Maier, H. W., Three Theories of Child Development, Harper, New York, 1965.
Piaget, J., and Inhelder, B., The Psychology of the Child, Basic Books, New York, 1969.
Roiphe, H., “On the Early Genital Phase with an Addendum on Genesis,” in The Psychoanalytic
Study of the Child, Vol. 23: pp. 348-365, International Universities Press, New York,
1968.
_____, and Galenson, E., “Early Genital Activity and the Castration Complex,” Psychoanal. Quart.,
41:334-347, 1972.
Rutter, M., “Normal Psyehosexual Development,” J. Child Psychol. & Psychiat., 11: 259-283- 1971.
Sacks, L. J., “A Case of Castration Anxiety Beginning at Eighteen Months,” J. Amer. Psychoanal. A.,
836
10: 329-337, 1962.
_____, “On the Concept of the Superego,” in The Psychoanalytic Study of the Child, Vol. 13, pp. 128-
162, International Universities Press, New York, 1960.
_____ , et al., “The Ego-Ideal and the Ideal Self,” in The Psychoanalytic Study of the Child, Vol. 18, pp.
139-158, International Universities Press, New York, 1963.
_____, and Joffe, W. G., “Notes on Obsessional Manifestations in Children,” in The Psychoanalytic
Study of the Child, Vol. 20, pp. 425-438, International Universities Press, New York,
1965.
_____, and Rosenblatt, B., “The Concept of the Representational World,” in The Psychoanalytic
Study of the Child, Vol. 17, pp. 128-148, International Universities Press, New York,
1962.
Sears, R. R., Maccoby, E., and Levin, H., Patterns of Child Rearing, Row, Peterson & Co., Evanston,
Ill., 1957.
Stone, L. J., and Church, J., Childhood and Adolescence, Random House, New York, 1957.
Waelder, R., Basic Theory of Psychoanalysis, International Universities Press, New York, 1960.
Watson, R. I., Psychology of the Child, John Wiley, New York, 1963.
Woodward, M., “Piaget’s Theory,” in Howell, J. G. (Ed.), Modern Perspectives in Child Psychiatry,
Charles C Thomas, Springfield, Ill., 1965.
Notes
[1] See references 3, 7, 8, 9, 10, 38, 42, 46, 53, 54, and 55 in the Bibliography at the end of this chapter.
[2] Mussen, Conger, and Kagan have described in detail the toddler’s progressive development in
838
Chapter 14
John A. Sours
in both sexes, more marked in boys, at about age nine to ten, with subsequent
sharp rises in adolescence. The excretion of estrogens gradually rises in both
preoccupation with theories about the creation of babies, his attraction to the
called the nursery school years, the preschool years, and the stage of initiative
versus guilt. Although this phase of development occurs between the ages of
three and six, there are variations in its chronology from child to child. In
some respects many developmental issues during this phase overlap the age
span of three to six years. This fluidity between psychosexual stages is clearly
seen at both ends of the phallic-oedipal period. Mahler, Roiphe, and Galenson
suggest that sexual arousal can occur before the second birthday; for some
reaction can also occur this early. Although many character traits are
discernible by the age of five years and have some permanence, character
840
the anal-muscular phase of development, especially the subphases of
and capacity and reaches libidinal object constancy at about 36 months. With
his entry into the phallic years he experiences another burst of energy,
curiosity, and initiative. Erikson has referred to the phallic-intrusive mode as
the make,” “making,” and pleasure in the “conquest” are colloquialisms for
this phase of development. This intrusive quality is more prominent in boys,
but, nevertheless, it has its parallel in girls as far as “catching,” reaching out,
conceptualizing his place in his family and his relationship to people in his
immediate community. According to Mahler, at the end of the fourth
allows him, among other things, to delineate more clearly his self and gender
the phallic-oedipal years, he fumbles his way through his frustrations and
wondering about pregnancy and birth and how he came to be born. Even if he
has been instructed in sexual facts by his parents or has witnessed sexual
intercourse, he still must, by virtue of his level of capacity and emotional life,
wonders in many ways about pregnancy, curious about the possibility of his
mother having more children; he raises questions about his own ability to
have a baby, even with his father. He is now more inclined to ask his mother,
not too sheepishly, whether he can marry her. Often he sees no incongruity in
his intent, but whatever he fantasies and initiates in reality only reinforces his
sense of inferiority, anxiety, and guilt. His wishes pale before reality. He is
smaller and less strong than adults. He cannot run as fast and, in fact, is quite
apt to trip and fall. His ability to throw a ball is most likely better than his
sister’s, but he cannot throw as well as his father. Now he tries to drive his
father’s car, but the best he can do is to sit on his father’s lap, only to have the
wheel taken from him as soon as the father notices an oncoming automobile.
He wants to help his father cut the grass, shovel snow, and rake leaves. These
842
tasks challenge his strength, and he becomes fatigued more quickly than his
father. If his father has mechanized yard equipment, he is told to stay away
lest his foot or hand be cut off. His father takes him out to show him how to
play tennis or golf. It is bad enough that he cannot play these sports as well as
his father. He is further humiliated in the locker room when he notices the
smallness of his genitals. He wonders how he will ever be able to fill his
father’s role. All his experiences as a failure reinforce his feelings of smallness
and his awareness of genital smallness. The phallic-oedipal struggle meets
to assert his power and autonomy. His is a hopeless fantasized situation that
leads to guilt and resignation. The joys of his power fantasies turn to the
existence. She, too, is frustrated in many ways and fails every day. She tries to
help her mother with household chores, but she is always told that she cannot
do sufficiently well. Often her job is said to be taking care of her little brother
When she looks at her younger sibling, she cannot help but feel that she
would be a better mother than her own mother. Often she makes invidious
comparisons with her mother, noticing how inept the mother is in doing
household chores and how lacking the mother is in her tastes and manners.
The mother’s cooking is hardly gourmet enough for the girl’s father. The
reveal her age to her daughter. The girl at this time can hardly imagine why
her father continues to show the mother so much attention and, even at
times, love. Before the father comes home the girl quickly dresses up for him.
She rushes to her closet to pull out a new dress that only that day she was
able to buy over the objections of her mother. As the father comes home, she
rushes to show him her new dress. His response is enthusiastic. He may even
be adoring of her. Too quickly does the girl see that the father’s attention is
directed, instead, to his wife. He tells his wife about what happened during
The mother then regales the father with the events of her own day, with the
result that the girl is ignored, left only with the prospect of having to help the
mother set the table or feed her little brother. Thus the girl at this time feels
increasingly annoyed with the mother. She views the mother as inadequate
and lacking, wonders whether she too may be deficient in the same manner,
and strives all the harder to make an impact upon her father. Nevertheless,
regardless of her efforts, her charms, and her beauty, the father’s attention to
her is interrupted by his involvement with his wife and his preoccupation
with his work and with social interests, which take both him and the girl’s
844
development and to proceed on to resolution of the oedipal complex, a
child must go through many socializing experiences within both the family
In the age span from three to five years physical growth accelerates. The
average boy grows about five inches and gains almost ten pounds. The
average girl is slightly shorter and lighter. Physical growth is very rapid
during the preschool years; in fact, by the fifth year 75 per cent of the weight
five, 90 per cent of the nervous system has attained an adult level of
stimuli.
encouraging to the phallic child. By the age of four years the child is capable of
smoother movements, faster running, and stronger broad jumps. His
is still rough and unpredictable in its accuracy. By the time the child is five his
however, are quite good and are appreciated by the child as soon as he enters
kindergarten and first grade. Now he is able to pick up pellets quite easily,
draw straight lines, copy squares and triangles. As a result, he has many adult
motor patterns that allow him to use tools and more complicated toys with
at bat and make a valorous try at hitting a ball. With all these new motor skills
he tries to play out various roles. He may be the engineer or the truckdriver
or the athlete or some other model figure. He seems to enjoy the status of
dependent upon fantasy and ludic play. He is now better able to establish
connections between thoughts and words. And with his improved
846
communicative capacity he is able to make greater strides toward awareness
comprehend better the phenomena that he encounters every day in his world.
syncretic way. Words stand for objects and events as well as actions and
fantasies. For a three-year-old a dog is a class of all animals with four feet. A
child syncretically thinks of words such as “eat” as meaning food and being
fed, as well as the process of eating. By the age of five, however, words are
In his object relations the child remains egocentric up to the age of four
to five. He cannot put himself empathically in the place of others. As he passes
sociocentric. His speech is more socially oriented. Fantastic and symbolic play
is less needed as a child moves during the latency years into sociocentric
communications and relationships with his peer group. The child now has
less need for imaginary companions. There is less need for dramatization of
different roles.
parts of stimuli. He is now able to attend to both the whole and the parts. A
and mirror images. Only with increasing age can the child regard spatial
organization of objects as a relevant dimension. This is due in large part to his
learning the labels “right” and “left” as well as “up” and “down.”
their application. Between two and four years, according to Piaget, a child can
form a representational world. During the preconceptual phase of intelligence
the child develops a symbolic representation of the world, lie requires labels
for the things that lie now perceives. From the age of four to seven years he is
perceptual aspect of the stimulus. As an example, at the age of four years the
child thinks that beads in a tall cylinder jar are greater in quantity than the
same number held in a short squat jar. If a round piece of clay is pressed out
848
onto an elongated cylinder, a child of this age is apt to think that there is more
clay in the latter form. From the age of five to seven, however, the child begins
of changes in the shape of the containers or the clay. Thus the phallic-oedipal
child adds thought to his perception and is better able to comprehend his
world. This is what Piaget means when he says that the late phallic child
very much present in the dreams. Simple wish fulfillment dreams do occur,
child tends to play house, puts on adult clothing, and plays the roles of
cowboy, doctor, ship captain, jet pilot, and nurse. His play reflects his anxiety
about his smallness, with a compensatory fantasy aimed at the denial of the
anxiety. The wish is to be big and to do the things that big people do. Dramatic
play occurs during this time in many exfoliations. The child’s energy, vitality,
tend to be very rich and dramatic, centering primarily on the theme of “twins”
and “family romance.” Fairy tales embody many aspects of oedipal
Jack and the Beanstalk and Cinderella are two outstanding examples found in
years. Until age three his peers were relatively unimportant to him.
Reciprocal play was minimal. His contact with children stylistically reflected
rewarded prove unacceptable elsewhere and, in fact, may even incur for him
acute and can bring about changes in his social behavior as he moves into the
preschool years. The child goes from solitary to parallel play and then to
cooperative play and finally to reciprocal play during the phallic-oedipal
years. His play activity is vitally important, not just for the discharge of
instinctual drive and motor energy, but also for the practice of new skills and
850
The phallic-oedipal phase of development is not just a psychosexual
level of maturation both in the cognitive and perceptual spheres and in living
awareness of goals, many of which can be gratified only in play and fantasy.
Genital arousal and pleasure are obtainable only through fantasy,
The boy wants to take over his mother. The girl wants to be like the
mother, even though she may resent and denigrate her, in order to take over
the father. The boy tries to do in his fantasies what his father can do in
everyday life. And this provides a fertile soil for guilty feelings that can
undercut the boy’s sense of initiative. His guilt is much greater than the
shame and doubt he experiences at the anal-muscular stage of development.
The girl experiences guilt in her desire to usurp the mother’s role, but her
principal emotional burden is one of self-disappointment, frustration, shame,
and inadequacy. She feels more and more that she is defective, and it is only
on her mother that she can cast the blame. As she looks about from her
position of injury and inferiority, she sees her father and brothers seemingly
in a far superior position. They seem to have more fun, to be capable of more
activity, and to be the recipients of more rewards. Before a boy and girl enter
ego growth and experience, the instinctual and ego development of the phallic
period, and interaction with his parents and family; death and illness, the
phallic-oedipal development.
Phallic Erotism
complex, with the specific aim of penetration and procreation. The erotism of
the phallic-oedipal period is clearly different from genital erotism, which
852
Freud viewed the phallic-oedipal phase of development as one stage in
girl as primarily masculine in character, pointing out that the erotogenic zone
of the female at this time is located in the clitoris, which is homologous to the
masculine genital zone of the glans penis. For both sexes at this
developmental phase only the male genital has prominence and primacy.
to press in, to tear open, and to make a bull’s-eye. If the child is made sexually
ideas of sexual contact and pregnancy, ideas that come from his own
experience and feelings. His wishes lead him to want to penetrate through the
mouth, anus, navel and in some indefinable way to create a baby. The aim of
anally penetrated. The child’s wish to have the phallic zone stimulated by
(“She doesn’t have a penis now, but it will grow back.”) The child may go on to
Normally these upsetting fantasies are repressed at this stage and the child
resolves his Oedipus complex. The pervert, however, has no solution to the
denial through fantasy. Freud states in his paper on splitting of the ego that
the pervert is faced with the fact that his mother has no penis. To fill the gap
Early in the phallic stage the boy becomes aware of anatomical gender
differences, and his awareness of the male genitalia furthers his identification
with his father, brothers, and male peers. Now he thinks that he can do what
his father does. In addition, his view of the father’s relationship with the
with the mother. Now the boy wants to exhibit his phallus to his mother and
at the same time look at her breasts and genitals. He may request that she go
854
to the bathroom with him, or he may blatantly exhibit himself at bedtime to
a special pleasure structure of the body that he has become aware of through
masturbation, exhibition, and sex play.
The boy views himself as a little man; his father is his adult rival. The
mother becomes the object of all his pleasures, around whom he weaves a not
too innocent “romance.” The boy at this time tends to be very protective of his
mother, imitating his father in many respects. On the other hand, he may
downgrade his father or even at times openly attack him verbally. He may try
to play games involving the father’s role. He is apt to make up stories and
fantasies about larger rivals whom he can easily overcome, like Jack and the
Beanstalk. The boy realizes, however, that the father’s size, dominance, and
assumes for the little boy an aura of dread and expectant injury. This threat
assumes the form of castration anxiety, which ushers in a new developmental
theme. This threat can exist only in the child’s fantasies and has no real roots
in reality. Often enough, however, the boy has sensed the father’s annoyance
because of his persistent intrusions into the parents’ relationship. Then, too,
any punishments the father dispenses to his son during this period, for
omissions and commissions irrelevant to the boy’s phallic wishes, are seen as
direct punishments for his phallic impulses. The conflicts centered around
suppression and repression shift the ego’s defense organization. Evidence for
and as well as in the fantasies, fairy tales, and dreams of this period of
development. Furthermore, anthropological studies of totemic animals,
his wishes, he can react to her in a jealous rage, which either gives rise to or
reinforces a wish to kill her and to be loved by the father in her place. The
negative Oedipus complex also leads to fear of injury and castration because
of passive aims. Both negative and positive wishes in the oedipal period,
therefore, arouse castration anxiety.
The boy is quite prone to respond to the oedipal situation with fear of
castration. There are many determinants to this fear. The erogenous phallus
concludes that the girl has lost her penis. Direct and indirect threats of
punishment from either the father or the mother reinforce the fantasy that he,
too, may lose his penis. In addition, his earlier experience of losing the breast
856
in weaning and in losing feces in defecation are preoedipal antecedents to
body loss and castration anxiety. The fantasy of castration involves loss of the
penis and not necessarily the testicles. The fantasy is based on his view of loss
of body part going back to his previous stage of development, where loss of
the fecal “stick” suggested a body loss. The boy’s castration anxiety is further
manifested by overt concern with the body, excessive fear of injury, phobias,
and nightmares. The boy must resolve his oedipal conflict by renouncing his
character. The boy’s libidinal wishes are partly desexualized and sublimated
that sexual development in boys and girls was similar, a view that he changed
in his paper, “A Child Is Being Beaten.” He later realized that the girl has to
change not only her sexual object from the mother to the father but also her
erotogenic zone from the clitoris to the vagina. Psychosexually the girl is
Her earliest erotic fantasies, like the boy’s, involve the mother as object.
Between the ages of two and three years the girl begins showing a preference
for the father. Much like the boy, the girl increasingly masturbates, using the
clitoris instead of the penis. It is here that a gender difference in psychosexual
development occurs. Her desire to play the man does not flounder on
castration fear. It is castration fear that propels the girl toward the Oedipus
complex. She blames her mother for the genital difference and seeks out her
father in the hope of repairing her body damage and becoming a man. Even
though she may become aware in the phallic-oedipal period of her vagina, the
Decisive awareness of gender difference occurs when the girl shifts her
libidinous strivings from her first object, the mother, to the father in the hope
hostility toward the mother. Often the girl catalogues her many complaints
against her mother. The shift from the mother to the father occurs at the time
when the girl has become aware of anatomical differences between herself
and the male. Her first impulse is to repudiate the sexual difference. The
858
antagonism toward the mother and increases her fear of more retaliation
from the mother. The wish for the penis heightens her interest in her father
and brothers. Penis envy expressed as shame, inferiority, jealousy, and rage is
most evident at this time. The girl has a passive wish for the father’s penis.
She then turns to the father as her principal love object. She is soon rebuffed
by the father and forced to renounce her oedipal wishes. The girl’s feelings of
The boy discovers his penis and the girl is quickly made aware of her
deficiency. Both boys and girls during the phallic-oedipal years evidence
also by dread of injury. The slightest injury is regarded by the child as worthy
of a band-aid.
The discovery of sex differences means to the boy that the girl has lost
her penis.’ He is frightened that he, too, may suffer the same fate. He resorts to
ego-defensive maneuvers. He may believe that everybody is built like himself.
He can try to convince himself that the girl has a penis that is hidden inside
her vulva. Or he can believe that the girl’s penis will grow back some day. He
to pop forth. He can displace to other parts of his body his concern over
castration. He can deprecate girls, even trying to hurt them, to further his
image of them as injured. His anxiety can lead to increased masturbation
aimed at reassuring himself that his penis is still intact. He can threaten other
The girl, on the other hand, can deny the fact that she has no penis. She
may feel that the mother took it away from her. She can repress her
phallic girls, even from sophisticated backgrounds, can deny the vagina well
into latency years. The phallic child’s view of the parents’ external genitalia
can further intensify castration fears. The boy, in seeing his father’s penis, is
apt to feel even more inferior. The girl is frightened in seeing her father’s
penis. She can fear that her wish to touch his penis may come true. Or she can
be alarmed by oral fantasies that aim to incorporate the father’s penis. The
phallic boy, in seeing his mother nude, may fantasize that her penis is inside
860
primal scenes. Hearing the parents moving about in bed, awareness of the
mother’s giggles, the father’s heavy breathing, and various noises at the time
of orgasm are most stimulating to the child’s fantasies. The child does not
know who is doing what to whom. A number of children also see their parents
having intercourse. Visual primal scenes during the toddler years make the
period. Whether the child’s primal scene is visual or auditory, the child tends
the child’s sibling rivalry feelings and forces the child to elaborate his sexual
Preoedipal Sexual Identification with Love Objects and the Negative Oedipus
Complex
primary identification with the mother. Later the child internalizes parts of
both parents.’’ At around two to three years the girl imitates the mother and
carries out a flirtation with the father. At this time most of the little girl’s
investment is with the mother. And in this sense the little girl is experiencing
her negative oedipal complex. With the first separation and individuation the
little girl then proceeds to the positive oedipal complex in which she reaches
aggression to the father. She attaches her libidinal drives to the oedipal
mother. For the male at age two and three and a half, the identification shifts
from the mother to the father. The boy in his negative oedipal feelings
feelings, he then makes a switch in his allegiances to the mother and transfers
his aggression to the father. The mother is now valued and the father is seen
as a competitor.
stage in which he subordinates his active wishes for his mother. During the
time of the negative oedipal complex there are two possibilities. The boy can
have sexual wishes for the father, wanting to put himself in the father’s place
and to play a passive role. Or the boy is apt to want to supplant the mother
and to be loved by the father.
862
psychoanalysis. It is the central part of his psychosexual theory of
development and is in many respects the phenomenological core of his
instance, reviews the empirical data that support many of Freud’s phallic-
oedipal formulations.
The developmental trends that lead to the Oedipus complex involve the
child’s obligatory dependency on his parents and the child’s need to be loved
by and to love his parents— the first love objects. The Oedipus complex is a
strivings that bring him face to face with his erotic feelings and phallic wishes
toward the parent of the opposite sex. The desire for both affection and
stimulation from the contrasexual parent pushes the child into a competitive
relationship with the isosexual parent. For the boy this results in fear of
castration. For the girl this intensifies her antagonism to the mother, her wish
to have a romance with her father, be like her father, and be part of the male
world. The Oedipus complex is an apprenticeship for heterosexuality and a
sublimating his incestuous wishes and further identifying with his father.
She feels antagonistic and hostile toward her mother. Her first impulse is to
guilt, however, she may give up masturbation for a while; or, on the other
hand, her wish for possession of the father’s penis may be strengthened. Rage
and despair intensify the little girl’s rivalry with the mother. She further turns
to the father as her principal love object. She is then rebuffed in one way or
another by her father, so that she must now renunciate and repress these
oedipal wishes the best she can. She may attempt to remain a “pal” of the
father, wanting to do things with him, particularly if she is competitive with
her brother. In passing through the “tomboy” stage, she furthers her
masculine identification with the father. The shift back to the mother only
castration threat can make the girl relinquish her father, the girl’s oedipal
conflict is not resolved until adolescence or adulthood.
864
the infantile neurosis to the Oedipus complex. Nagera has reviewed the
that “the infantile neurosis is ... an attempt to organize all the previous and
into a single unit of the highest economic significance. ... For these reasons—
with accretions from latency and adolescent years, to adult neurosis. Anna
Freud also emphasizes the necessity for certain developmental steps to have
number of other postulations that take issue with Freud’s view, particularly in
normal attitude of the phallic child as that of an equal interest in the father
the mother, he regarded sexual pleasure as incidental to the quest for power.
He saw sexual pleasure as incidental in the boy’s quest for power and
domination over the mother. For Adler the Oedipus complex is simply one of
the many forms of child pampering, and in many respects the child eventually
becomes the victim of his own fantasies toward the mother.
independence and autonomy. He felt that if there is no freedom for the child,
the Oedipus complex must inevitably lead to conflict. He introduced the term
achieve more autonomy and the need to return to the relative security of the
father are key factors in Jung’s view of the Electra complex. Freud rejected
between the attitudes of the two sexes.” Furthermore, Freud felt that Jung’s
view added nothing.
Rank, who viewed the complex as the origin and destiny of man. The average
person, Rank believed, never really overcame his birth trauma. From the
866
primal horde came the primal family, the group family, and eventually the
matriarchal society. The Oedipus complex, for Rank, became a saga, a
her the family relationship is a force in the molding of the matrix of character
and hostile impulses toward them, as well as the need to cling to parents for
love and security. She doubted whether sexual wishes toward the parents had
Fromm’s concept of the Oedipus complex. He does agree with Freud that
there arc sexual strivings in children, that the tie to the contrasexual parent is
frequently not severed, and that the father-son conflict is characteristic of
and no patriarchal authority. He, too, doubted whether the tie to the mother is
primarily sexual; instead, the fixation to the mother is caused by maternal
Harry Stack Sullivan also took issue with Freud on the Oedipus complex.
He suggested that feelings of familiarity toward the child on the part of the
and hostility in the child. A parent treats the child of the opposite sex with
of strangeness deprive the parent of motives for control of the child’s life.
Consequently the child is treated more carefully. The freedom from pressure
results in the child’s feeling greater affection for the contra-sexual parent and
family relations. In his view parents provide the child with conditions that
reflection of inborn instinctual drives and their vicissitudes. The child’s first
sexual pleasure is from autoerotic manipulations. A subsequent shift to
868
another object comes only after the child has established an affectionate tie to
the mother. Now he has learned that he must share the mother with the
father and siblings. This initially intensifies his need for exclusive possession
of the mother as a dependency object. Consequently both boys and girls in the
family are interested in the mother primarily as the affectionate object. In this
sexes. The striking gender difference is in the attitude of the little girl toward
This is the root of the girl’s penis envy, a repressed wish to castrate the boy as
activities are not interfered with, the Oedipus complex is resolved initially by
substitution of himself through masturbation and later by substitution of
complicated and in many respects not as well understood. For the girl the
first sexual object is her mother. Later she turns to her father, not, according
persuasion by both the mother and the father. The mother dampens the
daughter’s sexual interest in herself. She promotes the shift in the little girl’s
attention to the father through the many examples of her own behavior to the
father. As a consequence she helps the girl identify with her, especially if the
woman. A contradiction soon arises for the girl. The parents become alarmed
at the dramatic shift they have encouraged. Alarm occurs because of sexual
870
which then leads to sexual intimidation of the girl in much the same manner
that this occurs for the boy. The little girl is now aware of genital differences.
In the adaptational formulation castration anxiety for the boy and the
girl occurs after parental intimidation. It is not in any respect related to
proceeds in the same manner as that of the boy. This view challenges the view
that castration anxiety ends the Oedipus complex in boys but initiates it in
girls. In the adaptational view the relationship of castration anxiety is the
same for both sexes. It sets in motion repression of the Oedipus complex. In
This view facilitates her repression of her sexuality. Her penis envy is
exaggerated by the various contrapuntal cultural attitudes between men and
withdraws from men and is forced to deny her sexual yearnings for pleasure
and comfort.
relationship with past objects (parents and siblings) is seen. Anaclitic and
free of the incest taboo, takes place. Further sexual differentiation occurs.
perpetuating the incest taboo and preventing the ego from returning to
libidinal object cathexis. The libidinal components of the Oedipus complex are
desexualized and sublimated; in part they are inhibited in their aim and
transmuted into impulses of affection. Freud saw the process as more than
form the nucleus of the superego. ... In normal, or, it is better to say, in ideal
872
eases, the Oedipus complex exists no longer, even in the unconscious; the
superego has become its heir.” In the Ego and the Id Freud, in discussing the
loss of the love object resulting in a “setting up of the object in the ego,”
further comments about the dissolution of the Oedipus complex: “The broad
general outcome of the sexual phase dominated by the Oedipus complex may,
these two identifications in some way united with each other. This
modification . . . confronts the other contents of the ego as the ego-ideal or
superego.”
castration threat is in large part the result of the child’s use of the mechanism
of projection, but it is further strengthened by overt or covert punishment for
masturbation and sex play and the boy’s observation of sexual differences.
When the child abandons the Oedipus complex, his identification with the
father maintains the object relationship to the mother that has been linked to
the positive Oedipus complex and at the same time replaces the object
relationship to the father that has been part of the negative Oedipus complex.
The same intrapsychic events take place in connection with the mother
identification. Freud feels that the relative intensity of the two identifications
With the abandonment of sexual aims and the change of object cathexis into
complex, Freud thought that the superego formation was quite different for
the girl. Fear of castration plays no part in the breakup of the infantile genital
organization for the girl. For the girl threats of loss of love threaten the
Oedipus complex, but what eventually abolishes the Oedipus complex is her
increasing awareness through later development that her wish to have a child
Jacobson has analyzed the development of the superego from its earliest
874
object images. Before the phallic period the superego schema reflects the
idealized and desirable qualities of the parents and encourages the child to
behave, which gains for the child a feeling of being loved. At this point the
structure is formed. Now the introject can substitute for the real object as a
With the resolution of the Oedipus complex the child enters the phase of
with his body, its functions and its orifices. Latency extends to the
prepubertal growth spate of adolescence. During this time further sexual
more common as the child spends less time with his family. In his relationship
with other authoritarian figures, as well as in his relationship with peers,
mother in her feelings toward her new son-in-law. Later in life grandparents
aging has taken its toll on cognitive control and capacity for instinctual delay,
a man may give vent to long repressed oedipal urges through molestation of
young girls.
has had multiple deprivations during childhood, these experiences will result
sexual and aggressive impulses, along with little capacity for pleasure, can
ensue. Harlow’s primate studies have demonstrated that female infants who
development and remains absent, the child’s contrasexual object relation will
be strained. He can become overly attached to the parent of the same sex,
876
making it more difficult for him to work out a heterosexual object choice.
Many times, however, relatives, friends, and older siblings offer other
remaining parent takes the child as a symbolic substitute for the lost spouse.
of the same sex during the oedipal period can foster conflicts since these
Ideally for the resolution of the Oedipus complex the isosexual parent
full confidence in objects of the opposite sex. Third, parents should show no
Fourth, the child should identify with a satisfactory view of marriage, seeing it
as providing pleasure, comfort, and security so that he may subsequently
Fathers who are harsh and punitive make oedipal resolution more
difficult. Struggling with such a father, a boy may feel it necessary to give up
all women and to assume a passive, compliant attitude toward his father. He
may aspire to be the main object in his father’s life and see his mother as a
identification with the aggressor. With such a father the girl can assume a
masochistic attitude toward men and regard the penis as a sadistic weapon to
aggressive and a relatively masculine person and the father is passive and
feminine in character, the boy must deal with his aggressive, punitive mother.
His inadequately masculine father cannot help him and cannot provide
him with a satisfactory identificatory model. Thus the boy must follow in the
A girl may feel that she was deprived by the mother during her
preoedipal development. She may think that her feminine attitude has been
depreciated by the mother. Thus she can adopt a rather passive attitude
878
father as weak and withholding, and entering into a homosexual relationship
later in adolescence. On the other hand, she can assume a maternally
protective attitude toward the father and establish strong bonds with him
that she is never able fully to relinquish. Sometimes older siblings of the
opposite sex provide substitutes for the parents, and the oedipal problems
may therefore be displaced onto these siblings. Sibling competition with a
infantile sexuality, particularly phallic erotism and the Oedipus complex, must
fantasies, dreams, wishes, and other mental events have been comparatively
scene experiences, penis envy, birth fantasies, and oedipal and masturbatory
fantasies are phallic phenomena that warrant research. In addition, fairy tales
and myths provide rich sources of research material. The nature of infantile
amnesia is poorly understood, partly because of our ignorance of memory
cannot easily report experiences. The use of play and direct observation can
produce very misleading and at times naive results. Play techniques are
useful as modes of expression. Translations from play to language are
Child analytic work offers the most convincing evidence for infantile
sexuality. Since the child analyst has the opportunity to observe the child over
880
supply a physiological support to psychoanalytic concepts.-The connection of
thumb-sucking with masturbation has been questioned by Wolfe, who views
questions of gender role and gender identity. Hampson and Money have
gonadal sex, and the morphology of both internal and external reproductive
learning. Imprinting, a model taken from animal studies of learning, has been
suggested as the possible cognitive activity that occurs at the time of the
identity is quite similar to language in that for both there is a critical period of
points out that gender identity depends in the beginning upon sex assignment
and that it is established by the age of two and a half to three years. Gender
identity comes from experiential rather than constitutional factors and occurs
well before the appearance and resolution of the Oedipus complex. Stoller
views this process as leading to the development of core gender identity and
Therefore, gender identity is not entirely the result of fixation by conflict, but
The child cognitively organizes his social world along role dimensions. This
patterning is based on the child’s concept of physical things. The social world
concept is cognitively organized in terms of universal physical dimensions.
The organization of role perception and role learning depends on the child’s
concepts of his body and his role. The schemata that cement events together
include his concepts of the body, of the physical and social world, and of
882
unchangeable sexual identity that has its analogues in his concepts of the
data differently from an adult. In all likelihood changes in cognitive ego style
the fear of incest. There are recent family studies of incest but only a meager
son, father and daughter, and between siblings is not known. Incest studies of
cycle.
point out that genetic sex at fertilization is potent during the first six weeks
the crura and bulb emerge the male external genitalia. Thus there is in the
and transactions of the child vis-a-vis isosexual and contrasexual parents are
phenomenological. In his review of normal psychosexual development Rutter
884
points to a corpus of empirical data that child analysts encounter daily in
their work. At another level of observation are dreams, fantasies, and
another level of conceptualization are postulates of the libido theory and the
theory of object relations.’’’ It is in this area that child analysts-’ can provide
industry versus inferiority. When the child begins shedding his first
dramatic changes of the preschool years, with the resolution of the oedipal
situation and the diminution of his narcissistic preoccupation with his body
and its various orifices and functions, and the prepubertal growth spurt of
confusion of that period, the latency child goes through a great deal of
psychosexual and psychocultural development. Between the ages of three and
dependency position vis-a-vis his siblings and his parents. During this time he
lives out a happy illusion of being a miniature adult. From age five to seven,
however, he is forced to come to terms with his illusion through the solution
latency children, remarks that mock adults’ intelligence and for a brief period
In latency the child is no longer satisfied with just play and make-
believe. He identifies with people who know things and suggest to him a
sense of competence. The danger that his success is illusive is always present.
from which he can win recognition by producing things. He learns with others
to do competitive tasks with the idea of finishing things. Unlike the child
during the stage of initiative, when the emphasis is on the goal but actually
very little is done, the latency child aims at completion. During this time he
learns to read and write. In primitive cultures he turns instead to gender-
appropriate activities that are essential to the survival of the tribe. In most
instruction is provided.
886
In middle childhood the differentiation of male and female becomes
more complete. Boys are taken away from their homes, given tools, instructed
years. They are unable to enjoy the tool situation and often feel inadequacy
and despair in regard to tools and skills. The period of inferiority can become
overpowering for the child, particularly if his mastery of the preceding stage
was not accomplished. Work contributes another step in identity
development in that the child learns to do what counts. He has more than
does. If mistrust, shame, and guilt are experienced during growing up, he is
more likely to develop a negative image of himself.
Harry Stack Sullivan referred to latency as the juvenile era where the
competitive display. New roles are promoted and the child learns new modes
of participating with his peers and adults.
because of peer group and school activities. Peer interaction enables the child
numbers and words. There is also a strengthening of superego and ego ideals.
The superego authority is introjected as part of the outcome of the oedipal
conflict. Now for the first time it is available to assist the ego in controlling id
period occurs from age eight to ten and is marked by sexual quiescence. The
resolution of the Oedipus complex, Freud believed, leads to repression as the
gratification since aims are inhibited. In 1905, however, Freud indicated that
latency is from six to ten. He underscored his belief that a sexual quiescence
continues during these years until puberty. Sarnoff points out in his review of
888
sexuality is less observable, usually repressed, and most commonly
suppressed. Few have continued to believe that latency is a biologically
pregenital impulses is commonly seen, more so in boys. The child has to work
out new defenses against the pregenital drives. Ego development and the
Freud was less interested in latency partly because he felt that most of
during latency is that children are much more circumspect and socially aware
about sexuality.
this time so that the child becomes more aware of what is socially acceptable.
Those children who are cognitively impaired, such as mentally retarded
divided into two phases. The first phase is from age six to eight. During this
Masturbation is inhibited. The child is greatly involved with himself. The ego
can temporarily regress to pregenitality with reaction formations of shame,
disgust, and guilt. The superego is extremely strict and feels like a foreign
890
the superego intensify the ambivalence. Parents cannot be viewed as sexual
objects. Drive discharge is through fantasy. Masturbatory fantasies vary
part of an active fantasy life, which is the primary means of coping with
stress. Castration anxiety can persist for the girl. Defenses against penis envy
are usually quite apparent. Secondary process thinking waxes and wanes.
Increased contact with reality furthers differentiation of secondary
The later phase, age eight to ten, shows better cognitive functions and
is less needed for drive discharge and by age eleven is used more for reality
planning. The superego is less strict. The child in the second phase of latency
shows decreasing omnipotence. Defense and affect are now closer to the ego
Between the ages of six to nine the child has to find out how to get along
partly from cognitive immaturity. At the age of nine the child, however, has a
concept of reciprocity. He now feels that it is fair to change the rules provided
everybody agrees and new rules apply to all. From age eleven to twelve he
players in games with his peer group. He is able to realize that another child’s
needs can be different and has thus transcended his egocentrism. He is able to
shift his perspective and to be empathic.
At the age of eight the child has a well-developed time perspective. His
delay gratification and has some tolerance for frustration. He has realistic,
His quest for mastery is apparent in many things that he does. Self-esteem
increases and is contingent on mastery of competition and competence. There
autonomy, initiative, and industry. With this cognitive expansion and shift
892
toward the peer group, the latency child becomes more involved with his peer
self-esteem, offer social means of lessening tension, and reduce the danger to
the balance between excitement and control. Peers remind one another of
social goals and gratifications. The group helps to maintain its own controls
Physical Growth
From age six onward there occurs a deceleration of growth during the
latency interval. At age six the average child is 46 inches tall and weighs 48
pounds. By the time he is age 12, he is 60 inches tall and weighs from 95 to
100 pounds. Physically boys surpass girls in that they are slightly taller and
heavier than girls, stronger, better integrated and coordinated neurologically,
however, generally ceases at the time of the pubescent growth spurt when
girls become slightly taller than boys and remain so until about the age of
fifteen.
that lead toward mastery and self-control. In peer groups the child must feel
that to subordinate his individual needs and goals to the total group, he must
strike a balance between the activities of his parents and those of his peer
group. The peer group forces the child to reevaluate his internalized values.
His means for coping with aggressive and sexual needs are constantly
evaluated by his peer group and his teachers as well as by his parents.
and accretions in superego and ego ideals occur, with some reduction in the
strictness of the consciencc between eight and ten years.
groups affects the school-age child in many ways. He becomes more critical of
his parents and invests them with less delegated omnipotence. At times he is
parents. In the absence of parents the child’s ambivalence shows its hostile
side in the form of aggressive feelings and fantasies toward his parents. His
894
The school-age child must be more self-reliant in handling fears. His
remains in a vicarious balance between his old magical world and the new
world of reality, often shifting back and forth in his cognitive appraisal of
himself and the world. The child may defensively regress temporarily to an
earlier stage where he can utilize old behavior in the service of emotional
and shame against infantile impulses that during this growth period become
part of the child’s character development.
identification. His parents are not enough since he can do so few of the things
adults do. Thus girls tend to idealize prestigious and romantic figures. Yet in
their play activities they will often act out the roles of mother and daughter.
Boys, on the other hand, are prone to identify with people who have status in
society—leaders who are strong and assertive. For both sexes peer group
large part on the adequacy of the child’s sex-typed activities and attitudes.
Girls are more obsessive, boys, more compulsive, in keeping with the
Models are selected for identification on the basis of the child’s own
skills and personality traits and the familial and peer group pressure toward
for his model, more so if the parents indicate their preference and encourage
him to develop masculine interests and activities. Pressure from the family
varies inversely with social class. In other words, lower-class parents are
concrete and more specific about what constitutes culturally sex-appropriate
role behavior. Children perceive the masculine role as more aggressive than
the feminine role. Both boys and girls view the male as both more competent
others, has been related to the more negative self-concept that the average
girl possesses in our culture.
896
Sex-appropriate behavior is important in the development of children
because it is one of the factors that shapes the attitude of peers toward the
can be at variance with his behavior, career choices are in consonance w’ith
child’s need for autonomy. Patterns of control can deviate in either direction.
Domineering parents are apt to foster shyness, inhibition, and apathy in the
child. Overprotective parents encourage children to be stubborn and
Limits for behavior must be set by the parent so that the child can make his
choices and decisions. Complete freedom for the child is now an old-
principles and is fascinated with the new, strange, and distant places and
long-range goals.
898
is a crucial determinant. Specific capabilities and maturational readiness to
undertake the essentials of education are important. His position and social
class also bear on his school behavior. Lower-class children adjust less readily
to school because their parents are less encouraging and the peer group less
reinforcing of the positive merits of the school experience. Furthermore,
curriculum for the middle-class child does not always suit the child in the
The sex of the child is another important factor. Boys are apt to adjust
tend to react to women teachers with anxiety and tension. They are more
hostile to school. Kagan indicates that if more men were to teach children,
particularly in the lower primary grades, boys would be more apt to associate
the act of acquiring knowledge with masculinity. For example, boys have far
more reading and spelling difficulties than girls.’ This has been explained in
the past totally on the basis of a psychoneurological differential in brain
kindergarten and first grade as feminine since those classroom activities tend
to involve cutting out, pasting, and doing “pretty things.” Furthermore, boys
of children obtained from age six to ten is .70. At the Fels Institute 50 per cent
of the children studied showed changes over the years, most markedly the
boys. The drive to learn increased as the children became more assertive and
independent at school. Those girls whose IQ changed over the years were
closely attached to their mother with whom they identified and whom they
perceived as valuing intellectual achievement. Latency children do not have
fully developed cognitive functions until adolescence. When they first enter
school, latency children tend to be concrete but less animistic and magical in
latency deductive processes are available to the child. Piaget has serially
There is a wide variation in peer group ego ideals and values existing
within social classes. A lower-class child may be poorly accepted by his peers
if he excels in school. The heroes of the lower-class children are not upper-
class authority figures. These children are apt to be more receptive to the
“heroes” of the television world. The violence of television has more impact
900
upon children from the lower social classes, in which there is less anxiety
bearing on acceptance by the child’s peer group. Aggressive boys will seek-
out aggressive friends. Friendships are made on the basis of gender grouping.
shift. With increasing age general interests become crystallized and the
friendships are more apt to be enduring. The peer group interaction has a
very decided socialization function. It has a molding effect on the child’s self-
image and goals. If the values of the peer group are discordant with those of
the child’s parents, the child may be much more susceptible to peer influence,
especially if the child has not made a strong identification with the parent of
the same sex, or if he comes from a home where nurturance has been
inadequate. This discordant value selection may also be made more likely if
the child is not accepted by his peer group and is forced to seek out the group
Games with rules, Piaget’s third category of play, come into prominence.
Hobbies, halfway between play and work, are selected. Some can lead to ego
mastery and a sense of job competence. In general, the latency child plays
down his deficiencies, plays up his achievements, plays up to his
Latency has its own special culture with its own rules, games, rhymes,
and riddles, from which all grown-ups are scrupulously excluded. Children in
middle childhood tell repetitiously the same old jokes. Their rites include
and frequently are precursors to later work. Coded communications are used
in the subsocieties of clubs, packs, and gangs, all of which pride themselves on
the group’s solidarity and individuality. Play is more realistic and imaginative.
Peer groups are meticulously organized and founded on rules, oaths, and
do not fit into the special identity of the group. Girls organize their clubs for
the express purpose of keeping other girls out and gaining strength to reject
masculinity. On the other hand, boys are much more involved with the
concrete, such as trips, games, and innumerable projects. Their trading of
902
collections and prized objects is quite common. Barter is a boy’s way of
Pubescence
spurt in physical growth. Physical changes take place including both primary
suddenly realized, with rapid spurts in height and weight and rapid growth of
the arms, legs, and neck; changes in body structure, increased sexual
impulses, and growth of the genitals occur. The triggers for pubescence are
neuroendocrinological. Both physical and emotional changes are not fully
body concern, the pubescent child is completing his shift in cognitive function
the middle childhood years often produce a picture of the dissocial or early
In general boys are more immature and more apt to regress than their
more mature and sophisticated female counterparts. Boys often feel inferior.
They fear any trace of femininity in themselves. They are concerned about
growth changes, particularly ones involving the genitals. Both boys and girls
are very much aware of body hair as an early indication of sexual maturation.
Modesty, which was of little importance during the early middle childhood
years, now becomes maximally important to shroud the child until he has
“arrived.”
904
Physical Changes in Adolescence
striking from ages 11 to 15. In the male from age 13 to 15 there occurs a
growth spurt. Fourteen inches is maximal growth for boys, the average being
about eight. The average boy gains roughly 40 pounds. Between 15 and 18
growth slows down and then ceases. The girl experiences her growth
between 11 and 13. Her average gain is five to six inches. Her growth is thus
two years earlier than that of the boy. From age 13 to 16 her growth slows
down and then ceases. The popular notion that girls mature earlier than boys
stems primarily from the fact that girls attain their adult height and weight
about two years earlier than boys.
later for boys. The “baby phase” of childhood begins to disappear. The
forehead becomes higher and wider. The mouth widens and flat lips become
fuller. The slightly receding chin of childhood begins to jut out. Relatively
large head characteristics of childhood become smaller in proportion to the
total body height, due to the fact that during this period the extremities are
growing at a faster rate than the head. The reproductive system particularly
increases in size, but the brain does not change noticeably during this period.
There is a decrease in subcutaneous fat so that the proportion of body weight
speeds up and is completed in the female by age 17 and in the male by age 19.
For the female between age 12 and 15 there is pronounced growth; for the
male, between age 15 and 16. Motor performance, coordination, strength,
speed, and accuracy in the female improve to age 14, in the male to age 17.
In the female the primary sex characteristics involve the genital urinary
This is followed by pubic and axillary hair and increased widening and
deepening of the pelvis. When ovulation appears two to four years after
changes occur from 12 to 14. Secondary sex characteristics are initially pubic
with later axillary, facial and bodily hair and changes in voice.
The sequence for the male is increasing size of the testicles and scrotum,
gland, penile growth, and the occurrence of ejaculation one year after pubic
hair. Spermatogenesis takes place between the age 15 and 16 and marks the
906
beginning of nubility.
for the American girl appears on the average at the age of 13. In 1900 the
average age was 14. This change is attributable to better health and nutrition.
Ninety-seven percent of girls have first menarche between 11 and 15, but the
age range is from 9 to 20. The year following the year during which there has
sexual maturity. In one study only 6 per cent of teen-age girls indicated any
usually occur with erotic dreams. Fischer and Dement have demonstrated
that during stage two REM sleep, penile erection occurs. A boy’s sense of
shame about nocturnal emissions may stem from his fear of instinctual
vulnerability and his concern that oedipal wishes will be detected by his
parents.
The psychic changes that take place in adolescence are part of the
908
second separation-individuation phase, which involves intrapsychic infantile
objects rather than the “raw” parental objects of the toddler years. These
Bibliography
Baldwin, A. L., Theories of Child Development, John Wiley, New York, 1967.
Barton, D., and Ware, T. D., “Incongruities in the Development of the Sexual System,” Arch. Gen.
Psychiat., 14:614-623, 1966.
Beach, F. A. (Ed.), Sex and Behavior, John Wiley, New York, 1965.
Benedek, T., “An Investigation of the Sexual Cycle in Women,” Arch. Gen. Psychiat., 8:311-322,
1963.
Birdwhistell, R. L., The Tertiary Sexual Characteristics of Man, AAAS, Montreal, 1964.
Blauvelt, H., and McKenna, J., “Mother-Neonate Interaction: Capacity of the Human Newborn for
Orientation,” in Foss, B. M. (Ed.), Determinants of Infant Behavior, pp. 38-49, John
Wiley, New York, 1961.
Blos, P., “The Second Individuation Process of Adolescence,” in The Psychoanalytic Study of the
Child, Vol. 22, pp. 162-186, International Universities Press, New York, 1967.
Bornstein, B., “Masturbation in the Latency Period,” in The Psychoanalytic Study of the Child, Vol.
8, pp. 279-285, International Universities Press, New York, 1951.
______, “On Latency,” in The Psychoanalytic Study of the Child, Vol. 8, pp. 279-285, International
Universities Press, New York, 1951.
Brown, D. G., “Sex-Role Development in a Changing Culture,” Psychol. Bull., 55: 232-242, 1958.
Campbell, J. D., “Peer Relations in Childhood,” in Hoffman, M. L., and Hoffman, L. W. (Eds.), Review
of Child Development Research, Vol. 1, pp. 289-322, Russell Sage Foundation, New
York, 1964.
Casuso, G., “Anxiety Related to the Discovery of the Penis,” in The Psychoanalytic Study of the
Child, Vol. 12, pp. 169-174, International Universities Press, New York, 1957.
Chodoff, P., “A Critique of Freud’s Theory of Infantile Sexuality,” Int. J. Psychiat., 4:35-48, 1967.
Decarie, T. G., Intelligence and Affectivity in Early Childhood, International Universities Press, New
York, 1965.
Dickes, R., “Fetishistic Behavior: A Contribution to Its Complex Development and Significance,” J.
Am. Psychoanal. A., 11:203-330, 1963.
Erikson, E. H., “Identity and the Life Cycle,” Psychol. Issues, 1:50-100, 1959.
Fenichel, O., The Psychoanalytic Theory of Neurosis, Norton, New York, 1945.
Flavell, J. H., The Developmental Psychology of Jean Piaget, Van Nostrand, Princeton, 1963.
Ford, C. S., and Beach, F. W., Patterns of Sexual Behavior, Ace Books, New York, 1951'
Frank, R. L., “Childhood Sexuality,” in Hoch, P., and Zubin, J. (Eds.), Psychosexual Development, pp.
143-158, Grune & Stratton, New York, 1949.
Freud, A., The Ego and the Mechanisms of Defense, Hogarth, London, 1936.
910
______, “The Infantile Neurosis: Genetic and Dynamic Considerations,” in The Psychoanalytic Study
of the Child, Vol. 26, pp. 79-90, Quadrangle Books, New York, 1972.
______, Normality and Pathology in Childhood, International Universities Press, New York, 1965.
______, (1919), “A Child Is Being Beaten,” in Strachey, J. (Ed.), Standard Edition, Vol. 17, pp. 175-
204, Hogarth, London, 1961.
______, (1924), “Dissolution of the Oedipus Complex,” in Strachey, J. (Ed.), Standard Edition, Vol. 19,
pp. 173-179, Hogarth, London, 1961.
______, (1931), “Female Sexuality,” in Strachey, J. (Ed.), Standard Edition, Vol. 21, pp. 223-246,
Hogarth, London, 1961.
______, (1927), “Fetishism,” in Strachey, J. (Ed.), Standard Edition, Vol. 21, pp. 149–158, Hogarth,
London, 1961.
______, (1923), “The Infantile Genital Organization of the Libido,” in Strachey, J. (Ed.), Standard
Edition, Vol. 19, pp. 141—148, Hogarth, London, 1961.
______, (1924), “The Loss of Reality in Neurosis and Psychosis,” in Strachey, J. (Ed.), Standard
Edition, Vol. 19, pp. 183-190, Hogarth, London, 1961.
______, (1908), “On the Sexual Theories of Children,” in Strachey, J. (Ed.), Standard Edition, Vol. 9,
pp. 205-226, Hogarth, London, 1961.
______, (1938), “An Outline of Psychoanalysis,” in Strachey, J. (Ed.), Standard Edition, Vol. 23, pp.
141-208, Hogarth, London, 1961.
______, (1917), The Sexual Life of Human Beings,” in Strachey, J. (Ed.), Standard Edition, Vol. 10, pp.
3-148, Hogarth, London, 1955.
______, (1925), “Some Psychological Con sequences of the Anatomical Distinction between the
______, (1940), “Splitting of Ego and Process of Defense,” in Strachey, J. (Ed.), Standard Edition, Vol.
23, pp. 271-278, Hogarth, London, 1961.
______, (1905), “Three Essays on the Theory of Sexuality,” in Strachey, J. (Ed.), Standard Edition,
Vol. 7, Hogarth, London, 1961.
Fries, M. E., “Review of the Literature on Latency Period,” J. Hillside Hosp., 7:3-10, 1958.
Gelenson, E., “Prepuberty & Child Analysis (Panel Report),” J. Am. Psychoanal. A., 12:600-609,
1964.
Goodman, S., “Current Status of the Theory of the Superego Report,” J. Am. Psychoanal. A., 13.172-
180, 1965.
Hartley, R. E., and Hardesty, F. P., “Children’s Perception of Sex Role in Childhood,” J. Genet.
Psychol., 105:43-51. 1964.
Hartmann, H., “The Genetic Approach to Psychoanalysis,” in The Psychoanalytic Study of the Child,
Vol. 1, pp. 11-30, International Universities Press, New York, 1945.
Hendrick, I., Facts and Theories of Psychoanalysis, Alfred A. Knopf, New York, 1958.
Hoffman, M. L., and Hoffman, L. N. W. (Eds.), Review of Child Development Research, Vol. 1, Russell
Sage Foundation, New York, 1964.
Jacobson, E., The Self and the Object World, International Universities Press, New York, 1964.
Jessner, L., and Pavenstedt, E. (Eds.), “Some Observations on Children Hospitalized during
Latency,” in Dynamic Psychopathology hi Childhood, pp. 257-266, Grune & Stratton,
New York, 1959.
912
Jones, E., “The Phallic Phase,” Int. J. Psychoanal., 14:1-33, 1933.
Kagan, J., “Acquisition and Significance of Sex Typing and Sex Role Identity,” in Hoffman, L. W.,
and Hoffman, M. L. (Eds.), Review of Child Development Research, Vol. 1, pp. 137-
168, Russell Sage Foundation, New York, 1964.
______, “The Concept of Identification,” in Mussen, P. H., Conger, J. J., and Kagan, J. (Eds.), Readings
in Child Development and Personality, pp. 212-224, Harper, New York, 1965.
Kaplan, B., and Wapner, S. (Eds.), Perspectives in Psychological Theory, International Universities
Press, New York, 1960.
Kardiner, A., Karush, A., and Ovesey, L., “A Methodological Study of Freudian Theory,” J. Nerv.
Ment. Dis., 129.11-19, 133-143. 207-221, 341-356, 1959.
Katin, A., “Distortions of Phallic Phase,” in The Psychoanalytic Study of the Child, Vol. 15, pp. 208-
214, International Universities Press, New York, 1960.
Kernberg, O., “A Contribution to the Ego. Psychological Critique of the Kleinian School,” Int. J.
Psychoanal., 50:317-333, 1969.
Kestenberg, J. S., “Vicissitudes of Female Sexuality,” J. Am. Psychoanal. A., 4:453-477, 1956.
Kidd, A. H., and Rivoire, J. L. (Eds.), Perceptual Development in Children, International Universities
Press, New York, 1966.
Kinsey, A. C., et al., Sexual Behavior in the Human Female, Saunders, Philadelphia, 1953.
Koff, R. H., “A Definition of Identification: A Review of the Literature,” Int. J. Psychoanal., 42:362,
1961.
Lampl-DeGroot, J., “Ego Ideal and Superego,” in The Psychoanalytic Study of the Child, Vol. 17, pp.
94–106, International Universities Press, New York, 1962.
______, “On Masturbation and Its Influence on General Development,” in The Psychoanalytic Study
of the Child, Vol. 5, pp. 153-174, International Universities Press, New York, 1950.
______, “The Pre-Oedipal Phase in the Development in the Male Child,” in The Psychoanalytic Study
of the Child, Vol. 2, pp.75-83, International Universities Press, New York, 1946.
Laurendeau, M., and Pinard, A., Causal Thinking of the Child, International Universities Press, New
York, 1962.
Levy, D., “Studies of Reaction to Genital Differences,” Am. J. Orthopsychiat., 10: 755-762, 1940.
Lichtenstein, J., “Identity and Sexuality,” J. Am. Psychoanal. A., 9:179-260, 1961.
McDougall, J., “Primal Scene and Sexual Perversion,” Int. J. Psychoanal., 53:371-384, 1972.
MacLean, T. D., “New Findings Relevant to the Evolution of Psychosexual Functions of the Brain,”
J. Nerv. & Ment. Dis., 135:289-301, 1962.
Mahler, M. S., “On the First Three Subphases of the Separation-individuation Process,” Int. J.
Psychoanal., 5,3:333-338, 1972.
Maier, H. W., Three Theories of Child Development, Harper, New York, 1965.
Mead, M., “The Childhood Genesis of Sex Differences in Behavior,” in Tanner, J. M., and Inhelder, B.
(Eds.), Discussions on Child Development, Vol. 3, pp. 13-90, International
914
Universities Press, New York, 1958.
Minuchin, D., “Sex-Role Concept and Sex Typing in Children as a Function of School and Home
Environments,” Child Dev., 36:1033-1048, 1965.
Money, J., “Psychosexual Differentiation,” in Money, J. (Ed.), Sex Research, pp. 3-23, Holt, New
York, 1965.
______, Hampson, J. G., and Hampson, J. L., “Imprinting and the Establishment of Gender Role,”
Arch. Neurol, & Psychiat., 77:333-336, 1957.
Mullahy, P., Oedipus: Myth and Complex, Hermitage Press, New York, 1948.
Mussen, P. H., Conger, J. J., and Kagan, J., Child Development and Personality, Harper, New York,
1965.
Nacera, H., “Early Childhood Disturbances, the Infantile Neurosis, and the Adulthood
Disturbances,” in The Psychoanalytic Study of Child, International Universities
Press, New York, 1966.
Novick, J., and Novick, K. K., “Beating Fantasies in Children,” Int. J. Psychoanal., 53:237-242, 1972.
Parsons, T., “The Incest Taboo in Relation to Social Structure and the Socialization of the Child,”
Brit. J. Sociol., 5.101-117, 1954.
Pauly, I. B., “Male Psychosexual Inversion: Trans-sexualism,” Arch. Gen. Psychiat., 13:172-181,
1965.
Peller, L., “Reading and Daydreams in Latency: Boy-Girl Differences,” J. Am. Psychoanal. A., 6:57-
70, 1958.
Rado, S., “An Adaptational View of Sexual Behavior,” in Psychoanalysis of Behavior, Vol. 1, pp. 201–
203, Grune & Stratton, New York, 1956.
Ramsey, G. V., “The Sexual Development of Boys,” Am. J. Psychol., 56:217-233, 1943.
Raphinc, D. L., Carpenter, B. L., and Davis, A., “Incest: A Genealogical Study,” Arch. Gen. Psychiat.,
16:505-512, 1967.
Raush, H. L., and Sweet, B., “The Preadolescent Ego,” Psychiatry, 24.122-132, 1961.
Reevy, W. R., “Child Sexuality,” in Ellis, and Abarbanel, A. (Eds.), The Encyclopedia of Sexual
Behavior, Vol. 1, pp. 258-267, Hawthorn Books, New York, 1961.
Roiphe, H., and Galenson, E., “Early Genital Activity and the Castration Complex,” Psychoanal.
Quart., 41:334-347, 1972.
Rutter, M., “Normal Psychosexual Development,” J. Child Psychol. & Psychiat., 11:259-283, 1971.
Salzman, L., “Psychology of the Female,” Arch. Gen. Psychiat., 17.195-204, 1967.
Sandler, J., “On the Concept of the Superego,” in The Psychoanalytic Study of the Child, Vol. 15, pp.
128-162, International Universities Press, New York, 1960.
______, et al., “The Ego Ideal and The Ideal Self,” in The Psychoanalytic Study of the Child, Vol. 18, pp.
139-158, International Universities Press, New York, 1963.
______, and Rosenblatt, B., “The Concept of the Representational World,” in The Psychoanalytic
Study of the Child, Vol. 17, pp. 128-148, International Universities Press, New York,
1962.
Segal, H., Introduction to the Work of Melanie Klein, Basic Books, New York, 1964.
916
Slater, M. K., “Etiological Factors in the Origin of Incest,” Am. Anthropol., 61: 1042-1047, 1959.
Sours, J. A., “Growth and Emotional Development of the Child,” Postgrad. Med., 40.515-522, 1966.
Spitz, R. A., “The Derailment of Dialogue,” J. Am. Psychoanal. A., 12.752-775, 1964.
______, The First Year of Life, International Universities Press, New York, 1965.
______, “A Note on the Extrapolation of Ethological Findings,” Int. J. Psycho-anal, 36:162-165, 1955.
Stoller, R. J., “A Contribution to the Study of Gender Identity,” Int. J. Psychoanal, 45.2 20-226,
1964.
______, “The Hermaphroditic Identity of Hermaphrodites,” J. Nerv. & Ment. Dis., 139-453-457, 1964.
______, “Passing and the Continuum of Gender Identity,” in Marmor, J. (Ed.), Sexual Inversion, pp.
190-210, Basic Books, New York, 1965.
Tennes, R. H., and Lampl, E. E., “Stranger and Separation Anxiety in Infancy,” J. Nerv & Ment. Dis.,
139:247-254, 1965.
Velikovsky, I., Oedipus and Acklination, Sidgwick & Jackson, London, 1960.
Waelder, R., Basic Theory of Psychoanalysis, International Universities Press, New York, 1960.
Woodward, M., “Piaget’s Theory,” in Howell, J. G. (Ed.), Modern Perspectives in Child Psychiatry,
Charles C Thomas, Springfield, Ill., 1965.
Yarrow, L. J., “Separation from Parents during Early Childhood,” in Hoffman, M. L„ and Hoffman, L.
N. W. (Eds.), Review of Child Development Research, Vol. 1, Russell Sage Foundation,
New York, 1964.
918
Chapter 15
Cognitive Development
Jules R. Bemporad
Introduction
has caused one writer to call cognition the Cinderella of psychiatry. As in the
fairy tale, in recent years this neglected Cinderella has indeed been
The reasons for this sudden surge of interest in cognition, which for
many years had been the domain of somewhat isolated academicians, are
many and complex. On a theoretical level the existence of mind has again
to deal solely with stimulus and response has lost its former prominence. It
organism, which then selects a response pattern. The ever increasing number
psychoanalytic theory has shown that behavior is more than the simple
the self, and object-relations that are difficult to integrate with classical
metapsychology and seem to imply cognitive rather than energetic structural
models. Therefore, the importance of the cognitive functions of the mind has
reasserted itself in terms of dealing with both external and internal
stimulation.
920
reliance on retrospective accounts of adults has underscored the need for an
childhood as well as the eventual psychic world of the adult. The more
children were studied, the more it became apparent that their behavior could
not be explained solely on the basis of accumulated S-R habits or on the basis
area of study in psychiatry. This has been a salutary change since, after all, in
textbook, tn the following pages some of the more pertinent issues, as well as
summarized.
ontogenesis. Although the causes for the course of this development are
reinforce inborn patterns. There is also a great emphasis on the role of mental
necessary for the growth of cognitive skills. Underlying this view of cognitive
development as an evolving progression toward more increasing complexity
is the concept of epigenesis, which states that mature abilities at each stage
grow out of simpler forms of cognition and that these complex abilities are
922
simple innate reaction patterns and passing through various phases to
culminate in adult capabilities such as abstract ideas, relative independence
At each stage the mind is seen as actively structuring a world view, beginning
with a primitive logic of action and building on each successive stage to
complexity.
position. Plato’s doctrine of Anemnesis proposed that prior to earthly life the
tradition thus holds that the sources of knowledge derive from innate
structures that are independent of experience. Perhaps the most extreme
adherent of this view was the philosopher Leibnitz who conceived of the
mind as a “windowless monad” that had no contact with its environment and
whose experience was the unfolding of a predetermined program.
the mind’s gradual accumulation of sense data. As John Locke proposed, the
mind at birth is a tabula rasa, a blank tablet, which has no inborn structure or
organization, and upon which are imprinted the perceptions of sense data.
The empiricist tradition had its greatest popularity in England and France in
his attempts to educate the “wild boy” of Aveyron. Itard’s two monographs
defective children. However, Itard’s intent was to prove the correctness of the
develop the mind of a boy who had apparently lived alone in the forests of
France until puberty. Ultimately Itard’s experiment ended in failure: the child
never attained the use of language, and Itard concluded that the wild boy had
been born defective. It may well be, however, that too many years had passed
and that it was too late for linguistic abilities to be formed.
924
any, theorists would subscribe to either a strict idealism or empiricism in
is less a question of how much is due to innate or learned abilities than how
do these two sources of development interact to reinforce each other and
deprivation or overstimulation.
behavior. In primates and humans Hebb speculates that there occur two
and can be observed in very young children or in more mature organisms that
were deprived of specific stimulation (such as children born with congenital
prolonged and less effective form of the primary type. It seems that as we go
up the phylogenetic scale, there is an increase of type two learning but also
that type one learning takes longer and longer. For example, a rat reared in
darkness may require 15 minutes to an hour to learn a visual task after
which combine and integrate these sense data. Through phylogenesis there is
low A/S ratios show rapid primary learning since sensorimotor sequences
are easily established because there is a paucity of association fibers to be
organized. However, this same lack of association areas limits the amount of
flexibility of behavior after the connections have been established. In
contrast, organisms with high A/S ratios require a great deal of time for
stimuli to organize the massive association areas. However, once this is
importance for higher organisms since it is during this period that the
926
association areas are structured and thus cognitive relationships may be
formed that persist throughout life. This aspect of Hebb’s work strongly
writings Hebb seems to view the plasticity of the very young nervous system
Some support for Hebb’s theories has come from Sapir’s and Whorf’s studies
Hebb’s work is closely related to what has been termed “critical period”
environment interaction, stressing that there are “critical times” for certain
Critical period theory evolved from the field of ethology with the early
that as a result of this one-time presentation, his image had been “imprinted”
in the chicks. Later experiments by Hess showed that there were peak times
for imprinting to occur and that after a certain amount of maturation
imprinting could no longer be elicited. Scott’s work with puppies showed that
even in higher species there were optimal times for the formation of an
raised in isolation for two years were grossly abnormal in play, defensive, and
sexual behavior; those raised in isolation for six months were able to develop
some play behavior; while those who returned to a natural setting after 80
days of age showed an almost total reversal of the isolation effects. There
was ineffective.
Rene Spitz found that infants who were separated from their mothers at six
months of age and were not provided with an adequate substitute became
months, after which reunion with the mother did not completely nullify the
928
the eventual developmental defects as a result of stimulus deprivation rather
than the absence of mothering. Similarly Province and Lipton found that
The pressing questions raised by critical period theory are whether the
patterns. Counterarguments are that most of the evidence for critical periods
has been in lower species, which, as described by Hebb, have little capacity
are thus less able to modify past learned behavior. Also most critical periods
studied involve formation of affective rather than cognitive functions. The
lack of hard evidence for the existence of critical periods in human cognitive
development has caused Wolff to criticize strongly the application of this
intellectual growth. Wolff believes that the greater complexity of the human
brain makes feasible much more flexibility than critical period theory allows.
such as the learning of a second language, but that on the whole the human
mind can make compensations that are beyond lower species. In support of
his argument he quotes recent stud- ies that seem to indicate that the effects
of early deprivation are not as irreversible as previously thought. Another
important point raised by Wolff is that there is little agreement about what
language skills and abstract ability; however, the cause as well as the best
methods for remediation are still hypothetical.
not develop the ability to identify nuances of sound.[3] Fineman stresses the
importance of mother-infant interplay in the development of an active inner
fantasy life and ultimate cognitive ability. Pavenstedt emphasizes the need for
930
emotional tranquility and regularity for any learning to take place.
Most remedial programs have found that intervention before age three
is crucial, some suggesting that compensatory tutoring should begin prior to
unless early cognitive tasks are properly mastered, later development will be
deficient. However, positive care during the first three years does not insure
throughout childhood. In fact, most of the gains made by Head Start programs
have been rapidly lost once these programs were discontinued. The
difficulties that beset attempts to specify the causes of deficient cognitive
years, respect for autonomy and curiosity during early childhood, parental
motivation and models during middle childhood, and the effect of peer
from the total growth of the child. Recent studies have shown that children
learn predominantly through action, that sensory stimulation by itself is
darkness, but regularly placed in a circular drum whose interior was painted
kitten was placed in a gondola directly opposite the “active” kitten, but it was
unable to exercise. Each time the active kitten moved, he caused the “passive”
kitten to be passively moved by a bar connecting the kittens. In this manner
hours in the apparatus the active member of each pair showed normal visual
behavior in terms of averting collision with objects, not going off a “visual
cliff,” and so forth. After the same period the passive kitten failed to show
these behaviors.
932
by “development?” It is well known that a 15 year old can perform mental
tasks that are beyond the capacity of an 8 year old, who, in turn, can utilize
little in terms of theory beyond the known fact that certain abilities increase
with age.
stages through which the species had traversed in evolution. The behavior of
showed the influence of our simian ancestors just as the pleasure in outdoor
very similar theory was espoused by Thorndike, who saw the behavior of the
child as expressing those actions that had allowed the species to survive.
with phylogeny. Today these two processes are seen as similar but far from
identical so that the one cannot be used to explain the other, although both
may follow analogous laws.
himself in a series of articles and his major book, The Comparative Psychology
open system. He thus antedated “general systems theory” and was a pioneer
934
in the field of theoretical model-building for biological systems. Through this
however, for our purposes the discussion will exclude these other
as the mere addition of new abilities. For Werner development is creative and
organismic, bringing about totally new abilities and radically changing the
developing entity. Each new stage represents a totally new organizational
to those determining the preceding level” (p. 22). Werner attempted to find
standards by which to compare and measure these differing stages of
development. The two major changes that occur in development and that thus
could be used to assess it were: (1) that development proceeds from a state of
relative globality to a differentiation of parts, and (2) that there is an
the same board. In comparing the adjustments made for a static picture
(grazing horse) and a dynamic picture (running horse), it was found that
younger children increasingly adjusted the dynamic picture series to a slower
speed than the static picture series. The dynamic aspects of the presented
form were syncretically fused with its actual speed for the younger children
so that the running horse series seemed to be moving faster than the grazing
936
horse series.
qualities that to the adult seem separate from the object itself.
perception.” Werner means that the child ascribes human qualities to all sorts
of objects so that they appear animate and express some sort of inner life. A
rock may be happy or a hat may be sad. Even adults retain this form of
while for the adult the imagery is metaphorical, the child actually ascribes
feelings to inanimate objects, again fusing qualities that to the adult seem
quite discrete. Werner also noted that in pathological states such as brain
damage and schizophrenic psychosis there is a regression of formal thought
relation to the whole. Werner showed this tendency of young children to omit
More complex figures were similarly simplified. A more crucial aspect of the
detail of the whole with the whole itself. Werner reports a boy who was afraid
of spiders becoming upset when a hair stuck to his fingers. When the hair was
removed the child asked, “Didn’t the hair bite you?” showing that he equated
qualities (biting) of the whole (spider) with the part (hair). In an analogous
made the situation of being picked up by uncle identical to being fed by nurse.
Again the use of part-symbols to represent wholes is often used by adults in
allegorical works, but to the child the identity of the associated situations or
objects is real rather than poetic or metaphorical. Werner termed this type of
938
cognition pars pro toto (or part for whole) reasoning. This type of logical
similar parts.
The remaining three parameters can be dealt with more briefly. The
the “organismic” point of view. Wapner describes four major stages in the
cognitive development of the child. The first is the biological-organismic level,
which thought and behavior are dominated by the most striking perceptual
elements in the environment. The last stage is the conceptual operations level,
events rather than pure mirroring of reality. Wapner stresses, as did Werner,
that as newer levels are reached, the older cognitive styles are not eliminated
defining discrete stages. The more painstaking and perhaps thorough task of
studying the child’s cognitive behavior as it relates to developmental stages
940
as well as the total process has been more closely actualized by Piaget and his
Theoretical Introduction
adult.
of this kind they turned to the study of the child and in so doing promoted
child psychology to the rank of genetic psychology. Genetic psychology
experience, Piaget shows his basic roots in biology and his great debt to
time this knowledge cannot go beyond our actual experience as human beings
instincts; (2) learning that relates to the concrete physical world; and (3)
logical mathematical structures that are utilized in nonrepresentational
ability to vary the course of a behavioral response for maximum benefit. For
Piaget, cultural or social interaction takes the place of previously fixed
942
scale, the id becomes increasingly estranged from its reality, giving rise to the
and fulfillment; for Piaget, however, this development of mind does not bring
about any psychological disharmony.
action process. Cognitive functions not only subserve action but also are
forms of action themselves. Thinking is not only for action but also is action.
sequences; thus the early motor action sequences constitute the source of all
later cognitive operations. This stress on mind as action and as specifically
concerned with solving problems that will insure adequate functioning helps
explain Piaget’s notion of the nature of intelligence and of some of the driving
forces in cognitive growth. This view of thought as internalized action shows
meant the process whereby “reality data are treated or modified in such a
way as to become incorporated into the structure of the subject.” The
into the existing mental capabilities of the subject. For Piaget “intelligence is
assimilation to the extent that it incorporates all the given data of experience
within its framework.” The corollary process, accommodation, occurs when
must modify itself to deal with this new experience. Each process is never
pure since each assimilation introduces some new element that causes
accommodation; and each accommodation, by creating new mental schemes,
sets the stage for more sophisticated assimilation. It is this interplay between
and response. The cyclic process can be found in all stages of development,
944
abstract formulations.
to describe development, these are not the forces that cause cognitive growth;
rather Piaget delineates four general factors that are important causes for
acquired experience from action performed upon physical objects. This area
physical world. The third factor is social interaction and transmission. The
This last factor is as far as Piaget seems willing to go in favor of any pre-
“in the development of the child there is no pre-established plan but a gradual
various stages of development. This goal helps explain his most frequently
able to document a series of stages that describe the major cognitive modes of
childhood. What changes during development are the mental schemes, the
mode of organizing and constructing experience.
The earlier or more primitive schemes are concerned with action per se
assurance and finds the nipple more easily when it has slipped out of his
mouth than at the time of his first attempts.” This stage of reflexes gives rise
to the stage of acquired habits. The infant begins coordinating vision and
prehension; that is, the child begins to manipulate freely objects in his visual
946
field. This ability to act upon environmental objects initiates what J. M.
turn, tends to affect further behavior. In this manner the response pattern
tends to prolong itself and to stabilize its own existence. Through a positive
a repetition of the act that had fortuitously produced the change. This type of
behavior appears around four months of age and ushers in the beginning of
rattle at this stage. At the same time the child begins to separate internal
actions from external results. He begins to form the concept of an external
world of permanent objects existing in continuous space. After the age of four
months the child begins to react toward a partially hidden object, such as the
nipple or a bottle, as he formerly did toward the whole bottle. In the next
stage of the sensorimotor level extending from 8 to 12 months, the child is
able to utilize his action schemes in new situations to produce novel results
and achieve new goals. The schemes have become an instrumental act that
about one year of age the child can search for an object if it is placed behind a
barrier. Thus the child has the concept of the permanence of that object that
continues to exist even when it is not directly observed. However, if the object
is removed from behind one barrier and in full view of the child placed behind
a second barrier, the child will continue to search for it behind the first. The
child has the idea of object permanence but not of the multiple displacements
of the object. It has to exist where it belongs. It is not until a later stage
the multiple displacement of objects and to search for the object wherever it
was last put. Yet at this stage the child still cannot cope with “invisible”
movements. Thus if an object such as a ball is held in a clenched fist, the fist
put behind a pillow and out of view of the child, and the ball released behind
the pillow, the child will persistently search the hand for the ball, never
considering that the ball may have been left behind the pillow. It is only with
witness directly and thus searches for the ball behind the pillow even though
948
tertiary circular reactions whose central attribute is the invention of new
behaviors to achieve desired ends. In the secondary circular reactions the
child was able to use established patterns in novel situations. Here the
accidentally stumbled upon. It is important to note that these schemes are not
created de novo but evolve from acquired habits that, in turn, grew out of
innate reactions.
The child is able to find new means, not only by “external or physical groping
to realize their permanence. The ability to picture objects mentally allows the
able to cross a path from multiple fixed positions is basic to seeing space as a
continuous medium. At the same time the internal representation of space is
necessary for the child to see himself in a space and to be able to follow a
continuous map from one position to another. A possible limitation of Piaget’s
stage plays in later life. Similarly, although Piaget has devoted an entire book
schemes that make possible the mental manipulations of objects that are not
thought but not necessarily so in reality. Prior to this stage the schemes are
“preoperational.” They are composed of internalized actions but are still tied
thinking, which should be taken only in its epistemological sense: the child
cannot put himself in the place of another person. For example, when asked to
950
describe the view of a model of mountains from positions other than his own,
the child at the preoperational level is unable to describe or to select out a
proper perspective of the model other than what he sees from his own
rather than to expand these categories to give a more realistic grasp of his
fantasy in play. The play is unhampered by external rules, which are altered
as the situation demands, or by a strict adherence to the realistic nature of
This level of intelligence can further be subdivided into two stages, that
of preconceptual thought, which lasts from roughly age two to age four, and
that of intuitive thought, which lasts from roughly age four to age seven. The
former stage begins with the internalization of action, that is, the conceptual
intelligence. The child shows deferred imitation, which gives evidence of the
symbolic play and through the use of drawing and painting materials. Finally
the development of language gives the child the usage of symbols by which to
sensorimotor level the child had to follow events without altering their
speed). The reasoning of the young child, however, is still concrete and at the
same time distorts reality. Piaget describes how the young child forms
equated with the whole in relating objects. The child has not as yet derived a
to group objects into classes, but only on a perceptual rather than a cognitive
basis. The child has not achieved the primacy of thought over appearance. For
example, Piaget presented children with a box containing 20 wooden beads,
18 of which were brown and 2 of which were white. The children were then
asked whether a necklace made from the brown beads would be longer,
the intuitive level mostly replied that the brown beads would make the longer
necklace. From this and similar experiments Piaget concluded that the child
952
at this stage is incapable of thinking of two subordinate classes, that is, white
and brown beads, at the same time as he is thinking of the whole class, that is,
the total number of wooden beads. The child’s attention is centered on the
of “brown beads to white beads” to the relation of “brown beads to the total
longer even after they acknowledge that there are more wooden beads than
brown beads. The point is that these two aspects of the same situation cannot
roughly age seven to age eleven, however, the child immediately answers that
the wooden bead necklace would be longer because “there are more wooden
beads than brown beads.” Here the child can simultaneously take into
consideration the relation of brown beads to white beads (part to part) and
brown beads to wooden beads (part to whole). Piaget asserts that at this later
stage the child’s thought is “decentered,” that is, no longer exclusively focused
on the perceptual, and is “reversible,” that is, can move back and forth
two identical beakers, A-1 and A–2, which the child acknowledged as the
B-1 and B–2, directly in front of the child. The child is then asked if the liquid
in the beakers B-1 and B-2 was equal to the amount in the original beaker A-
1. Children at the intuitive level of intelligence felt that the quantity of liquid
had been altered when poured into the two smaller beakers. Similar
alterations in quantity were ascribed to when the liquid was poured into
different shape beakers, although here again the liquid was poured directly in
view of the child. Piaget concludes that these interpretations are due to the
child’s lack of the schemes of reversibility and conservation; the child centers
on what he sees and cannot disengage his thought from his perceptions so
that he can mentally reverse the process and conclude that the amounts of
water were originally the same. Because of this perception bound set the
child cannot consider two aspects of one situation simultaneously, but can
only examine one aspect at the expense of all the others. For example, when
the child at this stage is shown a ball of clay that is rolled into a sausage
shape, he will say that there is either more clay because the sausage is longer
than the ball or less clay because the sausage is thinner than the ball. The
child cannot conceive of the ball simultaneously becoming both longer, thus
having more clay, and thinner, thus having less clay. It is this ability to attend
that leads to the scheme of conservation and marks the beginning of the
operational stage. Similarly with the bead experiment described above, the
954
child in the preoperational stage cannot conceive that white beads and brown
egocentric. He can shift rapidly between his own views and the views of
logical, rather than a haphazard, perceptual structure. The child forms the
schemes of reversibility and conservation despite perceptual evidence to the
Yet during the first part of the operational period children can only
reason in this manner when they are actually manipulating concrete objects.
darker than Lois. Who is the darkest of the three?” The child can reason
(classes), to the relations between objects and the counting of objects. Thus
the logical organization of judgments and arguments is inseparable from their
content.” The child can only reason with what is palpably before him. He
makes the advance to the stage of formal operations possible. In this final
stage there is a disconnection of thought from concrete objects so that the
mind is capable of dealing with relationships between things rather than with
advance are that the adolescent can conceive of the future and plan for it, can
think not only about concrete things but also about his own thought.
956
Furthermore, this ability to consider all alternatives leads to an
a preliminary inventory of all the factors and then varies each factor alone,
keeping the others constant. At the level of concrete operations the child
concrete and formal operations quite clearly. They arranged a series of jars of
colorless liquids and then showed the child that by adding a few drops from
the last jar to an unknown mixture of the liquids a yellow color could be
produced. The significant aspect of this problem was that there was no way
for the child to figure out ahead of time which mixture of liquids would
produce the yellow color once the indicator was added. Inhelder and Piaget
arrive at the yellow color. The younger child attacked the problem by adding
a few drops from the last jar to each of the others and then felt essentially
not think of mixing various liquids and then adding the drop from the last jar.
The child at the stage of formal operations, however, solved the problem by
only solved the problem but also identified the different liquids as to their
relationships. For example, one jar contained a substance that prevented the
can generate theories about relationships and derive laws that will explain
operations is that the latter are centered on reality whereas the former grasps
transformations and assimilates reality only in terms of imagined or deduced
events.[6]
It will be obvious at this point that Piaget and his associates have
derived an enormously rich and complex concept of development, any small
958
loose, disconnected pattern. Objects and events form groupings rather than
decentering allows the mind to follow reason rather than appearance. Piaget
different, with perception being an inferior and more rigid form of behavior.
the real world. At first these operations are possible only when directly
in biology, stressing that each advance in schemes serves the more pertinent
purpose of organismic adaptation. Piaget seems most interested in the mind
various stages. As such, he has been less interested in the irrational, poetic,
and creative aspects of mind, and his effort has been one of a rigorous
In recent years there has been a renewed interest in Piaget that might
be best described as an explosive revival. Piaget has been discovered, not just
example, found that children of varying social classes did equally well on
experiments like Piaget’s until two years of age, when lower socioeconomic
Odier has utilized much of Piaget’s work to show the childhood origins of
forms of cognition. For example, Odier sees a resemblance between the child’s
reification of his own feelings and perceptions in believing in their objective
960
applications have been salutary, Piaget has warned against the overly
pragmatic use of theory and what he calls “the American question,” meaning
strong point that development has to proceed at its own pace. Too much
stimulation or instruction is simply not assimilated and eventually might be
harmful.
theoretical hypotheses rather than practical aspects of his own work. While
much applied, and misapplied, to all sorts of educational and psychological
have always been a part of psychoanalysis, these have been used mainly in
model, mental excitation flowed from sensory structures to the motor process
that discharged the excitation. Along this basically S-R path memory traces
When, however, the ability to discharge the energy through action was
blocked, it reversed its flow back toward the sensory end, resulting in an
internal psychic experience rather than action. This model sought to account
for dreams, hallucinations, and psychiatric symptoms. The point of this model
energy is blocked. In a later paper Freud used the same model to account for
the mental life of infants and the development of thought. The beginnings of
thought or images appear when instinctual satisfaction, and thus the
962
attempt at wish fulfillment and follows what Freud called the “pleasure
gratify the instinctual need, and the infant must come to grips with external
century.
revisions brought about by the “structural theory” and ego psychology, the
means of trial action that helped the individual adapt to his environment.
Later psychoanalytic thought stated that the ego does not arise out of
the id through conflict resolution, but that the ego and its functions develop
stresses that the ego (and thus cognitive functions) has an autonomous
development that unfolds throughout ontogenesis and that development is
solely concerned with the discharge of energy through any means. Its goal
was release of tension or pleasure, and it was not characterized by any strict
this meant that instinctual energy could be displaced onto neutral figures, or
this facilitated tension reduction. The primary process was essentially the
mode of the unconscious; it manifested itself in dreams, psychosis,
964
parapraxis, and other symptoms that revealed the true instinctual desires of
the individual. On the other hand, the secondary process is characterized by
Aristotelian logic and typifies most of our everyday conscious behavior. This
terms of development the infant’s cognition follows the primary process and
frustrations, however, the infant learns to cope with the environment, and
through the attainment of the reality principle he develops secondary process
process and the development of ego controls over the biological drives that
cannot be expressed because of environmental restrictions have formed the
the child. David Rapaport, who was perhaps the psychoanalytic theorist most
interested in cognitive theory, stated quite clearly that the major concern of
psychoanalytic formulations in the development of cognition was to trace the
child development repeat the theme of ego mastery and view cognitive
growth only in the service of this primary aim.
cognitive processes as significant in their own right and not simply as better
study to the child’s cognitive experience and lessening the emphasis on the
beginning stages and has not as yet arrived at definitive formulations. Other
authors who have dealt with topics such as identity formation or the relation
who has dealt with the development of inner reality and motivational forces
from a truly cognitive frame of reference. While praising the psychoanalytic
emphasis on inner life, Arieti’' disagrees with its stress on instinctual and
higher order concepts such as expectancies of others, demands from the self,
966
and internalizations of significant others rather than discharge of energy or
has not been with the child’s ability to manipulate the physical environment
as much as with the transformation that occurs in intrapsychic life.
Toward the end of the first year of life, according to Arieti, the infant
and relationships. The child can create an image—a memory trace that has
mechanisms but a psychological content that retains the power to affect its
possessor, now and in the future. In contrast to Piaget and some of the stricter
environment. Arieti calls these feelings “second order emotions” because they
are not elicited by immediate, external threats to homeostasis but by the
external event. In this manner purely inner cognitive events begin to alter the
life of the child. As early as 1947 Arieti attempted to separate fear and anxiety
on a cognitive basis: fear is a primitive reaction to an environmental object,
while anxiety results from an anticipated image, that is, from a cognitive
construct.
At this stage of development the child also constructs what Arieti has
termed the “paleosymbol.” By this he means a specific mental concept that
represents something that truly exists in reality but whose meaning and value
are highly private and personal; the meaning of the paleosymbol is not
paleosymbols may account for the young child’s seemingly irrational likes or
fears of common objects. According to parental handling, neutral objects such
968
but also it is essential for the construction of inner life; they become the
reality. Much of what has only internal meaning is projected or acted out on
the environment. The child readily mixes fantasy and fact. This flexibility may
account for the richness of clinical material that may be obtained through
symbolic play techniques with children. At this stage they literally act out
their inner fantasies through the use of dolls and the like, losing themselves in
the context of play so that it is no longer “play” in the adult sense of the word,
ft is only gradually that the child separates the two domains of internal and
of expression.
primitive and its logical characteristics. During the first stage there is an
categories, but the associative linkages are highly arbitrary and idiosyncratic.
adult. Objects or events are seen as identical if they have one quality in
970
objects were associated by their most prominent perceptual quality, as well
as to Werner’s pars pro toto functioning. It is also similar to what Freud had
For example, an individual may dream that he is in the presence of a king, and
on analysis of the dream he will reveal that the king was representative of the
dreamer’s father. Here a similar element (exalted authority) had been used to
organization the “primary class.” In contrast, what Arieti calls the “secondary
events that have elements in common, but these elements are seen as
separate from the object that may be abstracted or conceived of in pure form.
This type of organization that underlies adult thought does not deduce
While the phantasmic world was predominantly visual and static, the
rudimentary abstractions. The child can begin to reason and to build on his
experience: he can separate similar data from the manifold of objects and
begin to organize these objects into classes. However, because this process of
abstraction is far from complete, the part is often confused with the whole, or
organization and are unfortunately retained into adult life. These early
misrepresentations are all too often seen in the irrational behavior of adults.
Concomitant with this increased ability to organize life events, the child
in which most things occur because someone has so willed them. Arieti
pertinent aspect of this new dimension of thought for the emotional and
cognitive development of the child is that events are caused by people and
thus one is responsible for these events. This new insight is necessary for
what Arieti calls “third order” emotions. These emotional states presuppose a
knowledge that a person can have an emotional affect on another, that one
972
can cause a feeling state in someone else. Typical of this highest class of
emotions are depression, hate, love, and joy. Here again Arieti is stressing that
When the child reaches the level of conceptual thought—that is, his
truly prevail and concepts are organized into secondary classes. This type of
instinctual energies. As the child develops, higher order concepts form his
as cognitive entities that grow through ontogenesis. Arieti has stressed that
974
reconstruction and understanding of the inner world of childhood has an
important place in the study of cognitive development.
Conclusion
in the world can be mentally represented. Once this internal world is created,
the child begins to structure stimuli and select adaptive responses rather than
which events and objects are associated by primitive logical linkages, into
formulate cognitive laws to order the chaotic world of the senses are the
complexity of our modern industrial society, greater than at any time in the
past were the province of a very small privileged minority. Despite this
requirement for more sophisticated levels of mentation for both economic
achieve this ultimate aim and cannot share in the rewards or responsibilities
of modern society. The study of how the mind develops, the forces that affect
this development, and the ways to correct deficiencies due to both internal
and external forces has thus become a desperately important scientific
discipline, not simply for the satisfaction of intellectual curiosity, but for the
greater benefit of all.
Bibliography
976
Anthony, E. J., “The Significance of Jean Piaget for Child Psychiatry,” Brit. J. M. Psychol., 29:20-34,
1956.
Arieti, S., “Cognition and Feeling,” in Arnold, M. B. (Ed.), Feelings and Emotions, Academic Press,
New York, 1970.
_____, “Contributions to Cognition from Psychoanalytic Theory,” Science and Psychoanalysis, 8:: 16
—37, 96.5-
_____, “The Process of Expectation and Anticipation,” J. Nerv. & Ment. Dis., 106: 471-481, 1947.
_____, “The Role of Cognition in the Development of Inner Reality,” in Hellmuth, J. (Ed.), Cognitive
Studies, Brunner/Mazel, New York, 1970.
_____, “The Structural and Psychodynamic Role of Cognition in the Human Psyche,” in Arieti, S.
(Ed.), The World Biennial of Psychiatry and Psychotherapy, Vol. 1, Basic Books, New
York, 1971.
Bobath, B., “Very Early Treatment of Cerebral Palsy,” Develop. Med. Child Neurol., 9:372-390,
1967.
Cassler, L., “Maternal Deprivation: A Critical Review of the Literature,” Monogr. Soc. Res. Child
Dcvcl., 26:11, 1961.
Dennis, W., and Najarian, P., “Infant Development under Environmental Handicap,” Psychol.
Monogr., 71, 1957.
Deutsch, C., “Auditory Discrimination and Learning Social Factors,” Merrill-Palmer Quart., 10:277-
296, 1964.
Fineman, J. A., “Observations on the Development of Imaginative Play in Early Childhood,” J. Am.
Acad. Child Psychiat., 2.167-181, 1962.
Freeman, T., and McGhie, A., “The Bele-vance of Genetic Psychology for the Psychopathology of
Freud, A., Normality and Pathology in Childhood, International Universities Press, New York,
1965.
Freud, S. (1911), Formulations on the Two Principles of Mental Functioning, in Strachey, J. (Ed.),
Standard Edition, Vol. 12, Hogarth, London, 1958.
______(1900), The Interpretation of Dreams, in Strachey, J. (Ed.), Standard Edition, Vols. 4 & 5,
Hogarth, London, 1953-
______(1905), Three Essays on Sexuality, in Strachey, J. (Ed.), Standard Edition, Vol. 7, Hogarth,
London, 1953.
Furth, H. G., Piaget and Knowledge, Prentice- Hall, Englewood Cliffs, N.J., 1969.
Harlow, H. F., and Harlow, M. K., “Social Deprivation in Monkeys,” Scientific American, 207:136-
146, 1962.
Hartmann, H., Ego Psychology and the Problem of Adaptation, International Universities Press,
New York, 1958.
Hebb, D. O., The Organization of Behavior, Science Ed. Inc., New York, 1961.
Held, R., “Plasticity in Sensory-Motor Systems,” Psychobiology: Readings from Scientific American,
W. H. Freeman, San Francisco, 1967.
Hernandez-Peon, R., et al., “Modification of Electric Activity in Cochlear Nucleus during ‘Attention’
in Unanesthetized Cats,” Science, 123:331-332, 1956.
978
Hess, E., “Imprinting in Birds,” Science, 146, 1964.
Inhelder, B., and Piac.et, J., The Groioth of Logical Thinking From Childhood to Adolescence, Basic
Books, New York, 1958.
Itard, J. M. G., The Wild Boy of Aveyron (Tr. Humphrey, G., and Humphrey, M.), Appleton-Century-
Crofts, New York, 1962.
Lichtenberg, P., and Norton, D. G., Cognitive and Mental Development in the First Five Years of Life,
Public Health Service Publications, No. 2057, 1971.
Odier, C., Anxiety and Magic Thinking, International Universities Press, New York, 1956.
Piaget, J., “Biologie et Connaissance,” in Furth, H. G., Piaget and Knowledge, Prentice-Hall,
Englewood Cliffs, N.J., 1969-
_____, The Construction of Reality in the Child, Basic Books, New York, 1954.
_____, Play, Dreams and Imitation in Childhood, Norton, New York, 1962.
_____, The Origins of Intelligence in Children, International Universities Press, New York, 1952.
_____, “Psychology and Philosophy,” in Wolman, B. B., and Nagel, E., Scientific Psychology, Basic
Books, New York, 1965.
_____, The Psychology of Intelligence, Routledge & Kegan Paul, London, 1947.
_____, and Inhelder, B., The Psychology of the Child, Basic Books, New York, 1969.
Province, S., and Lipton, R., Infants in Institutions, International Universities Press, New York,
1962.
Sandler, J., and Rosenblatt, B., “The Concept of the Representational World,” in Psychoanalytic
Study of the Child, Vol. 17, pp. 128-145, International Universities Press, New York,
1962.
Schaefer, E. S., and Aaronson, M., “Infant Education Research Project: Implementation and
Implication of a Home Tutoring Program,” Mimeographed manuscript.
Schafer, R., Aspects of Internalization, International Universities Press, New York, 1968.
_____, “Critical Periods in the Development of Social Behavior in Puppies,” Psychosom. Med., 20:42-
54, 1958.
Spitz, R., The First Year of Life, International Universities Press, New York, 1966.
Werner, H., The Comparative Psychology of Mental Development, International Universities Press,
New York, 1948.
_____, “The Concept of Development from a Comparative and Organismic Point of View,” in Harris,
D. B. (Ed.), The Concept of Development, University of Minnesota Press, Minneapolis,
1957.
_____, and Kaplan, B., “The Developmental Approach to Cognition. Its Relevance to the
Psychological Interpretation of Anthropological and Ethnological Data,” Am.
Anthropol., 58:866-880, 1956.
980
Whorf, B. L., Language Thought and Reality, John Wiley, New York, 1956.
Wolff, P. H., “The Developmental Psychologies of Jean Piaget and Psychoanalysis,” Psychol. Issues,
11, i960.
_____, and Feinbloom, R. I., “Critical Periods and Cognitive Development,” Pediatrics, 44:999-1007,
1969.
Yarrow, L. J., “Separation From Parents during Early Childhood,” in Hoffman, L. W., and Hoffman,
M. L. (Eds.), Review of Child Development Research, Vol. 1, pp. 89-136, Russell Sage
Foundation, New York, 1964.
Notes
[1] An actual incident may demonstrate the role of cognition in the behavior of children. A three-year-
old girl whose father often traveled by airplane developed an enthusiasm for flying.
When the family planned to take a vacation and to travel by air the girl was ecstatic.
However, when they were ready to board the plane the young girl panicked and refused
to go on the plane. After calming her down, her parents inquired about the reasons for
her “plane phobia”; the girl quite simply and honestly replied that she didn’t want to get
on the plane because she didn’t want to shrink. The girl had been watching planes taking
off and diminish in size as they became airborne, and her immature concept of size
constancy did not allow for such rapid and extreme changes. The point is that her fear
was a result of her immature cognitive ability and not of underlying dynamic events or
prior learned habits.
[2] Hebb developed neurophysiological correlates of these types of learning. Very briefly, early simple
percepts create “cell assemblies” or self-stimulating reverberating neuronal circuits in
the brain. More complex impressions are stored in the form of “phase sequences” made
up of a series of cell assemblies in a specific series. Although this aspect of this theory is
important in neurophysiologv, its detailed explanation in terms of anatomy is beyond the
scope of this chapter.
[3] In neurophysiological studies Hernandez-Peon, et al., have found that distraction tends to shut out
information. Similarly Galambos, et al., have shown that stimuli that are not reinforced in
terms of reward or punishment are extinguished and not recorded by the brain. The
[4] See Chapter 49 American Handbook of Psychiatry Volume 1 for an exposition of these aspects of
Werner’s theories.
[5] These concepts clearly have their roots in biological theory. For example, primitive embryonic cells
are undifferentiated and similar. Through maturation these cells differentiate and
become capable of performing specific functions of the various organ systems.
Furthermore, the cellular structure ultimately forms a hierarchy so that certain cells
control the activities of others and direct the organisms’ behavior. These two principles,
differentiation and hierarchization of parts, form the essence of Werner’s definition of
development.
[6] In a rigorous manner Piaget has been able to characterize formal operations as a system of four
cognitive processes: i, identical transformations; n, inverse transformations; r, reciprocal
transformations; and c, correlative transformations—each describing a process.
Significant as this reduction is, a thorough exposition of it is beyond the scope of this
summary.
982
Chapter 16
Katrina de Hirsch
Introduction
determined by the interaction of many factors: those that spring from within
himself, those that derive from the interplay between him and his mother,
and those that impinge upon him from the particular culture to which he
belongs.
The potential for language is laid down in the central nervous system.
relationship. The role of language in the formation of the ego is related to this
linguistic and learning difficulties, which are closely related, this aspect is, at
present, very much in the foreground.
It is far beyond the scope of this presentation to sketch more than the
984
Earliest Responses to Auditory Stimuli and Vocalizations
mechanisms for processing sounds are fully mature at birth. Toriyama, et al.,
reported EEG responses to 60 db tones bursts three hours after delivery.
respiration and oxygenation of the blood. Palmer maintains that the cries of
From his earliest days the baby vocalizes, utilizing the expiratory phase
of the respiratory cycle. The air flow is modified by the vocal cords and the
Hunger, pain, and discomfort will make the neonate cry. These
discomfort cries approximate low front vowels and are usually nasalized.
Shortly afterward the active and alert baby will produce different kinds of
consist of low front vowels combined with high back ones and a few
consonants such as guttural /r/ and palatal /g/. Very early, then, the child
a distinct meaning.
Quite early the baby distinguishes between male and female voices and
both synthetic speech and the human voice. On the basis of their experiments
Elmas, et al., concluded that perception in the linguistic mode may well be
part of the biological makeup of the organism and must be operative at a
986
surprisingly early age. That babies do a far greater amount of discriminative
listening than has hitherto been shown is demonstrated by Friedlander’s
includes her smiling face, the presence of caresses, and the satisfaction of
bodily needs. Turnure has shown that a three-month-old baby can be “tuned
Cooing
Before they are three months old babies engage in playful cooing
interchanges with the mother when she imitates the baby’s own sounds. This
is probably a universal phenomenon. Piaget observed such early forms of
interaction from the first month on and called it “verbal contagion.” These
In the fourth month, with increasing chewing activities as the result of the
introduction of solid foods and the baby’s tendency to put all sorts of objects
Mother-Child Dialogue
The vocalizations that mothers use with their babies are tailored to the
child’s affective needs. They differ from those she uses in other situations in a
tendency to rhythmic iterations. Snow says that children who are learning
language have available a sample of speech that is simpler, more redundant,
Di Carlo has made the pertinent observation that the mother caresses
the child with her voice. Wyatt calls the dialogue between the mother and her
baby a process of mutual feedback. The learning of the “mother language,” she
talked to in situations that are essential to their well-being. The vocal and
affect communication between mother and child during bathing, feeding, and
voice is undoubtedly heavily cathected for the baby. The extent to which this
but it is quite possible, as maintained by Eveloff, that the first 18 months are
988
crucial for symbolic language development and that serious flaws in the
interaction between the baby and the mothering adult would have
Provence and Lipton’s study of such infants, whose vocal and verbal
development is often severely delayed. We have no systematic investigations
well-mothered babies, who have a repertoire of most of the vowels and half of
the consonants by the end of the first year. Not all institutions are alike, of
course. Tizard, et al, found that the language comprehension scores of young
children correlated significantly with both the quality of the speech directed
to them and the way the residential nurseries were organized. A careful
those of babies who have received ample sensory and affect stimulation
might, nevertheless, reveal much earlier deficits in institutionalized babies
than those shown by Brodbeek and Irwin, who found that differences in
verbal development between deprived youngsters and middle-class ones
control group.
Between the fifth and the tenth month of life, usually around the time he
attempts to turn over, to sit up, to drink from a bottle, the baby begins to
babble.[1] There is no clear demarcation from expressive sounds to babbling.
The various stages of language development overlap. From short cooing
phrases the baby proceeds to the use of long strings of sounds that are no
longer tied to specific situations. Now the baby lies in his crib, amuses himself
with his fingers and toes, and plays with sounds that he produces
spontaneously, obviously for the sheer pleasure of making them. These
vocalizations are presymbolic. They are playful and probably autoerotic.
There is no mistaking the intense gratification the baby derives from the
mouthing of sounds and the enjoyment he gets from this repetitive playful
experimentation and stimulation. It is thus not surprising that analysts are
impressed by the role this particular oral activity plays in early psychosexual
development.
During babbling the baby “discovers” how to mold the outgoing breath
stream so as to produce a whole repertoire of sounds. At the same time an
auditory feedback loop is being established. As sound-producing movements
are being repeated over and over again, a strong link is being forged between
tactual and kinesthetic impressions, on the one hand, and auditory
sensations, on the other. A pattern of alternate hearing and uttering is set up.
990
Sounds—and as time goes on they take on a more and more repetitive
schemata. The baby not only produces a whole range of different sounds but
Every mother knows that she can stimulate long babbling conversations
between herself and her child. It has been shown that nonsocial stimuli such
as the sound of chimes do not increase vocalizations. Nor does the mere
presence of the human being result in more copious babbling. It is the human
significant adult. Mother and child engage in what Piaget calls “mutual
imitation.” The baby, stimulated by his mother’s vocalizations, produces more
of his own. Thus, even at this early stage, a corrective feedback mechanism is
established that, according to Wyatt, is a sine qua non for smooth language
development. Of course this is possible only if the child has learned to store—
if only for a limited time—and to retrieve the auditory-motor configurations
the mother models for him. It is she who monitors the baby’s vocalizations by
early, some much later. However, intactness of the central nervous system is a
behavior. This loop does not become functional in babies who are deaf or
hard of hearing. Deaf babies babble, but they discontinue doing so after a
while because they lack the stimulation derived from hearing their own
the very early establishment of the auditory feedback loop, the language
normal ones.
only those of their mother language but also many others that drop out later
the facts. He did not, for instance, find fricatives or affricatives[2] /th/, /s/,
/z/, /sh/, or /ch/ among his children’s babbled sounds. He concluded that the
992
to seven-month-old Chinese babies differed from those of Russian and
American ones. Early and selective imitation of input, therefore, must play a
significant role in babbling. Quantity and quality of babbling varies from one
child to the next, but as babies advance in age, their babbled sounds become
more differentiated and more clearly patterned.
Echolalia
Around the tenth month, as control over volume and pitch develops,
the baby begins to imitate the more patterned utterances he hears in his
heavily loaded with affect, that is selected for imitation, and it is the initial
syllable of such a word that is usually chosen for duplication.
and language has been known for some time. Infants’ systems for processing
acoustic and linguistic input mature much faster than those for generating
language. How do babies make some order out of the “buzzing confusion” that
backward and forward speech and between flat and bright intonations.[3]
994
him, that he use some objects appropriately, and that he has a rudimentary
sense of self, of being separate. Lewis- says that the child responds first to the
the age of 12 months the child shows signs of understanding simple phrases
Expressive Language
Although new research has thrown light on some of the factors that
what happens when the child produces his first meaningful utterances.
Indeed, there is little agreement on what constitutes the first word. Is it the
word the child uses in contexts other than imitation, the utterance that stands
when the child produces sound combinations that resemble actual words. As
as Jakobson and Halle, on the other hand, draw a sharp dividing line between
We know that at the age of 12 months the child is able to imitate the
long strings of sounds that resemble those of adults in melody and pitch.
Mothers respond to these vocalizations as if they were definite messages,
modulated strings of sounds the baby produces even before he can utter a
Linguistic Dimensions
996
Several dimensions of language are described by linguists: (1) the
words; (2) the semantic deals with word meanings; (3) the syntactical
concerns the formal relations and underlying rules for processing and
number of sentences.[4]
contrasts between certain features, such as the one between voiced and
voiceless sounds, for example, /p/ and /b/.
For the infant sounds are probably at first indistinguishable from one
perceptual distinctions children are able to make between birth and the age
production of sounds. Some, for example, acquire fricatives far earlier than
several of them. A child who substitutes “dar” for “car” misses not only the
From then on his production of the sounds of his language increases by leaps
and bounds as a result of further differentiation. Sudden spurts are followed
As a rule children use only those sound sequences that are part of their
native language. An English child will not, for instance, produce the cluster
“pf,” which is a common one in German (as in the word “pferd”), but he will
use the cluster “pl” which is acceptable in English. Children do not usually
need formal training to learn these rules. While it is obvious that the mastery
of the phonological system of the language requires a degree of central
998
nervous system maturation, the child primarily needs a model. It is the
mother who usually serves as the primary language model and who literally
feeds back to the child those sound sequences that are acceptable in his
the language.
months. They usually select those words that provide essential information or
those that are strongly affectively colored. Words at this age reflect the
magical universe of the small child. There is a close link between the name
and the qualities of an object. Single words at this age may also stand for
Brown says that parents intuitively provide the names that reflect the
structure of the child’s world. The parents may say, “spoon” and not
rather than the more specific referent. Children enlarge their vocabulary
is at first only the child’s small, fluffy toy dog; a little later the word describes
the real dog the child sees at a neighbor’s, and finally it stands for all
members of the species “dog.” The meaning of the word has been expanded.
The opposite process takes place when the child says, for instance, “He write
a picture.” When he learns that the word “write” refers only to those graphic
activities that involve letters and numbers, he has restricted and refined the
Some concepts and the words that represent them are learned earlier
than others. Only 10 per cent of 240 two year olds in Palmer’s group’
understood the word “around.” Concepts such as “backward” are difficult for
three year olds.”
1000
child uses 700 to 800 words, and between three and five years he adds at
least 50 new words to his vocabulary each month. The growth of meaning
endowment may differ within social milieus and even within given families).
words, on her ability to clarify shades of meaning, on the easy give and take
between her and her child, and on the constant feedback provided by the
maternal teaching variable was the extent to which the mother defined tasks
and named specific qualities of the environment. Thus the child’s cultural and
affective milieu play a vital part in fostering delight in the use of words and
interest in shades of meanings. Children do need models, above all, for the
development of syntax, the set of rules that governs the organization of the
more or less limitless number of possible utterances, imitation is not of
the underlying rules of language, and linguists admit that the very young child
auditory memory and because they cannot as yet program longer units, they
repeat only two to four items. These repetitions are usually systematic
slow process and proceeds from primitive to more and more differentiated
combinations. Brown points out that the two single utterances “push” and
“car” are not simply joined. The unit is programmed as a whole, and “push” is
subordinated to “car” by means of lesser stress and lower pitch. The
transition from the generating of single words to two- word units that are
be changed around like beads. The position of words in the string becomes
relevant; the principle of word order, a powerful linguistic signal in English, is
established.
consist of the most highly stressed and informative words— nouns, verbs,
adjectives—content or “open class” words. This telegraphic speech is
1002
characterized by the omission of functor words, prepositions, auxiliaries,
inflections, articles. These constructions are slowly expanded by the use of
modifiers such as “push pretty car” and are the building blocks of subsequent
sentences.
Brown and Bellugi describe the next level, the noun phrase, as an
and the like. Two or more such modifiers can be combined with nouns, and
they slowly learn the privileges and constraints belonging to each modifier.
The noun phrase can be moved to different positions in the string and can
correctly formed sentences. That language learning involves much more than
the storing of longer and longer bits of utterances heard has been
demonstrated by Berko. In a series of ingenious experiments she used
rule that asks for the ending “ing” in this particular construction. A child may
have memorized the plural form “witches,” Lenneberg says. But if he
produces the plural “gutches,” he shows that he has incorporated the rule that
the plural of words ending with /ch/ is formed by adding /ez/. The very
existence of “overgeneralizations” such as “mouses” (as in “houses”) proves
that the child has derived a set of abstract rules from the linguistic data to
which he was exposed. These rules are basic to the decoding and encoding of
1004
language.
contrast between subject and object in the active but not in the passive voice;
Controversies
McNeill and other nativists claim that children are born with a set of
“linguistic universals” as part of their innate endowment and that they are
depends on differential reinforcement on the part of adults who care for the
Stimulation
1006
intervention. What expansion does is clarify and enrich verbalization at the
very moment the child is engrossed in a situation that holds his attention.
Young children focus attention best when they are affectively engaged. If a
youngster cries out, “Teddy table hurt,” and the mother takes him on her lap
and says, “Poor Teddy, yes, you bumped into the corner of the table, it hurts,”
she is involved with him in a highly meaningful experience. Mothers filter
their own output: they seem to know which stage in language development
the child is passing through at a given moment. With young children they use
the kind of constructions the children themselves will use a number of
months later. In terms of content mothers deal very much with the “here” and
“now.” The timing and the tuning in to the child’s concerns are all-important.
There are mothers who fail to cue in. They do not expand their children’s
telegraphic utterances, and they thus miss an opportunity to enrich
verbalizations that, in his terms, are totally irrelevant. Wyatt presents some
excellent examples of the kind of affective and linguistic interaction that
fosters comprehension and use of language and in the last instance presents
Sociocultural Factors
will deny that there are large differences within the same social group in the
models. Nevertheless, the experiments carried out by Hess and his group
convinced them that the teaching style of many lower-class mothers is less
explicit and therefore less effective than that of middle-class ones. Tulkin, et
al., found that working-class mothers often did not believe that their children
were able to communicate and hence felt it was futile to attempt to interact
with them verbally. The fact that these mothers’ handling of their children, in
general, tends to be more authoritarian and less based on verbal exchange
than that of middle-class mothers would account for some of the intergroup
differences.
elaborated and more restricted than middle-class speech, and it offers less
opportunity for categorizing environmental stimuli. As a result it is relatively
1008
under heavy attack by sociolinguists. They maintain that black dialect is by no
means a more primitive language than standard English, but is rather a
defective in the black child. A recent paper by Quay shows that much of the
Cazden, who has dealt extensively with the deficit-difference issue, feels
that both concepts are inappropriate. For one thing they are probably too
effectiveness. Thus Cazden stresses the speaking situation and the children’s
ability to perceive and categorize a social situation and to adjust their speech
to its requirements.
there appear slight differences in favor of girls.” Not only length of sentences,
but almost all other measures that show developmental trends with age—
articulation, word usage, complexity of output, and grammatical competence
predictor of subsequent cognitive development in girls than was the case with
1010
girls, at least during the earlier years.
Birth Order
children. McCarthy points out that this superiority is out of proportion to that
linguistic and affect interaction with adults. Firstborns do better than younger
children probably for the same reason. Twins and triplets, who have to share
their mother’s lap, are worse off then single babies. The study of the language
only neurophysiological factors (many twins are prematurely born) but also
biological organization and plays a crucial role in the formation of the ego,
which is the special human organ for adaptation. Ego development depends
largely on an optimal level of verbal expression, and conversely ego defects of
one of the most general, earliest and most necessary accomplishments of the
ego, not as one of its activities.”
1012
verbalize helps to delay action; it constitutes the “trial action” Freud speaks
of. Words are needed for purposes of impulse control. Postponing
nonself becomes clearer. The child probably has an emerging sense of self
even before he begins to use words. But the distinction between self and
nonself becomes much more differentiated when categories such as “I” and
run parallel with the most rapid spurt in language development. One would
which corresponds to the child’s consciousness as one, whole and apart from
others, the importance of this sign cannot be overestimated.”
to anchor the significant people in the child’s environment; they reassure him
that the mother will return even if she is gone for a while; and they thus
fantasies and thus renders them less dangerous. It makes possible the
between the outer and inner cosmos, thereby assisting reality testing, one of
tool for cognition. There is thus no need for extensive elaboration of this point
nonverbal tasks. Kimbal and Dale have shown that forming categories of color
names facilitates recognition. By freeing the child from the here and now, by
words allow the child to discover the common properties of perceptions and
events and permit him to group single entities into larger wholes. Language
helps in the shift from associative to cognitive levels of learning and paves the
1014
way for high order operations.
the word I intended to say and my thought unembodied returns to the realm
of shadows.”
Bibliography
Baratz, J. C., “Language and Cognitive Assessment of Negro Children: Assumptions and Research
Needs,” ASHA, 11:87, 1969-
Bench, J., “Sound Transmission to the Human Foetus through the Maternal Abdominal Wall,” J.
Gen. Psychol., 113:85, 1968.
Berko, J., “The Child’s Learning of English Morphology,” Word, 14:150, 1958.
Bernstein, B., “Social Class and Linguistic Development: A Theory of Social Learning,” in Halsey, A.
J., Floud, H., and Anderson, C. A. (Eds.), Education, Economy and Society, Free Press,
New York, 1961.
Bloom, L., Form and Function in Emerging Grammars, M.I.T. Press, Cambridge, 1970.
_____, Readings in Language Development, Simon & Schuster, New York, 1970.
Blumenthal, A. L., Language and Psychology, John Wiley, New York. Reference to Carla and
William Stern, 1907.
Braine, M. D. S., “The Ontogeny of English Phrase Structure: The First Phase,” Language, 39:1,
1963.
Brodbeck, A. J., and Irwin, O. C., “The Speech Behavior of Infants without Families,” Child Dev.,
Brown, R., “The Acquisition of Language,” in Riach, D., and Weinstein, E. A. (Eds.), Disorders of
Communication, Res. Puhl. Ass. Nerv. Ment. Dis., 42:56, 1964.
_____, and Bellugi, U., “Three Processes in the Child’s Acquisition of Syntax,” Harvard Educ. Rev.,
34:133, 1964.
Cazden, C., Child Language and Education, Holt, Rinehart & Winston, New York, 1972.
Cazden, C. B., “Three Sociolinguistie Views of the Language and Speech of Lower- Class Children
—With Special Attention to the Work of Basil Bernstein,” Dev. Med. Child Neurol.,
10:600, 1968.
Chomsky, N., Aspects of the Theory of Syntax, M.I.T. Press, Cambridge, 1965.
Cruttenden, A., “A Phonetic Study of Babbling,” Brit. J. Disord. Comm., 5.110, 1970.
Despert, L., Discussion of “Irrelevant and Metaphorical Language in Early Infantile Autism,” Am. ].
Psychiat., 103:242, 1946.
Dwornicka, B., Jasienska, J., Smolary, W., and Wawryk, R., “Attempt of Determining the Foetal
Reaction to Acoustic Stimulation,” Acta Otolaryng., 57:571, 1964.
Edelheit, H., “Language and Ego Development,” J. Am. Psychoanal. A., 16:13, 1968.
Elmas, P. D., Siqueland, E. R., Jusczyk, P., and Vigorito, J., “Speech Perception in Infants,” Science,
1016
303-306.
Ervin-Tripp, S., and Slobin, D. I., “Psycholinguistics,” Ann. Rev. Psychol, 17: 435, 1966.
Eveloff, H., “Some Cognitive and Affective Aspects of Early Language Development,” Child Dev.,
43.1895-1905, 1971.
Fay, W. H., and Butler, B. V., “Echolalia, IQ, and the Developmental Dichotomy of Speech and
Language Systems,” J. Speech & Hearing Res., 11:365, 1968.
Freud, A., The Ego and the Mechanisms of Defense, International Universities Press, New York,
1936.
Friedlander, B. Z., “Receptive Language Development in Infancy: Issues and Problems,” Merrill-
Palmer Quart., 16:7, 1970.
_____, “Time Sampling Analysis of Infants’ Natural Learning Environment in the Home,” Child Dev.,
43:730-740, 1972.
Friedman, D. G., Personality Development in Infancy, Holt, Rinehart & Winston, New York, 1968,
pp. 258-287 reference to Kurt Goldstein.
Fry, D. B., “The Development of the Phonological System in the Normal and Deaf Child,” in Smith,
F., and Miller, G. A. (Eds.), The Genesis of Language, M.I.T. Press, Cambridge, 1966.
Gibson, E. J., Principles of Perceptual Learning and Development, Appleton-Century- Crofts, New
York, 1969.
Grossman, W., and Bennet, S., “Anthropomorphism,” in The Psychoanalytic Study of the Child, Vol.
24, p. 78, International Universities Press, New York, 1969.
Hess, R., and Shipman, V. C., “Influences upon Early Learning,” in Hess, R., and Bear, R. H. (Eds.),
Early Education: Current Theory, Research and Action, Aldine, Chicago, 1968.
Jakobson, R., Selected Writings I, Mouton and Co., The Netherlands, 1962.
_____, and Halle, M., Fundamentals of Language, Mouton and Co., The Netherlands, 1956.
Johansson, B., Wedenberg, E., and Westin, B., “Measurement of Tone Response by the Human
Foetus,” Acta Otolaryng., 57: 188, 1964.
Kagan, J., “Continuity in Cognitive Development during the First Year,” Merrill- Palmer Quart.,
15.101, 1969.
Kaplan, B., “The Study of Language in Psychiatry,” in Arieti, S. (Ed.), American Handbook of
Psychiatry, Vol. 3, Basic Books, New York, 1959.
Karelitz, S., and Fischelli, V. R., “Infants’ Vocalizations and Their Significance,” Clin. Proc. Children’s
Hospital, Washington, D.C., 25.11, 1969.
Katan, A., “Some Thoughts about the Role of Vocalization in Early Childhood,” in The
Psychoanalytic Study of the Child, Vol. 16, p. 184, International Universities Press,
New York, 1961.
Kimbal, M., and Dale, P., “The Relationship between Color Naming and Color Recognition Ability
of Preschoolers,” Child Dev., 43:1895-1905, 1971.
Lenneberg, E., The Biological Foundations of Language, John Wiley, New York, 1967.
_____, “Speech as a Motor Skill with Special Reference to Nonaphasic Disorders,” in Bellugi, U., and
Brown, R. (Eds.), “The Acquisition of Language,” SRCD Monographs, 29:115, 1964.
Leopold, W. F., “Patterning in Children’s Language Learning,” Language Learning, 5 4:1, 1953.
_____, Language, Thought and Personality in Infancy and Childhood, Harrap, London, 1963.
1018
Lieberman, P., Intonation, Perception and Language, M.I.T. Press, Cambridge, 1967.
Luria, A. R., The Role of Speech in the Regulation of Normal and Abnormal Behavior, Pergamon
Press, New York, 1961.
McNeill, D., “Developmental Psycholinguistics,” in Smith, F., and Miller, G. A. (Eds.), The Genesis of
Language, M.I.T. Press, Cambridge, 1966.
Mahler, M. S., “Thoughts about Development and Individuation,” in The Psychoanalytic Study of
the Child, Vol. 18, International Universities Press, New York, 1963.
Menyuk, P., “The Role of Distinctive Features in Children’s Acquisition of Phonology,” J. Speech &
Hearing Res., 11.138, 1968.
Nakzima, S., Okamoto, N., Murai, J., Tanaka, M., Okuno, S., Maeda, T., and Shimizu, M., “The
Phoneme Systematization and the Verbalization Process of Voices in Childhood,”
Shinrigan-Hyoron, 6:1, 1962.
Palmer, F. H., “Socioeconomic Status and Intellective Performance among Negro Preschool Boys,”
Develop. Psychol., 3:1, 1970.
Palmer, M. F., “The Speech Development of Normal Children,” J. Speech Disord., 5:185, 1940.
Peller, L. E., “Freud’s Contribution to Language Development,” in The Psychoanalytic Study of the
Child, Vol. 21, p. 448, International Universities Press, New York, 1966.
Piaget, J., The Origins of Intelligence in Children, International Universities Press, New York, 1952.
Provence, S., and Lipton, R., Infants in Institutions, International Universities Press, New York,
1962.
Quay, L. C., “Language Dialect, Reinforcement and the Intelligence-Test Performance of Negro
Children,” Child Dev., 42: 1971.
Snow, C., “Mothers’ Speech to Children Learning Language,” Child Dev., 43:549- 565, 1972.
Stewart, W., “Continuity and Change in American Negro Dialects,” Florida FL Reporter, 7.1, 1968.
Stodolsky, S. S., “Maternal Behavior and Language and Concept Formation in Negro Pre-school
Children: An Inquiry into Process,” Ph.D. diss., University of Chicago, 1965.
Taylor, O., “Recent Developments in Sociolinguistics: Some Implications for ASHA,” ASHA, 13:341,
1971.
Templin, M., “The Study of Articulation and Language Development during the Early School
Years,” in Smith, F., and Miller, G. (Eds.), The Genesis of Language, M.I.T. Press,
Cambridge, 1966.
Toriyama, M., Matsuzaki, T., and Hayashi, “Some Observations on Auditory Average Response in
Man,” Int. Audiol., 5:234, 1966.
Torkewitz, G., Birch, H., and Cooper, K., “Responsiveness to Simple and Complex Auditory Stimuli
in the Human Newborn,” Developmental Psychobiology, Vol. 5, pp. 7-19, John Wiley,
New York, 1972.
Turnure, O., “Response to Voice of Mother and Stranger by Babies in the First Year,” paper
presented at Society for Research in Child Development Meeting, Santa Monica,
1020
Calif., 1969.
Weir, R. H., “Some Questions on the Child’s Learning of Phonology,’" in Smith, F., and Miller, G. A.
(Eds.), The Genesis of Language, M.I.T. Press, Cambridge, 1966.
Weisberg, P., “Social and Nonsocial Conditioning of Infant Vocalization,” Child Dev., 34:377, 1931.
Wyatt, G. L., Language Learning and Communication Disorders in Children, Free Press, New York,
1969.
Notes
[1] Cruttenden objects to the definition of babbling as the stage in which children utter sounds just for
the pleasure of making them. He prefers a more objective definition and suggests that
babbling be defined as the stage when the baby first produces “pulmonic-lingual”
consonants, for example, dental and velar plosives, alveolar and palatal nasals, in
addition to a growing variety of vowel-like sounds. The production of these sounds
would imply “a new awareness” on the part of the child of how to combine tongue
movements with breathing. This stage, he says, more or less ends with the emergence of
the first words.
[2] In contrast, Leopold asserts that in the case he studied, affricatives occurred very early during
cooing and babbling but quite late—in the last third of the second year—in imitation of
real words.
[3] Friedlander’s tape recordings of the children’s “natural home language environment” and
specifically of the language interaction between parents and children could provide
important clues in terms of verbal competence at later ages.
The author is aware of the limitations of the section that follows; it only attempts
to summarize the groundbreaking work done in this area. Not only does the scope of the
[5] Not discussed in this chapter is the “motor theory” of perception proposed by the Haskins group.
[6] Bloom feels that what is called “transformational grammar” describes only the most formal aspects
of children’s language development. Her own sophisticated formulations show that a
child’s identification and reproduction of a particular syntactical structure is intimately
related to his interaction with the world of objects, events, and relationships.
[7] That the Skinnerian model of language acquisition is inappropriate has been shown in a brilliant
review by Chomsky, who more or less demolished the theories expounded in Verbal
Behavior. Nor can Braine’s contingency and transfer of training theory account for even
fairly elementary phrase structure. Although it is true that certain aspects of language
learning in children are more dependent on contact with the adult than others (parent-
child interaction has more impact on semantic and phonological than on syntactical
development), it is far too simplistic to think of such learning in terms of even highly
sophisticated stimulus-response theory. Children might learn words and even phrases
by way of differential reinforcement on the part of the adult who “shapes” desirable
verbal responses; they will not, however, acquire language—that is to say, the attitudes
underlying communication, the investment in verbal exchange, and the joy of expressing
subtle meaning by way of words.
[8] Brown makes the interesting differentiation between the adult’s imitation of the child’s speech by
means of expansion and the child’s imitation of adult speech by means of reduction.
[9] No attempt was made to discuss the development of inner speech, which appears more or less
around the time when “egocentric” speech disappears. For a classic discussion of both,
see Vygotsky, Thought and Language.
1022
Chapter 17
E. James Anthony
Definition
The juvenile period, outside its legal sense, was a term incorporated by
Sullivan into his developmental system, but others have classified the same
passed in grade school and bifurcated for good educational reasons into a
primary triennium from grades one to three and an elementary triennium
from grades four to six. For the developmental psychologist this is the era of
of the Oedipus complex and its reactivation in early adolescence. For the
dentist the juvenile stage begins with the last of the baby teeth and ends with
the complete eruption of the permanent set, minus the “wisdoms.” In
have been accentuated. Piaget has pointed to the concrete operational mode
of thinking, Sullivan to cooperation within interpersonal relationships, and
Erikson to the opposing tendencies of industry and inferiority that can make
or mar the school child. There would appear to be, therefore, some grounds
to learn as much as he can about the environment in which he lives and his
own particular place in it. There is a growing flight from family life and
space and time with every year of development. The middle years form a self-
1024
recollections are to a large extent a sustaining, utopian illusion and that the
miseries of the middle years are as real and as scarifying as any experienced
Descriptive Development
Physical growth during the middle years is surprisingly regular and free
from breaks or spurts as long as the environment is optimal. The evidence for
the existence of a midgrowth spurt between five and eight years is dubious;
until more exact longitudinal data are available, there is every indication of a
weighs 40 pounds and the average child leaving latency at 12 years measures
5 feet and weighs 80 pounds. His muscular strength more or less doubles
during the same period. Latency girls, in general, keep ahead of the boys and
enter puberty earlier. Very little is known about hormone excretion during
the child’s development, but there would seem to be no striking changes from
infancy to puberty. Some parts of the pituitary, the adrenal cortex, and the
gonads do not function until puberty, but others are secreted in proportion to
the size of the growing child. The 11-oxysteroids of the adrenal cortex,
cortex and gonads, make a surprising appearance around about nine or ten
years in both male and female children and some have termed this the
hormones are secreted and lower the threshold to stimuli. More is known
docile, manageable, and easily led children whom he terms “ductile.” These
children tend to drift inevitably into delinquency. The theta rhythms are
characteristically prominent during early latency and are easily evoked with
frustration. The decline in theta parallels the decline in temper outbursts in
preschool children, and its association with the frequent annoyance and
deprivation of the preschool period suggests the reason for its relative
inactivity during the latency phase. Its presence has been linked to the level of
emotionality in the individual. The alpha rhythms attain their adult
distribution sometime between the ages of nine to eleven, but the variations
may be considerable. There are juveniles who show no alpha rhythm at all
and others in whom it persists throughout the waking day, whether the eyes
are closed or open, and whether the child is concentrating or relaxed. The rise
1026
of alpha may have something to do with the child’s new orientation to his
to his mother that may take her away from him. His dreams reflect these
same concerns, and girls especially may fear and dream of men getting into
their rooms and attacking them. In the later part of latency the emotions are
brought more under control, and the juvenile is in much better equilibrium
with others. Whereas in the early years he was somewhat humilious and
unamenable to management with humor, later he is able to develop a good
sense of humor and can even laugh at himself. The later fears tend to be
realistic and concerned with school problems, competitive situations, and
worries about failure, and although far fewer dreams are reported in the later
these.
class children, and they say very little about children in general, children in
centered world to which it belongs. In early latency Gesell describes the self
the self may even seem to inhabit “another world” and to withdraw into this
about the body and the beginnings of modesty, especially in the girl. Shame is
a powerful affect stemming from lapses of competence. Later, from nine
onward, the child seems gradually to change for the better, to be more
more responsible and much busier and more actively interested in school
work, hobbies, and a variety of tasks. At this point he becomes a “worker” and
may even prefer work to play. He is increasingly self- aware about what he
does, what he is, and what he can and cannot do. He is likely to complain a lot
about life in general, his life in particular, and the way in which his body is
1028
crisis.
although living within adult society, he picks his way through it preoccupied
with its own traditions, rules, regulations, values, and loyalties, and like
primitive cultures it is handed down largely by word of mouth from child to
child. In this proving ground the child learns to function apart from adults and
practices a variety of roles both in play and in social interaction. For the
younger child play especially represents a time out in which he allows himself
emotions of preschool, he may use play further for catharsis, wish fulfillment,
of his group or gang he may take his place in the pecking order and construct
a fairly valid concept of himself in terms of his usefulness to the group,
capacity for leadership, and organizational skill. The membership carries with
it the joys of belonging and the pains of exclusion or ostracism. Neighborhood
may be direct continuity between early childhood groups and the street-
At this stage it is usual for the two sexes to play separately, although
they may still share in the same interests and even play the same games. Few
practically no boys ever openly engage in what are thought of as female ones.
However, the interest of the two sexes shows convergence, and the sex
girls who may spend a large part of latency rehearsing for motherhood,
homemaking, and child care. Only a few adult occupations are continuous
with boyhood culture.
“corrective emotional experience” for the child and although the contacts are
1030
solidarity may prevail outside it. The children hand down clothes, toys,
traditions, customs, and play patterns from one developmental stage to the
next, and they model for one another in terms of appropriate sex and age
behavior. The world of parents is gradually left further and further behind
although they are still a central pivot in the child’s life. He may boast of their
achievements, demand their backing and enthusiasm in his pursuits, and still
appeal to them as the final arbiters where sensitive matters of justice and
that of sexual latency. Latency begins with the resolution and repression of
the Oedipus complex and ends with its reactivation at puberty; it is a kind of
psychosexual moratorium in human development that allows the future adult
to learn the technical skills necessary for a future work situation. This is
adolescent so that he can find a place for himself in society. The first
moratorium is brought about by mechanisms of repression and sublimation,
magic devices for controlling impulses and feelings, including the anxieties
and hostilities derived from the oedipal conflict. Latency children, with their
superstitions, their collecting and hoarding habits, their mysterious chants
compulsions, thoughts, and snatches of music that they cannot be rid of,
magical counting devices before test situations, and sometimes quite
elaborate systems of checking and undoing. All these are still within the range
of normative development and the symptoms disappear with the stage. The
Questions have been raised about how latent the situation really is, and
1032
investigators such as Broderick have pointed to the amount of heterosexual
as well as homosexual interests and play in the preteen years. He feels that
sexuality is still active but simply hidden from adult attention. Forbidden
at this age and the toilet function inseparable from the sexual one. In children
who have been overstimulated or seduced, a greater degree of precocity may
develop and at the same time provoke much anxiety. The main repression,
parent of the opposite sex, and it is this element that is universally latent. The
Henrys have furnished us with protocols from the doll play of children in an
Indian tribe, and the record is replete with gross references to copulation.
The latency children in many primitive societies spend a lot of time in sexual
acting out under the permissive aegis of the elders, and Harlow has pointed to
the fact that sexual play among immature rhesus monkeys is essential to
The drives that made the preschool child dream and play undergo
sublimation into a host of latency activities, the most important being the
child ever closer to a manifest neurosis. Infantile sexual theories are further
ideas are invented by children in order to contradict older, better, but now
by his instructor: “It is possible that your father and other people do such
things, but I know for certain that my father would never do it.”
Two fantasied offshoots of the Oedipus complex in latency are, first, the
beating fantasy, which has its origin in the girl’s incestuous attachment to the
father or the boy’s feminine attitude toward his father, and second, the family
romance, which represents a stage in the estrangement of the child from his
parents. In early childhood he may feel that he is not getting his full share of
parental love and attention, and he may develop the idea that he is a stepchild
1034
the family romance undergoes a “peculiar curtailment”; the father becomes a
stranger and exalted but the mother remains the same, although in dreams
they remain king and queen. In one of his papers Freud reproduces a letter
from a motherless girl of 11 years who urgently asks her aunt the “truth.” “We
simply can’t imagine how the stork brings babies. Trudel thought the stork
brings them in a shirt. Then we wanted to know, too, how the stork gets them
out of the pond, and why one never sees babies in ponds. And please will you
tell me, too, how you know beforehand when you are going to have one.” (The
obsessive questioning.)
Erikson, identity is one of the “indispensable coordinates” of the life cycle and
emerges more firmly, more completely, and with an increasing sense of inner
unity with each crisis that is encountered and mastered. Each turning point in
and begins to perceive himself and others more correctly. When development
and justice. She has also been able to inculcate a deep and almost “somatic”
conviction that there is meaning to her management of the child. The
psychosocial issue of trust to mistrust is a crucial quotient for the rest of the
preschool years, he is more than ready to get down to work and discipline
comparing himself unfavorably with his father. A great deal depends on the
parental surrogates who step into the picture to continue the work of the
1036
parents. The good enough teacher knows how to alternate work and play,
recognize special efforts, and encourage special gifts. The good enough
parents encourage their children to trust their teachers. The good enough
school is not simply an extension of grim adulthood and the puritan ethic into
the classroom or an extension of the expansive imagination of childhood
school age to the sense of identity can be expressed in the words: “I am what I
can learn to make work.” To many children this is also the end of identity and
comparable status, and ends with the need for an intimate relationship with a
single person of comparable status. Sullivan reiterates many times that this
outside the home. It almost seems as if Sullivan is implying that one stage of
be able to exploit this ameliorating capacity to the full. Sullivan suggests that
unless the juvenile era can alter the spoilt or self-effacing child for the better,
himself in somewhat exaggerated terms and that most of his assertions need
minimal experience. In order to get along in the new milieu, the juvenile must
in getting along, getting by, and getting away with things. With increasing
social sophistication the juvenile is able to detoxify the frightening authority
figures and reduce them to the proportion of people. Without such necessary
de-idealization the parents and their homologues remain sacrosanct and the
Therefore, the juvenile era is the time, as Sullivan puts it, “when the
world begins to be really complicated by the presence of other people” in
communication. As a result of all these, the juvenile learns a good deal about
1038
how to create a secure environment for himself. The self-system at the core of
overlapping terms and tends to avoid the issue. “It has been so many years
Since life at this time is largely lived in groups, the question of belonging
to outgroups or ingroups becomes a crucial factor for healthy development. It
can be hearers (judging the relevancy of what one is saying) or spectators (of
what you showed to others). Since these act in an inhibitory way, they can be
As the individual reaches the end of the juvenile era, he gains, whether
one leaves the juvenile era with a bad reputation, it is likely to stick to one
The individual is not only subjected to influences from the peer group
but also from the parent group, and one of the less fortunate things that
parents can do at this stage is to teach disparagement. As Sullivan puts it in
his usual vivid style, “the disparaging business is like the dust of the streets—
it settles everywhere.” It can be very disastrous for the individual if the only
way he can maintain his self-esteem is by pulling down the standing of others.
1040
Security achieved in this way is not real security and can easily crumble.
By the end of the juvenile era, all being well, one becomes “oriented in
living” or, put in another way, “well-integrated.” The integration includes
some eventual gain. The juvenile who is well oriented to living has a more or
less assured future; the juvenile not so oriented is destined to be, to use some
“lamentable nuisance.”
Piaget’s and Gesell’s notion of development. As Hunt has pointed out, both
employed the cross-sectional method of confronting children of various ages
with situations and materials, at the same time observing how the children
transitions from one stage to the next. Anthony has suggested that a system
such as this with well- defined stages, transitional periods, and a dynamic
process of differentiation between the ego and the world is still incomplete.
The child is at the center of the universe, and his perspective is subjective,
juvenile period a revolution in perspective takes place, and the child sees
himself as a thing among many other things in the universe and by no means
objective and relative, and for the first time the child becomes capable of
getting himself in someone else’s shoes and perceiving the world through the
other’s eyes. However, by six or seven years he is not wholly free from
egocentrism, and his world is still alive in every part with animistic
1042
projections and magical-phenomenistic forces. The sun and moon follow him
around; his dreams come in through a window at night; a stone will feel a
prick if it is rolling; twisted string unwinds itself because it feels all twisted
sobers down and becomes much more realistic and down-to-earth. The child
juvenile era. Not only does the child think more logically, but his previously
environment becomes less amorphous and syncretistic and more precise and
that Piaget finds useful for describing cognitive operations). As a result the
juvenile can solve many problems that lie beyond the capacity of the
preschool child. A child from seven to eleven years behaves as though his
primary task consists of organizing and ordering what is immediately and
conservation, inclusion, the dimensions of time and space, and basic notions
of movement and velocity, all of which help to make him familiar with the
workings of his environment.
which is the only motivation that Piaget recognizes. Furthermore, the child’s
feelings are not tied to his motivations but to his cognitions and undergo a
parallel development that is simply the reverse side of the coin. The intellect
furnishes the structure and the affect provides the energy. During the juvenile
era, the emotional life is isomorphic to the logico-arithmetic organizations
and is characterized by highly structured systems of values, concepts of
sources. There is a moral realism about crime and punishment and the need
to fit them together literally, so that a child who breaks six glasses is twice as
1044
culpable as the child who breaks three and must be punished twice as
harshly. Punishment is dictated by the lex talionis. No one can escape justice;
it is immanent in the entire universe, so that a child who has been stealing
apples may very well break a leg as he attempts to escape over a wall. In the
second part of the juvenile period, morality is based on norms of reciprocity
agreed upon by the participants, and the sense of fairness may extend even to
the point of making allowances for natural inequalities. For example, the child
who has an injured knee will be given a handicap in the race. The moral sense
authority figures. The justice meted out is “distributive,” which means fairly
different systems do not articulate very closely, nor do they agree very often
child turns away from his family and from his egocentric self to a society of
and psycho- sexual latency, he can use a lot of his energies for epistemological
and his concrete thinking allows him to categorize his world, though to a
the group. He is on the way to developing a full and consistent identity and a
sense of self that gives him a feeling of continuity throughout all the
vicissitudes of developmental change. The self, which has private and public
components and both true and false aspects, may emerge into self-
Definition
any time after the tenth year. Educationally the largest number of
1046
eleventh and the fourteenth year. It is the transitional period between
existence; some give it a passing reference, while others, like Sullivan, speak
operational thinking makes its first appearance during this era, and with it a
signaling the end of growth latency, and along with this comes changes in the
facial and body proportions, the appearance of primary and secondary sexual
characteristics, and a variety of other physical changes that may sometimes
both sexes the extremities and neck grow at a faster rate than the head and
trunk, giving the self-conscious youngsters the long-legged, gawky, and
coltish look characteristic of this age. The shoulders broaden in the boy and
the pelvis widens in the girl, who, to a greater extent than the boy, develops a
layer of subcutaneous fat that rounds and softens the contours of the body. In
general, the boys remain leaner and more angular. The growth of pubic,
axillary, facial, and chest hair adds to the transformation. The skin becomes
coarser, the pores larger, and the sebaceous glands more active, and as a
composition of the sweat also alters and the odor becomes stronger. This,
girls the areolas grow larger and become elevated and pigmented, and the
breasts may attain almost full size prior to the menarche (according to
Aristotle, menstruation tended to begin when the breast was two fingers
this as “split growth.”) The resulting asymmetry may further intensify the
child’s feeling of being “off kilter” and this, together with early and late
has shown that personality differences between early and late maturing
individuals may persist well into adult life. Early maturers as a group were
gonadal hormones, which then inhibit the pituitary hormones and cause
of the gonads also slow down and the pituitary once again becomes active.
1048
Why the pituitary becomes active at this particular time is not known, but it is
The new developments in the physical system create new feelings and
new urges in the psychosexual sphere, with some increase in sexual tension.
complementary increase in strength, so that the child’s ego may become more
heavily defended than at any other time during his development. Some
analytic therapists insist that the child is more difficult to treat at this period
than at any other and that transference work is particularly hard to carry out.
If one looks at the middle years in terms of defense, there are marked
changes in the picture presented. During the first phase of latency the new
superego is harsh, rigid, and, according to Bornstein, “still a foreign body.”
Two different sets of defenses begin to operate. The first is directed against
formation. This brings about the first character change in latency. As a result
latency” during which the instinctual demands have been successfully warded
off. There is some truth, however, in the assertion that infantile neurosis
decreases during the second part of latency. Certainly the sexual demands
seem less pressing, the superego less rigid, the ego more preoccupied with
child is caught between latency and pubertal struggles, between old and new
sexual aims. The latency peer relationship is now reduced to a group of two
sexual practices may erupt from time to time, associated with shame and
1050
guilt. A recapitulation of the psychosexual development of the first five years
may come into evidence toward the end of the preadolescent period.
Erikson has very little to say about preadolescence, and it does not
this oversight on his part, since the child obviously does not jump from
industry into the confusions and turbulences of adolescence without some
the child becomes a very different person with greater capacities for action,
reaction, and interaction and that the psychosexual moratorium is there for
the specific purpose of learning the basic grammar of the culture during the
sexual lull when the polarities of industry and inferiority are operating and
Sullivan has much to say about preadolescence and what is for him the
the juvenile era. The developmental force that brings this about is the
he is saying is that real love begins in preadolescence and that all previous
each partner moves toward the other for the purpose of mutual satisfaction.
This special sensitivity with regard to the other person and his feelings is the
feelings to we-feelings. Because of the intimacy and the new capacity for
fantastic notions about oneself or others. Here again Sullivan puts forward his
1052
interlocking with other two- groups. Another basic unit is the three-group,
other two. Thus, there is a lot of mutual influencing in the gang. When the
members are confronted with serious problems that overwhelm them, one of
the “models” may assume the role of leadership for the purpose of solving the
to correct the leftover egocentrisms of the juvenile era or the marginal case,
constantly on the fringe of ostracism, who may have been in the outgroup of
juvenile society. Sullivan pooh-poohs the alleged dangers of homosexual
He agrees that in bad circumstances and bad environments there are likely to
be bad gangs, but even in these extreme cases the gang experience can be of
value for socialization. So therapeutic is this phase in Sullivan’s eyes that even
cured. The juvenile who has a vicious disparaging tendency that constantly
pulls people down may also have this somewhat mitigated by the
establish the type of intimacy required for a chumship, and puberty may be
established before they can reap the benefits of the period. The persistent
juvenile who tries to avoid growing up may eventually wend his way into an
child is particularly likely to suffer from the competitions and rivalries of the
juvenile era, but he may come into his own with the development of
preadolescence and the helping hand of a chum.
this risk and insists that his own hope would be that the preadolescent
relationship was intense enough “for each of the two chums literally to get to
know practically everything about the other one that could possibly be
means by this, but he clearly is proclaiming his faith in the “great remedial
1054
the adult outcome has provided him with the confidence for such assertions.
phase and sometimes out of relationship with each other. Bad couplings may
result from preadolescents’ linking with those still juvenile or those already
loneliness reaches its full significance and goes on relatively unchanged for
the rest of life. The defense against loneliness is what shapes existence.
starts to construct theories and make use of the ideologies that surround him.
Piaget links these new capacities to the development of neurological
of the nervous system can only determine the totality of possibilities and
impossibilities at a given stage, but the social environment remains
process characterizes all exchanges between the nervous system and society,
and the individual has to learn to adapt to both physical and social worlds.
The preadolescent differs from the juvenile in that he thinks beyond the
build “systems” as well as to think systematically. The juvenile does not try to
at first. He may also develop theories as part of his intellectual life with the
gang. He is not only capable of thinking about the past, the present, and the
future, the present and the absent, but he is also able to think about thinking,
What Piaget calls the third form of egocentrism emerges at this stage
1056
adjust the environment to his ego rather than the other way about. As a result
there is a relative failure to distinguish between his own point of view as an
individual and the point of view of the group. The preadolescent society helps
reforming the present sorry state of affairs. All this is generally fuzzy and
Conclusion
eventual purpose is to shape the future of the world. It is there to repair all
the disastrous damages of development and prepare the person for the new
Bibliography
Anthony, E. J., “The Significance of Jean Piaget for Child Psychiatry,” Brit. J. Med. Psychol., 29:20-
34, 1956.
Benedek, T., “Adaptation to Reality in Early Infancy,” Psychoanal. Quart., 7:200-214, 1938.
Bornstein, B., “On Latency,” in The Psychoanalytic Study of the Child, Vol. 6, pp. 279-285,
International Universities Press, New York, 1951.
Broderick, C. B., and Fowler, S. E., “New Patterns of Relationship between the Sexes among
Preadolescents,” Marriage & Fam. Living, 23:27-30, 1961.
Freud, A., The Ego and the Mechanisms of Defence, Hogarth, London, 1942.
Freud, S., “Family Romances,” in Collected Papers, Vol. 5, pp. 74-78, Basic Books, New York, 1959.
_____, “On the Sexual Theories of Children,” in Collected Papers, Vol. 2, pp. 59- 75, Basic Books, New
York, 1959.
_____, “The Sexual Enlightenment of Children,” in Collected Papers, Vol. 2, pp. 36-44, Basic Books,
New York, 1959.
_____, “Three Essays on Sexuality,” in Strachey, J. (Ed.), Standard Edition, Complete Psychological
Works, Vol. 7, pp. 135-243, Hogarth, London, 1953.
1058
Gesell, A., and Ilg, F., Child from Five to Ten, Harper & Row, New York, 1943.
Harlow, H. F., and Harlow, M. K., “The Affectional Systems,” in Schier, A. M., Harlow, H. F., and
Stollnitz, F. (Eds.), Behavior of Nonhuman Primates, Academic Press, New York,
1968.
Henry, J., and Henry, L., “The Doll Play of Pilega Indian Children,” Am. J. Orthopsychiat. Res. Mono.,
4, 1944.
Hunt, McV. J., “The Impact and Limitations of the Giant of Developmental Psychology,” in Elkind,
D., and Flavell, J. H. (Eds.), Studies in Cognitive Development, Oxford University
Press, New York, 1969.
Jones, M. C., “Psychological Correlates of Somatic Development,” Child Dev., 36: 899-911, 1965-
Piaget, J., The Child's Conception of the World, Harcourt Brace, New York, 1929.
_____, The Growth of Logical Thinking from Childhood to Adolescence, Basic Books, New York, 1958.
_____, The Moral Development of the Child, Free Press, Glencoe, 1932.
Stone, L. J., and Church, J., Childhood and Adolescence, Random House, New York, 1968.
Sullivan, H. S., The Collected Works of Harry Stack Sullivan, Vol. 1, Norton, New York, 1953.
Tanner, J. M., and Inhelder, B., Discussions on Child Development, International Universities Press,
New York, 1971.
Adolescence
Irene M. Josselyn
Adolescence Defined
confusion for the reader unless it is specifically defined in the context of the
discussion offered. In this chapter the term “adolescence” is used to describe
1060
is not, as implied by the term “latency,” a dormant period, but rather a span of
of growth, adolescence.
what will become the architecture of the adult personality and character, as
unless the bricks and mortar that are the fundamental components of that
solution of prelatency conflicts will result in the latency phase being poorly
balanced; in addition, that lack of balance will distort what occurs as the
independent of the past but rather, for good or bad, a superstructure upon
that past.
intensity until approximately the last 30 years. Even with the evolution of
thinking regarding psychological development from birth on, for a long time
Hall, and in her early work, Anna Freud." Prior to their writings there were
protests by some against youth and wonderment or despair about what the
youth of that day would do to the future. For the most part it was presumed
that if adolescence was ignored the idiosyncrasies would end. There was little
two diametrically different points of view. There are those who describe
others a degree of pathology that they do not believe exists. The latter group
believe that normal adolescence is not full of turmoil; they argue that those
who indicate otherwise base their conclusions upon their study of manifestly
disturbed individuals and therefore attribute to all the troubles of relatively
few.[2]
1062
The disagreement concerning the dynamics of adolescence may be
transient episodes of clinging to the old; at the same time the strongest force
in the normal individual is to thrust forward. There are also brief false steps
ten-year-old boy of today will be the same fifteen years from now; he will
have “grown up.” He will have grown from childhood to adulthood, having
reevaluated many facets of himself and the outer world during adolescence.
not just seek it in playacting as he did earlier; rather he seeks for an internal
His position is comparable to that of the pioneers who explored the West;
they knew the way led west, but the miles between their familiar homes and
the anticipated riches at the end of their trek were uncharted except for the
vague guidelines of the sun and the stars. Children of Western culture know
them the freedom to choose on their own, within broad limits. Before the
individual makes his ultimate choices, he reevaluates many concepts that he
well realize that he is different from what he was as a child. Frequently the
change is only apparent after a period of absence. A boy of this type goes
away to college, and when vacations reunite the family he seems strange to
his parents. He is, as the family vaguely describes it, more grown up. He also is
aware of, and frequently uncomfortable about, the change, but he tolerates
1064
Another group of adolescents cause concern for their parents and
pleasure in living and at other times acting depressed, bored, or irritable. Any
don’t know, I just feel this way,” or a curt, “Can’t you let me alone?” School
achievement may be less than in the past, or it may manifest the same
sporadic shifts as the mood swings, with successes and failures occurring
unpredictably. This group in particular are frequently still diagnosed as “just
adolescent”; family and teachers are assured that “it will pass.” This group is
perhaps most secretive about its thoughts. For a variety of reasons the
individual prefers to find his own solutions to the internal problems with
which he struggles. Only when he feels overwhelmed by some aspect of his
times they do find pseudoadults who, as confused as they are, may become
their mentors. On the other hand, most of them are soon disillusioned by
these pseudoadults, will talk with them but will not, except for a shorter or
longer period of time, follow them. In the latter instance the adolescent has
tried on for size the ideas the adult has expressed and finally, often after long
consideration, decides those ideas do or do not fit.
There are adolescents that may or may not be a part of the third group
A certain number of them, either with help or by their own mastery of their
inner turmoil, will leave this type of behavior behind them as they begin to
resolve their phase-typical conflicts, and they will seek wiser ways to bring
1066
developmental history does not give a means of quick diagnosis of the
syndrome they present." The first group described above may have among its
that will become manifest in adulthood. The third group may include those
which group he appears to represent now, may develop later a mental illness
that would appear more characteristic of a different adolescent type.
after a period of real communication with the individual, the adult becomes
aware that the young person he is studying does not consistently fall into any
of the above groups; rather he is shifting from one to the other and is at times
proper diagnosis, the diagnosis being difficult because of the shifts that occur
the menstrual cycle in women. The young adolescent of either sex, about the
easily elated, more readily depressed, and more quickly angered over minor
reacts intensely to what is beautiful and to what is ugly, the former typically
1068
he finds a positive element in the person or object that he has hated, he may
reverse his attitude and abandon his hostility and temporarily only feel love.
He often, particularly with people he cares for a great deal, finds his inability
to handle his love and his anger, or his inability to accept imperfections, very
is reacting in this way do not understand and respond to each of his opposing
feelings as if each erased the other. If others cannot harmonize his feelings,
how can he? This is readily observed in an adolescent who has a basically
sound relationship with his parents. At times he feels hostility toward them
and can’t understand why they are not the people he would love. Then later
he loves them and can’t understand why they don’t believe that love.
necessarily how they really feel within themselves. One boy—who seemed in
it.” If one accepted only his overt behavior of indifference to his parents, it
was easy to see why they felt that he didn’t love them.
This sensitivity in the adolescent is often the secret that they carefully
all adults, one thing can be learned from certain participants. Their
his future life. This sensitivity to his internal feelings explains in part why he
works so hard to find a way to bring conflicting sensations into some sort of
1070
In his confusion society does not offer him a great deal of help; modern
civilization offers very little sharply defined structure as a framework for the
suspension from school! They cannot see the interrelationship of the total
forest because they are able to grasp only one tree at a time.
question have stressed the identity crisis as the chief characteristic. Prior to
adolescence the child had found his identity, but it was his identity as a child.
During normal latency he lived and enriched that identity. With the advent of
psychological adolescence that childhood identity begins to lose its
identity are the ego ideal and the superego. Together they assure a certain
degree of self-predictability based upon the individual’s own values. While
the ego ideal and superego are typically so interrelated it is often difficult to
tell them apart; during adolescence the demarcation between the two is
frequently apparent and the source of confusion for the adolescent (as well as
others).
mores. The ego ideal defines the healthily narcissistic value system that
this, defines, “This is the kind of person who will not be punished, but will be
loved by others.” The reason for the typical interrelatedness of these two in a
psychologically healthy individual is apparent. There is not much love for the
1072
During adolescence the childhood ego ideal, which was based upon
being a self-loving and lovable child, is partly abandoned. The lovable self
with his peer group, he learned the rules of the game for living in the world of
his peers; his earlier ego ideal had become enriched by including the
requirement of being a good player in that game. His self-image thus had
Discarding this social ego ideal and alienating himself from his peer group
is ashamed if he does not protest a parental demand as his peer group does,
or claims they do. He is ashamed if he dresses differently from his
companions and if he does not join them in violating a school dress code. He
probably would not mind not wearing ragged blue jeans, and even would not
abandon the self-confidence that has resulted from social acceptance by that
world of which he had become a part during latency.
On the other hand, often the code of his peer group violates an aspect of
not always an easy task for the adolescent to differentiate them. A simple
attitude that parents must be obeyed. There are cultures in which that aspect
of the superego remains intact in adult life. On the whole, however, in our
current culture the normal adult’s attitude is based upon the concept of self-
determination.
aware of the necessity for this shift and give verbal sanction to the change, the
childhood superego has become so much a part of the individual that its
origin in parental standards has become vague. While the parents’ assurance
1074
that modifications are correct, because what applied in childhood no longer
applies, does aid the adolescent in his attempt to attain a more mature
family, had (except for one episode of serious illness), an unbroken record of
class attendance through high school. This record was highly praised by the
parents; any deflection from it because of a cold or a headache (she had
determined by the student’s own desire to learn what the professor was
discussing at the time. In spite of her parents’ enthusiasm for this educational
approach, she could not fail to attend daily every class in which she was
enrolled; she indicated she would feel too guilty if she didn’t. As a result she
could not find the time to pursue her independent study. Finally she solved
the conflict between his childhood superego and the pressure to modify it to
comply with his image of an adult value system by rebelling, sometimes
may reveal some behavior that he has tried to keep hidden from his parents,
insisting they would not let him do it if they knew. A discussion with the
parents may indicate that they would not condemn the act; rather they had
wondered why he was not doing it. Pointing this out to the young person may
abandon.
times frightening. The superego provides security, assuring him that his
behavior will not be unpredictable. As a consequence the rebellion against the
superego often may be abandoned temporarily and the early standards held
1076
young. Yet statistical studies of college students during the 1960’s did not
confirm this modification.’> Why does this contradiction exist? It is possible
that one aspect of the contradiction represents a wish and the other
represents an actuality. Maybe the mores arc not changing as much as the
young people indicate they are. On the other hand, it is equally possible that
the mores have changed. If so, to what extent does the acceptance of the
in the major aspects of the value system remaining intact. Those aspects that
succumb to the adolescent rebellion are more typically relatively minor
murder!
that would involve a minimal expenditure for living expenses. Each individual
of the group had earned the money for the limited budget they projected. His
attempt to persuade and cajole him to accept the checks failed, they became
angry, pointing out they would worry about him and their summer would be
ruined. This created intolerable guilt in him; he almost abandoned the trip
because of the discomfort resulting from the conflict between his ego ideal
and his superego. Fortunately he solved the conflict by telling his friends
about his “neurotic parents,” and by plotting with his friends for a splurge
struggle to define an adult ego ideal and superego for himself; therefore, they
are often unable to help him wisely in his psychological clumsiness. Part of
1078
what the adolescent seeks are an ego ideal and superego that will incorporate
an occupational role he respects for himself and the training for and
achieve approval, not punishment, and a place in society for him. High school
and college educators commonly indicate to parents that if their son or
the young person frequently shifts his or her vocational goals, or appears to
have none; he or she will find that in college. Regardless of the practical
aspects of ability, a beginning college student who has not mapped out his
occupational future is still confused about one aspect of his adult ego ideal
and superego; he has not as yet determined who, vocationally and as a part of
abandon those values that were appropriate only during childhood, or that
were necessary in his situation as a child, and selectively retain those of value
for all ages. While his selection is facilitated through the wise, not rigid,
self-identity, not just one that is an image in a mirror, the image of someone
else.
Adolescence as Rebirth
in psychological growth. They are both the result of, and the stimulus for, that
were not a part of human psychology, clinical evidence suggests that at least
the human species does not abandon the past to start anew, but rather
repeats the old in order, if possible, to find a new answer. During adolescence
To the extent that he mastered any earlier phase, the recapitulation during
adolescence will be more easily handled, other things being equal, than if his
from the past or as the beginning of attainment of the goals for the future. It is
a rebirth in which neither the first birth can be ignored nor the future of the
1080
reborn person be assumed to be alien to the initial growth process.
typically begins at the time of the spurt in growth and the body changes
associated with prepuberty and puberty. This physical change results in the
piece of glass is a mirror because when we look into it we see a body that is
ours. Imagine what the experience of seeing his reflection would be for a
thirteen-year-old boy, who had not seen himself in a mirror for a year, during
which time he had grown several inches and his body contour had changed.
Actually, in a less dramatic way, the adolescent’s body, because of the typical
body changes, is less familiar to him than in the past. As one boy who had
farsighted; my feet are so far away when I stand up, but I can still see them.”
adolescents of today; during the period of rapid growth the young person is
his body. The infant lacked the development that enabled him to handle his
body as he would later. In contrast to the adolescent, the infant did not know
from where he came; he could not recall his fetal state before he had hands,
does know his physical past; he is often proud of the changes he sees in
himself. But he does not necessarily feel at home in this new encasement.
very conscious of his body, both its beauty and its malfunctioning. He is aware
1082
rapidly enough, and she fears she will have a masculine body while she is
striving to see her body as indicative of her femininity. These responses to
“normal” adolescent. Thus, the boy who has a feminine identification may
value his breast development; the girl may value her “boyish” figure because
it denies her biological femininity. But concern about body development does
perfect should make the adolescent very careful of his body. Although he will
during infancy. He may overeat in spite of gaining too much weight, or he may
eat foods that he knows the doctors believe cause acne. Food represents to
him comforting that in infancy was provided by others but that he can now
during early adolescence. She was quite insecure during this period, an
insecurity that appeared related to her confusion about her goals and to
a reducing diet. The latter was very effective, and in about two months she
became an attractive, feminine adolescent. Then her compulsive eating
patterns returned and with them her obesity. Her self-confidence appeared to
remain intact. It became clear, however, that her compulsive eating returned
at the time boys in her class changed their response to her. Previously she
had been an asexual friend to them; after she lost weight they sought her as a
“girl friend.” She finally recognized that she had been frightened by this
change in the boys’ attitude. Her sexual conflict, which had aspects of a
conflict deeper than her original insecurity, only then became clear.
1084
This reliving of early infancy becomes manifest in other broader
become more independent and strives to find his own self in a new form, he
in his own ability to make decisions and seeks advice from parents or parent
which adults would probably willingly give at great length. The advice
frequently sought is whether to ask a certain girl for a date, what courses to
take the next semester or, by the girl, what dress to wear, or whether her
lipstick is really a good color for her. The normal adolescent, when he seeks
such advice, may become angry with the advice that is given. From the
anxiety; then a new discontent arises. The adolescent does not want to be
to refuse the advice given. He therefore says the advice is stupid and does the
opposite. Fortunately, if the earlier child-parent relationship was positively
relatively minor, token aspects of his living; the color of lipstick is really not
that important.
There is another factor in his seeking advice on minor events in his life.
If the advice is given it assures him that in times of real stress he can still
independent. The mature adult does not wish to be independent to the extent
that he will not utilize the expertise of others. It is not surprising then that the
at times and seeks in a real or token way people to whom he can turn who are
willing to listen to the adult because he does want external help in sorting out
his confusion; the long-time goals are aspects of his life that he is mulling over
but about which he does not have to make an immediate decision as he would
if he had to decide whether to take a girl on a certain date. On important
issues the normal adolescent listens and often stores away what he hears to
think it over in his own secret way, even though on the surface he may seem
to resent the advice and imply that he will do the opposite. Adults who say to
the adolescent asking for advice, “Don’t ask me because you will do as you
1086
please anyway,” may lock a door that should be left open, irrespective of
whether the adolescent walks through it at that point.
adolescent. The two year old, as he becomes aware of the strength inherent in
putty; “no” indicates a strength of a solid form. The infant, as lie becomes
a child is not the adult identity that he now is seeking, utilizes again the
shear off their locks. When miniskirts became acceptable high school attire,
peer group, but different in the eyes of those who established the childhood
will he cling to the identity his negativism provided him with? The answer
1088
With the advent of adolescence the sexual drive becomes intensified,
sexual confusion exists in simpler societies in which the increased drive can,
within the framework of the mores of the social structure, find more readily a
permitted pathway of expression with the opposite sex. For many reasons
Western culture does not sanction such a pathway; instead, it complicates the
early discharge of sexual tensions by fostering the ideal that mature sexuality
represents a fusion of a biological urge and the emotional desire to love and
be loved.
preadolescent experience with love as the roots from which the ultimate
begins prior to the onset of adolescence. The intensified sexual feelings of the
young adolescent are not yet directed solely toward an heterosexual goal.
contribute to the intensity with which the young person responds to both
pleasure and disappointment. These modes of discharge are often
parents; the clearest pathway for expression of fused sexual response and
love is thus the familiar one of love for the parents. Because of the increased
and a child in his own eyes and those of his parents. He thus must deny and
intensification of positive feelings for the parent of the same sex. This offers a
dual conflict again. To relate in this fashion to a parent of the same sex again
1090
Consequently he denies, or attempts to repress, his affection for the parent of
the same sex and resents any implication of a strong emotional tie. The
utilizes her flirtatious manners that may have become ineffectual with her
long-time mate. She avoids the conflict inherent in such a response to her son
by being “motherly.” When, for example, she kisses him and he protests, her
answer is, “Why won’t you let your mother kiss you?” He probably doesn’t
when the son is in a good mood in which he feels free to express his affection
in a manner that he cannot express it to his male friends, finds with him a
gratifying relationship. The reverse situation exists with a girl; her father
finds her budding femininity stimulating, and he, under the guise of being
“after all her father,” responds warmly to her. She, if needing to deny her
affection for her father, is often quite resistant to his overtures. When she is
not fighting any expression of her affection for her mother, she again provides
the mother with a closeness that the mother does not know with friends.
gains strength from his closeness with his father if the struggle for self-
identity becomes too overpowering and external support is needed. The girl
likewise gains confidence in her femininity from her father’s response. At the
same time her closeness to her mother, when it is needed, provides her with
parents are not available to play this role, appear too threatening, or are
During the adolescent phase many solutions may be tried to resolve the
oedipal tie, solutions that if they were to become a permanent part of the
example, a boy, instead of turning toward his mother, may transiently seek a
girl who will mother him; he may seek a girl who represents only a sexual
object; he may deny any interest in any girl; or he may choose a girl who does
not have a psychologically feminine orientation. He may turn to an older man
or to some male peer whom he can love as he fears to love his father. He may
renounce his masculinity, rejecting any identification with his father or any
1092
masculine figure. These intense, frequently ambivalent relationships are often
brief. While this brevity may be evaluated by the adult world as evidence of
sex is the harbinger of an ultimate homosexual adult life pattern. In some this
experience.
the confusion of the adolescent as he deals with the increased intensity of his
sexual aims, it is by no means the sole source of sexual conflict. In most
identification with the older person has not assured him that he is the same,
doubts about his own sexual adequacy, he fears it will be seen by others;
because of his tie to a person of the same sex he worries about homosexuality.
To deny these concerns, he may talk or act out a genital sexual pattern
fear that he can’t act it out. If he acts out a pseudoheterosexual role, he either
finds it unsatisfactory or is vaguely aware that the sexual act itself is a mutual
young adolescent girl, for she is often frigid. She interprets this as evidence of
her failure in her feminine sexual identity. The fact that the reproductive
glands do not reach full maturity with the increased functioning at puberty
probably contributes to some adolescent confusion. There has not been
1094
sufficient study of this to state it as more than an hypothesis, but it may be
that part of the difficulty in fulfilling the sexual goals of the young adolescent
for genital discharge of sexual tension with anyone of the opposite sex. It is
considered to be attained when love for the sexual partner and sexual
discharge are one. Often the love an adolescent experiences for another
person of the opposite sex is an expression of a need of the young girl or boy
that is not readily melded with sexuality. Possibly such melding cannot occur
until the sexual glands have attained a stable maturity, and emotional needs
interested in his school work, but now he orients it to the reality of his future,
not just to the present. He works out in fantasy many possible roles that he
can play in the social and economic structure when he becomes an adult. He is
interested in sports, either as a participant or as an observer, and formalizes
into a social philosophy for the future the standards of fair play and
period he often translates his philosophy into thinking about social issues, the
His protest becomes verbal, and he may join with those who with similar
those whom they consider barriers to the fulfillment of their goals, for
temporarily becomes a source of concern to others and may lead the young
adolescent into activities that are basically incompatible with the philosophy
he is expressing.
the self, must find new rules by which to live. Lack of life experience leads
often to naive, but sincere concepts. At the same time, however, it is not only
inexperience and the resultant naiveté that energizes the drive toward these
social goals. The drive may be intensified by: the wish to find an area of
adequacy; the need to find a securely dependent relationship in a group that
1096
provides a familylike unity that is obviously not the primary family; the need
to rebel against the symbol of a childhood relationship with his family (at
self; or a wish to discharge sexual tension through love for a cause and for
individuals who are abstractions and thus do not threaten intimacy.
and defense, and the firm establishment of defenses and adaption against
ego-alien impulses, is described by many as regression in response to the
the patient, after regressing and coming to recognize the infantile manner in
tools; he is experimenting with new tools that may more adequately serve his
needs. Many of the former tools prove of value with or without some
modification; even though at times he casts them aside, he ultimately uses
them again. Other and new tools appear at times to be the only answer to
himself as an adult.
Resolution of Adolescence
This process occurs throughout adolescence, but during the early phase
He becomes at home in his new body and with his new physiology. This
is facilitated by the completion of the physical and biological growth that has
been initiated by prepuberty and puberty. He has a body image of himself that
represents his external self-concept.
1098
He learns by experimentation, evaluation, and from the behavior of
his own right. What was negativism earlier becomes a capacity to think
Hopefully he does not completely abandon his earlier naive attitudes, but
rather exposes them to a rational evaluation that enables him to see their
maturation. With this forward step he can experience his nonsexual love for
his parents without anxiety, accepting them and hopefully being accepted by
sexual identity as a male (or female). A sense of sexual adequacy relieves the
anxiety experienced earlier and frees the individual to enjoy that adequacy. At
the same time there is a relief from the strain of multiple sexual goals, and
patterns for himself with the development of familiarity and the acceptance of
his own identity. He clarifies his role in his family of the past and, if married,
his new family; he finds secure employment; and he accepts responsibilities
part. He has become an adult. Later he may modify or change the roles, but he
the multiple facets of his familiar role and the new one by which he is
tempted.
1100
completely achieved by any individual. One of the frequent unfortunate
consequences of failure to achieve an adequate resolution of adolescence is
their naiveté is confronted with the negating aspects of reality, too many
be involved in, and to offer wise participation and leadership in areas beyond
Deutsch, H., “Selected Problems of Adolescence,” The Psychoanalytic Study of the Child,
Monograph No. 3, International Universities Press, New York, 1967.
Erikson, E. H., Identity and Youth Crisis, Norton, New York, 1968.
Freud, A., “Adolescence,” in The Psychoanalytic Study of the Child, Vol. 13, pp. 255-278,
International Universities Press, New York, 1958.
Bibliography
Bell, R., and Buerkle, J., “Mother and Daughter Attitudes to Pre-marital Sexual Behavior,”
Marriage & Fam. Living, 23: 390-392, 1961.
Benedek, T., Studies in Psychosomatic Medicine: Psychosexual Functions in Women, Ronald Press,
1102
New York, 1952.
Blos, P., “The Second Individuation Process of Adolescence,” in The Psychoanalytic Study of the
Child, Vol. 22, pp. 162-186, International Universities Press, New York, 1967.
Erikson, E. H., Identity and Youth Crisis, Norton, New York, 1968.
Freedman, M. B., “The Sexual Behavior of American College Women,” Merrill Palmer Quart.,
11:33-48, 1965.
Freud, A., “Adolescence,” in The Psycho-analytic Study of the Child, Vol. 13, pp. 255-278,
International Universities Press, New York, 1958.
_____, The Ego and the Mechanisms of Defense, International Universities Press, New York, 1936.
Grinder, R., and Schmitt, S., “Coeds and Contraceptive Information,” J. Marriage & Fam., 28:471-
479, 1966.
Hall, G. S., Youth, Its Education, Regimen, and Hygiene, D. Appleton & Co., New York, 1904.
Halleck, S., “Sex and Mental Health on the Campus,” J.A.M.A., 200:684-690, 1967.
Healy, W. H., The Individual Delinquent: A Textbook of Diagnosis and Prognosis for All Concerned in
Understanding Offenders, Little, Boston, 1915.
Lichtenstein, H., “Identity and Sexuality: A Study of Their Interrelationship,” J. Am. Psychoanal. A.,
9.179-260, 1961.
Piers, G., and Singer, M., Shame and Guilt, Charles C Thomas, Springfield, Ill., 1953.
1968.
Stuart, H. C., “Normal Growth and Development during Adolescence,” New Eng. J. Med., 234:666-
672, 693-700, 732-738, 1946.
Notes
[1] Editor’s Note: Some authors distinguish also a juvenile and preadolescent period.
[2] These apparently opposing points of view are summarized in Wiener’s Psychological Disturbance in
Adolescence
1104
Chapter 19
Kenneth Keniston
Most discussions of the life cycle assume a certain fixity of life stages.[1]
Psychiatrists, social scientists, and laymen in the Western world take for
granted that life can be divided into a definite series of “stages,” beginning
with early infancy, continuing with two or three further stages during the
then by adolescence, early adulthood, and so on until old age and death. These
are, after all, the stages of life that are acknowledged, sanctioned, and
institutionalized in modern industrial societies.
It has gone relatively unnoticed until recently that other societies and
other historical eras segment the life cycle in different ways. As Erikson notes
in his discussion of Indian concepts of the life cycle, there are indeed parallels
between his own theory of human development and the traditional wisdom of
defined age-grades.
adolescence were not recognized. For example, Aries, in his study of medieval
concepts of the life cycle, shows that nothing like the modern notion of
childhood existed. Instead, the medieval child at birth entered a stage of life
called infancy, which lasted six or more years. After infancy he was simply
considered a small adult, expected to dress and act like what we would today
recognized that those whom we call children were in some ways different
from those whom we call adolescents and young adults. But this recognition
was nowhere institutionalized or sanctioned. For example, insofar as schools
existed at all, they were graded by ability, not age: the same medieval
classroom might contain within it students from eight to 45, grouped on the
1106
eighteenth centuries. In this new view children were thought to possess an
“innocence” that required protection from the adult world; age- grading
prosperous bourgeoisie that could exempt its children from the work
language and numbers that rarely could be taught at home. For the new
“protection” from adulthood that extends well beyond the medieval period of
with changes in the social and economic structure of Western Europe, which,
adolescence is even more recent. Freud, writing at the turn of the century,
the family, note the virtual absence of mention of anything like modern
adolescence until the latter part of the century. And even then those whom
we would call adolescents were often discussed as a new problem, as what
one writer called the “dangerous classes” who made up the street gangs that
1108
began to transform the social, economic, and familial structures of those
societies. The old working family, where parents and children labored side by
an industrial society required far more than rudimentary education from any
that became the special province of the secondary schools that opened by the
major social and economic changes that drastically affected the lives of
life cycle is not a psychological or cultural constant, and that the way life
stages are distinguished and defined is intimately related both to the social,
between definitions of the life cycle, socioeconomic context, and the actual
that concepts of life stages tend to correspond with, reflect, and sanction
If these surmises be correct, they have far- reaching implications for the
understanding of human development. We have tended to assume that the
and women who constitute the source material for most contemporary
onto which the child steps at birth and up which he continues willy-nilly until
he has passed through all the stages until death. This escalator model is a
tempting one, for it corresponds with what we know of physiological
maturation, which, barring the grossest of insults to the organism, tends to be
The escalator model also corresponds with the fact that every society,
however it defines the life cycle, does segment life in some way: age-grading,
1110
functioning, presumably based upon what Anna Freud' calls the increasing
“structuralization” of the personality or what Piaget calls the development of
ever more complex and inclusive schemata. The escalator model does not
age-grading.
supports and challenges during the first few years, suffer severe and probably
irreversible retardations. " Furthermore, the utility of developmental
concepts like fixation, foreclosure, arrest, retardation, and lag indicates the
frequency of failures of development that occur either because of the absence
than inevitable.
large differences in the way different societies segment and organize the life
cycle. For example, in many nonliterate and subsistence societies children are
routinely expected to join their parents in adult work at around the age of
seven or eight. What little we know about the conditions that stimulate
different effects on the final cognitive and affective development of the typical
adult, when compared with societies that insist on prolonged schooling
during the same years. Literacy alone appears to have massive effects on
argues that only with literacy does there emerge a capacity to reflect upon
“achievements” are not attained by many or most people in any given society.
Such, indeed, seems to be the case. For example, the psychoanalytic concept
of “genitality” refers to a psychosexual orientation that is often not realized.
1112
Similarly Kohlberg’s work on moral development (see below) has
among blacks. And other recent research suggests that a near majority of
adult Americans lack certain aspects of the cognitive capacity for formal
operations that in Piaget’s work is said to emerge around the age of puberty.
“blind” to real developmental changes that actually occur in their young. But
lines.
therefore supports the hypothesis that shifting historical definitions of the life
cycle reflect not merely shifting cultural fashions but actual changes in the
developmental matrix within which the typical child grows up, and, thus, real
changes in the type and level of development actually experienced by typical
sanctioned until a significant portion of the young have begun to pass through
that stage. Furthermore, if we assume that developmental potentials are
environments in all societies makes it likely that some rare individuals will
pass through any given stage of life, even in a social context that makes entry
into that stage very unlikely. Thus, once a stage is culturally recognized, we
can look back in history and discover men and women who passed through it
long before it was named and sanctioned. But the cultural “discovery” of a
stage of life tends to coincide with a time when ever more young men and
women are, in fact, entering this stage, exhibiting the visible hallmarks that
1114
the precise nature of adolescence still remains controversial. Some observers
the inevitability of turbulence, rebellion, and upheaval in this stage of life. But
American society has once again transformed itself. From the industrial era of
the turn of the century, we have moved into a new era without an agreed
upon name—it has been called postindustrial, technological, postmodern, the
age of mass consumption, the technetronic age. And a new generation, the
first born in this new era of postwar affluence, television, and the Bomb,
raised in the cities and suburbs of America, socially and economically secure,
received by children has increased by more than six years. In 1900 only 6.4
per cent of young Americans completed high school, while today almost 80
per cent do, and more than half of them begin college. In 1900 there were
only 238,000 college students: in 1970 there were more than seven million,
ager, upon the adolescent of Hall’s day. Today we are nervous about new
“dangerous classes”— those young men and women of college and graduate
school age who can’t seem to “settle down” the way their parents did, who
refuse to consider themselves adult, and who often vehemently challenge the
foremost problem.
The factors that have brought this new group into existence parallel in
many ways the factors that produced adolescence: rising prosperity, the
created not only prosperity and longevity but power to destroy the planet
revolution. The “new” young men and young women emerging today both
reflect and react against these trends.
1116
describe these young men and women, we find none that is adequate.
Characteristically they are referred to as “late adolescents and young
“nothing but” delayed adolescent rebellion. To those who are more hopeful
about today’s youth, “young adulthood” seems a more flattering phrase, for it
suggests that maturity, responsibility, and rationality lie behind the unease
But in the end neither label seems fully adequate. The twenty-four-year-
old seeker, political activist, or graduate student often turns out to have been
through a period of adolescent rebellion ten years before, to be all too formed
in his views, to have a stable sense of himself, and to be much further along in
his psychological development than his fourteen- year-old high school
brother. Yet he differs just as sharply from “young adults” of twenty- four
whose place in society is settled, who are married and perhaps parents, and
existing society, questions of vocation, questions of social role and life style.
who find it hard to settle down have failed the adolescent developmental task
would enable the young to reconcile themselves to abilities and a world that
are rather less than they had hoped. Another interpretation of youthful
unease blames society, not the individual, for the “prolongation of
exercise the adult powers of which they are biologically and intellectually
capable. According to this view, the solution would be to allow young people
to “enter adulthood” and do “real work in the real world” at an earlier age.
Yet neither of these interpretations seems quite to the point. For while
some young men and women are indeed victims of the psychological malady
earlier age would run directly counter to the wishes of many youths, who
view adulthood with all of the enthusiasm of a condemned man for the
guillotine. Far from seeking the adult prerogatives of their parents, they
vehemently demand a virtually indefinite prolongation of their nonadult
1118
state.
what can we call them? My answer is to propose that we are witnessing today
to call this stage of life the stage of youth, assigning to this venerable but
vague term a new and more specific meaning. Like Hall’s adolescence, “youth”
is in no absolute sense new: indeed, once having defined this stage of life, we
can study its historical emergence, locating individuals and groups who have
had a “youth” in the past.* But what is “new” is that this stage of life is today
ways. First, I will comment on some of the major themes that dominate
during this stage. Third, youth is of all stages of life that in which issues of
of life may take a specific youthful form. And finally I will try to make clear
what youth is not, in order to underline what it is. What follows, then, is a
preliminary sketch of the issues that seem important to understanding youth
Perhaps the central conscious issue during youth is the tension between
self and society. In adolescence young men and women tend to accept their
the “real self” becomes more problematic and constitutes a focus of central
concern. The awareness of actual or potential conflict, disparity, lack of
congruence between what one is (one’s identity, values, integrity) and the
struggling to define who he is; the youth begins to sense who he is and thus to
1120
selfhood and his social order.
In youth pervasive ambivalence toward both self and society is the rule:
the question of how the two can be made more congruent is often
characteristic stance vis-a-vis both self and world, perhaps best described by
the concept of the wary probe. For the youthful relationship to the social
adolescence, but with more serious forays into the adult world, through
which its vulnerability, strength, integrity, and possibilities are assayed.
and decency in society, and often in both anger and hope. With regard to the
self, too, there is constant self-probing in search of strength, weakness,
individual’s capacity to withstand or use what his society would make of him,
1122
experienced as putty in one’s own hands. At other times, or for other youths,
it is the nonself that becomes totally malleable; then one feels capable of
from casting off old inhibitions, values, and constraints may also lead directly
acculturation. In keeping with the intense and wary probing of youth, the
his personality of his society and his culture. At times he may attempt to
break out of his prescribed roles, out of his culture, out of history, and even
out of his own skin. Youth is a time when earlier socialization and
acculturation are self- critically analyzed, and when massive efforts may be
made to uproot the now alien traces of historicity, social membership, and
culture. Needless to say, these efforts are invariably accomplished within a
reject history altogether, youth does so in a way defined by its historical era,
and these rejections may even come to define that era.
may last for months, years, or a decade, and they inspire deep commitment in
those who adopt them. Yet they are inherently temporary and specific to
youth: today’s youthful hippies, radicals, communards, and seekers often
recognize full well that, however reluctantly, they will eventually become
older and that aging itself will change their status. Some such youth-specific
identities may provide the foundation for later commitments; but others must
be viewed in retrospect as experiments that failed or as probes of the existing
society that achieved their purpose, which was to permit the individual to
Another special issue during youth is the enormous value placed upon
change, transformation, and movement, and the consequent abhorrence of
when they seem to block change: thus, youth grows panicky when confronted
with the feeling of “getting nowhere,” of “being stuck in a rut,” of “not
moving.”
At times the focus of change may be upon the self, and the goal is then to
be moved. Thus, during youth we see the most strenuous, self-conscious, and
1124
even frenzied efforts at self-transformation, using whatever religious,
cultural, therapeutic, or chemical means are available. At other times the goal
may be to create movement in the outer world, to move others: then we may
see efforts at social and political change that in other stages of life rarely
possess the same single-minded determination. On other occasions the goal is
psychological need to identify with the highest and the lowest, the most
distant and apparently alien.
The need for movement and terror of stasis often are a part of a
defined by the individual and his culture. In all stages of life, of course, all
individuals often wish to change in specific ways: to become wittier, more
attractive, more sociable, or wealthier. But in youth specific changes are often
need not be fully conscious. Indeed, it often surfaces only in its inverse form,
as the panic or depression that accompanies a sense of “being caught in a rut,”
“not being able to change.” But for other youths change becomes a conscious
goal in itself, and elaborate ideologies of the techniques of transformation and
care is not to exist; for the four-year-old nonbeing means loss of body
For the youth, however, to lose one’s essential vitality is merely to stop. For
efforts to change and the resulting sense of being forever trapped in an un-
moving present.
stability of parents enables them to nurture the rapid change of their children.
the youthful situation itself. The desire to prolong youth indefinitely springs
not only from an accurate perception of the real disadvantages of adult status
1126
in any historical era but from the less conscious and less accurate assumption
existing social order, but not always by active political or other opposition to
it. It is a mistake to identify youth as a developmental stage with any one
social group, role, or organization. But youth is a time when solidarity with
the shared developmental positions and problems of youth. Much of what has
traditionally been referred to as “youth culture” is, in the terms used here,
adolescent culture; but there are also groups, societies, and associations that
are truly youthful. In our own time, with the enormous increase in the
number of those who are entering youth as a stage of life, the variety and
importance of these youthful countercultures is steadily growing.
feelings, to issues and tensions that unite the often scattered experiences of
real individuals. The themes, issues, and conflicts discussed here are rarely
conscious as such; indeed, if they all were fully conscious, there would
the issues considered here with different intensity. What is a central conflict
for one may be peripheral or unimportant for another. These remarks, then,
should be taken as a first effort to summarize some of the underlying
during this stage. Once again only the most preliminary sketch of youthful
development can be attempted here. Somewhat arbitrarily I will distinguish
also mean to suggest its importance as an area of potential change. The late
adolescent is only beginning to challenge his society’s definition of him, only
1128
starting to compare his emerging sense of himself with his culture’s
possibilities and with the temptations and opportunities offered by his
adolescence itself, the “real” focus of conflict is 011 the family and all of its
internal psychic residues. In youth, however, the “real” focus begins to shift:
tension between self and society, with ambivalent probing of both, comes to
and society are affirmed, in the sense that the autonomous reality-relatedness
For Jung the individuated man is a man who acknowledges and can cope with
social reality, either by accepting it or by opposing it with revolutionary
fervor. But he can do this without feeling his central selfhood overwhelmed.
Even when most fully engaged in social role and societal action, he can
preserve a sense of himself as intact, whole, and distinct from society. Thus,
process whereby self and society are differentiated internally. But the actual
conflicts between men and women and their societies remain and, indeed,
may become even more intense.
whether from self or from society. At one extreme is the total alienation from
self that involves abject submission to society, “joining the rat race,” “selling
out.” Here society is affirmed but selfhood denied. The other extreme is a total
alienation from society that loads not so much to the rejection of society as to
its existence being ignored, denied, and blocked out. The result is a kind of
self-absorption, an enforced interiority and subjectivity, in which only the self
and its extensions are granted reality, while all the rest is relegated to a limbo
periods. And for some whose further development is blocked, they become
the basis for lifelong adaptations—the self-alienation of the marketing
1130
Sexual development continues in important ways during youth. In
their late teens or early twenties: the modal age of first intercourse for
American college males today is around twenty, for females about twenty-
feelings with intimacy with a real person. And as sexual behavior with real
prohibitions against sex with one’s closest intimates. During youth, when
these fears and prohibitions can be gradually worked through, they yield a
capacity for genitality, that is, for mutually satisfying sexual relationships
assumption that the interpersonal world is divided into only two categories:
in which the individual can relate warmly to others who are different from
him, valuing them for their dissimilarities from himself. Finally the phase of
of the ways in which others are identical to oneself, the ways in which they
are similar and dissimilar, and the ways in which they are absolutely unique.
Only in the stage of mutuality can the individual begin to conceive of others as
separate and unique selves and relate to them as such. And only with this
1132
kinds of relationships with elders become possible: psychological
apprenticeships, then a more complex relationship of mentorship, then
and confirmed by the elder. The sponsor, for example, is one who supports
and confirms in the youth that which is best in the youth, without exacting an
excessive price in terms of submission, imitation, emulation, or even
gratitude.
parents. Adolescents commonly discover that their parents have feet of clay
and recognize their flaws with great acuity. Childish hero worship of parents
gives way to a more complex and often negative view of them. But it is
generally not until youth that the individual discovers his parents as complex,
three-dimensional, historical personages whose destinies are formed partly
by their own wishes, conscious and unconscious, and partly by their historical
situations. Similarly it is only during youth that the questions of family
tradition, family destiny, family fate, family culture, and family curse arise
with full force. In youth the question of whether to live one’s parents’ life, or
to what extent to do so, becomes a real and active one. In youth one often sees
to test its possibilities and limits, experience it from the inside, and (perhaps)
free oneself of it. In the end the youth may learn to see himself and his
fashion, themes and conflicts that date from earlier stages. In each individual
the weight and origin of the reevoked past will vary, depending on the
development. For example, the stage of early adulthood involves entry for the
first time into the world of work; it thus re- evokes isomorphic issues of
competence, industry, and inferiority that were experienced in childhood
upon entry for the first time into the world of school.
concerns focused on the “anal” stage, with its conflicts over autonomy, will,
1134
from dependency on and control by the family, then the isomorphism
between the anal phase and adolescence becomes clearer. Each stage entails,
avoid total control by his parents. Even the proverbial embarrassment of the
adolescent, now focused upon his or her incipient adult sexuality, resembles
the “shame” of the child during the anal stage.
that he has a will of his own; during the oedipal period he learns to take
initiative, using that will. In a parallel way the adolescent hopefully achieves
because the inhibitions of the oedipal stage remain so powerful that the
The tendency among youth to defer actual sexual relationships until the
twenties also helps explain the centrality of oedipal themes in this stage of
life. Although oedipal issues obviously recur in different forms throughout
the point in life when the individual attempts to unite intimacy and sexuality
usually unstated, taboos laid down within the child’s family, prohibiting the
joining of overtly erotic and affectionate ties, are powerfully reawakened. For
this reason the first real sexual relationships are more often than not
psychologically triadic rather than simply dyadic. Same-sex friends and rivals
are often as much in the forefront of consciousness during the beginning of
“mature,” to whom one reports in more or less graphic detail the sexual and
1136
These triadic relationships often appear flagrantly neurotic, and can be,
which the real existence of the partner is central rather than peripheral. But
the longitudinal clinical study of young men and women in the process of
could precisely label one specific level within each developmental line as
distinctively youthful, we would find that few people were “youthful” in all
at a truly adolescent level in her relationship with her parents, but at a much
with the dim awareness of relativism. Analysis of any one person in terms of
specific sectors of development will generally show a simultaneous mixture of
concept of youth here proposed is an ideal type, a model that may help
understand real experience but can never fully describe or capture it.
Ideology in Youth
Of all stages of life, youth is the most ideological. The potential for the
development of ideology rests upon affective and cognitive changes that may
begin in adolescence but that extend far beyond it. In the ideological
Erikson, quoting George Bernard Shaw, termed “a clear view of the world in
and norms. For psychologists and psychiatrists, however, the term has a
1138
primarily individual referent: it points to the individual’s developing world
view, conscious or unconscious, shared or idiosyncratic, especially seen as a
defensive and expressive system. Thus, on the one hand, the intellectual
historian may interpret ideology only as a cultural cement that binds together
a society, while the individually-oriented psychiatrist may consider ideology
only a “projective system” that expresses the complexes and conflicts of early
childhood.
ingredients of any individual’s ideology are borrowed from others, from his
individual and his society and history; ideology formation entails at best a
synthesis of elements that are uniquely personal with ideas, symbols, and
values that connect the individual to his community and to his historical
tradition.
perspectives from which any individual perceives and interprets the world
simultaneously to his own personal history and to the history of his society
and generation.
personality that can occur after adolescence. The most crucial of these is what
Inhelder and Piaget term the capacity for formal operations— namely, the
1140
ability to perform hypothetico- deductive operations whereby the observable
and concrete world of the real comes to be seen as a subset of the world of the
attained in rudimentary form around the time of puberty. But as Piaget notes,
the full integration of the capacity for formal operations is often long
the real and the possible, the actual and the ideal.
Many of the ideological struggles of youth are built around the painful
not, and may never be, actualized. During youth this conflict between the
ideal and the actual is worked on, and at best worked through, with regard to
both self and society. Vis-a-vis the self, the conflict entails an awareness of all
that one might conceivably be (and become) but is not (and will never be). It
limitations. At the level of society the struggle involves confrontation with the
gulf between societal creed and deed, a gulf probably widest in societies like
America whose ideals are so frequently and nobly stated but so rarely
society.
psychological and social reality has not been achieved. For this reason youth
is the stage of life where the demand for both psychological and social change
is most compelling. Nor should this demand be automatically dismissed as a
sign of immaturity. On the contrary, one may ask whether the acceptance of
the imperfection of self and society expected of adults does not constitute a
“acceptance” has been so excessive as to leave them with a lifelong fear that
ideology formation is to come to terms with the gap between the real and
ideal. And how one does this determines where on the spectrum between
revolutionary and organization man one is likely to spend the remainder of
one’s life.
1142
operations there may lie a further stage of “thinking about thinking.” In
practice just such a stage can be observed in some intellectual and
Throughout history there have always been some rare youths who
consciousness involves not only agents like hallucinogenic drugs but a return
awareness.
see a passage beyond simple views of right and wrong, truth and falsehood,
good and evil to a more perspectival view. And as youth proceeds, we may
look for the development of commitment within a universe that remains
relativism is fraught with difficulty, and that many young men and women,
vaguely sensing the uncertainties of a relativistic universe, may temporize or
involves relatively egocentric concepts of right and wrong as that which one
can do without getting caught or as entailing primitive notions of reciprocity
1144
(“I’ll scratch your back if you’ll scratch mine”). This stage is followed, usually
and evil are identified with the concept of a good boy or a good girl (that is,
development into this stage occurs at all, it is most likely to occur during
youth. This stage involves more abstract moral reasoning that may lead the
individual into conflict with conventional morality. The lower level of the
the long-term welfare of the community. This type of reasoning can be called
the social contract level, in that it construes moral rules and moral behavior
codes, rules, and laws not as objective and eternal, but as manmade,
changeable, and amendable.
but even the social contract: this level confronts the possibility that even rules
made in the public interest may be unjust. At this level general precepts,
Golden Rule, the sanctity of life, the Kantian categorical imperative, the
all situations and persons regardless of time, place, society, station, and
situation. At the level of personal principles the individual not only may find
himself in conflict with existing concepts of law and order but also may at
universalistic principles.
reason the parallels between the three accounts are the more striking. All
three accounts emphasize the centrality of the transition from the empirically,
culturally, or morally “given” to a new mode of functioning that transcends
the given. Stated more psychodynamically, all three suggest the limitations of
“internalization” as a mechanism of learning beyond adolescence and point to
standards.
1146
Equally important, all three accounts emphasize the hazards that
accompany the transition from the given to the synthetic, from the traditional
to the formulative. Perry notes that the movement from dualism to relativism
is fraught with special dangers that result from renouncing the certainty
argues, many young men and women temporize, stagnate, or retreat to earlier
threshold of relativism to reassert the verity of the world view from which he
moral regression that may occur as the individual begins to question the
with little apparent difficulty. But among those who begin to challenge
conventional moral codes, a number “regress” to preconventional moral
confrontation with the relativism, and to that degree the arbitrariness, of the
but in a return to more familiar, primitive structures that also negate the
that which avoids punishment and increases pleasure. When this regression
1148
countercultures. The consequence is a scathing collective attack on
the most sacred norms and taboos of those who adhere to dualistic truths and
confrontations that serve as catalysts for and are intertwined with cognitive,
intellectual, or moral terms; and if they do, we rightly suspect that we are
hearing only a part of the story, which serves as a “cover” for that which is left
unmentioned. In practice, then, the cognitive, intellectual, ethical changes that
cognitive capacity.
are found in realms other than the purely intellectual and moral: they may
someone whose world view is very different from one’s own; membership in
with the gap between public practice and public preaching; and so on. In the
end human development is neither affective nor cognitive, but both; only as a
matter of analytic convenience or research strategy can we separate its
points made here: the interweaving of the uniquely personal with the
1150
advances, and regressions; the agonized and often prolonged shock that
follows the “discovery” of the relativism of truth and the arbitrariness of
(or the creation of new ones) in the search for a world view to replace the
dualistic security of childhood; the crucial role of ideology in uniting the
struggles.
development, for there is clear evidence that the majority of young men and
women between the ages of 18 and 30 do not pass through most of the stages
I have outlined. For most adult men and women it is most precise to say that
ideology is borrowed rather than developed. These are those whom William
James long ago termed the “once-born,” who accept with little anguish or
conclusive in the realm of ideology. Kohlberg and his associates have found
that only a minority of teen-agers possess the cognitive capacity for formal
operations; and if higher levels of this capacity are measured, then a majority
Americans.
and Kohlberg. Perry found that only a few of the college students he studied
the individual’s level of moral reasoning, finds that the majority of middle-
class college students have not moved beyond conventional structures at the
age of 24. Among working-class subjects (and their fathers) the proportion
that for both male and female college students, the modal moral position is
1152
among the advantaged, educated young men and women in economically
advanced societies who occupy so much of psychiatrists’ time. These studies
further impel us to remember that it is possible and normal for men and
morality. It seems that most of mankind has always lived this way and that, as
a result, most men and women have not experienced the full force of the
ideological tensions that constitute a central part of youth. Youth involves the
actualization of the usually latent human potential for departure from societal
different from that which exists, and for thinking about thought.
Psychopathology in Youth
symptoms often lies in crises, conflicts, or feelings that date from earlier
of the developmental stage during which they occur. Thus, the relationship
necessarily occur during a stage of life, and their content is therefore shaped
development entails what Anna Freud and Peter Bios have termed
1154
achievement itself may be equated with motion, and failures to achieve are
vitality in youth.
youth are commonly related to these issues. Few young men and women pass
through this stage of life without considering, whether distantly or concretely,
understood not only as efforts to end life but as misguided attempts to regain
a sense of inner momentum, and with it a feeling of “really being alive.” If so,
1156
interpersonally isolated youths, estrangement may reach pathological
proportions of acute depersonalization and derealization. The individual
searches desperately for efforts to connect up with others, with himself, with
the experience of real relationships. Those who are severely inhibited in their
depersonalization.
world, it is important not to undercut these fantasies too harshly, for these
today, any attempt to define pathology in the realm of ideology must rest on a
1158
ideological expression of their own conflicts, and at times a protected context
where they can navigate an unusually troubled stage of development.
The greatest danger for clinicians who work with ideological youth,
expressive, and defensive role. It is indeed accurate to say that each youth
and of the previous generation. And as Erikson has pointed out, ideology at a
collective level can express and give meaning to widespread conflicts,
the real and the ideal. Thus, the therapist who works with youth does well to
recognize that, whatever the pathologies of ideology in a patient, the goal of
therapy must not be the eradication of ideology, but support for those
processes that will enable the individual to develop an ideology that both
expresses his unique selfhood and unites him to the rest of mankind.
reenactments.
competitor (or all of these things) of one or both of the core partners. All
parties involved are likely to acknowledge that the situation is a “mess”: the
third party may be explicitly being “used” by both partners; or the couple
sensing that a rupture must eventually come. But even though the
interminably, with no one able to make (or sustain) a real break. Guilt,
neediness, identification, genuine affection, fears of isolation, the hope of
change, the fantasy of omnipotentiality, and a host of other factors are the
glue that makes these triads so sticky.
1160
are evoked by such imbroglios, oedipal themes predominate. A young woman
who alternates between two lovers—one assertive and aggressive, the other
father, all the while avoiding the guilt that would be aroused by a relationship
with a “whole man.” The young man who sustains an unhappy affair with a
married woman often turns out to be far more preoccupied with his fantasies
about the husband than with his lover. Finally these situations tend to be
tears of pain, rage, and frustration, anxiety-laden reunions, and joyous if brief
relationships almost indefinitely, and if the relationship finally ends, they may
compulsively seek out another equally entangled imbroglio. At times,
from oedipal fears, inhibitions, and fantasies that stood in the way of any
prolonged intimacy.
separation. The individual reacts to the loss by isolating himself from anyone
who might enable him to express or test his fantasies, ideas, and feelings.
established boundaries between self and world, inner and outer, conscious
1162
and insight gives way to a feeling of confusion, disorientation, and even
incommunicably they were stated. The sense of “too much, too fast” in the
write off psychotic thoughts and behaviors as “crazy.” If we study those many
experience itself.
a form of moratorium, which it clearly still is for some). But today such
1164
encapsulation, lack of reality testing, rejection of outgroup members, the
helpful for some disturbed (or not so disturbed) youths. But for others these
groups may in the long run serve an adaptive and developmental role. One
study of young men and women involved in the East Village “hippie”
community in the late 1960’s found that the average member stayed less than
two years, that the majority eventually returned to their homes and reentered
the educational process from which they had dropped out, and that only
those who were highly disturbed or highly creative (or both) remained for
longer periods. For the remainder the “hippie” world seems to have served as
a collective psychosocial moratorium, a shared “developmental regression”
that permitted them to work out and work through some of their inner
conflicts. The rapid turnover in youthful communes, political groups, and the
clear the fuzziness of the boundary between significant disorder and normal
conflict, entails turmoil, and often requires the capacity to regress before
moving forward. But during youth conflict, turmoil, and regression may last
not for weeks or months but for years. Schizoid ideation, hypomanic
turmoil and retrogression. During youth, even more than during other stages,
a step forward may have to be preceded by a step backward, and the absence
and perhaps most work themselves out without special therapy. The study of
youths who are not patients provides examples of young men and women
1166
whose self-prescribed “therapies,” however remote from the traditional
modalities of formal psychotherapy, prove highly successful. People were
invented; and they continue to do so, even today, in ways that often defy the
explanatory power of our psychological theories.
the patient, however disturbed his behavior may be; a capacity to focus on the
them with a real and honest human relationship with another person who has
more or less successfully weathered the turmoil of youth.
clear what it is not. For one thing youth is not the end of development. I have
described the belief that it is—the conviction that beyond youth lie only
contrary, youth is but a preface for further transformations that may (or may
not) occur in later life. Many of these center around such issues as the
vocation is crucial, but the issue of work—of productivity, creativity, and the
younger now assuming responsibility for the elder. Like all stages of life,
throughout adulthood.
It is also a mistake to identify youth with any one social group, role,
class, organization, or position in society. Youth is a psychological stage; and
those who are in this stage do not necessarily join together in identifiable
groups, nor do they share a common social position. Not all college students,
for example, are in this stage of life: some students are psychological
adolescents, while others are young adults—essentially apprentices to the
1168
existing society. Nor can the experience of youth as a stage of life be identified
with any one class, nation, or other social grouping. Affluence and education
that may underlie and promote the transformations of youth. But there are
poor and uneducated young men and women, from Abraham Lincoln to
Malcolm X, who have had a youth, and rich, educated ones who have moved
some of the factors that facilitate youth also exist in the less advanced nations,
Nor should youth be identified with the rejection of the status quo, or
specifically with student radicalism. Indeed, anyone who has more or less
self and society. This tension may take the form of avid efforts at self-reform
that spring from acceptance of the status quo, coupled with a sense of one’s
own inadequacy vis-a-vis it. In youth the relationship between self and
practice most young Americans who enter this stage of life tend to be
between the ages of 18 and 30. But they constitute a minority of the whole
conventional level by the age of 24. Thus, “youths” constitute but a minority
of their age group. But today those who are in this stage of life largely
human life, each level of development, has its characteristic vices and
the potentials for zealotry and fanaticism, for reckless action in the name of
the highest principles, for self-absorption, and for special arrogance are all at
a peak. Furthermore, the fact that youth is a time of psychological change also
reworking of the past. This reworking can rarely occur without real
regression, whereby the buried past is reexperienced as present and, one
1170
hopes, incorporated into it. Most youthful transformation occurs through
need for constant motion, and the terror of stasis—may generate youthful
pathologies with a special virulence and obstinacy. In one sense those who
have the luxury of a youth may be said to be “more developed” than those
who do not have (or do not take) this opportunity. But no level of
with health.
positions of youth become part of the cultural stock-in- trade. There thus
develops the phenomenon of pseudoyouth: preadolescents, adolescents, and
Establishment. And many an adult, unable to accept his years, may adopt
of earlier developmental levels, conflicts, and stages, no one can ever be said
to be completely “in” one stage of life in all areas of behavior and at all times.
consider him a “youth,” will also contain some persistent childishness, some
not outgrown adolescence, and some precocious adulthood in his makeup. All
we can say is that, for some, adolescent themes and levels of development are
relatively outgrown, while adult concerns have not yet assumed full
and will continue to witness a growth in the proportion of young men and
women in their late teens and twenties who pass through that postadolescent
stage I have called youth. If this be true, it will become the more important to
1172
recognize the differences between adolescence, youth, and early adulthood,
viewing youth as neither prolonged adolescents nor young adults who have
not quite been able to navigate the passage to adulthood. Clearly these
young people to enter a period of youth, yet at the same time defines for them
the alternatives available during that stage of life. We must learn to identify
youth.
the great majority of men and women have been concrete in their cognitive
functioning, conventional in their moral judgments, and dualistic in their
views of truth. It can be argued that cultural, social, and political stability,
along with the secure transmission of culture from one generation to the next,
will have major effects upon all of those institutions, from the family to the
churches, from the political system to the schools, that have traditionally been
implications we begin to see in the sense of social and cultural malaise in all
has rarely if ever been historically actualized on a mass scale. It may be that
affluence, the impact of the new media, the prolongation of education, the
deferral of adult responsibilities, the rapidity of social change, and so on— are
autonomous men and women. A society of such men and women would be
vastly different from any we have known. It may not be too early to begin
imagining how it could be a better society than ours.
1174
a child. A similar principle appears to hold in other sectors of development.
For example, the concept of interpersonal mutuality, defined as care for
incomprehensible to people who can care only for those whom they consider
like themselves. Those who are related to their parents through bonds of
implications for therapists, as for others who deal with youth. It is, of course,
that one has not experienced oneself: a therapist need not have been
psychotic himself in order to understand a patient who has been or is.
But the possibility remains that, just as able and complex high school
students are often misunderstood by teachers less able and less complex than
themselves, so some youthful patients may encounter therapists who
possibility remains that the patient may be right—that the therapist ma not
their patients, and that they will view the therapeutic process not only as a
way of helping someone else to grow but as a human experience in which
Bibliography
Apter, D. E. (Ed.), Ideology and Discontent, Free Press, New York, 1964.
Aries, P., Centuries of Childhood: A Social History of Family Life, Random House, New York, 1962.
Berger, B. M., “The New Stage of American Man—Almost Endless Adolescence,” New York Times
Magazine, November 2, 1969.
_____, “Uber eine typische Form der mannlichen Pubertat,” Imago, 9, 1923.
1176
Bourne, R.
Bowers, M. B., “The Onset of Psychosis: A Diary Account,” Psychiatry, 28:346, 1965.
_____, and Freedman, D. X., “Psychedelic Experiences in Acute Psychoses,” Arch. Gen. Psychiat.,
15:240-248, 1960.
Bowlby, J., Maternal Care and Mental Health, World Health Organization, Geneva, 1951.
Bruner, J. S., “A Psychologist’s Viewpoint: Review of Inhelder and Piaget, The Growth of Logical
Thinking,’ ” Brit. J. Psychol., 50:363-370, 1959.
_____, Olver, R. S., and Greenfield, P. M., Studies in Cognitive Growth, Chapters 11-14, John Wiley,
New York, 1967.
Davies, A. F., Private Politics: A Study of Five Political Outlooks, Melbourne University Press,
Melbourne, 1966.
Davis, N. Z., “The Reasons of Misrule: Youth Groups and Charivaris in Sixteenth-Century France,”
paper presented at Sir George William University, March 5, 1970.
Demos, J., and Demos, V., “Adolescence in Historical Perspective,” ]. Marriage & Fam., 31:632-638,
1969.
Deutsch, H., The Psychology of Women, Vol. 1, Grune & Stratton, New York, 1944.
Douvan, E., and Adelson, J., The Adolescent Experience, John Wiley, New York, 1966.
Eisenstadt, S. N., From Generation to Generation, Free Press, New York, 1956.
Erikson, E., Childhood and Society, 2nd ed., Norton, New York, 1963.
_____, Gandhis Truth: On the Origins of Militant Non-Violence, Norton, New York, 1969.
_____, Young Man Luther: A Study in Psychoanalysis and History, Norton, New York, 1958.
Fishkin, J., Keniston, K., and MacKinnon, , “Moral Reasoning and Political Ideology,” J. Pers. & Soc.
Psychol., 27:109-119, 1973.
Freud, A., “Adolescence,” in The Psychoanalytic Study of the Child, Vol. 13, International
Universities Press, New York, 1958.
_____, The Ego and the Mechanisms of Defense, International Universities Press, New York, 1946.
Freud, S., “Three Essays on the Theory of Sexuality,” in Strachey, J. (Ed.), Standard Edition,
Complete Psychological Works, Vol. 7, Hogarth, London, 1953.
Feuer, L. S., The Conflict of Generations, Basic Books, New York, 1969.
Greenfield, P. M., and Bruner, J. S., “Culture and Cognitive Growth,” in Goslin, A. (Ed.), Handbook of
Socialization Theory and Research, Rand McNally, Chicago, 1969.
Haan, N. Brewster Smith, M., and Block, J. H., “Moral Reasoning of Young Adults: Political-Social
Behavior, Family Backgrounds, and Personality Correlates,” J. Pers, & Soc. Psychol.,
10:183-201, 1968.
Hall, G. S., Adolescence: Its Psychology, and Its Relations to Psysiology, Anthropology, Sociology, Sex,
Crime, Religion, and Education, D. Appleton & Co., New York, 1904.
1178
Harris, D. B. (Ed.), The Concept of Development: An Issue in the Study of Human Behavior,
University of Minnesota Press, Minneapolis, 1957.
Hauser, S. T., Black and White Identity Formation, Wiley-Interscience, New York, 1971.
Hunt, D., Parents and Children in History: The Psychology of Family Life in Early Modern France,
Basic Books, New York, 1970.
Inhelder, B., “Some Aspects of Piaget’s Approach to Cognition,” Monog. Soc. Res. Child. Dev., 27:19-
33, 1962.
_____, and Piaget, J., The Growth of Logical Thinking from Childhood to Adolescence, (Tr. by Parsons,
A., and Milgram, S.), Basic Books, New York, 1958.
James, W., The Varieties of Religious Experience, Longmans, Green, New York, 1902.
Jung, C. G., Psychological Types: The Psychology of Individuation, Random House, New York, 1962.
Kardiner, A., The Psychological Frontiers of Society, Columbia University Press, New York, 1945.
Katz, J., et al., No Time for Youth: Growth and Constraint in College Students, Jossey-Bass, San
Francisco, 1968.
Keniston, K., “Postadolescence (Youtli) and Historical Change,” in Zubin, J., and Freeman, A. (Eds.),
The Psychopathology of Adolescence, Grune & Stratton, New York, 1970.
_____, “Student Activism, Moral Development and Morality,” Am. J. Orthopsychiat., 40:577-59,
1970.
_____, The Uncommitted: Alienated Youth in American Society, Harcourt, Brace & World, New York,
1965.
_____, Young Radicals: Notes on Committed Youth, Harcourt, Brace & World, New York, 1968.
Kohlberg, L., “The Child as a Moral Philosopher,” Psychology Today, 25-30, 1968.
_____, “The Concept of Moral Maturity,” paper read at NICHD Conference on the Development of
Values, Washington, D.C., May 15, 1968.
_____, “The Development of Children’s Orientations towards a Moral Order I: Sequence in the
Development of Moral Thought,” Vita Humana, 6:11-33, 1963.
_____, “Education for Justice: A Modern Statement of the Platonic View,” Burton Lecture on Moral
Education, Harvard University, Cambridge, 1968.
_____, “The Relations between Moral Judgment and Moral Action: A Developmental View,” paper
read at Institute of Human Development, Berkeley, 1969.
_____, and Gilligan, C., “The Adolescent as a Philosopher: The Discovery of the Self in a
Postconventional World,” Daedalus, 100.1051-1086, 1971.
_____, and Kramer, R., “Continuities and Discontinuities in Childhood and Adult Moral
Development,” Human Dev., 12: 93-120, 1969.
Kramer, R., “Changes in Moral Judgment Response Pattern during Late Adolescence and Young
Adulthood,” Ph.D. diss., University of Chicago, 1968.
Krebs, R. L., “Some Relationships between Moral Judgment, Attention and Resistance to
Temptation,” Ph.D. diss., University of Chicago, 1967.
Kuhn, D., Langer, J., and Kohlberg, L., “The Development of Formal-Operational Thought: Its
Relation to Moral Development,” unpublished paper, Harvard University, 1971.
1180
Lidz, T., “Egocentric Cognitive Regression and a Theory of Schizophrenia,” paper presented at the
Fifth World Congress of Psychiatry, Mexico City, December 1971.
Loevinger, J., “The Meaning and Measurement of Ego Development,” Am. Psychol., 21:195-206,
1966.
Mannheim, K., Ideology and Utopia, Harcourt Brace, New York, 1936.
Myrdal, G., An American Dilemma, Harper & Row, New York, 1944.
Offer, D., Psychological World of the Teenager: A Study of Normal Adolescent Boys, Basic Books,
New York, 1969.
Parsons, T., and Platt, G. M., “Higher Education, Changing Socialization,” in Riley, M. W., Johnson,
M. E., and Foner, (Eds.), A Sociology of Age Stratification, Volume III, Of Aging and
Society, pp. 236-291, Russell Sage Foundation, New York, 1972.
Perry, W. G., Jr., Forms of Intellectual and Ethical Development in the College Years, Holt, Rinehart
and Winston, New York, 1970.
______, “Patterns of Development in Thought and Values of Students in a Liberal Arts College,”
Harvard University Bureau of Study Counsel, Cambridge, 1968.
Provence, S., and Lipton, R. C., Infants in Institutions, International Universities Press, New York,
1962.
Pumpian-Mindlin, E., “Omnipotentiality, Youth and Commitment,” J. Am. Acad. Child Psychiat., 4:1-
18, 1965.
Reich, C. A., The Greening of America, Random House, New York, 1970.
Rest, J., “Developmental Hierarchy in Preference and Comprehension of Moral Judgment,” Ph.D.
diss., University of Chicago, 1968.
Shapiro, R. L., “Adolescence and the Psychology of the Ego,” Psychiatry, 26:77-87, 1963-
Silverstein, H., “Study of East Village Youth,” unpublished ms., prepared for Joint Commission of
Mental Health of Children, 1968.
Slater, P., Microcosm: Structural, Psychological and Religious Evolution in Groups, John Wiley, New
York, 1966.
Spitz, R., “Hospitalism,” in The Psychoanalytic Study of the Child, Vol. 1, pp. 53-75, International
Universities Press, New York, 1945.
Sullivan, H. S., The Interpersonal Theory of Psychiatry, Norton, New York, 1953.
Notes
[1] Throughout this essay I assume some familiarity with the works of Erik Erikson, virtually all of
which clarify the stage I term “youth.” Portions of this essay were previously published
in The American Scholar. The research on which it is based is supported by a grant from
the Ford Foundation.
[2] Obviously interpersonal development, and specifically the development of relationships with peers,
begins long before adolescence, starting with the “parallel play” observed at ages two to
four and continuing through many stages to the preadolescent same-sex “chumship”
described by Sullivan. But puberty in middle-class Western societies is accompanied by
major cognitive changes that permit the early adolescent for the first time to develop
hypothetical ideals of the possibilities of friendship and intimacy. The “search for a soul
mate” of early adolescence is the first interpersonal stage built upon these new cognitive
abilities.
1182
[3] Research work with nonpatients suggests that the experiences I have termed “prepsychotic” are
common among intellectual youth; that they are often precipitated by hallucinogenic
drugs; and that they only occasionally lead to a truly psychotic episode.
Cyril Sofer
that affect the quality of his everyday work experiences and relations and the
way in which his work fits in with the rest of his personal life and social
1184
with each other in a planned set of arrangements; an appreciable part of his
his superiors in the quantity and quality of his output. The work is subject to
he has to manage these in a way that makes his behavior acceptable to all
that it is done in the name of objectives not necessarily identical with the
not from that of the preferences of employees; creativity and innovation are
space, comfort), rather than being intrinsic to the performance of the task
itself, and are related to observed contribution to the overall “organizational”
scale tasks in mass societies, yield economic and social benefits from
specialization and coordination, allocate work to employees systematically on
supervision as the main indices of bureaucracy, the results show that those in
1186
conformity. They spent their leisure in more intellectually demanding
activities. These findings applied to both the public and private spheres of
levels, and the more complex jobs they do. At the same time he notes that
bureaucracies provide especially close supervision of staff and that, having
hired educated men and given them complex jobs to perform, they may fail to
lower turnover rates, and fewer labor disputes. The explanation for this is
satisfaction, since one can assume, at least in some technologies, that the size
of work groups can vary independently of this.
Workers do not choose randomly with respect to the type of firm they
factors select the smaller ones. This type of differential selection leads to
similar turnover rates in the two types of firms. A separate study of auto
workers reports that the men deliberately gave priority to high economic
work. The majority said they would not be bothered by job changes that
would move them away from their current colleagues. Nor did they look to
their supervisors for social and psychological support in their work roles.
persons, asked whether they would continue to work if this were not
financially necessary for them, say they would continue to do so, those in
different job or to express significant reservations about what they are doing.
Two major stress-producing conditions appear to be the role conflict and role
persons who can handle or who enjoy conflict and ambiguity fill roles where
these conditions are especially likely to occur. But however they are handled,
1188
the endemic nature of these stressful conditions is incontrovertible. In a U.S.
national survey of 725 persons representing that part of the labor force
employed during the spring of 1961, about half the respondents reported that
they were caught in the middle between two conflicting persons or factions:
in 88 per cent of these cases at least one of the persons involved was an
reported work overload, that is, conflict among tasks or problems in setting
priorities. Four forms of ambiguity were reported as particularly
troublesome: uncertainty about the way one’s superior evaluates one’s work,
people had with their organizational roles increased as conflict and ambiguity
increased. On the other hand, ambiguities in such areas can be worked into
defensive attitudes and ideologies that function to protect self-esteem. In the
and the capacities of the occupant; and difficulties that are primarily
intrapsychic but are acted out in the work environment. But all these
problems, that is, those created by the individual’s attempts to cope with the
core problem. Tensions arising from difficulties in work roles are not
friend, or citizen.
collective output, in the course of which the parties seek to overcome, injure,
workers, strikes are the most conspicuous examples of such conflicts, but
they appear also in such less organized forms as work limitation, slowdowns,
outlook, and aspirations differ from and compete with each other. Nor are
1190
management. In the large, modern, complex organizations a particularly
more destructive forms, because the parties usually have other overriding
interests in common and because lines of cleavance are multiple, so that it is
not in the interests of the parties to press any one division to its logical end.
about the behavior of oneself and others, encourages unrealistic beliefs and
employment. Even though structural forces and social processes provide the
experience: while this can be argued to confer meaning and identity, there is
clearly also a risk that people will become unduly dependent on their
employing organizations and will play out on the organizational stage the
The nature of work has changed appreciably during the past few
decades. Physical tasks are increasingly being relegated to machines and
1192
physical labor is being displaced by mental effort. The occupational skills of a
person may have to change often during his lifetime or may become
formed once and for all in childhood, and at least their external
manifestations continue to be actively reshaped in adulthood, largely through
occupations disappear and new ones emerge, for example, those of systems
analyst and computer programmer. This process reduces certainty in
unskilled manual occupations at the bottom. The higher the level of the
either during one’s own lifetime (which is highly unusual) or from one’s
father’s occupational status, and to help one’s children move up from one’s
higher-status roles or may have aspired to higher-status roles that they have
ideologies that help to rationalize lack of achievement. But equally one can
expect some less socially and personally “adjustive” reactions, such as deviant
semiskilled workers, and low- level production workers, mental health was
1194
found to vary consistently with level, with more problems reported at the
lower levels. It is not altogether clear, however, how far this is a direct result
Notes
experience but also more generally in the quality of one’s personal and social
will enter are the social class (largely occupational class) of his parents, the
number of years of formal education he has had, the size of his family, and the
and social origin decrease in importance over time relatively to what has
happened in one’s career. Important handicaps to career advance are having
a broken family (which affects both the husband and male offspring), having
persons either in their former or present social class in regard to life style and
reciprocal influence. Mobile persons are more apt to be prejudiced against
minorities and more apt to be preoccupied with their health; these attitudes
fates and life styles. When the children of professionals are not successful
1196
localized, is their likely social destiny.
Blue-Collar Workers
Operatives
great deal of systematic vocational guidance and are not well equipped with
course of the work itself and are derived from immediate work colleagues:
allegiance to the work group and adherence to group norms and standards of
output become a necessary condition for learning and for pleasant or
offer little scope for affirming personal competence (in a way that gives the
The context of the work may involve isolation from what is felt to be the
autonomy or control over working conditions, and effort to maintain and gain
pacing and repetitiveness. A large number wanted jobs that lacked these
characteristics. The mass production characteristic most disliked was
The work often demanded “surface mental attention”; that is, it required a
high degree of attention but was not intellectually demanding, thus being
workers. Ability to interact was also limited by noise, speed of the line, and
1198
The combination of the content and context of manual work is
(the feeling of being in, but not of, society, a sense of remoteness from the
This is not a complete picture. There are many kinds of occupation and
the levels of satisfaction actually available in their jobs and for adapting even
to the fact that few satisfactions (apart from income) may be available on the
vary widely in the extent to which their self-esteem is affected by the work
they do; this depends on their relative investments in a wider range of human
satisfactions.
with each other to use their relationships to express feelings and attitudes
(both positive and negative) not strictly related to their work situation.
expectations of satisfaction from work may not be high and the instrumental
aspects of work are emphasized. Satisfaction with a particular job docs not
depend purely on the quality of the work experience but on the relation
between that experience, the expectations of the worker, and his assessment
of the alternatives realistically open to him.
aspirations of blue-collar workers arc typically not high, and their definitions
1200
them, that is, largely in terms of security of employment and reasonableness
of hours, colleague- ship, and supervision. On these criteria blue- collar jobs
have their own typical sources of anxiety and stress. Such jobs are less secure
than others; the posts held by an individual typically are not related to each
other in an orderly sequence; and earnings do not rise concurrently with
increasing family needs, being related more to strength, skill, and speed than
after others that is generally accepted to come with age. The industrial
worker is more subject to occupational vicissitudes than persons in more
among which is the opportunity that work offers for the use of their abilities
apt to be poorer where plants are large, a high proportion of employees are at
a low level of education and skill, and personnel policies and services are
below average. Mental health tends to be poorer as job level falls. Men
individual with the union generally bulks larger as he comes to scale down his
aspirations, settles for a steady job, and relies on the union to protect and
advance his interests in the employment relationship and in competition with
among those who remain ambitious to rise into the ranks of management.
1202
The sheer size of modern industrial organizations combined with the
American workers appear to value most highly the job security and the
and the union. Acute conflicts in loyalty are most likely to occur in the
broken for a union to be formed. In some cases the worker has little use for
either employer or union, viewing both as evils to be tolerated and the whole
the organization of industry and society and look to the union for a more
equitable distribution of business income and for insurance against improper
treatment.
At its highest this role has been described as mediation between the
the informal “communal” aspects of shop floor work life have to mesh.
project all 55 production foremen in the same plant were interviewed. On the
whole and in spite of rough times, difficulties, and frustrations, the foremen
liked their jobs, their employing organization, their economic rewards, and
existed and real problems stemmed from the technical environment and the
problems of maintaining quality and keeping the line manned. Combined with
1204
pressure from many sources and still not become a symbol of pressure to his
men. The foremen felt they needed help from their managements, and this
was the main criterion for evaluating managerial colleagues. The foreman’s
main way of keeping up productivity was by keeping the line manned, but
absenteeism (partly prompted by the assembly line) often frustrated this aim.
The foreman was exposed to the fact that those who experience compulsions
below—typically demands for productivity (or its equivalent) from above and
noncommissioned officer was valued from above for “being a strong military
leader” and from below for “being a good fellow.” Ratings of foremen by
superiors and subordinates have been found to be inversely correlated, with a
tendency for those who are well thought of by one group to be badly thought
of by the other. The supervisor must uphold the organizational standards
superiors and for the daily social interaction that makes work situations
The supervisor may have to choose between “riding” his men or being
make decisions.
representatives about what is going on in his section. The foreman acts as the
who has taken away a different segment of what used to be the supervisory
job.
1206
wide range of matters (including labor contracts and laws, company policy
and regulations, technological processes, training methods) although he may
well have come up the hard way and not have had much formal education.
Nor may he be well prepared for the managerial side of his role: workers at
For the majority of supervisors little lies ahead in the way of promotion,
managerial rank. Desk work may not in any case be attractive, or the entry
White-Collar Workers
hand, their preoccupations lie more with deciding what to do than with
getting an acceptable job.
They may have to build a view of their capacities and occupational life
their competence, and provide scope for achievement. Like these other
they are usually able to take for granted the security, continuity, and
adequacy of income that are problematic for the blue-collar man. Their
problems lie rather in whether they can exercise a relatively high measure of
whether they can identify as their own and render visible to others the
contributions they make to collective efforts in which the impact of any
1208
individual is diffuse and hard to specify. Work tasks are more central to
personal identity in this group, so that expectations from the work situation
incorporation of work tasks into the self and a high measure of identification
with the employing organization makes life satisfaction highly dependent on
While the blue-collar worker has to tolerate the risk that he may be
only partly technical but are also largely his expertise in the administrative
with their work than those at lower levels; satisfaction seems to arise from
the very fact of being in an occupation that ranks higher than others, and this
has a halo effect on other aspects of the occupation and the work it involves.
White- collar workers have higher expectations of their work and, in general,
more sources of satisfaction. The executive and the professional have more
hierarchical authority, at least in the way of direct surveillance. They have the
and can be integrated into their nonwork activities. This contrasts with the
needs for security and for social interaction met, but satisfactions in esteem,
report more satisfaction in their jobs than staff managers, especially in regard
1210
proportion of the work life even though objective opportunities for
promotion actually decline.
The modern office and its staff are an outgrowth of large-scale industry.
small, there were relatively few office employees, they were appreciably
collecting personal taxes through employers, and in unionism, there has been
U.S. studies have emphasized that increased costs have led to the
rationalization of office work and changed roles for the office worker. The
roles of bookkeeper, clerk, and secretary have been fragmented, become
more routinized and to some extent more mechanized—in this way following
differences exist in the connection of the duties of the office worker with
In regard to work satisfaction, one of the few exceptions to the rule that
that skilled manual workers are slightly more satisfied than rank-and-file
white-collar workers. This is found in the United States, Germany, and the
U.S.S.R.
Over the past few decades the salaries of U.S. office workers and blue-
collar workers have converged, partly through rationalization of work, partly
Strains among office workers and the lowest levels of management are
thought to arise from salaries that are too low to finance the middle-class
technological advances.
1212
In Britain the basic skill of literacy used to set the clerk apart from the
working man and give him a foothold on the lowest rung of the middle-class
powerful. But the connection with middle-class status has been altered by
social and economic changes. Economic power has shifted toward organized
labor and educated people have become less scarce. There has been a fall in
the desirability and prestige of clerical work in the eyes of other occupational
groups.
The clerk belongs neither to the middle class nor the working class. In
opportunity for upward mobility, clerks in Britain can still perhaps claim a
higher status than most manual workers. But using other criteria such as
The position of clerical workers and lower- level managers has recently
been particularly affected by the introduction of electronic data processing.
many have worked under conditions more stable than those of either blue-
collar workers or executives. The disorganization and reorganization
jobs is changing with the automation of office processes. The most routine
jobs are being eliminated and work pace is becoming more closely tied to
machines, so that absence and lateness matter more. While the office worker
still has more freedom than the blue-collar worker to leave his workplace or
to vary his production level, more specific work quotas have been imposed.
Opportunities for promotion may have been somewhat reduced, and some
shift work has been introduced. There is lower tolerance for errors, which
become transmitted far through the system and are more visible to superiors
and customers. With the rationalization of the work system, each job gains
significance in the continuity of the overall process and the individual
jobs may be eliminated or changed radically. While new jobs are created, the
persons displaced may not be able to fill them or may not be easily amenable
to retraining.
In a British study drawing on data from nine firms that had introduced
computers, it was found that this and concomitant reorganization were
experienced as a threat to staff security. There was much initial anxiety, even
where little redundancy ensued. Staff often had to be redeployed. It proved
difficult to avoid reducing the status and salary of staff in the 45 to 55 age
group, particularly if they had held supervisory positions. In the clerical area
1214
there was a greater concentration of responsibility and a need for more staff
to master complicated new skills. In some firms junior managerial roles also
the new computer installations were negative. Many of the younger clerical
Middle-Level Managers
struggles derives largely from the investments made by the persons involved
in their occupational training and experience and from the difficulty of radical
occupational shifts in adulthood— particularly among those wishing to
upward rise. Most organizational tasks are carried out by groups that develop
solidarity, shared definitions of their mission and status, and shared
conceptions of how they should relate to other task groups, subordinates, and
refrain from pressing his own claims to special consideration and merit. But if
1216
subject to clear-cut criteria of adequacy. This makes assessment of the
executive’s competence dependent on evaluation by colleagues, of which
only his performance but also his potential: an aspect that necessarily brings
into issue the amount of flexibility and capacity for growth and change in his
tor the appraiser also. The executive faces a unique life situation in that he
reciprocal support. The executive’s career becomes linked with that of his
1218
helped to do so by the personnel institutions of their organizations. The
disappointed person may be able to call on his individual defense
mechanisms in the sense that he can tell himself that he has not been given a
fair chance or that he would not stoop to the methods used by others to
central theme is that personal merit is not the main determinant of success.
Some are able to find compensations in other aspects of their lives. External
compensatory roles may include devotion (or more devotion) to familial,
will, and vitality from one’s work role, complying with the formal
self-identity on the assumption that they will in due course come to occupy
certain organizational roles more senior than their own. A career
closest to him his revised expectations and evaluations, the person may have
Technical Specialists
staff managers, mainly because the latter feel they have to be directed by
others.
routines and controls that are alien to their notions of reciprocal control by
equals; that they are overconstrained by considerations of practicality and
discipline and to colleagues wherever they are located from those whose
1220
more abiding interests and personal loyalty reside with their employing
organization. While important conflicts no doubt exist, most people are
career ladders have sometimes been created so that specialists can improve
their prestige, income, and facilities without giving up their specialties. Those
people who are most insistent on pure science and academic freedom are apt
to avoid careers in the applied research departments of large organizations.
work by their organizational superiors will give them the facilities and
resources they need for successful research. At the same time they become
Senior Administrators
research shows that within management security and social affiliation needs
are equally met, but that the needs for esteem, autonomy, and self-
actualization are better met at each higher level. The phenomenon of greater
1222
needs were better satisfied in their jobs.
adhering to the instructions issued to them. Their errors are usually less
visible and their rights more likely to be defended by formal collective
organization, the means by which these must be filled or vacated, and the
changes, such changes are liable to alter the existing distribution of power
and prestige. A tension can be set up between following out the logic of an
organizational change and accepting the implications that the change will
have for one’s own position and behavior.
In the earlier phases of his career the senior administrator will probably
first have developed and practiced some form of specialist expertise, then
most senior levels opportunities for direct development and practice of such
special knowledge decrease, and usually the transition has to be made to
challenge.
views of each but may, nevertheless, have to act in ways that advance the
interests of some and obstruct those of others. In order to maintain
loneliness. His wife may also find herself in a similar position in relation to
responsibility for large sums of money, large numbers of people, and far-
have more scope for variation and for idiosyncratic interpretation than those
lower down. This is largely because it is the function of the senior executive
1224
person or executive group to define organizational priorities. If, as is usual in
large organizations, a number of people are involved, either formally or
relative power and duties. How things turn out will clearly depend on a
combination of formal position, personality, traditions of colleagueship and
large in the psychological life space. There will be a further division of labor in
the psychological sense that each senior administrator will tend to perform
of these roles among a colleague group of three and implied that, apart from
objective task definition, problems may arise if administrators fit poorly into
the psychological functions allocated to them by group processes, if they are
Bibliography
Bedrosian, H., “Managerial Obsolescence in Banking,” in Lazarus, H., and Warren, K. (Eds.), The
Belbin, E., and Belbin, R. M., “New Careers in Middle Age,” in Neugarten, B. L., Middle Age and
Blackburn, R. M., Union Character and Social Class, Batsford, London, 1967.
Blau, P. M., “Social Mobility and Interpersonal Relations,” Am. Sociol. Rev., 21, 1956.
_____, and Duncan, O. D., The American Occupational Structure, John Wiley, New York, 1967.
Blauner, R., Alienation and Freedom: The Factory Worker and His Industry, University of Chicago
_____, “Work Satisfaction and Industrial Trends in Modern Society,” in Galenson, W., and Lipset, S.
M. (Eds.), Labor and Trade Unionism: An Inter-disciplinary Reader, John Wiley, New
York, 1960.
1226
Cain, L. D., “Life Course and Social Structure,” in Faris, R. E. L. (Ed.), Handbook of Modem
Centers, R., “Attitude and Belief in Relation to Occupational Stratification,” J. Soc. Psychol., 27.159-
185, 1948.
Chinoy, E., The Automobile Worker and the American Dream, Doubleday, New York, 1955-
Coser, L., The Functions of Social Conflict, Free Press, Glencoe, 1956.
Chicago, 1964.
Dill, W. R., Hilton, T. L., and Reitman, W. R., The New Managers: Patterns of Behaviour and
Down, E., and Adelson, J., “Social Mobility in Adolescent Boys,” J. Abnorm. & Soc. Psychol, 56, 1958.
Fleishman, E. A., Harris, E. F., and Burt, E., Leadership and Supervision in Industry: An Evaluation of
Glaser, B. G. (Ed.), Organizational Careers: A Source Book for Theory, Aldine, Chicago, 1968.
Goffman, E., “On Cooling the Mark Out: Some Aspects of Adaptation to Failure,” Psychiatry, 15,
1952.
Goldthorpe, J. H., Lockwood, D., Bechhofer, F., and Platt, J., The Affluent Worker: Industrial
Gouldner, A. W., “Cosmopolitans and Locals: Toward an Analysis of Latent Social Roles,” Admin.
_____, “The Unemployed Self,” in Fraser, R. (Ed.), Work, Vol. 2, Penguin Books, London, 1969.
Gross, E., Industry and Social Life, Brown, Dubuque, Iowa, 1956.
Herzberg, F., Mausner, B., and Snyderman, B. B., The Motivation to Work, John Wiley, New York,
1959.
Hodgson, R. C., Levinson, D. J., and Zaleznik, A., The Executive Role Constellation, Harvard Graduate
1228
Ingham, G. J., Size of Industrial Organisation and Worker Behaviour, Cambridge University Press,
Cambridge, 1970.
Inkeles, A., “Industrial Man: The Relation of Status to Experience, Perception and Values,” Am. J.
Jennings, E. E., Routes to the Executive Suite, McGraw-Hill, New York, 1971.
Kahn, R. L., Wolfe, D. M., Quinn, R. P., and Snoek, J. D., Organizational Stress: Studies in Role Conflict
Knupper, G., “Portrait of the Underdog,” Public Opinion Quart., 11, 1947.
_____, “Bureaucratic Man: A Portrait and an Interpretation,” Am. Sociol. Rev., 36, 1971.
Kornhauser, A., Mental Health of the Industrial Worker, A Detroit Study, John Wiley, New York,
1965.
Levinson, H., “Reciprocation: The Relationship between Man and Organisation,” Admin. Sci.
Quart.,9:370-390, 1964.
Berkeley, 1959.
MacWhinney, W. R. H., and Adelman, S. R., “Mental Health of the Industrial Worker: An Analysis
Mann, F. C., and Williams, L. K., “Organizational Impact of White Collar Automation,” Proceedings
Marcson, S., The Scientist in American Industry, Harper, New York, 1960.
Menzies, I. E. P., “A Case Study in the Functioning of Social Systems as a Defence against Anxiety:
A Report of a Study of the Nursing Services of a General Hospital,” Human Rel, 13,
1960.
Merton, R. K., Social Theory and Social Structure, Free Press, Glencoe, 1957.
Moore, W. E., and Tumin, M. M., “Some Social Functions of Ignorance,” Am. Sociol. Rev., 14, 1949.
Morse, N. C., and Weiss, R. S., “The Function and Meaning of Work and the Job,” Am. Sociol. Rev.,
20, 1955.
1230
Mumford, E., Living with a Computer, Institute of Personnel Management, London, 1964.
Neff, W. S., Work and Human Behaviour, Atherton Press, New York, 1968.
Neugarten, B. L. (Ed.), Middle Age and Ageing, University of Chicago Press, Chicago, 1968.
Palmer, G. L., “Attitudes toward Work in an Industrial Community,” Am. J. Sociol., 63, 1957.
Pellegrin, R. J., and Coates, C. H., “Executives and Supervisors. Contrasting Definitions of Career
Porter, L. W., “Job Attitudes in Management,” J. Appl. Psychol., 46, 1962; 47, 1963; 47, 1963.
_____, and Lawler, E. E., “Properties of Organization Structure in Relation to Job Attitudes and Job
Roy, D. F., “‘Banana Time’: Job Satisfaction and Informal Interaction,” Human Organization, 18,
1959–1960.
_____, “Work Satisfaction and Social Rewards in Quota Achievement: An Analysis of Piecework,”
Stouffer, S. A., Lumsdaine, A. A., Lumsdaine, M. H., Williams, R. M., Brewster Smith, M., Janis, I. L.,
Star, S. A., and Cottrell, L. S., The American Soldier, Vol. 2, Combat and Its Aftermath,
_____, Suchman, E. A., De Vinney, L. C., Star, S. A., and Williams, R. M., The American Soldier, Vol.
Turner, A. N., and Lawrence, P. R., Industrial Jobs and the Worker, Harvard Graduate School of
von Mises, L., Bureaucracy, Yale University Press, New Haven, 1946.
Vroom, V. H., Work and Motivation, John Wiley, New York, 1964.
Walker, C. R., and Guest, R. H., The Man on the Assembly Line, Harvard University Press,
Cambridge, 1952.
_____, _____, and Turner, A. N., The Foreman on the Assembly Line, Harvard University Press,
Cambridge, 1956.
1232
Watson, W., “Social Mobility and Social Class in Industrial Communities,” in Gluekman, M. (Ed.),
Closed Systems and Open Minds, Oliver & Boyd, London, 1964.
Wilensky, H. L., “Work, Careers and Social Integration,” lnternat. Soc. Sci. J., 12, 1960.
_____, and Edwards, H., “The Skidder: Ideological Adjustments of Downward Mobile Workers,” Am.
Weiss, R. S., and Riesman, D., “Social Problems and Disorganization in the World of Work,” in
Zytowski, D. G., Vocational Behaviour: Readings in Theory and Research, Holt, Rinehart, New York,
1968.
Ian Alger
Introduction
history, and whatever the joys and anguishes it may bring, the fact that in our
society marriage is the goal, both striven for and achieved, of the
this chapter intends to deal with marriage at this current time in history, and
focus is being undertaken because this type of marriage is the one about
which most clinical psychiatric experience has been accumulated and, indeed,
is the one about which over 90 percent of the psychiatric literature is written.
This is not to say that marriages in other classes of our society, among
minority groups of various racial and ethnic backgrounds are not relevant
and important. It is to say, however, that knowledge about them comes from a
1234
sociological and anthropological base, that even this knowledge is only
gradually being developed with any completeness as survey and statistical
studies improve, and that these marriages are by and large not the ones that
Just as types of marriage other than the middle-class variety exist in our
society, different types of marriage exist in other cultures and societies, not
only now, but also back through history. Again no major focus will be placed
on these other varieties, except to underline the point that the institution of
basis of providing for the needs of that society and its people, and these needs
can be described as biological and social. For example, needs for food, shelter,
and sexual experience and needs for security, companionship, and child
must have favored the evolution of marriage. In all probability (for again we
must remind ourselves how little we really know of origins) these motives
were connected with the rising institutions of property. Individual marriage
came through the desire of the male to have cheap slaves, and to avoid
liberationists who call for equality and freedom from the enslavement of
marriages in which women are treated as property. Leaving aside for the time
a discussion of the merits of this argument, it would seem true that marriage,
arrange marriages with other powerful families, and a king in one realm
not only is power and property preserved, but also religious beliefs and social
position, which, in turn, tend to preserve the economic and political structure
of the society.
1236
With this introduction let us turn to an examination of marriage as it
experienced pain in that growing up, and who saw the frequent despair and
anguish of our parents, nevertheless join with the large majority of our
fellows and, despite any earlier protestations to the contrary, get married. But
the tendency to marry is even more impressive than that. Over the past 40
years the divorce rate in this country, and not alone in this country, has risen
markedly.[1] In the past decade the rate has shown another increase. Yet most
of those who have divorced remarry, and, indeed, contrary to earlier
hypotheses, the majority of those in second marriages claim that they have
found greater satisfaction and happiness than in their first.[2] Thus, since
1940 for every unit of increase in the proportion of the population divorced,
there have been five units of increase in the proportion married (p. v).
moment on.” These implications involve not only the relationship between
the two partners but also possibly myriad responsibilities to the larger
society and to associate members of the marriage system, such as children,
the couples’ own parents, other relatives and assorted in-laws, and occasional
times merely liabilities, may begin in random and erratic ways from the
moment of the wedding vow and continue until the system closes with death
Society has always made entering the marriage system easier than
leaving it. This commitment by the two partners holds both the promise of
satisfaction in a close relationship with another human being through a
that arise in relationship to it, and while we then consider what therapies and
remedies are, or may become, available to ease the suffering.
1238
have chosen to talk of it as a “system” because I want to imply the features of
change and dynamism, of interrelationships within the marriage and between
the marriage system and other systems in the society. In addition, I wish to
include the concept of the system existing and changing in time as other
systems in the world also alter in time and relationship. When marriage is
becomes instantly apparent. Let us pursue the idea of the “marriage system” a
little further, then. In this system two main partners voluntarily enter a
relationship that actually is licensed, or certified, by the authority of society
and that thereby becomes, whatever else it may be, a legal contractual
as both shall live. The impossibility of anyone’s having sufficient control over
the eternity from the promise and opens the option of certain release from
such impossibly burdensome emotional obligation. However, rarely at the
moment of making the vows do the parties to the contract consider the future
shadow it may cast. Rather, they are more often eager and desirous of
publicly declaring their affection and love for one another, and they look
forward to the happiness that can come from the growing together of two
long to share more. They anticipate the unique human fulfillment that can
between a man and a woman. In such hopes are found one of the basic forces
that make marriage so appealing. Loneliness is an unhappy feeling, and
although in one sense we must all exist alone, in another sense we all seek
cared for us as infants and children. As we live we seek the constant renewal
of that humanity in this sharing. For those who grew up deprived of this kind
of human contact and love, relationships with others may be anticipated with
anxiety and defensiveness. Still others may have grown up with such self-
mistrust and low self-esteem that they continue to seek a chronically infantile
dependency on others. More will be said later of the problems these and other
developmental deprivations and distorting experiences can create in the
marriage system. For the moment, however, let us emphasize again the
dyadic closeness.
In addition to this appeal, the marriage system also offers the couple the
sanction of having their own children and moving from the role of children
themselves to that of mother and father. Indeed, in these days when young
people so often easily live together with no formal marriage vows, it is the
1240
wish to have children legitimated in society’s eyes that leads many of them, if
not to the altar, then to the desk of the county clerk. From another
most telling motive in many teen-age marriages that are statistically most
likely to end in early divorce.[3]
If the desire for children motivates the origin of many marriage systems,
then the presence of the children binds the marriage more tenaciously than
any other factor. Children conceived in love so often become the main reason
for continuing the marriage when the love is gone. Although love for the
children may often be a telling factor in one parent’s decision not to leave, it is
also true that the children can serve as a convenient rationalization for those
who fear to move on in their lives. Some partners have become so dependent
on the marriage for realistic or emotional reasons that they dare not attempt
to make a life apart from their current marriage, feeling that such an effort
A third reason for marriage has a less lofty tone, but nevertheless
resounds with practicality. If suburbia has little to offer for single people, the
rural climes have less, and urbanity notwithstanding, the big city can be a
very lonely place as well. In other words, the larger society is compatible with
the marriage system, and one might even surmise that the two were made for
each other. It seems evident that coupled living is favored by all kinds of other
A fourth reason for marriage has been deliberately left to last, not
because it plays no part, but because it plays a diminishing role in the
deliberation preceding marriage. It is the factor of sexual fulfillment. With the
widespread availability of reliable and easy methods of oral contraception,
and with all the other changed conditions that permit young people an easy
and early intimate association, sexual experience before marriage has become
more and more the usual course, and marriage is more rarely hurried along
on the wings of intense but frustrated lust. One might think that with
increasingly liberal sexual attitudes and expanding sexual freedom the
importance of romantic love as a central force in mate choice and marriage
would diminish. But romantic love is actually not that closely associated with
sex itself; rather, it grew from the eleventh- and twelfth-century courtly
games of idealizing the “loved” one beyond all reality, and in the haze of
daydreaming ecstasy imagining a life of superb joy lived in idyllic
wonderment and delight in a never ending transcendence of rapture. The
myth of this impossibility spilled from the chambers of the court, beyond the
aristocracy, and today the romanticism floods our lives, given special
propulsion by the power of multimedia advertising. The promise of perpetual
1242
youthful glow, of poised and promising breast, of never fading allure sweeps
through the airwaves and drowns us in a commercial gush. But still the
seductive promise of a life of everlasting love, of the one and only, falsely
leads the multitude to anticipate the continual glow of warmth and closeness.
Alas, the romanticism has a short half-life, and the hopes of one who has
shattered by the day-to-day realities with which the marriage system has to
engage.
Who Is Chosen
the marriage partners, all well and good. Of course, in our own society many
marriages are still arranged, although the details of the arranging are often
kept obscure. Nevertheless, marriage within the same class not only is
common but is given much support, especially in the upper class, and when
this tradition is broken, wills are frequently changed and the details of trust
funds altered so that the passage of wealth and power can be controlled and
class lines take place, and certainly the trend to upward mobility favors this
democratic idea of the freedom to marry the person one loves, the great
white spouses are married to white spouses, and 99 percent of black spouses
are married to black spouses. The least crossing of class occurs in the upper
and politically powerful classes where the largest stakes in terms of money
and power are in jeopardy. Royalty and the upper classes have always been
keenly aware of the importance of marriage in maneuvers of political power,
and although they have always had more sexual liberty and freedom of
relationships than the rest of the population, they have been scrupulously
careful in the way marriage contracts have stipulated the ownership and
inheritance of property. Undoubtedly much of the age-old concern for
women’s chaste behavior has grown from men’s fears that their worldly gains
are not held as persons; it will be explored further in the section dealing with
the nature of the relationship between the partners in the marriage system
and with the burgeoning women’s liberation movement.
affects not only the mate choice but also the quality of married and family life
1244
that develops. Large proportions of our population move every year, often to
new areas thousands of miles away from the old home. With this constant
either partner. Although many attributes of such newly formed couples may
lie within narrow and similar boundaries, such as educational level, race, and
religion, many other features may be quite unfamiliar, having to do, for
succeed. Although that sought after quality of close intimacy may be lacking,
unions based on these self-serving yet solid motivations may endure and
fulfill the lives of those so united in many ways. Other reasons for mate choice
may fall into an increasingly neurotic category and be related more to the
cultural or other forces in the general social system. An immature person, for
example, may seek a new family haven in a marriage at the point where other
distortedly based on her physical appearance and her sexual coefficient, many
young women still caught in the trap of such a dehumanizing attitude may
rather than wait, because to most waiting may mean waiting forever, and to
many in our culture this seems like a fate worse than married death.
The basis of neurotic attraction may be even more closely tied to the
involved may not be able to adapt by themselves to a new life in which more
independence is required.
1246
Functioning in the Marriage System
who have the temerity to give advice may say that it should not be
undertaken too young, and yet not too late, that marriage is best undertaken
between those of different natures, and yet between those of the same
background. Statistics show some convincing data on the marriages that have
some better chance of surviving,[6] but other critics might question whether
survival of a marriage is any valid criterion of its worthwhileness. It would
seem that when it comes to a specific case the task of advising a couple
whether to marry is most difficult. What makes the prognosis even more
uncertain is the very fact that marriage is a system and will evolve in
relationship to all the other world and life forces; thus, the mass of factors
affecting the prediction lie mostly in the future and beyond the grasp of the
The course will be different depending on how old the partners are; what is
whether there are auxiliary members of the system at the start, such as
children from earlier marriages or relatives who will be living in the same
Earlier mention was made of the existential truth that in one sense each
of us is alone in this life. And yet in another sense we are never alone, and our
series of roles, and our social beings are defined by this multiplicity of roles.
through all the roles, but the role self is no less real because the behavior
changes from role to role. The idea that in marriage “two become one” has a
romantic beauty, but a practical pitfall. The individual who grew from a child
in a family was part of that family system. But as he grew he joined other
indeed, he often had formed a separate existence in several ways by the time
he was ready to enter marriage. The marriage system as a rule requires a
more stringent “togetherness” than any other system, even the primary
1248
merges in the identity of a “couple,” and it is in the constricting implications of
in the coupling system that weeks or months (or occasionally years) may pass
with the spouses so involved in the pleasure of their relationship together,
and with the possibilities of growth contained within it, that the limitations
are not experienced as such. The newly formed system has much pleasure
and challenge to offer. Since close living will be one of the hallmarks, there is a
awareness and beyond awareness, during which basic rules of living are
established. The intricacy is such that rules must evolve about who makes
rules, and in this way hierarchies are established in different areas. Such
for experience together, with just the two of them, that may be very sweet
and quite rare in their previous experience. It is true that the trend now,
close personal living experience, together with working out some of the
advantage of these informal arrangements is that one person may live with
several different partners; thereby he learns that the experience can be very
different with different people, and yet that some of the living situations that
In the early stages of the marriage there are also many new and exciting
tasks that can best be accomplished by the two working together, and from
this kind of joint effort a good deal of satisfaction is inevitable. Usually a new
handling these things. In the economic area agreements must also be made,
either openly or covertly, about the patterns of earning, buying, and saving
that will develop in the particular marriage system. Two people from similar
backgrounds and having similar outlook will have less difficulty reaching
agreement on such practical issues. Agreement, of course, also depends on
the creation of adequate communication, and factors other than background
determine this, varying from personal communication style, to personal
1250
past.
marriage continues, there still is the potential for much trouble deriving from
be true that entering a marriage system does not necessarily mean closing
down other possibilities for personal growth, and, indeed, the thesis that
marriage need not mean this will be pursued later in the chapter; but the
experience of a multitude of married persons has been that entering the
hate and resentful duty. The reasons for the erosion may actually relate less
to the closeness than to the isolation that is so often associated with it. And
the reasons for the isolation vary in each marriage system, yet may stem from
Reference has already been made to our highly mobile population; this
mobility not only breaks up kinship systems but also disrupts friendship
community, and then be relocated on the other side of the country for the
overwhelmed by sheer closeness and numbers, and in the midst of the crowd
and community areas for recreation and even local shopping where friends
can meet are eliminated, families are increasingly isolated in their living
arrangements. This is true as well in the suburbs where neighbors may live
next to one another for years and yet never meet or even speak for more than
a superficial exchange. Again the isolation is the key, with the resulting
turning in. A further factor is work for members of the family. Places of
employment may be far from the place where one lives. If both husband and
wife work they may travel in different directions. This could lead to an
independence that one would think might counter the effects of the too great
closeness. But if both must return to be together after work, the advantages of
the separateness cannot be exploited, and the strings of the marriage “bag”
1252
partner would like to move out more freely, he or she may find no welcoming
for this, since the multitude of others are sequestered in their own
Both partners in a marriage system are usually invited out for dinner, to a
party, or to the theater. If independent activities are included, they most often
are organized along sexually segregated lines, such as women’s card groups
or men’s bowling clubs. If sexually mixed activities are sanctioned they most
often are related to some specific task, such as educational classes, parent-
teachers associations, political clubs, and the like. From these examples one
can see that opportunities for one individual to develop himself or herself in a
The greater pressure, however, may come from within the structure of
the marriage system itself, for in such a closed system expectations are set up
that work against individual spontaneity and that tend to regulate the lives of
the people in the system. Since so much of life is approached from the need to
work in the system mutually, compromises are made and each partner tends
to gear his life more and more in relationship to the other. Thus, if the wife is
working during the day and taking classes for a degree some evenings,
expectations will be set for the times she should be through and ready to
spend time with her husband. Since he may have arranged his time to meet
her after class, her option of making arrangements with someone later is
the very way in which the system now operates. To be cherished, loved, and
for you is also a most gratifying human experience. But to define, especially
unconsciously, your own value in terms of the way another human being
is that this neurotic dependency on another for one’s own sense of self leads
to excessive demands on the other person that disregard the other’s own
individuality and personal integrity and attempt to control the other person.
The aftermath of such relating is a deluge of resentment, frustration,
1254
operates in a neurotically dependent way, opposing the growth and
because it plays such a crucial part in the marriage systems that are
developed, and also because it is being challenged anew with a vigor that
already has shown results. That women have been discriminated against as a
discrimination is easily found, and only relatively recently have women even
begun to have equal rights under the law in civic matters as basic as the right
to vote. But the effects of the discrimination are so widespread and so
universal that the lives of women in our society are adversely affected either
directly or indirectly every day in every place where women are to be found
—the home, the school, work, the arts. In spite of revolutionary efforts on the
part of women’s rights advocates, there is a remarkable persistence of the
conviction that a woman’s place is in the home, that a girl should be raised
primarily to be a good wife and mother, and that, indeed, if this does not
continue the very institution of the home and family will be undermined and
the future of the country itself placed in jeopardy. Raising a girl to believe that
her basic goal is to become capable of attracting a man who will then marry
her may make it almost impossible for her to achieve her full potential as an
woman into an image of a plasticized sex object, the damage to dignity and
person and shows herself to be intelligent and capable she will be running the
can be no better illustrated than to note the incredible fact that in a test
involving the completion of a story about a student who placed first in a
medical school graduating class, the women being tested, more often than
not, saw this honor as a disadvantage when the first place student was a
woman; in contrast, when the top student was a man, the distinction only
heralded a future of continuing benefits.
Not only does the denigration of women as people have stifling effects
on the growth of a maturing girl, but also the deleterious effects continue
throughout the marriage and eventually lead to intense resentments and
competition and lack of equality that breeds chronic domestic warfare and
alienation. In the later stages of marriage the woman is often more hopelessly
1256
trapped in an intolerable life because she lacks the grounding that could
enable her to develop her own individuality and find a new and independent,
battle of the sexes, small wonder that it is over sex that many of the battles
are fought. Again it must be noted that many in the younger generation today
have moved a long distance from the attitudes described. With the acceptance
of equality between men and women has come the recognition of women’s
right to enjoy their own sexuality with the same freedom traditionally
provided much more freedom for women, and liberalized abortion laws, such
as the one passed in 1971 in New York, has added further social sanction to
the new sexual and personal independence of women. As women truly are
given more equality, their degraded position as sexual objects loses relevance,
and sexuality between men and women will also express their mutual
married and some aspects of the way in which the partners develop rules of
cooperative behavior and communication systems, as well as some of the
tasks and goals related to this phase of their lives. Often both may work while
the young have not each developed sufficiently as individual persons to allow
a contract that has much likelihood of endurance. Before long, the growth in
both partners may be such that disparities develop that can never be bridged.
This, together with the adventuresomeness and energy of youth and the more
understandable why the rate of divorce among the very young is so high.
For those who enter the marriage system and do not soon leave it for
divorce, the family system does not, and the members of that system (mother,
father, and siblings, plus all the extended family members) continue in their
family relationships as long as they live. Children, let it be said again,
profoundly affect the marriage system. If the system was locked in before, the
ties that bind are now vastly multiplied. Responsibility for the children tie the
parents to each other as well as to the children, and the love and affection for
the children create some of the strongest bonds and devotion known. Not
1258
only do children raise the cohesion coefficient, but also they alter the intimacy
factor in the marriage system. Earlier we mentioned that the close intimacy in
the marriage often resulted in an isolation and alienation of the partners from
other relationships. With children added to the system not only is the former
isolation from others still present, but now the closeness between the
husband and wife is encroached upon. Intimate times are difficult logistically,
and when they are finally arranged the husband and wife (now also father
and mother) may have little energy and incentive left. Such are the joys of
parenthood.
The mother more often than not bears the brunt of the added work and
strain at home, while the father increasingly becomes aware of his new
sharing the tasks is difficult, and the continual yet often trivial chores are not
relieved, even by the relatives, the aunts, grandmothers, and sisters who used
experienced as a duty and an exploitation. During this period men are more
system, we can see how the relationship between the man and woman
system. Gross disruption of the system would include one member leaving
the system entirely, or the collapse of one member, such as hospitalization, or
violence among the members. Stress may be applied by forces outside the
marriage system itself. For example, the husband may lose his job, not as a
recession in the society. Or severe illness may strike a child or the mother and
require a mobilization of all other family members, with a reallocation of
development brings a series of crisis points, and these can be moments when
the adaptational capacity of the family may be sorely tested. On the other
1260
hand, at such moments of stress the family has the greatest challenge and
opportunity for growth, and each member of the family system may have a
new occasion to redefine goals and relationships, so that not only may the
The problems that children bring in infancy and early childhood are
often the source of much tension because the parents are aware of the literal
responsibility that falls on them as adults. In later childhood school and peer
problems are often the focus of family stress. Then as adolescence approaches
and the children increasingly move in their own directions and challenge the
authorities at home and at school, a whole new series of tensions must be met
that take on a more social aspect and that break into the insularity of the
family. Here again a paradox is seen, because in our society family life has
other systems in the society. Education in schools now includes sex and
family life, while the education brought into the homes through television
and parents in many families, and the alliances and blame thrown back and
and the family adaptation is strengthened when the marital partners can
redefine their goals and relationship and then cooperate in managing ways to
meet the demands and responsibilities of the growing family, while at the
same time not being engulfed to the extent that no life as individuals, or as
college education is included in the children’s future the economic strain and
the sacrifice demanded may be quite severe. But assuming that a family
manages to hold together through these stages, a new and most critical point
in the marriage system is in the offing. At the time when the children have
reached the point where they are more and more responsible for themselves,
and certainly by the time some or all of the children are either in college or
are working for themselves, the focus inevitably begins to turn again to the
marriage relationship and to the fate of each of the two individuals in that
relationship.
1262
For the woman in many families, moments of personal decision may
have been experienced when it was planned to begin a family, when the
youngest child entered school, leaving more of the day free for other
activities, when children reached their teens and were able to provide more
care for themselves, and then when most of the children were old enough to
employment; some mothers may go back to teaching when their own children
are in school, and others may reenter jobs in business. Other women, who had
part-time basis, and a large number of women in their late twenties and early
thirties become very aware that unless they begin to make progress in their
own development they may not have the opportunity later, for it will be too
late.
For these reasons, among others, many women reach a point of crucial
decision in their thirties, when they review the lives they are living, and
consider whether any changes may be possible. At this point women may feel
that if they are ever going to make a change in their marital situation they
At this time the husband may feel more pressure to increase his income,
and many men may take on an extra job, or work overtime, or undertake
after forty further significant advancement will be unlikely, and the pattern
for the future of the employment career will be fairly well settled. On this
between forty and forty-five, when they realize that this is their last chance
for a major change in life style. At this point many men form new
relationships with younger women and experience a resurgence of youthful
feeling, with the desire to live through many of the fantasies that they may
emerge, with the feeling that if the home, in this case the home of the
secondary family, is not left at this time, the future will be closed, and the old
life will continue until true death brings an end. At this time many men also
make rather radical changes in career, or at the least make a major shift
1264
wife are able to change together and evolve a very new kind of life for
themselves. When this does not occur, and when the resolution does not
result in a continuation of the old life pattern, divorce ensues, and friends may
individuals often are infused with a new excitement, and that both may go on
to experience happier and more fulfilled lives. The course of the marriage, it
would seem apparent, has to do not only with the external realities of
children and finances but also with the intrinsic strengths of the marriage
When the marriage system continues after the critical period of middle
age, new goals emerge. The possibility of more leisure time together may
bring new enjoyment into the lives of the couple. The loss of friends becomes
more common, and the facts of aging and death are increasingly evident.
Illness may have been experienced before, but now the certainty is that illness
and decline will be more and more an inevitable part of the agenda. Often
Although more affluent older people may be able to establish retirement ways
of life, large numbers of the population are left increasingly to their own
resources, which usually are meager; with their failing health and the
the married couple upon each other becomes more crucial and necessary
anxiety, for roles of who will be dependent on whom may suddenly, after a
lifetime, forcibly be reversed. Goldfarb has noted that the crux of most marital
Intrinsic Factors
marriage system. We have considered reasons why people may join the
a workable system, and an overall view of the goals and difficulties present at
1266
provide a workable arrangement for its members within the intertwining
matrix of all the other systems in the society. At this point let us examine
more closely certain intrinsic factors in the traditional system that reflect
both its strengths and its shortcomings, and particularly let us examine the
relationship of the individual in the marriage to the system itself, to himself,
flourishing of love, which is one of its top priority goals, is discouraged by all
the features that coerce and demand allegiance and affection. Compulsion
breeds rebellion and resentment; duty and obligation discourage spontaneity
and delight. Love cannot be forced by legal decree and formal contract, any
justified by the necessity of protecting property rights, and the social good of
preserving stable family situations for the nurturing and rearing of children,
serve at the same time to entrap the partners in the marriage and provide a
soil hostile to the development of mutual affection and love. The commitment
and the added irony is that the spouse who promised to love now hosts a
growing resentment, and at the same time through his own vow has cut
himself off from the love of those he has forsaken. Nor in this system of values
establish a modus vivendi permitting his own and his partner’s individual
children and members of the community at large. This task is almost too
much to expect from any individual, particularly in a system that puts so
middle-class married people, and from the detailed reports concluded that
there were five main marriage arrangements. The classification was based on
the interview material of people whose marriages had lasted ten years or
more and who said that they had never seriously considered divorce or
battle with one another constitutes the cohesive factor insuring the continuity
of the marriage.
1268
The second type of relationship is described as “devitalized.” The
‘deeply in love’ during the early years, as having spent a great deal of time
together, having enjoyed sex, and most importantly of all, having had a close
identification with one another. The present picture ... is in clear contrast—
little time is spent together, sexual relationships are far less satisfying ... and
interests and activities are not shared.” Further comment is made that this
type of “duty” relationship in marriage is very common, and that those in it
the devitalized, except that the passivity pervading the association has been
there from the start, giving the devitalized at least a more exciting set of
love and gratitude toward the wife who fits this mode.”
The fourth category is in extreme contrast to the first three and is called
the “vital” relationship. The essence of it is that the mates are intensely bound
comes from being together in the doing.” The authors elaborate, “They find
their central satisfaction in the life they live with and through each other—all
else is subordinate and secondary.”
cases all the important life foci are vitally shared.” Both these last two types
From the description of these five main types, it can be seen that factors
relationship can be the single most eroding factor in the marriage system. By
with other people, a marriage partner can pursue his or her own
development in a way that is not possible if most activities are restricted to
those engaged in with one’s marriage partner. Possibly one of the most
1270
man or woman in this framework is expected to be a companion, a friend, an
intellectual equal, a lover, a helper, a parent, a sharer in interests in sports,
and on and on and on. No one person can meet the needs of another in all
these ways, and, indeed, no one may be able to satisfy another fully in any one
of these areas.
for each of the partners. In turn, as each flourished with the addition of this
renewed and with more to offer the partner. In this light the idea grows that
loving one person increases ones’ capacity to love others, and that love is not
probably for this reason so many of these outside relationships are carried on
anxiety. As a result they either have periodic unsatisfying “flings,” or live with
a burdened feeling of uneasiness, or eventually break the doubleness by
breaking the marriage, or by giving up the double life and settling for a more
drab and unsatisfying continuity in their marriage.
Therapeutic Approaches
problems. In the chapter so far, problems in living of almost every sort have
been discussed. Within the definition of the marriage system, it is evident that
any problem that affects any individual in the system, or in the expanded
family system, or any situation that influences the effective functioning of the
sense, though, this means that almost every human problem can be seen as a
problem related to marriage and the family. Indeed, there is much to
commend this point of view. With the development of general systems theory
and theories of communication, the idea that any human behavior can be
understood outside the context of its occurrence has lost ground. The
increasing expansion of family theory and family therapy is a clear-cut
his behavior is understood in the light of the behavior of those around him,
and in the particular context of his living. So it is, more specifically, that when
one member of a marital partnership has behavioral or symptomatic
1272
marriage therapy is a variety, as a method for treating the family, as opposed
therapy, has noted that the concept of family therapy is inclusive and
influenced in his behavior without that influence having an effect on all other
parts of the system. Briefly, then, he holds that family therapy is all that has
ever been practiced, although often the practitioners were themselves
for the moment to a further appraisal of the problems. Leaving aside those
consider the complaints that overtly can be related to the marriage system
and in fact are presented as such. Greene has provided a recent listing of the
major reasons couples give when they appeal for professional help with their
marriages. Based on the responses of 750 couples, the survey shows that the
clearly left with the partners, who come to an expert for appraisal and
consultation, who may be able to gain some further understanding of the
reasons for the dysfunction of their system, and who may also take
suggestions and advice from the consultant and in an experimental mode try
out various new possibilities. In light of the previous discussion on the factors
affecting the system at various moments in its evolution, one can see that the
the stresses being applied in both general and specific ways. With this kind of
visited once a year, or possibly one partner might cut down on committee
activities in a local political club. Again, the consultant might suggest that
1274
problems in the way the two partners were communicating might be
therapist can act as consultant to the marriage system; and by considering the
multitude of factors present in the system, and by utilizing his own special
training and skills, he can engage the partners in their own therapeutic
endeavor.
There is still a difference in approach among those who will see only the
couple, those who will see only one of the partners, those who will see both
partners, but only in separate sessions, and those who will vary their
approach and see at times one, at others times both, and at other times each
system in himself, but never only a system in himself. The individual always
member. This pivotal choice becomes the therapist’s moment of truth, for it is
at this juncture that he reveals himself as one who believes in the freedom of
the individual to choose his own destiny, or as one who believes that the
needs and merits of the particular system override those of any particular
Other Directions
make many false starts and return to start over again, and often never are
able to achieve the growth they would like. A couple may seek marriage
therapy, but find as they explore the possibilities that one or both do not want
to continue either the therapy or the marriage. The variations are many. One
Only some seek therapy, which, as has been noted, may eventuate in several
1276
possible outcomes. More recently others have been seeking new styles of life
that attempt to make over the old marriage system entirely. Some have
our younger generation to find new possibilities for relationship, leads to the
conclusion that at this time in history the traditional marriage system is
evolve. Perhaps the most promising hope lies in the direction of more
openness in the system, of greater freedom for the individuals in the system
contribution.
Ackerman, N. W., “The Family Approach to Marital Disorders,” in Greene, B. L. (Ed.), The
Alger, I., “Joint Psychotherapy of Marital Problems,” Curr. Psychiat. Ther., 7:112–117, 1967.
_____, “Joint Sessions: Psychoanalytic Variations, Applications, and Indications,” in Rosenbaum, S.,
and Alger, I. (Eds.), The Marriage Relationship, Basic Books, New York, 1968.
_____, “Therapeutic Use of Videotape Playback,” J. Nerv. & Ment. Dis., 148:430–436, 1969.
_____, and Hogan, P., “The Use of Videotape Recordings in Conjoint Marital Therapy,” Am. J.
Ard, B. N., Jr., “Communication Theory in Marriage Counseling: A Critique,” in Ard, N., Jr., and Ard,
Ashley, M., “Love and Marriage in 17th Century England,” Hist. Today, 8:667, 1958.
Balzac, H., Epigrams on Men, Women, and Love, Peter Pauper Press, New York, 1959.
Bandura, A., Principles of Behavior Modification, Holt, Rinehart and Winston, New York, 1969.
1278
Bateson, G., Jackson, D. D., Haley, J., and Weakland, J., “A Note on the Double Bind-1962,” Fam.
Proc.,2.154-162, 1963.
Berne, E., Sex in Human Loving, Simon & Schuster, New York, 1970.
Bird, H. W., and Martin, P. A., “Countertransference in the Psychotherapy of Marriage,” Psychiatry,
19:353-360, 1956.
Blinder, M. G., and Kirschenbaum, M., “The Technique of Married Couple Group Therapy,” in Ard,
B. N., Jr., and Ard, C. (Eds.), Handbook of Marriage Counseling, Science and Behavior
Carter, H., and Glick, P. C., Marriage and Divorce: A Social and Economic Study, Harvard University
Cavan Shonle, R., American Marriage, Thomas Y. Crowell, New York, 1960.
Cone, J. D., Jr., “Social Desirability and Marital Happiness,” Psychol. Rep., 21: 770-772, 1967.
Constantine, L. L., and Constantine, J. M., “Group and Multilateral Marriage: Definitional Notes,
Cuber, J. F., and Harroff, P. B., Sex and the Significant Americans, Penguin Books, Baltimore, 1966.
Dreikurs, R., The Challenge of Marriage, Duell, Sloan and Pearce, New York, 1946.
Drellich, M. G., “Psychoanalysis of Marital Partners by Separate Analysts,” in Rosenbaum, S., and
Alger, I. (Eds.), The Marriage Relationship, Basic Books, New York, 1968.
Durant, W., Our Oriental Heritage, Simon & Schuster, New York, 1954.
_____, and Durant, A., The Lessons of History, Simon & Schuster, New York, 1968.
Ellis, A., “Healthy and Disturbed Reasons for Having Extramarital Relations,” J. Human Rel.,
16:490-501, 1968.
Fitzpatrick, J. P. (S.J.), “The Structure of the Family in American Society,” in Bier, W. C. (S.J.)
1280
Frumkin, R. M., and Frumkin, M. Z., “Sex, Marriage and the Family in the U.S.S.R.,” in J. Hum. Rel.,
9.254-264, 1961.
Gehrke, S., and Maxon, J., “Diagnostic Classification and Treatment Techniques in Marital
Goldfarb, A. I., “Marital Problems of Older Persons,” in Rosenbaum, S., and Alger, I. (Eds.), The
Greene, B. L., A Clinical Approach to Marital Problems: Evaluation and Management, Charles C
_____, Broadhurst, B. P., and Lustig, N., “Treatment of Marital Disharmony: The Use of Individual,
(Ed.), The Psychotherapies of Marital Disharmony, Free Press, New York, 1965.
_____, and Solomon, A. P., “Marital Disharmony: Concurrent Psychoanalytic Therapy of Husband
and Wife by the Same Psychiatrist, The Triangular Transference Transactions,” Am.
Haley, J., “Family Therapy: A Radical Change,” in Haley, J. (Ed.), Changing Families—A Family
Hall, E., and Poteete, R. A., “Do You Mary, and Anne, and Beverly, and Ruth, Take These Men ... A
Hefner, H. M., “Excerpts from the Playboy Philosophy,” in Ard, B. N., Jr., and Ard, C. (Eds.),
Handbook of Marriage Counseling, Science and Behavior Books, Palo Alto, Calif.,
1969.
Horner, M., “A Bright Woman is Caught in a Double Bind. In Achievement-Oriented Situations She
Worries Not Only About Failure but Also about Success,” Psychology Today, 3:37-
40, 1969.
Jackson, D. D., and Bodin, A. M., “Paradoxical Communication and the Marital Paradox,” in
Rosenbaum, S., and Alger, I. (Eds.), The Marriage Relationship, Basic Books, New
York, 1968.
1282
Jeger, L. M., “Why Not Marriage Reform?” New Statesman, 72:219, 1966.
Kempler, W., “Experiential Psychotherapy with Families,” in Fagan, J., and Shepherd, I. L.
Kinsey, A. C., Pomeroy, W. B., and Martin, C. E., Sexual Behavior in the Human Male, W. B.
_____, _____, _____, and Gebhard, P. H., Sexual Behavior in the Human Female, W. B. Saunders,
Philadelphia, 1953.
Knight, T. S., “In Defense of Romance,” Marriage & Fam. Living, 21:107-110, 1959.
Psychiat.,118:1036-1041, 1962.
Laing, R. D., and Esterson, A., Sanity, Madness and the Family, Vol. 1, Basic Books, New York, 1964.
Laqueur, H. P., Laburt, H. A., and Morong, E., “Multiple Family Therapy: Further Developments,” in
Haley, J. (Ed.), Changing Families—A Family Therapy Reader, Grune & Stratton, New
York, 1971.
Lewis, C. S., “We Have No Right to Happiness,” Saturday Evening Post, 10.10-12, 1963.
Luckey, E. B., “Number of Years Married as Related to Personality Perception and Marital
Martin, M. J., “Hostile Dependency in Marriage,” Editorial, Minnesota Med., 51:511, 1968.
Martin, P. A., and Bird, H. W., “An Approach to the Psychotherapy of Marriage Partners: The
Masters, W. H., and Johnson, V. E., Human Sexual Inadequacy, Little, Brown, Boston, 1970.
Meares, A., Marriage and Personality, Charles C Thomas, Springfield, Ill., 1958.
Quart.,13:479-491, 1944.
1284
_____, “The Concurrent Analysis of Marital Couples,” Psychoanal. Quart., 17:182-197, 1948.
O’Neill, N., and O’Neill, G., Open Marriage, M. Evans and Co., New York, 1972.
Parke, R. Jr., and Glick, P. C., “Prospective Changes in Marriage and the Family,” J. Marriage &
Fam.,29:249, 1967.
Ravich, R. A., “A System of Notation of Dyadic Interaction,” Fam. Proc., 9:297–300, 1970.
Reider, N., “Problems in the Prediction of Marital Adjustment,” in Eisenstein, V. W. (Ed.), Neurotic
Robbin, B. S., “Psychological Implications of the Male Homosexual ‘Marriage,’ ” Psa. Rev., 30:428-
437, 1943.
Rosenblatt, P. C., “Marital Residence and the Functions of Romantic Love,” Ethnology, 6:471, 1967.
Satir, V. M., “Conjoint Marital Therapy,” in Greene, B. L. (Ed.), The Psychotherapies of Marital
Seidenberg, R., Marriage in Life and Literature, Philosophical Library, New York, 1970.
Solomon, A. P., and Greene, B. L., “Marital Disharmony: Concurrent Therapy of Husband and Wife
Tereshkova, V., Chairman, Soviet Women’s Committee, “The New Soviet Marriage Law,” New
Turner, C., “Conjugal Roles and Social Networks: A Re-examination of an Hypothesis,” Human Rel.,
1286
20.: 121-129, 1967.
Van De Velde, T. H., Ideal Marriage: Its Physiology and Technique, Random House, New York,
1930.
Van Horne, H., “Are We the Last Married Generation?,” McCalls, 96:69, 1969.
Westermarck, E. A., The History of Human Marriage, 5th ed., Allerton Book Co., 1922.
Whitaker, C. A., “Psychotherapy with Couples,” Am. ]. Psychother., 12; 18-23, 1958.
_____, and Miller, M. H., “A Re-evaluation of ‘Psychiatric Help’ When Divorce Impends,” in Haley, J.
(Ed.),Changing Families—A Family Therapy Reader, Grune & Stratton, New York,
1971.
Zehv, W., “Letter to the Editor. The American Sexual Tragedy: Critique of a Critique,” ]. Marriage &
Notes
[1] Rates of final divorce decrees granted under civil law per 1,000 population: United States, 1932,
1.3; 1945, 3-5; 1960, 2.2; 1965, 2.5; France, 1932, 0.5; 1945, 0.6; 1950, 0.9; 1960, 0.7;
Sweden, 1932, 0.4; 1945, 1.0; 1955, 1.2; 1960, 0.9; 1965, 1.2. Divorce rate per 1,000
married couples: United States, 1935, 7.8; 1964, 10.7; France, 1935, 2.3; 1963, 2.9;
by remarriages. For example, in 1960 over four-fifths of the white men who had first
married some 18 years previously and had been divorced had remarried. The
remarriage rate of nonwhite men was nearly as high; the corresponding rate for white
women was seven- tenths, and that for nonwhite women was about five-eighths (p. 400).
[3] The divorce rates per 1,000 married persons, from four selected states having rates available,
1960-61: the total divorce rate for men under twenty was 24.8, and for women 29.0 (p.
57).
[4] A great deal more is known about the divorced population than the separated ... at the time of the
1960 census, over 2 million were separated and over 3 million were divorced. (p. 222).
About 2.7 million men in 1967 were bachelors (statistically 35 years old or over
who have never married), and 2.8 million women were spinsters (statistically 30 years
[5] Among couples who married during the 1950’s and were still in their first marriages in 1960, the
median educational attainment was 12.3 years for both husbands and wives.
comprised a husband and wife of the same national origin. English-speaking and German
persons of foreign stock had high rates of outmarriage to persons of other origins
including native Americans, whereas those of Polish, Russian, and Italian foreign stock—
1288
Persons of Russian foreign stock very rarely married persons of Irish or Italian foreign
stock.
A cross section of married Protestants and Roman Catholic adults in the United
States have a similar moderate amount of intermarriage; married Jewish adults have
relatively little religious intermarriage by comparison with the levels for the other two
groups.
The 1960 census showed that only 0.4 percent of United States married couples
[6] In 1960 rates of dissolution were highest for those who married in their teens and lowest for those
who married in their twenties. Persons with marriages “not intact” included the
separated as well as the divorced and the widowed; among these persons the proportion
of nonwhites was about twice as high as that for whites. The percentage of adults who
were divorced was smaller among the foreign born than among the second generation.
The Northeast had by far the lowest percentage divorced. The West had
uniformly the highest percentage divorced. The rural areas generally had the lowest
percentage divorced and separated, and the large cities had the highest.
Well-educated white men had a much lower percentage of divorces than the less
educated. The relationship was more complex for non white men; the percentage
divorced rose irregularly as education increased to the level of entrance into college and
then fell as education increased further. Likewise among women, rising education up
percentage of divorces was lower for college graduates, it reached its highest level for
1960 included accountants, college professors, draftsmen, physicians, and high school
teachers. Corresponding occupations for women included librarians, music teachers, and
[7] During the first year of marriage one in every ten couples lives with relatives, according to data for
1960. For nonwhite couples the rate was more than twice that high.
couples married less than five years, every third couple had already started to pay for a
[8] More women now than a generation ago are sharing in the process of bearing and rearing children.
Now only about a tenth bear no children, as compared with a fourth of the older
generation. A part of this change resulted from a drop from about one-twelfth to one-
twenty-fifth in the proportion who remained single through the childbearing period. At
the same time the average number of children has declined from about four to two and
1290
Chapter 22
Natalie Shainess
It is generally agreed that the changes of the last decade have been so
great that their extent is hardly recognized. The scientific advances alone are
said to equal or exceed those of the last century, which in itself was
remarkable. All human beings have experienced massive changes, and any
specific changes affecting women have also affected men. Man and woman are
interdependent, and each affects the balance and movement of the other.
changes in personality and social life that reflect a “massive shift of human
consciousness.” He feels the “new people” have taken over the world,
participating in the destruction of old concepts of identity, sexuality, and
ways of living. He suggests that the most radical changes of all are in the areas
Ibsen’s Peer Gynt and the image of the button-molder. Winick also noted the
significance of Playboy-fostered voyeurism, nongenital sex, and the general
and thus postponing (avoiding?) living. Slater describes the emotional and
intellectual poverty of the housewife’s role—one that often delivers the coup
second, described by Horney, in which the person is cut off from his own
feelings, although there is no other gross abnormality. In Arieti’s “new
in his inner life: “Inner conflicts are denied, introspection is frowned upon . . .
1292
constant demands and claims on others.” These claims utilize a projective
style, blaming others, and are used by the young in particular to blame
the end of the first year of life as the capacity for choice in pleasing self or
that maturational ability to choose the reality principle over the pleasure
women, the contrast with the picture of even a decade ago is very great; of
course, this refers to Western woman, and particularly the American woman.
preoccupied with her double role as wife and mother, taking on all of the
and success. Large families are essentially a thing of the past, and the one-
The high divorce rate has resulted in women spending longer periods of life
situation.
The sexual revolution—meaning, for the most part, free and casual sex
—is a very real change, although many still tend to deny this. It is rather
Masters and Johnson, varied changes have taken place, from lessened guilt
and greater freedom for some, to a general tendency to a greater voyeurism
1294
sexual participation, with “forced change.”
While the old double standards have seemingly been abandoned, they
are still present in new form, favoring the attractive young woman in her
for some has been great, noticeable at the university as well as beyond, and
reported by patients in treatment.
simply mean that women have to pay a price until new patterns are
that suggests the latter: “Nuclear Age Woman has reason to be concerned
about the threats to these (the family, and her value). . . . Men, glorifying in the
here, as there are many facets to change of this kind). The fading of gender
these changes.
for change affecting women. It has also been greatly concerned about gender
distinctions because these have interfered with woman’s status as equals, and
socially.
Cultural change has thus affected every aspect of women’s lives: the
acceptance of gender-role assignments, living style and work, mode of sexual
motherhood and child care, abortion and contraception, and finally gender
1296
including sexual role, Erikson has described the “identity diffusion” of youth
today—a lack of firm boundaries, or what might be called a failure of
complete severance of the original symbiotic mother- child tie. Erikson notes
that the process involved in the formation of identity lies at the core of the
individual and also at the core of his communal culture. It involves what
Sullivan termed “reflected appraisals” and Erikson calls “simultaneous
of others and molding himself along those lines. He observed that the media
may take a major part in the identity-forming process, usurping the place of
fragments.
the contemporary changes in the relations of the sexes and in the wider
awareness spread by the media and technology. He notes the great change
between the youth of today and those of 20 years ago. It appears that for
many the identity conflict, more hidden than apparent, no longer exists in the
challenge to parents and authority. Yet there is also a very positive trend
among the young to be more collaborative in household tasks, ignoring
previously practiced false gender-role distinctions.
relationship to their mother, they will start their identification process with
the dispassionate day-care worker, the mechanical teacher—be it television
or machine. Will they identify with the characters created to titillate or to sell
learning, like the squawky Big Bird of “Sesame Street,” or the colored
numbers jumping up and down? Perhaps they will identify with the
female.” Baby dolls have now been replaced with sex dolls, wearing bikinis
and sexy clothes. Will their sexual identification be related to all of the
pseudo- sex-education films—in or out of school or on TV—in which there is
images appear with ever increasing speed. All suggest the development of a
Neutering Process
1298
The neutering process, one manifestation of which has been considered
play, the rebellion against authority, and many other processes, a hatred (not
anyone who rises, in nonconforming ways, above the masses, the denial of
expertise and its misinterpretation as authority—all of these represent on a
more general level what can also be observed on a sexual level: the denial of
example, rock music, with its insistent beat provoking the loosely paired
the exhibitionism of the tidal wave of pornography, young men and women
seem arrested in the infantile sexuality of the Freudian pregenital phase; that
is, sexual expression has increasingly become what was formerly considered
foreplay, including acts also considered perversions. These are fast becoming
the total aim in sex; they offer the instant satisfaction of partial sex and
masturbation to those who want to push a button and obtain a response, like
especially the use of sexual innuendo in advertising every product from air
travel to chutney, the alienation from the person’s own sentience—all result
Komarovsky observes that women have been hindered by “the old chestnuts”
men have offered, and adds that men’s “hostility and arrogance have been
1300
shot up like the mercury in a hot thermometer. “A dozen times a day, events
“immodest proposal.” She feels that American society has been so inundated
girls often undergo a kind of cultural hazing process, keeping them locked in
Chaucer’s Canterbury Tales (Tale of the Wife of Bath), Betty Friedan’s outcry
against the Freudian psychology of women and the bonds of the stereotyped
feminine gender role gave new impetus and created an almost tangible new
draught in the air. But how have the majority of women responded?
hard for the vast majority of women to say clearly what they feel most deeply.
Why the status quo is accepted by many women was strikingly revealed
profession, and it gives me all the satisfaction I want.” Its pointedness was
made even clearer by the elaborate jewel she was wearing. But why men
actively maintain the status quo is even clearer: few people voluntarily
surrender power.
are expressing themselves more confidently, and researchers in the social and
psychological fields have undertaken numerous studies of gender concepts.
standards of emotional health are utilized for men and women, paralleling
sex-role stereotypes; the very features that are considered healthy in men,
1302
studies, such as one by Steinmann, confirmed this.
This observation was also noted by jean Baker Miller, who studied man-
woman relationships in terms of the processes between dominant and
determined way, for perhaps the first time in history. The formation of the
A curious side issue is the growing envy by men of certain aspects of the
passive-dependent role and of the presumed idle time spent as the individual
by the driver, and generally including “how lucky you dolls are.”
change in concepts of sexuality and sexual behavior within the last five years.
college student echoed the statements of friends, who discussed, not whether
they might be overcome (with passion) at the moment and yield to their
boyfriends, but when and how they could “lose their virginity.” Veryl
current view of the first sexual encounter and the loss of virginity as a “button
to be ripped off, to roll in the dust under a shabby bed.”
in reality been an accusation against them, and they seem almost frantic in
their efforts to overcome this and to live up to the norms set by sex
But while basically rejecting Freud’s feminine psychology, I still see Freud as
1304
Concern with orgasm has become enormous and omnipresent, leading to
what has been described as “orgasm worship.” Noted along with this is the
problems.
senior had a blind date arranged with the brother of a girl she knew. He
arrived at her apartment and within ten minutes announced that he was
“horny.” She thereupon felt it was incumbent upon her to relieve that state.
She appeared as devoid of feeling as Camus’ Stranger, who seemed to move
through life without feeling, even without motivation, going like a vehicle
along some predestined track, at a preordained pace, taking turns that he had
no part in choosing. The Stranger attends his mother’s funeral, even though
he has no feeling for her, not even hate, meets a girl, goes to the beach,
the Homey type of alienation on the verge of Arieti’s third type: beginning to
seek sensory experiences to submerge in. It is not by accident that the beach,
a place for fun, is the setting for murder. But returning to the girl described,
she did note the young man’s failure to call her again—the failure of her
a holiday weekend date for her with a highly eligible young man. There was
had time to comment to the mutual friend: “Say, that was a superchick you
value in relation to sexual behavior has left young people bereft of any other
standards. Most lack the ability to evaluate sensibly the so-called situational
ethics. Here is need for sex education, in terms of value in the individual’s
development and in interpersonal relations.
Halleck has noted that in spite of the sexual revolution, matters have not
Gloria Steinem has commented on the fact that “men wise in the ways of
1306
power understand its sexual uses well.” Perhaps the ugliness of sex in return
for status and power on both sides of the equation is more clearly revealed in
of course, has always been a woman’s ticket of admission to the social scene,
but it has now become virtually the only means, as little else enters into
quick sexual liaisons. A very personable young male patient reported on his
escapades via this medium. Although he appeared the soul of innocence and
safety, he was something less than that, and it became unavoidable to reflect
upon the risks young women were taking, in leaving a bar and going off to the
a man asked a woman he had just met: “Would you like a sensual visitor
tonight?”[5]
1308
With greater experience women are sexually wiser, have expectations of
men as lovers, and experience a growing discontent. Many men are finding
on the normality and desirability of sex play that was formerly considered
Along different lines an old, and yet new, sexual style has developed—
new in the sense that the age disparity of incest-model dating has grown in
sexual relationships of very young women with considerably older men. From
are to be seen with men easily in their fifties or even sixties. The “anything
goes” concept of sex, together with the new alienation, seems responsible for
this, and young women do not seem aware that they may be “selling
themselves short.” Judith Viorst wrote a delightful poem called “A Lot To Give
Each Other,” capturing the lack of commonality in anything but sex: “He
worries about his prostate, and She worries about her acne, and He was born
before television, and She was born after running boards—but they feel
they’ve got a lot to give each other . . .” The reverse young-old pattern with
women as the older partners, of which there are always a few instances
among the wealthy, seems not to have caught hold. In the light of the
aforementioned change, many men are living in a “captain’s paradise,” that is,
course, it is not always pure fun for such men, some of whom are
For the older woman new problems seem to exist, and the new sexual
freedom is proving to be a bad check. If married, and unless there has been an
including the sexual, especially as the large corporation has made increasing
demands on men and offered all kinds of “rewards.” Infidelity has become
almost a norm. Jessie Bernard has indicated that sex researchers have
promoted the acceptance of infidelity. An example of sexual image-making is
first words to meet the eye, in big bold type, are: “WE ARE HUMAN.” It is an
not going to pass this way again.” Unverbalized is the concluding phrase: “so
grab everything you can.”
to the partner (and the impression is that it is always known at some level),
1310
she does note that it is much more commonly acted upon by men. Wolf notes
that in a patriarchal society there is less infidelity by women. He also
observes the stress added to the wife’s role by the image she must fill as an
organization wife. Yet he feels there is less hypocrisy in marriage today. Quite
aside from the fact that marriages that do not have common goals are in the
process of destruction, Bernard fails to note the social and economic base to
possible, while women have a history of accepting hurt, or settling for the
most likely means of survival. My impression is that infidelity, whatever its
basis, always causes a serious wound in either sex, however it is glossed over.
The problems of aging for men, aside from the inherent psychological
still valuable powers and capacities exist, so that Goodman Ace has
humorously suggested a “Used Man Lot” to deal with the problem of male
obsolescence. However, the older woman’s problems are even more serious.
She has to contend with the menopause, which seems to punctuate the
approaching end of her sexuality and her life, at the same time that she must
cope with the “empty nest syndrome”—the end of her major life role as a
mother. Where her stereotyped gender role, into which she has been molded,
has not been tempered by any other interest or any activity bolstering self-
“crack.” She views with horror the long period of life—empty life—still ahead
of her in the face of her tenuous relationship with her husband, whose
belonging to her former husband, usually stored in the closet, and now
scratched and worn. She said: “I am alone and empty. I am unused as a
reality in a paired society, especially for the woman who sees herself as only
capable of the passive feminine role for which society ordains her. The
combined despair and anger this elicits was revealed in a Christmas card sent
me by an attractive but faded widow in her early sixties, who had arranged a
1312
to come” was pointed out, and it was suggested (without complete conviction,
it must be acknowledged, since nothing compensates for the lack of a close
This predicament of the older woman alone has been well documented
by Isabella Taves, who observed her sexual as well as social dilemma: she
married men or live a celibate life. The divorced older men who remarry
older woman, when I can have an attractive, sexually appealing young woman
who will wait on me hand and foot, be happy about what I can give her, and
make few demands upon me? And it makes me feel young to start a family
again.” As logic it seems unassailable, but it spells a serious existential
dilemma for the older woman, especially as her value as the person she has
become seems nonexistent, and her sexual life must either become degrading
with inadequate men out of desperation, asked: “Why aren’t there men to
Marriage
analyst’s point of view, and whether he espouses the view that passivity is
normal for women. Seidenberg also calls attention to the unfair expectations
statements about what is wrong with unequal marriage, and what marriage
can achieve with true equality and communion between partners. His view, of
that phobias are the women’s way of handling repressed anger within the
marriage, and that with growth the marriage is often disrupted, as the
1314
fundamental nonverbalized premises are challenged. Yet up to now working
and professional women have not greatly challenged these premises and still
undertake the Herculean effort of doing what amounts to three or four jobs at
once. Caroline Bird, whose social study of the inequitable position of women
broke ground for the women’s liberation movement, recently pointed out the
added advantage that men, and professional men in particular, have in wives
Although the majority of women still seem satisfied with, or accept, the
false view of marriage as freedom in the sense of escape from the childhood
that the threat of violence was an important basis for this power. She also
marriage networks, and open marriage, among others. Greene believes that
support these alternative concepts, or deny that marriage can be viable in any
Many express a belief that marriage and the nuclear family are failures,
and some of the young have entered communal living arrangements and
communal marriages. A famous illustration was that reported as a “course in
1316
fantasied expectations and sexual guilt. Many young couples write their own
marriage ceremony, stressing equality and mutuality. Along with these
part of feminine nature— and a valid one. On a positive note Rostow suggests
by other and unconscious forces, there has been a rise in lesbianism. Radical
women seem to make a conscious effort in this direction, as part of an
attempt to eliminate men from their lives. As one college girl, who was “trying
out” lesbianism, put it, “If only my friend Vera had the head of Jane Fonda, and
the body of a man!” Retreats and encounter weekends fostering lesbianism
the street many girls seem to take pains to be noticed as pregnant. One gets
the impression that this is their weapon against mother and society. But there
is a large faction who totally reject the idea of motherhood, which Betty Rollin
centers as a regular aspect of child life from birth on. That is, they seem to
On the other hand, women are demanding the right to total control over
their reproductive function, including abortion. Their efforts, coupled with
1318
Christlike, carrying their crucifix within; they have often been
toward the act that placed women in this position and little empathy for their
and reality; and those freed from the “psychological set” of having to defer to
men are very clear about it and are taking effective action. They have begun
to realize that the refusal of abortion can also be seen as a power mode to
restrict sexual expression, but only by one sex, or, politically, to enlarge a
specific group. In any event the tide is turning.
How will women ever solve the career versus motherhood problem?
that they must give something extra to achieve their goals. It does not seem in
the best interests of children and society for women to attempt to live in
exactly the same style as men. Women’s lives are perhaps more phase-
centers can take over. They also need more help from men, who have largely
been absentee fathers, and who will gain from their wives’ efforts. Already
there is evidence among young couples of a change in the direction of a more
My own solution, which I was fortunate in being able to carry out, was
until my children were attending school full-time. The opportunities for any
direct their lives can be embittering. But as a corollary, men need to be more
generous and more helpful in aiding women to do their best. For women
whose work is an economic necessity when the children are small, or who
flatly reject child care, obviously child-care centers are the answer.
Conclusion
1320
toward the creation of male and female “humanoids,” becoming still more
alienated, mechanical, unfeeling, compulsively cruel, asexual but sexually
including drugs, devoid of the capacity for deep relationships, and with an
increasing will to power by any means. The society of the on- rushing future,
which is already today, has not only veered from the repressive to the
multidimensional, and in some areas they are in direct conflict. Women are
more direct—and “harder.” They demand social equality in every form, yet a
majority are slow to seek or accept change, which has always been promoted
by the young. They are sexually freer, yet also sexually compulsive and
alienated. They have not gained too much through the “sexual revolution.”
They, as well as men, are less totally involved in the marital relationship. As a
group they have considerably less interest in motherhood. And many are
tending to doubt psychiatry’s ability to help them.
alienation and the loss of humanity, in some ways an even greater problem
for women than for men. Perhaps social psychiatrists and psychologists will
join them to deal with broader aspects of this illness, but there is little ground
On the other hand, the degree of change and its effect upon women
within the last decade suggests something not sufficiently recognized: human
beings are remarkably plastic, and great care should be taken before
significant fact of our time in relation to treatment generally, and with regard
to women specifically, is the necessity to understand the social setting of
Sullivan that the therapist must be clear about his own values yet not impose
1322
In this sense Freudian feminine psychology, which has been nibbled at
attain reasonably satisfactory lives. Mastery over their own bodies and
emancipation. The recognition that all humans are aggressive at times, that it
is not a particularly desirable quality, but no worse in women than men,
basis to good therapy for women. And again, as with all human beings,
quality of being penetrating in a man. But even these are distorted by other
processes. For women any specific feminine psychology relates only to the
May Romm has asserted that “the thinking woman can no longer accept
sapiens. So what emerges with great clarity is that male therapists, and
prejudices, listen carefully to women patients, and search for the setting of
note.
leading women back into contact with themselves—an important issue for
men as well. Certainly it has been my experience that many a rebellious,
angry, or destructive young woman has been led along the path of
she has had a chance to perceive that stereotyped, and sometimes demeaning,
Bibliography
Arieti, S., “Volition and Value: A Study Based on Catatonic Schizophrenia,” Comprehensive
1324
_____, The Will to Be Human, Chap. 6, Quadrangle Books, New York, 1972.
Bernard, J., “Infidelity: Some Moral and Social Issues,” in Masserman, J. (Ed.), Science and
_____, “Woman Who Make Great Success. . . Have Husband Who Make Great Coffee,” New Woman,
November 1971.
Erikson, E., Identity: Youth and Crisis, Norton, New York, 1968.
_____, “Inner and Outer Space: Beflections on Womanhood,” in Lifton, R. J. (Ed.), The Woman in
Farnham, M. F., Modem Woman: The Lost Sex, Harper, New York, 1947.
Greene, B. L., “Sequential Marriage: Repetition or Change? in Rosenbaum, S., and Alger, I. (Eds.),
Greenson, R., “Masculinity and Femininity in Our Time,” in Wahl, C. W. (Ed.), Special Problems of
Diagnosis and Treatment in Medical Practice, Free Press, New York, 1967.
Koedt, A., “Myth of the Vaginal Orgasm,” Notes from the First Year, N. Y. Radical Women, June
1968.
Komarovsky, M., Blue Collar Marriage, Random House, New York, 1962.
Lederer, W., The Fear of Women, Grune &Stratton, New York, 1968.
Lifton, R. J., “Experiments in Advocacy Research,” William V. Silverberg Memorial Award Lecture,
1971.
Marmor, J., “Changing Patterns of Femininity: Psychoanalytic Implications,” in Rosenbaum, S., and
Alger, I. (Eds.), The Marriage Relationship, Basic Books, New York, 1968.
Masters, W. H., and Johnson, V. E., Human Sexual Inadequacy, Little, Brown, Boston, 1970.
Miller, J. B., Social Policy: New Political Directions for Women, International Arts & Science Press,
1326
White Plains, N.Y., 1971.
______, and Mothner, I., “Psychological Consequences of Sexual Inequality,” Am. J. Orthopsychiat.,
41:767-775, 1971.
Otto, H. A., “Has Monogamy Failed?” Saturday Review, April 25, 1970.
Romm, M., “Women and Psychiatry,” J. Am Med. Womens A., 24.1-8, 1969.
Bosenbaum, V., Long Way from Home, American Poet Press, Santa Fe, 1966.
Bosenkrantz, P., Broverman, I., Broverman, D. M., Clarkson, F., and Vogel, S. R., “Sex-Role
Stereotypes and Clinical Judgments of Mental Health,” J. Consult. & Clin. Psychol.,
34:1-7, 1970.
_____, Vogel, S. B., Bee, H., Broverman, I., and Broverman, D. M., “Sexual Stereotypes and Self-
Rossi, A., “Equality between the Sexes,” in Lifton, B. J. (Ed.), The Woman in America, Beacon Press,
Boston, 1965.
Bostow, E. G., “Conflict and Accommodation,” in Lifton, B. J. (Ed.), The Woman in America, Beacon
Seidenberg, R. B., “Is Sex without Sexism Possible?” Sexual Behavior, pp. 47, 48, 57-62, 1972.
_____, Marriage in Life and Literature, Philosophical Library, New York, 1970.
_____, in Schulder, D., and Kennedy, F. (Eds.), Abortion Rap, pp. 121-137, McGraw-Hill, New York,
1971.
_____, “Abortion: Social, Psychiatric and Psychoanalytic Perspectives,” N.Y. State J. Med., 68:3070-
3074, 1968.
_____, “The Danger of Orgasm Worship,” Med. Aspects Human Sexuality, 4:73-80, 1970.
_____, “Images of Woman: Past and Present, Overt and Obscured,” Am. ]. Psychother., 23:77-9 7,
1969.
_____, “Is There a Normal Sexual Response?” Psychiatric Opinion, 5:27-30, 1968.
_____, “Is there a Separate Feminine Psychology?” N.Y. State J. Med., 70:3007- 3009, 1970.
1328
_____, “Masters and Johnson Reconsidered,” lecture, University of Syracuse Medical School
Department of Psychiatry, Feb. 10, 1972, (published as: “How ‘Sex Experts’ Debase
Science and Psychoanalysis, Vol. 10, Grune & Stratton, New York, 1966.
_____, “Toward a New Feminine Psychology,” Current Med. Dialog, April 1972.
_____, “Women’s Liberation and Liberated Woman,” in Arieti, S. (Ed.), World Biennial of Psychiatry
_____, “Viewpoints: Do Women Dress to Please Men or Other Women,” Med. Aspects Human
Spiegel, R., “Depressions and the Feminine Situation,” in Goldman, G. D., and Milman, D. S. (Eds.),
Steinmann, A., “Male-Female Perceptions of the Female Role in the United States,” J. Psychol.,
64:265-276, 1966.
Symonds, A., “Phobias after Marriage: Woman’s Declaration of Dependence,” Am. J. Psychoanal.,
Taves, I., Women Alone, Funk and Wagnalls, New York, 1968.
Viorst, J., “A Lot to Give Each Other,” New York Magazine, June 22, 1970.
Winick, C., The New People, Western Publishing Co., New York, 1969.
1330
Wolf, A., “The Problem of Infidelity,” in Rosenbaum, S., and Alger, I. (Eds.), The Marriage
Notes
[1] It confirms the unfortunate reality that reaction is not improvement, and that valuable change must
[3] The Born-Einstein Letters, reviewed by D. M. Locke, Saturday Review, September 11, 1971.
[4] Case illustrations will be anecdotal, since they are intended only to illustrate cultural trends rather
Therese Benedek
Introduction
filial affections, since the social instinct seems to be developed by the young
remaining for a long time with their parents” (p. 6). It is obvious that Darwin,
1332
Psychoanalytic theory is (primarily) a biological approach to
continuum can be explained. This brief essay written in such a broad setting
can serve only as an outline. At the same time it intends to show that
converge.
as a culturally molded pattern, and its individual variations, are focal points of
maintained. The drive organization has three consecutive phases: (1) the
(gametes), sets in motion the processes that maintain the fertilized ovum,
supports its maturation, and guides parturition; (3) the care of the offspring,
which, although it takes place outside of the mother’s body, is a part of the
the female propagative function is discussed. Here will be pointed out only
those aspects of the female drive organization that elucidate the difference
1334
of pregenital development are repeated in correlation with the evolution of
the gonadal cycle. The pregenital tendencies (oral, anal, and pregenital) are
integrated in the mature sexual drive, which reaches its peak at the time of
maturation so that the secondary, sexual instinct can come to the fore at
be performed in men, one may assume that man’s sexual drive is derived
the sake of brevity, ethologists’ terms are useful) are constitutionally “given”
mating behavior. While courtship and mating represent the most accurate
coordination of hormones and behavior for all the vertebrate species, this is
not wholly true of infrahuman primates. In regard to man, history, as well as
current anthropological and cultural changes, masks the hormonal effects
But what about man? Man’s role is discharged in one act that does not
involve tissue changes beyond the production and deposition of semen. This
process is under hormonal control. The innate specificity of the procreative
This raises the question, what about fatherhood? Are men trapped into
the social (sociological) role of fatherhood just by the compelling desire for
1336
toward being a father, a provider? The biological root of fatherhood is the
instinctual drive for survival. The drive organization of species survival has
three phases differently employed in the sexes. In phase one both are equal;
in phase two the function of the male lasts a short time; in phase three the
male of all species is involved for the time necessary for the maturation of the
offspring. In Homo sapiens man’s biological function as provider reaches
beyond the maturation of the children; it reaches even beyond the family; it is
The role of the father and his relationship to his children are further removed
from the instinctual roots that make his relationship with his children a
mutual developmental experience. Fatherliness, like motherliness, has two
experience. Yet there are differences between the sexes regarding the
evolution of these primary attributes of parental behavior. In the
development of fatherliness, the biological bisexuality and the male infant’s
of the young. In many instances the male takes over the care of the deposited
ova or the feeding of the young as the instinctual organization of the species
the care of the offspring. Nature seems to be able to reach deep into the
impeded by cultural denial. Hormone chemistry has helped but little since
with their own babies. One also observes a great variety in women’s skill and
aptitude for genuine motherliness. The inhibition of these primarily biological
1338
dependent phase.
Every man’s earliest security, as well as his orientation to his world, has
been learned through identifications with his mother during infancy. In the
results not only in the sexual, oedipal competition with the father but also in
multiple identifications with the various roles of the father as protector and
provider. In the development of the girl the infantile identifications with the
mother reinforce the gender anlage and facilitate the normal evolution of
female sexuality.[1]
The primary drive organization of the oral phase, the prerequisite and
consequence of the metabolic needs that sustain growth and maturation and
lead to differentiation of the procreative function, is the origin of parental
Parenthood
a parent means being a link in the chain of generations. “It is only Homo
sapiens who has the distinction and the responsibility for raising children
children not only what the parents inherited (with the genic code) but also
the complex culture with its ethical restrictions and potential gratifications.
lengthy dependence of the human child. The family is the psychological field
and their children take place. The core of this field is the husband and wife,
who bring to their marriage particular personalities as they have developed
from infancy in transaction with their own parents, siblings, and other
1340
experience, since it invests the marriage as an institution with (narcissistic)
libido. If such self-investment exists, the feedback of being married and being
Closest to its biological source is the mother’s empathy for her infant.
level in the use of empathy. As the child develops and becomes more and
more a person in his own right, parental empathy has to undergo intrapsychic
elaboration. Empathic response is a direct instinctual or intuitive reaction to
What is said about the empathy of the mother also holds true for the
character trend that enables the father to act toward his child or toward all
and tolerance of the disturbance and difficulties that naturally arise in rearing
a child.
1342
if it were hidden by the physiology of male sexuality and by the
socioeconomic function of fathers as providers. While biology makes
invariable the role played by the mother in the propagation of the species, the
for survival.
influences that can modify motherliness and fatherliness. After the child
actual need of the child, by the situation in which the need arises. The
unconscious motivations of parental behavior are rooted in the personality.
concretely after they are born. Indeed, Freud was right when he stated that
the tender love of fond parents for their children originates in the narcissism
fatherliness.
his behavior has been studied in detail from birth through adolescence. The
balance between the child’s confident expectation of gratification and his fear
of frustration modifies his sense of security with his parents. The reciprocal
process in the parent rarely has been studied. It is, or used to be, generally
assumed that the adult parent’s ego organization is not subject to change
under the influence of his object relationship with his infant, with his growing
child, and even with his grown-up child. Probably such self-secure, mostly
parents.
The parent’s emotional security toward the child, even when expressed
1344
as authority, has a double function. It protects the child and insures the
parent against being unduly affected by the child’s behavior. His authority
helps him to repress or deny his fears and negative anticipations about the
child and about his own ability to cope and love at the same time. The
anticipation of negativistic attitudes in their children makes parents insecure,
afraid, and often angry even before the child gives them cause. This mobilizes
sense of guilt in modern parents. The guilty feelings may increase the
insecurity, and so a negative spiral evolves between parents and child.
their first child or with a child who is not healthy or normal. In patriarchal
families fathers usually felt uninvolved with and not responsible for the care
of the infant. In the young families of our age fathers feel involved and
consider it a duty to help their wives. Not infrequently they prove themselves
more secure in handling the newborn than the young mother. This, however,
may have a negative effect on the wife, who, feeling inferior in performing this
innate duty, may become depressed and alienated from the child. Such an
incidence illustrates that the emotional balance of the family triangle depends
that originate within the parents certainly influence, at least transiently, their
processes between parent and child that, motivated by the phasic libidinal
development of the child, reactivate in the parent old conflicts of the same
period.
child during the oral phase of development, we may generalize that the spiral
of transactions in each phase of development can be interpreted on two levels
of motivation in terms of each participant. The parent’s behavior is
the many traces of the parent’s behavior, the infant learns and so acquires a
past that enables him to anticipate the parent’s response to his behavior. This
yet existent in the young infant, but it becomes noticeable early in the second
quarter of the first year; from this time on it evolves to facilitate the child’s
1346
orientation to and interaction with his environment. It is rarely observed how
much irritability of the parents toward each other, stimulated by inefficiency
development of the infant; even less investigated is how much the infant’s
thriving compensates for the emotional stress between the parents.
Is there any psychoanalytic evidence that would support the thesis that
the child, being the object of the parent’s drive, has, psychologically speaking,
a similar function in the psychic structure of the parent? Does the child,
child. The imitating child holds up a mirror image to the parent. Thus the
parent may recognize and even say to himself or to the child, “This is your
father; this is me in you.” If the child’s imitative behavior shows the positive
aspect of their relationship, the parent will like what he sees and
consequently will feel that both child and parent are lovable. Imitation then
reinforces the positive balance of identifications. It can also happen that the
internalized from infancy. It exposes not only the child’s identification with
the “omnipotent” parent but also his anger because of frustrations imposed
upon him by the parent. The parent’s responses to the hostile imitation of the
with whom he identifies in the process. It should not be forgotten that any
become like her or in her son’s promise to marry her because she is the best,
Much has been written about the oedipal child, but, except for the
contact with the child of that age, by the tendency to hide, to forget, actually
to repress libidinal impulses that were more freely expressed with the
1348
younger child. On the other side are those parents who, under cultural
influences, assume that any sexual control is inhibiting to the child’s
expose their children to undue sexual stimulation, yet such parents often have
to struggle with their own conflicts and with the psychological consequences
concentrates anxiously on the toilet training of the child. Even if this has been
occurred. One may generalize that, unaware as parents usually are of the
the parent becomes insecure in his response to the child’s behavior. The
anxious behavior of the parent is instrumental in conveying to the child the
parent’s own fixation.[2] The fear that a childhood symptom may be repeated
by the child does not necessarily lead to anticipation that this will occur.
Looking back at the childhood symptom from the security of his adulthood,
the parent relives with the child his own conflict, now without fear. In the
parent.”
Each parent has to deal in his own way with the positive as well as the
aspects of the self as it is exposed through the child” (Benedek, 1970 p. 131).
With the help of the positive manifestations of the child’s development, the
parents’ confidence in their child grows and with it grows the conviction that
they are achieving the goal of their existence. In terms of dynamic psychology
this means that while the parents consciously try to help the child achieve his
developmental goal, they cannot help dealing unconsciously with their own
conflicts, and thus they achieve a new level of maturation themselves.
1350
and a late phase. With each child all parents live through these three phases,
which necessarily overlap. Parents can be in the late phase of parenthood
with their oldest child and at the same time be young parents with their
youngest child.
and the separation-individuation phase. But even in these early years there
within the kinship; in our society the upper classes may have maids, nurses,
or governesses who take over the duties of the mother; in other situations
mothers go to work and therefore need helpers. Besides these, nursery school
and kindergarten shorten the period of “total parenthood.” But before school
age the child’s developmental needs for expansion are basically under
parental surveillance.
and maturational level to which Freud attributed the end of the oedipal
phase. With this the mental development achieves the ability to incorporate
parents against the growing independence of the child and against those who
promote it. Usually the second and third child replenishes the libidinal
supplies of the parents (more that of the mother than the father) when the
first child reaches school age.
conceptualization, however, does not cover parenthood during the life cycle.
Conceptualizing parenthood according to its early, middle, and late phases
Parents are total parents with each of their children and live through
the early phase of parenthood with each of them until and through various
1352
family lineage may thus occur. The baby of the grandmother is the aunt or
uncle of the child born to a son or daughter.
child relationship. The shift in these processes pushes the child in the
During the preoedipal and oedipal phase the evolution of the dominant
trends in the child. Secure in their love for the child, parents rarely feel
responsible for his passing problems. All that happens seems to be open to
the empathic understanding of the parents; therefore, they respond with the
School age often disturbs the security of the parents. School represents
authority for the parents as it did when they were children. School means to
parents that their child’s behavior, his performance at work and at play will
be exposed to scrutiny, and thus the parents themselves feel exposed. In
parents.
Yet parents observe with concern that their children are growing up
faster than they did themselves. Very often they seem to want to slow down
child. On the one hand, they would like to hang on to the past when they felt
that they knew everything about the child; on the other hand, they have to
weigh the child’s competitive achievement with their ambition that he should
perform on every level with adequate competence. But modem parents are
wrought with apprehensions regarding educational aims.
efficient individuals, they refrain from applying controls lest the child become
inhibited through punishment and grow up to hate them.
children and parents of latency children and adolescents. The preschool child
1354
that is a manifestation of a maturing individual. Whereas with young children
the parents’ developmental past refers prevalently to unconscious processes,
to the problems set by their children of that age are motivated by reaction
formation to the actual or psychological consequences of their own
experience.
developmental past justifies their wish to provide their children with better
conditions than they themselves had. However, there are many parents who,
raised by permissive parents, grew up with the advantages of an affluent
capable, contented adults. Can one formulate the educational task of such
parents? It is beyond the scope of this chapter to discuss the transactional
phenomena that set normative goals for the children of such parents by
parental reactions to the sexuality of their children. A half century ago one
could have responded to such a request with a simple statement. The
according to the state of their own conflicts. They are not too disturbed to
observe a young child playing with his genitals. The father who threatens a
three-year-old child that he will “Cut it off” is becoming rare. During the boy’s
latency fathers usually are more concerned with the son’s athletic ability and
with his general manliness than with his sexual behavior. With the increasing
sexual freedom among adolescents, fathers become concerned when their 16-
to 18-year-old son is not sexually active. On the same basis they feel
interest toward their daughters, they assume that girls are blissfully innocent.
Mothers are different. Being more aware of their defensiveness against sexual
impulses, they often become suspicious when children, even of the same sex,
play together behind closed doors and are too quiet. Mothers are intent on
protecting their children, the daughters more than the sons. Their worries
become intensified when the period of dating begins and rarely cease until
the daughter lands safely in marriage. Regarding their sons, their worries are
different in degree, but not in kind.
In general, one may say that women who feel positively about their
femininity and enjoy sexuality are usually less envious and less suspicious of
their daughters’ sexual lives. They trust their children since they trust
themselves and their own experiences. In their intuitive confidence in the
1356
power of their own personalities, they feel they have conveyed to the children
they are often blind to the obvious. There are parents who want to be even
more modern; they convince themselves that this is “her life,” and that they
want her to “live it fully.” They are shocked by the realization that they have
shame; the disappointment in the daughter is their own failure. The middle-
emotional significance she has denied. Even parents who trust their children
and enjoy their confidence are left in the dark about the most important
experiences of their children. This probably must be so. If it is sincere,
intrusive vigilance have usually repressed their own sexuality and had
comes, they realize that their daughters are not popular, their sons are not
going out with girls. The insecure mother relives her own adolescence with
than fathers from the inferiority feelings of their children. They begin to push
their adolescent children; they advise and scheme in order to help. Painfully
appears to be the best way to find relief. This often leads to emancipation of
the daughter and the son; it permits new experiences away from the watchful
eye at home.
popularity. The more usual complaint of daughters about their father is that
he scrutinizes the boys too closely, criticizes them frankly, and often tries to
scare them away. One can say that fathers have a double standard regarding
their adolescent children’s sexuality. They watch with Argus eyes over the
virginity of their daughters, but unconsciously identify with their son’s
experience; they smile at the young girl with whom the son is in love as long
parenthood are many, but the main characteristic is the parent’s involvement
1358
series of love affairs leading to consecutive promiscuity before marriage, it is
all to culminate in marriage. Whether the parents’ marriage is happy, just
marital struggles of the parents influence their children, all of the past is
forgotten and the future appears rosy in the light of a new marriage. Except
when difference in race, religion, and social status seems irreconcilable, both
sets of parents unite in their hope that the children will live happily ever after.
the child discontinues. The parents cease to be closest of kin by law, since the
new husband and wife, even if they have known each other for only a short
time, become next of kin. Parents feel this first probably when the wedding is
over and they come home to rest. Then they begin to feel and rationalize
about their sudden sadness. These parents may still be young people, living in
the unity of early parenthood with their younger children, yet they have
entered the late phase of parenthood with the newly married child.
parental home to live in the parental home of her husband, the marriage of
our civilization it is still not uncommon that both sets of parents of the young
couple live close to each other, are neighbors or friends, that the young
parenthood.
for the parents; they have to encompass the husband of the daughter or the
wife of the son, not only in their own family, but also in their own psychic
identifications with their own child. The object relationship to the in-laws
remains shaky for a time. The ambivalence easily flares up, rationalized by
the parental concern for the happiness of their child. Just as when the child
first went to school, parental narcissism makes them see the fault in the other
rather than in their own child. Yet the young couple can “fight it out” and
settle the differences more easily when the conflict remains their own
problem and does not spread in circles like pebbles thrown in a pond. In this
respect mothers are more often at fault than fathers.
identify with the married daughter or son and want to be involved in, or at
least informed about, every detail of their life. Whether we see the problem
1360
from the point of view of the young husband or the wife, the mother is almost
always the “in-law,” the often feared, critical investigator of one partner of the
marriage. Yet today one sees very definite changes in this respect. As long as
law,” the butt of jokes, ridicule, and hidden or open hatred. Now the more
self-reliant woman’s husband does not need to fear that his wife has to side
with her mother. Mother-in-law jokes have almost disappeared from
are middle-aged or older, the child who becomes a parent does not have the
same psychological relationship with the parent; his psychic structure has
changed. More than the deepening relationship with the spouse, parenthood
does change the psychic structure of the young parent. The parents of
this reduces the parents’ self-esteem. This generation gap does not cause
but by slow evolution of the late phase of parenthood. The gap between
generations, which began with marriage and parenthood of the young
aging, even without severe, clinical depression. Yet her sensitivity increases
relatively early age as mothers. One reason for this is that fathers maintain
more distance from the interpersonal problems of the family. As long as the
father’s ability to work is not diminished, aging has a mellowing effect on his
parenthood arrives later for fathers than for mothers, or it seems so because
at that age level fathers become more interested and therefore more involved
1362
parenthood brings about the gratification of the life cycle,grandparenthood.
disappointment and frustration, and also the source of the anxiety caused by
this condition. Sometimes these individuals have guilt feelings and blame
themselves for wishing for something beyond their ken. The somatic
correlations of such depressive states originate in the wish to survive in the
grandchildren.
remember what their mothers told them about the pleasurable or frightening
protect her daughter, may convey her anxiety to the pregnant woman. Such
anxious overidentification of the prospective grandmother, however, often
enjoy their grandchildren more than they enjoyed their own children. Since
they do not have the responsibility for rearing the child toward an unknown
goal, their love is not burdened by doubts and anxieties; they project the hope
of the fulfillment of their narcissistic self-image to their grandchildren.
hostility, open or suppressed, the grandparents can feel free to love their
grandchildren. This does not mean just giving candy and toys or playing with
them. The love of grandparents gives the child a sense of security, in being
loved without always deserving it. What does the grandparent receive in
return? A loving glance from a happy child, a trusting hand, an actual appeal
the child that they were, and still are, good parents.
1364
toward the parents, who are the objects of their conflicting instinctual drives.
The relationship with the grandparents is never so highly charged; therefore,
Grandparenthood is, however, not the same for everyone. There are
and the expectations of the young parents in regard to them depend upon the
cultural and socioeconomic changes in the family structure.
seems urgent when the grandparents are well over their procreative period
and they have had to wait a long time for grandchildren.
adaptive tasks of aging itself. From the multitude of these tasks, only those
the status and function of the elderly parent in the family. In order to put this
in a psychodynamic frame of reference, the overall psychodynamic character
of each major phase of the life cycle is pointed out: (1) from infancy through
(3) as the supply of vital energies declines with aging, the positive,
of old age; they motivate also the psychological processes that bring about the
age-determined changes between parents and their children.
generation does not follow suit as they did earlier. When the pattern and
course of the psychodynamic processes of the parent are known, it is not
1366
difficult to establish the distortions caused by the involutional processes of
the parent and understand with sympathy the influence that old age exerts
Since it cannot draw upon fresh resources of libido, it enlarges the remaining
resource by identification with the young and by rekindling the memories of
becomes irritating, even to the grandchildren, let alone to their parents. But
this irritation means increased frustration and makes increasing demands in
the senescent. The senescent person’s ability for empathy with the younger
egotism of the old are justified. The solace offered by the younger generation
usually does not satisfy the senescent since he unconsciously wishes and, in
some ways, consciously demands that his children and grandchildren remove
the burdens of his age and make him unaware of his weakness. Many
explained; they all illustrate the complete turn of the cycle. As one time the
parent was the need-fulfilling object of the child; now the “adult child” or the
middle- aged child is the need-fulfilling object of the aged parent. The old
identity that integrates the biological and social functions of the personality.
age, removed from his procreative period by two generations, he clings to his
adult children and seeks in them the psychic images they once had been and
therefore will always remain, his children. Supplied by memories of past
parenthood ends when memory is lost and psychic images fade out.
Bibliography
Abraham, K. (1924), “A Short Study of the Development of the Libido, Viewed in the Light of
Mental Disorders,” in Selected Papers, pp. 418-501, Basic Books, New York, 1955.
Benedek, T., “The Family as a Psychological Field,” in Anthony, E. J., and Benedek, T. (Eds.),
1970.
_____, “Fatherhood and Providing,” in Anthony, E. J., and Benedek, T. (Eds.), Parenthood: Its
_____, “On the Organization of the Reproductive Drive,” Int. J. Psychoanal., 41:1-15, 1960.
1368
_____, “Parenthood as a Developmental Phase,” J. Am. Psychoanal. A., 7:389-417, 1959.
_____, “Personality Development,” in Alexander, F., and Ross, H. (Eds.), Dynamic Psychiatry, pp. 63-
_____, “The Psychosomatic Implications of the Primary Unit: Mother-Child,” Am. J. Orthopsychiat.,
19:642-654, 1949.
Darwin, C., The Descent of Man, Murray, London, 1871. Quoted from Kaufman, C., “Biologic
Freud, S. (1914), “On Narcissism: An Introduction,” in Strachey, J. (Ed.), Standard Edition, Vol. 14,
_____ (1940), “An Outline of Psychoanalysis,” in Strachey, J. (Ed.), Standard Edition, Vol. 23, pp.
Harlow, H. F., “Primary Affectional Patterns in Primates,” Am. ]. Orthopsychiat., 30:676-684, 1960.
Hartmann, H., Kris, E., and Loewenstein, R. M., in Wilbur, G. B., and Muensterberger, W. (Eds.),
22:475-496, 1953.
Kestenberg, J., “The Effect on Parents of the Child’s Transition into and out of Latency,” in
Notes
[1] First emphasized by psychoanalysts, this fact has been confirmed by investigations of ethologists.
[3] Material in this section has been drawn extensively from my Chapter 8 with the same title in
1370
Chapter 24
Richard A. Gardner
the institution. According to Census Bureau figures, the divorce rate in the
United States has been rising since the turn of the century. In 1890 the
divorce rate was 5 per 1,000 total population. In 1946 the rate was 4.6—a
1958. Since then the rate has been climbing steadily; figures for recent years
are: 1966, 2.5; 1967, 2.6; and 1968, 2.9.
3.3 per 1,000 total population. Since 2,146,000 marriages were reported
during this year, the ratio of divorces to marriages is 660,000/2,146,000 or
1/3.25. This ratio is the basis for the prediction that one in three marriages
wide range of previous years, any one of which had fewer total marriages
than 1969. Therefore, the possibility of a 1969 marriage ending in divorce is
ended in divorce are for the year 1967. The median duration was 7.1 years.
The modal duration was between one and two years. Other generalizations
regarding divorce may be drawn from the Census Bureau data. There is, for
example, a greater risk of divorce for those who marry in their teens. The
1953, 45.5 percent of the divorces in the United States involved children; in
1958 the figure was 55.1 per cent; and in 1963 the percentage was 61.1.
Apparently the belief that marriage should be maintained “for the sake of the
children” is losing its force.
Within the United States there are significant regional variations in the
divorce rate. In 1963 the rates were 0.9 per 1,000 total population in the
1372
Northeast, 2.2 in the North-Central states, 2.8 in the South, and 3.6 in the
West. These regional differences are in part related to varying degrees of
Census Bureau calls “migratory divorces.” In 1967, for example, the divorce
rate in New York was 0.4 per 1,000 total population while Nevada had a rate
of 22.3. The divorce rate in Nevada was thus 56 times the rate in New York.
Far from being a statement about the relative stability of marriages in the two
states, the figure primarily expresses the fact that a great many New Yorkers
were going to Nevada to obtain their divorces. In spite of migratory divorces,
however, the West has had a higher rate of divorce than the East since the
How do divorce rates in the United States compare with those of other
countries? Although almost all countries report their annual divorce totals to
the Statistical Office of the United Nations, which publishes them in the
Paraguay, Peru, Philippines, and until 1970, Italy, do not provide legal means
for the dissolution of marriage.
Table 24-1.
Number of Divorce Decrees per 1,000 Population Granted under Civil Law in
1968
Hungary 2.07
Egypt 1.92
Czechoslovakia 1.49
Libya 1.41
Sweden 1.39
Austria 1.32
Bulgaria 1.16
Finland 1.15
Yugoslavia 1.02
Source: Demographic Yearbook, United Nations, New York, 1969, pp. 671-674.
Although Table 24-1 lists the countries with the highest divorce rates
1374
for 1968, the order is somewhat selective. For example, the Falkland Islands
reported a divorce rate of 2.50, which would make it third highest in the
world. The population of the islands is so small, however, that only five
divorces were necessary to achieve this rate. Factors other than population
reported for Southern Rhodesia and South Africa, for example, include only
man’s basic personality structure. The ever rising divorce rate has led others
contact between parent and child that all agree is essential if the child is to
leave her but scant time for her children. Polygamous cultures, on the other
hand, foster intense rivalries between the males that distract them from
When two people marry today, “love” is taken to be the primary and
1376
with other psychological phenomena in the human repertoire, cultural
influences have played an important role in the formation, manifestation,
legacy of the early French Renaissance and the chivalric tradition. The
ancients had sung the joys and struggles of love, but it was not until the
thirteenth century that the concept of courtly love gained acceptance and
all selfish motives, complete fealty, and Platonic idealization of the beloved.
Without entirely excluding sensuality, the new love placed great emphasis on
purity and virtue. As Huizinga says, “Love now became the field where all
possibilities of their bodies than their forefathers. Nevertheless, they still feel
strongly that to get married there must be a spiritual bond, euphoric feelings,
and at least a measurable degree of fidelity. Some part of these feelings must
inescapable confrontations not only with the partner’s all too human defects
major neurotic elements in marriage that are “inflated and reinforced by the
divorce. “We are no longer in love” is probably the most common reason
given for divorce.
culture that marriage will increase one’s personal happiness. In the extreme,
factor driving some from one marriage to another. Hunt believes that “the
Our Western society places a premium on youth and beauty. Many men
1378
In American society an ideal, “happy” marriage is considered to be one
those who wish to look elsewhere for some of their important satisfactions
college, for example, where interests are not only shared but also similar, may
begin to evaporate when the husband begins to acquire the highly specialized
There can be little doubt that increased social mobility has contributed
religious strictures against divorce have been eased, and religious obligations
and commitments no longer impede the dissolution of an unsatisfactory
marriage.
While increased social equality for women has given them more power
interests. Others remain married, but they are so guilt-ridden over role
conflicts that their gratifications are markedly reduced.
Kubie suggests that one explanation for the increasing divorce rate may
be the increasing life span. Marriages have always been fraught with
difficulty, but the participants died before their years of agony could
culminate in divorce. With an increase in divorce in the middle and late years
of life, younger people have now had more exposure to the divorce
experience. They are, Kubie feels, more likely to emulate their predecessors
and feel more free to divorce.
Last, but certainly not least important, are the individual neurotic
1380
basically relate best to a man who is dependent on her. All may go well in the
early years of marriage when he relies on her efforts while he builds his
career. Once he has established himself, there is no longer any realistic need
the chances of finding happiness in the next marriage are exactly zero. . . . The
second, third, and nth marriages are but repetitions of the previous
divorced two times or more, the probability of another failure is nearly five
times greater than that for a first marriage.
The dire statistical projections of Bergler and Monahan are not open to
an unhappy first marriage, although it may constitute a high tuition fee, may
second marriages are 50 percent more likely to fail than first marriages. In
one marriage, these mothers are less likely to admit failure in a second—even
to themselves.
Despite encouraging signs, it appears that the same neurotic needs that
have not been able to find any studies that satisfactorily confirm or deny the
efficacy of therapy in this regard.
1382
patient will be better off married or divorced, it behooves the therapist to
maintain a strictly neutral position regarding the question.
behavior so that the patient may make healthier and more prudent choices. In
all events the decision to divorce must be the patient’s. He must feel that he
took the risk on his own, that no one but himself is to blame if his decision
turns out to be an unfortunate one, and that there is no one else to thank if his
remaining married when both partners would be better off divorced. The
marital history often plays a role. If his own divorce resulted in a significant
when separation might be the more therapeutic course. And the therapist
who has never been married, whatever his assets, is compromised in his
already in therapy finds himself facing a decision regarding divorce; and (3)
those in which one partner only presents himself in order to forestall or work
through the problems of an impending divorce.
I agree with Whitaker and Miller that the ideal counseling situation is
one in which the marital partners are seen conjointly by a therapist who has
only does conjoint therapy allow the therapist to hear both sides of the story;
it also permits him to observe the interaction between the couple. Further, if
partners have had an experience in mutual inquiry that should serve them in
good stead in their future relationship. If they decide to divorce, their sessions
should leave them clearer about their reasons for separation. What they have
learned may even help each avoid another unsatisfactory marriage.
In working with such couples the therapist must side only with health,
1384
and inappropriate behavior, regardless of who professes it. If he acts as a
benevolent participant observer, there is less likelihood that either spouse
will accuse him of favoring the other even though in any given session one
The therapist must resist either partner’s attempts to use him as a tool
in neurotic manipulations. The husband, for example, may try to enlist the
therapist’s support in influencing his wife to stay with the marriage when she
is strongly inclined to terminate it. The wife may attempt to get the therapist
to pressure her husband into drinking less or spending more time at home
Even if the therapist maintains the most careful neutrality, motives will
be imputed to the therapist that are really the projections of his patients. The
wife, for example, may believe that the decision to divorce was encouraged by
the therapist because she needs support and agreement for such an
When a couple seeks consultation to avert divorce, they often claim that
they want to stay together “for the sake of the children,” an attitude that has
both realistic and pathological elements. Studies suggest that on the whole
therefore, that the spouses should remain together for the children is suspect;
and I generally make it clear that one cannot know in advance whether or not
clarify these underlying issues for the couple while playing down the falsely
benevolent considerations regarding the children’s welfare.
available. Certain issues, however, are more justifiably discussed in the more
intimate interviews with the couple alone.
1386
maintain the pathological patterns of interaction. Sometimes the partner can
form healthier patterns of relating, and the marriage may be continued along
new lines. Often he cannot make these adjustments, and his only alternative is
then to seek others who can provide him with the pathological gratifications
the intimacy that the therapist shares with the patient cannot help causing
reconcilable.
The individual who presents himself for treatment because his spouse
threatens divorce is a poor candidate for therapy. His motivation does not
generally stem from an inner desire to change things within himself because
of the personal pain his problems cause him. He comes, rather, with the hope
of altering those aspects of his behavior that are alienating his spouse or with
Sometimes both partners are in therapy and one or both may refuse
with a third person. Sometimes a spouse who feels guilty about instituting the
divorce may encourage treatment for the partner who is left behind in order
when the complainant or petitioner has proven that he has been wronged or
injured by the defendant or respondent. Acceptable grounds for divorce are
1388
punishes the offending party by granting the divorce to the successful
complainant. If the court finds both husband and wife guilty of marital
rarely successful once litigation has been instigated. The lawyer advises his
client to withhold information that might endanger his legal position and to
gather whatever data he can that might strengthen his case. Patients who are
in this delusion by the therapist. I only accept couples for conjoint therapy on
the condition that therapy will continue only as long as neither partner
instigates legal action.
When a spouse instigates legal proceedings, the intent may not always
be clear and the motivation is often fragile. For these reasons the lawyer’s
usual practice of recommending reconciliation at his initial meeting with his
prospective client may have untoward results. It may have taken the
prospective client many years to take a healthy step toward divorce, and the
marital problems, and the lawyer’s advice may help them proceed. Quite
Once divorce litigation has begun, the woman, more usually, may try to
involve the lawyer for other than legal reasons. This involvement, which
doesn’t necessarily include sex, may help the woman compensate for the
she may be seeking a substitute neurotic tie to replace the one that is being
severed. While every divorce lawyer has experience with these involvements,
not all are aware of their psychological implications.
The therapist who must assume the role of King Solomon and offer
meets parents who are genuinely seeking a solution that is best for the
children. In practice, however, each parent usually pleads only his own cause,
backed up by a lawyer who wants the psychiatrist’s testimony only if it
1390
emotional claims by each parent—the child and his welfare are subordinated
to the desire to wreak vengeance on the spouse by depriving him of a prized
one who has not been, and will not be, the therapist for any of the children
involved. His decision cannot fail to alienate the parent who has “lost” the
child in litigation, which, in turn, jeopardizes future therapy with the child.
Any child’s chances of being helped in therapy are markedly reduced if either
of the parents is significantly hostile toward the therapist. The child senses
his parent’s antagonism toward his therapist (even when not overtly
expressed) and is torn between the two—hardly a situation conducive to a
matter how explosive the announcement itself may appear. The prospect of
what divorce entails may be quite frightening, and it may safely be said that
the divorce decision, tainted as it is by so many negative aspects, is much
harder to arrive at than the original decision to marry. Inertia and the
may be necessary, and the therapist must respect his patient’s reactions, his
proceeding rapidly— even after the decision has been made and the divorce
promises to be salutary.
often asked “how to tell the children.” I generally suggest that both parents
together tell the children, describing the main issues in terms that are
comprehensible to the child: “Mommy and Daddy don’t love one another any
more.” “Daddy has had trouble drinking too much whiskey, and now Mommy
is tired of his drinking and doesn’t want to live with him any more.”
secrecy and dishonesty that the child senses and reacts to at a time when he
matters, and he may be told that just as he has certain matters that are
1392
that most of his questions will be answered. The child should, in fact, be
encouraged to repeat his questions, for they are part of a process that is vital
may get upset—a prospect they see as damaging to their children. On the
contrary, such displays of emotion may be most salutary for they show the
child acceptable ways to handle his own reactions. If parents aren’t free
enough to honestly express their emotional reactions, they can hardly expect
Since the divorce rate is highest in the first few years of marriage, the
affected children tend to be young and, therefore, more vulnerable than older
child at the time of the abandonment the more severe the psychiatric
death. In the older child, the reactions run the gamut of psychiatric disorders.
It may be difficult to separate the effects of the divorce from those of the
When the child first learns about the divorce, he may respond with
parent’s forthcoming departure that the parent may seriously question his
child’s affection and involvement. Even after the parent has left, and the child
has been repeatedly and painstakingly told about the separation, he may
quietly ask when the parent will return or why he hasn’t yet come back. Or
the child may intellectually accept the fact of the divorce but go through his
child is repressing the inevitable emotional reactions that are evoked by the
divorce, and his repression may be consciously or unconsciously sanctioned
by the parents. Stoic advice such as “Be brave” and “Big boys and girls don’t
cry” may bolster the child’s repression of his emotional reactions. The
parents’ decision not to express their own feelings in front of the children is
another way in which the denial and repression reactions can be fostered.
through which some children can work through their grief reactions—in or
out of the therapeutic situation.
1394
Children may also react to the divorce with symptoms of depression,
accident prone behavior, unconcern with their safety, and suicidal fantasies.
The depression is not simply reactive in many cases. Hostility redirected from
the parents to the child himself and the feelings of self-loathing that the child
compensation for that which has been lost. Overprotective parents and those
who attempt to assuage the guilt they feel over the divorce by indulging the
may also be a motivating factor. In addition, the hostile impulses that the
child harbors toward the parents for the divorce can be gratified by his
awareness of the worry and frustration that his absence causes them.
The child may feel guilty and consider the divorce to have been his fault.
He may believe that the departing parent can no longer stand his “badness” or
that he has been too much of a financial burden. Often comments that the
parents may have made during their altercations may be taken by the child as
verifications of these ideas. Such guilt is complex. It may be related to oedipal
problems. The boy may feel that his father’s departure was caused by his own
conscious or unconscious wishes. Girls may experience similar guilt when it is
the mother who leaves. The guilt reaction is often related to the child’s desire
to gain control over this chaotic event in his life. Control is implied in the
notion, “It’s my fault.” The child may reason: “If they got divorced because I
was bad, maybe they’ll get married again if I’m good.” The hostility the child
feels toward the parents for having divorced may also contribute to his guilt
1396
feelings. Whatever the psychodynamics, to reassure the child that the divorce
was not his fault is misguided; the fundamental issues that have brought
On rare occasion the child may have contributed to the divorce. He may
have been unwanted or he may suffer from a severe illness and the departing
mechanisms. Denial of it is common. The child has already lost one parent; he
fears doing anything that might alienate the other. Some direct their anger
toward the parent with whom they live, since the absent parent is not so
readily available. Often the person who first instigated the divorce becomes
proceedings may have been. Other children have temper tantrums. Some may
utilize compulsive rituals for the symbolic discharge of hostility; others
project their anger and then see themselves as innocently suffering at the
become excessively concerned for the welfare of one or both parents and fear
that they will be sick, injured, or killed. Some harbor the notion that their
say about their affection for him and how they act toward him. Father, he is
told, still loves him although he never visits or sends support money. Mother
is said to love him, yet she spends many nights and weekends away with
strange men. His parents may adhere to the dictum that they should not
speak unfavorably of one another to the child —lest his respect for the
child can only ask, “If he was so perfect, why did you divorce him?” Such
parental dishonesty (no matter how well-intentioned ) can only create in the
child distrust of his parents and confusion about what love is.
possible—as people with both assets and liabilities. This will lessen the
likelihood that he will have unrealistic goals in his own marriage, and it will
increase his chances of more realistic expectations from all people whom he
parent who cannot love his own child; and there is no reason why the child
cannot obtain the love of others both in the present and future.
1398
Many factors may contribute to the feelings of inadequacy that children
“abandonment” as proof that he is unworthy. He may feel that the parent with
instability of human relationships. If one parent can leave him, what is to stop
the second from doing so as well? If his mother and father (whom he once
considered to be omnipotent) cannot solve their problems, the world must be
a shaky place indeed. If his mother, for example, can get rid of his father so
easily, what is to stop her from getting rid of him with equal impunity? The
parent with whom the child lives may attempt to make the child a confidant
or force him to participate in decisions that he is ill-equipped to make.
Although some children rise to the occasion and assume a maturity beyond
their years, most become even more insecure as they observe themselves
incapable of meeting the demands made upon them—demands that they may
feel they should be capable of meeting. The parent with whom the child lives
may displace hostility toward the absent ex-spouse onto the child. Being the
other factors such as unconscious hostility and death wishes are usually
reassured that his death wishes have not been realized. Such anxieties over
hostility may contribute to the formation of other phobic symptoms such as
After death the absent parent is usually idealized; after divorce there
household. In either case exaggerations distort the child’s view of his parent,
he may have about his absent parent. He may devalue the parent who has
gone in order to protect himself from the painful feelings of having been
abandoned. It is as if he were saying to himself: “No great loss. He wasn’t such
a good person anyway.” Although he may derive some specious solace from
this defense mechanism, its utilization deprives him of a model for emulation,
identification, and superego formation. Excessive idealization is also common.
expose the child to guilt and self-loathing. Such idealization also hinders the
1400
Children whose parents are divorced are quite prone to the
development of oedipal difficulties. The child may try to take over the role of
the absent parent—especially when the child is the same sex as the departed
significant anxiety. Such parental seduction need not serve sexual purposes. A
mother, by getting her son to act like his departed father, may more readily
justify the use of him as a scapegoat upon whom she can vent the rage she
feels toward her former husband.'” A female child, sensing her mother’s
identify with, may also develop homosexual tendencies. These and other
But even when this does not occur, he invariably feels different. Others live
with two parents while he lives with only one. He may become ashamed to
bring other children home and may even try to conceal the divorce from his
friends. Hiding the fact of the divorce produces a continual fear of disclosure
that only increases his difficulties. This duplicity also adds to the child’s
If the divorced parents are still fighting, the child may take advantage of
their discord and try to play one against the other for his own gain. He may
for the loss of the parent. This capacity, which is vital to the child’s healthy
adjustment to the divorce, reaches its extreme form when the child uses peers
as parental surrogates. Freud and Burlingham described this phenomena
regression, detachment, and soiling. The child who reacts in this manner,
1402
With divorce practical problems arise that may not necessarily be
related to any pathological processes in the child. He may come to view his
entertainment and his mother as “mean” because she always seems to be the
one imposing restrictions on him. Because the child has already been
visitations may become a chore for both the father and child as each feels
compelled to live up to the full allowance of time together as stipulated in the
divorce contract. Actually both would be far better off if all would agree to a
more flexible schedule in which the child could choose to skip an occasional
visit, or to shorten the visit, or to bring a friend. Also it is not necessary that
all siblings visit simultaneously. These arrangements can diminish the
pressures on both the child and the visiting parent and insure more gratifying
If the mother works, the child may exhibit angry and depressive
particularly if he must forego recreational activities that his peers have time
that they may enjoy from their new-found obligations can be salutary. Others,
however, regress in the face of these new duties.
jealousy, anger, or denial. He may, on the one hand, try to get rid of each new
date for fear that his privileged position with the parent with whom he lives
will be jeopardized. On the other hand, he may approach each new date with a
question about his marital intentions—much to the embarrassment of all
the child feels toward the absent parent onto the date. On the positive side a
new date, or friend of the parent, is a potential stepparent and—proverbial
meaningful substitute relationship for the lost parent. The child who is
happier through the new marital tie, he, too, will benefit through the happier
state his parent is in. I have discussed these and some of the other more
practical problems that children of divorce must deal with in a book written
1404
event. Westman’s study reveals that those in treatment came primarily from
there was total abandonment. On occasion a parent may bring the child to the
very guilty over his having left the child. By placing him in the hands of a
therapist he hopes to lessen his guilt and insure that no further damage will
be done. Putting the child in “good hands” also serves the parent’s purpose of
getting someone else to undo the psychological damage that he has done—
may be helpful, time itself is a potent healer—the child does not seem to be
able to dwell long on calamities. One of the dangers, however, that the divorce
holds for the child is that he will generalize from his experiences with his
parents and when older will eschew marriage entirely because his view of the
marital state is one of unpredictability, unreliability, and intense psychic
trauma. Another danger is that he will reproduce in his own marriage the
obsession of each parent and have its toll on the children as well as
subsequent spouses. About half of the 425 divorcees studied by Goode either
that the ideal to be attained is that the divorce be able to relate to the former
The one who has been left often considers the rejection a severe insult
to his self-esteem. He or she may press for reunion, not so much out of love
but in the misguided attempt to repair the ego defect that the abandonment
has caused.
Each may become excessively involved with the child of the opposite
sex, who may come to symbolize the absent spouse. Oversolicitous attitudes,
that which has been lost. The parents may vie with one another to gain the
preference of the child. (This is not only an attempt to make up for the
feelings of being unloved that the divorce may have engendered but has
1406
hostile implications as well.)
The children may be used in many other ways as pawns in the parental
conflict. The mother may express her hostility toward the father by refusing
to let him see the children despite his legal right to do so. (He may then have
money, and energy.) Or, more passive-aggressively, she may structure the
children’s preparations for his visit in a way that frequently results in their
being late. She may “forget” what day it is and not have them home when the
father arrives to pick them up. The father may express his hostility by
withholding funds, not showing up for the children after the mother has
planned her day around their absence, or returning them at other than the
arranged for times. The father may withhold support or alimony payments—
often forcing his ex-wife into expensive and time-consuming litigation. In
such cases the courts may be used as the weapons with which the parents
The child may have to endure for years the parents’ derogation of each
other. Valid criticisms of one parent by the other can help the child gain a
more accurate picture of his parents that can serve him well in the formation
seething rage, and criticisms of such distortion that he becomes confused and
his relationship with the vilified parent is undermined.
Vituperation and vengeance may become the way of life. There are
women who claim they will not remarry because to do so would result in
their having to give up the gratification they derive from knowing how much
of a burden the alimony payments are to their former husbands. This is really
The therapist who treats a divorced person involved in such a tragic and
wasteful struggle does his patient a great service indeed if he can help bring
about its cessation. He must be aware that his patient’s perception of the
former spouse may be distorted; he should not take at face value all the
criticisms that are presented to him; and he must try to help his patient look
1408
Some divorced patients try to elicit the pity of others as they bemoan their
fates. The recitation of woes may, in fact, become their primary mode of
toward extracting himself from the conflict. He must be helped to see that the
mother need not retaliate by withholding the children from visitation. She
may do her children and herself a greater service by earning her own money
and resigning herself to the fact the funds will not be forthcoming. She may
then be poorer, but she will not be expending her energies in futile endeavors
The parent must be helped to appreciate that the most effective defense
against the ex-spouse’s vilification of him to the child is not to react in kind, or
to point out the absurdities in each of the criticisms, but rather to exhibit
behavior that appropriately engenders genuine respect and admiration in the
child. Trying to present a perfect image to the child is also an ineffective way
relationships they will have to form— both with their former friends as well
The divorced woman, feeling that she has been a failure as a wife, may
become overprotective of her children, and they may become the main focus
of her life. Such involvement may also provide her with a rationalization for
displaced onto her children, especially the male child whose rejection may
even result in his being sent to a foster home or boarding school. Or the
children may become more nonspecific scapegoats for the resentments and
For the first time in her life she may have to take a job. Guilt over
The divorcee is usually faced with many sexual difficulties. Many men
see her as easy prey, and wives may be threatened that she will be a lure to
their husbands. Dating may present her with many difficulties. What will be
1410
the effects on her children of their seeing each new date? Will it raise up and
then dash their hopes for her remarriage? If a man friend sleeps over, how
will this affect her children and her reputation in the neighborhood? In some
eases having a man sleep over may provide a litigious and vengeful ex-
husband with grounds for having her declared unfit as a mother and thereby
deprived of the custody of her children. Some may hide their dating from
their children in order to protect themselves from the hostility that dating
Her whole way of life and her concept of herself must be altered. With
her married friends she may feel out of place—like a “fifth wheel.” She may
now find herself more comfortable with divorced men and women. Forming
new relationships and altering her whole modus vivendiin the middle of her
life is a difficult task indeed.
The father, too, usually has to adjust to a whole new way of life. His may
be the lonelier existence. His separation from his children may be particularly
painful and guilt-evoking. The divorce may bring home to him for the first
time just how important his children were to him. He may get feelings that he
is superfluous to them. He is now deprived of involving himself in many
children in order to assuage the guilt they feel over having left them. Others
do this to compete with their ex-spouses for the children’s affection. The
father may be hesitant to discipline appropriately lest the child become even
more resentful. The days spent together are often contrived—fun and
activities on the agenda. Such fathers would do far better for themselves and
their children if they would try to spend the day more naturally, combining
both the usual day-to-day activities and the recreational ones. Relating to the
child in activities that aremutually meaningful can be salutary. Many fathers
primarily take the child’s wishes into consideration when planning the
visitation. The resentment they thereby feel when engaging in an activity that
is boring or only tolerated cannot but be felt by the child, and so he is robbed
may fear expressing his feelings. Some are ashamed to bring their children to
their new dwelling because it may compare so unfavorably with the old.
1412
When remarried the visitation with the children often is resented by the new
The father with custody may feel quite resentful of his extra
responsibilities and vent his hostility on the child. The father who uses the
child as a weapon against his former wife, or who withholds the child’s
support payments in an ongoing postdivorce battle, may compromise his
Concluding Comments
monogamy still proves itself to be most consistent with his needs, then
changes will certainly have to be made if the institution is to be improved or,
The trend among young people today to live with one another prior to
stigma over unwed motherhood may also lessen the number of poor marital
relationships that will end in divorce. Young people today profess more
vociferously than their predecessors concern with basic reality elements in
society. “Tell it like it is” has become their byword. If, indeed, this trend
proves to bring people into closer contact with reality, it may play a role in
lessening man’s predilection to utilize the kinds of denial and excessive
expectations about others. Such developments, if they come to pass, may also
Bibliography
Ackerman, N. W., The Psychodynamics of Family Life, Basic Books, New York, 1958.
Arnstein, H. S., What to Tell Your Child, Pocket Books, New York, 1962.
Bergler, E., Divorce Won’t Help, Harper & Brothers, New York, 1948.
1414
Bernard, J., Remarriage: A Study of Marriage, Dryden Press, New York, 1956.
Bernstein, Norman R., and Robey, J. S., “The Detection and Management of Pediatric Difficulties
Bettelheim, B., The Children of the Dream, Macmillan, New York, 1969.
Blaine, G. B., Jr., “The Effect of Divorce upon the Personality Development of Children and Youth,”
Bowlby, J., Maternal Care and Mental Health, World Health Organization, Geneva, 1951.
Egleson, J., and Egleson, J. F., Parents without Partners, Ace Books, New York, 1961.
Freedman, H. C., “The Child and Legal Procedures of Divorce,” in Grollman, E. A. (Ed.), Explaining
Freud, A., and Burlincham, D. T., Infants without Families, International Universities Press, New
York, 1944.
_____, and _____, War and Children, International Universities Press, New York, 1943.
64, 1956.
Gardner, B. A., The Boys and Girls Book about Divorce, Science House, New York, 1970.
_____, “The Guilt Reaction of Parents of Children with Severe Physical Disease,” Am. J. Psychiat.,
126:636-644, 1969.
_____, “More Advice for Divorced Parents,” Psychiat. & Soc. Sco. Rev., 3(10):6- 10, 1969.
_____, “The Use of Guilt as a Defense against Anxiety,” Psychoanal. Rev., 57: 124-136, 1970.
Glueck, S., and Glueck, E., Unraveling Juvenile Delinquency, Harvard University Press, Cambridge,
1950.
Grollman, E. A., “Prologue,” in Grollman, E. A. (Ed.), Explaining Divorce to Children, Beacon Press,
Boston, 1968.
Huizinga, J., The Waning of the Middle Ages, Doubleday, New York, 1954.
Hunt, M. M., The World of the Formerly Married, McGraw-Hill, New York, 1966.
1416
(Eds.), The Marriage Relationship, Basic Books, New York, 1968.
Kline, S. G., The Complete Guide to Divorce, Parallax Publishing Co., New York,
Kubie, L. S., “The Challenge of Divorce,” J. Nerv. & Ment. Dis., 138:511-512, 1964.
_____, “Psychoanalysis and Marriage: Practical and Theoretical Issues,” in Eisenstein, V. W. (Ed.),
Landis, J. T., “The Trauma of Children When Parents Divorce,” Marriage & Fam. Living, 22.7-13,
1960.
Mahler, M. S., and Babinovitch, B., “The Effects of Marital Conflict on Child Development,” in
1956.
McDermott, J. F., “Divorce and Its Psychiatric Sequelae in Children,” Arch. Gen. Psychiat., 23:421-
427, 1970.
Monahan, T. P., “The Changing Nature and Instability of Remarriages,” Eugenics Quart., 5:73-85,
Neubauer, P. B., “The One-Parent Child and His Oedipal Development,” in The Psychoanalytic
Study of the Child, Vol. 15, pp. 286-309, International Universities Press, New York,
1960.
Nye, I. F., “Child Adjustment in Broken and in Unhappy Unbroken Homes,” Marriage & Fam.
Plateris, A. A., Divorce Statistics Analysis: United States—1963, Public Health Service Publication
No. 1000, Series 21, No. 13, U.S. Government Printing Office, Washington, D.C.,
1967.
_____, Increases in Divorces: United States—1967, Public Health Service Publication No. 1000,
Series 21, No. 20, U.S. Government Printing Office, Washington, D.C., 1970.
Polatin, P., and Philtine, E. C., Marriage in the Modern World, J. B. Lippincott, Philadelphia, 1964.
1418
Schwartz, A. C., “Beflections on Divorce and Bemarriage,” Soc. Casework, 49:213- 217, 1968.
Watson, A. S., “Psychoanalysis and Divorce,” in Rosenbaum, S., and Alger, I. (Eds.), The Marriage
Wels, B. H., “Psychiatry and the Law in Separation and Divorce,” in Eisenstein, V. W. (Ed.),
Westman, J. C., Cline, D. W., et al., “Role of Child Psychiatry in Divorce,” Arch. Gen. Psychiat.,
23:416-420, 1970.
Whitaker, C. A., and Miller, M. H., “A Reevaluation of ‘Psychiatric Help’ When Divorce Impends,”
The World Almanac, “Marriages, Divorces and Bates in the U.S.,” Newspaper Enterprise Assoc.,
Adoption
Viola W. Bernard
without parents, a permanent family of their own that has been socially
1420
created can offer optimal protection against the damaging effects of parental
deprivation. To be sure, children born into the families that raise them are not
thereby automatically insured against developmental hazard; but children
who lack parents and family are clearly at great maturational disadvantage.
They constitute the primary population at risk with which this chapter is
concerned.
The number of such children in any one year far exceeds the number of
those adopted. Thus in 1970, the last year for which national child welfare
of this massive unmet need; that adoption is, 011 the evidence, the plan of
choice to prevent or mitigate the destructive effects of such need; and that
for a positive impact in that adoption can be a means for: supporting sound
infant-child development by preventing parentlessness; making the
fulfillment of family life possible for couples who are unable to bear children,
1422
relieving pathogenic stress for many of those who, having given birth, are
unable, for one or another reason, to function as parents.
both voluntary and public welfare agencies, but they involve other
policy.
including this author, to examine and exchange ideas and information about
the complexities of adoption. Since then major changes have evolved, the
more so in the past few years, so that adoption today is very different in many
fundamental respects.
For readers who are unfamiliar with the sequence of steps and stages in
here.
authorized agencies, public and voluntary, are under discussion. It is true that
many independent adoptions turn out well and that many agency adoptions
turn out badly. On balance, however, agency placement offers by far the
greater advantage and protection to the greatest number of those concerned,
both children and adults. My stand on this question, discussed more fully
against the black market in babies, seem to have had some effect. In 1970,
slightly more than three-quarters of the reported placements in the United
represents a steady rise since 1957, when the numbers of independent and
1424
agency placements were almost equal.
Preplacement Phase
interviews. Through these the couples learn more about the realities of
adoption; they explore and confront their own motives, conflicts, fears, and
their own. The agencies utilize these interviews for the dual functions of
anticipatory guidance. The sessions are a way of screening out and screening
Biological parents, of whom a majority are unwed mothers (88 per cent
of the children adopted by nonrelatives in 1970 were born out of wedlock),
about adoption and with the process of surrendering their baby to the agency,
which then becomes the guardian pro tem—that is, until legal adoption has
been consummated.
that such agencies, which are charged with strengthening family relationships
for the children in their custody, reach out actively to help these parents—
psychiatric consultation, ease work, and practical aid with social, economic,
and medical problems may mobilize latent parental strengths and thereby
prevent family breakup; they may, on the other hand, lead to the diagnostic
feasible and that a permanent adoptive home for the child is the plan of
choice.
Parents who have come to agree with this conclusion, through such a
process of help and clarification, free their child for adoption through
however, most of the children whose parents neither free them for adoption
nor undertake their care are consigned year after year to the limbo of
indefinite temporary care.
Yet there are situations in which courts may intervene despite the
found to have abandoned the children or to have left them for long periods in
1426
foster care without any meaningful contacts or efforts to plan for the future,
the courts are empowered to terminate parental rights and to give
the agency should have distinguished a case in which legal retention of family
ties is in the best interests of the child from one in which it is not. The agency
will thereby have become equipped to present evidence on which the court
can base a considered and sound decision.
are cared for in agency nurseries or temporary foster homes, where their
special attributes are studied and their special needs met, and where their
feasible to transfer newborn infants directly from the hospital; older children,
however, need various forms of specialized help in overcoming the effects of
For the new parents and the children, whatever their age, the child’s
actual entry into the home as a family member is a critical, emotionally laden
responsibility for the child’s welfare. The agency workers try to implement
this contact by offering practical and psychological help. The parents’
reactions to the evaluative function, however, tends to limit how fully they
can, at that same time, accept and make use of the help. Group meetings of
couples who are all going through this experience, for the discussion of their
common problems, seem particularly useful, perhaps because they are less
relationships.
1428
For the biological parents, usually the mother, there is a period of time—
during which she can change her mind before the adoption is made legally
final. This is a means of protecting her from hurried decisions made under the
before and during her decision to surrender, and the availability of such help
Poignant court custody battles have dramatized the pressing need for
adoption law reforms. (Anna Freud’s seminars at Yale Law School have
Postadoptive Phase
Since the postadoptive period extends for an indefinite time after legal
adoption, one may think of it in both short- and long-range terms. A number
adoptive agency service, adopted children and parents utilize the full range of
widened range of children who are considered adoptable. For a long time
such children were almost exclusively white infants, with no detectable
placements are being made, and homes recruited, not only for these infants
but also for older children, children from minority groups and of mixed racial
and religious background, and children with various physical, emotional, and
changes in eligibility criteria, for adoptive parents, who are no longer drawn
predominantly from among infertile couples. The psychic correlates of both
to them.
1430
to obscure their far more salient particularities. It is these that dictate the
specifics for applying mental health concepts and methods on their behalf to
Closely linked to the foregoing has come the recognition that it is the
an adaptive solution adoption has been a creative way of balancing the needs
of adoptable children, of adoptive couples, and of parents who could not
function as such. That balance has now shifted decisively in favor of the child.
numbers of children for whom adoptive homes are now being sought. Since
this has been coupled with the hugely escalating number of children born out
of wedlock each year—about a third of them find their way into adoption—
the need for homes has greatly outdistanced their availability, even though
the number of applicants has also been increasing greatly throughout the past
decade.
The relative decline in the applicant-child ratio does not hold true,
however, for healthy white infants (nor recently for black infants either); on
the contrary, the number of these that are available for adoption has been
abortion laws and wider use of contraceptives are reducing the number of
unwanted babies who would otherwise be given up for adoption; and (2)
many more white unwed mothers are now deciding (as have their nonwhite
counterparts right along, largely as the result of there being fewer adoptive
opportunities available to them) to keep and rear their infants. One can
Two trends, however, in addition to those that have already been referred to,
do seem to warrant special mention from the standpoint of primary
prevention.
For one thing there has been considerable gain in the social acceptance
1432
the self-esteem of adoptive family members and lessening their need for
concealment, with all its attendant emotional problems. In fact, many
adoptive parents have formed highly vocal and visible organizations. The
sharing of interests at both the personal and societal levels as well as the
concerted approach to common problems, helps these parents to dispel
Organizations are working actively for legislative reforms and for the
Placements in Infancy
of all the children adopted in 1970 by unrelated persons were less than three
months old when placed in an adoptive home). This reflects the influence on
adoptive practice of recommendations made by child development and
mental health specialists that, in the adoption of infants, the most favorable
time for placement, from the standpoint of primary prevention, is during the
first few months of life. It is generally thought that such early placement can
prevent or mitigate certain adverse effects on the child’s development of
and, with regard to it, six different kinds are identified, with correspondingly
different effects on the child’s subsequent development. The most lasting and
children are undergoing, at the time when they are being placed in their
permanent adoptive homes, at least one separation—from whoever it was
who had been taking care of them. But, as Yarrow’s distinctions emphasize,
separation from the agency’s foster home, following which the new
permanent mother figure had been immediately available. They reported
finding few long-term personality disturbances, when the children were five
experience.
1434
They did note, however, that there might be a critical period of
reactions. All those children placed after six months of age, however, showed
some disturbance—for the most part quite marked. The infant’s vulnerability
its height, a change of the mother may be extremely disruptive to the infant
object relationship with the mother figure. Yarrow and his co-workers,
however, found no significant differences, when the children became ten
years old, on a rating of overall adjustments between those who had left their
According to their research, infants who are moved into adoptive homes
and life experiences that serve to mitigate or reinforce the impact of the
original separation stresses.
capacities. This is all the more true of couples who are adopting their first
child, particularly if they are infertile and have not gone through the parental
adoption, they also differ from one another, of course, with regard to such
and latent vulnerabilities and talents. As yet we know far too little about
which personality characteristics of the parents can be matched with which
that can deal with the complexity of relevant variables in such a way as to
1436
Patterns and Styles of Adoptive Parenting
the same adoptive child is well illustrated in Krugman’s “A New Home for Liz:
Behavioral Changes in the Deviant Child.” The facts of this case may be
This child, who had been under the agency’s care since birth, was placed at
three months in an adoptive home where the same agency had placed
another baby some years before, who had adjusted well, thus attesting to
symptoms, panics, and distress became so intense that when she was 34
months of age, the agency’s psychiatrist, psychologist, and social work staff
The child was therefore removed from the adoptive home and transferred
to one of the agency’s supervised boarding homes. There her behavior and
replaced for adoption. In this second adoptive home she adjusted well,
without any unusual efforts or special plans being made on her behalf. Her
maturational progress continued till age six, when the case report stops.
mothers.
This case illustrates the fact that under certain circumstances it can be
therapeutic to uproot a three year old from her familiar and apparently
benign social and physical environment by moving her out of it into a totally
strange new life situation. But how can we reconcile this with the findings,
placements? Would not such separations be all the more traumatic for an
from whom the child is separating, and to what and to whom he is going.
Permanence is the unique attribute of adoption as a form of substitute family
care; it is what gives it such power to prevent the ravaging effects of parental
deprivation. Yet if the wrong child happens to be with the wrong parents, this
and act before the finality of legal adoption took place. The appropriate
emphasis for describing the move Liz made from her first adoptive home
would seem to be that of gaining an environment in which her development
1438
could go forward, rather than that of losing a mother and a home that were
actually imperiling her future sanity.
Sarah was already almost 11 years old when her pressing need for
adoption became evident. At that time she was indeed “hard to place,” even
more so then—it was in the mid-1950’s—than nowadays. When she was nine
her mother, who was unmarried, had to enter the hospital, where she died
with whom she might have lived, Sarah spent one and a half years in a small
children’s institution. This deeply hurt child, who had unusual strengths of
personality and intellect, was placed for adoption, following some case work
evaluate her adoptability. The preadoptive study of the couple with whom she
was placed when 11, as well as the placement process, were speeded up
After the newly formed adoptive family had spent one summer together,
trained seal more than a daughter). Sarah, who had already been acutely
decision! This youngster was already showing psychic ill effects from all the
her from this adoptive home was bound to entail trauma in the here and now,
which could harm her further—perhaps seriously. Not to remove her,
however, would destroy her chances, I felt sure, ever to reverse her emotional
1440
adoptive parents not only agreed but were distinctly relieved.
To inform Sarah and explain this to her was one of the most painful
tasks I have encountered. It was a psychiatric equivalent of radical surgery.
Every ounce of her energy for survival was mobilized in fighting to stay in the
which she was clinging with all her might; it felt to her like the only
This is a vignette, not a full case report; its intent is to illustrate a limited
four months later, after a period of special foster care, Sarah was once again
placed for adoption. Legal adoption followed at age 13. During the interval
between adoptive placements the case worker and I both worked intensively
with the child, while the agency made a strenuous and at that time innovative
who could learn about and become interested in Sarah was greatly multiplied.
[6] This made it possible to select from among quite a few families—a process
Did that decision in 1955—to separate Sarah from her first adoptive
“Yes!”
Sarah and the members of her new permanent family had a turbulent
period of initial adjustment; but they weathered it, thanks to the positive
emotional qualities and effort each brought to their interrelationships. In her
late teens, while at college, Sarah resumed contact with me (directly this time,
not through the agency). She felt she needed psychotherapy, as, indeed, she
did. She had matured and grown secure enough to want to work on her
unfinished emotional business. In debating whether I should become her
of the latter, and it did prove to be a major therapeutic asset. Sarah achieved
an excellent treatment result. I still see her from time to time, as when she
When the adoption agency first intervened—Sarah was just under 11—
her prognosis for healthy development was poor, in the absence of special
remedial measures. Removal from the first ill-chosen adoptive home was a
crucial crossroads experience, prerequisite to the effectiveness of everything
1442
else that helped to undo the psychic injuries she was already then showing. It
made her accessible to the emotional nourishment of the adoptive family
have made a superior adaptation possible for this particular young woman. I
have learned a great deal from her, over a span of 18 years, about how to help
The cases of Liz and Sarah were cited to illustrate several points.
Although in both these instances the first placement came to grief and was
frequently remove children once they have placed them for adoption. On the
selecting and preparing particular parents and children for making a good life
together. In recent decades as the weighting of factors has shifted with regard
among adoptive applicants. The basic personal qualities that have been
sought as mental health assets for all adoptions, whatever the age and
diversity of life styles and personality patterns —concern the capacity for
warm, mature love for a child as an individual in his own right, by each parent
and by both as a unit[7] along with a stable compatible marriage and the
flexibility to cope with life’s unpredictable vicissitudes.
Criteria that are more specific to adoptive parenthood also enter into
1444
adopt a nonwhite youngster as a way of making a sociopolitical statement, or
is it primarily for love of the child? Can another couple, who would like to
adopt an older child, allow him his memories and the sense of his past
own rescue fantasies to be able to know the child as the person he really is?
must know how to listen for meanings behind what is said, and to understand
how these are likely to affect the adoptive family process. The screening out
for example, to relieve the bereavement of a couple whose own child recently
died is almost bound to lead to misery: disappointment for the parents and
rejection for the child. Instead, such couples should be invited to reapply, if
they still want to adopt, after having gone through a mourning process for the
child they lost. Nor should adoption ever be considered, of course, as a means
of trying to hold together a faltering marriage.
become parents than for ruling them either in or out, by way of some
on certain factors. One of these has to do with greater awareness of the limits
both the near and the far future, before the couple has even begun the process
of becoming parents.
psychologically sensitive case worker can facilitate. But for most couples the
period between their application to adopt and its approval by the agency is a
time of stress and uncertainty. Far from using this interval as an occasion to
1446
face and work out conflicts and anxieties that the much desired adoption may
unconsciously evoke, they more often tend to defend themselves against the
risk of agency turndown by not letting themselves believe that they will really
their purpose.
are in the middle range. Selection among these entails such subtle
at that stage, in terms of reliability, is to identify and screen out, from the
reasons for this. Such a diagnostic attempt demands unrealistic levels of skill
on the part of most social workers; moreover, it has to be carried out within
the relatively few interviews that comprise an adoptive home study.
diagnostic judgments.
useless, it should be noted that according to one study, even those families
these clues in the first place, the problematic nature of these homes might
have been predicted after all. If so, adoptive maladjustment might have been
prevented either by the agency’s not placing the child in the home or by
parents and children throughout the adoptive experience, not only in the
stages before legal adoption, but extending on after it. These changes follow
from agency efforts to cope with new situations : in sharp contrast with the
past, there is now a shortage of applicants relative to the increased numbers
and kinds of children for whom adoption has become a recognized right. In
response to the pressing need for homes, especially for nonwhite and older
children, and in the light of improved research, many earlier requirements for
adoptive parent eligibility have been revised, relaxed, or dropped. An
1448
intensified search for more homes, in relation to need, is also being carried on
by a diversity of other changes in practice. Among these are the use of TV and
public education programs for recruiting homes for children with special
needs.
homes were approved for every 100 white children available for adoption,
while only 39 nonwhite homes were approved for every 100 nonwhite
black or who belong to other minority groups has not risen significantly,
despite special efforts by social agencies to find adoptive homes for them. In
1969 children from these groups constituted an estimated 10 per cent of
nonrelative adoptions. Published figures for 1970 reveal a 2 per cent increase.
One of the most promising among the new ways of reducing this
number of less affluent black couples to qualify for adoption, but also it makes
it possible for black foster parents to convert their status to that of adoptive
care of foster children, they were ambivalent about assuming the financial
and psychological responsibilities of adoption. They were subsidized as foster
parents and also given active psychological and social help by the agency,
with the understanding that this might lead to their deciding to adopt.
Concurrently the agency worked with the children as well. The study
that agency and 50 who adopted through the subsidy program—a program
that had doubled the number of homes available for the permanent
Transracial Adoption
without any family. American Indian, black, and Oriental children, as well as
1450
in recent years. In discussing the psychodynamics of transracial adoptions,
Marmor has suggested that the psychological qualifications of such parents
should include, in addition to the basic criteria, their relative freedom from
Between 1958 and 1967, 355 homeless American Indian children were
placed for adoption with white families by agencies affiliated with the Child
undertook in cooperation with the Bureau of Indian Affairs. Fanshel has just
also sought to learn about the phenomenon of adoption across ethnic and
racial lines, as well as to develop a five-year follow-up picture of the
from tribes in 11 states. He found that the adoptive parents, rather than being
a homogeneous group, represented a cross-section of attitudes among
transracial adopters.
rough periods ahead for their youngsters around problems of dating and of
their sense of personal identity and worth, especially when they reached their
teens. They were planning ways of protecting the children against the ill
white parents. On the one hand, given the still current social circumstances
that have deprived so many nonwhite children of families of their own race—
than the damaging life situations they would otherwise face. On the other
1452
hand, a segment of the black movement has renounced the goal of integration,
at least for now, as a threat to their people’s effort to achieve a positive sense
of individual ethnic identity and group unity, which they regard as essential
to their fight for equality. On this basis they sharply oppose the adoption of
black children by white parents.
Close family attachments between parents who are white and their
black or partly black children are epitomes of racial integration. It is ironic,
therefore, that these transracial adoptions have come under fire from
least so long as the relative scarcity of black adoptive homes persists. Most
recently, thus not yet in published reports, it has become generally possible
for agencies to find black homes for adoptable black infants; it is the older
Some guidelines for recruiting and selecting families that can enjoy
transracial adoption and experience it constructively have been emerging
from the experience to date. Agencies, for instance, recognize that some
already borne children, but who are interested in what is now referred to as
“room for one more.” Many of the case reports of these placements reveal
how greatly those children who are already part of the family can help the
of white adopting parents. The journalist author and his wife have themselves
adopted three children across racial lines. He tells the story of four families
who between them have adopted ten such children. Racially these were black,
American Indian, part black and part Indian, part black and part white, and
Korean.
1454
decisions to adopt across racial lines, the reactions of their families and
friends, their difficulties and their successes. He also reports on the different
ways in which a strong sense of parenthood came into being for these
that adopting parents will vary as to how well they raise their children for
reasons that may or may not have to do with race. He is convinced that
“adoptive parents develop a sense of parenthood for their children every bit
As the title of his book conveys, Anderson sees the blackness and
brownness of these children not as liabilities, but as assets for the white
families who adopt them. As “children of special value” they make possible for
Parental perception of such children’s special value, he believes, makes all the
problems to be expected in raising them more manageable.
children per se, Kadushin followed up 91 families who had adopted white
healthy children between five and eleven years old. When adoptive outcomes
were assessed on the basis of overall parental satisfaction, it was found that
factors that agencies need to take into account in order to prevent and reduce
problems for both the child and parents. This requires that agencies apply
children may suffer an unconscious conflict of which their new parents, and
the agency workers, too, are unaware; in recognizing it case workers could
he will not be legally adopted and his simultaneous fear that he will. Already
adoptable, he is in terror lest his new family decide against keeping him
1456
“forever.” This makes it all the more vital, he feels, to conceal his opposite fear
both from them and from himself: that the finality of being legally merged
him—will dissolve his sense of continuity with himself and his past, and thus
destroy his internalized attachments to previous parent figures. As a general
principle, instead of older children being adopted, they and their parents
applicants have been willing to assume the risks of parenting children with
have been placed. Study data have provided evidence that permanent
Adoptive parents are also now being found for mentally retarded
children when the degree of retardation is mild, and when the child is thought
to be able to fit into family life and to become self-supporting. In discussing
Single-Parent Adoptions
represents one further way of increasing the number of permanent homes for
children who would otherwise face long-term foster care “careers.” So far
such placements are made infrequently and only when no suitable two-
school age, or close to it. Despite its relative infrequency, however, single-
Psychoanalytic case studies are the most intensive and detailed mode of
reports in the literature— and presented one of his own—in which the
absence of one parent had taken place before or during the oedipal phase.
1458
This was found to cause “oedipal deficiency,” which, in turn, was related to
the child’s pathological and social development. Unlike children who had
never known a father relationship and were then adopted by a single woman,
to nine million children are currently growing up in one- parent homes in this
Herzog and Sudia have noted a widespread tendency to regard the one-
millions of children and have produced many effective and apparently happy
functions. . . .” For single women who want to adopt, agency criteria are being
formulated; especially careful exploration of such applicants’ motives to
adopt is indicated.
women rather than with white couples. The outlook for transracial adoption,
in terms of its emotional assets and drawbacks, would seem to hinge on the
future course of the black movement. If the present vehement opposition to
Adoptive Outcomes
and if so, how can adoptive services increase such a prospect? Or is adoptive
1460
experience per se, because of certain built-in factors, conducive to
refuted by others, including this author)? If so, how can adoptive service
level of research sophistication, findings from particular studies are far from
comparable. In overall terms, however, the results of all these studies, taken
together, do confirm the preventive value of adoption for children who lack
homes and who have often experienced antecedent deprivation. Thus
between 1924 and 1968 under the following headings: size of study group
and lapse of time between placement and study; number and percentages of
categorization (good, questionable, poor, and so forth); data used for follow-
up assessment (interviews with adoptive children, adoptive parents, case
records, and the like); and nature of the adoption being studied, whether
adoptees had been followed up; the adjustment of 74 per cent of these had
been rated as unequivocally successful, 11 per cent as fairly successful or
variables are washed out in this form of tabulation; nor can it do justice to the
1462
as infants are told about their adoption before they have reached the latency
phase of development.
past dozen years or so has consisted mainly of studies comparing the rates of
children in the case loads of clinical settings. Much of the impetus for this
series of investigations came from a 1960 paper by Schechter, in which he
reported that about 13 per cent of the 120 children he had seen in private
practice over a six-year span had been adoptees (EFA); he concluded that
these children were told about their adoption when they were between the
ages of three and six. Such telling, he believed, leads to various problems of
superego and ego ideal formation. Thus, to learn that they really do have dual
parentage —by birth and by adoption—at an age when children still tend to
fantasize two sets of parents, one “good” and one “bad,” prevents adoptees
from the subsequent normal fusing (so Schechter thinks) of the split between
parental images. Information about adoption should therefore be postponed
parents. Similar warnings about early “telling” were advanced by Peller soon
entails a gradual process over time, not a one-time event, and must therefore
be sensitively attuned, in terms of content, to the growing child’s emotional
its content, under headlines such as "The Truth Hurt Our Adopted Daughter”
and “Why So Many Adoptions Fail.” Understandably such “revelations” were
1464
adoption may be viewed as a calamity from the standpoint of public health
among children referred for treatment as Schechter had first reported, they
have confirmed the fact that EFA children are overrepresented to some extent
in clinical settings.
have shared the view of Schechter and his co-workers that it is the factors,
inherent in adoption that render adoptees more liable than other children to
disturbance is greater for adopted than for nonadopted children have also
aggressive and sexual behavior problems. Evidence to the contrary has been
provided by studies that compare the adjustment of adopted and nonadopted
with their parents; they found no significant differences between the adopted
and nonadopted groups. From among other studies with similar results, that
of 500 adoptions studied ten years after placement were matched with a
discussed earlier, I do not mean to deny that adoptive children and parents
1466
professionals need to recognize and help to mitigate. It is just that it seems
regrettable that so much of the available psychiatric time and effort has had
can point to ways of preventing them, several investigations have found that a
damage. This seems, in large part, referable to the prenatal period, and to the
of prenatal services attuned to the needs of unwed pregnant girls and women,
though not directly a function of adoptive services, is relevant to preventing
about medical genetics, insofar as this knowledge can be applied to the field
of adoption.[9]
Now that agencies have corrected their earlier policy of severing contact
arise. One area, for example, of helping adoptive parents stems from our
passed through the oedipal phase. Many of us have found that parental
mobilized around the questions of whether, what, and when to tell their
children about their adopted status. In postadoptive counseling of parents, for
instance, this has proven to be one of the most regularly recurring sources of
Side by side with their genuine wish to protect the child from
psychological harm and insecurity, parents often reveal an unconscious
displacement of their own conflicts about adoption onto the more ego-
1468
may mean exposing themselves as inadequate. For others an unrealistic sense
of guilt—as if they had stolen the baby from its mother, or somehow did not
adoption to the child. Many parents, too, seem to fear that once their
youngster learns he was adopted, he will stop loving them as much and wish
adopted and to learn that fact from their adoptive parents. To find it out from
extremely traumatic for the child and can also seriously impair parent-child
Of course, just how one defines the essential nature of parenthood has
much to do with the kind of meaning that one gives to what the adoptive
parents are really “telling.” From an experiential point of view, they can
justifiably feel and convey that they are their child’s true parents, not only by
law, but also by virtue of their parental role behavior and relationship ever
since his adoption. According to a widely held biological orientation, however,
troubling situation, indeed, for adoptive parents and children to have to live
with.
and Peller with regard to this question of where real parenthood lies, has
noted the frequency with which, in his initial article, Schechter used the
words “real” and “own” in connection with the biological parents, while
neither adjective was used at all with the adoptive parents. She challenges
these authors’ assumptions that children who are adopted as infants do, in
actual fact, have two sets of parents—the first, and more “real,” set having
rejected them— and that for children to learn about this, especially in early
childhood, is a critical determinant of psychopathology.
and seven when studied, and had all been told about their adoption before
she saw them. She could find no evidence of parental image diffusion or of
any other distinguishing “signs” of adoptive living among them.
1470
As we seek to improve the psychological understanding of adoption, it
would, indeed, seem that we, as psychiatrists, cannot mainly rely on our
preventing and mitigating the effects, for adoptive parents and children, of
the special stresses and strains entailed in adoptive family process. But the
central reality of adoption is its power to prevent the misery and
Bibliography
American Academy of Pediatrics, Adoption of Children, rev. ed., American Academy of Pediatrics,
Anderson, D. C., Children of Special Value: Interracial Adoption in America, St. Martin’s Press, New
York, 1971.
Bernard, V. W., “Adoption,” in Encyclopedia of Mental Health, Vol. 1, pp. 70- 108, Watts, New York,
1963.
Psychoanalysis and Social Work, International Universities Press, New York, 1953.
_____, “Community Mental Health Programming,” J. Am. Acad. Child Psychiat., 4:226-242, 1965.
_____, and Crandell, D., “Evidence for Various Hypotheses of Social Psychiatry,” in Zubin, J., and
Freyhan, F. A. (Eds.), Social Psychiatry, pp. 183-196, Grune & Stratton, New York,
1968.
Bernstein, B., “Deterrents to Early Prenatal Care and Social Services among Unwed Mothers,”
Biskind, S. E., “Helping Adoptive Families Meet the Issues in Adoption,” Child Welfare, 45:145-
151, 1966.
Borgatta, E. F., and Fanshel, D., Behavioral Characteristics of Children Known to Psychiatric
Brown, F. G., “Services to Adoptive Parents after Legal Adoption,” Child Welfare, 38:16-22, 1959.
Chess, S., “The Adopted Child Grows Up,” Child Study, 30:6, 36, 1953.
Child Welfare League, Standards for Adoption Service, rev. ed., Child Welfare League of America,
1472
New York, 1968.
Fanshel, D., Far from the Reservation: The Transracial Adoption of American Indian Children,
Festinger, T. B., “Unwed Mothers and Their Decisions to Keep or Surrender Children,” Child
Franklin, D. S., and Massarik, F., “The Adoption of Children with Medical Conditions,” Child
Gallagher, U. M., “The Adoption of Mentally Retarded Children,” Children, 15, Jan., Feb., 1968.
Goldberg, H. L., and Linde, L. H., “The Case for Subsidized Adoptions,” Child Welfare, 48, Feb.,
1969.
Goodman, J. D., and Mandell, W., “Adopted Children Brought to Child Psychiatric Clinic,” Arch. Gen.
Grow, L. J., A New Look at Supply and Demand in Adoption, Child Welfare League of America, New
York, 1970.
“A Guide for Collaboration of Physician, Social Worker, and Lawyer in Helping the Unmarried
Hoopes, J. L., Sherman, E. A., Lawder, B. A., Andrews, B. G., and Lower, K. D., “Post-Placement
Jaffe, B., “The Outcome of Adoption: Perceptions of Adult Adoptees and Their Adoptive Parents,”
_____, and Fanshel, D., How They Fared in Adoption: A Follow-up Study, Columbia University Press,
Kadushin, A., Adopting Older Children, Columbia University Press, New York, 1970.
_____, “Adoption,” in Maas, H. S. (Ed.), Research in the Social Sciences: A Five- Year Review, National
1474
______, “Single-Parent Adoptions: An Overview and Some Relevant Research,” Soc. Service Rev.,
44:263, 1970.
Kenny, T., Baldwin, B., and Mackie, J. B., “Incidence of Minimal Brain Injury in Adopted Children,”
Kirk, H. D., Shared Fate: A Theory of Adoption and Mental Health, Free Press, New York, 1964.
____, Jonassohn, K., and Fish, A. D., “Are Adopted Children Especially Vulnerable to Stress?” Arch.
Krugman, D. C., “A New Home for Liz: Behavioral Changes in a Deviant Child,” ]. Am. Acad. Child
Lawder, E. A., Hoopes, J. L., Andrews, R. G., Lower, K. D., and Perry, S. Y., A Study of Black Adoption
_____, Lower, K. D., Andrews, R. G., Sherman, E. A., and Hill, J. G., “Post- Placement Functioning of
Maas, H. S., “Children in Long-Term Foster Care,” Child Welfare, 48:321, 1969.
_____, and Engler, R. E., Jr., Children in Need of Parents, Columbia University Press, New York, 1959.
McWhinnie, A. M., Adopted Children: How They Grow Up, Routledge, London, 1967.
Marmor, J., “Psychodynamic Aspects of Trans-Racial Adoptions,” in Social Work Practice, Selected
York, 1964.
Mech, E., “Adoption: A Policy Perspective,” in Caldwell, B. M., and Ricciuti, H. N. (Eds.), Review of
Mikawa, J. K., and Boston, J. A., Jr., “Psychological Characteristics of Adopted Children,” Psychiat.
National Center for Social Statistics, Adoptions in 1970, U.S. Government Printing Office,
Neubauer, P. B., “The One-Parent Child and His Oedipal Development,” in The Psychoanalytic
Study of the Child, Vol. 15, p. 286-309, International Universities Press, New York,
1476
i960.
Pasamanick, B., and Knobloch, H., “Epidemiologic Studies on the Complications of Pregnancy and
Peller, L., “Comments on Adoption and Child Development,” Bull. Philad. A. Psychoanal., 11, No. 4,
Ripple, L., “A Follow-up Study of Adopted Children,” Soc. Service Rev., 42:479, 1968.
Sandgrund, G., “Group Counseling with Adoptive Families after Legal Adoption,” Child Welfare,
41:248, 1962.
Schechter, M. D., “Observations on Adopted Children,” Arch. Gen. Psychiat., 3:21, 1960.
_____, Carlson, P. V., Simmons, J. Q., Ill, and Work, H. H., “Emotional Problems in the Adoptee,” Arch.
Schultz, A. L., and Motulsky, A. G., “Medical Genetics and Adoption,” Child Welfare, 50:4, 1971.
Schapiro, M. (Ed.), A Study of Adoption Practice, Vols. 1, 2, 3, Child Welfare League of America,
Simon, N. M., and Senturia, A. G., “Adoption and Psychiatric Illness,” Am. J. Psychiat., 122:858,
Skeels, H. M., Adult Status of Children with Contrasting Early Life Experiences: A Follow-up Study,
Monographs of the Society for Research in Child Development, Serial No. 105,
Sweeny, D. M., et al., “A Descriptive Study of Adopted Children Seen in a Child Guidance Center,”
U.S. Department of Health, Education, and Welfare, Children’s Bureau, “Legislative Guides for the
Publication No. 394, Children’s Bureau, Washington, D.C., 1961 (reprinted 1966,
1968).
Witmer, H. L., Herzog, E., Weinstein, E. A., and Sullivan, M. E., Independent Adoptions: A Follow-up
Work, H. H., and Anderson, H., “Studies in Adoption: Requests for Psychiatric Treatment,” Am. ].
Yarrow, L., “Maternal Deprivation: Toward an Empirical and Conceptual Re-evaluation,” Psychol.
_____, “Separation from Parents during Early Childhood,” in Hoffman, M., and Hoffman, L. (Eds.),
1478
Review of Child Development Research, Russell Sage Foundation, New York, 1964.
_____, and Goodwin, M., “Some Conceptual Issues in the Study of Mother-Infant Interaction,” Am. ].
_____, Goodwin, M. S., Manheimer, H., and Milowe, I. S., “Infancy Experiences and Cognitive and
Personality Development at Ten Years,” in Stone, L. J., Smith, H. T., and Murphy, L.
B. (Eds.), The Competent Infant: A Handbook of Readings, Basic Books, New York,
1972.
Notes
[1] This work deals only with the adoption of children by nonrelatives; almost half of the adoptions in
this country each year are by stepparents or other relatives. The former are sometimes
[2] It should be noted that for convenience the single term “adoption” is used throughout this chapter
to refer to any or all of its several meanings: a form of personal family experience; a
investigation.
[3] Because of its recognized leadership role in the effort to improve adoptive service, the Child
membership of over 300 member agencies that provide care and services for deprived,
neglected, and dependent children. Its activities cover the entire child welfare field, of
which adoption service is a part. As one of its range of services, the League develops and
authoritative, for example, Standards for Adoption Service(revised in 1968).In the form of
monographs and books, as well as articles in its monthly journal, Child Welfare, the
subject (several of its titles are included in this chapter’s bibliography). It also sponsors
research and conferences on adoption, and initiates special projects such as ARENA—the
Adoption Resource Exchange of North America. As a totality the League has been a force,
in the public as well as the voluntary agency sector, for positive change on behalf of
children.
[4] For some of the more up-to-date reviews in the social service literature of these changing trends,
the reader is referred to the Child Welfare League’s 1968 revision ofStandards for
[5] I am participating in a prospective longitudinal study of adoption in infants that may shed some
light on this issue. It is in process at the Child Development Center, New York City, under
[6] It is now generally recommended that statewide adoption resource exchanges be set up in order to
1480
increase the opportunities for both children and adoptive applicants. These exchanges,
in turn, should work through ARENA, the Adoption Resources Exchange of North
America, which has already been established by the Child Welfare League of America.
Also at the international level recommendations for improving intercountry laws and
practices were made by the 1971 First World Conference on Adoption and Foster
Placements.
[7] Under certain conditions some single individuals are also now being approved as adoptive parents.
[8] Several of the more outstanding investigations of adoptive outcome, covering a range of
methodologies that help to supplement each other, are listed in the Bibliography at the
[9] Such application of knowledge from other fields to our topic exemplifies the reciprocal relationship
that exists between adoptive concepts and practices, on the one hand, and the research
uses of adoption for investigating broader basic issues, on the other. Psychiatric
integrating pertinent findings from each of these different but mutually supplementary
Edward C. Senay
Introduction
A woman who seeks to abort a pregnancy she does not want presents us
with a complex problem. The basic thesis of this chapter is that she is a
human being in an acute psychological and social crisis. The definition of her
situation is crucial. Some see her in moral terms; others see her in operant
terms—for example, they view her as a “manipulator.” Few appear to
tend to diminish their perceptions of her in order to deal with the abstract
abortion laws, medical, legal, and political recognition of the true nature of
because the psychology of her problem has not been understood and
articulated clearly.
1482
At this writing the woman in question remains an ethical dilemma for
distance from the woman with an unwanted pregnancy. The lack of social
sanction for our engagement with the problem, coupled with the possibility of
legal reprisal, has served to create our collective attitude. Our response has
also been hindered by a lack of knowledge, for it is only in the past two
abortion; they do so in every known religious group and social class in the
Western world, and they do so and have done so in every known cultural and
referral for psychiatric resolution of their crisis when psychiatric facilities are
deny a given woman access to all modern medical means to express her
vision of what is moral. A corollary of this second hypothesis is that one can
abortion. But the set will narrow rapidly if one will consider the real
individuals involved.
The most complete expression of the abortion dilemma lies in the minor
pregnant by paternal rape. Such cases, while not frequent, do occur and
a situation. Any serious discussion of the problem of abortion must deal with
such a case; each of the options for the girl, for her family, for her potential
1484
child, and for society must be made explicit. These alternatives must be
weighed in the light of modern findings that, for the large majority of women,
significant here to note that what is generally the best and most scholarly
modern review of the question of abortion nowhere considers the question of
pregnancy by rape nor does it confront the issue of pregnancy in minors. Such
therefore, the bias in this chapter is that one should create a guiding
abstraction by starting from the experiences of people, not vice versa.
or the more disturbed the family situation, the more severe the crisis picture.
While its form may vary, women with unwanted pregnancies have significant
and severe psychological pain without exception. Further, this pain can have
Ordinary defensive styles usually are employed to cope with the crisis,
but, as is true in so many areas of life, those with fewest supports and poorest
adaptive styles have far the worst time of it. For the Aid-to-Dependent-
Children mother with six or more children, perhaps living on the ninth floor
of a public housing project where she fears to use the elevator because of
precipitates a more severe crisis than is seen in the married suburban mother
who has a stable home, fewer children, and less social and economic pressure.
manipulative defensive operations that they present in any other crisis, but to
define the general problem of abortion by making these few women its
1486
the focus of a section below.
which the woman is a part. Clinical observation will confirm that in the
led to feel that they are bad, inferior, criminal, inhuman, and undeserving of
the same consideration as those “genuinely” in need. It is human—
particularly in time of crisis—to internalize such attitudes with the result that
they clearly identified the fetus with these frightening qualities. They
these ugly potentials within them. Such fantasies, of course, form a powerful
stimulus for anxiety. Many months were needed by one woman to work
abortion for the woman with an unwanted pregnancy. Space does not permit
then attempting to become the social and psychological mother, or giving the
child up for adoption, or giving the child to its grandparents for raising. All
point of view for those who can choose them. There is no question that for
certain women they serve well to resolve the crisis, but we have no
systematic data from which we might make fully scientific judgments in this
regard.
Clinical experience would suggest that more than one out of four
pregnancies brought to term are unwanted for one reason or another. Thuwe
1488
and Forssman’s study suggests that the unwanted pregnancy may represent
an even more consequential crisis for the fetus than for the mother, for they
found that social and psychological outcomes at age 21 were poorer on all
separation from a child to whom they have given birth is almost unthinkable,
and their moral revulsion is equivalent in all respects to that of persons who
the entirely healthy desire to raise the level of care for her living children and
to improve her chances of fulfilling her potential as a person. It is a grievous
on demand is the creation of a new option that large numbers of women will
elect; apparently they are women who will not use illegal avenues, for the rate
of illegal abortions under such conditions does not appear to decrease. Single
Swedish girls, for example, go to Eastern Europe rather than face registration
These facts suggest that there is great pressure in the female population
for abortion services, and that many women, particularly the single and more
youthful girl, will not use medical services that involve registration or the
incontrovertible that they will use medical services where their only
relationship is with a physician of their choice and where no other parties are
involved.
1490
however, have found that only 12 percent of women refused abortion then
actually obtained illegal ones. The fact that married women predominate in
concluded from a study of 249 women refused abortion that the mental status
of many suffered from the fact of refusal. Hook also noted that nearly one-
third of those who went ahead and gave birth were not functioning well in
their maternal role. Clinical experience suggests that the burden of unwanted
sense contradicts the finding that there are significant numbers of women
for the women who seek them out on this question. Where rigid antiabortion
laws prevail, one of the few paths open to women is through psychiatry.
Usually suicide, psychosis, or impending severe behavior disorders furnish
grounds upon which women can obtain complete modern medical care.
The basic fact is that the intent of abortion laws cannot be determined;
for example, “to preserve the life of the mother” can be interpreted variously.
Given the fact of legal uncertainty, it is entirely legitimate and proper for
the psychiatrist to be involved on the same grounds upon which he engages
with any other patient in crisis and to interpret the laws according to his best
judgment that a patient has some degree of risk of suicide if pregnancy is not
terminated. Since such judgments are highly subjective, there is ample room
for the psychiatrist who identifies with the predicament of the woman with
an unwanted pregnancy to be liberal in his assessment of such risks;
1492
conversely the critics of such a psychiatrist, particularly those who equate
abortion with murder, are inclined to read dishonesty into such judgments,
Sim, Sloane, and others have written that suicide is less frequent in
pregnant than nonpregnant females and that suicide rates are low in the
unwanted pregnancies. Most of them do not have crystallized plans, but the
carried out in the past 20 years. Ekblad’s work, the largest of the early
were content with their choice of abortion and had no negative sequelae of
any kind. The balance felt, for limited periods of time, some self-reproach and
guilt or they suffered from mild depression, but only 1 per cent was in real
difficulty and these were women who would have had major problems with
or without abortion.
1494
Subsequent Scandinavian studies and a recently growing number of
American and English studies appear to confirm these early findings. As Fleck
psychological moment; indeed, Simon, et al., Levene and Rigney, Peck and
Marcus, Meyerowitz, et al., and Ford, et al., have found in their studies that
many patients were improved following abortion, and this was so despite the
fact that disturbed women were overrepresented in their study samples.
philosophical debate about abortion, for now, in addition to the growing body
that antiabortion laws prevent some women from obtaining the psychological
benefit that could accrue to them if they were free to follow their moral codes.
spontaneous abortions, and normal delivery and found that the respective
rates were 1.92, 0.27, and 0.68. The greater rate of disorder following legal
abortion no doubt reflects the fact that women predisposed to psychiatric
problems were much more heavily represented in those having legal abortion
All workers find that single women are more prone to develop
postabortion problems than married women, and there is practically
universal agreement that the more psychopathology seen before abortion, the
real question here lies in before and after comparison in the single case, not in
comparison of populations. Interestingly age does not appear to contribute
usually resolves rapidly once the patient learns that her pregnancy can be
for the married woman there may be an increase in family solidarity as the
crisis is overcome.
Following the abortion itself, most women appear to suppress the entire
1496
unwanted pregnancies—I found that 16 of the 18 women with unwanted
work of Kennell, et al., who observed that mourning of dead newborn infants
was most difficult for mothers who were most pleased with their pregnancies.
open to them and who then elect abortion will have an increase in self-esteem
and no symptoms whatsoever in the postabortion period. Such an outcome is
acceptance of the idea that serving such patients is fully legitimate. On the
other hand, passivity and dependence carry heavy costs. The patient who will
traits. Usually she also has a high degree of psychopathology combined with a
low degree of social support. Her pregnancy represents a new stress that
but most observers feel that one never sees such pictures in women who
were not severely disturbed before the abortion. Examination of the histories
motives and once established were used, at least in part, for manipulative
recognize with great clarity that they could not perform as mothers.
the patient and physician with no third parties involved. Pfieffer, who
discriminates between psychiatric indication, for example, suicide, and
1498
psychiatric justification, for example, avoidable stress due to economic
hardship, also feels that psychiatrists should be removed from their positions
as “social decision makers” and should not have to be involved unless “hard”
crisis, the role for the psychiatrist is clear. He or she can be involved
meaningfully because human crisis is a proper area for psychiatric
our patients, as recent research has demonstrated. Our role vis-a-vis legal
aspects of this kind of crisis should be one of advocacy for our patients.
Early diagnosis of fetal abnormality is now possible, but in states where fetal
indications are not accepted, women are, of course, probing the psychiatric
route to abortion. The prospect of seven to nine months of living with the
knowledge of carrying a deformed fetus certainly appears to be a prepotent
human being. One’s bias should be made explicit. It appears to me that public
morality cannot be built upon the compulsory pregnancies of psychotic
internists take the position that any disease occurring in association with
pregnancy can be managed without loss of the mother’s life. Such a judgment
equates life with respiration, and other definitions of life can be held that
such scenes, for the overwhelming majority of women with major medical
problems turn to the illegal market when refused by licensed physicians and
they risk their life by so doing.
Management
1500
primacy of decision to the woman, but sustained efforts should be made to
obtain consensus either for or against abortion.
results of the research of the past two decades. Commonly women— even
those who are highly educated—appear to feel that abortion causes grave
strong positive transference. Women who feel that we should have abortion
on demand are more likely to have such negative feelings, and women who
feel high degrees of guilt about their situation also tend to develop negative
these feelings, and they are best offered the continuous option of discussing
them without pressure to do so.
Some women may use abortion to punish significant males in their lives.
Again, if possible, such motives should be faced and worked through.
Bernstein and Tinkham report that older married women made good use of a
the experience and, as one put it, “to get back to normal as soon as I can.
Contraindications
wishes of someone else without engaging her ego with the problem.
Commonly such women are passive and dependent and will disregard their
mother, or adviser. The psychiatrist’s role here calls for gentle insistence on
separating out the patient’s feelings and helping her to identify them. Minors
Some of the few severe postabortion syndromes one will encounter are
1502
The Law and Abortion
varieties of laws in various states and nations. The present differences in laws
between Illinois and New York, for example, has the effect of creating
sufficient resources from this state can afford the trip to New York, but her
poorer sister is restricted to the same set of options she inherited from the
past.
experiences suggest that unless there is concerted action by all nations on the
population problem, it may be that there can be no sustained advance
anywhere.
role is assured if only to identify those patients for whom the procedure is
contraindicated. If the definition of this problem as a human crisis is correct,
unwanted pregnancies, and we have just started to consider the social and
role in both wanted and unwanted pregnancies into the foreseeable future.
Bibliography
Bernstein, B., and Tinkham, B., “Group Therapy Following Abortion,” J. Nerv. & Ment. Dis.,
152:303–313, 1971.
Calderone, M. S. (Ed.), Abortion in the United States, Hoeber-Harper, New York, 1958.
Callahan, D., Abortion: Law, Choice and Morality, Macmillan, New York, 1970.
Devereux, G., “A Typological Study of Abortion in 350 Primitive, Ancient, and Pre-industrial
Societies,” in Rosen, H. (Ed.), Therapeutic Abortion, Julian Press, New York, 1954.
Ekblad, M., “Induced Abortion on Psychiatric Grounds: A Follow-up Study of 479 Women,” Acta
Fleck, S., “Some Psychiatric Aspects of Abortion,” J. Nerv. & Ment. Dis., 151:42–50, 1970.
Ford, C. V., Tedesco, P. C., and Long, K. D., "Abortion—Is It a Therapeutic Procedure in
1504
Forssman, H., and Thuwe, I., "One-Hundred and Twenty Children Born after Application for
Group for the Advancement of Psychiatry, “The Right to Abortion: A Psychiatric View,” 7:75,
1969.
Hardin, G., “Abortion—or Compulsory Pregnancy,” J. Marriage & Fam., 30:249, 1968.
Hook, K., “Refused Abortion: A Follow-up Study of 249 Women,” Acta Psychiatrica Scandinavia, 39
Huldt, L., “Outcome of Pregnancy When Legal Abortion Is Readily Available,” Lancet, 1: 467–468,
2 March, 1968.
Jansson, B., “Mental Disorders after Abortion,” Acta Psychiatrica Scandinavia, 41: 108–110, 1965.
Kay, D. W., and Schapira, K., “Psychiatric Sequelae of Termination of Pregnancy,” Br. M. J., 1:299–
302, 1967.
Kennell, J. H., Slyter, H., and Klaus, M. H., “The Mourning Response of Parents to the Death of a
Kolstad, P., “Therapeutic Abortion: A Clinical Study Based upon 968 Cases from a Norwegian
Kummer, J. M., “Post-Abortion Psychiatric Illness—A Myth?” Am. J. Psychiat., 119: 9982–9986,
1963.
Levene, H. I., and Rigney, F. J., “Law, Preventive Psychiatry, and Therapeutic Abortion,” J. Nerv. &
Lindberg, B. F., “What Does the Applicant for Abortion Do When the Psychiatrist Has Said ‘No’?”
Meyerowitz, S., Satloff, A., and Romano, J., “Induced Abortion for Psychiatric Indication,” Am. J.
Patt, S. L., Rappaport, R. G., and Barglow, P., “Follow-up of Therapeutic Abortion,” Arch. Gen.
Peck, A., and Marcus, H., “Psychiatric Sequelae of Therapeutic Interruption of Pregnancy,” J. Nerv.
1506
Senay, E. C., and Wexler, S., “Fantasies About The Fetus in Wanted and Unwanted Pregnancies,” J.
_____, “Therapeutic Abortion: Clinical Aspects,” Arch. Gen. Psychiat., 23:408–415, 1970.
Sim, M., “Psychiatric Sequelae of Termination of Pregnancy,” Brit. Med. J., 1:563–564, 1967.
Simon, N. M., Senturia, A. G., and Rothman, D., “Psychiatric Illness Following Therapeutic
Sloane, R. B., “The Unwanted Pregnancy,” New Eng. J. Med., 280:1206–1212, 1969.
Taussig, F., Abortion—Spontaneous and Induced: Medical and Social Aspects, C. V. Mosby, St. Louis,
1936.
Tietze, C., “Therapeutic Abortion in the United States,” Am. J. Obstetrics & Gynecol., 101:784–787,
1968.
White, R. B., “Induced Abortions: A Survey of Their Psychiatric Implications, Complications, and
Whitlock, F. A., and Edwards, J. E., “Pregnancy and Attempted Suicide,” Comprehensive Psychiat.,
9.11, 1968.
1508
Chapter 27
Harold I. Lief
Separating male from female sexuality is an exercise in abstraction, perhaps
the sexes, especially since most sexual disturbances arise in the context of
marriage or some other heterosexual relationship.
components further defined in order to set the stage for a discussion of male
disturbances in sexual functioning.
turn, arc composed of belief systems and their related values. Important
facets of sexual attitudes are linked with the image of oneself as male or
identities. Highly significant as well are other internal states such as sexual
drive or interest and the capacity for erotic arousal and responsivity. Sexual
behavior goes far beyond “physical” sex, for it includes as well sex-typed
behavior that not only varies enormously among individuals but also varies in
Cultural Variations
1510
abundantly clear that patterns of sexual behavior and morality have taken
many diverse forms over the centuries. Far from being “natural” and
love, marriage, and “proper” sexual behavior are meaningful only within
the context of our own cultural and religious mores. Thus, in the first
public nudity was no cause for shame (as is still true in some aboriginal
arrangement, and extramarital relations were taken for granted. Frank and
open sexuality was the rule, and incest was frequent. Women were open
distinction because it often implied that some important person had slept
with one’s mother. In early feudal times new brides were usually
deflowered by the feudal lord (jus primae noctis). In other early societies
all the wedding guests would copulate with the bride. Far from being
initial coitus would not be associated with the husband, [Marmor, p. 165]
Karlen, “there are societies where modesty calls for hiding body and face,
others where it insists that the male hide only his glans penis; where widows
commit suicide, and where women have several husbands; where girls
commence coitus at 11, and where they and their lovers are put to death for
they do so with a reindeer’s leg tendon or with a live mink whose jaws are
tied shut; where every male has experienced sodomy at some time in his life,
and where one homosexual act may cause ostracism or even execution.” (p.
475).
which there is unlimited sexual access to most potential partners; (2) some
form of incest barrier is always found, involving at least some members of the
nuclear family; (3) heterosexual coitus is the standard pattern for adults
everywhere; no society makes homosexuality, masturbation, bestiality, or any
other noncoital form of sexual activity the dominant form for adults.
Sexuality as a System
1512
If sexuality refers to the totality of one’s sexual being, its essence is even
more what one “is” than what one “does.” One’s sense of being male and
masculine, female and feminine and the various roles these self-perceptions
include:
Biological Aspects
Chromosomal Abnormality
biological sex, and change in sex is usually unwise after eighteen months.
Some of these people and some without evident biological defect have
that differential sensitivity and responsiveness are built into the controlling
1514
hypothalamus plays a leading role in the control mechanisms. In normal
development the genetic factors structure the endocrine environment, which,
in turn, affects the psychosexual bias of the nervous system. Instead of having
Sexual Identity—
Core Gender Identity
stimuli and is more subject to the effect of previous experience. Males, more
than females, have to learn to copulate, and this capacity among males is
experiments conducted by the Harlows, the lack of peer group social and
sexual play differentially affected the sexes, so that males, even more than
females, failed to develop the capacity for adult sex behavior and successful
copulation.
Gender Identity
Money and the Hampsons defined gender identity as “all those things
that a person says or does to disclose himself or herself as having the status of
affected mostly by the cultural and familial factors provided by all the
1516
transactional experiences, explicit and implicit, planned and unplanned,
encountered in childhood and adolescence. Indeed, the process of gender
and genital) postulated by Freud are only gross approximations of the usual
maturational processes, the nuances of which are very different in different
during the anal stage is not related to an alleged anal eroticism, but, instead, is
related to the nature of the interaction of the child with his parents and the
For the creation of the standard sexual identity, the child must have a
parent or parent substitute of the same sex who is neither so punishing or
weak as to make it impossible for the child to identify with him; a parent or
trust members of the opposite sex; and parents who do not systematically
reject the child’s biological sex and attempt to force him into behavior more in
Gender Identity
During the period three to seven years of age, the child gradually
1518
realizes that people are placed in two related categories, boys or girls, men or
behavior with boys and girls, and characteristic sex-linked behavior in the
kitchen, the garage, or the backyard. Physical differences between men and
women, boys and girls, play a large part in the concept of masculinity and
femininity learned at an early age; for example, a girl should be pretty and
small, a boy large and strong. By the time the child is eight or ten, the primary
sex-typed attribute for girls is having an attractive face, while for boys it is
cultures, including our own, promote aggressivity in the male and a passive-
receptive stance in females. Many studies have demonstrated the connection
between maleness and aggression, and the evidence is almost as strong for a
greater dependency, conformity, and social passivity for females than for
class girl than the lower-class girl in choosing toys and in undertaking
must acquire reactions from other people since she cannot know whether she
environment. This promotes her dependency upon other people. The boy, on
the other hand, develops many important sex-typed behaviors while alone.
fixing his bicycle), and these will strengthen his convictions that he is
The pressures from society and from families for stereotyping sex-
linked behavior are enormous. The studious or artistic boy and the
mathematically inclined girl may suffer humiliation at the hands of his or her
family or peers. These stereotypic attitudes and values learned early in life
1520
generally persist into adult life and often come into sharp conflict with
changing societal values, especially with regard to the role of women.
differentiation between men and women, are changing so rapidly that there is
hardly a job or task that is completely absorbed by one sex alone. Sexual roles
are now no longer assigned by tradition but are negotiated, creating a potent
Despite the changes, given our still current cultural emphases, by the
time a boy is an adolescent a satisfactory sexual identity for him involves
sexual experiences with girls. Thus, much sexual activity among males is as
Whether this carries over to the area of physical sex itself depends on the
intensity of anxiety, guilt, or hostility toward the opposite sex and on the
types of reinforcing or extinguishing (corrective) stimuli the child receives
during adolescence.
Sexual Behavior
of the genitals and other areas of the body that are commonly recognized as
erogenous zones. In the early weeks of life male infants respond to internal or
external stimuli with erections, and even at the time of delivery erections in
the newborn are seen. This indicates the presence of a built-in sexual reflex.
In adult life the basic biological nature of the reflex sexual response is seen in
per cent of the children engaged in genital play at this age (Kirkendall &
involving themselves and other male or female children. When children are
threatening and that sexual expressions are to be regarded with guilt and
shame.
1522
13. At most, between the ages of 5 and 11, there is a relative decline in
many things about the world in which he lives and as he increases his
contacts with his fellows, curiosity about his family, including intense sexual
curiosity, abates. He leaves the protective canopy of his family for the wider
world, but his sexual interests are still there, somewhat masked by his
involvement and commitment to the exploration of his milieu. If that
to enlarge his horizons, the child’s sexual curiosity and behavior may become
active, even florid. (In a St. Louis housing project prepubertal children
children and adults were engaged openly in sexual encounters of all types, in
the hallways, elevators, lobbies, laundry rooms. Mothers even encouraged
children to engage in adultlike sex play, for it kept them off the streets and out
of trouble with the police.) Broderick and others have demonstrated that
there is no period in which the majority of boys and the great majority of girls
are not interested in the opposite sex. Four out of five pubertal boys and even
boys are commonly interested in their own sex. Many of them go through a
“homosexual stage.” There is a danger that parents will regard this same-
Puberty
in males. Preoccupation with sex causes many concerns at this time. Boys are
Commonly puberty arrives for boys about two years later than for girls
(11 to 18 for boys and 9 to 16 for girls). Whether the age of puberty has
actually been getting lower for both sexes over the past half-century is still a
and penis, (2) appearance of straight pigmented pubic hair, (3) early voice
changes, (4) first ejaculation, (5) kinky pubic hair, (6) period of maximum
growth, (7) auxiliary hair, (8) marked voice changes, and (9) development of
the beard.
1524
standard sexual pattern and becomes a problem only if there is guilt or
anxiety associated with it. While masturbation is now accepted as a perfectly
natural part of sexual development, for the first time its positive features are
males and above 60 per cent for females. Most people who masturbate as
things with someone who is admired, whereas males are more likely to have
direct coital fantasies with someone of whom they are fond. Persons with
more education fantasize more frequently; yet they are absent in about 12
per cent of college men and about 20 per cent of college women. Women are
much less likely than men to fantasize having sex with a stranger or in a
group. On the other hand, fantasies of being forced into sex are more common
in women (rape fantasies are a way in which the woman decreases her sense
About 10 per cent of males and about 4 per cent of females become
identity, gaining control over their impulses, and learning how their bodies
function are more important in the early phases than release of sexual
standard pattern for high school seniors of petting to orgasm gradually shifts
to coitus sometime during their college years. A minority of high school boys
and girls have coital experience (the differences among social classes are
highly significant), but the majority have engaged in coitus by the time they
finish college. Studying a representative sample of the population (not
The major shift over the past 30 years is in the sexual behavior of girls. A
generation ago about 30 per cent of senior college girls had premarital
1526
intercourse. Now over 50 per cent report “going all the way.” The
predominant sexual norm both for high school and college students is
the major tasks of adolescence, involves the capacity for intimate sharing of
trust, to value fidelity, and to permit the loved person to develop his own
unique style of living. With all the pressures impinging on the adolescent that
often difficult for him to put aside his own satisfactions sufficiently long to
develop genuine intimacy. This is a process that has its beginnings in early
vicissitudes into adult life. Although sex can be pleasurable in the absence of
love or of intimacy, for most people sex is greatly enhanced in the presence of
tenderness.
eventually marry.
Masters and Johnson estimate that over half the married couples in the
United States have a significant sexual problem, and they are referring only to
husband and for a wife. The battle of the sexes more often involves battles
over sexual roles than conflicts over foreplay and coitus. Nevertheless, as
they probably affect every couple at least at some point in their marriage.
important difference is that men have a refractory period in which they are
whereas females can have orgasms following each other at intervals of a few
seconds.
1528
readiness for sexual activity. It is affected by many factors such as the partner,
the setting, the mood, and the positive or negative effect of emotion (love,
anxiety). The details of the four stages of human sexual response have been
Sexual relationships not only can promote intimacy but also can serve
setting for aversive feelings such as anger, revenge, dominance, and self-
bipotential, since it can serve as the expression of the most significant, tender,
affectionate, and intimate feelings between two people or it can serve to
four times a week. Nonetheless, as people get older they can continue to have
an active and satisfying sexual relationship. Over 50 per cent of men in their
sixties and at least 25 per cent of men over 70 continue to have satisfactory
motive state” increases with age. Since his ejaculatory needs have diminished,
he is better able to control his “staying power,” slowing down his ejaculation
far more effectively than at an earlier age. Sexual capacity in older people
depends on continued sexual expression and interest through middle life and
In middle age many couples report waning sexual interest. This is either
that about 75 per cent of couples coming for counseling have a significant
sexual problem, but only 15 per cent have a sexual problem that is a primary
cause of marital disharmony. In the other 60 per cent sexual problems are a
consequence of disharmony in other areas of their relationship.
1530
transvestitism, voyeurism, exhibitionism, fetishism, and sadomasochism are
covered in other volumes of the American Handbook of Psychiatry. This
functioning, most of which occur within the context of the marital or other
sex- pair relationship. This chapter will contain discussions of impotence,
genital sex and coital positions), conflicts over the emotional components of
sexuality, and infidelity. Finally this chapter will deal with special problems of
the single male such as the fear of intimacy, the fear of marriage, and
performance anxiety.
elsewhere. The interviewer should follow the patient’s leads and not unduly
structure the interview so as to cut off information and the flow of affect.
changing topics. Obviously, here as elsewhere, the greater his mastery of the
field the greater will be his competence in taking a history and in interviewing
problem, special skills are required. Since sex evokes so many highly charged
feelings, and anxiety and embarrassment are such frequent occurrences, the
will soon overcome his own anxiety. If the patient is clearly inhibited about
discussing sexual matters, the therapist must take the initiative. Sometimes
the decision whether to probe or wait until the sexual material comes up in a
more appropriate context after the patient has worked through some of his
resistances is a difficult one, and the interviewer will have to depend on his
experience to make such a judgment. More often than not, gentle and tactful
1532
other house officers in dealing with sexual problems of patients. Most of them
have never learned this kind of interviewing when they were medical
The only cure for this anxiety is to carry out interviewing under close
supervision until the psychiatrist’s growing skills make him more confident of
his ability.
guilt about certain facets of sexuality may create much discomfort. Anxieties
about potential homosexual behavior may create a blind spot in dealing with
related aspects of sexual attitudes and behavior. Anxieties about his own
life style may be in contrast to those of his patient, yet he has to learn not to
be unduly influenced by his own sexual morality and preferences. One should
“liberalize” a patient before he is ready for the suggested behavior may be just
interviewer can follow. He can move from less to more highly charged areas
people engage in oral-genital sex, so tell me your feelings about this.” One can
ask “How young were you when you first masturbated?” Another help in
sexual interviewing is to ask about attitudes before behavior. The physician
may say, for example, “Research tells us that the majority of married men
have one or more extramarital relations. What are your feelings about that?”
It is usually easier for the patient to talk about his attitudes than about his
personal experiences. Another general technique is to learn what
1534
categories: identifying data, childhood sexuality, which should include family
attitudes about sex, learning about sex, childhood sex activity, primal scene
experiences before and after marriage, feelings about oneself as masculine (or
feminine), sexual fantasies and dreams, dating, engagement, marriage,
including premarital sex with partner, the wedding trip, sex in marriage,
behaviors.
and talk with each other as well as by their bodily movements. In these cases
he gets important information about their feelings and attitudes toward each
other. Facial expressions and movements of the body may indicate concern,
protectiveness, disdain, anger, and so forth. The physician is able to watch
complains that her husband gives her little affection, one can observe very
dimensions. The husband has a perception (1) of himself, (2) of his wife, (3)
of his wife’s perception of him, (4) of the marital relationship. This is likewise
true for the wife, who has the complementary perceptual system. The
feedback. To take one example, the therapist may ask the wife, “How do you
think your husband feels about the way you respond to him in bed?” (Her
perception of his perception of her.) She will respond and the interviewer can
then turn to the husband and say, “How does this fit in with the way you feel
about her sexual responses?” (His perception of her.) In this fashion one can
get immediate feedback about any of these perceptual areas or about
communication in general. It is sometimes helpful to have a spouse repeat
back what the other one has just said in order to make certain that one of
When one therapist is working with both the husband and wife, the
usual format is to take a short sexual history from the husband and wife
together to get some notion of their interaction and then to interview each of
them separately, either on the same occasion or at the next interview. If a dual
sex therapy team is doing the interviewing, as recommended by Masters and
1536
Johnson, it is customary to have the husband interviewed by the male
therapist and the wife by the female therapist separately and then switch at
the next session so that each marital partner is being interviewed by the
therapist of the opposite sex. Conjoint interviewing then takes place at the
third session.
The use of a dual sex therapy team has many advantages. Better
understanding is assured by the identification between the therapist and the
patient of the same sex. Often the therapist of the same sex can articulate the
feelings of that patient far more effectively than the two members of the
opposite sex in the room. As in any group therapy situation, the co-therapists
can aid each other in multiple ways such as clarification of points, making
interviewing.
Diagnosis or Appraisal
possible. More than that, he must be able to appraise how the sexual problem
fits into the fabric of the patient’s life. The man who comes in complaining of
impotence and wants treatment for this dysfunction presents a different
the unique and subtle aspects of an individual’s life style. Yet some gross
categories are aids to conceptualization. Sexual problems are either overt and
out in the open in the initial interview or soon after, or they may remain
or exaggerate potentialities for dysfunction that the patient brought into the
relationship. With some patients the sexual problem is critical in the sense
1538
experience for seven years. When his wife was interviewed, it turned out that
she was less concerned about the sexual dysfunction than about her
usually impossible to treat the sexual problem without dealing with the total
marital or sex-pair relationship.
first occurred, (2) the patient’s reaction to the symptom, (3) the wife or
partner’s reaction to the symptom, (4) the nature of the marital interaction,
(5) situational components (the symptom may appear only at times or may
Based on the appraisal, the therapist must decide whether the patient
Therapeutic Considerations.
Impotence
sufficient for him to penetrate the vagina and maintain successful coitus.
Inprimary impotence the man has never been able to complete coitus
satisfactorily because of his failure to achieve an erection. In secondary
Primary Impotence
males with primary impotence over an 11-year period. The dominant feature
in these men is the association of sex with sinfulness and dirtiness. Guilty fear
is the “emergency” emotion found most frequently. There may have been
frequent sexual, although not necessarily coital, experiences with the mother
adolescent boy during his dating and courting period, resulting in an almost
complete absence of sexual encounters with girls. When some encounters
take place, there is such a feeling of awkwardness resulting from his fumbling
efforts at sexual contact that anxiety about his competence is added to the
underlying feeling of wrongdoing. For their mates these men tend to select
virginal wives whose own inexperience augments the male’s awkward efforts.
In some men a homosexual predilection, either overt or covert, leads to a
are other contributing causes. Occasionally initial coital efforts under the
influence of alcohol or drugs leaves a highly vulnerable young man with the
1540
impression that he is totally incompetent sexually. Initial failures, whatever
their underlying cause, are then intensified by the strong anxiety about
adequate performance.
Secondary Impotence
the therapist must be aware of the possibility of some defect in the machinery
of the body. The differentiation can be made readily. If a patient is able to
erection.
Systemic Disease
impotence is one of the earliest symptoms of diabetes. The reasons for the
relationship between impotence and diabetes are not clear, since one does
not always find neuropathy in such cases. Other systemic illnesses in which
Local Disease
most adult males will not be troubled by impotence following castration. The
some role in that there are more cases of impotence following the perineal
Drugs
1542
Aging
impotence. If an active sexual life has been maintained through middle age
and there is a willing and cooperative partner, men are often capable of
stimulation than he was in his early years, and psychic factors have less
wife. If it occurs, for example, almost every time the wife has been flirtatious
alcohol or drugs.
children’s voices, unexpected telephone calls, and the like. Other important
causes in the first episode are anger at his wife, the failure of his wife to
respond, or guilt toward his wife, perhaps for some extramarital relationship,
real or fantasied. Occasionally the first episode occurs because of something
that has nothing directly to do with the patient’s sexual life. It may have
1544
intense that the man’s entire life is affected. He may become seriously
depressed and unable to function. At any rate the most common response is a
since one cannot will an erection any more than one can control his breathing
for any length of time. The more the man concentrates on his performance,
the less able he is to have an erection or to maintain it. The other frequent
embarrassment.
humiliation. He may redouble his efforts to please his wife; the increased
demand for performance can only have an adverse effect on his sexual
competency.
may improve the prognosis. A detailed history of the marital couple’s sexual
interaction will be helpful to put the present difficulty in its historical context.
The degree of responsivity of the wife is an important factor. Whether
factor.
with his wife but fully potent with a mistress or the reverse may be true.
Sometimes a man is potent with only one type of woman, such as one from a
evoked by a woman who reminds him least of his mother. Since sex is also
female whom he views as degraded, such as a prostitute. Women are put into
It is probably true that all men have some anxiety about maintaining
potency especially with the advance of age. Most highly vulnerable are those
men with a deficient sense of masculinity (gender identity) in whom
1546
castration anxiety is particularly strong. In these men the anxiety that follows
the initial failure to achieve or maintain an erection is so intense that the fear
first time a man is unable to achieve an erection twice, and it is panic when
forties had been impotent for two years. Although occasionally troubled by
erection in more than 20 years of marriage. Two years prior to his seeking
for him.
in his mid-thirties had been impotent for seven years. Raised in a family in
didn’t have the faintest notion that he would have to give his wife any
and divorced. She had had two difficult pregnancies and deliveries, fraught
with considerable danger because of eclampsia. When she became pregnant
for the third time (the first in his marriage), the husband became even more
indifferent and virtually left her alone all during the labor. Her feelings of
isolation were heightened by some careless and inconsiderate nursing care.
She never really forgave her husband for his neglect. Consequently she began
to withdraw from him emotionally, while she reproached him for his passivity
mother, he fantasized that the vagina was a huge hole that would engulf him.
As a consequence he preferred nymphets whom he could fondle and caress
but with whom he avoided coitus. He enjoyed foreplay with his wife but
would try as much as possible to avoid sexual intercourse. On the other hand,
his wife’s idea was that any kind of sex that did not quickly move on to coitus
was perverse. Both of them were highly frustrated by this interaction. Again
1548
marital therapy was employed to resolve this dilemma.
earlier. He had had no difficulty with potency prior to his marriage and during
the first three months following the wedding. When his wife became pregnant
she announced that this was all she wanted out of the marriage and refused
him any further sex. Within the year they were divorced. Following this
trauma, the patient had a phobia that he would impregnate a woman and then
the ensuing years. On only one occasion was he potent. This followed his
partner’s discovery that his condom, into which he had ejaculated with a
semierect penis, was still in her vagina. The patient began to tremble, to
sweat profusely, and to feel faint, but within 20 minutes he had the best
erection he had had in 17 years and was able to have successful coitus for the
first and only time. Discussion of his feelings during this episode revealed that
his fear of pregnancy had been completely relieved by the fact if he were
going to impregnate the woman, he had already done so and no further harm
was possible. By the time he came for treatment his phobia of impregnating a
woman was so intense and so impervious to reason that he would not even
nonorgasmic female. Coitus had never been consummated. The patient had
relationship. His mistrust of women, which had been submerged during his
first marriage, came to the surface. He selected a woman who had a violent
misconception of sex and who unconsciously sabotaged any possibility of
overcoming the husband’s fear and mistrust of women. This vicious cycle
that at age 13 he had discovered his mother, to whom he had been closely
gaining revenge on all women by “knocking them up.” The only way he could
have intense sexual excitement was when there was the danger of
impregnating his female partner. It was with great glee that he would receive
the news that the girl was pregnant. As a crude jest he called himself “Jack the
Dripper.” Over time his pleasure had begun to wane, and he no longer got an
1550
became impotent. His depression was so intense that he required psychiatric
hospitalization.
Premature Ejaculation
entrance, the pathological nature of his behavior is much less certain. Kinsey
reported that this is the average time; hence he found nothing abnormal
about it. Since rapid ejaculation is found among animals of diverse species
including the primates, Kinsey held that in the human rapid ejaculation was a
but even these women are not usually that quickly responsive to coitus.)
cultural demand in our society. Presumably far fewer men were labeled as
premature ejaculators in Victorian England.
definition is inevitable. Presumably the one set forth by Masters and Johnson
absurd “if the female partner is persistently non- orgasmic for reasons other
than rapidity of the male’s ejaculatory process.”
For every male who presents himself to a therapist for treatment, presumably
there are thousands who try to deal with their failure to control the speed of
differences. Among many people in the lower social class, there may be no
recognition that such a malady exists. If the husband is intent only on his
pleasure and sheds responsibility for his wife’s pleasure and if the female
takes little pleasure in coitus and would just as soon get it over with, then
neither will complain about premature ejaculation. Furthermore, it is
during adolescence. The cultural demand for speed, especially when sexual
activity is being carried out in situations where the couple may be “caught” as
in the back seat of a car or in the living room of the girl’s parental home,
1552
predisposes the adolescent to the development of premature ejaculation.
which in itself is well-nigh universal. If, on top of this, there is also fear of
impregnating the girl, along with the feeling that one is doing something
wrong anyway, the combined anxiety will almost certainly produce
premature ejaculation.
intense erotic arousal in young males, especially when there has been
infrequent contact with the opposite sex, and the heightened excitement of a
new or relatively new experience, coexist with the anxieties cited previously.
more remarkable is that the majority of men seem able to learn to control
ejaculation either before or during marriage.
absent, there is nothing the man can do to prevent ejaculation. But if he learns
to recognize this internal signal, he can stop thrusting or otherwise signal his
partner to modify their pelvic movements in order to decrease excitement.
This is the rationale for the “squeeze technique” developed by James Semons
and elaborated by Masters and Johnson. This will be discussed under Specific
performance and fear of their partner’s scorn and ridicule and continue the
pattern of premature ejaculation for many years. Some of these men learn
that frequent coital experiences will help them gain control since their
The typical case coming to the therapist is that of a man in his late
twenties or early thirties who, after five to ten years of marriage, has had a
reproaches has heightened the demands for performance that only increase
the man’s anxiety and failure. This vicious cycle requires marital therapy for
its solution.
Ejaculatory Incompetence
1554
who is even unable to masturbate to ejaculation, but most men who have
ejaculatory incompetence have no such difficulty. The condition is rather rare.
Masters and Johnson report having seen only 17 males with ejaculatory
would lead one to believe. I have seen five cases in the past two years.
In many cases marked guilty fear seems to be the most prominent emotion.
Severe reprisal for masturbation and even for nocturnal emissions may result
simply mean that detection is that much more possible since the soiled
striking examples of psychic trauma. Masters and Johnson report the case of a
young man who was caught at the point of ejaculation by the police while
parked in a lover’s lane. In another case they cite, children burst into the
room just as the husband was ejaculating. Since these experiences must
either despised or hated. Either out of hostility to the woman or the fear of
impregnating her, some men deliberately stop thrusting when they are about
to ejaculate. If this is done over a period of time, unconscious mechanisms
take over and the man becomes unable to ejaculate even if he consciously
wants to.
with. He also was intensely frightened by the first wet dream and thought that
he had developed a serious illness. In three sessions a member of my staff,
with reassurance and education, was able to cure a symptom that had been
Paradoxical Orgasm
1556
This is a very rare condition in which male orgasm, generally with a
occurs with a semierect or flaccid penis, but in which the circumstances are
in which sexual arousal is entirely out of place. In most cases studied, orgasm
phone booth. But even here the conversation during the phone call is usually
the same time they have a strong fear of retaliation. Symbolically they want to
“put it out” but are afraid it will be chopped off. These men usually have
pseudohomosexual anxieties, if not latent homosexual impulses. They are
usually incompetent with their wives or sex partners, having either severe
Relationship Problems
sex-pair relationships arise out of conflict in nonsexual areas, with the sexual
object for use and manipulation rather than an equal co-partner. However the
man may directly act out his passivity and dependency by being markedly
underassertive, giving his wife the feeling that she has a baby to care for
instead of a man to lean on when she needs him. All of these problems can
lead not only to the difficulties cited above, but also to conflicts over
not only to dissatisfaction with the sexual aspect of the marriage, but also to
infidelity.
Infidelity
1558
husbands (35 per cent of wives) have had at least one episode of extramarital
sex by midlife. The number of people involved alone would tell us that not all
of them are reacting to neurotic conflicts. Extramarital sex may result from a
search for variety, sometimes even sanctioned by the spouse, who may be
engaging in parallel affairs. In many cases no lasting harm is done to the
without endangering the marital relationship. This may be true as well if the
wife is interested in sex but not responsive. The lack of response may
diminish the husband’s interest in marital sex while it awakens his interest in
when both are aware that the marital difficulties have reached a point of
crisis.
Even when one partner seemingly accepts the situation with resignation,
relationship.
infidelity are an intense search to prove one’s gender identity, the Madonna-
Nontraditional Relationships
lustful enjoyment of sex for its own sake. One of the striking findings in group
seems to take place in this setting. Group sex (swinging) either attracts people
1560
with the potential for homosexual or bisexual behavior, or it releases
impulses that are widespread in the population but are held under check
the latter.
sexual conflicts. On the one hand, he has to manage intense feelings of sexual
always he has to cope with the fear that he may not be a competent sexual
performer. As has been indicated previously, these anxieties provide the basis
for premature ejaculation and, occasionally, impotence.
number of years, and the fear of intimacy is omnipresent. This may take the
one is homosexual; this, in turn, augments the underlying fears about one’s
Therapeutic Considerations
therapist is skillful in that form of treatment. This means that the therapist
has to become competent in a variety of forms of therapy or, failing that, he
treatment of sexual problems fall into three main groups: (1) individual
therapy, (2) marital therapy, or (3) a combination of these. Individual therapy
1562
behavior therapy has three basic techniques: (1) gradual desensitization, (2)
since the skills required are quite different from those involved in individual
therapy. If marital therapy is generally the treatment of choice in problems of
per cent of departments of psychiatry now claim that they teach some form of
sometimes indicated.
What are the factors that determine the selection of treatment? The
therapy and sees himself as the primary recipient of psychiatric care, this may
either preclude marital therapy or the patient may require persuasion that
marital therapy is the better choice. Put briefly and concisely, the issue is
whether the relationship between the husband and wife or the intrapsychic
that the relationship will be dealt with. Even in this situation one spouse may
Most spouses can be brought in willingly if they are asked to cooperate in the
treatment process by aiding the therapist to overcome the patient’s
difficulties. If the wife has any commitment to the marriage at all, this appeal
generally is effective.
problems in the marriage have been worked through so that the therapist can
tackle the sexual problems directly. In the former approach the hostility of
one spouse to the other might manifest itself as a refusal to follow the
regimen set forth by the therapist. If coitus is interdicted in the first phase of
1564
prevent the treatment from becoming successful. One partner may go through
the motions of acting in accordance with the suggestions of the therapist and
marital relationship is the focus rather than the sexual problem, problems of
communication, mutual hostility, and so forth are dealt with first in order to
increase the motivation of the couple to try to work more effectively on the
sexual problem.
Impotence
patient must be protected from the demand for penetration both from his
spouse and himself. This decreases the fear of being incompetent. As a
decrease the patient’s own demand for successful penetration has been
known for a long time, at least since the time of John Hunter over 200 years
insisting that they “refrain from coitus during six consecutive amatory
Johnson.
After the couple has learned the pattern of mutual pleasuring that
Masters and Johnson called the “sensate focus,” erotic arousal has been
increased, and the male has had a series of successful erections, the wife (or
time when she can control the decision for penetration, places her mate’s
penis in her vagina until the man can appreciate the sensation of vaginal
until he can generally last for 15 to 20 minutes before ejaculation. If his penis
becomes soft, the woman withdraws, repeats the stimulation until erection is
secured, and once again mounts him. This process is repeated until impotence
is overcome altogether.
If the male is not married or has no partner whom he can bring in for
sex-oriented marital therapy, individual therapy is the only form of treatment
that can be applied. The therapist then has to choose between psychoanalysis,
1566
behavioral modification of both conditions. Desensitization, with or without
the assignment of tasks outside of therapy to overcome inhibitions, is the
holding, petting with clothes on, undressing and light petting, heavy petting,
and finally, coitus. In psychotherapy the decision to deal with the total
approach may be primarily historical, dealing with psychic traumas and their
effect on present functioning, or therapy may emphasize the anxieties in the
inhibitions sufficiently so that the patient begins to carry out in real life what
Premature Ejaculation
been devised by Masters and Johnson based on a technique for the individual
male originally formulated by Semons. The “squeeze technique” involves the
female placing her thumb and two fingers at the coronal ridge of the penis
when she has been signaled by her mate or realizes through other cues that
prevent ejaculation and cause partial flaccidity. This is repeated many times
until the male senses the sensation just prior to ejaculatory inevitability. Since
he can stop stimulation at this point, this gives him greater control. Eventually
he learns to signal his mate when he senses that he is about to ejaculate, and
both of them can stop or decrease their efforts at mutual stimulation. In this
way the patient acquires the necessary control to continue intromission for
15 to 20 minutes. The individual male who does not have a partner can learn
Semons).
Ejaculatory Incompetence
Masters and Johnson suggest that the wife masturbate her partner to
ejaculation. When this is successful it is rare that the patient fails to be able to
experience inhibiting attitudes toward the mate have to be worked out. These
1568
If marriage-oriented therapy is the treatment of choice, the relationship
the sexual problem. When this motivation is high and the interfering
emotional factors have been reduced, then the sex- oriented therapy just
described can be used effectively. The dual sex therapy team, recommended
by Masters and Johnson, has many advantages, some of which have been
should be reassured that they can handle these problems effectively although
perhaps over a somewhat longer time than when a dual sex therapy team
groups of couples with sexual problems. When this is done the use of
between the husband and wife. In a similar fashion audiovisuals may be used
necessary. Since sexual problems arise most often in the context of a marital
relationship, and since, furthermore, in over half the couples the partner of
the “presenting” patient also has a form of sexual inadequacy, marital therapy
Bibliography
Broderick, C. B., “Heterosexual Interests of Suburban Youth,” Med. Aspects Human Sexuality, 4:83-
103, 1971.
Brown, D. G., and Lynn, D. B., “Human Sexual Development: An Outline of Components and
Christensen, H. T., and Gregg, C. F., “Changing Sex Norms in America and Scandinavia,” J. Marriage
Commission on Population Growth and the American Future, Population and the American
1570
Future, New American Library, New York, 1972.
Durois, C., The People of Alor, Harvard University Press, Cambridge, 1960.
Ford, C., and Beach, F., Patterns of Sexual Behavior, Ace Books, New York, 1951.
Freud, S., Three Contributions to the Theory of Sex, 4th ed., Nervous and Mental Disease Publishing
Gadpaille, W. J., “Research into the Physiology of Maleness and Femaleness,” Arch. Gen. Psychiat.,
26.193-206, 1972.
Gagnon, J. H., “Sexuality and Sexual Learning in the Child,” Psychiatry, 28:212-228, 1965.
Green, R., and Money, J. (Eds.), Transsexualism and Sex Reassignment, Johns Hopkins Press,
Baltimore, 1969.
Group for the Advancement of Psychiatry, Committee on the College Student, Sex and the College
Hammond, E. B., and Ladner, A. J., “Socialization into Sexual Behavior in a Negro Slum Ghetto,” in
Broderick, C. B., and Bernard, J. (Eds.), The Individual, Sex and Society, Johns
Harlow, H., and Harlow, M., “The Effect of Rearing Conditions on Behavior,” in Money, J. (Ed.), Sex
Research: New Developments, pp. 161-175, Holt, Rinehart and Winston, New York,
1965.
Kagan, J., “Acquisition and Significance of Sex Typing and Sex Role Identity,” in Hoffman, M. L.,
and Hoffman, L. W. (Eds.), Review of Child Development and Research,” Vol. 1, pp.
Kardiner, A., The Individual and His Society, Ace Books, New York, 1951.
Karlen, A., Sexuality and Homosexuality: A New View, p. 475, Norton, New York, 1971.
Kinsey, A. C., Pomeroy, W. B., and Martin, C. E., Sexual Behavior in the Human Female, W. B.
_____, _____, and _____, Sexual Behavior in the Human Male, W. B. Saunders, Philadelphia, 1948.
Kirkendall, L. A., and Rubin, I., Sexuality and the Life Cycle, SIECUS Study Guide No. 8, 1969.
Kluckhohn, C., “As an Anthropologist Views It,” in Deutsch, A. (Ed.), Sex Habits of American Men: A
1572
Lidz, T., The Person, Basic Books, New York, 1968.
Lieberman, B. (Ed.), Human Sexual Behavior: A Book of Readings, John Wiley, New York, 1971.
Linton, B., Culture and Mental Disorders, Charles C Thomas, Springfield, Ill., 1956.
Malinowski, B., Sex and Repression in Savage Society, Meridian Books, New York, 1955.
Marmor, J., “ ‘Normal’ and ‘Deviant’ Sexual Behavior,” J.A.M.A., 212:1165-170, 1971.
Masters, W. H., and Johnson, V. E., Human Sexual Inadequacy, Little, Brown, Boston, 1970.
_____, and _____, Human Sexual Response, Little, Brown, Boston, 1966.
Mead, M., Male and Female, New American Library, New York, 1955.
Money, J., Sex Errors of the Body, Johns Hopkins Press, Baltimore, 1968.
Offer, D., and Sabshin, M., Normality: Theoretical and Clinical Concepts of Mental Health, Basic
Pfeiffer, E., Verwokrdt, A., and Davis, G. C., “Sexual Behavior in Middle Life,” Am. J. Psychiat.,
128:82-87, 1972.
Phoenix, C. H., Goy, R. W., and Resko, J. A., “Psychosexual Differentiation as a Reaction of
Pomeroy, W. B., and Christenson, C. V., Characteristics of Male and Female Sexual Responses,
Reiss, I. L., The Social Context of Premarital Sexual Permissiveness, Holt, Rinehart and Winston,
Shiloh, A. (Ed.), Studies in Human Sexual Behavior: The American Scene, Charles C Thomas,
Stoller, R. J., Sex and Gender, Science House, New York, 1968.
_____, “The ‘Bedrock’ of Masculinity and Femininity: Bisexuality,” Arch. Gen. Psychiat., 26:207-212,
1972.
1574
Taylor, D. L. (Ed.), Human Sexual Development, F. A. Davis Co., Philadelphia, 1970.
Therese Benedek
The aim of this chapter is to present the interaction of physiological and
psychological factors in the sexual function of women. One cannot discuss the
factors and the modifying cultural influences without beginning with the
In Freud’s time the concept of instinct did not need explanation, it was
1576
self-explanatory. It was based on the thesis that what is universal is self-
evident truth for those who perceive the lawfulness of nature. Such self-
evident, universal experience is conceptualized in “the instinct of self-
equated the former with “ego instincts,” the latter with “sexual instincts.” In
his search for universal explanations of psychic conflicts, he assumed that the
according to its source, aim, object, and impetus, thus formulating the concept
instinct theory, based on the axiom that the mind originates in and is always
dependent on the body, is the foothold of psychoanalysis among the natural
from observations of adults and children; this led, almost paradoxically, to the
Viewed from the point of view of biology, the term “pregenital sexuality”
processes that are repeated in the maturation of the human embryo. He also
envisioned that the mind receives its energy, at least partially, from the
although it originated in the instinct theory, did not deal with sexuality and its
1578
sexual cycle of woman. Without the theory and technique of dream
interpretation, without the aim- directed analyses of the multiple motivations
the homeostatic regulatory functions of the organism are the vital, primary
instincts. They serve the regulation of breathing, water balance, food intake,
shows the physiological time interval between the need and its gratification.
The sexual instincts are secondary; they are in the service of procreation.
Intake from the outer world seems to play no role in this instinct; sexual
instincts. “When instincts are viewed as serving the body by effecting the
necessary interchange of substances with the outer world, the organ and the
of the insight that Freud and Abraham must have had when they considered
the organ of intake, the mouth, and the organs of elimination, the anus and
the urethra, the origins of the instinctual development during infancy.
around the apertures of organs that serve primary instincts. The significance
converted into somatic processes. In the context of this study, however, the
meaning is that it supports the method and the result of the investigation of
the sexual cycle. It is gratifying to realize that the “apertural hypothesis” puts
into the frame and language of biology the same idea that Franz Alexander
expressed in his vector concept and used for 30 years as the basis for his
1580
qualities expressed in the psychodynamic tendencies of intaking, retaining,
were reduced to the dominant psychodynamic tendency; from this the phase
of the hormonal cycle was predicted. This prediction was compared with the
independently established diagnosis of the state of the gonadal cycle based on
the basal body temperature and the Papinacolou smear of the vaginal mucosa.
“apertural,” pregenital motivations; at the peak of the hormonal cycle they are
represent a unit that might be taken as the core of the sexual instinct, far
distant, of course, from the complexity of those processes that account for
sexual behavior.
To which group does the sexual cycle belong? In women the sexual cycle
repeats monthly the developmental pattern of the pre- procreative
procreative goal of sexuality in the human female. The species is “free from
estrus.”
time when she can become pregnant as a result of copulation,” and he adds,
Investigation of the sexual cycle showed that the traces of estrus can be
discovered by psychoanalysis; there is a psychodynamic peak of the
hormonal cycle that occurs at ovulation. The investigation revealed also that
the sexual instinct is rooted in the primary instincts that maintain the
1582
homeostasis of the organism and secure its growth and maturation so that
the secondary sexual instinct can come to the fore and preserve the species.
limitations of estrus, from the obligation to serve the survival of the species,
the factors that promote that basic evolutionary fact continue to interact with
intraorganismic and environmental conditions and increase the gap between
long time lag between infancy and maturity, by the network of instinctual
derivatives, the secondary and tertiary elaboration of the instinct broke the
generally known that the whole gamut of emotions, from love to hate, from
tenderness to brutality, from happiness to sorrow, may find release, comfort,
What is that which we call sexual drive in men and women? The answer
is not simple since the drive is not energized by the sexual instinct alone.
direction of the drive: active in the male and passive in the female. It is
assumed that sexual energy, its appetitive strength and the intensity of its
“consummatory behavior,” to use the ethologist’s term, are constitutionally
induce changes in the nervous system which affect those systems that
control, this does not hold true with the same stringency for infrahuman
achieving the aim of the sexual instinct. Seeking the mate seems superficial,
quasi the end of the chain of hormonal feedback circuits. The master gland,
the hypophysis, controls the function of the pituitary gland. In women the
pituitary produces the follicle-stimulating hormone (FSH) and the luteinizing
hormone (LH) that maintain the cyclical changes of the ovarian hormones,
estrogen and progesterone. Although the human species is free from the
1584
The Organization of the Propagative Drive
species divided between the sexes. The sexual drive is organized differently in
the male and female in order to serve a specific function in procreation. The
propagative function of the male under the control of one gonadal hormone,
(FSH), estrogen, which brings about the maturation of the ovum, and the
hormone of the corpus luteum (LH), lutein or progesterone, which prepares
the uterus for nidation and maintains the pregnancy if impregnation occurs.
Yet the drive organization that motivates pregnancy and lactation is not
genital in the same sense as mating behavior.
egg takes place, through the chromosomal makeup of the gametes (the ovum
and the sperm nucleus). The embryo is thus endowed with the potentiality to
develop toward one sex. It was generally assumed that the structural
differentiation stemmed from an undifferentiated condition. New
species. In the human embryo it lasts five to six weeks. Then the influence of
the sex genes begins to be exerted. The primordial testes begin to produce
androgens that induce the transformation of the female genital anlage into
1586
It is beyond the scope of this chapter to give a summary of observations
hormones in the fetal stage affect each sex, influencing development toward
established.
influences that exert control over the development of the personality. Our
parents. The complex “learning” during the oral phase occurs primarily
through identification with the mother in boys and girls alike. This implies the
basic assumption that children of both sexes have a biological predisposition
also of the opposite sex; without this, communication between the sexes
would not be possible. Such communication is a prerequisite for establishing
sexes excrete in their urine both androgenic and estrogenic hormones. These
remain on a low oscillating level until the age of six to eleven years when
the age of two to three years, but no increasing hormone production was
found in connection with the oedipal phase. Jones found as early as 1927 that
in the preoedipal “phallic” phase girls as well as boys might have the tendency
complicate the motivational system of the oedipal phase, with its ambivalent
object relationship toward both parents. During the latency period the
personality of the child enlarges its field of action externally and stabilizes its
organization internally. One may speculate whether the extragonadal steroid
period.
1588
Puberty is induced by the function of the anterior lobe of the pituitary
time of early puberty its function is to stimulate the growth of the secondary
sex characteristics and the genital organs. Estrogenic hormone levels
thus prepare the uterus and maintain its readiness for the changes that will
be imposed upon it by the corpus luteum, which produces progesterone, the
“hormone of maturation.”
and also in subhuman primates may occur before ovulation. This brings about
a period of adolescent sterility.
the castration of the female sex. As if menarche were a puberty rite cast upon
sympathetic way. This seems not only to diminish the fear of menstruation
but also to lessen its often painful accompaniments. Not educated in the fear
generalization, however, does not mean that girls are never disappointed by
the experience. There are anatomical variations, not pathological per se, and
hormonal conditions that cause menstrual cramps, lower backaches, and
other discomforts.
Not only adolescent girls but also mature women often have anxiety
dreams before the menstrual flow sets in that may be interpreted as fear of
mutilation. Whether the anxiety dream originates in castration fear or in
penis envy has to be investigated in each case. There are other causes of the
Menstruation enforces the awareness of the organ that until menarche is not
part of the body image. It also activates the process of integration of the
latent, partial identification with the mother toward the future task of
childbearing. Fliess formulated this process by calling attention to the womb
1590
body” (p. 216).
hostility, the girl is able to accept her heterosexual desire without anxiety and
prohibitions and the related anxiety and guilt, the longer pro- creative
maturation will be delayed. In this regard, constitutional, genetic, and
series, at one end would be those cases in which the stability of the
factors meet and forecast whether adaptation to sexuality and the tasks of
motherhood will succeed or fail.
In woman the ebb and flow of the gonadal hormone production renders
accessible to study. The first such investigation was published by the author
1592
manifestations of the sexual drive evolve in correspondence with the ovarian
The cycle begins with the gradual production of estrogen; parallel with
in dreams and fantasies as well as in behavior. If the desire is not satisfied, the
emotional tension may increase parallel with the hormone; restlessness and
irritability, even anger and anxiety, may be signs of thwarted sexual urge. The
reveal the psychodynamic tendency. They occur in any phase of the cycle,
After ovulation relief from preovulative tension follows. Then the increased
receptive tendency fused with heterosexual tendency creates the highest
reactions. The best known is the heightened basal body temperature. From
shifts to her own body. What one may describe as “narcissistic” characterizes
that phase of the cycle in which the woman is most desirous for intercourse.
assurance that she is lovable and therefore she can let herself be loved. On the
observation justifies the assumption that the specific retentive and receptive
tendencies are the psychodynamic correlates of the “mother instinct.”
1594
After ovulation the progesterone phase evolves. This is a high hormonal
phase since both hormones, estrogen and progesterone, are produced. But
wish for pregnancy, or the fear of it, or hostile aggressive defenses against it
the memory traces of infancy, the oral dependent phase. While these appear
during the estrogen phase of the cycle, they repeat and represent the
vicissitudes of the developmental identifications of the girl with her mother
be fed and taken care of—are replaced by an adult woman’s ability to give, to
during this phase of the cycle. As the physiological and emotional maturation
progresses, the progesterone phase reflects the “reconciliation” with the
follows. With the diminishing progesterone, which in the later phase of the
Few women are completely free from mood changes and from
discomfort during this part of the cycle. The symptom manifestations show
great variation. Apprehension of what might happen to one’s body, fear of
the factors responsible for the fact that at this phase of the cycle all needs and
desires appear imperative, all frustrations seem unbearable; the emotions are
less controlled than at any other time during the cycle. This is characteristic
1596
of sexual behavior also. The heterosexual desire that occurs during the late
premenstrual phase (stimulated probably by the beginning of the next cycle)
often appears more intense and demanding than the sexual desire at the peak
of the cycle.
The end of the sexual cycle is marked by menstrual flow that, ushered in
The course of the sexual cycle shows that the gonadal cycle forces the
emotional processes of the adult woman into regulated channels. This was
confirmed soon after the preliminary publication of the sexual cycle research
change, that is, the progesterone effect. Their investigation measured the
such general manifestations as moods that transiently pervade the ego state.
processes. But affects and emotions exert influence upon the hormonal cycle
also. The comparative study of a series of cycles in the same woman reveals
the effects that stimulating and inhibiting emotional factors have upon the
course of the gonadal cycle. It is well known that emotions may precipitate or
delay the menstrual flow; less known is the fact that ovulation may vary
period from the eleventh to the seventeenth day of the cycle, the variation in
emotions upon the hormonal cycle, psychic factors exert long-term influence
1598
the ensuing progesterone phase. Similarly, in the integration of psychosexual
maturity, the capacity for heterosexual love prepares the woman for
acceptance of the feminine sexual role, not only the physiological processes of
phases of the cycle will be normal; this implies practically normal ovulation
and average length of cycles. If, because of organic disposition or crippling
physiology. The four distinct phases through which coitus, or any sexual
clitoris and outer third of the vagina constitute a functional unit. Since the
outer third of the vagina. Because of this, clitoral and vaginal orgasms are not
orgasmic apparatus in women does not necessarily indicate that the process
clitoris during the excitement phase with its consequent retraction into the
clitoral hood (prepuce), which functions like a “miniature vagina” during the
1600
plateau phase (p. 78). If stimulation is reduced the retracted clitoris descends,
that is, regains its normal size. The retraction and descent of the clitoris can
pattern if stimulation ceases. This is evidence that the woman’s orgasm is not
attraction, a flood of libido quickens the sexual response in man and woman.
The heightened libidinal state is felt as a satisfying state of one’s own body
and gives rise to a libidinal sensation in the genitals—erection in man, and
vary their experience, it begins with the man’s tendency to take over and the
woman’s wish to submit. This quality of the sexual drive enhances the
behavior” express the emotions that make the technique of love- making
effective. While the physiology of the sexual response is universal, the modes
of behavior that bring about orgasm have innumerable variations. From these
each man and woman adopt a few—some more, others less. Motivated by the
patterns are charged with the current flow of libido and help to arrive at the
completeness of the mutual experience.
Much has been written about this, especially since orgasm as an equal
sensory cells known as “genital corpuscles” are confined in the glans clitoridis
The woman, however, not only perceives the orgasm that she excited in
her sexual partner, but she also continues actively to add to the stimulation
and orgasmic release, which extend beyond the musculature of the pelvic
organs, the buttocks and involve her whole body, add actively to her receptive
1602
gratification. Yet experience shows that women are so active only if their
lovers desire it. Otherwise, women can relax in the flow of their receptive
indicate that women, especially young and unmarried women, consider their
sexual experience satisfactory if their performance gratifies the partner and is
praised by him.
biological difference in the aim of the sexual instinct, and its consequence in
himself, man also aspires to give gratification to the other, the object of his
love. Probably this is the biological “reason” that such orgasmic experience
elevates man’s ego beyond what is the result of sexual gratification. It
consolidates his sexual identity as it also forges the link of identification with
the woman who enables him to have such an experience of his virility.
result of orgasm. Yet the woman’s sexual identity does not depend on her
orgasm to the same degree that the man’s does. Her sexual experience, stirred
consider the male orgasm as their own achievement. This kind of elated
Then the feeling of a job well done, having produced a miracle, flows over the
woman’s ego state and encompasses her infant in her psychic system. Of
comparison with the orgasm of men. Our knowledge of the phasic course of
the physiological orgasmic process does not clarify the variations in the
sexual response of the same woman with the same mate (and even with
different sexual partners ). Our knowledge of the sexual cycle, the (gonadal)
account for variations in the desire for sexual intercourse; however, this in
itself does not influence the intensity or the quality of the orgasm. The more
we study the sexual experience of women, the further away we get from its
physiological substratum, described by Masters and Johnson. The
1604
interaction with the drive experience may build up defenses in each phase of
development that make free experience of orgasm impossible. This is true for
both sexes, but, in general, man’s potency is less frequently affected than
Bisexuality and its consequent “penis envy” is the rock bottom of the
developmental conflicts that may (or may not) lead to frigidity. The term
should be used with caution. Every woman experiences at some time the
shrinking feeling of withdrawal that does not seem to tolerate the most
tender touch. Indeed, passionate women may often experience such transient
frigidity. Those women who are unaware of the vaginal participation in their
clitoral orgasm are not “frigid” either. Really, there are many fewer frigid
women than one used to assume.
severe hypogonadism. Women may have all forms and degrees of frigidity
and still have normal gonadal function.[4] Fear of being injured by the penis,
fear of being impregnated, and hostility toward men often bring about
inhibitions in the woman’s capacity for orgasm. Since the social and
husbands, especially in times past when orgasm, or the desire for it, was
considered unwomanly. The effect of the sexual mores that prescribe the
“complete orgasm” as a necessary requisite of woman’s fulfillment does not
appear much healthier. This may increase in many women the anticipation of
frustration. Because of this such women watch the course of the act with
anxious impatience; thus they interfere with what they are seemingly eager to
achieve.
of the urogenital structure. But the Greek word dispareunia, means “badly
mated.” It was known in Hippocratic times that pain or fear of pain can be
vaginal muscles. The spasm may be located in different areas of the vagina; it
that these symptoms may express, vaginismus achieves its unconscious goal
by excluding the penis, by expelling it, or by painfully enclosing it. Since the
1606
fearful fantasy of the “vagina dentata.” Vaginismus occurs usually in young
consequences of the serious forms of frigidity, one may assume that besides
the constitutional predisposition, the primary factors are psychological,
through each gonadal cycle may in time suppress the cyclical evolution of
vasodilatation, and further stasis in the pelvic and sexual tissues. Although
developmental conflicts that have interfered with the normal course of the
tendencies; they are the psychic representations of the need for fuel to supply
Pregnancy
replenish the primary narcissism of the woman, this becomes the wellspring
of her motherliness. It increases her pleasure in bearing her child, stimulates
her hopeful fantasies, and diminishes her anxieties. While the mother feels
her growing capacity to love and to care for the child, she actually experiences
1608
a general improvement in her emotional state. Many women who suffer from
neurotic anxiety are free from it during pregnancy; others, despite the
discomforts of nausea and morning sickness, feel emotionally stable and have
the “best time” during pregnancy. Thus healthy women demonstrate during
pregnancy, as during the high hormone phase of the cycle, an increased
There are many attitudes, realistic fears, and neurotic anxieties that disturb
the woman’s desire for pregnancy. Some of these may be motivated by
wedlock may cause the pregnancy to be unwanted and the infant rejected
before it is born. Even such pregnancies usually have a more or less normal
to the beginning of her life. The complex steps toward motherhood and
motherliness begin in the mother’s own oral phase of development. It seems
that the memory traces of those experiences that were never conscious are
repeated in the psychodynamic process of normal and pathological
mutual consent, can count on their husbands’ care and loving participation in
symptoms are usually alleviated as the pregnancy progresses. During the last
month the increasing bodily discomfort, disturbance of sleep, and fears
connected with parturition may again interfere with the contented mood of
pregnancy.
task appears greater with the first child. The physiological and emotional
maturation of the first pregnancy makes motherhood generally easier with
the second and third child. Yet it may happen that fatigued by the never
ceasing labor of motherhood, women experience pathogenic regressions
1610
during later pregnancies.
for those whose ego cannot withstand the psychodynamic processes inherent
goes hand in hand with the hostility toward the self, the rejection of the self.
pathological pregnancy.
infantile fantasies. In some instances the “missing penis,” in others the envied
beauty of the mother or envy of her pregnancy, is the nucleus of the fantasies
projected on the embryo.
The fetus is a part of the mother’s body. Normally the fetus is cathected
with narcissistic libido. This does not always mean pleasurable emotional
concept that may be projected to the unborn child. Thus the fetus can
represent the “bad, aggressive, devouring self,” engendering the fear of having
a “monster.” Many women identify the fetus with feces and relive during the
pregnancy the ambivalent feelings and the mysteries of the “anal child.” There
are many instances in which the regressive fantasies do not interfere with the
1612
projected to the child is charged with ambivalence. The anxiety and
Parturition
the “basic anxiety” of women. The fear of labor is universal. Even those
obstetricians are aware of the significance that sudden and violent emotions
have on the course of labor, just as psychiatrists are aware of the influence of
obstetrical traumata on the mother and her relationship to the child. A long
period of severe labor pains may activate severe postpartum reactions. Pain
pain.
complications that interfere with the course of delivery. There are also
respect requires. The sense of failure may then activate inferiority feelings,
changes that induce and control parturition, the labor pains, and the
excitement of delivery interrupt the emotional continuity of the mother-child
unity. It is, indeed, a biological model of “separation trauma.” During the last
phase of labor the mother usually concentrates upon her own survival. After
delivery the love for the newborn wells up in her as she first hears the cry of
the baby. This sensation reassures the mother of the continuity of her
oneness with the child. But it may not avoid spells of tearful sadness that
often occur, with a pervading sensation of vulnerability, probably a result of
1614
hormonal imbalance. In a recent investigation Hamburg-8 compared the
for the infant, they feel “empty” and cry frequently. The free flow tears is
will activate a sense of guilt in her, make her insecure about her ability to be a
good mother, and therefore cause her to withdraw from the infant. The
incipient depression often goes unnoticed and is cured by the love and
affection that the woman receives from her husband. This helps to overcome
the fear of being alienated from her child. More serious postpartum reactions
usually evolve during the first or second trimester; these conditions are
Lactation
The organism of the mother is not ready to give up the symbiosis after
mothering activities center. The woman’s desire to nurse the baby, to be close
to it bodily, represents the continuation of the biologic symbiosis, not only for
the infant, but for the mother as well. While the infant incorporates the
breast, the mother feels united with the baby. The identification with the baby
permits her to “regress,” to repeat (on the unconscious level) her own
personality development.
the loving, succoring activities of the mother. In simple societies the biological
1616
and ego aspirations of the woman are easily integrated in her ego ideal. Our
culture, however, conveys to the woman an active, extraverted, “masculine”
ego idea, which may conflict with the passive tendencies inherent in the
women respond with guilt and anxiety and often with a sense of frustration to
“The ability to nurse is equivalent to the will to nurse” (Kroger & Freed p.
gland, yet it seems to be under emotional influence also since it may occur if
the woman sees another lactating.
pregnant with the next, often abandoning their child because they can not
originating in the mother’s fear of separation from the infant, intensify her
receptive, incorporating need and consequently that of her child. Beata Rank
postpartum symbiosis.
The mother’s receptive needs toward the child are not easily
these instinctual tendencies. With her baby the mother feels whole, complete,
1618
but not without him. Many young mothers feel “emptiness” when they leave
the baby, are compelled to eat, or become anxious and worried. This indicates
mother, her need for love and affection, her wish to reunite with her baby, to
overprotect and overpossess him are all exaggerated manifestations of the
and each manifestation of love for the child may be fused with an urgent need
to hold on to him. Characterizing such mothers, we speak of “overprotective,
possessive” mothers. As the mother clings to her child, he becomes for her
psychic economy (at least partially) the needed, loved, and hated object of her
infancy. Reciprocally the child, affected by the incorporative need of the
Psychosomatic Infertility
defense against the dangers inherent in the procreative function. There are
few known reasons for absolute infertility, but reasons for relative infertility
assumed that emotional factors may play a role in functional infertility, even
Investigating the factors that bring about functional infertility, one has
to take into account the constitutionally “given” differences in the fertility
complementary series of fertility rates from one extreme to the other. The
variables are too numerous. In some individuals fertility varies under the
the case of pregnancy, his sexual potency, and, of course, his reproductive
the cultural processes that, in interaction with the former factors, play a role
in the organization of the personality and may modify the woman’s attitude
toward motherhood.
1620
The woman responds to the tasks of motherhood during the
progesterone phase of the cycle from puberty on. Normally, through the
monthly repetition, she overcomes her anxieties and absorbs the conflicts of
developmental conflicts reinforce the signal anxiety, the primary anxiety that
originates in the fear of pregnancy may be repressed, but the related conflicts
exert a stress, a continuous and monthly intensified charge of defensive
psychic energy that may lead to suppression of ovulation. Such a process may
interfere with full maturation of the gonadal cycle, but it occurs often after full
active, capable, and adaptable women who, except for functional infertility,
are well-integrated, healthy individuals. In these instances infertility develops
who are afraid of men and marriage are not considered infertile from a
diagnostic point of view, yet the psychoanalysis of unmarried women often
reveals that fear of childbearing is the primary motivation for their sexual
suppressed during the fertile period and coitus takes place only during the
often clamor for pregnancy. Yet this does not exclude the possibility that the
same women may avoid conception or would suffer severe anxiety if they
conceived.
does not clarify the psychopathology of the symptom. What is primary, the
1622
somatic or the psychological process? Its somatic core is the “inhibition” or
suppression of gonadal hormone production that evolves in constitutionally
means the defensive cathexis against the signal anxiety that prevents the
often be explained on the same basis; in other instances one may have
evidence of the resolution of the conflict that impeded the woman’s potential
to become pregnant. The effects of hormone therapy with gonadotrophic
Pseudocyesis
“infantile” or “hysterical,” may even have the qualities of an imposter, but the
thus the woman could have realized that she is not pregnant. The symptom
might occur in young women, in adolescents who have never had sexual
intercourse. Indeed, the condition is well characterized by Brown and
Interactions.”
infertility. The latter is characterized by the lack of ovulation, thus by the lack
1624
childbearing. Pseudocyesis, in contrast, is induced by the physiological and
This is consistent with the observation that each phase of the procreative
function of woman goes hand in hand with the increase of receptive-retentive
prepares for and maintains pregnancy may bring about depression in those
women whose personality organization regresses under the regressive pull of
luteum accounts for the depression that seems crucial for pseudocyesis.
What accounts for the maintenance of the corpus luteum? The wish for
few known steps in this interaction are: (1) the persistence of the corpus
the breast changes suffice as evidence for pregnancy, especially during the
first trimester. With this evidence the fantasy life of the woman may complete
the picture, even if the attitude toward pregnancy is motivated by ambivalent
Climacterium
failure of the ovaries brings about the symptoms. The symptoms, however,
1626
hormones than to simple deprivation. Hoskins assumes that the
overproduction of pituitary gonadotrophin—a characteristic feature of the
(p. 310).
There is evidence that menopause sets in earlier and often with more
intense reactions in women who had never had children than in those who
had several normal pregnancies. This is in harmony with the assumption that
basis of the woman’s characteristic reactions to this phase of her sexual cycle,
relieved from the responsibilities of child-rearing, seek and find new aims for
their psychic energy. As in childhood the repression of sexual impulses led to
gonadal function releases new impetus for socialization and learning. Thus
period, its capacity to love and give, to do for others, will sustain her
personality when the woman faces the change of life. With the passing of
health and her growing interest and activity indicate that the adaptational
many women.
She does not love with youthful ardor, but much of her ambivalence, jealousy,
and insecurity have been overcome. Her love becomes more tolerant and
shows more “postambivalent” qualities. These evolve effortlessly toward her
1628
grandchildren. Identification with her pregnant daughter or daughter-in-law
permits the aging woman to be a mother again. One step removed, she is now
less involved; her love for her grandchildren is freer from the conflicts that as
a mother she had toward her own children. Through the manifold
gratifications within and outside her family, healthy women approach
involution of senescence.
cases reveals that the symptoms that are aggravated during this period have
existed before, or were preformed in the precarious organization of the
accompanies the low hormone level. As a result the integrative capacity of the
ego declines, permitting repressed conflicts and affective reactions to emerge,
and the consequent decline of libido production. The sensation that indicates
the deprivation of libido I designate as internal frustration.[7] It refers to the
inability of the woman to feel love, to feel satisfied with herself or with
psychic energy. The freed aggression, manifest in the flow of hostility toward
the self and others, is the origin of the “agitated depression,” the
by it. The interacting instinctual factors, motivating the pathology, are: (1) the
development; (2) the narcissistic ego strivings dominate the psychic economy
throughout life; (3) these factors interfere with the primary gratifications of
female sexuality. The narcissistic gratifications may protect the woman from
happen to me” is a protest often heard. As the patient perceives her failure in
maintaining the usual level of ego mastery, inferiority feelings and self-
accusations mount, causing anxiety and depression. The anxiety brings to the
1630
develop in the struggle to maintain the self. The process may lead to full-
blown psychosis.
is indicated by the fact that endocrine therapy affects the autonomic nervous
system reactions and not the psychiatric symptoms.
Bibliography
Abraham, K., “A Short Study of the Development of the Libido, Viewed in the Light of Mental
Disorders,” in Selected Papers, pp. 418-501, Basic Books, New York, 1955.
Alexander, F., “The Logic of Emotions and Its Dynamic Background,” Int. J. Psychoanal., 16:399-
413, 1935.
_____, “On Orgasm and Frigidity,” Panel on Frigidity in Women, reported by Moore, B. in J. Am.
_____, “The Psychobiological Aspects of Mothering,” Am. J. Orthopsychiat., 21: 272-278, 1956.
_____, “The Psychosomatic Implications of the Primary Unit: Mother-Child,” Am. J. Orthopsychiat.,
1632
19:642-654, 1949.
_____, “Toward the Biology of the Depressive Constellation,” J. Am. Psychoanal. A., 4:389-427, 1956.
_____, and Rubenstein, B. B., “Correlations between Ovarian Activity and Psychodynamic
Processes, I. The Ovulative Phase; II. The Menstrual Phase,” Psychosom. Med., 1:245-
_____, and _____, The Sexual Cycle in Women, National Research Council, Washington, D.C., 1942.
Brown, E., and Barglow, P., “Pseudocyesis, A Paradigm for Psychophysiological Interactions,”
Cannon, W. B. (1932), The Wisdom of the Body, Norton, New York, 1963.
Chadwick, M., The Psychological Effects of Menstruation, Nervous and Mental Disease Publ. Co.,
Corner, G. W., The Hormones in Human Reproduction, 2nd ed., Princeton University Press,
Deutsch, H., The Psychology of Women: A Psychoanalytic Interpretation, 2 vols., Grune & Stratton,
Dorfman, B. I., and Shipley, B. A., Androgens: Biochemistry, Physiology and Clinical Significance,
Dunbar, H. F., Emotions and Bodily Changes: A Survey of Literature on Psychosomatic Relationships,
Escalona, S. K., “Emotional Development in the First Year of Life,” in Senn, M. J. E. (Ed.), Problems
of Infancy and Childhood, pp. 11-92, Transcript 6th Conference, Macy Foundation,
Fliess, R., Erogeneity and Libido: Addenda to the Theory of the Psychosexual Development of the
Ford, C. S., and Beach, F. A., Patterns of Sexual Behavior, Harper, New York, 1951.
Freud, S., “Femininity,” in Strachey, J. (Ed.), Standard Edition, Vol. 22, pp. 112-135, Hogarth,
London, 1964.
_____, (1915), “Instincts and Their Vicissitudes,” in Strachey, J. (Ed.), Standard Edition, Vol. 15, pp.
_____, (1914), “On Narcissism: An Introduction,” in Strachey, J. (Ed.), Standard Edition, Vol. 14, pp.
Gottschalk, L., Kaplan, S., Gleser, G., and Winget, C., “Variations in Magnitude of Emotion: A
1634
Method Applied to Anxiety and Hostility during Phases of the Menstrual Cycle,”
Greenfield, N. S., and Lewis, W. C., “Preface of the Editors,” in Psychoanalysis and Current
Hamburg, D. A., “Effects of Progesterone on Behavior,” Res. Publ. Ass. Nerv. & Ment. Dis., Vol.
43,Endocrines and the Central Nervous System, Williams & Wilkins, Baltimore, 1967.
Hoskins, B. G., Endocrinology: The Glands and Their Functions, Norton, New York, 1950-
Jones, E. (1927), “The Phallic Phase,” in Papers on Psychoanalysis, pp. 452-484, Williams &
Kinsey, A., et al., Sexual Behavior in the Human Female, Saunders, Philadelphia, 1953.
Kroger, W. S., and Freed, S. C., Psychosomatic Gynecology, Saunders, Philadelphia, 1951.
Loeb, J. (1912), The Mechanistic Concept of Life, Harvard University Press, Cambridge, Mass.,
1964.
the Child, Vol. 18, pp. 307-324, International Universities Press, New York, 1963.
Marmor, J., “Some Considerations Concerning Orgasm in the Female,” Psychosom. Med., 16:240-
245, 1954.
Masters, W. H., and Johnson, V. E., Human Sexual Response, Little, Brown, Boston, 1966.
Moos, B. H., Koppell, B. S., Melges, F. T., Yalom, I. D., Lunde, D. T., Clayton, R. D., and Hamburg, D.
Morris, T. A., and Sturgis, S. A., “Practical Aspects of Psychosomatic Sterility,” Clin. Obstetrics &
Pratt, J. P., “Sex Functions in Man,” in Allen, Edgar, et al., Sex and Internal Secretions, pp. 1263-
Rank, B., Putnam, M. C., and Rochlin, G., “The Significance of the ‘Emotional Climate’ in Early
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Seward, G. H., Wagern, P. S., Henrich, J. F., Bloch, S. K., and Meyerhoff, H. L., “The Question of
545, 1965.
Sherfey, M. J., “The Evolution and Nature of Female Sexuality in Relation to Psychoanalytic
Westoff, C. F., and Kiser, C. W., “Social and Psychological Factors Affecting Fertility; An Empirical
Young, W. C., and Yerkes, R. M., “Factors Influencing the Reproductive Cycle in the Chimpanzee;
154, 1943.
Notes
[1] There are signs indicating the ways by which the estrus disappeared through the ages. Apes and
monkeys are known to indulge in sexual intercourse in which they cannot be fertilized.
Menstruation is not a distinction of the human female only, since menstruation occurs in
all species of apes and in some kinds of monkeys, governed by the regularly alternating
secretion of hormones.
[2] For more detailed literature on the inductor theory of primary sexual differentiation, see Sherfey.
however, man’s fear of her. Blood coming from the female body may activate the dread
of castration in men.
[4] The opposite seems to be true in many instances. Women, even young girls, who have not had
sexual relations, may have normal sexual appetite and enjoy heterosexual coitus even
after total extirpation of the ovaries and uterus. This is evidence of the central
[6] Westoff and Kiser probably expressed the same idea: “The woman’s ability to conceive would
depend on the psychosomatic balances both within and between the would-be parents”
(p. 421).
[7] In psychoanalysis the term “frustration” implies that the drive is thwarted in attaining its goal. Thus
frustration may be the result of external or of internal prohibitions of the superego that
1638
Chapter 29
Middle life has received relatively little attention from students of the
life cycle. The early part of life, paced by a biologically timed sequence of
the past few decades a large body of research has grown up about old age.
The years of maturity, by contrast, are less understood. Only a few attempts
have been made to develop a psychology of the life cycle, and the search for
view on the part of many psychologists that personality is stabilized and the
major life commitments completed in the period of youth and that nothing of
great significance occurs for the long time until senescence appears.
climacterium is thought to constitute one such crisis; for men the perception
of decline in sexual prowess is considered a serious crisis; and the
crisis.
boundary of middle age. While it is often said that retirement constitutes the
upper boundary for men, there is 110 agreed upon boundary for women. The
major life events that characterize the middle part of the life span—reaching
the peak of one’s occupational career, the launching of children from the
home, the death of parents, climacterium, grandparenthood, illness,
1640
sequence, occur at varying chronological ages and are separated by varying
intervals of time. Most behavioral scientists therefore concur that
chronological age is not a meaningful index by which to order the social and
emerge from a combination of biological and social cues rather than from a
sometimes said that middle age should be described as a state of mind rather
than as a given period of years. If so, it is a state of mind that has an important
influence upon the individual’s perceptions of himself and his strategies for
individual always assesses his present in terms of both his past and his future.
Perceptions vary from one person to the next regarding the timing and
rhythm of major life events and the quality of life at successive periods of
adulthood was generally seen as divided into four periods: young adulthood,
maturity, middle age, and old age, each period having its unique
characteristics. These major periods of life were recognized by all
respondents, but there were differences in the views of men and women and
dividing points and a relatively gradual progression from one period of life to
the next. Women saw one major dividing point that outweighed the others in
significance, and they often described adult life in terms of two somewhat
disconnected lives, one before and one after 40. Among business executives
and professionals, a man did not reach middle age until 50, nor old age until
70. For the blue- collar worker, on the other hand, life was paced more
The themes of life associated with middle age varied also with the social
status of the respondent. For the upper-middle class, young adulthood (20 to
30) was described as a time of exploration and groping, of “feeling one’s way”
in job, marriage, and other adult roles, and as a period of experimentation.
Maturity (30 to 40) was the time of progressive achievement and increasing
autonomy. Middle age was described as the period of greatest productivity
and of major rewards, the “prime of life.” Women, while mentioning the
adjustments required by the departure of children from the home, also
1642
described middle age as a period of mellowness and serenity. Old age was
The blue-collar worker had a different view. Both men and women
described young adulthood as the period, not when issues are explored, but
when they become settled, and when life’s responsibilities loom up as
inescapable. One becomes increasingly sensible, older, wiser, and quieter. Not
only does middle age come early, but it is described in terms of decline—
In a related study of over 600 middle-aged men and women, there was a
will be fine if my health stays good,” or “I don’t mind old age as long as I don’t
nor fear of social isolation. Fear of dependency was the only theme to occur
with any frequency, and it occurred approximately as often for men as for
view appear that childhood was a discernible period of life with special needs
stage called youth, a stage that has appeared only in the last few decades
when social change has become so rapid that it threatens to make obsolete all
institutions and values within the lifetime of each generation and when a
growing minority of young persons face the task of reconciling the self with
the social order. It has been suggested that, in terms of the developmental
polarities suggested by Erikson, in which the central psychological issue of
A parallel case can be made for the fact that the period of middle age is a
recently delineated stage in the life cycle. In this instance the significant
dimensions of social and technological change are the enormous increase in
1644
longevity that has occurred since the beginning of this century and the
growth of leisure in the affluent postindustrial society. At the risk of
psychological task for middle age relates to the use of time, and the essential
polarity is between time mastery and capitulation.
can be illustrated from changes in the family cycle and the work cycle.
Dramatic changes have occurred over the past several decades as age at
marriage has dropped, as children are born earlier in the marriage and are
Census data show, for instance, that in 1890, only 80 years ago, the
average American woman left school at about age 14, married at 22, had her
first-born child within two to three years and her last-born child when she
was 32. Her husband died when she was only 53, her last child married when
she was 55, and she herself lived to about 68. The average woman was
widowed, then, before her last child left home.
In 1966 this picture was very different. Then the average woman left
fulltime when she was only 32. The projections for this group of women were
that the last child would marry when she was 48, her husband would die
when she was 64, and she herself could expect to live to almost 80. Thus, our
average woman can now look forward to some 45 years of life after her last-
Historically the family cycle has quickened for both sexes as marriage,
parenthood, empty nest, and grand- parenthood all occur earlier, and as the
interval of time becomes extended (now some 16 years) when husband and
wife are the remaining members of the household. (While the family cycle
runs its course a few years later for men and women at higher social class
levels, the general pattern of historical change is the same for both higher and
lower levels.)
that parenthood has been coming earlier in life. Changes in parental behavior,
with, for example, fathers becoming less authoritarian, may in part reflect this
1646
widespread financial help that flows from parents downward to their adult
children. In a study of three-generation families in which styles of behavior by
under 65 as compared with those over 65) more often followed the fun-
seeking pattern. The fun-seeker is the grandparent whose relation to the child
is informal and playful and who joins the child for the purpose of having fun,
Changes in the work cycle are also changing rapidly, affecting the
perceptions of middle age. With longer education and later entry into the
labor force, and with earlier retirement, the proportion of the life span spent
at work is diminishing for men. For women the trend is the opposite. While
fewer women work, and fewer work full-time, the trend is to extend the
proportion of the life span spent in the labor force. With more than half of all
women aged 50 to 55 now in the labor force, middle-aged women have
gained in status relative to men, and relationships are changing not only
between the sexes but between the generations within the family. Not only
While direct data are lacking, it is probable that these changes in the
family and in the economy are contributing to major differences between the
of new economic and civic roles now tend to coincide with the biological
new period of life and contributing to the new sense of freedom expressed by
and in the relationships between younger and older participants in the work
setting. Increased complexity of knowledge is required, not only of the
1648
leaders show that the average age of the business elite rose steadily from
1870 to 1950. The increase in size, complexity, and bureaucratization that
the early phases of the career line. It has been taking longer than in earlier
generations for a man to rise to the top of the administrative ladder, a fact
that perhaps underlies some of the efforts now being made by business firms
changing family cycle, are all influencing the experience of middle age.
command of all they survey, nevertheless recognize that they constitute the
powerful age group vis-a-vis other age groups; that they are the norm bearers
and the decision makers; and that they live in a society that, while it may be
to describe only a few of the psychological issues of middle age as they have
been described in one of our studies in which 100 highly placed men and
this group were highly introspective and verbal persons who evidenced
considerable insight into the changes that had taken place in their careers,
their families, their status, and in the ways in which they dealt with both their
inner and outer worlds. Generally the higher the individual’s career position,
the greater was his willingness to explore the various issues and themes of
middle age.
their positions within different life contexts—the body, the career, the family
—rather than to chronological age for their primary cues in clocking
these various contexts, so that the cues utilized for placing oneself in this
period of the life cycle are not always synchronous. For example, one business
1650
executive regards himself as being on top in his occupation and assumes all
the prerogatives that go with seniority in that context, yet, because his
children are still young, he feels he has a long way to go before completing his
the generations, both within the family and within the wider contexts of work
and community. At the same time he has a clear sense of differentiation from
both the younger and older generations. In his view young people cannot
understand nor relate to the middle-aged because they have not accumulated
the prerequisite life experiences. Both the particular historical events and the
When I see a pretty girl on the stage or in the movies, and when I realize
she’s about the age of my son, it’s a real shock. It makes me realize that I’m
middle-aged.
younger and older persons and how to act one’s age. Most of our respondents
are acutely aware of their responsibility to the younger generation and of
what we called “the creation of social heirs.” One corporation executive says,
I worry lest I no longer have the rapport with young people that I had
some years back. I think I’m becoming uncomfortable with them because
they’re so uncomfortable with me. They treat me like I treated my own
employer when I was 25. I was frightened of him. . . . But one of my main
problems now is to encourage young people to develop so that they’ll be
able to carry on after us.
You always have younger people looking to you and asking questions. . . .
You don’t want them to think you’re a fool. . . . You try to be an adequate
model.
The awareness that one’s parents’ generation is now quite old does not
lead to the same feeling of distance from the parental generation as from the
younger generation.
1652
I sympathize with old people, now, in a way that is new. I watch my
parents, for instance, and I wonder if I will age in the same way.
the feeling that those who are older are in a position to understand and
My parents, even though they are much older, can understand what we are
going through; just as I now understand what they went through.
greater projection of the self in one’s behavior with older people, sometimes
to the extent of blurring the differences between the two generations. One
I was shopping with mother. She had left something behind on the counter
and the clerk called out to tell me that the “old lady” had forgotten her
package. I was amazed. Of course the clerk was a young man and she must
have seemed old to him. But I myself don’t think of her as old.
Women, but not men, tend to define their age status in terms of the
timing of events within the family cycle. Even unmarried career women often
discuss middle age in terms of the family they might have had.
adjustment to be made.
It’s a totally new thing. Now there isn’t the responsibility for the children.
There’s more privacy and freedom to be yourself. All of a sudden there are
times when we can just sit down and have a conversation. And it was a
treat to go on a vacation alone!
It’s the boredom that has grown up between us but which we didn’t face
before. With the kids at home, we found something to talk about, but now
the buffer between us is gone. There are just the two of us, face to face.
A recent review of the literature on the family of later life points to the
theme of progressive disenchantment with marriage from the peak of the
honeymoon to the nadir of middle life, and to the fact that a number of studies
unsatisfactory. There are other studies, however, that indicate the opposite.
the contrary, nationwide statistics show that divorce rates are highest for
teen-age marriages, then drop steadily with age and duration of marriage.
1654
women interviewed feel that the most conspicuous characteristic of middle
age is the sense of increased freedom. Not only is there increased time and
energy available for the self, but also a satisfying change in self-concept takes
place. The typical theme is that middle age marks the beginning of a period in
which latent talents and capacities can be put to use in new directions.
statement of a woman,
I discovered these last few years that I was old enough to admit to myself
the things I could do well and to start doing them. I didn’t think like this
before. . . . It’s a great new feeling.
You’re thankful your health is such that you can continue working up to
this point. It’s a matter of concern to me right now, to hang on. I’m forty-
seven, and I have two children in college to support.
I’m afraid I’m a bit envious of my wife. She went to work a few years ago,
when our children no longer needed her attention, and a whole new world
has opened to her. But myself? I just look forward to writing another
volume, and then another volume.
outside the family context, often from the deferential behavior accorded them
in the work setting. One man described the first time a younger associate held
open a door for him; another, being called by his official title by a newcomer
in the company; another, the first time he was ceremoniously asked for advice
by a younger man.
Men perceive a close relationship between life line and career line.
Middle age is the time to take stock. Any disparity noted between career
expectations and career achievements— that is, whether one is “on time” or
lawyer said,
I moved at age forty-five from a large corporation to a law firm. I got out at
the last possible moment, because if you haven’t made it by then, you had
better make it fast, or you are stuck.
middle years, or by age 35." Some of the more highly educated continue to
move up the ladder in their forties and occasionally in their fifties. On the
other hand, some men, generally the less schooled, start slipping sometime in
the years from 35 to 55. The majority tend to hold on, throughout this period,
to whatever rung they managed to reach. Family income does not always
reflect a man’s job status, for by the time of the mid-forties such large
1656
numbers of wives have taken jobs that family income often continues to rise.
For this and other reasons there is considerable variation in family income in
The most dramatic cues for the male are often biological. The increased
attention centered upon his health, the decrease in the efficiency of the body,
the death of friends of the same age—these are the signs that prompt many
men to describe bodily changes as the most salient characteristic of middle
age.
Mentally I still feel young, but suddenly one day my son beat me at tennis.
Or,
It was the sudden heart attack in a friend that made the difference. I
realized that I could no longer count on my body as I used to do . . . the
body is now unpredictable.
Of course I’m not as young as I used to be, and it’s true, the refrain you
hear so often in the provocative jokes about the decrease in sexual power
in men. But it isn’t so much the loss of sexual interest, I think it’s more the
energy factor.
I think as the years go by you have less sexual desire. In fact, when you’re
younger there’s a need, in addition to the desire, and that need diminishes
without the personal relationship becoming strained or less close and
warm. ... I still enjoy sex, but not with the fervor of youth. . . . Not because
I’ve lost my feelings for my wife, but because it happens to you physically.
data are poor regarding the sexual behavior of middle-aged and older people.
It would appear that sexual activity remains higher than the earlier
stereotypes would indicate and that sexual activity in middle age tends to be
consistent with the individuals’ earlier behavior; but at the same time there is
gradual decrease with age in most persons, and the incidence of sexual
inadequacy takes a sharp upturn in men after age 50. Masters and Johnson,
making many of the same points made earlier by Kinsey and others, point to
the manifold physiological and psychological factors involved in sexual
behavior in both sexes. Most clinicians seem to agree with their view that in a
1658
Changes in health and in sexual performance are more of an age marker
for men than for women. Despite the menopause and other manifestations of
to concern over health. Body monitoring is the term we used to describe the
given levels of performance and appearance; but while these issues take the
form of a new sense of physical vulnerability in men, they take the form of a
rehearsal for widowhood in women. Women are more concerned over the
out by other studies. Not only is there the grief and reorganization of
established life patterns to face, but widows experience a drop in status with
minority group who are singled out for unequal treatment and who regard
themselves as objects of social discrimination. Many widows feel demeaned
by limiting their socializing to other widows and feel that friends avoid them
in the attempt to ignore the whole subject of death and grief. The rehearsal
left to live rather than time since birth. Not only the reversal in directionality,
You hear so much about deaths that seem premature. That’s one of the
changes that comes over you over the years. Young fellows never give it a
thought.
Another said,
The recognition that there is “only so much time left” was a frequent
said,
There is now the realization that death is very real. Those things don’t
quite penetrate when you’re in your twenties and you think that life is all
ahead of you. Now you know that death will come to you, too.
come to terms with that actuality. Death rates over the life span show a
sudden and dramatic rise at middle age. The rate for men aged 45 to 64 is six
1660
times as high as it is in the preceding 20-year period, and for women it is
three times as high. A second factor that may be equally significant is that
accidents, but for the age range 45 to 64, for both men and women, malignant
neoplasms and heart disease account for nearly two-thirds of all deaths. To
put this another way, in early life death is exceptional and accidental; but in
middle age not only does death strike frequently, but it strikes from within.
Despite the new realization of the finiteness of time, one of the most
both men and women the perception of greater maturity and a better grasp of
You feel you have lived long enough to have learned a few things that
nobody can learn earlier. That’s the reward . . . and also the excitement. I
now see things in books, in people, in music that I couldn’t see when I was
younger. . . . It’s a form of ripening that I attribute largely to my present
age.
There is, for instance, the 45 year old’s sensitivity to the self as the instrument
by which to reach his goals; what we have called a preoccupation with self-
I know now exactly what I can do best, and how to make the best use of my
time. ... I know how to delegate authority, but also what decisions to make
myself. ... I know how to protect myself from troublesome people . . . one
well-placed telephone call will get me what I need. It takes time to learn
how to cut through the red tape and how to get the organization to work
for me. . . . All this is what makes the difference between me and a young
man, and it’s all this that gives me the advantage.
Other studies have shown that the perception of middle age as the peak
such study there was consensus that the middle-aged are not only the
wealthiest, but the most powerful; not only the most knowledgeable, but the
1662
most skillful.
It is as if there are two mirrors before me, each held at a partial angle. I see
part of myself in my mother who is growing old, and part of her in me. In
the other mirror, I see part of myself in my daughter. I have had some
dramatic insights, just from looking in those mirrors. ... It is a set of
revelations that I suppose can only come when you are in the middle of
three generations.
stocktaking, the heightened introspection, and, above all, the structuring and
restructuring of experience— that is, the conscious processing of new
information in the light of what one has already learned and the turning of
one’s proficiency to the achievement of desired ends. These people feel that
is a sense of increased control over impulse life. The middle- aged person
and successful persons, they express many of the same attitudes expressed
less fluently by persons of less education and less achievement, persons who
also feel in middle age the same increasing distance from the young, the
reports are also congruent with the views of Havighurst, Peck, and others
who have described the developmental tasks of middle-age, and with the
insights of clinicians like Butler, Levinson, Gould, and Soddy, who have turned
their attention to gathering data on nonclinical populations.
1664
Is Middle Age a Crisis Period?
producing events for women; and for men, health problems, sexual
impotence, and career decline. The implication is often that early middle age
is second only to adolescence as a period of stress and distress.
The Climacterium
changes. Because it signifies that reproductive life has come to an end, it has
Benedek is one of the few psychoanalysts who has taken a more optimistic
previously used to cope with the fluctuations of the menstrual cycle and
reproduction is now released for new forms of psychological and social
expansion.
school age, data were obtained on a large number of psychological and social
satisfaction, and self-concept. It was found that these women minimized the
significance of the menopause, regarding it as unlikely to produce much
anxiety or stress. Among the aspects disliked most about middle age, only one
woman of the 100 mentioned menopause, and even after considerable time
given to the topic on two different interview occasions, only one-third could
think of any way that a woman’s physical or emotional health was likely to be
tolerate stress. “It depends on the individual. Personally I think if women look
1666
On a specially devised checklist of attitudes toward menopause, the
climacterium. Three-fourths took the view that, except for the underlying
biological changes, women even have a relative degree of control over their
on), it was found that even those women with high symptom scores
discounted the importance of the climacterium as a factor in their current
middle age, they seldom related them to climacteric change. This was not
true, however, of the other two cultural groups, both of whom came from
traditional settings in which the role of women had altered relatively little
since Biblical times. For women in the latter groups climacteric changes were
more salient and more closely related to their perceptions of major changes
at middle age.
Nor did our data support the common view that the cessation of fertility
is perceived as a major loss. Among the 100 American women just described,
no regret over lost fertility was expressed: on the contrary, many women
stated that they were happy to be done with childrearing/' A survey of nearly
1,200 middle-aged women of five Israeli subcultures that varied from
differences in family size (an average of more than eight children among the
most traditional women, and an average of two children among the most
modern women), women in every cultural group emphatically welcomed the
1668
cessation of fertility.
All this is not to gainsay the fact that while perhaps most middle-aged
women attach only secondary significance to the climacterium, some
advocating estrogen maintenance from puberty to death;- but still others take
Handbook.
of such a change are unknown. Redlich and Freedman are among those who
suggest that the mild depressive symptoms seen among men in their fifties
are perhaps related to a career decline rather than to intrinsic organic change.
similar. He suggests that the logical inference is that there are very few
differences between the sexes in attitude changes that are due directly to
hormonal influences; sex differences are more likely due to cultural and social
studies indicate that it, too, has been given exaggerated importance in terms
of its consequences for mental health. One set of evidence comes from the
women whose reactions to the menopause have just been described. These
women were divided according to family stage: the intact stage, in which
none of the children had yet left home; the transitional stage, with one or
more gone but one or more remaining; and the empty nest stage. Those
1670
women who had children under age 14 at home were also compared with
those whose youngest child was 15 or older. Life styles or role orientations
were identified, and the sample was separated into those who were primarily
pattern of role activities, assessing the extent to which each woman had
role patterns and measures of psychological well-being were low. Rather than
being a stressful period for women, the empty nest or postparental stage was
associated with a somewhat higher level of life satisfaction than were the
other family stages. For at least the women in this sample, coping with
children at home was presumably more stressful than seeing their children
and women whose youngest child was about to leave home showed that
while some persons in the sample had serious problems, the problems were
not related to the departure of the children. The authors concluded that the
confrontation of the empty nest, when compared with retrospections of the
low points in the past and expectations of the future, is not of a nature to
Somewhat the same case can be made for the effects of other life events.
While important alterations in the life space of the middle- aged person take
place and may necessitate a certain degree of personal reorganization, it can
be argued that the normal life events of middle age do not in themselves
rise from childhood to a peak in the period 25 to 34—that is, during young
adulthood—and then drop gradually through middle age, rising sharply after
age 65. Similarly, in a study of 2,500 adults 21 and over, reports of past
emotional crises were given by about a fifth in all age groups, but by a slightly
higher proportion in the group aged 35 to 44, with the proportion then
dropping steadily with age. The same study also showed that self-reported
age for males but do not peak in middle age, while for females the rate
remains low with a slight drop after age 60 to 69. Thus, neither self-reports
nor gross external criteria such as these support the crisis view of the middle
years.
We interpret all this as support for our view of the “normal, expectable
life cycle.” Adults develop a set of anticipations of the normal life events, not
1672
only what those events should be, but also when they should occur/’ They
make plans, set goals, and reassess those goals along a time line shaped by
those expectations. Adults have a sense of the life cycle: that is, an
be similar to the lives of others and that the turning points are inescapable.
This ability to interpret the past and foresee the future, and to create for
oneself a sense of the predictable life cycle, presumably differentiates the
healthy adult personality from the unhealthy one. From this point of view the
forties and fifties regard the climacterium as inevitable; they know that all
women survive it; and most women therefore take it in stride. Similarly men
and women expect their children to grow up and leave home, just as they
themselves did in their own youth, and their feelings of relief and pride are
event can be illustrated for events at the upper boundary of middle age as
expectable event. Yet in much of the literature on the topic, the investigator
conceptualizes it as a crisis, with the result that the findings from different
accepting the opportunity to withdraw from work at age 55. The latest
were content in their retirement, compared with less than 20 per cent of the
or loss of job. Even death becomes a normal, expectable event to the old, and
there are various studies that describe the relative equanimity with which it
is anticipated. Judging from our many interviews with old people gathered in
the course of large-scale studies of aging, the crisis is not death itself as much
as the manner in which one will die. It appears that it is the prospect of dying
in a nonnormal, unexpected circumstance (in an institutional setting, say,
rather than in one’s accustomed family setting) that creates the crisis.
for both younger and older widows in the months following bereavement,
consultation rates for psychiatric symptoms were very high for women under
65 but not for women over 65. In a large-scale study of American widows, it
1674
has been pointed out that the hardest hit are those who experience
mental illness, physical illness, and mortality indicate that there is excess risk
at younger rather than at older ages for both sexes. Is this because by the time
a woman reaches old age the death of her husband, a husband usually several
All these findings are not to deny that the expectable life event
may more often be the timing of the life event, not its occurrence, that
constitutes the problematic issue. This observation is not a denial of the fact
that many of the major life events in middle age (and in old age) are losses to
rather, that the events are anticipated and rehearsed, the grief work
completed, the reconciliation accomplished without shattering the sense of
ill, nor had they found their way into mental hospitals with any greater
frequency than others. Mental illness, on the other hand, was associated with
The distinction is worth making then, that it is the unanticipated, not the
anticipated, that is likely to represent the traumatic event. Major stresses are
caused by events that upset the sequence and rhythm of the expected life
middle age; when marriage does not come at its desired or appropriate time;
when the birth of a child is too early or too late; when occupational
constitutes a crisis period in the life cycle any more than any other period of
life. For most persons middle age brings with it the anticipated changes in
family and work and health. Some of these changes are not necessarily
1676
the individual, but they also bring occasions to demonstrate an enriched
sense of self and new capacities for coping with complexity.
Bibliography
Back, K. W., and Bourque, L. B., “Life Graphs: Aging and Cohort Effects,” J. Gerontol., 25.249-255,
1970.
Baler, L. A., and Golde, P., “Conjugal Bereavement: Strategic Area of Research in Preventive
Psychiatry,” in Working Papers in Community Mental Health, Vol. 2, No. 1, Harvard
School of Public Health, Department of Public Health Practice, Cambridge, 1964.
Barfield, R., The Automobile Worker and Retirement: A Second Look, Institute for Social Research,
University of Michigan, Ann Arbor, 1970.
Bart, P., “Depression in Middle-Aged Women: Some Socio-Cultural Factors,” Ph.D. diss., University
of California, Los Angeles, 1967.
_____, “On the Psychic Economy of Developmental Processes,” Arch. Gen. Psychiat., 17:271-276,
1967.
Bigelow, N., “The Involutional Psychoses,” in Arieti, S. (Ed.), American Handbook of Psychiatry, Vol.
1, pp. 540-545, Basic Books, New York, 1959.
Birren, J. E. (Ed.), Relations of Development and Aging, Charles C Thomas, Springfield, Ill., 1964.
Botwinick, J., Cognitive Processes in Maturity and Old Age, Springer, New York, 1967.
Buhler, C., “The Course of Human Life as a Psychological Problem,” Human Dev., 11: 184-200,
1968.
_____, and Massarik, F. (Eds.), The Course of Human Life, Springer, New York, 1968.
Butler, R. N., “Toward a Psychiatry of the Life Cycle,” Psychiat. Res. Rep., 2,3:23,3- 248, 1968.
Cameron, P., “The Generation Gap: Which Generation Is Believed Powerful versus Generational
Members’ Self-Appraisals of Power,” Develop. Psychol., 3:403—404, 1970.
Cohen, S., Ditman, K. S., and Gustafson, S. R., Psychochemotherapy: The Physician’s Manual, rev. ed.,
Western Medical Publications, Los Angeles, 1967.
Coleman, R., and Neugarten, B. L., Social Status in the City, Jossey-Bass, San Francisco, 1971.
Cristenson, C. V., and Gagnon, J. H., “Sexual Behavior in a Group of Older Women,” J. Gerontol.,
20:351-357, 1965.
Datan, N., “Women’s Attitudes towards the Climacterium in Five Israeli Subcultures,” Ph.D. diss.,
University of Chicago, 1971.
_____, Maoz, B., Antonovsky, A., and Wijsenbeek, H., “Climacterium in Three Cultural Contexts,”
Tropical & Geographical Med., 22:77-86, 1970.
Davis, M. E., Lanzl, L. H., and Cox, A. B., “Detection, Prevention and Retardation of Menopausal
Osteoporosis,” Obstetrics & Gynecol., 36.187-198, 1970.
Demos, J., and Demos, V., “Adolescence in Historical Perspective,” J. Marriage & Fam., 31:632-638,
1969.
Deutsch, H., “The Climacterium,” in Deutsch, H., The Psychology of Women, Vol. 2, Motherhood,
Grune & Stratton, New York, 1945.
1678
Deutscher, I., “Socialization for Postparental Life,” in Cavan, R. S. (Ed.), Marriage and Family in the
Modern World, 2nd ed., Thomas Y. Crowell, New York, 1965.
Dunlop, E., “Emotional Imbalance in the Premenopausal Woman,” Psychosom., 9: 44-47. 1968.
Frenkel-Brunswick, E., “Adjustments and Reorientations in the Course of the Life Span,” in
Neugarten, B. L. (Ed.), Middle Age and Aging, University of Chicago Press, Chicago,
1968.
Glick, P. C., Heer, D. M., and Beresford, J., “Family Formation and Family Composition: Trends and
Prospects,” in Suss- man, M. B. (Ed.), Sourcebook in Marriage and the Family, 2nd
ed., Houghton Mifflin, Boston, 1963.
Gould, R. L., “The Phases of Adult Life: A Study in Developmental Psychology,” Am. J. Psychiat.,
129:521-531, 1972.
Goulet, L. R., and Baltes, P. B., Life Span Developmental Psychology, Academic Press, New York,
1970.
Gregory, F. W., and Neu, I. D., “The American Business Elite in the 1870’s,” in Miller, W. (Ed.), Men
in Business, Harvard University Press, Cambridge, 1952.
Gurin, G., Veroff, J., and Feld, S., Americans View Their Mental Health: A Nationwide Interview
Study, Basic Books, New York, 1960.
Gutmann, D. L., “An Exploration of Ego Configurations,” in Neugarten, B. L., et al., Personality in
Middle and Late Life, Atherton Press, New York, 1964.
Havighurst, R. J., “Changing Roles of Women in the Middle Years,” in Gross, I. (Ed.), Potentialities
of Women in the Middle Years, Michigan State University Press, Lansing, 1956.
_____, “The Social Competence of Middle-aged People,” Genet. Psychol. Monog., 56:297-375, 1957.
Jacques, E., “Death and the Mid-life Crises,” Internal. J. Psychoanal., 46:502-514, 1965.
Jung, C. G., “The Stages of Life,” in C. G. Jung, The Collected Works of C. G. Jung, Vol. 8, The Structure
and Dynamics of the Psyche, Pp. 387—403, Pantheon Books, New York, 1960.
Kerr, M. D., “Psychohormonal Approach to the Menopause,” Modern Treatment, 5; 587-595. 1968.
Kinsey, A. C., et al., Sexual Behavior in the Human Female, W. B. Saunders, Philadelphia, 1953.
Klerman, G. L., and Levinson, D. J., “Becoming the Director: Promotion as a Phase in Personal-
Professional Development,” Psychiatry, 32:411-427, 1969.
Lieberman, M. A., and Coplan, A. S., “Distance from Death as a Variable in the Study of Aging,”
Develop. Psychol., 2: 71-84, 1970.
Lopata, H., Widowhood in an American City, Schenkman Publishing Co., Cambridge, Mass., 1972.
Lowenthal, M. F., and Chiriboga, D., “Transition to the Empty Nest,” Arch. Gen. Psychiat., 26:8-14,
1972
_____, et al., Aging and Mental Disorder in San Francisco: A Social Psychiatric Study, Jossey-Bass, San
Francisco, 1967.
Maoz, B., Dowty, N., Antonovsky, A., and Wijsenbeek, H., “Female Attitudes to Menopause,” Soc.
Psychiat., 5:35-40, 1970.
Masters, W. H., and Johnson, V. E., Human Sexual Response, Little, Brown, Boston, 1966.
Munnichs, J. M. A., Old Age and Finitude: A Contribution to Psychogerontology, Karger, Basel, 1966.
Myrdal, A., and Klein, V., Women's Two Roles: Home and Work, 2nd ed., Rout- ledge and Kegan
Paul, London, 1968.
Neugarten, B. L., “The Awareness of Middle Age,” in Owen, R. (Ed.), Middle Age, British
1680
Broadcasting Co., London,
_____, “Dynamics of Transition of Middle Age to Old Age: Adaptation and the Life Cycle,” J. Gcriatric
Psychiat., 4:71-87, 1970.
_____(Ed.), Middle Age and Aging: A Reader in Social Psychology, University of Chicago Press,
Chicago, 1968.
_____, et al., Personality in Middle and Late Life, Atherton Press, New York, 1964.
_____, and Carron, D. C., “Attitudes of Middle-aged Persons toward Growing Older,” Geriatrics,
14:21-24, 1959-
_____, and Gutmann, D. L., “Age-Sex Roles and Personality in Middle Age: A Thematic Apperception
Study,” Psychol. Monog., 72, 1958.
_____, Havighurst, R. J., and Tobin, S. S., “The Measurement of Life Satisfaction,” J. Gerontol., 16:134-
143, 1961.
_____, and Kraines, R. J., “Menopausal Symptoms in Women of Various Ages,” Psychosom. Med.,
27:266-273, 1965.
_____, Kraines, R. J., and Wood, V., “Women in the Middle Years,” unpublished manuscript on file,
Committee on Human Development, University of Chicago, 1965.
_____, and Peterson, W. A., “A Study of the American Age-grade System,” Proceedings of the Fourth
Congress of the International Association of Gerontology, 3: 497-502, 1957-
_____, and Weinstein, K., “The Changing American Grandparent,” J. Marriage & Fam., 26.199-204,
1964.
_____, Wood, V., Kraines, R. J., and Loomis, B., “Women’s Attitudes toward the Menopause,” Vita
Humana (now Human Dev.), 6:140-151, 1963.
Peck, B. F., and Berkowitz, H., “Personality and Adjustment in Middle Age,” in Neugarten, B. L., et
al., Personality in Middle and Late Life, Atherton Press, New York, 1964.
Redlich, F. C., and Freedman, D. X., The Theory and Practice of Psychiatry, Basic Books, New York,
1966.
Riegel, K. F., “On the History of Psychological Gerontology,” Working Paper No. 8, Center for
Research on Conflict Resolution, History of Science Program, University of
Michigan, Ann Arbor, 1971.
Riley, M. W., Foner, A., et al., Aging and Society, Vol. 1, An Inventory of Research Findings, Russell
Sage Foundation, New York, 1968.
_____, Riley, J. W., Johnson, M. E., et al. (Eds.), Aging and Society, Vol. 2, Aging and the Professions,
Russell Sage Foundation, New York, 1969.
Rothstein, S. H., “Aging Awareness and Personalization of Death in the Young and Middle Years,”
Ph.D. diss., University of Chicago, 1967.
Sonkin, L. S., and Cohen, E. J., “Treatment of the Menopause,” Modern Treatment, 5: 545-563,
1968.
Sussman, M. B., “The Help Pattern in the Middle Class Family,” Am. Sociol. Rev., 18:22-28, 1957.
Szalita, A. B., “Psychodynamics of Disorders of the Involutional Age,” in Arieti, S. (Ed.), American
Handbook of Psychiatry, Vol. 3, Basic Books, New York, 1966.
Troll, L. E., “The Family of Later Life: A Decade Review,” J. Marriage & Fam., 263-290, 1971.
Vedder, C. B., Problems of the Middle Aged, Pp. 45-64, Charles C Thomas, Springfield, Ill., 1965.
1682
Warner, W. L., and Abegglen, J. C., Occupational Mobility in American Business and Industry, 1928-
1952, University of Minnesota Press, Minneapolis, 1955.
Wilson, R. A., Forever Feminine, M. Evans and Co., New York, 1966.
_____, and Wilson, T. A., “The Fate of the Non-treated Post-menopausal Woman,” J. Am. Geriatric
Soc., 11:347-362, 1963.
[1] Portions of the present chapter have appeared in earlier papers by Bernice Neugarten.
Adjustment To Retirement
ever had the number or the proportion that are found in industrialized
societies of the present. Nor have they experienced the phenomenon of
alone. Unlike other social role changes throughout the life span, which are
marked by a series of role transitions and gradations from one more or less
clearly defined social role to another, the retirement role is beset with a lack
1684
structural parameters. Rather, the process of adjustment must also be viewed
in terms of the patternings and availabilities of social roles that are emerging
for this life stage and the extent and the manner in which the individual
established norms and role behaviors for each stage of the life cycle, and
socialization processes that prepare the individual for and induct him into
successive stages. The historical perspective focuses upon changes that occur
in society’s system of age role definitions during the life span of the individual
and his generational cohort. These are factors that may transcend the usual
boundaries of life cycle and socialization theory by adding a generational
we were to observe political attitudes common to the aged of the 1960’s that
differed from those of younger age groups, we might infer, employing our
developmental perspective, that these are changes that occur with aging.
However, if historical inquiry reveals that the attitudes held by older persons
in the 1960’s were indeed similar to those acquired during their period of
political attitude formation some 40 or 50 years earlier, then the change we
have observed has not occurred to the individual as a consequence of the
half has set into motion a series of trends that are transforming the position
of the aged in human society. The more advanced stages of industrialization
The rapid increase of the population 65 and over has been a recent
their population in the 65 and over age group. Declining fertility and
increasing survival efficiency at younger ages, associated with the later stages
of aged in the advanced industrial nations.[1] In 1850 only one nation, France,
bad as much as 6 per cent of its population in the 65 and over age group; in
1686
1900 only three countries—France, Sweden, and Norway—had as much as 7
per cent of their population in this age group. In 1969 only the advanced
population) had 7 per cent or more in the 65 and over age bracket, with a
proportion of 13 per cent or higher recorded for Belgium, France, the United
in numbers the increase has been from 3 million to 20 million in this period.”
The aged in our population and in other industrial societies in this century
have been increasing at over double the rate of the population as a whole.
that has accompanied it, has also led to a change in the basis of participation
in the labor force. The taking of production out of the home into the factory
established a separation of work life from the home and family life. The
From the point of view of the older worker, this meant that remaining in
the labor force was no longer determined by his ability to turn out a product
as such. Rather, it depended upon factors external to him: that is, keeping
pace with a production line whose rate of operation is usually set in terms of
the capacities of younger workers, and learning new techniques where the
industrial societies to the increase in the proportion of the aged and to their
increasingly led to a withdrawal of the older workers from the labor force. In
the United States, for example, the proportion of older males in the labor
force has declined from 65 per cent in 1900 to 45 per cent in 1950 and 26 per
cent in 1970.
The withdrawal of older workers from the labor force has also led to the
In the past hundred years public and private pension and insurance programs
1688
industrial societies. These were independent of the “poor relief’ patterns of
support of the indigent aged that had been part of the Western tradition;
rather than upon need per se. They were to emerge as an “earned right” and
were to become instrumental in defining a retirement status as appropriate
extended to include almost all categories of public and civil service. fn 1970
over 95 per cent of public employees in the United States were covered under
enterprises (for example, railroads), but it was not until the last two decades
when they became subject to collective bargaining that they were to effect a
significant and still expanding portion of the labor force. In 1969 48 per cent
of the U.S. labor force was included in private pension programs, and federal
income tax provisions have recently given impetus to the establishment of
pension programs for the self-employed. The first modern social insurance
laws making provision for the aged were enacted in Germany in 1883 and
1889. This national system provided for compulsory health insurance and
disability, old age, and death benefits. By 1935 when the U.S. Social Security
broadened in scope as well as in coverage from the acts passed in the late
1930’s. In 1940 only 7 per cent of the aged population was receiving
retirement benefits under this legislation; in 1950 the figure was 17 per cent;
and in 1968 it had expanded to 63 per cent of the population. Further, its
which they became eligible to retire. In so doing, they were defining a new
age role for human society, one that was to have more extensive and
expectation for workers in advanced industrial societies as yet does not have
clearly defined functions or behaviors associated with it; nor is there a group
of persons established in this role for a long enough period of time to serve as
1690
changing significance of this new life stage and contain both contradictions
and paradoxes. Thus, pensions and insurance provisions, which define
retirement as a right and a deferred payment for service, still hold some of the
stigma once attached to disability and indigency payments. A society that has
for so long stressed only work-related values seems to be reluctant to accept
class in the form of the retired aged. Finally the aged themselves reflect this
dilemma to the extent that they evaluate the merit of a status or activity in
terms of its recognition in a market economy, rather than attaching intrinsic
the changing definition of the appropriate roles and age for retirement. In the
United States the limited number of public and private pension programs that
were in effect prior to 1930 usually were tied to declining or impaired work
capacity as the condition for retirement. The few that specified a compulsory
retirement age usually placed this at age 70, again with the implication that
the worker would not be a productive employee beyond this age. The
incapacitation of old age. The Depression of the 1930’s, which forced the
termination of most of these earlier plans, was also to lay the foundation for a
federal old age and survivor insurance program through the introduction of
the Social Security system in 1935. The legislation originally stipulated 65 as
proportion of the labor force has been required to retire at 65, its inclusion as
the age of eligibility has contributed significantly to its establishment as the
benefits increased from 1.8 million in 1950 to 12.4 million in 1968; average
Studies at the beginning of the period indicated that more than half of
all retired workers regarded retirement as an involuntary decision, giving
1692
physical disability or compulsory retirement requirements as the reason for
their withdrawal from the labor force.- A check of auto and steel workers in
the Detroit and Pittsburgh area in 1950 indicated that 60 per cent of those
eligible for retirement were unwilling to accept retirement at age 65. Other
studies of the period in the United States and Great Britain suggested a
such as those of Streib and Thompson. According to their study, 63 per cent of
study of employed industrial workers, Tuckman and Lorge found that 59 per
cent of the men and 73 per cent of the women studied were either planning to
retire or would like to if they were financially able. Studies of retired workers
similarly indicated a strong relationship between adequacy of retirement
the labor force. In 1950 45 per cent of the males 65 and over were in the labor
force; the proportion has decreased steadily to 32 per cent in 1960 and 27
per cent in 1970. More recent studies such as those of Palmore, Reno, and
Shanas et al. have shown a steady increase in the proportion of men in good
health retiring voluntarily during the past two decades in the United States.
inseparable from the total pattern of activity that survival or society dictated.
1694
activities are organized, distinct from, although obviously not unrelated to,
separate sphere of life activity work does not seem to take precedence over
other life areas for most workers. Dubin found that most industrial workers
in his survey sample failed to regard work as their “central life interest,” nor
did they perceive their job as the locus of their most important social
aspirations tend to peak in the middle years of adulthood for most workers,
with variations according to skill and occupational level. Studies of assembly
workers in the auto industry put the peaking in their early thirties, noting
that they look to other areas of their lives for achievement or personal
gratification. Studies of white-collar and professional occupations, however,
put the aspiration peak in the fifties and tend to suggest that work remains a
central life interest until late middle age at these occupational levels. Palmer’s
around age 35, while the emphasis on achievement began to decline in this
decade.
years of adult life, the job has come to have a variety of meanings for the
worker, deriving from both the intrinsic significance that the performance of
the task itself holds and a set of extrinsic significances that contribute to and
structure his participation in other spheres of life activities. Viewed in terms
activity, and it may also serve the worker in other ways as an important
source of obtaining approved types of societal rewards and achievement, a
locus for friendship relations or for the gratification of other individual needs.
serve as the basis of the worker’s status and prestige or facilitate in other
the job suggest that no simple cultural theme fits all occupations and
vary with the nature of the job itself and with the individual’s place in the
social structure.
The concept of the meanings of work has been employed in the analysis
of the transition to retirement to establish categories of “loss” experienced by
1696
the worker upon separation from job activity, to explore the differential
relationship between the significance that work has for the individual and his
assigned by the lower skilled groups strongly stressed the routine activity
and time-filling aspects of the job. In the skilled, white collar, and professional
among the several groups. Preference for retirement at age 65 was found to
vary directly with occupational level, ranging from 68 per cent of the lower
continue past 65, although the relationship was not as strong. They note,
activity, since they found workers at all levels for whom intrinsic meanings
were important who also accepted retirement. Rather the analysis of the full
significance which work has come to have for the older worker at the time of
his retirement can provide a more specific understanding of the losses
experienced upon separation from it in retirement and the life meanings and
job as the factor they would miss about their jobs if they stopped working,
study did not deal with the subject of retirement at age 65, it did pose a
enough money to live on. Men in the manual occupations showed a greater
groups of the study. Some American studies have not consistently borne out
toward retirement. Although they have not dealt directly with the significance
of work per se, they show a direct relationship between amount or adequacy
1698
of income and satisfaction with retirement, with income adequacy increasing
workers) looked forward to retirement more than any other group in their
greater extent and had a higher level of work commitment than the
semiskilled workers, neither work orientations nor prospects of income loss
level in the study and also stressed intrinsic meanings of work and indicated a
high level of work commitment to a greater degree than any other group
studied. Within this occupational level, differences in work orientation were
for the American workers. But it indicated that American workers reported
more positive satisfactions about both work and retirement than did their
European counterparts. The Danish and English workers were much more
likely to indicate that they would miss “nothing” about the job or “money
only.” The study also indicated a much larger proportion of Danish and
when contrasted with American workers. What the study seems to suggest is
a lifetime of work. In the United States men see the retirement period as a
time for activity, and Americans in retirement enjoy their ‘freetime’ activities
or various leisure time pursuits. In fact, the data suggest that activity is so
highly valued by older Americans that the pastimes of retirement take on the
aspects of work.” (p. 344)
1700
The separation of work as a commitment and source of intrinsic
However, the extent to which work represents a dominant life theme for the
studies during the 1940’s and the early 1950’s reflected an overwhelming
had established.
proportion of the labor force past age 65 remaining on the job. Further
selected private pension programs during the past decade. By the middle of
the 1960’s American studies were consistently reporting a favorable outlook
society in the past are now shaping the conceptions of retirement. But the
exception noted in the professional occupational levels is significant and
deserves further discussion for two reasons. First, behavioral and social
science researchers and practitioners concerned with retirement are
themselves members of occupational groupings whose attitudes toward
retirement are most influenced by the intrinsic meanings that they have
attached to their jobs. Second, it suggests an added dimension of the work
time use.
The professions and the upper levels of the managerial ranks are among
1702
the few occupations in industrial society that are task- oriented. Economic
of the time and activity patterns in the accomplishment of the task is largely
the control of the individual but is imposed by the employer and the work
organization. In preindustrial societies work was task-oriented and income
was tied to the fulfillment of the task. Men were able to structure their own
working lives and the rhythm of their life patterns; the alternation between
work and non- work activities was under their control as well. As the
historian E. P. Thompson notes, the “work pattern was one of alternate bouts
of intense labour and of idleness wherever men were in control of their own
lives”(p. 73).
Preindustrial man with his “natural time” did not have to be concerned
with exactness in time allocation; the rhythm of life was marked by the
seasons, the months, the days, the demands of family, friends, community,
work, and leisure. These were interrelated demands and the time assigned
upon the linking of the tasks of large numbers of workers into a single
effectiveness, and work time was the unit for which the employee was paid.
Time has become the unit that the worker sells; it has also become a
demand a shorter work week early in the century and as paid vacations were
established as a work right, time was now being purchased by him for
activities other than work. Leisure, which was once the possession of a
privileged class not required to work, was now defined as “free time” in the
life of the working man. It is time free from the obligations of work but, as
Shanas’s study suggests, for the American worker the significance of nonwork
activities is reckoned in the calculus of their time-filling values in addition to
whatever intrinsic gratifications the tasks of leisure may have for the worker.
Life is now paced by the clock, rather than by the task to be performed.
retired but is symptomatic of the fracture that has developed between work
and nonwork spheres of activity in the life of industrial man. Maddox notes
1704
important stabilizing force in contemporary life, has an uncertain future” (p.
126). A number of social science observers of industrial work forces have
“leisure time” is well used if it advances work goals, the casting of free time in
a worklike time use pattern, and the absence of a satisfactory mesh between
work and nonwork life spheres. Wilbert Moore suggests that a measure of
satisfactory integration between the individual’s work and nonwork lives
between the demands of the economic and family spheres in the life of the
younger worker. The second occurs “toward the end when energy declines
work and nonwork activity are problems of the entire adult life cycle.
industrial man.
“Adjustment” to Retirement
1706
Conceptions of Adjustment
Adjustment in the social and psychological sciences has rested upon and
stability of the assumed system is itself questionable, that is, if it can be seen
stable ones.
process and with adjustment within such a framework. The earliest work was
1708
concentrated on objectively identifiable patterns of behavior—activities,
social roles and relationships, and organized life patterns of these— relating
However, it should be noted that these approaches have lacked base line
and quantifiable system variable relationships. Rather, the latter have been
empirically sought. As a result arbitrary premises about criteria standards for
positively related to role activity and social interaction. Another has been the
imposition of developmental criteria as standards when their very existence
and character have been the questions at issue. This has led to conflicting
Criteria of Adjustment
The major criteria used in judging retirement adjustment have been: (1)
of ordinary usage; and (2) extent and degree of activity and social
1710
participation, largely indicated by reported activity and participation rather
Rosow points out that it is all too easy to confuse “happiness” as a social
viewed as relative to given dimensions of age and sex: “As happy as a man
(woman) of my age .could be.” In these terms it is of interest that research has
found that most older persons rate themselves as happy, while at the same
degree of happiness from ages 21 to 34, 35 to 44, 45 to 54, and 54 and older in
the general population, while the rating of happiness is overwhelming: 95, 90,
86, and 82 per cent, respectively, consider themselves either pretty happy or
very happy. This might force us to treat all of adult life as a period of
While the same points can be applied to some correlative notions like
clinically based judges’ morale ratings, and questions concerning the uni- or
multidimensionality of the attitudes measured and whether they, in turn, tap
more basic personality dimensions. Finally there are also questions about the
social and cultural bias inherent in some of the items on morale scales that
situations and measured morale, and that there is often consistency in such
data. Morale typically is not used to explain anything, but rather serves as an
inversely and cumulatively with felt economic deprivation and poor health
among retired men, one can treat this at a direct factual level without
1712
measure adjustment create two types of difficulties: (1) These discriminate
the population and between different cultural subgroups. They tend to favor
active, lifelong patterns of the manual working class. And they tend to ignore
persons who are inactive and even isolates who may also be “happy” or
This has led to the concern with varying types or kinds of “adjustment”
processes. The recognition of the relevance of life styles over the entire life
span, developed by Reichard, Livson, and Peterson and Williams and Wirths,
measures that assume universally constant generic processes and tend to set
perspective have been made in recent years, but their implications have not
been fully taken up or translated into research meaningful for interpreting
adaptation to the process of retirement. One reason for this is that they have
1714
have been concerned with adjustment to old age, or the aging process, and
given some thought to what life is about and what he wants to live for” (p.
385). Although not specifically cast this way, Buhler’s view could encompass
This would involve some important changes, but since Buhler stresses total
life continuity rather than simply the process of transition from middle to old
age and retirement, she introduces the basis for evaluating the individual’s
adaptation in terms of his own behavior as a norm.
middle age and old age stages that he associates with specific ego problems in
Reichard, Livson, and Peterson emphasize continuity with past life style
among their empirically derived personality types of older males, the well-
1716
all have specific types of adaptive processes that are lifelong and are by no
means “to be explained solely, or even largely, on the basis of personality
variations.” While the small size of their sample precluded analysis of the
middle 50’s, and coming to some ‘final’ resolution in the early or mid-6o’s.”
cultures. Each one of these postulated types relates differently to work and
reacts differentially to the event and process of retirement. Gutmann does not
of crises resolution in later life. Viewed broadly, U.S. society supplies neither
the age-status system nor the traditional patriarchal orientations most
1718
developmental approach that sees life history and social-cultural factors as
largely providing the environment in terms of which inner universal
adjustment problem that has its roots elsewhere and is manifested well
before retirement. Since a data base is lacking for estimating the likely
distribution of outcome types in the United States or other societies, the
U.S. cultural values do tend to support the autoplastic autonomy style, and
given sufficient income, such people can still wall off and furnish relatively
private enclaves, and they can tend satisfying gardens within them. Senior
citizen’s clubs, communities, and special activity programs are also helping
to create the required enclaves where elderly people of the autonomous
persuasion can associate with their own kind in their own preserves and
deplore the immorality of the young. For the affluent, autonomous aged,
these may indeed be the “golden years.” Post-retirement programs will
probably have to deal mainly with casualties and potential casualties
within the counter-dependent and emphasized-receptivity styles.
Continuity of life patterns between middle age and older age is viewed as an
adjustment; and stable patterns that continue negatively assessed aspects are
1720
change. As a consequence prior attitude toward change becomes a key
changes in biology, psychology, and overt social behavior, these studies have
shown that neither the “increased interiority of the personality” (as the
increased inward turning of ego functions that projective tests indicated
orderly and sequential time clock of major punctuation marks in the adult
such age-graded norms increased with the respondents’ age; that is, older
dimensions of social class, sex, and occupational role, this has largely
generations of older persons with their role expectations. In this light inner
personality variables cannot be treated as active apart from the cultural
1722
Interestingly enough, the situational and generational influences of
Orbach, and Poliak and Rosow have emphasized and that others are
of research findings.
of retirement adjustment as they have all matters associated with aging. They
have done so both as general social myths and as incorporations into
with the loss of vitality and virility, and to older persons in our society—the
“youth cult”—has colored our perception of later life and of retirement in
particular.
functions has obviously animated the concern over continued vital activity as
inexorably with advancing age, based on general findings over more than a
quarter of a century, has recently been shown to be the consequence of the
unchangeable. Historical fact and evidence were and still are being distorted,
1724
not necessarily intentionally, to fit uncritically held biases. One example: “In
entirely ignore the facts that (1) the German retirement policy was adopted
only after patchwork solutions to the problems of old age indigency via the
traditional common law methods of poor relief, attempted for almost 50
years, had entirely broken down, threatening the social stability of large areas
of urban, industrial Germany; (2) it was introduced to alleviate the real and
desperate condition of the aged; (3) it was consciously modeled on the almost
conspiracy against the aged, as if older persons before 1937 enjoyed both free
access to continued employment and relative economic and physical well-
ailment; as if it were foisted upon them instead of being in good measure the
political and social response to the Townsend Movement, the most massive
self-organization of the aged as a political force that has occurred in our
history.
retirement, apart from the actual circumstances that surround the event of
that many people die soon after retirement. Post hoc, ergo propter hoc.
1726
retirement effect and, if anything, suggest its opposite: retirement benefits
physical well-being. Longitudinal analysis shows the same pattern of changes
in health in both retired and nonretired members of the same sample cohorts.
higher death rates than the general male population immediately after
retirement for males who retired voluntarily, but his study also indicated that
that is why retirees die. Other studies reach similar conclusions.- Research
into reasons for retirement have consistently shown that health is the major
reason given for retirement, and the 1968 Social Security Survey of Newly
Entitled Beneficiaries has reported not only that 44 per cent of all newly
retired beneficiaries give health as the major reason for retirement, but also
that among those who retire early, 54 per cent report health as the major
reason compared with 21 per cent of those who retire at age 65. The
burdens of work, itself often the cause of poor health status, retirement has
no adverse effect on continued health, but more usually a beneficial one.
Mental Health
retired. It was undoubtedly this factor that led the most comprehensive
The factor which has recurred again and again in the consequential
network is physical health . . . physical problems were seen as involved in
the decision-making that led to the psychiatric ward in approximately two-
thirds of the cases and precipitated the psychiatric illness in 10 per cent. . .
. Even for those persons diagnosed as suffering from psychogenic
disorders, studies of health history showed that physical problems often
preceded the development of psychiatric symptoms (p. 68).
Again, lifelong patterns of illness, both mental and physical, have often
been overlooked as the basic causes of mental illness after retirement; and
visible numbers and proportion of the aged in mental institutions can be seen
1728
Family Relationships
Retirement has also been described as a crisis time for family life and
patterns; (2) the occupational role system largely controls the nature of the
family role system; it is central to personal and family role identity; and its
reduced family life to the status of a servile appendage of the world of work,
postparental period even before retirement, though its “shock” has often been
viewed in terms of its effect on the wife. This has been based largely on
clinical experiences with persons having so much difficulty that they resort to
great sense of crisis in the overwhelming majority of cases over the “empty
nest” stage. Indeed, the majority of couples saw it as a time of new freedoms:
time since the children came along. So, too, studies of family relationships in
the time available for husband- wife or parent-child relationships free of the
demands of work, or the possible cushioning effect of the family on the
1730
“distressed” retired man, have been in the past largely ignored, not to
mention the availability of family relationships as a primary outlet for the
However, more recent research has begun to make clear the empirical
than prevailing views had foreseen, children viewing the impact of the
viewing change judging it positively, and little or no crisis in family life due to
children than the children do,” a point also made in other studies. The
the father’s retirement, 71 per cent said it was no problem at all, 25 per cent
said it was not serious, and only 4 per cent said it created a serious crisis. In
response to a question asking if they felt retirement had brought their father
closer to his immediate family, 68 per cent said there had been no change, 30
per cent said retirement had brought him closer to his family and 2 per cent
said it had made him feel less close. Again, replying to a question asking
for the way members of the family got along with each other, 83 per cent
reported no change, 15 per cent said it had been mostly for the good, and only
2 per cent said it had been mostly bad for the family. Streib’s research,
covering the first six years after retirement, does cover a somewhat better-
than-average group with respect to income and occupation, and it does not
1732
children, something that is clearly lifelong; and financial assistance or help
Social Interaction
location in society and its effect upon him, a dramatically reduced social life
space and loss of social esteem. The general decline in activity noted with the
older ages, taken as a sign of the process of aging, has been viewed as being
spurred on by the event of retirement, and often the process of retirement has
In one important sense this latter view lies at the core of the
interaction between the older person and society based on norms sanctioning
such “retirement.”' In the light of this, the disengagement approach, however,
does not see the event of retirement as the initial cause of any crisis or
life’s central roles—work for men, marriage and family for women—results
in a dramatically reduced social life space, it will result in crisis and loss of
1734
Furthermore, both viewpoints see the preretirement state of
decrement of activity and satisfaction. Maddox has shown how the type of
research design employed—gross cross-sectional analysis utilizing central
retirement and social interaction of various types, there is no basis for the
life space and activity when the effects of health, socioeconomic status,
situational and cultural factors, and lifetime patterns of adaptation are
controlled.
the immediate environment. For both, as the social role world contracts after
marital status also act as influences here such that poor health, low economic
status, and lack of a spouse serve to increase dependence on the immediate
study of retired men has demonstrated the same basic relationships between
1736
interaction: “. . . the transition to retirement is misconceived if it is thought of
activated and replaces that of worker (for low economic status, working-class
varying patterns of activity is also a function of his social status and lifelong
Those who have little to do vvitli neighbors are not invariably distressed,
nor do those with high interaction with them necessarily feel satisfied.
People’s desires are one significant condition of their integration into
friendship groups, and it is erroneous to regard such ties as a universal
value, pervasively shared and uniformly enjoyed. This would he an
uncritical view of a more complex matter (p. 104).
The same considerations have been shown to hold with respect to all
types of social interaction. What has become clear above all is that the effect
of retirement on the individual’s activity pattern is complex and varied,
adaptation.
having the deviant, dramatic patterns presented as the typical ones. If one
pitfalls inherent in such a procedure and with the clear understanding that
there are important and significant exceptions —one would have to conclude
that most persons today have a generally positive attitude toward retirement
as a future status; are more likely to strongly exhibit this attitude the higher
their expected retirement income, the better their health, the greater their
1738
educational and occupational level and attainment, and the less they find
work to be the major or only source of intrinsic satisfaction in life. This is the
case regardless of their satisfaction with their work or with life in general.
Furthermore, most retired persons adapt relatively well to their situation and
find satisfaction in retirement to the degree that their attitudes and situations
correspond with the preceding description. There is good evidence that most
that follows a delimited period of work and one that has potentialities for its
own intrinsic satisfactions.
doubts and fears. Instead of thinking that retirement means being put on the
shelf, the majority of Americans see it as a chance to lead a different and not
unpleasant life.” In response to the question, “Has retirement fulfilled your
expectations for a good life or have you found it less than satisfactory?” 61
per cent of a national survey said that retirement had fulfilled their
expectations, 33 per cent found it less than satisfactory, and 6 per cent were
not certain. Among the dissatisfied group 40 per cent gave financial problems
as the reason for their attitude, 28 per cent gave poor health or disability, 10
per cent gave the loss of a spouse, and 22 per cent said they missed working.
retirement itself.
nothing in retirement that pleases him. ... It is not so much their occupational
backgrounds that determine what men enjoy in retirement. Rather it is their
degree of capacity, their ability to get about, that influence their retirement
every case postretirement attitudes of the same groups of retirees, both men
and women, were more positive toward the retirement experience than
preretirement attitudes. Every one of their cohorts of retirees during the mid-
1740
1950’s tended to overestimate the adverse effects of retirement before they
retired. For example, 25 per cent of the men retiring in 1957 and 42 per cent
of the men retiring in 1958 thought they would miss being with other people
at work, but the proportions reporting they had missed being with other
people at work after they retired were 16 per cent and 25 per cent,
respectively. The comparable proportions for women in the same years were
63 and 56 per cent estimating they would often miss others at work
compared to 29 and 28 per cent reporting they had so missed others after
they were retired. Similar sizable differences were found between
missing the feeling of doing a good job, wanting to go back to work, and
worrying about not having a job. More direct evidence of the positive impact
mostly good for a person.” Each of four groups of men and of women retiring
to 45 per cent increases in the year after retirement. In addition, for those
cohorts studied over a longer period of time, the proportions continue to
increase, so that all of them finally show these magnitudes of change over
four to six years, with an overall proportion of 75 to 87 per cent expressing
this attitude. More generally, about one-third of both men and women report
that their retirement has turned out better than they expected; a little less
expected it; and only 4 per cent of the men and 5 per cent of the women say it
Harris also reported that two-thirds of American adults not yet retired
to retire at age 60 or under, 46 per cent would like to. While these
expectations and desires are much more in evidence among younger adults—
that is, among those 35 to 49 years of age, 25 per cent expect to retire at age
60 or under, while 53 per cent would like to, compared to 6 per cent and 23
related attitudes since already retired men were not included and more than
half of the men retiring and claiming Social Security benefits each year since
Support for this interpretation comes from Katona’s studies in 1963 and
1966, which reported even stronger indications of early retirement plans and
an increase in such plans among family heads in the labor force with annual
1742
44, 33 per cent aged 45 to 54, and 22 per cent aged 55 to 64 planned to retire
before age 65, compared to 25 per cent, 23 per cent, and 21 per cent,
respectively, so planning in 1963. Katona also found that 51, 54, and 48 per
early retirement. The proportion planning early retirement was about 30 per
cent for those with expected retirement incomes ranging from under $2,000
to $3,999, rose to 40 per cent for those expecting $4,000 to $4,999, to over 50
per cent for those expecting $5,000 to $5,999, and to 57 per cent for those
expecting $6,000.
or not planning to do so. Being able to afford to retire or poor health was
linked with the first and not being able to afford to retire with the latter. In a
like manner Reno, analyzing data from the Social Security Administration’s
1968 Survey of New Beneficiaries, reports that among men who claimed
benefits at the earliest possible age and stopped working,[4] the proportion
who did so willingly rose from 15 per cent of those with less than $1,000 in
yearly retirement income to 75 per cent of those with $5,000 or more income.
Twenty-five per cent of men retiring at age 62 did so willingly with a second
pension and a median yearly income of $4,100. On the other hand, some 57
the same time 45 per cent had no second pension, did not want to retire, and
had a median income of only $930 from Social Security benefits. While one
cannot determine to what extent these last two categories are overlapping,
there is no doubt that a sizable number of men in poor financial
Nonetheless, Reno reports that these men tend to file for retirement benefits
as soon as they are qualified at the earliest age. However, it should be clear
and other studies have shown, that among those men retiring at age 62 with
poor health and the lowest levels of retirement income, a large proportion
have had lifelong patterns of low income due to irregular and disorderly work
careers, often involving extensive periods of unemployment in part
attributable to poor health and disability. For these men retirement hardly
represents a significant change in an important or central occupational role,
“retirement” for them. The continuing detailed studies of the Social Security
1744
these questions in the next few years.[5]
may pose some of the severest problems that will demand public attention.
for a small sample of Southern blue-collar workers (50 per cent) as opposed
to white-collar workers (28 per cent). They find this to be related to the
in contrast to the blue-collar workers (78 per cent opposed to 38 per cent).
level of satisfaction appears to decline with the passage of time while the
Maddoxreport. Obviously their findings also are not congruent with Loether’s.
1746
mass production industrial workers, have indicated a strong and increasingly
positive attitude toward retirement and a high degree of satisfaction with the
reached 35 per cent as early as 1962, almost three times the 12 per cent who
retirees believe their decision to retire when they did was right and that over
three-quarters would advise others to retire at the same age as they did. Most
problems with their health, and those reporting declining health in recent
years were much less likely to be satisfied with retirement than other
In all studies the basic factor in the decision to retire was the level of
however, that this is less true for the most recent early retirees, who, he
indicates, may be highly relieved to be free from the world of work and
enjoying a relatively novel leisure-based life style. The special benefits of the
come into focus in the absence of financial problems. Barfield reports, for
example, that over three-fourths of these early retirees have not been forced
to dip into their savings; 20 per cent have in fact increased their savings since
retirement. About two-thirds claim to be spending as much as or more than
before retiring, and over three-fourths view their living standard as being at
least as high as that enjoyed before retiring (and of those who have seen some
deterioration in standard of living, about half still believe they have enough to
live comfortably). Interestingly Barfield finds that those who have decreased
their levels of social interaction, interest in world affairs, and amount of
satisfaction with retirement life than those who have maintained the same
levels of activity and those who have increased their activity levels. Part of the
change in activity levels is related to health changes, but not all. However,
1748
some men were not in good health when they retired, and although they may
not have perceived any change in health since then, they may have had to
reduce their activities to maintain their health. At the same time one other
Men who had to retire unexpectedly were much more likely to be dissatisfied.
Barfield concludes that, “In the final analysis, though, and inferring
among auto workers who have been out of the work environment for several
retirement on the part of most auto workers derive primarily from simple
relief at having escaped a bad situation. We remain convinced that, for many
people, the satisfaction of a life free from the demands of work are both
of men who chose it. Those who were dissatisfied in some way and returned
financial reserves.
of some 3,229 federal civil service early retirees, which is unusual because
these workers were all between 55 and 60 years of age when they retired,
indicated they would certainly retire again under the same circumstances, 24
per cent probably would, and 6 per cent indicated they certainly would not.
Among this select group of men and women, one-third had retired at age 55.
Wanting to quit while still able to enjoy retirement was the most important
reason given for retiring (23 per cent), followed by economic reasons such as
seeking a better paid job, being better off with annuity plus outside earnings,
wanting to qualify for Social Security (22 per cent), dissatisfaction with the
job (18 per cent), health or family reasons (14 per cent). These retirees
covered all categories of skill and professional levels in the federal service.
Seventeen per cent reported living better than before retiring, 34 per cent
about as well, 32 per cent not quite as well but all right, and 13 per cent
reported having had to reduce their standard of living drastically to get by.
Health did not seem to have been very much of a consideration in this group
as one might expect from their young ages and type of work. Interestingly
enough, former postal service employees were among the groups reporting
1750
The rising rates of early retirement among a variety of public employees
groups of industrial workers like the automobile workers, has raised many
questions about the nature of their future lives. Conccrn about boredom and
adjusting to inactivity has given way to concern about their future financial
viability. It is not yet clear to what extent various categories of workers will
be able to feel financially secure in early retirement—ignoring for the
moment the serious problem that large numbers of regular retirees who exist
trends in the economy. Some of these categories of early retirees will have
qualified for generous retirement incomes, and many may have accumulated
sufficient reserves to see them through their retirement years. If one were to
judge by the early experience of the auto workers, where only about 17 per
cent have engaged in remunerative employment since retirement, or by the
retirement. Many will for some time, or from time to time, seek some
additional sources of income to maintain their desired level of living.
supplement their retirement income. For the present, however, the highly
positive attitudes expressed indicate that for most of them, given an adequate
retirement income, even quite early retirement poses no crisis or trauma but
rather is seen as a valued privilege.
Professional Retirement
comparing his findings with Benz’s earlier study of retired academics and
given the implicit assumption of their high work orientation. Rowe reports
that, “Even though they generally do not plan for retirement beyond checking
many of them. They tend to accept retirement as part of their ‘life-cycle’ and
not especially disruptive to their happiness. Although they may perceive their
research situation as less fruitful than their earlier years, their retirement
1752
situation is a relatively contented and independent one with opportunity to
continue to ‘engage’ in science” (p. 118). Most continue a fairly active level of
reading in their fields, some continue research, others attend meetings and
professional gatherings, and some are able to continue to receive funds for
studies and consulting work. Rowe found that the extent of continued
involvement was related to the scientist’s eminence in his field, which reflects
discipline and not to his “job,” and this allows him to treat his job retirement
as apart from his scientific commitment. Benz’s earlier study found a similar
continued engagement was less than that of the scientists, while being much
greater than that of the administrators who seem to lose touch with the
“ethos” of the discipline. Rowe suggests that the identification with the
of a spouse are conditions that serve to lessen the scientists’ activity and
engagement with this quest for knowledge.
“ethos” may vary widely. Certainly some professions are more instrumental
for their members and may lack the strong sense of scientific “ethos” of the
orientation than other occupational groups in their study would indicate that
very little is really known about the “professional” and retirement. Perhaps
more research has been concerned with farmers, in the course of which the
myth of the farmer’s inability to stop working was laid to rest.
Nonwhites in Retirement
Very few studies have been done on the adjustment of nonwhite groups
concern for ethnic aged studies in the last few years, but these have
study of retired black men suggests a positive attitude toward retirement, but
1754
it is difficult on the basis of this small study of one community to determine to
what extent the major attitudes are those applicable to working-class poorer
from the South, are proportionately overrepresented among the very low
with their having a low-income, irregular work history in the rural economy
Women in Retirement
and women consistently in their study and find women workers in the 1950’s
and consequently less satisfied with it, very few other studies have devoted
much attention to women workers as a distinctive group. In most instances
they have been used as a basis for comparison with men, and almost no study
group. The fact that women overwhelmingly choose to retire under Social
Security at the earliest possible ages for qualification has simply been taken
as a reflection of their marginal role in the labor force in recent times. One
would assume that this will soon be corrected since greater attention to
women in the labor force has been evident for some time, even before the rise
expressed more satisfaction with their retirement role (91 per cent of the
single women finding no difficulty in not working as compared to 65 per cent
individuality, while the married woman, “If (she) is still working at sixty-five
years of age, she is working for a good reason. Either she feels that she and
1756
her husband need the money, or she may enjoy work more than the tasks of
divorced women workers and their relation to the event and process of
retirement—both their own and that of their spouses and friends and
structure of the retirement role has been a great deal of concern about
planning for retirement. Numerous programs have been developed over the
past two decades by industry, labor groups, educational institutions, and
private organizations. A large and extensive literature has been produced that
includes many programs for educating workers preparing for retirement, and
reports of such programs have been published and extensively discussed.
However, few research studies were designed or carried out to assess their
value and impact until quite recently. Thompson’s research concluded that
bo of relatively less direct importance” (p. 43). Since he implied that planning
than the simple function of making available useful and otherwise not easily
employees, with control groups not exposed to the programs. While they
admit that the effects were difficult to measure, they do report a positive if
program, but evidence of any contribution, even if only at the beginning of the
retirement process, suggests the value of the efforts that go into such
1758
programs.
point out that the longer range implications of such programs are not known,
nor is it entirely clear to what extent many of the positive results are the
consequence of special factors outside of the program, such as self-selection
of the volunteers who took the program and the preexistence of highly
of the auto workers’ pension system and the positive encouragement of the
union are factors that have to be taken into consideration. If the program
communication that might be more readily achieved in other less costly and
then, there may be great utility in having educational institutions develop and
maintain such programs as part of a larger program of adult education that is
lifelong and not just a seemingly last minute attempt to compensate for prior
failings.
Bibliography
Adams, D. L., “Correlates of Satisfaction among the Small Town Elderly,” Ph.D. diss., University of
Missouri, 1971.
Anderson, N., Work and Leisure, Free Press, New York, 1961.
Atchley, R. C., “Retirement and Leisure Participation: Continuity or Crisis,” The Gerontologist,
11:13–17, 1971.
Back, K. W., and Guptill, C. S., “Retirement and Self-Ratings,” in Simpson, I. H., and McKinney, J. C.
(Eds.), Social Aspects of Aging, Pp. 120-129, Duke University Press, Durham, N.C.,
1966.
Barfield, R. E., The Automobile Worker and Retirement: A Second Look, Institute for Social
Research, University of Michigan, Ann Arbor, Mich., 1970.
1760
_____, and Morgan, J. N., Early Retirement: The Decision and the Experience, Institute for Social
Research, University of Michigan, Ann Arbor, Mich., 1969.
Barron, M. L., “The Dynamics of Occupational Roles and Health in Old Age,” in Anderson, J. E.
(Ed.), Psychological Aspects of Aging, Pp. 236-239, American Psychological
Association, Washington, D.C., 1956.
_____, Streib, G. F., and Suchman, E. A., “Research on the Social Disorganization of Retirement,” Am.
Sociol. Rev., 17: 479-482, 1952.
Benz, M., “A Study of the Faculty and Administrative Staff Who Have Retired from New York
University, 1945-1956,” J. Educ. Sociol., 32:282-293, 1958.
Birren, J. E., “Increments and Decrements in the Intellectual Status of the Aged,” Psychiat. Res.
Rep., 23:207-214, 1968.
_____ (Ed.), Relations of Development and Aging, Charles C Thomas, Springfield, Ill., 1964.
Blakelock, E., “A New Look at the New Leisure,” Admin. Sci. Quart., 4:446-467, 1960.
Blauner, R., Alienation and Freedom: The Factory Worker and His Industry, University of Chicago
Press, Chicago, 1964.
Bracey, H. E., In Retirement: Pensioners in Great Britain and the United States, Louisiana State
University Press, Baton Rouge, La., 1966.
Breen, L. Z., “The Aging Individual,” in Tibbitts, C. (Ed.), Handbook of Social Gerontology, Pp. 145-
162, University of Chicago Press, Chicago, i960.
Buhler, C., “Meaningful Living in the Mature Years,” in Kleemeier, R. W. (Ed.), Aging and Leisure,
Pp. 345-388, Oxford University Press, New York, 1961.
_____, Powers, E., Falkman, P., and Frederick, D., Life after 70 in Iowa: A Restudy of Participants in
the ig6o Survey of the Aged, Sociology Report No. 95, Iowa State University,
Department of Sociology and Anthropology, Ames, Iowa, 1971.
Burgess, E. W., “Aging in Western Culture,” in Burgess, E. W. (Ed.), Aging in Western Societies: A
Comparative Survey, Pp. 3-28, University of Chicago Press, Chicago, 1960.
_____, Corey, L. G., Pineo, P. C., and Thornbury, R. T., “Occupational Differences in Attitudes toward
Aging and Retirement,” J. Gerontol., 23:203-206, '
Butler, R. N., “The Life Review: An Interpretation of Reminiscence in the Aged,” Psychiatry, 26:65-
76, 1963.
_____, “Patterns of Psychological Health and Psychiatric Illness in Retirement,” in Carp, F. (Ed.),
The Retirement Process, Pp. 27-41, Public Health Service Publication No. 1778, U. S.
Department of Health, Education and Welfare, National Institute of Child Health
and Human Development, Washington, D.C., 1969.
Cain, L. D., Jr., “Aging and the Character of Our Times,” The Gerontologist, 8:250- 258, 1968.
_____, “Life Course and Social Structure,” in Faris, R. E. L. (Ed.), Handbook of Modern Sociology, Pp.
272-309, Rand McNally, Chicago, 1964.
Carp, F. M. (Ed.), The Retirement Process, Public Health Service Publication No. 1778, U. S.
Department of Health, Education and Welfare, National Institute of Child Health
and Human Development, Washington, D.C., 1969.
Cavan, R. S., “Self and Role in Adjustment during Old Age,” in Rose, A. M. (Ed.), Human Behavior
and Social Processes, Pp. 526-536, Houghton Mifflin, Boston, 1962.
_____, Burgess, E. W., Havighurst, R. J., and Goldhamer, H., Personal Adjustment in Old Age, Science
Research Associates, Chicago, 1949.
1762
Charles, D. C., “Effect of Participation in a Pre-retirement Program,” The Gerontologist, 11 (No. 1,
Part II): 24-28, 1971.
Chinoy, E., Automobile Workers and the American Dream, Doubleday, New York, 1955.
Clague, E., “Work and Leisure for OlderWorkers,” The Gerontologist, 11:9-20, 1971.
Clarke, H. J., Social Legislation, 2nd ed., Appleton-Century-Crofts, New York, 1957.
Corson, J., and McConnell, J., Economic Needs of Older People, Twentieth Century Fund, New York,
1956.
Cottrell, F., Technological Change and Labor in the Railroad Industry, D. C. Heath, Lexington, Mass.,
1970.
_____, and Atchley, R. C., Women in Retirement: A Preliminary Report, Scripps Foundation, Oxford,
Ohio, 1969.
Cumming, E., “Further Thoughts on the Theory of Disengagement,” Internat. Soc. Set. J., 15-377-
393, 1963.
_____, and Henry, W. E., Growing Old: The Process of Disengagement, Basic Books, New York, 1961.
De Grazia, S., Of Time, Work and Leisure, Twentieth Century Fund, New York, 1962.
Deutscher, I., “Socialization for Postparental Life,” in Rose, A. M. (Ed.), Human Behavior and Social
Processes, Pp. 506- 525, Houghton Mifflin, Boston, 1962.
Donahue, W., et al. (Eds.), Free Time: Challenge to Later Maturity, University of Michigan Press,
Ann Arbor, Mich., 1958.
_____, Orrach, H. L., and Pollak, O., “Retirement: The Emerging Social Pattern,” in Tibbitts, C. (Ed.),
Handbook of Social Gerontology, Pp. 330-406, University of Chicago Press, Chicago,
1960.
Eteng, W. I. A., and Marshall, D. G., Retirement and Migration in the North Central States:
Comparative Analysis of Life and Retirement Satisfaction—Wisconsin, Florida and
Arizona, Population Series No. 20, University of Wisconsin, Department of Rural
Sociology, Madison, Wise., 1970.
Fillenbaum, G. G., “A Consideration of Some Factors Related to Work after Retirement,” The
Gerontologist, 11.18-23, '
_____, “On the Relationship between Attitude to Work and Attitude to Retirement,” J. Gerontol.,
26:244-248, 1971.
_____, “Retirement Planning Programs—At What Age, and for Whom?” The Gerontologist, 11:33-
36, 1971.
Fleming, R. W., and McGaughey, R., Civil Servants in Retirement, University of Wisconsin,
Industrial Relations Center, Madison, Wise., 1952.
Friedmann, E. A., “The Impact of Aging on the Social Structure,” in Tibbitts, C. (Ed.), Handbook of
Social Gerontology, Pp. 120-144, University of Chicago Press, Chicago, 1960.
_____, “The Work of Leisure,” in Donahue, W., et al. (Eds.), Free Time: A Challenge to Later Maturity,
University of Michigan Press, Ann Arbor, Mich., 1958.
_____, and Havighurst, R. J., The Meaning of Work and Retirement, University of Chicago Press,
Chicago, 1954.
Friedmann, G., The Anatomy of Work, Free Press, New York, 1961.
Glenn, N. D., “Aging, Disengagement, and Opinionation,” Public Opinion Quart., 33:17-33, 1969.
Glick, P. C., and Park, R., Jr., “New Approaches in Studying the Life Cycle of the Family,”
Demography, 2.187-202, 1965.
1764
Gordon, M., “Aging and Income Security,” in Tibbitts, C. (Ed.), Handbook of Social Gerontology,
University of Chicago Press, Chicago, 1960.
_____, “Work and Patterns of Retirement,” in Kleemeier, R. (Ed.), Aging and Leisure, Oxford
University Press, New York, 1961.
Grann, L., “Social and Personal Adjustment of Retired Persons,” Sociol. & Soc. Res., 39:311-316,
1955.
Great Britain Ministry of Pensions and National Insurance, Reasons for Retiring or Continuing
Work, H. M. Stationery Office, London, 1954.
Greene, M. R., Pyron, II. C., Manion, V. V., and Wixkelvoss, H., Early Retirement: A Survey of
Company Policies and Retirees' Experiences, University of Oregon, College of
Business Administration, Eugene, Ore., 1969.
_____, Preretirement Counseling, Retirement Adjustment, and the Older Employee, University of
Oregon, College of Business Administration, Eugene, Ore., 1969.
Gurin, G., Vehofk, J., and Feld, S., Americans View Their Mental Health: A Nationwide Interview
Study, Basic Books, New York, 1960.
Gutmann, D., Ego Psychological and Developmental Approaches to the “Retirement Crisis" in Men,
unpublished paper, University of Michigan, Department of Psychology, Ann Arbor,
Mich., n.d.
Harris, L., “ ‘Pleasant’ Retirement Expected,” The Washington Post, November 28, 1965.
Havighuhst, R. J., “Successful Aging,” in Williams, R. H, Tibbitts, C., and Donahue, W. (Eds.),
Processes of Aging, Vol. 1, Pp. 299-320, Atherton Press, New York, 1963.
_____, Neugarten, 15. L., and Tobin, S., “Disengagement and Patterns of Aging,” in Neugarten, B. L.
(Ed.), Middle Age and Aging: A Reader in Social Psychology, Pp. 161-172, University
of Chicago Press, Chicago, 1968.
Heron, A., “Retirement Attitudes among Industrial Workers in the Sixth Decade of Life,” Vita
Humana, 6.152-159, 1963.
Kaplan, M., “Toward a Theory of Leisure for Social Gerontology,” in Kleemeier, R. W. (Ed.), Aging
and Leisure, Pp. 389-412, Oxford University Press, New York, 1961.
Katona, G., Private Pensions and Individual Saving, Monograph No. 40, University of Michigan,
Institute for Social Research, Ann Arbor, Mich., 1965.
_____, Morgan, J. N., and Barfield, R. E., “Retirement in Prospect and Retrospect,” in Trends in Early
Retirement, Pp. 27-49, Occasional Papers in Gerontology, No. 4, Institute of
Gerontology, University of Michigan-Wavnc State University, Ann Arbor, Mich.,
1969.
Kerckhoff, A. C., “Family Patterns and Morale in Retirement,” in Simpson, I. H, and McKinney, J. C.
(Eds.), Social Aspects of Aging, Pp. 173-192, Duke University Press, Durham, N.C.,
1966.
_____, “Husband-Wife Expectations and Reactions to Retirement,” in Simpson, H., and McKinney, J.
C. (Eds.), Social Aspects of Aging, Pp. 160-172, Duke University Press, Durham, N.C.,
1966.
Kleemeier, R. W. (Ed.), Aging and Leisure, Oxford University Press, New York, 1961.
_____, “The Effect of a Work Program on Adjustment Attitudes in an Aged Population,” J. Gerontol.,
6:373-379, 1951.
1766
_____, “Leisure and Disengagement in Retirement,” The Gerontologist, 4:180- 184, 1964.
Kolodrubetz, W. W., “Trends in Employee-Benefit Plans in the Sixties,” Soc. Secur. Bull., ,34:21-34,
1971.
Kooy, G. A., and Van’t Klooster-Van Wingerden, C. M., “The Aged in an Urban Community in the
Netherlands,” Human Dev., 11:64-77, 968.
Kreps, J., “Employment Policy and Income Maintenance for the Aged,” in McKinney, J. C., and de
Vyver, F. T. (Eds.), Aging and Social Policy, Pp. 136-157, Appleton- Century-Crofts,
New York, 1966.
Kuhlen, R. G., “Aging and Life-Adjustment,” in Birren, J. E. (Ed.), Handbook of Aging and the
Individual, Pp. 852- 897, University of Chicago Press, Chicago, 1959.
_____, “Motivational Changes during Adult Years,” in Kuhlen, R. G. (Ed.), Psychological Backgrounds
of Adult Education, Pp. 77-113, Center for the Study of Liberal Education for Adults,
Chicago, 1963.
Kutner, B., Fanshel, D., Togo, A. M., and Langner, T. S., Five Hundred over Sixty: A Community
Survey on Aging, Russell Sage Foundation, New York, 1956.
Lehr, U., and Dreher, G., "Determinants of Attitudes toward Retirement,” in Havighurst, R. J.,
Munniehs, J. M. A., Neugarten, B. L., and Thomae, H. (Eds.), Adjustment to
Retirement: A Cross-National Study, 2nd ed., Pp. 116- 138, Van Gorcum and
Company, Assen, The Netherlands, 1970.
Lemon, B., Bengston, V. L., and Peterson, J., “Activity Types and Life Satisfaction in a Retirement
Community: An Exploration of the Activity Theory of Aging,” paper presented to
the 8th International Congress of Gerontology, Washington, D.C., 1969.
Life Extension Foundation, Retirement Study: Overall Summary of 1546 Questionnaires, The
Foundation, New York, 1956.
Lipman, A., “Role Conceptions and Morale of Couples in Retirement,” ]. Gerontol., 16:267-271,
1961.
Loether, H. J., “The Meaning of Work and Adjustment to Retirement,” in Shostak, A. B., and
Gomberg, W. (Eds.), Blue-Collar World, Pp. 517-525, Prentice- Hall, Inc., Englewood
Cliffs, N.J., 1964.
Lowenthal, M. F., “Social Isolation and Mental Illness in Old Age,” Am. Sociol. Rev., 29:54-70, 1964.
McKain, W. C., Retirement Marriage, Monograph No. 3, Storrs Agricultural Experiment Station,
University of Connecticut, 1969.
McKinney, J. C., and De Vyver, F. T. (Eds.), Aging and Social Policy, Appleton- Century-Crofts, New
York, 1966.
McMahan, C. A., and Ford, T. R., “Surviving the First Five Years of Retirement,” J. Gerontol., 10:212-
215, 955.
McNeil, J. S., and Giffen, M. B., “Military Retirement: Some Basic Observations and Concepts,”
Aerospace Med., ,36:25- 29, 1965.
_____, “The Social Impact of Military Retirement,” Soc. Casework, 46:203-207, 1965.
Maddox, G. L., Jr., “Activity and Morale: A Longitudinal Study of Selected Elderly Subjects,” Soc.
Forces, 42,195-204, 1963.
_____, “Fact and Artifact: Evidence Bearing on Disengagement Theory from the Duke Geriatrics
Project,” Human Dev., 8.117-130, 1965.
_____, “Persistence of Life Style among the Elderly: A Longitudinal Study of Patterns of Social
Activity in Relation to Life Satisfaction,” in Proceedings of the 7th International
Congress of Gerontology, Vienna, 8:309-311, 1966.
_____, “Retirement as a Social Event,” in McKinney, J. S., and de Vyver, F. T. (Eds.), Aging and Social
Policy, Pp. 117-135, Appleton-Century-Crofts, New York, 1966.
1768
_____, and Eisdorfer, C., “Some Correlates of Activity and Morale among the Elderly,” Soc. Forces,
40:2.54-260, 1962.
Martel, M. U., and Morris, W. W., Life after Sixty in Iowa: A Report on the 1960 Survey, Iowa
Commission for Senior Citizens, Iowa City, Iowa, 1961.
Martin, J., and Doran, A., “Evidence Concerning the Relationship between Health and Retirement,”
Sociol. Rev., 14:329-343, 1966.
Messer, E. F., “Thirty-Eight Years is a Plenty,” in Trends in Early Retirement, Pp. 50-66, Occasional
Papers in Gerontology, No. 4, Institute of Gerontology, University of Michigan-
Wayne State University, Ann Arbor, Mich., 1969.
Miller, S. J., “The Social Dilemma of the Aging Leisure Participant,” in Rose, A. M., and Peterson, W.
A. (Eds.), Older People and Their Social World, Pp. 77- 92, F. A. Davis Co.,
Philadelphia, 1965.
Moore, W. E., Industrial Relations and the Social Order, esp. Chapter 21, “The Aged in Industrial
Societies,” Pp. 519–537, Macmillan, New York, 1951.
_____, Industrialization and Labor: Social Aspects of Economic Development, Cornell University
Press, Ithaca, N.Y., 1951.
_____, Man, Time and Society, John Wiley, New York, 1963.
Morrison, D. E., and Kristjanson, G. A., Personal Adjustment among Older Persons, Technical
Bulletin No. 21, South Dakota State College, Agricultural Experiment Station,
Brookings, S.D., 1958.
Morse, N. C., and Weiss, R. R., “The Function and Meaning of Work and the Job,” American Sociol.
Rev., 20:191-198, 1955-
Murray, J. R., Powers, E., and Havighurst, R. J., “Personal and Situational Factors Producing
Flexible Careers,” The Gerontologist, 11 (No. 4, Part II): 4-12, 1971.
Neugarten, B. L., “Adult Personality: Toward a Psychology of the Life Cycle,” in Neugarten, B. L.
(Ed.), Middle Age and Aging: A Reader in Social Psychology, Pp. 137-147, University
of Chicago Press, Chicago, 1968.
_____, “Personality and the Aging Process,” The Gerontologist, 12.-9-15, 1972.
_____, Moore, J. W., and Lowe, J. C., “Age Norms, Age Constraints, and Adult Socialization,” Am. J.
Sociol., 70:710- 717, 1965.
_____, and Peterson, W. A., “The American Age-Grade System,” in Proceedings of the 4th Congress of
the International Association of Gerontology, Merano, Italy, 3:497-502, 1957.
Nosow, S., and Form, W. H. (Eds.), Man, Work and Society, Basic Books, New York, 1962.
Orbach, H. L., “Normative Aspects of Retirement,” in Tibbitts, C., and Donahue, W. (Eds.), Social
and Psychological Aspects of Aging, Pp. 53-63, Columbia University Press, New York,
1962.
_____, “Social and Institutional Aspects of Industrial Worker’s Retirement Patterns,” in Trends in
Early Retirement, Pp. 1-26, Occasional Papers in Gerontology, No. 4, Institute of
Gerontology, University of Michigan-Wayne State University, Ann Arbor, Mich.,
1969.
_____, “Social Values and the Institutionalization of Retirement,” in Williams, R. H., Tibbitts, C., and
Donahue, W. (Eds.), Processes of Aging, Vol. 2, Pp. 389-402, Atherton Press, New
1770
York, 1963.
_____, and Shaw, D. M., “Social Participation and the Role of the Aged,” Geriatrics, 12:241-246,
1957.
Orzack, L., and Friedmann, E. A., Work and Leisure Interrelationships, paper presented at Fourth
World Congress on Sociology, Milan, Italy, September 1959.
Owen, J. P., and Belzung, L. D., “Consequences of Voluntary Early Retirement: A Case Study of a
New Labor Force Phenomenon,” Brit. J. Indust. Rel., 5: 162-189, 1967.
Palmer, G., “Attitudes toward Work in an Industrial Community,” Am. J. Sociol., 63:17-26, 1957.
Palmore, E. B., “Differences in the Retirement Patterns of Men and Women,” The Gerontologist,
5:4-8, 1965.
_____, “Retirement Patterns among Aged Men: Findings of the 1963 Survey of the Aged,” Soc. Secur.
Bull., 27 (No. 8): 3-10, 1964.
Peck, R., “Psychological Developments in the Second Half of Life,” in Anderson, J. E. (Ed.),
Psychological Aspects of Aging, Pp. 42-53, American Psychological Association,
Washington, D.C., 1965.
Phillips, B. S., “A Role Theory Approach to Adjustment in Old Age,” Am. Sociol. Rev., 22:212-217,
1957.
Pihlblad, C. T., and Rosencranz, H. A., Retirement Status of Older People in a Small Town, Interim
Report, Vol. 3, University of Missouri, Department of Sociology, Columbia, Mo.,
1968.
_____, Social Adjustment of Older People in the Small Town, Interim Report, Vol. 4, University of
Missouri, Department of Sociology, Columbia, Mo., 1969.
Pollak, O., Social Adjustment in Old Age: A Research Planning Report, Bulletin 59, Social Science
Research Council, New York, 1948.
_____, “Early Retirement: Relationship to Variation in Life Satisfaction,” The Gerontologist, 11:43-
47, 1971.
Reichard, S., Livson, F., and Peterson, P. G., Aging and Personality, John Wiley, New York, 1962.
Reno, V., Retirement Patterns of Men at OASDHl Entitlement, Preliminary Findings from the Survey
of New Beneficiaries, Report No. 2, U. S. Department of Health, Education and
Welfare, Social Security Administration, Office of Research and Statistics,
Washington, D.C., 1971.
_____, Why Men Stop Working at or before Age 65, Preliminary Findings from the Survey of New
Beneficiaries, Report No. 3, U. S. Department of Health, Education and Welfare,
Social Security Administration, Office of Research and Statistics, Washington, D.C.,
1971.
Richardson, A. H., “Alienation and Disengagement among the Very Aged,” in Proceedings of the 7th
International Congress of Gerontology, Vienna, 8:539-545, 1966.
Riesman, D., The Lonely Crowd, Yale University Press, New Haven, 1950.
_____, and Bloomberg, W., Jr., “Work and Leisure: Fusion or Polarity?” in Arensberg, C., et al. (Eds.),
Research in Industrial and Human Relations, Pp. 69- 85, Harper & Brothers, New
York, 1957.
Rosenberg, G. S., The Worker Grows Old: Poverty and Isolation in the City, Jossey- Bass, San
Francisco, 1970.
Rosow, I., “Adjustment of the Normal Aged,” in Williams, R. H., Tibbitts, C., and Donahue, W.
(Eds.), Processes of Aging, Vol. 2, pp. 195-223, Atherton Press, New York, 1963.
_____, “Intergenerational Relationships: Problems and Proposals,” in Shanas, E., and Streib, G.
(Eds.), Social Structure and the Family, Pp. 341-378, Prentice-Hall, Englewood Cliffs,
N.J., 1965.
1772
_____, Social Integration of the Aged, Free Press, New York, 1967.
Ryser, C., and Sheldon, A., “Retirement and Health,” J. Am. Geriatrics Soc., 17: 180-190, 1969.
Schneider, C. J., “Adjustment of Employed Women to Retirement,” Ph.D. diss., Cornell University,
1964.
Scotch, N. A., and Richardson, A. H., “Characteristics of the Self-Sufficient among the Very Aged,”
in Proceedings of the 7th International Congress of Gerontology, Vienna, 8:489–493,
1966.
Sewell, W. H., Ramsey, C. E., and Ducoff, L. J., Farmer’s Conceptions and Plans for Economic Security
in Old Age, Research Bulletin 182, Wisconsin Agricultural Experiment Station,
Madison, Wise., 1953.
Shanas, E., “Facts versus Stereotypes: The Cornell Study of Occupational Retirement,” ]. Soc.
Issues, 14 (No. 2): 61-62, 1958.
_____, and Streib, G. F., eds., Social Structure and the Family: Generational Relations, Prentice-Hall,
Englewood Cliffs, N.J., 1965.
Friis, H., Milhj^j, P., and Stehouwer, J., Old People in Three Industrial Societies, Atherton Press, New
York, 1968.
Sheppard, H. L., “Discontented Blue-Collar Workers—A Case Study,” Monthly Labor Rev., 94:25-
32, 1971.
Simmons, L. W., The Role of the Aged in Primitive Society, Yale University Press, New Haven, 1954.
Simpson, I. H., Back, K. W., and McKinney, J. C., “Attributes of Work, Involvement in Society, and
Self-Evaluation in Retirement,” in Simpson, I. H., and McKinney, J. C. (Eds.), Social
Aspects of Aging, Pp. 55-74, Duke University Press, Durham, N.C., 1966.
_____, “Orientations toward Work and Retirement, and Self-Evaluation in Retirement,” in Simpson,
I. H., and McKinney, J. C. (Eds.), Social Aspects of Aging, Pp. 75-89, Duke University
Press, Durham, N.C., 1966.
Simpson, I. H., and McKinney, J. C. (Eds.), Social Aspects of Aging, Duke University Press, Durham,
N.C., 1966.
Smith, J., and Marshall, D. G., Retirement and Migration in the North Central States: Two Planned
Retirement Communities, Population Series No. 23, University of Wisconsin,
Department of Rural Sociology, Madison, Wise., 1970.
Smith, K. J., and Lipman, A., “Constraint and Life Satisfaction,” J. Gerontol., 27: 77-82, 1972.
Spence, D. L., “Patterns of Retirement in San Francisco,” in Carp, F. (Ed.), The Retirement Process,
Pp. 63-76, Public Health Service Publication No. 1778, U. S. Department of Health,
Education and Welfare, National Institute of Child Health and Human Development,
Washington, D.C., 1969.
Spengler, J. J., “The Aging of Individuals and Populations,” in McKinney, J. C., and de Vyver, F. T.
(Eds.), Aging and Social Policy, Pp. 3-41, Appleton-Century-Crofts, New York, 1966.
Stanford, E. P., “Retirement Participation in the Military,” The Gerontologist, 11: 37-42, 1971.
Stecker, M., “Beneficiaries Prefer to Work,” Soc. Secur. Bull., January 1951.
Steiner, P., and Dorfman, R., The Economic Status of the Aged, University of California Press,
Berkeley, Calif., 1957.
Stokes, R. G., and Maddox, G. L., Jr., “Some Social Factors on Retirement Adaptation,” J. Gerontol.,
22:329-333, 1967.
1774
1968.
_____, “Family Patterns in Retirement,” J. Soc. Issues, 14 (No. 2): 46-60, 1958.
_____, “Intergenerational Relationships: Perspectives of the Two Generations on the Older Parent,”
J. Marriage & Fam., 27:469-475, 1965.
_____, Longitudinal Study of Retirement: Final Report to the Social Security Administration,
Washington, D.C., Cornell University, Department of Sociology, Ithaca, N.Y., 1965.
_____, “Participants and Drop-outs in a Longitudinal Study,” J. Gerontol., 21: 200-209, 1966.
_____, and Orbach, H. L., “Aging,” in Lazarsfeld, P. F., Sewell, W. H., and Wilensky, H. L. (Eds.), The
Uses of Sociology, Pp. 612-640, Basic Books, New York, 1967.
_____, and Schneider, C. J. (S.J.), Retirement in American Society: Impact and Process, Cornell
University Press, Ithaca, N.Y., 1971.
_____, and Thompson, W. E., “Personal and Social Adjustment in Retirement,” in Donahue, W., and
Tibbitts, C. (Eds.), The New Frontiers of Aging, Pp. 180- ig7, University of Michigan
Press, Ann Arbor, Mich., 1957.
Taietz, P., and Larson, O. F., “Social Participation and Old Age,” Rural Sociol., 30:229-238, 1956.
_____, Streib, G. F., and Barron, M. L., Adjustment to Retirement in Rural New York State, Bulletin
919, Cornell University Agricultural Experiment Station, Ithaca, N.Y., 1956.
Thompson, E. P., “Time, Work Discipline and Industrial Capitalism,” Past and Present: A Journal of
Historical Studies, 38: 56-97, 1967.
_____, and Streib, G. F., “Meaningful Activity in a Family Context,” in Kleemeier, R. W. (Ed.), Aging
and Leisure, Pp. 212, Oxford University Press, New York, 1961.
_____, “Situational Determinants: Health and Economic Deprivation in Retirement,” J. Soc. Issues,
14 (No. 2): 18-34, 1958.
_____, _____, and Kosa, J., “The Effect of Retirement on Personal Adjustment: A Panel Analysis,” J.
Gerontol., 15.165-169, 1960.
Tibbitts, C. (Ed.), Handbook of Social Gerontology, University of Chicago Press, Chicago, i960.
_____, and Donahue, W. (Eds.), Social and Psychological Aspects of Aging, Columbia University
Press, New York, 1962.
Tissue, T., “Downward Mobility in Old Age,” Soc. Prob., 18:67-77, 1970.
Treanton, J.-R., “The Concept of Adjust ment in Old Age,” in Williams, R. H., Tibbitts, C., and
Donahue, W. (Eds.), Processes of Aging, Vol. 1, pp. 292-298, Atherton Press, New
York, 1963.
Tuckman, J., and Lorge, I., Retirement and the Industrial Worker: Prospect and Reality, Columbia
University, Teachers College, Bureau of Publications, New York, 1953.
Tyhurst, J. S., Salk, L., and Kennedy, M., “Mortality, Morbidity and Retirement,” Am. J. Public
Health, 47:1434-1444, 1957.
United Nations, Department of Economic and Social Affairs, The Aging of Populations and Its
Economic and Social Implications, Population Studies No. 26, United Nations, New
York, 1956.
_____, Department of Economic and Social Affairs, Demographic Yearbook, 1970, United Nations,
1776
New York, 1971.
U.S. Department of Commerce, Bureau of Census, Statistical Abstract of the United States, 1970,
U.S. Government Printing Office, Washington, D.C., 1971.
_____, “United States, General Population Characteristics, Advance Report,” PC(V2)-i, February
1971.
U.S. Social Security Administration, Soc. Secur. Bull., 33 (No. 4), 1970.
_____, Bureau of Old Age and Survivors Insurance, More Selected Findings of the 'National Survey of
Old Age and Retirement Insurance Beneficiaries, 1951, Washington, D.C., 1954.
Valaoras, V. G., “Young and Aged Populations,” Ann. Am. Acad. Pol. Soc. Sci., 316:69-83, 1968.
Videbeck, R., and Knox, A. B., “Alternative Participatory Responses to Aging,” in Rose, A. M., and
Peterson, W. A. (Eds.), Older People and Their Social World, Pp. 37-48, F. A. Davis
Co., Philadelphia, 1965.
Walker, C. R., and Guest, R., Man on the Assembly Line, Harvard University Press, Cambridge,
Mass., 1952.
Webber, I. L., “The Organized Social Life of the Retired,” Amer. ]. Sociol., 59: 340-346, 1954.
Wilensky, H., “Life Cycle, Work Situation and Participation in Formal Associations,” in Kleemeier,
R. W. (Ed.), Aging and Leisure, Pp. 213-242, Oxford University Press, New York,
1961.
_____, and Lebeaux, C., Industrial Society and Social Welfare, Free Press, New York, 1965.
Williams, R. H., Tibbitts, C., and Donahue, W. (Eds.), Processes of Aging, Vol. 2, Atherton Press, New
York, 1963.
_____, and Wirths, C. A., Lives through the Years, Atherton Press, New York, 1965.
Youmans, E. G., “Family Disengagement among Older Urban and Rural Women,” J. Gerontol.,
_____, “Objective and Subjective Disengagement among Older Rural and Urban Men,” J. Gerontol.,
21:439-441, 1966.
[1] Increased life span has not been a significant factor in this increase. Although life expectancy at
birth has increased dramatically in the last century, life expectancy at age 50, for
example, has increased only a couple of years. Thus, more persons are now living to the
later stages of adulthood but, once having reached there, they do not have a substantially
greater life expectancy than their counterparts 100 or 200 years ago.
[2] The growing relationship between institutionalization of retirement income provisions and its
acceptance as a social role should not be allowed to obscure the extent of financial
hardship among the currently retired. The institutionalization of measures for providing
more adequate income support for the aged over the past two decades has reduced the
proportion of the aged living below a government-defined poverty level from 35 percent
in 1959 to 25 percent in 1968, but it still leaves poverty as one of the major problems of
the retired in the United States.
[3] Streib and Schneider cite examples of this from the 1963 Encyclopedia of Mental Health. Dr. Douglas
Orr writes, “Retirement is a mental health hazard under any circumstances.” Discussing
situations leading to reactive depressions, Dr. Felix Von Mendelssohn lists “forced
retirement” along with such situations as “crippling accidents and diseases, totally
hopeless situations . . . and loss of skills.” According to Dr. Kenneth Soddy, “Many men
find their most important identity in their career, which, being relinquished, establishes
a strong tendency toward early breakdown and death” (p. 107). They also point out that
in each of eighteen instances where the notion of retirement from work is meaningfully
discussed, the depressive or negative effects are emphasized.
[4] Under Social Security men may file entitlement claims but not receive benefits because they
continue to work. Another reason for filing in recent years is to qualify for Medicare
benefits.
[5] One problem in particular is clue to the fact that most studies of early retirement indicate a strong
positive relationship with high retirement income, while studies of Social Security
beneficiaries indicate, in addition, a stronger positive relationship to extremely low
income and marginal relationship to the labor force. Perhaps these latter cases are by-
1778
passed in the other studies because their marginality excludes them from inclusion in
the labor force.
Old Age
Robert N. Butler
For some, old age becomes a consummation of one’s life; for others it is
an occasion for grief, guilt, and despair; and for many it is complicated by
insufficient medical services. In this chapter we shall deal with the nature of
old age, its normal conditions, and its potentiality for psychopathology.
Handbook.
“Many a man goes fishing all his life without realizing it is not the fish he
helpful in delineating the culmination of the life cycle range from the poetic
1780
endeavors to provide therapeutic help as well as upon our understanding of
old age.
Old age is one part of a continuing process of the life cycle and cannot be
understood in a vacuum. The perspectives of both the life cycle and history
are useful. The individual life cycle comprises successive stages and processes
First, there is variation over time in the status and roles of old people. Second,
there is the impact of the history of one’s own times. The student of aging and
impact of historic experience upon older people in the third quarter of the
twentieth century, one should read such pertinent works as Barbara
Tuchman’s The Proud Tower and Frederick Lewis Allen’s The Big Change.
Old people and children have become increasingly socially visible since
other philosophers and writers have considered the life cycle as a concept
and have proposed various divisions and stages. The Swedish sociologist
Ellen Key wrote of the twentieth century as the “century of the child.” The
Childhood, emphasized the social and historical evolution of the child in the
last two centuries. Victor Hugo, among others, observed the conspicuousness
of old people in number and social significance from the turn of the
sociologists, and psychologists have shown some interest in the nature of the
life cycle. William James, Mead, Buhler, Havighurst, Benedek, Erikson, Pressey
and Kuhlen, and Neugarten are among recent writers who have given
attention to the nature of the life cycle with some particular emphasis upon
old age and the transitional middle-age period. In 1922 G. Stanley Hall
published the first major American study of the psychology of old age.
Rothschild, Grotjahn, Goldfarb, Weinberg, Linden, Busse, and Simon are a few
1782
has pointed out, sociology remains primarily concerned with class
course of life. The mass media have been somewhat more conscious of the
aged, and old people) necessitate the recognition of three generic classes of
variables, historical, generational, and life stage. First are historic changes
accounting for any differences that are found, for example, different amounts
of education. The second class concerns the parent-child relationship, the
one age group and another and to the processes or stages of life. For example,
the roles, responsibilities, and preoccupations of a person in middle age must
How people live their lives, how they change in the course of time, and
human development rather than one. Special problems include the study of
the subjective experience of the life cycle, including aging, changes of the body
and the self-concept, and approaching death. Because of the intensive, long-
term nature of psychoanalytic relationships, psychoanalysts could potentially
provide special insights about the nature of the middle years, the experience
of aging and disability, the denouement of character, and the crises of the
creative personality moving through time from youth into the middle and
Old age cannot be seen as a static, fixed, unitary period, but must be
seen as the resultant of a range of forces. In that sense the study of old age has
particular value. It is only the elderly who can teach us about the nature of the
life cycle as a whole, who can provide us with insights into the ultimate
through time. They can give us special, if poignant, insights into the nature of
grief, despair, and depression. If we understood these various subjects better
—from our studies of the elderly— our understanding would have general
influenced by our better understanding of the old. Our treatment of grief and
1784
the possibility of suicide in the young would be helped by our understanding
of these in the old. In the United States it is the elderly who account for one-
In 1900, 4 per cent of the population was 65 years and older, and the
average life expectancy at birth, combining both sexes, was 47 years of age.
years. The elderly now constitute nearly 10 per cent of the population. The
In social terms old age is defined as 65 years and above. The choice of
conception.
Of the 20 million Americans over 65, half are over 73. Gerontologists
now think in terms of early and of advanced old age, 65 to 74 and 75 and
above. Indeed, the age 65 is an obsolete cutoff point in terms of health, ability,
and social status. Life expectancy at 65 is 15 years; for men it is 13 years, for
women 16. More than 11 million of the elderly are women; more than eight
excellent status. In 1970, for every 100 older persons over 65, 57 were
women and 43 men. There were 135 older women to every 100 older men.
The ratio increases from 120 at age 65 to 69 to more than 160 at age 85 and
over. Throughout the world, wherever there are decent living conditions, low
Most older men are married, most older women are widowed. There are
Three times as many older women live alone or with nonrelatives as do older
men. Once again we see the extent to which the older woman is especially
isolated. Some 16,000 older women marry each year; some 35,000 older men
do.
Seven of every ten older persons live in families. Nearly one-quarter live
older people live in an institution. Approximately 5 per cent live in old age
homes, nursing homes, and a variety of other types of facilities. Put more
1786
White persons make up less than 90 per cent of the total population, but
they make up 92 per cent of the older population. This is because of the
Although the black population dies at a greater rate throughout the course of
life, once a black has survived to old age, he has a greater survival rate.
the general characteristics of old age. Since “being educated” in the best sense
statistics is suspect. Half of the older population has had only elementary
schooling or less, while half of those under 65 have had at least a high school
education. Of every 100 older people, eight men and eight women 65 years
and older had no schooling or less than five years and are therefore
If one utilizes the highly stringent and conservative poverty index, one
out of every four older people live below the poverty line. Thus, in 1969 4.8
million persons 65 and over lived in poverty. Although 10 per cent of the
population, they constitute 20 per cent of America’s poor. Eighty-five per cent
of the aged poor are white. Between 1968 and 1969 the poor, 65 and over
deprivation. For instance, as of January 1971 ten million, that is, one-half of
the elderly population of the United States, lived on less than $75 per week or
some $10 per day. Twice as many aged blacks live in poverty as aged whites.
Social Security and Medicare have not met the income maintenance and
medical needs of older people. The average Social Security earnings of older
Americans in early 1971 was $118 per month. Medicare only covers
approximately 45 per cent of all health needs and the older person has to
make up the rest. Since the life expectancy for black men is 60.1, they often do
Twenty-nine per cent of the income of the elderly still derives from their
own earnings. Three of ten men and one of ten women over 65 are in the
65 years of age were in the labor market, but by 1970 only one-fourth were.
On the other hand, the rate of employment of elderly females increased from
1788
about 8 per cent in 1900 to about 10 per cent in 1970. The aggregate income
of the elderly is nearly $60 billion a year. Twenty-nine per cent is earned, 52
per cent comes from retirement, Social Security, and welfare programs, and
Older people, black and white, tend to live in central cities and in rural
which older people migrate). The majority of aged blacks reside in the South
(60.8 per cent). States that have populations of older people greater than the
national average include Florida (13.2 per cent), Iowa, Kansas, Maine,
Vermont. New York State has nearly two million older people. California,
Illinois, and Pennsylvania also have over one million older people. New York
City alone has approximately one million old people. Arizona, Nevada, Florida,
Hawaii, and New Mexico showed the greatest percentage growth between
1960 and 1965.
cent of all older people are registered to vote, and nearly two-thirds of older
people routinely do vote. These are much higher percentages of participation
than many other age groups have. The bulk of American voters are in their
forties. This is important from the psychological point of view because of the
restlessness and “militancy” for “senior power.” With a sense of influence and
into an effective political force commensurate with their numbers and vote.
existence is out to destroy us.” His diaries written in his eighties and nineties
delineate these feelings as one moves through the trajectory of the life cycle.
On the one hand, there is growth and development and, on the other hand,
1790
concerned with what happens to their children in their immediate world, the
famous with their immortality. We see the sense of sponsorship of the young,
people as they move through the postmeridian period of life. Some grow
that are really due to the inimical forces at work—or one may see interest in
society, the facts of disease and poor care, and the impact of poverty. Old age,
of course, is also the congeries of outcomes of personalities that may have
appropriate appraisal. Both the generalities of old age and the particularities
of the individual older person must be evaluated.
creative forces.- The sense of legacy or continuity may be seen in many forms,
body, its organs or parts, counseling, teaching and sponsoring, and the
resolution of the problem of time (with the end of time panics and boredom)
with the development of an appropriate valuation of time. With serenity or
tranquility there may develop a sense of historic perspective, the capacity to
summarize and comment upon one’s times and work as well as upon one’s
life.
Erikson has contributed the idea of generativity, on the one hand, and
stagnation, on the other. With respect to later life he has proposed the
alternatives of ego integrity and despair. These polarities, while useful, are
1792
oversimplifications of extremely complex human experiences. Increasingly
students of the middle and later years have a growing respect for the
and taking on new ones is characteristic of the flow of life as a whole, if one
takes the life cycle perspective. Young people, for example, must give up their
parental attachments and seek new ones. However much difficulty the young
conducive to mental health is contrary to the hard data and the impressions
of many sophisticated observers. Social valuation, roles, and interaction
profound, and affect so many systems, bodily as well as social, the advantage
and adaptive level of older people. For purposes of convenience, these factors
fall into two broad categories: extrinsic and intrinsic. Among the extrinsic
Anger and extreme rage in addition to grief and despair may be present.
1794
Social losses of status and prestige occur in the absence of roles—the
country profoundly affect the older person. Many older people do not wish
especially keenly felt. Organic brain disease that may be minimal or mild may,
are losses in the speed of processes and of responses. For example, reaction
which some respond with fear, some with denial, and most with equanimity.'
A few wish to die, and many increasingly welcome it, especially in terminal
illness. There is a sense of release. I have had patients calmly put themselves
to bed falsely thinking they are about to die. Some people consciously or
unconsciously panic.
and to those that follow as well as to the resolution of one’s life experience.
They also depend upon the openness and quality of one’s immediate
1796
relationships. There is now an extensive literature on dying, including Eissler,
Glaser and Strauss, and Kubler-Ross, yet perhaps no one has delineated the
age comes the salient process that I have called the life review, prompted by
the realization of approaching death and characterized by the progressive
successfully reintegrated, the life review can give new and significant
meaning to one’s life and help prepare one for death, mitigating one’s fears.
This naturally occurring process has been found to correlate with adaptation.
point, as one and perhaps only one variable began to fail, the whole “house of
the older person; if any one of them or if a number of them collectively attain
don’t realize how many answers they already have. Through their
new, important, valued social roles for the elderly along with a sense of
pleasure and celebration in life would provide important ingredients to
adjustment to old age. Work and retirement patterns are important to mental
health.'
“shelved” despite tested ability and the desire to work. Our society has chosen
the lazy way out through arbitrary retirement rather than through the
1798
individualized approach.
younger, healthier, and better educated. The average age of admission into
length now averages about 14 years, may average 25 years by the year 2000.
It is apparent that educational and cognitive obsolescence is induced by our
scholar of human nature and the psychiatrist must have a vision of the
varying patterns of health care and life expectancy. Newborn infants are not
likely to be too different from historic era to historic era, depending, of
course, upon basic health and sanitation. But those who have lived through a
life of change may be quite surprisingly different from one historic period to
another. Moreover, old people are a variegated group and not a homogeneous
variation in the character of old people. There are certain great “levelers,”
particularly massive brain disease, illiteracy, and poverty. But when those
personality is obvious.
social function and in the deeper sense of a need to acquire meanings about
the nature of human existence and one’s life and death. Older people are not
ideas. These notions are found in our “advanced culture” as well as among so-
The old often need to make reparations for the past. They may
undertake a variety of expiatory behaviors in order to resolve their profound
reassurance. Old people generally act as if they had free will and self-
responsibility and not as if their behavior were determined by the historic
conditions of their childhood. American old people in the third quarter of the
pride. This helps account for their difficulty in seeking public assistance even
when it is justified by poverty that occurred beyond their control. Old people
resist seeking help although they have paid personal and property taxes over
the years that would more than cover their cumulative welfare payments.
Suicide reaches its peak in men in their eighties. This partly reflects
marginal social status or anomie. Some kill themselves to spare their families
1800
economic devastation when they have a lingering fatal illness. Others assert
their right to die and request euthanasia. Old people, unlike young people,
see the dangers of excess identity vividly portrayed in Arthur Miller’s Death of
a Salesman.°
One of the most striking, important, and adaptive qualities of old age is
the continuing presence of curiosity and surprise. This relatively rare type of
factors make sustained growth extremely difficult. Obstacles stand in the way
compulsive and schizoid personalities, for example, are impairing at any age
of life. However, in old age both of these may prove to be adaptive. This
The compulsive person may find his ritualistic and fastidious behavior useful
in filling the void of retirement. Perlin observed that dependent people may
concepts, not in a vacuum, but in the contemporary context that itself must be
evaluated.
Some people hold grudges for a lifetime: hates may outlast love.
various disease states, from senile vaginitis to prostatic disease, desire and
1802
health, and in good relationships, sexuality proceeds late into life. Once again
chronological age per se, while important, may not have such overriding
Rigidity in old age may be a function of anxiety, as Atkin pointed out in 1941.
Weinberg has pointed out that old people may protectively exclude stimuli.
This is seen in the older person who hears what he wishes to hear. Old people
may not only exploit their disabilities in aging, however. Out of pride they
invalids, too, may exploit their disabilities, especially if they fear their needs
will not be met.) The dependent needs of the elderly, the reality of their
reduced resources, has been stressed by Goldfarb, who, in fact, thinks of age
adaptation. Given equal personal, social and bodily losses, one person may
thrive while another fails. The most effective form of adaptation is that
average expectable life cycle as well as that of the sense of the life cycle.
Not all older people display the various characteristics and qualities that
have been observed in this chapter, but a sufficient number of older people do
so, thus revealing the healthy normal trends related to the closing chapter of
life.
definitions of the later stages of the life cycle as there are for early childhood
and adolescence. We rely primarily upon conventions, usually employing
While in old age the autobiographical process manifests itself as the life
1804
review, in middle age it has the apparent purpose of stocktaking. It provides
an opportunity to consider new possibilities and alternatives in order to
the other. Another critical element in the middle years concerns the testing of
one’s personal, professional, and other commitments. This problem of fidelity
underlies and includes the narrower question of marital fidelity. One’s fidelity
Growing awareness of the realities of aging and death also lead to body
Middle age is often viewed as “the prime of life,” but it is the period in
which the sense of success or failure may deeply plague and frighten people
called empty nest phenomenon may affect both the middle-aged man and
states in women. Old wives’ tales particularly terrify women in this regard.
Psychiatric disorders are “explained” by the menopause without deeply
melancholia.” There have been studies among women of various ages of the
life cycle. Nearly 50 per cent of the U.S. population is under 25 and ten per
cent over 65, leaving 40 per cent to bear the social, economic, and personal
responsibilities for the two groups who are most vulnerable economically and
1806
contemplative, and yet these are values that the older person might
potentially offer (if their whole life had not been otherwise prescribed). If the
recollect, reminisce, counsel, and comment upon his experience, the final
chapter of life may in the future offer the sense of dignity and self-respect that
have there been studies of personality development and change in the adult
years. Little has been specified about the continuity of personality over long
various reasons. W hat few studies there are of cognitive abilities show the
preservation and even the increase in intellectual functioning over the years.
This is true of Owens’s' studies of college alumni. Study of Terman’s group of
gifted children followed into their late forties indicated that, with few
When comparisons are made between one age group and another,
XIMH studies comparing healthy young controls and healthy old people, the
old people did not show the declines of cerebral oxygen consumption, blood
flow, and intellectual functioning that had been expected. The long-term
studies of community elderly by Busse" and his group are available. Aging and
psychotherapists are often pessimistic about change after middle life. Freud,
himself very pessimistic about change after middle life, made most of his
Hartmann wrote of the “genetic fallacy.” For instance, castration anxiety has
1808
been used to explain fear of death in older people, leaving out basic human
concern with death per se in old age, which is also reinforced by specific,
realistic, personal concerns about the effects of one’s death upon other
people. Another overused and misused construct has been regression. Among
lay people the comparable overused and misused term is “second childhood.”
functioning may be studied by using elements that deplete the ego such as
drugs and organic brain damage. Schuster has reported on one 106-year-old
man.
Kelly studied 300 engaged couples first examined in the 1930’s and
retested in 1955 when they were in their forties. After correcting the
inevitable. For example, in Erikson’s view the last stage manifests ego
integrity at best; that is, inevitably “the acceptance of one’s one and only life
substitutions. . . Buhler, on the other hand, sees development in the life course
atrophy of the ability to project oneself into the future as a feature of old age.
One major source for understanding the nature of old age is the writings
of articulate, perceptive old people. Tolstoy’s and Berenson’s last diaries are
remarkable. The description by the author Eric Hodgins of his “stroke” and
the care he received (and didn’t receive) should be read by all physicians.
life, are important. Politicians and judges are relatively immune from
to prejudice, they may be better prepared for the prejudices operative against
the elderly. Much more must be learned about the black elderly. The
1810
also have yet to be studied in sufficient detail.
The family structure and relations of old people have been the subject of
and grandchildren may have very close relationships and enter into covert
and secret struggles with the middle generation. Even outside of formal
photograph albums, old letters help support the older person in his
environment, preserve his sense of continuity, aid his memory, and provide
1812
arrangements that might be of value in providing more adequate support for
the aged in different cultures.
Creativity may continue late into life; it does not invariably decline with
Humboldt, Franck, Hugo, Verdi, Tolstoy, Shaw, and Freud are but a few
famous examples. Had Freud died before he was 40, we would hardly know
him. He was 44 when his magnum opus, The Interpretation of Dreams, was
published. He was 67 when The Ego and the Id appeared, containing his
structural hypothesis with the concepts of id, ego, and superego. Factors that
facilitate or impede the creative life must be studied. The autodidact or self-
Grief and widowhood the nature of time and leisure, late life alcoholism,
age and of the potential vulnerabilities for emotional and mental disorders.
Old people are subjected to infantilization, patronization, blunt hostility, and
disparagement. They are called crocks, biddies, old fogies, witches, and crones
among other epithets. With increasing life expectancy likely through the
opportunities, of old age will be increasing. The human sciences and the
Bibliography
Albrecht, R., “Social Roles in the Prevention of Senility,” J. Gerontol., 6:380, 1951.
Aldrich, K., and Mendkoff, E., “Relocation of the Aged and Disabled: A Mortality Study,” J. Am.
Geriatric Soc., 11: 185-194, 1963.
Aries, P., Centuries of Childhood: A Social History of Family Life, Knopf, New York, 1962.
Bahn, A. K., Outpatient Population of Psychiatric Clinics, Maryland 1958-59, Public Health
Monograph No. 65, 1965.
Bartko, J. J., Patterson', R. D., and Butler, R. N., “Biomedical and Behavioral Predictors of Survival:
A Multivariant Analysis,” in Palmore, E. (Ed.), Prediction of Life Span, Heath,
Lexington, Mass., 1971.
Benedek, T., “Climacterium: A Developmental Phase,” Psychoanal. Quart., 19:1- 27, 1950.
1814
7:389-417, 1959.
Berenson, B., Sunset and Twilight: Diaries of 1947-58, Harcourt, Brace & World, New York, 1963.
Berezin, M. A., Some Intrapsychic Aspects of Aging,” in Zinberg, N. E., and Kaufman, I. (Eds.),
Normal Psychology of the Aging Process, International Universities Press, New York,
1963.
Birren, J. E., Handbook of Aging and the Individual, University of Chicago Press, Chicago, 1959.
_____, Butler, R. N., Greenhouse, S. W., Sokoloff, L., and Yarrow, M. R., Human Aging: A Biological
and Behavioral Study, U.S. Public Health Service Monograph Publication No. 986,
Washington, D.C., 1963, Paperback reprint, 1971.
_____, _____, _____, _____, and _____, “Reflections,” in Granick, S., and Patterson, R. D. (Eds.), Human
Aging II: An Eleven Year Biomedical and Behavioral Study, U.S. Public Health Service
Monograph, Washington, D.C., 1971.
Blenkner, M., “Environmental Changes and the Aging Individual,” The Gerontologist, 7:2, 1967.
Brotman, H. B., Facts and Figures on Older Americans, U.S. Department of Health, Education and
Welfare, Washington, D.C., March 1971.
_____, Who Are the Aged: A Demographic View, Institute of Gerontology, University of Michigan-
Wayne State University, Ann Arbor, 1968.
Buhler, C., “The Curve of Life as Studied in Biographies,” J. Appl. Psychol., 19:405- 409, 1935.
Busse, E. W., Therapeutic Implications of Basic Research with the Aged, Institute of Pennsylvania
Hospital, Strecker Monograph, Series No. 4, 1967.
Butler, R. N., “Ageism: Another Form of Bigotry,” The Gerontologist, 9:243-246, 1969.
_____, “The Destiny of Creativity in Later Life,” in Levin, S., and Kaharna, R. (Eds.), Geriatric
_____, Hearings, Part 1, Subcommittee on Retirement and the Individual, Special Committee on
Aging, U.S. Senate, U. S. Government Printing Office, Washington, D.C., 1967.
_____, “The Life Review: An Interpretation of Reminiscence in the Aged,” Psychiatry, 26:65-76,
1963.
_____, and Lewis, M. I., Aging and Mental Health: Positive Psychosocial Approaches, The C. V. Mosby
Co., St. Louis, 1973.
Butler, R. N., “Toward a Psychiatry of the Life Cycle: Implications of Socio-psychologic Studies of
the Aging Process for the Psychotherapeutic Situation,” in Simon, A., and Epstein, L.
J. (Eds.), Aging in Modern Society, Chap. 20, American Psychiatric Association, 1968.
_____, Dastur, D., and Perlin, S., “Relationships of Senile Manifestations and Chronic Brain
Syndrome to Cerebral Circulation and Metabolism,” ]. Psychiat. Res., 3:229-238,
1965.
_____, and Sulliman, L. G., “Psychiatric Contact with the Community-Resident, Emotionally-
Disturbed Elderly,” J. Nerv. & Ment. Dis., 137:180-186, 1963.
Carp, F. M., A Future for the Aged: Victoria Plaza and Its Residents, University of Texas Press,
Austin, 1966.
_____, The Retirement Process, Public Health Service Publication No. 1778, U.S. Government
Printing Office, Washington, D.C., 1968.
Clark, M., and Anderson, B. G., Culture and Aging: An Anthropological Study of Older Americans,
Charles C Thomas, Springfield, Ill., 1967.
Comfort, A., The Process of Aging, New American Library, New York, 1961.
Cumming, E., and Henry, W. E., Growing Old: The Process of Disengagement, Basic Books, New
York, 1961.
1816
DeGrazia, S., Of Time, Work and Leisure, Twentieth Century Fund, New York, 1962.
Donahue, W., and Tibbitts, C. (Eds.), Politics of Age, University of Michigan Press, Ann Arbor, 1962.
Eissler, K., The Psychiatrist and the Dying Patient, International Universities Press, New York,
1955.
Erikson, E. H., Childhood and Society, 2nd ed., Norton, New York, 1954.
Friedman, E. A., and Havighurst, R. J., The Meaning of Work and Retirement, University of Chicago
Press, Chicago, 1954.
Gitelson, M., “The Emotional Problems of Elderly People,” Geriatrics, 3:135, 1948.
Glaser, B. G., and Strauss, A. L., Awareness of Dying, Aldine, Chicago, 1965.
_____, “Prevalence of Psychiatric Disorders in Metropolitan Old Age and Nursing Homes,” J. Am.
Geriatrics Soc., 10:77-84, 1952.
Gordon, M. M., “Social Class in American Sociology,” Am. J. Sociol., 55:262-268, 1949-
Gorer, G., Death, Grief and Mourning in Contemporary Britain, Grosset Press, London, 1965.
Greenleigh, L., “Timelessness and Restitution in Relation to Creativity and the Aging Process,” J.
Amer. Geriatrics Soc., 8-353-358, 1960.
Group for the Advancement of Psychiatry, Toward a Public Policy on Mental Health Care of the
Elderly, Report No. 79, 1970.
Gutmann, D., “Mayan Aging: A Comparative TAT Study,” Psychiatry, 29:246-259, 1956.
Hall, G. S., Senescence, the Last Half of Life, Appleton, New York, 1922.
Hodgins, E., Episode: Report on the Accident inside My Skull, Atheneum, New York, 1964.
Jackson, H., Double Jeopardy—The Older Negro in America Today, National Urban League, 1964.
Jackson, J. J., “Social Gerontology and the Negro: A Review,” The Gerontologist, 7: 169-178, 1967.
Kelly, E. L., “Consistency of the Adult Personality,” Am. Psychol., 10:659-681, 1955.
Krapf, E. E., “On Aging,” Proc. Roy. Soc. Med., 46:957-964, 1953.
Kutner, B., Fanshel, D., Toc.e, A. M., and Langner, T. E., Five Hundred over Sixty: A Community
Survey of Aging, Russell Sage Foundation, New York, 1956.
Lawton, M. P., “Gerontology in Clinical Psychology and Vice-Versa,” Aging & Human Dev., 1:147-
159, 1970.
_____, Liebowitz, B., and Charen, H., “Physical Structure and the Behavior of Senile Patients
Following Ward Remodeling,” Aging & Human Devel., 1:231-239, 1970.
Lehman, H. C., Age and Achievement, Princeton University Press, Princeton, 1953.
Lehmann, V., and Mathiason, G., Guardianship and Protective Services for Older People, National
Council on Aging Press, New York, 1963.
Linden, M. E., “The Older Person in the Family: Studies in Gerontologic Human Relations, VII,” Soc.
1818
Casework, ,37:75, 1956-
Lowenthal, M. F., “The Relationship between Social Factors and Mental Health in the Aged,” in
Simon, A., and Epstein, L. J. (Eds.), Aging in Modern Society, American Psychiatric
Association, 1968.
_____, and Zilli, A., Interdisciplinary Topics in Gerontology: Colloquium on Health and Aging of the
Population, Vol. 5, S. Karger, New York, 1969.
Maddox, G. L., “Disengagement Theory: A Critical Evaluation,” The Gerontologist, 4: 80-82, 103,
1964.
Marris, P., Widows and Their Families, Routledge and Kegan Paul, London, 1958.
Moorehead, H. H., “Study of Alcoholism with Onset Forty-Five Years or Older,” Bull. N. Y. Acad.
Med., 34:99-106, 1958.
Neugarten, B. L., “ ‘Menopausal Symptoms’ in Women of Various Ages,” Psychosom. Med., 27:266-
273, !965-
_____, (Ed.), Middle Age and Aging: A Reader in Social Psychology, University of Chicago Press,
Chicago, 1968.
_____, Personality in Middle and Later Life, Atherton Press, New York, 1964.
_____, and Weinstein, K. K., “The Changing American Grandparent,” J. Marriage & Fam., 26:199-
204, 1964.
Oriol, W. E., “Social Policy Priorities: Age vs. Youth; The Federal Government,” The Gerontologist,
10:207-219, 1970.
Owens, W. A., Jr., Age and Mental Abilities: A Longitudinal Study,” Genet. Psychol. Monog., 48:3-54,
1953.
Perlin, S., “Psychiatric Screening in a Home for the Aged. I. A Followup Study,” Geriatrics., 13:747-
751, 1958.
Pressey, S. L., and Kuhlen, R. G., Psychological Development through the Life Span, Harper & Row,
New York, 1957.
Reichard, S., Livsen, F., and Paterson, P. G., Aging and Personality, Wiley, New York, 1962.
Rogow, A. A., James Forrestal: A Study of Personality, Politics and Policy, Macmillan, New York,
1964.
Rosow, I., “Retirement Housing and Social Integration,” in Tibbitts, C., and Donahue, W. (Eds.),
Social and Psychological Aspects of Aging, pp. 327-340, Columbia University Press,
New York, 1962.
Sands, S. E., and Rothschild, D., “Sociopsychiatric Foundations for Theory of Reactions to Aging,” J.
Nerv. & Ment. Dis., 116:233, 1952.
Saveth, E. N., Utilization of Older Scientific and Professional Personnel, National Council on Aging,
New York, 1961.
Schuster, D., “A Psychological Study of a 106-Year-Old Man,” Am. J. Psychiat., 109: 112, 1952.
Shanas, E., and Streib, G. F., Social Structure and the Family: Generational Relations, Prentice-Hall,
Englewood Cliffs, N.J., 1965.
Simmons, L. W., The Role of the Aged in Primitive Societies, Yale University Press, New Haven,
1945.
Strehler, B., “Long-Range Programs and Research Needs in Aging and Related Fields,” Testimony,
Hearings, Special Committee on Aging, U.S. Senate, 90th Congress, December 5 and
6, 1967, Part I, Pp. 1397-1414, U.S. Government Printing Office, Washington, D.C.,
1820
1965.
Task Force, Special Committee on Aging, U. S. Senate, Economics of Aging: Toward a Full Share in
Abundance, U.S. Government Printing Office, Washington, D.C., 1969.
Terman, L. M., and Oden, M. H., The Gifted Group at Middle Life, Stanford University Press,
Stanford, 1959.
Thompson, P. W., “The Church and Its Role in the Promotion of Health in Older Persons,” in The
Aging and the United Presbyterian Church, United Presbyterian Church, Chicago,
1964.
Tobin, S. S., and Neugarten, B. L., “Life Satisfaction and Social Interaction with Aging,”J. Gerontol,
16:244-246, 1961.
Tolstoy, L. (1886), The Death of Ivan Ilych, Signet Classics, New York, 1960.
_____, Last Diaries (Ed. by Stilman, L.), G. P. Putnam, New York, 1960.
Van Gennep, A., The Rites of Passage, University of Chicago Press, Chicago, 1960.
Weinberg, J., “Personal and Social Adjustment,” in Anderson, J. E. (Ed.), Psychological Aspects in
Aging, American Psychological Association, Washington, D.C., 1956.
Yarrow, M., Blank, P., Quinn, O. W., Youmans, E., and Stein, J., “Social Psychological Characteristics
of Old Age,” in Human Aging: A Biological and Behavioral Study, Chap. 14, Public
Health Service Publication No. 986, 1953, Paperback reprint, 1971.
Rose Spiegel
Overview of Crisis
Scope of Crisis
Crises are part of the vicissitudes of living— not only as painful stress,
extremes of emotional disorders outside the usual flow of life. They may arise
from specific stress events that are predominantly situational but are
are crises of confrontation between the individual and his culture, with a wide
1822
generally all these aspects are involved in some proportion. Actually a less
obvious aspect may be the well-spring for the particular crisis and, in turn,
arising in their lives—nor in his own since he, too, is subject to vicissitudes
whether individual, family, or group, that does not at some time involve crisis.
Crisis may be the moving force toward therapy. Indeed, some persons come
others. For instance, they may be bound to relationships with persons who
are in crisis or who are crisis-prone and are demandingly dependent.
precipitator of therapy in the first place, they generally occur in the context of
specific life situations—of career, of marital or other interpersonal
relationship. But these types of stress experience barely touch on the large
tides of life that basically affect everyone and at times make the person seek
help. However, under the ostensible specific events and situations of overt
crises, the vulnerability often exists because of the deeper surge of these
Emotional crises and crises in living may arise from such stark
and its aftermath, with which we were intimately familiar in the Nazi era and
World War II, and which we are again forced to face in the crisis of values and
the destruction resulting from the war in Vietnam. The current crisis of
of personal decision and position. Another variation in the role of the culture
is, the culture often is crisis-making because of the values attached to the
Other crises are more related to specific personal experience and to the
the areas of decisions directly related to the ailment, of threats to one’s sense
of identity, of the meaning the physical has to the person, and of psychological
1824
adaptation.
maturity, and decline, and the challenges involved in coming to terms with
the ultimate. Falling in love presents a crisis not only interpersonally but also
Besides this progression, this hidden pageantry in life itself, there are
the prosaic, seemingly trivial everyday confrontations that, in miniature, test
interpersonal tensions and inner conflicts. These include the competitive and
ethical issues of everyday life. Subtly these involve living with oneself in a
perspective on the crisis. This is true both in private lives and on the social
crisis for him may involve his reaction to the visible crisis, to his lack of power
to enter into its solution. Crisis is a threat to homeostasis. Both when the
for disaster, that the protagonist in the crisis senses profoundly and with
anxiety or even terror. The reactions and defenses that may fan out are
legion. Anxiety is only one of that range and often not at all on a verbal
feeling they are most alive in the challenge of coping. At times the distinction
appropriate practical terms and coming out on the other side of the crisis into
the next phase in living with an enhancement of ego powers and of the whole
personality.
1826
To me the irreducible characteristic of crisis is the unpredictability of
generally for all concerned, including the person in the therapist role. Crisis
already occurred; the action called for to meet the catastrophe is generally
more clear than in crisis, although whether the coping measures will be
adequacy of the response to it. Emergency often calls for the mopping up of
others who are involved in it with him. That is, there is varying ability to
does at different times, subject to what affects his stamina in general. The
factual doubt inherent at a particular time in the crisis situation may be
personality reactions to crisis, but also in an overall sense they vary in the
maturity they bring to crisis, in the preparation by life experience and
Thus there often is a convergence of the cognitive, the emotional, and the
outer reality. Crisis often involves not only the individual but also other
persons linked to him —the central individual—in his network of
larger and larger groups, until with some individuals larger segments of
society are involved, for which they generate crises in turn. The illness or the
the classical example of the central crisis setting off spreading waves of
their relationship and role both in generating and in coping. This clarification
unresolved crisis, such as in family situations, lasts about six weeks, generally
changing its character of acuteness for chronicity. That is, either acute stress
1828
falls into a persistingly bad condition, with transformation of the sense of
acuteness, or the situation takes still another form, with a realignment of its
However, although this time span offers a handy and useful formula, the
persists far longer than the allotted span, eliciting the characteristic painful
tension and desperation, and still remains unrecognized as crisis. For some
repression, denial, or lack of recognition, as the case may be, moving toward
development. In due course the next stage emerges, in better or worse form,
whether in fullness or as a token marking the progression. We do know that
aging.
but on lack of direction for resolution or coping, on despair and a quiet giving
anxiety and insecurity, particularly in children. We can see the parallel with
potentially catastrophic, and which of itself is not open to choice and decision,
sweep of crisis, from inception and even provocation to the coping. The
1830
living as crises. Every semblance of the new and different is experienced as
crisis, sometimes authentically, sometimes as an expression of manipulative
in coping with crisis involves stress. It involves both physical and emotional
mobilization of energies and reading a level of readiness to act. This is
up athlete and the conditioned or warmed up one. In meeting stress and crisis
point in time the same person can cope effectively. Where the person is at in
the crisis response is important to sort out. For instance, there may be a
2. The persons involved and their role and reactions, ranging from the
central person, perhaps as storm center, to the person who,
formally or not, is in the helper role.
5. The external resources that may be called on to help cope with the
crisis.
1832
culminating and terminating with the prime of life, but as an arc of total life,
going on to the final stages of change and adaptation, namely, aging and
dying. Maturation does not fall into a simple, smooth linear graph, but
involves transition stations that are critical points. These critical points are
not necessarily points of crisis but are landmarks of vulnerability, which may
transitions and critical points involve fulfillment of one phase and separation
from its mode of experience and relatedness, followed by a new mode, with
qualitative overlap with the past as well as with change. In the early years the
new epochs are involved with change into a different organization of the
psyche. Characteristic also of developmental transitions and critical points
are somatic forces, with correlated reverberations in the psyche that are
for the newborn as well as for the mother. The birth process is a physiological
revolution, whose alternatives involve life and death, existence with a sound
organism or a damaged one. Rank, in his Trauma of Birth, elevated aspects of
in his terms. Indeed, there is separation from the mother, but for our
purposes it is not necessary to follow Rank in taking this separation as the
basic pattern for all separation, and “the temporary asphyxiation at birth”
with its physiological symptoms as the fundamental model for anxiety. Suffice
and slapping the infant to hasten his breathing, thus curtailing the due and
slower and less shocking changeover from the intrauterine world to the
1834
physiological, for better or worse. The emergence of the power of choice is
part of development itself, and cultivating the art of choice is part of the art of
living. In the very young the prototype of choice is close to the level of
physiological protest against what violates him, and it blends with the power
to rebel that soon begins to declare itself in more psychological form.
very young are subject to usually are generated and inflicted by others. The
Sullivan- early pointed out. These are the everyday stress experiences, which,
depending both on the child and the parent, may be severe enough to make
for crises in the child’s anxiety concerning mastery of skills and the “reflected
development and on the gratification of the budding psyche with its needs for
tenderness and for communication. Thereby the infant is subject to crises of
clearly observable have their critical points of transition, which, whether for
1836
playmates, and chums. Each enlargement bears with it a separation and a
vulnerability. Unfortunate resolution of separation crises of what should be
tension, hostility, and indifference. The young are subject to anxiety and
subsequent depression from separations that could have been handled better
— particularly those of divorce. While the adult is undergoing the grave crises
cope with, without outside help. Not only does the child suffer in the
accident- prone came from homes with serious family problems of physical
and psychiatric illness and marital discord. Other children in that study had
responded to their stress with other kinds of symptoms such as asthma and
frequently comment with surprise that others seem to “know” what they are
burgeoning femininity and sexuality concerns the role of her father. His
acceptance of her as a woman and his anxiety, intimacy, or distancing from
her at adolescence affect her from the point of view of sanction. But beyond
the actual developmental period the separation from the father, whether
initiated by the girl as a defense or by him, has been observed by the writer to
Indeed, crises of early life for which effective help was not given, and which
then released in the later depressions, are often too simplistically attributed
to the later developmental stage.
1838
The identity crisis involves every transition in development, including
middle age and old age, but it is most dramatic and is experienced as most
of proper ego strengths, with new abilities, control, and sense of self. And in
all the sense of self involves a new integration of the sexuality of that era.
What is involved is not only sexuality but also the way the sexuality is related
It is an astonishing fact that in the last few years, I believe for the first
time, adolescent turmoil has not been simply an internal affair, but has made
its impact on society and the culture, forcing change in them. During their
identity crises adolescents may manifest a range of disturbance—depression,
and societal values—a questioning that deserves respect. The obscurity for
many adolescents of life goals often enters into the rebellion and also into
depression and despair. These and more variants generally fall within the
range of the normative identity crisis. It is the my clinical impression that the
cynically often has recourse to a tough, cynical surface that hides depression,
reactions. These carry a generally good prognosis, better than in the slower,
suicide is the outcome of a not yet established ego; love and its confirmation
are experienced qualitatively as a young child and quantitatively with the
power of youth, since the transition to mature strength in loving has not yet
been made. Either the experience of falling in love is overwhelming, or the
Adolescents, in contrast to young children, are far less at the mercy of adults,
1840
The establishment of maturity brings with it the added challenges both
mature sense involves not only intimacy and caring but also the intrapsychic
process of making room within for the intimate other. In fact, falling in love
and intimate loving present emotional crises that for some personalities, such
as the schizoid, are very frightening. The threat of chaos and anxiety in the
unhappy experience, take the position that safety lies in setting up barriers to
loving.
internal and external sources. The internal origin has to do directly with the
one’s parents, and one’s children grow up and leave. Over these one has little
There are other time-linked critical events that are not biological but
that have to do with the attitudes of others by which we are governed and
create crises for individuals and their families that the counterforces of the
community and protective laws can step in to compensate for the power the
individual lacks.
Maturity, marriage, and the birth and rearing of children bring critical
situations, which have been discussed from the point of view of the child and
are here to be viewed from the other end of the telescope. Pregnancy,
particularly the first one for both parents, is a critical period, both physically
and emotionally, in terms of the relationship between husband and wife. Like
falling in love, it requires making room in the psyche for the developing baby,
acceptance. How often this crisis period is passed through with flying colors is
suggested by the extreme anguish and frustration when the crisis moves
his “responsibility” in the pregnancy and at the baby, who was experienced as
a hostile stranger invading her body and against whom she was helpless to
1842
withdraw as she longed to.
Still other emotional crises, particularly for the girl or woman, involve
pregnancy. Important are the age and emotional era of life when it occurs, the
relationship to the partner, and the socioeconomic situation. The decision for
covertly and illegally affects the crisis situation, not only physically in terms
The crises of maturity, as has been said, include the situation of the
growing up and departure of one’s children. Parental overcontrol at this time
allied to the classical depressive reaction of reproaching the loved one for
Choice, the art of living and loving, and critical points in development
converge in later maturity. Again the art of living involves cultivation of one’s
self, the capacity to love, the ability to be productive and even creative.
For women the time around the menopause is a crisis period. There is
the well-known vulnerability to the depressions. The complexity of this
years and of worshiping the cult of youth and immaturity. The hormonal
crisis varies for different women, according to biochemical studies. For those
for whom the physiological upheaval is experienced as critical, medical help is
available—an outer resource for alleviating a (psycho) somatic crisis. The
woman’s struggles with this crisis period may involve the actual limitation of
choice on a cultural basis, which calls for problem-solving on other levels. A
particular woman may misread the attitudes, use the cultural attitudes as a
1844
For men, at approximately this age, but generally ten years or so later,
middle age and aging crisis bring with them various attempts at solution.
test one’s acceptability and to prove one’s masculinity sexually. This period
for men, as well as the rather earlier period for women, is depression-prone.
These periods of the crises of the middle years have the inner
this vulnerability. A prominent role in our society, more so for men than for
women, is acceptability for employment, and here society is harsh. For men
diminished employment opportunity with the middle years creates, in
Although one’s life style plays a role in this time of crisis, so do X factors of
health and constitution, and such situational factors as one’s world of friends,
relatives, and intimates. Obviously for many this is a period of powers
culture are recognizing and hopefully will deal with effectively and kindly.
each one as an individual and society in the large recognize dying and death,
establishing the values its members live by. And although the word “crisis” is
rampant on the social scene, society’s crisis-making force for the individual
has hardly been faced in those terms. Society inculcates not only explicit
values but also the standards for self-esteem and self-image. Standards for
success and failure, one’s self-expectations, and disappointment in career and
status are intimately involved with cultural values and with the familiar
periodic crises that few of us are immune too.
1846
There are in our various subcultures actively punitive attitudes directed
disapproved pairings of age, ethnic and religious differences, and sex. Those
violating these rules are faced with group hostility, even if not by organized
formal law, and they undergo crises of despair, sometimes unendurable and
everyone’s lifetime. Margaret Mead has urged preparation for change in the
Some years ago, but still within the lifetime of many of us, the code,
particularly for girls, was not to marry early, but after completing one’s
education, and to have two children to replace the parents. Then it was marry
early and have a large family. Then it became more permissive about
marriage, children in or out of wedlock, and small families, particularly
orientation to these challenges and changes in sexual patterns, life styles, and
crisis of coming to new terms with a world they doubt that they made.
particularly for higher- level business executives, makes for both personal
and economic crises, and crises in family relationships. The attachment of a
makes for crises that, though widespread, still are experienced in the
individual as a unit. Some of the crises in which society and the culture are
1848
Coping with crisis involves recognition of what it’s all about, problem-
Bibliography
Bowlby, J., “Process of Mourning,” in Gaylin, W. (Ed.), The Meaning of Despair, Science House, New
York, 1968.
Caplin, G., Principles of Preventive Psychiatry, Basic Books, New York, 1964.
_____, Hansell, N., Jacobson, G. F., Crisis Therapy, San Francisco, American Psychiatric Association,
May 11, 1970.
Deutscher, M., “Some Clinical Observations on Expectant Fathers,” paper presented at the Harry
Stack Sullivan Society of the William Alanson White Institute, January 14. 1962.
Erikson, E. H., Identity and the Life Cycle, International Universities Press, New York, 1959.
Farber, L. H., The Ways of the Will, Basic Books, New York, 1966.
_____, History of Family Problems Found in Children Who Suffer Accidents,” Medical Tribune,
Mead, M., “The Future as the Basis for Establishing a Shared Culture,” Daedalus, Winter 1965,
135-155, 1965.
Roesler, T., and Deisher, R. W., “Youthful Male Homosexuality,” J.A.M.A., 210: 1018-1023, 1972.
Shakespeare, W., As You Like It, act II, scene 7, line 139 ff.
Smith, W. G., “Critical Life Events and Prevention Strategies in Mental Health,” Arch. Gen. Psychiat.,
25.103-110, 1971.
Spiegel, R., “Depressions and the Feminine Situation,” in Goldman, G., and Milman, D. S. (Eds.),
Modern Woman, Charles C Thomas, Springfield, Ill., 1972.
_____, Management of Crises in Psychotherapy,” in Goldman, G., and Strieker, G. (Eds.), Practical
Problems of a Private Psychotherapy Practice. Charles C Thomas, Springfield, Ill.,
1972.
_____, Seminars on Crises and Psychoanalysis, William Alanson White Psychoanalytic Institute.
Sullivan, H. S., Conceptions of Modern Psychiatry, William Alanson White Psychiatric Foundation,
Washington, D.C., 1947-
Thompson, C., Psychoanalysis: Evolution and Development, Hermitage House, New York, 1950.
[1] In an unedited movie Breathing and Running. filmed by Peter Robinson, Inc., New York City, and
exhibited at the William Alanson White Institute, 1970 (now edited).
1850
Chapter 33
Alberta B. Szalita
I follow’d rest; rest fled and soon forsook me;
I ran from grief; grief ran and overtook me.
The shadow of death haunts man even when he does not think about it. With the expansion of
consciousness characteristic of our age of awareness, the transience of our
existence is brought home with greater force, particularly since the survival of the
race has become an ever present concern. Yet man manages to deny this ultimate
reality—his mortality—with illusions of perpetual youth, reliance on advances in
technology, and naive belief in magical solutions.
Only the giants of our globe, according to Gorki, are able to live as if
death did not exist while living in fear of it. The average human being has the
task of finding a midpoint between denial of death and obsessive fear of it. It
is noteworthy that the greatest intellects as well as the mentally ill show a
marked preoccupation with death. The former transform their obsession into
a creative quest for immortality; the latter suffer the anguish to the point of
Modern man does not place easy trust in religious systems to aid him in
this dilemma; rarely does he believe in life in the hereafter. Grief, sorrow, and
the dying patient and his family, as well as the rehabilitation of the physically
reason. Every patient soliciting help has many grounds for deep grief.
abundant and diverse; its sources are manifold. It is necessary to restrict the
1852
particularly a beloved person—he normally undergoes a period of grief and
reconciles him to the loss and permits him to continue his life with
place when one is confronted with a disappointment, failure, the loss of a love
Grief is a common human experience, for life does not spare any of us
those events, major or minor, that cause sorrow. Normally grief, even over a
very serious loss, is more easily resolved when shared; a person usually has
some intimate friends or family members with whom he is able to share his
pain. But beneath the surface of consciousness remains a core of deep sorrow
that the bereaved person has to work through alone. Profound sorrow is
silent.
suddenly killed in an automobile accident, her father warns her that it will
take time for the loss to sink in, and then it will get worse. He continues:
It’ll be so much worse you’ll think it’s more than you can bear. Or any
other human being. And worse than that, you’ll have to go through it alone,
because there isn’t a thing on earth any of us can do to help, beyond blind
animal sympathy.
What a grief-stricken person needs is “common sense,” love of life, and what
Those who seek help are sometimes very lonely people who have the sense to
look for someone to share their grief with them, or they may display various
aspects of the pathology of mourning, but the majority come for other
reasons.
Pathology of Mourning
1854
On the physiological side there are to be found conversion symptoms,
condition that caused the death. Somatic delusions have also been recorded.
Thus, a young man who lost his mother during adolescence and did not
mourn her death developed the menopauselike symptoms that she presented
following reactions to loss: (1) “normal” grief; (2) anticipatory grief; (3)
inhibited, delayed, and absent grief; (4) chronic grief (perpetual mourning);
Before focusing on some specific types of loss, I shall discuss the general
man still demonstrates an array of irrational beliefs and attitudes that fall
within the range of normality. Some of these are culturally determined, some
perhaps, through channels unknown to us. Thus, we often feel that the
moment the soul leaves the body it is everywhere, sees everything, and is
aware of our every thought. The first impulse is not to think anything bad nor
to say anything derogatory about the dead. De mortuis nil nisi bonum.
conscience; but to undergo the process effectively, one has to have the
vengefulness of the spirit or ghost of the dead. A vengeful image of the dead
only too often terrorizes those who had an intensely ambivalent relationship
1856
with the departed and who repressed or denied their hostile feelings,
particularly obsessive, compulsive characters. But it would be a mistake to
think that hysterically defended bereaved persons are free from such
tortures.
When the relationship was more or less mature and well integrated, the
loss, however hard it may be to bear, has a different quality of pain. One may
miss a person intensely, and feel the full impact of the loss—psychologically,
guilt, to justify one’s past behavior, apologize to and appease the dead. One is
able to deal more realistically with a real loss because of the relative absence
of unconscious guilt.
lost her extended family—her parents, a brother three years older than
War II. Their neighbors rounded them up and shot them, under the
her family might be wiped out had never entered her mind. Such things might
happen, but not to her family. Immediately after reading the letter, she felt
stunned. “Something snapped in my head,” she said. “It was as if a curtain had
fallen down on a part of my brain and chopped off part of it.”
Since she had not visited her childhood home for many years and had
been out of communication with her family from the beginning of the war,
news of the tragedy changed nothing in her life. And yet something changed
drastically inside her. She became extremely fearful and irritable at home. At
work she could take care of people “better than before,” she said, “because I
was able to shut out everything when I was with a patient; but at home I felt
empty.” She had previously read a great deal, but from the moment she
learned about the extermination of her family, she was unable to concentrate
thought, but would not be able to think about anything. To think meant to
think about the fate of her family, which she was afraid to do. She knew, she
said, that she had to follow in the footsteps of all the members of her family as
they moved toward their collective grave, but she was unable to do so.
Whenever she started to think about what had happened to them, she felt she
would either lose her mind or kill herself. She avoided any discussion of the
holocaust.
1858
She became self-absorbed at home, unresponsive to the needs of her
husband and child. For a time she felt incapable of being a good mother and
entrusted the care of her son to a spinster sister-in-law, only to reclaim him
later. Traveling to and from work she would often enter an empty subway car
and scream at the top of her lungs. She was gripped by a kind of inner-
directed attention, “as if I had to hold myself together and not think.” The only
time she allowed herself some pleasure, such as dining out or going to the
theater, was when a stranger was there to enjoy it with her; then she could
feel that she was doing something for another person. She entertained
thoughts of divorcing her husband because she felt she had nothing to offer
him. During this period she began to suffer from headaches, low back pain,
and anxiety attacks during which she felt as though she would faint or die.
places, and also of going alone anywhere except to work. Meanwhile, she
continued to work at peak efficiency. Thus, three years elapsed before she
sought help.
relationships, one after another, with her dead relatives. She would identify
herself totally with whatever member of the family she was concentrating on,
repeating his or her gestures, speaking in the same way, and behaving so as to
her guilt.
members were not supposed to experience negative feelings, let alone utter
them. In treatment she harbored suicidal thoughts when she became aware of
her anger toward the dead for “abandoning” her and her envious attitudes
toward her siblings; the uncovering of her death wishes for them so shocked
her that she became even more desperate. When these wishes became clear,
she felt that she was a danger to everyone close to her. She said that she was
responsible for the deaths in her family; Hitler had simply carried out her
wishes. She feared that her husband, son, and therapist would suffer a similar
fate through her evil influence. She experienced a strong need to be punished.
She burned herself while cooking or lighting a cigarette. In her dreams the
deceased were alive and often angry with her. Whether awake or dreaming,
Apparently each person she mourned was first sequestered in her mind,
isolated as a unit of behavior, and then accounted to, as if still living, in order
each of the departed before reaching the point where their deaths became a
reality for her. Until then they maintained a life of their own within her.
1860
Schematically one may distinguish the following stages in mourning:
live with them, for life is fraught with conflicts. There is good reason to equate
effective living with the mastery of polyvalence.
is the need to face the ultimate reality of life—death—with the full realization
of one’s helplessness to evade its finality. One dreams of eternal youth and
denies one’s own demise in countless ways, but real mourning affords no
hiding place from this existential truth.
The rituals prescribed for funerals, which many include under the term
“mourning,” vary from culture to culture, but they express a common theme.
They are all oriented toward appeasing and showing respect for the dead.
These ceremonials tend to retard the mourning process and intensify the
widows.
1862
President John F. Kennedy, Martin Luther King, and Robert Kennedy. Never
before the advent of television had an entire nation been joined together in
Melancholia
W’s—of Woe, Whine, and Wail—prevent the patient from taking stock of
what has happened and what might be done about it. Thus, a closed circle is
trace the pathology to early introjects that were excluded from awareness.
new loss (object loss or any other), a decompensation takes place; anal
defenses crumble and oral traits, such as envy, greed, avarice, and impatience
become predominant. As Abraham pointed out, envy may be oral and anal in
character; it is usually both. The patient is preoccupied with what others have
and devalues everything that he has or is. He blames others or fate for his
individuals weep over real losses, others over lost opportunities or things
they never had.
feared, malevolent person and are incapable of relating their behavior to any
1864
thought about a loss. That is why it is important to inquire about early deaths
and, in general, about those who were important in the patient’s formative
years.
and the patient reacts impatiently to any effort to console him. He feels
are his first encounters with death, whether of a human being or a pet.
Although the patient’s lamentations may strain the therapist’s patience and
foreclose his sympathy, the capacity for insight and the readiness to examine
the relationship and confront the ambivalence with the therapist’s help make
it possible to integrate the not-me into the personality. This accounts for the
The pain of the melancholic well illustrates that suffering by itself does
not generate wisdom. Protracted suffering exhausts the energy of the patient
Emotional Anesthesia
differentiate the state of these survivors from total apathy; they were quite
enterprising and were able to care for themselves and take advantage of any
1866
concentration camp at Majdanek, I was struck by the total absence of affect in
them. For example, a nine-year-old boy described the death of his mother,
who suffered from tuberculosis, in a matter-of-fact way; his face and voice
We all knew what she was going to do. She was going to throw herself into
the river. She wanted to do it before but we wouldn’t let her. This time we
let her go. She went and drowned herself. Later in the day the Germans
came to our home and killed everybody. I hid under the bed so they didn’t
see me. A Polish neighbor came to the house afterwards and took me home
with her. She kept me as long as she could and then turned me over to the
Germans. She had no choice.
Massive denial came to his rescue, permitting him to mobilize energy for
survival.
For example, a young man with such severe paraplegia of the lower
extremities that he could not walk without the aid of crutches, said during his
his memory, which had begun to fail him after the accident, so that he could
concentrate on his studies. A third patient, a paraplegic who was confined to a
wheel chair and lacked control of his bladder and bowels, complained only
about his stutter. If this speech defect could be overcome, he said that he
handicap or to have others confront them with it. The more intelligent the
individual, the more intense his efforts to guard himself against any intrusion
The temporary or limited use of denial may be useful and even desirable
for slowing down confrontation with a loss that is devastating to one’s self-
to help him develop or consolidate the ego strength necessary to tolerate it.
1868
On the other hand, the predominant and permanent resort to denial is
the other of a disabled or disfigured self, which is, as a rule, actively hated,
personified, and rejected. The stronger this conflict, the stronger is the
Before the patient can give up his denial of the disability, he must face
his handicap. This, so far as we know, can be accomplished only through the
any other loss, the mourning is almost inevitably more prolonged and more
painful, but it leads to reconciliation with the disability. Through this process
One should also bear in mind the deep narcissistic blow that physical
injury inflicts on the ego. This is familiar to psychoanalysts who work with
In order to come to terms with the disability, the patient has to face the
intense despair and grief that underlie his feelings toward his handicap; he
which deals with the life of a prince born with an atrophied arm, the worst
markedly present in widows and widowers, in many of the dying aged, and in
the parent who has lost a child. They feel stigmatized and ashamed, as if
accident in which he lost his right hand. “I miss my hand as one misses a
1870
sweetheart. I feel a yearning for it, as if it were a person.” This was said by an
immigrant peasant, whose right hand was his breadwinner. This I consider to
Loss of a Parent
mourned in early childhood since the child’s ego is not equipped to deal with
the task of separating itself from the object. As a rule the child continues to
maintain a living representation of the deceased, usually an idealized image.
The finality of death is inaccessible to a small child. For example, after one
mother had finished explaining to her four-year-old daughter that her father
had “gone to heaven,” the little girl asked, “When will daddy come back?”
In treating adults who lost a parent in early childhood, one notices over
and over again that the parent continues to live in their minds. In most cases
two contrary and independent attitudes are maintained. One is an
acknowledgment of the death and adaptation to it; the other is a denial of the
A lawyer who had lost his father at the age of six did not begin to mourn
him until he entered reanalysis 42 years later. He completed his first analysis
ten years earlier without deep mourning for the parent. There was a mere
acknowledgment of the death at the time. The father was talked about as a
dead person. The patient reported how he recited the Kaddish by rote at the
age of six without understanding a word of it and how, during the year he
attended synagogue, older Jews admired him and whispered, “Poor orphan,
accepted and at one with them gave him a sense of importance. He idealized
his father and cherished his memory.
During the second analysis the patient began to confront himself with
the meaning of his father’s death and the realization that his father had never
died for him. Very painful memories emerged and were expressed with tears,
despair, and anger. Left with a “halfcrazy” mother, he had to take care of her
so that she wouldn’t go completely mad. “I couldn’t even go crazy,” he cried
out. “I had to control myself.” When he went to work at the age of 11, his
mother, he said, “kept waiting for me to come home, and if I came home late
she would go out of her mind and abuse me both verbally and physically.” In
1872
patient cried bitterly, “Father left me with his job—caring for mother.” For
years he had talked in this way to his father, even though his grandmother
told him that his father was watching over him and taking care of him.
The patient had always gesticulated like an old Jew; many had noticed
to a pleasant joke, saying that imitating the old Jews he had met in the
synagogue strengthened memories that preserved the bond with his dead
father. In the reanalysis, during the period of working through oedipal guilt
and the concomitant castration- anxiety, and also his relationship to his
mother (then dead eight years), a curious identification with her behavior and
The dying patient has to face the ultimate reality—the loss of his own
dying patient in defense of their own feelings.[4] But if one wants to help the
dying patient, one needs to be able to transcend this self-protective shield and
become other-oriented, to alleviate his fear of abandonment and his
aloneness, which are more frightening than death itself.
off” emotionally long before the death occurs. Their guilt and helplessness
Even though they know they are going to die, human beings can hardly
imagine the end of their own lives. Freud said: “In the unconscious, every one
of us is convinced of his own immortality.” A patient condemned to death by
an incurable disease does not want to know he is dying. He wants the
environment to deny death, and he hopes against hope that he will pull
daughter avoided her because of their own fears and arranged for friends to
1874
visit her during her last weeks. When I made myself available to discuss
anything she chose, including her illness, she evaded the topic. She did not
Other families begin the process of mourning long before the death
occurs. In cases where the patient doesn’t know that he is suffering from an
incurable disease and those closest to him have to bear the burden alone, they
are likely to come to the psychiatrist for help. He has to help them confront
anxiety states, suicidal thoughts, and the like. As the classification cited above
indicates, there are few psychiatric conditions that may not mask a delayed,
oversimplification to assert that every human being has to face death in those
close to him and his own death, and that the human condition is afflicted with
sorrows, to which the schizophrenic is no less immune.
to undergo mourning when necessary, the therapist has to come to grips with
his own fears of death and the defenses he has erected against them.
Appropriate responsiveness springs from empathy and a quality of presence,
both of which are other-oriented, and a readiness to face the countless forms
into human nature grows, in some mysterious way, so that “he to whom it has
been given to experience vicariously even one single form of earthly suffering
acquires by reason of this tragic lesson, an understanding of all its forms, even
1876
These thoughts point to suffering as the royal road to insight, wisdom,
and empathy. It may be superfluous to observe that suffering per se does not
All of the bereaved need a great deal of compassion. But there are two
protection and vulnerability that evokes angry feelings toward the object of
compassion and wants him out of the way. The other is compassion free of
one’s own sensibilities and without making someone else’s suffering one’s
own burden.
Bibliography
Altschul, S., “Denial and Ego Arrest,” J. Am. Psychoanal. A., 26:301-318, 1968.
_____, “Object Loss by Death of a Parent in Childhood,” in “Panel on Depression and Object Loss,” J.
Arieti, S., “The Psychotherapeutic Approach to Depression,” Am. J. Psychother., 16: 397-406, 1962.
Auclair, M., Vers une vieillesse heureuse, Editions du Seuil, Paris, 1970.
Bellak, L., Manic-Depressive Psychosis and Allied Conditions, pp. 220-229, Grune & Stratton, New
York, 1952.
Bowlby, J., “Grief and Mourning in Infancy and Early Childhood,” Psychoanal. Study Child, 25.9-52,
1960.
Fleming, J., and Altschul, S., “Activation of Mourning and Growth by Psychoanalysis,” Internat. J.
Psychoanal., 44.419–432, 1963.
Freud, S. (1927), "Fetishism,” in Strachey, J. (Ed.), Standard Edition, Complete Psychological Works,
Vol. 21, pp. 149-157, Hogarth, London, 1961.
_____, (1924), “The Loss of Beality in Neurosis and Psychosis,” in Strachey, J. (Ed.), Standard
Edition, Vol. 19, pp. 183- 187, Hogarth, London, 1961.
_____, (1905), “Mourning and Melancholia,” in Strachey, J. (Ed.), Standard Edition, Vol. 14, pp. 243-
286, Hogarth, London, 1964.
_____, (1925), “Negation,” in Strachey, J. (Ed.), Standard Edition, Vol. 19, pp. 235- 239, Hogarth,
London, 1961.
1878
Rangell, L., “The Nature of Conversion,” J. Am. Psychoanal. A., 7:632-662, 1959.
Rochlin, G., “Dread of Abandonment,” in The Psychoanalytic Study of the Child, Vol. 16, pp. 451-
470, International Universities Press, New York, 1961.
Russell, B., The Autobiography of Bertrand Russell, Little Brown, Boston, 1967.
_____, Portraits from Memory, Simon & Schuster, New York, 1951.
Schoenberg, B., Carr, A. C., Peretz, D., and Kutscher, A. H., Loss and Grief: Psychological
Management and Medical Practice, Columbia University Press, New York, 1970.
Slater, P., The Pursuit of Loneliness: American Culture at the Breaking Point, Saunders, Toronto,
1970.
Sontag, S., Against Interpretation, Farrar, Straus & Giroux, New York, 1961.
Sperling, S. J., “On Denial and the Essential Nature of Defense,” lnternat. J. Psychoanal., 39:25-39,
1958.
Spitz, R. A., “Discussion of Dr. John Bowlby’s Paper,” in The Psychoanalytic Study of the Child, Vol.
15, pp. 85-95, International Universities Press, New York, 1960.
_____, A Genetic Field Therapy of Ego Formation: Its Implications for Pathology, International
Universities Press, New York, 1959-
_____, and Cobliner, W. G., The First Year of Life, International Universities Press, New York, 1965.
Szalita, A. B., “The Combined Use of Family Interviews and Individual Therapy in Schizophrenia,”
Am. J. Psychother., 22:419-430, 1968.
_____, “Discussion,” in Cayley, C., “Psychiatric Aspects of Rehabilitation,” Am. J. Psychother., 8:538-
539, 954-
_____, “The Family in Literature and Drama,” Fam. Proc., 9:99-105, 1970.
_____, “Further Remarks on the Pathogenesis and Treatment of Schizophrenia,” Psychiatry, 15.143-
150, 1952.
_____, “Psychotherapy and Family Interviews,” in Arieti, S. (Ed.), The World Biennial of Psychiatry
and Psychotherapy, Vol. 1, pp. 312-335, Basic Books, New York, 1970.
_____, “The Relevance of Family Interviewing for Psychoanalysis,” Contemp. Psychoanal., 8:31-43,
1971.
Tolstoy, L., “The Life and Death of Ivan Ilyich,” in Kamen, I. (Ed.), Great Russian Stories, Random
House, New York, 1959.
Wiener, J. M., “Reaction of the Family to the Fatal Loss of a Child,” and “Responses of Medical
Personnel to the Fatal Illness of a Child,” in Schoenberg, B., Carr, A. C., Peretz, D.,
and Kutscher, A. H. (Eds.), Loss and Grief: Psychological Management and Medical
Practice, Chapters 6, 7, Columbia University Press, New York, 1970.
1880
Zetzel, E. R., “Anxiety and the Capacity to Bear It,” lnternat. J. Psychoanal., 30:1-12, 1949.
[2] An anecdote related by Rabbi Solomon Tarshansky of New York illustrates this artificiality. In many
parts of the world it has been customary to hire mourners to keen at funerals. One shtetl
boasted of a woman who excelled in that profession. She was renowned for her artistry
in “carrying on” and inducing others to cry with her. But one day she refused to
“perform” at the funeral of a wealthy townsman, and the disappointed customer asked
her, “How come? Don’t you need money any more?” She answered simply, “Today I
cannot cry. My sister just died.” With grief in her heart, she was unable to pretend
sorrow.
[4] Anticipatory grief of the dying patient is perhaps best described by Tolstoy in The Death of Ivan
Ilyich, it is an excellent study of a 45-year-old official, facing a lonely and agonizing death
from cancer, whose wife and children are unwilling or unable to relieve his agony in the
slightest measure.
E. Mansell Pattison
Death has long been a taboo topic in American culture. But in a manner
similar to the broaching of sexuality as a subject for investigation at the turn
of the twentieth century, the decade of the 1960’s has witnessed the
broaching of death and dying. Research into this taboo area has presented to
American culture and its medical profession the evidence of their neglect in a
“There’s nothing more I can do for you, you’re going to die.” So said the
doctor, leaving the patient, the nursing staff, and the family to fend as best
they could with one of the fundamental issues of life. In contrast, a general
practitioner, Dr. Merrill Shaw, himself soon to die of rectal cancer, wrote of
his own dying process in a very different vein:
The period of inactivity after a patient learns there is no hope for his
condition can be a period of great productivity. I regard myself as
fortunate to have had this opportunity for a “planned exit.” Patients who
have been told there is no hope need help with their apprehension. Any
doctor forfeits his priesthood of medicine, if, when he knows his patient is
1882
beyond help, he discharges his patient to his own services. Then the
patient needs his physician more than anyone else does. The doctor who
says merely, “I’ll drop in to see you once in awhile; there’s nothing more I
can do,” is of no use to the patient. For the patient goes through a period of
unnecessary apprehension and anxiety.
Research of the past decade on death and dying has now produced
several thousand titles. Thus, in this chapter we shall allude to major areas of
research, but focus on the major clinical aspects of care of the dying.
Cultural Antecedents
American culture until the past decade. That is not to say that death and dying
were ignored, but rather what was repressed surfaced in the pornography of
death. The lurid, perverse, and seeming compulsive preoccupation with death
and dying themes has been obvious, reflected in a movie like The Loved One—
a parody on the Forest Lawn cemetery in Los Angeles.
confronted people with death. The success of medical technology and the
distant displacement of war has left many Americans with little direct contact
with death until well into adult life. However, a number of factors converged
to challenge our cultural denial. Medical advances prolonged life so that for
medical and surgical therapies confront medicine and the culture with hard
decisions about life and death. Thus, we have a greater degree of decision
regarding when we die, although we have no more capacity to influence the
to traditional values and their religious supports has left many facing an
fantasies, such as the movie 2001, and the interest in cryogenic methods of
preserving life. As an example one medical scientist stated: “I, myself, tend to
Cultural and medical awareness of the problems of dying has not come
directly to us. Our recent history begins perhaps with the studies of loss and
bereavement heralded by Lindemann’s paper on grief in 1944 and
1884
reemphasized by Engel’s distinction between healthy grief and pathological
mourning. A more direct approach marked the popular exposes and analyses
have we come to address fully the problems of caring for the dying. Thus, this
evolution of research seems to reflect the difficulty in confronting death that
Our behavior throughout life is determined by our culture, and the same
is no less true of our behavior in dying. Primitive cultures did not perceive
death as a final biological state. The worlds of the gods and various concepts
of continuing life provided a sense of continuum between this current life and
existence.
conflicts about death. Feifel reports that physicians tend to deny death more
Psychiatrists, too, share in the same cultural denial, although they use
situations: how a patient’s threat of suicide cows the therapist; how the
psychiatrist puts himself in physical danger with a dangerous patient without
noting the real danger; the therapist’s reluctance to allow a patient to expose
his deepest threatening fantasies and psychotic thoughts that intimate the
working with prisoners with a life sentence or facing death. How dead these
1886
The denial of the anxiety of death is perhaps best exemplified in the
physicians and staff are very apprehensive about talking with dying patients
They will suggest that the dying patient will become nervous, anxious, hurt,
upset, injured. Yet Kubler-Ross reports that only 2 per cent of 200 dying
patients. In my experience I have found most dying patients not only willing
but desirous of discussing their illness and dying. To be sure they discuss
these issues in guarded and partial ways at times, but they want to deal with
their life at the moment. On the other hand, like Kubler-Ross, I have observed
nurses become so anxious over a dying patient that they could not function,
physicians cry out in despair during an interview, and psychiatrists angrily
denounce the inhumaneness of talking with a patient about his dying. These
observations suggest that the fears about the dying patient voiced by the
personnel are projections of their own fears about handling the process of
dying.
and “Rage, rage against the dying of the light.” Or consider those who have
fought for causes, ideologies, families, or country, in defiance of the fact that
means to resolve life conflicts, or to kill the self for revenge or retaliation. The
desire not to live may occur among the severely disabled, debilitated, or
unhappy elderly, who seek release and escape from the misery of life. In
instances of neurotic or psychotic fantasy, one may seek reunion with loved
ones in the magical union of death. For example, in Othello and in Aida, the
In contrast to the above attitudes that sequester death apart from life,
there are the death-accepting attitudes, in which death is seen as a part of life
and an integral part of existence. Death as the concluding episode of one’s life
1888
romantic quality. As Schneidman points out, however, this view of death
tends to make accidental or early death a tragedy—the romantic life has been
cut short!
philosophies, which posit death as a central issue in the manner with which
we go about the process of living. For some existentialists dying does not
refer to that one event of physiological end, but rather to the potential threat
to one’s own non-being. Thus, Heidegger asserts that we are faced with a
not face and resolve our existential death anxiety, we are not free to live. In a
similar vein Norman O. Brown argues in Life Against Death that neurosis
arises from the incapacity to die. Once freed from avoiding death we can
joyously embrace life.
These broad cultural attitudes toward death and dying have received
less attention than the psychological and sociological factors. Some research
same way they have previously coped with life stresses. Thus, emotional
The meaning of death and the experience of dying varies throughout the
life cycle. Thus, the clinician must approach the dying patient in terms of the
For the infant and very young child dying is primarily the physical
discomfort of the disease process and the treatment procedures. For the
toddler and preschool child there is little concept of a personal death. For this
child the primary fear is that of separation from the nurturant parents. Often,
For the active young adult dying poses a problem of narcissistic loss—
investment in a growing family and life plan. Whereas for the middle-aged
adult dying more often poses a concern for one’s ongoing life involvement
with loved ones and spouse. For example, a 50-year-old woman was quite
agitated in the hospital because she feared she would die before she got home
1890
and saw that her house was in order, care for her children arranged, and her
husband made comfortable about her departure.
For the aged dying faces one with the history, consequences, and
meaning of one’s life. As Willie Loman says in Death of a Salesman, “A man
can’t go out just the way he came in. He’s got to amount to something.” I am
come to peace with their life. Erik Erikson summed up this life crisis as that of
It is acceptance of one’s own and only life cycle and of the people who have
become significant to it as something that had to be and that, by necessity,
permitted of no substitutions . . . and that for him all human integrity
stands and falls with the one style of integrity of which he partakes.
In addition, the elderly are faced with a large degree of social isolation,
Death is not a problem of life. Death is not lived through. Although there
are case reports of patients who have returned to life after experiencing a
sense of death, such events do not address the major issue of the dying
coming soon, we may feel a sense of defeat and therefore ignore the period of
living until the death event. This is the period of living-dying. The human
Dear Dr. Pattison: Quite by accident I read your treatise on dying. Because
I am so grateful for your guidance I am writing not only to thank you but to
suggest that the article be made available to relatives who care for
patients. . . . My husband has been treated for chronic glomeruli nephritis
for nine years. For the past five years, he has had biweekly dialysis which
equates to a living-dying stage of long duration. In these times, when there
is no doctor-patient relationship in this type of indirect care, the entire
burden of sharing the responsibility of death falls to the member of the
family. . . . Your listing of the fears was so apparent when I read your
paper, yet when my husband experienced them I was unprepared to see
them or even acknowledge them. When a patient is accepted on a kidney
program, he knows he is dying. Would it not be a kindness to the person
caring for him to know his fears and how to help?
life of the patient. During the period of acute crisis there is an increasing
anxiety that will reach a peak of tolerance. No one can continue to function
long at peak anxiety, and, therefore, the patient will call into play mechanisms
1892
to cope with the crisis of death knowledge. If the person successfully deals
with this knowledge crisis, he can proceed in an integrated pattern of dying.
But if the person does not deal with this crisis, his dying can become a
we can plot out what Straus and Glaser call the “trajectory of dying” (Figure
34-1).
aspects of crisis:
answer, and the ensuing anxiety makes it difficult to distinguish and cope
with the various aspects of the dying process. But here lies the opportunity to
intervene, for although we cannot deal with the ultimate problem of death, we
can help the person to deal with the various parts of the process of dying.
1894
B.D. = Biological Death
S. D. = Sociological Death
By focusing upon the various aspects of the dying process, we can assist
Now let us consider each of the fears that face the person in the
experience of dying.
Freud suggested that the unconscious does not recognize its own death
but regards itself as immortal. “It is indeed impossible to imagine our own
death; and whenever we attempt to do so, we can perceive that we are, in fact,
In this view we fear the unknownness of death. On the other hand, the
work of Lifton and others suggest that death anxiety harkens back to the most
primordial feelings of helplessness and abandonment. The fear of the
unknown is not the unknown death but the unknown of annihilation of self, of
which comes from the sudden awareness that our non-existence is entirely
possible.”
1896
This unknown cannot be processed within the self. Lifton suggests that
perhaps all of us must to some extent defend against this fear by a process of
psychic closing off. Although this may not be totally effective, it may enable
the person to focus on other aspects of his dying with which he can cope. Here
dying woman:
She told me that her only remaining fear was that dying was strange and
unknown to her, that she had never done it before. . . . She no longer
worried about what was to happen to her after death. . . . She felt that she
might be unnecessarily concerned with the actual process of death itself.
Fear of Loneliness
When one is sick there is a sense of isolation from oneself and from
others, reinforced by the fact that others tend to avoid a sick person. This
also a reflection of our urban culture and medical technology that has
dehumanized and mechanized the dying process. No longer does our culture
afford us the luxury of dying amidst our family and belongings; over 60 per
cent of deaths now occur in the impersonal, isolated hospital room. One of the
functions we have defined for hospitals in our society is that of dying places.
patient from openly facing the dying process and responding in a humane and
helpful manner.
In addition, family and staff begin to avoid the patient, visit less frequently,
answer call lights more slowly, and minimize the duration of contact with the
dying patient. The impact of all this isolation is a sense of human deprivation.
his isolation and human deprivation sets the stage for a type of anaclitic
depression. This is not the depression of the loss of a loved one, but the loss of
necessary human nurturance. Without this support one rapidly falls into the
1898
The process of dying confronts the person with the reality of losing
one’s family and friends through one’s own death just as much as if they were
dying. Hence there is a real object loss to be mourned and worked through.
Rather than denying this real separation and preventing the grief work, it is
possible for both the patient and his family to engage in “anticipatory grief
work.” The completion of such grief work may allow the patient and his
family to work out emotionally their mutual separation and part in peace.
This is akin to the Eskimo custom of having a ritual feast of separation before
the old person steps onto the ice floe and waves goodbye as he floats off to die
in the sea; similarly, in the Auca tribe of South America, after a farewell
ceremony, the old person leaves his clan to climb into a hammock to lie alone
until he dies. Failure to recognize this real object loss may block the normal
grief process and make it difficult for the dying person to distinguish between
his own problem of death and the healthy process of grief that can be
accomplished before death.
Since our bodies are so much a part of our self-image, when illness
distorts our body, there is not only loss of function but a psychological sense
of loss of self. This narcissistic blow to the integrity of the self may result in
disease better than internal disease because one can see clearly the loss of
structure and function. Although external disfigurement may seem ugly, it
poses less threat than the unknown and unspecified processes that the
person cannot see and keep track of. Hence the failing heart or hidden cancer
will provoke more anxiety than the external symptoms of disease.
In addition to the narcissistic loss, the patient may perceive his self as
disfigured and unlovely, hence see himself as unlovable. Then the dying
patient may try to hide his unlovely self from his loved ones, for fear that his
family will likewise despise his ugly self, reject him, and leave him alone.
This is especially true when one’s mental capacities are also affected. As
shown in studies of brain-damaged persons, the actual functional deficit may
1900
experiential states that pose loss of control or consciousness. This is reflected
in our social ambivalence over the use of psychedelic drugs and alcohol,
sort of self- acceptable loss of control. Thus, when they come to the
experience of dying, the loss of control of the body and the diminished sense
of consciousness may create anxiety and fear and poses a threat to the ego.
tasks and decisions, avoid shaming for failure of control, and help the person
Fear of Pain
diminish the sense of suffering. One may deal with suffering by providing
retains human dignity and integrity, allowing the patient to understand his
own pain and resolve his conflicts over it. This proposition is borne out
pain is not just a physical fear, but a fear of suffering, a fear of the unpleasant,
pain does not mean punishment or human suffering. People will not suffer
The loss of human contact, the loss of family and friends, the loss of
body structure and function, the loss of self-control and total consciousness,
all threaten the sense of one’s identity. Human contacts affirm who we are,
family contacts affirm who we have been, and contact with our own body and
1902
We can see that the dying process faces the person with many threats to
self-identity. How does one maintain identity and integrity in the face of these
restored, then one can accept the fact with a meaning that gives dignity to his
life, and purpose even to the process that is encroaching on his own vitality.”
Willie Loman, the salesman, speaks of his own death: “A man must not be
allowed to fall into his grave as an old dog.” It is not that we die, but rather
how we die. The tasks are to retain self-esteem and respect for the self until
death, to retain the dignity and integrity of the self through the process of
living we call dying. If the person cannot sustain his ongoing sense of self,
then he may fall prey to despair, the loss of self-esteem, the failure to respect
oneself for what one has been.
from continuing respect and affirmation from the family and professional
staff. This reaffirmation can continue to reflect to the dying person who he is.
reinforcing one’s identity through the maintenance and continuity of one’s life
via one’s family and friends. One can see identity in one’s children, life’s work,
and in the bequeathing of one’s possessions to others. This is acted out in the
leaving of a will and, in a more general sense, by leaving parts of one’s body,
such as in eye banks, bone banks, and the like. This personal sense of
both his life and my budding career. At one point the surgeons wanted to
his disease. Then he was happy to comply, feeling he could give me part of
for reunion with loved ones who have died before or who will die and join
one. These reunion fantasies include the sense of return to the primordial
mother figure as well as reunion with specific loved ones. There will be
reunion with one’s parentage and one’s progeny. Hence one can place oneself
Fear of Regression
Finally there is a fear of those internal instincts within oneself that pull
one into retreat from the outer world of reality, into a primordial sense of
others. Throughout the ego fights against this internal regression into
1904
selflessness. Freud called it Thanatos—the death instinct. Despite the
metapsychological ambiguities of this concept, we can appreciate the
boundaries, the relaxation of our awareness, the freedom from the demands
and constrictions of the real world awaiting our awakening. And with
exquisite pleasure we allow ourselves to float back off into a timeless,
regressive states, much less experience such states as enjoyable rather than
In the attempt to attenuate this fear of regression, some ten years ago
syntonic drug experience that was in itself pleasurable to the dying patient
the problem of terminal regression and its management. Clinical concern here
shifts from helping the patient face reality to helping the patient turn away
from reality. With support and encouragement the patient can approach an
a sense of union with the world out of which he has sprung. Then psychic
death is acceptable, desirable, and at hand.
Sequence of Dying
process of the patient. First, the patient is faced with the seemingly
impossible crisis of knowledge of death, which threatens to overwhelm the
self. Mankind seems to have always recognized that no one has the capability
to face this crisis alone, for we develop cultural customs whereby we actually
and literally help people to die. Given our interest, support, and guidance, the
1906
dying person can face death as an unknown with the realization that he
cannot know, and instead he can turn to consider the processes of dying that
he can know and deal with. If not deprived of human contact, he can learn to
where his grief is defined and accepted. He can tolerate the loss of body
structure if others accept that loss with him. He can tolerate the loss of self-
the source of pain and define the nature of his suffering. He can retain dignity
and self-respect in the face of the termination of his life cycle if he can place
his life in perspective within his own personal history, family and human
specific psychological phases through which the patient passes. For example,
Kubler-Ross suggests five stages: denial and isolation, anger, bargaining,
ignore the actual conflicts and needs of the patient by viewing dying as a
handle dying the way the clinician might handle his own dying, or the
clinician may push the patient to move through some preconceived set of
between knowledge of death and death itself. Glaser and Straus outline four
types of “death expectations”: (1) certain death at a known time; (2) certain
death at an unknown time; (3) uncertain death, but a known time when the
question will be resolved; (4) uncertain death, and an unknown time when
the question will be resolved. Each of these expectational sets has a different
effect upon the patient and his interaction with others. As the course of the
illness becomes clear, that knowledge does force the patient and the staff to
expectation and hope as desire. At the outset each dying patient holds hope
for himself in terms of the expectation that he may not die. As that
expectational set is dissolved, the patient may deny the inexorable process by
clinging to expectational hope.
1908
On the other hand, the patient may be assisted to change from
expectational hope to desirable hope; that is, it would be good to live but it is
not to be expected. This latter hope can play a role in the maintenance of
desirable hope might optimally give way to acceptable regression. For this
reason Cappon suggests that hope (in the desirability sense) should not cease
sociological death, that is, the withdrawal and separation between the patient
and significant others. This sociological death often occurs days and weeks
before terminus if the patient is left alone to die, or it may precede terminus
death, which occurs when the person accepts his death and regresses into
himself. Such psychic death may proceed coincident with the diminution of
actual psychic function. On the other hand, psychic death can occur earlier
where the heart and lungs may continue to function with artificial support.
And fourth is physiological death, which occurs when viable organ system
function ceases. As illustrated in Figure 34-2 these four aspects of death are
not necessarily closely related in time, thus often producing many problems
dying is to coordinate psychological and medical care so that all four aspects
process of living. Weisman and Hackett'' suggest that we consider how to help
a patient toward an appropriate death. They offer four criteria for an
1. Conflict is reduced
1910
2. Compatibility with the ego ideal is obtained.
adaptation rather than on an ideal goal. That is, we seek to help the patient
integrate his dying into his life according to the style, meaning, and sequence
different ways for each patient. Each man’s appropriate death will be
different, but his dying will be appropriate to him.
can share the responsibility for the crisis of knowledge of death, so that the
patient can deal with the first impact of anxiety and bewilderment. We can
clarify and identify with the patient the difference between death and dying
and specify the processes of dying with which the patient can deal. These
processes of dying are the realities of day-to-day life. We can make continued
human contact available and rewarding. We can assist in working through the
grief over the realistic losses of family and body image while retaining
can assume necessary body and ego function in the face of diminished self-
control and pain, without incurring shame or depreciation for the person,
thus helping him maintain integrity and self-respect. We can encourage the
person to work out an acceptance of his life situation with dignity so that
gradual regression can occur without conflict or guilt, while expectational
hope can be transformed into desirable hope and relinquishment of self can
be allowed.
for the dying patient. Although there are occasions when there is need for
brief psychotherapy or crisis intervention by mental health professionals, the
place.
Glaser and Straus offer four major recommendations for institutional change,
1912
deepened in schools of medicine and nursing.
Numerous case reports indicate that the dying patient often abruptly
confronts the psychiatrist, who becomes immobilized until he can resolve his
own internal conflicts.- In his parable, The League of Death, Allen Wheelis
shows us we cannot help until we no longer fear and flee from death.
of ongoing psychotherapy are less appropriate, and we must call upon our
dying often calls for skills in family therapy, for the clinician must address the
involvement of the psychiatrist, therefore, not only with the dying but with
those who care for the dying. Weisman and Kastenbaum have provided
schematic procedures for what they call the “psychological autopsy.” They
propose that hospital staff hold an autopsy evaluation of the dying process,
that occur in the dying process and consequently work out staff consensus for
more effective management. Such procedures, or similar joint staff work on
the problems of dying, may offer the vehicle for sound organizational
improvement.
psychiatrist and the staff may neglect the needs and relevance of the family
because they are not part of the organizational structure. It is noteworthy that
in the extensive literature on dying there is very little said about care for the
1914
family. Yet they merit concern on two counts. First, they are integrally related
to the manner in which the dying person will experience his dying. Second,
they are themselves vulnerable and affected by the dying process, and they,
too, may need assistance to live through the experience of dying in a healthy
manner.’’ Just as with the patient, the family must face the anxiety and
apprehension of the knowledge of the death crisis. They, too, must face the
separation and loss, so that they can reciprocally work through the
meaning of their lives reconstituted without the dying person. In this arena
we have generally neglected the contributions that the funeral director and
the minister can make. These people often have more intimate contact with
the family than the medical staff does. Consultation, collaboration, and
educational work with these community care agents should become a part of
At the outset I suggested that the problem of death is not solely an issue
of management of the dying process, but involves the whole texture of human
existence. A half century ago we learned that failure to reckon openly with
sexuality gave rise to neurotic distortions of existence. In similar vein I have
suggested that failure to reckon openly with death in our time may give rise
position that experience with death in childhood poses serious trauma to the
child, and, therefore, the child should be protected from exposure to death.
This position, however, confuses psychic stress and psychic trauma. There is
no doubt that death does impose a stress on the child, but that does not mean
deal appropriately with death. In fact, Eissler some fifteen years ago
suggested that we should practice “orthonasia,” that is, teach children about
death as a part of life, so that children will learn how to incorporate healthy
1916
The relationship between unresolved grief and neurotic depression
syndromes has been amply discussed. This data have come primarily from
is an increased physical and emotional morbidity rate among the family and
widow program, in which the widow and her family are contacted after the
funeral by the local mental health team, which provides assistance in their
grief work and guidance in reintegration into normal life patterns. Other
programs, which provide a natural community group for single parents, and
Big Brothers and Big Sisters programs, which provide parental surrogates for
children who have lost a parent." Such programs can provide support during
the normal grief process, provide new human relationships that can partly
replace the lost person, and provide guidance toward health integration.
Summary
integrating religious values, and medical advances posing new types of death
decision making, there are few reliable guidelines available to the layman and
the professional in the management of the dying process. We are in the midst
of a reevaluation of death in our culture. Death per se cannot be changed, but
we can change the patterns of dying. Help in the dying process must focus on
three areas: help to the dying patient, help to the hospital staff, and help to the
person’s family and friends. Since dying is a universal human experience, it
merits the serious attention of the psychiatric profession. As with all human
experience the clinician must first confront death within himself, and then he
can begin to practice the high therapeutic art of helping people to die.
Bibliography
Adsett, C. A., and Bruhn, J. G., “Short-term Group Psychotherapy of Post-Myocardial Patients and
Their Wives,” Canad. Med. A. J., 99-577-584. 1968.
Anthony, S., The Child’s Discovery of Death: A Study in Child Psychology, Harcourt Brace, New York,
1940.
Bakan, D., Disease, Fain, and Sacrifice: Toward a Psychology of Suffering, University of Chicago
Press, Chicago, 1968.
Barber, T. X., “Death by Suggestion: A Critical Note,” Psychosom. Med., 23: 153-155, 1961.
Bowers, M., et al., Counseling the Dying, Thomas Nelson, New York, 1964.
Bowlby, J., “Separation Anxiety: A Critical Review of the Literature,” J. Child Psychol., Psychiat. &
Allied Disciplines, 1: 251-275, 1960.
1918
Bowman, L., The American Funeral: A Study in Guilt, Extravagance and Sublimity, Public Affairs
Press, Washington, D.C., 1959.
Brim, O. G., Jr., et al., The Dying Patient, Russell Sage Foundation, New York, 1970.
Brodsky, B., “Liebestod Fantasies in a Patient Faced with a Fatal Illness,” Internat. J. Psychoanal.,
40:13-16, 1959.
Brown, N. O., Life against Death, Wesleyan University Press, Middletown, Conn., 1959.
Butler, R. N., “The Life Review: An Interpretation of Reminiscence in the Aged,” Psychiatry, 26:65-
76, 1963.
Chadwick, M., “Notes upon the Fear of Death,” Internat. J. Psychoanal., 10:321- 334, 1929.
Choron, J., Death and Western Thought, Collier, New York, 1963.
Cohen, S., “LSD and the Anguish of Dying,” Harper's Magazine, 231:69-78, 1965.
Easson, W. M., The Dying Child: The Management of the Child or Adolescent Who Is Dying, Charles C
Thomas, Springfield, Ill., 1970.
Eissler, K. R., The Psychiatrist and the Dying Patient, International Universities Press, New York,
1955.
Erikson, E. H., Identity and the Life Cycle, Psychological Monograhs, No. 1, International
Universities Press, New York, 1959-
Freud, S., “Thoughts for the Times on War and Death,” in Collected Papers, Volume 4, Hogarth,
London, 1915.
Friedlander, K., “On the Longing to Die,” lnternat. J. Psychoanal., 21:416-426, 1940.
Fulton, R. (Ed.), Death and Identity, John Wiley, New York, 1965.
Gatch, M. McG., Death: Meaning andMortality in Christian Thought and Contemporary Culture,
Seabury Press, New York, 1969.
Glaser, B. G., and Straus, A. L., Awareness of Dying, Aldine, Chicago, 1966.
Goldfarb, A. I., “Discussion,” in Group for the Advancement of Psychiatry, Death and Dying:
Attitudes of Patient and Doctor, New York, 1965.
Gorer, G., Death, Grief and Mourning in Contemporary Britain, Cresset, London, 1965.
Greenberg, I. M., “An Exploratory Study of Reunion Fantasies,” J. Hillside Hospital, 1,3:49-59, 1954.
Grotjahn, M., “Ego Identity and the Fear of Death and Dying,” J. Hillside Hospital, 9:147-155, i960.
Haberstein, R., and Lamers, W. E., The History of American Funeral Directing, Bulfin, Milwaukee,
1962.
Hamovitch, M. B., The Parent and the Fatally Ill Child, Delmar, Los Angeles, 1964.
1920
Heilbrunn, G., “The Basic Fear,” J. Am. Psychoanal. A., 3:447-466, 1955.
Hicks, W., and Daniels, R. S., “The Dying Patient, His Physician, and the Psychiatric Consultant,”
Psychosom., 9:47-52, 1968.
Hunter, R. C. A., “On the Experience of Nearly Dying,” Am. J. Psychiat., 124: 122-126, 1967.
Jackson, E. N., Telling a Child about Death, Meredith, Des Moines, 1966.
Joseph, F., “Transference and Countertransference in the Care of a Dying Patient,” Psychoanal.,
49:21-24, 1962.
Kirtley, D. D., and Sacks, J. M., “Reactions of a Psychotherapy Group to Ambiguous Circumstances
Surrounding the Death of a Group Member,” J. Consult. & Clin. Psychol., 33-195-199,
1969.
Kliman, G., Psychological Emergencies of Childhood, Grune & Stratton, New York, 1968.
Kutscher, A. (Ed.), But Not to Lose: A Book of Comfort for Those Bereaved, Frederick Fell, New
York, 1969.
_____, (Ed.), Death and Bereavement, Charles C Thomas, Springfield, Ill., 1969.
Leveton, A., “Time, Death, and the Ego-Chill,” J. Existentialism, 6:69-80, 1965.
Lewin, K. K., Brief Encounters: Brief Psychotherapy, Warren H. Green, St. Louis, 1970.
Lifton, R. J., “On Death and Death Symbolism: The Hiroshima Disaster,” Psychiatry, 27: 191-210,
1964.
Lucas, R. A., “Social Implications of the Immediacy of Death,” Can. Rev. Soc. and Antliropol., 5.1-16,
1968.
McConville, B. J., et al., “Mourning Process in Children of Varying Ages,” Can. Psychiat. A. 15:253-
255, 1970.
Mitchell, M. E., The Child’s Attitude to Death, Sehocken Books, New York, 1967.
Mitford, J., The American Way of Death, Simon & Schuster, New York, 1963.
Moriarty, D. M. (Ed.), The Loss of Loved Ones: The Effects of a Death in the Family on Personal
Development, Charles C Thomas, Springfield, Ill., 1967.
Needleman, J., “Imagining Absence, Non-Existence, and Death: A Sketch,” Review of Existential
Psychology and Psychiatry, 6:230-236, 1966.
Norton, J., “Treatment of a Dying Patient,” in The Psychoanalytic Study of the Child, Vol. 18, pp.
541-560, International Universities Press, New York, 193-
Pahnke, W. N., and Richards, W. H., “Implications of LSD and Experimental Mysticism,” J. Religion
6- Health, 5:175- 208, 1966.
Parad, H. J. (Ed.), Crisis Intervention: Selected Readings, Family Service Association of America,
New York, 1965.
Parkes, C. M., “Effects of Bereavement on Physical and Mental Health—A Study of the Medical
Records of Widows,” Brit. Med. J., 2:274-279, 1964.
Parsons, T., and Lidz, V., “Death in American Society,” in Sheidman, E. S. (Ed.), Essays in Self-
Destruction, Science House, New York, 1967.
Pattison, E. M., et al., “Response to Group Treatment in Patients with Severe Chronic Lung
Disease,” Internat. J. Group Psychother., 21:214-225, 1971.
1922
Pearson, L. (Ed.), Death and Dying: Current Issues in the Treatment of the Dying Person, Case
Western Reserve University Press, Cleveland, 1969.
Quint, J. G, Nurse and the Dying Patient, Macmillan, New York, 1967.
Rees, W. D., and Lutkins, S. G., “Mortality of Bereavement,” Brit. Med. J., 4: 13-20, 1967.
Rheingold, J., The Mother, Anxiety, and Death: The Catastrophic Death Complex, Little Brown,
Boston, 1967.
Rioch, D., et al., The Psychopathology of Death,” in Simon, A. (Ed.), The Physiology of Emotions,
Charles C Thomas, Springfield, Ill., 1961.
Rosner, A. A., “Mourning before the Fact,” J. Am. Psychoanal. A., 10:564-570, 1962.
Russell, B., Portraits from Memory, Simon & Schuster, New York, 1956.
Saul, L. J., “Reactions of a Man to Natural Death,” Psychoanal. Quart., 28:383-386, 1959-
Schneidman, E. S., “On the Deromanticization of Death,” Am. J. Psychother., 25: 4-17. 1971.
_____, “Suicide, Sleep and Death: Some Possible Interrelations among Cessation, Interruption and
Continuous Phenomena,” J. Consult. Psychol., 28:95-106, 1964.
Schoenberg, B., et al. (Eds.), Loss and Grief: Psychological Management in Medical Practice,
Columbia University Press, New York, 1970.
Shaw, M., “Dying of Cancer, ‘Horror’ Attitude Most Harmful,” Seattle Times, March 24, 1954.
Shere, E. S., “Group Therapy with the Very Old,” in Kastenbaum, R. (Ed.), New Thoughts on Old
Shontz, F. C., and Fink, S. L., “A Psychobiological Analysis of Discomfort, Pain and Death,” J. Gen.
Psychol., 60:275- 287, 1959.
Steen, M. M., “Fear of Death and Neurosis,” J. Am. Psychoanal. A., 16:7-31, 1968.
Straus, A. L., and Glaser, B. G., Anguish: A Case History of a Dying Trajectory, The Sociology Press,
Mill Valley, Calif., 1970.
Sudnow, D., Passing On: The Social Organization of Dying, Prentice-Hall, Englewood Cliffs, N.J.,
1969.
Switzer, D. K., The Dynamics of Grief: Its Source, Pain and Healing, Abingdon Press, Nashville,
1970.
Tart, C. T. (Ed.), Altered States of Consciousness, John Wiley, New York, 1969.
Thurmond, C. T., “Last Thoughts before Drowning,” J. Abnor. & Soc. Psychol., 38.165-184, 1943.
Toynbee, A., et al., Man’s Concern with Death, McGraw-Hill, New York, 1969.
Vernick, J. J., Selected Bibliography on Death and Dying, National Institute of Child Health and
Human Development, Washington, D.C., 1971.
Verwoerdt, A., Communication with the Fatally Ill, Charles C Thomas, Springfield, Ill., 1966.
Wahl, C. W., “The Fear of Death,” Bull. Menninger Clin., 22:214-223, 1958.
_____, et al., Helping the Dying Patient and His Family, National Association of Social Workers, New
1924
York, 1960.
Walters, M. J., “Psychic Death: Report of a Possible Case,” Arch. Neurol. Psychiat., 52:84-85, 1944.
Weisman, A. D., “Misgivings and Misconceptions in the Psychiatric Care of the Terminal Patient,”
Psychiatry, 33:76-81, 1970.
_____, _____, and_____, Hackett, T., “Predilection for Death: Death and Dying as a Psychiatric
Problem,” Psychosom. Med., 23:232—256, 1961.
_____, and Kastenbaum, R., The Psychological Autopsy, Community Mental Health Journal
Monograph Series, No. 4, 1968.
Wodinsky, A., “Psychiatric Consultation with Nurses on a Leukemia Service,” Ment. Hyg., 48:282-
287, 1964.
Worcester, A., The Care of the Aged, The Dying and the Dead, Charles C Thomas, Springfield, Ill.,
1950.
Wylie, H. W., Jr., et al., “A Dying Patient in a Psychotherapy Group,” Internat. J. Group Psychother.,
14:482-490, 1964.
1926
Chapter 35
Wendell S. Muncie
was as truly biological as was physiology. Such a view naturally led to two
further assumptions: (1) that the living man can only be studied as a whole
person in action,[2] and (2) that this whole person represents an integrate of
hierarchically arranged functions. Psychobiology offers a theory of
personality organization and activity, and an attitude toward the approach to
According to this concept, man is the indivisible unit of study, but this study
finally the psychobiological, that is, the activity of the whole person, as an
item of biography, using economizing symbolizations binding together past,
are necessary for the complete understanding of the latter, but the facts of
lower level. This total activity of the individual may be sampled at any given
includes man in his society as a part of the whole. The study of the individual
then inevitably merges with a study of his society, including the workable and
less workable aspects of each item. Furthermore, the facts of human biology
and societal structure force the attention for dynamic purposes onto the
1928
modify them.
their simplicity and for their lack of any definition or rules as to “where to go
the neurotic constitution). He stressed the selection of topics as the most vital
job confronting the worker in this field. History shows how the selection of
case can it be said that the topic has ever reached an exhaustive and
The significance of all this for treatment lies in the following facts:
Meyer often remarked that there seemed to be but a few ways in which
people could react. This underscores the clinical fact that the diversity of life
The emphasis in psychobiology, from its outset to the present, has been on
the effort to elucidate the interrelations of life experience, objectively and
1930
psychiatry if, indeed, not in all medicine.[3]
cannot be equated with causation. Meaning in illness may play a leading role
or may figure in an incidental sense only. It cannot be said that a wholly
satisfactory synthesis of form and content has as yet been achieved in regard
to any mental illness type, because of the inherent difficulties in the problem.
The facts of form were well, if not exhaustively, described by the early
for the belief that these items of form are themselves to a degree subject to
cultural influence (content). This seems to be true after allowance is made for
changes in “fashions” in diagnoses.
The forms of illness determine certain well- known content items and
left with many observers a note of regret at the massive shotgunlike attack,
At the moment, this is our best hope for attack on the “final common
pathways” of form in the major “functional” psychoses.
administered by people to people, and the full and final effect of the
treatments will bear the imprint of the working relationship between them. In
his belief in the physician’s grasp of his problem. Under such conditions the
treatments become a direct extension of the physician’s influence in the
situation.
1932
Psychobiological theory interposes no objection to combined
should determine what treatment method should be the leading one and
which one should serve in a more accessory capacity at any given time. All
treatment has for its goals: (1) positively, the realization of that best potential
(2) negatively, the avoidance of the introduction of factors that would leave
the patient less able to deal with his life situation.
Treatment as Negotiation
derives from a statement made in a staff meeting late in his tenure at the
substantially as follows: “The patient comes with his own view of his trouble;
the physician has another view. Treatment consists of the joint effort to bring
about that approximation of those views which will be the most effective and
the most satisfying in the situation.” This struck me forcibly at the time, for it
laid down what, I recognized, had been our established working method at
seems to have held the conviction that the great failures in psychiatry
commonly in good repute and to add his own variants depending on his own
assets (and needs). Consequently, trainees under Meyer ended with the most
diverse technical equipment, but all were touched to some extent by the
treatment as negotiation is basic for the best effort. I see this confirmed daily
both in its observance and in its breach. Negotiation implies mutual respect
1934
coercion which might arise from superior knowledge and faith in techniques.
It is a humbling thought that, in some ways, the patient always knows more of
himself than we ever will. If we can help in a more useful assembling of this
self-knowledge, we will have served our purpose. The phrase “more useful
assembling” has a certain teleological ring. We should not shrink from this
omnipotence or omniscience.
problem and communication to the sufferer of this expanding view, with the
need for encouraging a greater participation on his part in an expanded goal.
History Taking
How to get a history and what to do with it to alter the course of events
view of his problem, deriving from his own background and what the
reveal progressively the motives at work as well as the form of the malady.
The physician, for his part, must school himself to be a patient listener, and
and of its dynamic meaning, that is, of the items meaningful for provocation
and continuation. The material then is sifted for the tentative allotments of
etiology, and a “work sheet” of unfinished topics, or topics needing further
elaboration, is set up. Subsequent sessions are concerned with filling in this
material. This may be accomplished (1) by direct inquiry of the patient; (2) by
use of devices for gaining access to material which, for adequate reasons in
the preservation of the official version of the self, the patient has “forgotten”
who act out in antisocial ways, but, more often, such material serves to arm
1936
the physician with a knowledge of specially sensitive items and to warn him
away from brutal inquiry. It is good practice, in dealing with cooperative and
voluntary patients, to secure permission for discussing the case with others. I
do not mean that this must be a hard and fast rule, but in any case the
freely. In practice I do not put the patient under the obligation to tell all that
passes through his mind. I assume that the willingness or the desire to “tell
matter of privacy, a right dearly won and even more sorely pressed for its
story, because therein lies the opportunity to get purchase on the matter of
in action at the moment. I bolster this with analysis of dream material for the
purpose of pointing out to the patient that the material of our conversations
finds its spontaneous corroboration in his own productions, in a setting not
In order to keep the treatment related always to the complaint, that is,
to the terms of the present, analysis of historical material for motives and
attitudes is constantly interwoven with factual accounts of current activities.
This serves to keep the patient alert to the obligation to use now what he has
learned of his habitual tendencies and the opportunities for change in them,
and keeps treatment from degenerating into that endless situation that allows
the patient to say, in effect, “I’ll change some day when I have come to know
1938
all there is to know about myself.” Treatment should be carried on in an
atmosphere that expects change consistent with the current understanding,
encouragement to retrial.
a. Ease of accessibility.
b. Cost of treatment.
1940
objection to the combination, the decision resting on sound
clinical judgment as to:
description of the process by which the complaint was broken down into lines
of inquiry (involving any integrative level and, of necessity, using the methods
best adapted to study of the facts in question) combined with the attempt to
reassess the factors at work in the form of alternative combination, that is,
of variation. Meyer was not one to prescribe methods. His emphasis was on
the use of any method in an experimental sense. Nevertheless, in actual
practice this does not degenerate into the view that “anything works,” that is,
is admissible. Certain things are prerequisites for such work in this field:
the wide differences between overt assertion and covert intention; and (cl)
times.
family structure and its variants, and of the accepted principles of personal
and community mental hygiene as they apply to different ages and ethnic
groups.
1942
and liabilities and of the degree of control of the latter. The physician must be
aware of his own reactions to the patient and be able to deal honestly with
them in the same manner that he expects his patient to do. On occasion, this
may even require him freely to expose his own feelings to the patient,
together with his methods of dealing with those feelings. Such self-exposure
may alleviate the patient’s anxiety in discovering that the physician also has
however, it is not necessary for the physician to use such methods. He may
safely allow himself to remain in the role allotted him by the patient—-that of
a person who knows how to live better than does the patient and who can
help the patient find clues to his own better performance. Acknowledgement
of the difficulties involved in mature living will be enough to indicate that the
physician is not godlike in his perfection and has experienced his share of
difficulties.
trouble, with whatever concern for provocative factors can be elicited. This
account commonly suffers in the latter aspect owing to (1) the patient’s (or
selectively from the type of account given. Our further effort is directed
toward bringing this material to the patient’s awareness, to the degree that he
can emotionally accept; that is, the analysis of motives and actions, conscious
and less conscious, must proceed within the bounds set by the need to secure
the safety of the patient. Depending on the type and severity of the illness,
and conversely on the demonstrated degree of ego strength, this will vary
from the most thoroughgoing exposure to positive efforts at aiding its
repression and bolstering the ego in its efforts at reality adjustment.
between the hurt sustained and the defense offered to it. This leads further to
1944
and efforts at change.
of the physician’s understanding and approval.); and (3) the patient’s freeing
himself from the need for the physician’s support and approval as a process of
maturing, by his own efforts and those of the physician, and finally by the
final acceptance of the validity of those formulations which he has derived
however, nor should one dodge the responsibility when it is clearly indicated.
This need for categorical advice most commonly arises in dealing with
immature characters—weak, indecisive, and lacking in drive. The danger with
example:
1. Depression of all but the most incidental neurotic sort is made worse
by probing efforts at insight therapy. This must wait until the mood has lifted
or until its effects can be counteracted by massive supportive therapy.
have resulted from serious insults to the self-esteem. This fact should impose
in the life history of any individual—the drive to autonomy and the drive to
1946
much so as to be unpleasantly conspicuous; at the same time he wants to be
like others (of his selection), but not so much so as to be lost in the crowd.
How to be oneself and simultaneously a member of the group is a challenge
which each of us faces, and which each social aggregate faces with larger
integrates. Experience shows that this problem is made all the more difficult
when the individual suffers from an early imprint of patterns of behavior that
deviate from socially acceptable norms, or when his society, chosen or forced
personally acceptable norms. What the special forms are which conduce to
major and to more minor disorders are not too clear at this point in our
history, despite the appealing formulations of Freud, Adler, Jung, and others.
In a very general sense, I see in the vicissitudes and fates of the contrasting
developmental forces of free love (or approval) and contingent love (or
approval), acting from the earliest days and months of the child’s life, a basis
for much diverse psychopathology. This sets the stage for the struggle toward
autonomy and homonymy and for the attitudes to self and others. It
case at hand).
In the course of taking the history and in its elaboration, it will become
evident that the patient views the physician in a certain role. This is not a
fixed matter; it changes from patient to patient and in any patient from time
to time. It is almost certain that the kind of role has to do with (1) the
frequency of visits, (2) the relative dominance of direct conversation or of
free association or other indirect method, and (3) the importance for the
provocation of the illness of the preservation into the present of strong
unresolved early relationships with parents, siblings, or other significant
figures—unresolved in the sense that unhealthy childish attitudes are
preserved (resting either on reality or fancy) and are all projected onto the
physician. He is seen, then, not only as a physician but, in a sense, as that
other person.
and challenging the patient to learn and to use his insight in the development
of newer and better attitudes and actual living habits.
1948
Psychobiology uses all techniques as necessary, that is, as demanded by
the nature of the complaint and the critical vision of the opportunity for
change, but, unlike psychoanalysis, it does not view the development and
shrink from their use, but I do not commonly encounter treatment situations
sensitive to these contrasting needs: (1) the need to uncover the damaging
(2) the need to support the patient in his own efforts at betterment,
encouraging the use of the known assets, stressing the compensating assets,
makes.
Common sense tells us that the ways of getting through this life are
humiliating, by the individual and by his entourage. In the most general terms
invest us with the aura of having successfully accomplished this difficult feat
ourselves, and of having a fund of information and skill from which they can
also profit. It goes without saying that, as physicians, we should, in fact, justify
also basic that we do not attempt to impose our own solutions on others, but
work toward the maximum realization of the patient’s potentialities within
the framework of the necessity of living with others who also have their
needs.
degree that we can successfully deal with the following items: (1) accurate
recognition of the form of illness, that is, the kind of reaction exhibited
(diagnosis); (2) the experiential material which affords the most plausible
explanation of why this form of reaction has arisen and why it continues on
(dynamic analysis); and (3) sorting out of the items wherever leverage may
1950
be applied in one way or another to change the forces at work (either in kind
or degree), and the selection of method to be used for that purpose.
one of these items, but I would single out as most basic the failure to achieve a
working fusion of the concepts of form and of content in illness. Too many of
us are too content with the understanding of only one or the other item. This
means that those limitations and opportunities in treatment which are
determined by the fusion or interaction of the two elements are not fully
the patient.
“anything works sometimes.” To the extent that this is so, this means only
that the wide variety of content items in experiential material and the wide
Acceptance of the fact of variety does not imply acceptance of the truth
of the cynical dictum above. If this were so, there would be 110 need to
better reasons).
The most common error arising from the inadequate recognition of the
difficulties, together with the admixture of overt anxiety along with the
depression, lead the inexperienced physician into the error of treating the
extricate himself from the tangle. Experience should dictate, in such instances
laying the groundwork for more extensive personality study at a later date,
when the patient is able to face self-revelation without developing crippling
1952
loss of confidence, and if he chooses to pursue the matter further. By making
the matter elective, in the reasonably sure expectation that the mood will
pass anyway, the subject almost invariably responds to the support and can
patiently collaborate in the search for ultimate causes, free from that frantic
compulsion which ends in futility, deepened self-abasement, and even
suicidal risk. There is no more necessary equipment for the therapist than to
depressive affect. The safe rule of thumb is that when delusions and
These indicate (1) natural letdowns after more productive periods, (2)
resistance to and evasion of topics needing discussion, or (3) the fact that a
favorable plateau has been reached, and the patient is indirectly asking the
physician to make the decision to let him go on his own for a period. In (1) the
physician must school himself (and the patient) to ride out the inactive phase,
treatment, for good or for the time being. The latter is, in effect, a therapeutic
effectiveness of his insights and new habit patterns without the support of the
physician. A date for checking in can be made or left open, depending on the
patient’s own wishes, and his choice is a measure of his feeling of confidence
and security.
the “treatment” of the third member of the triangle may generally be left to
the patient himself. Yet even here, a simple explanatory statement to the
family, with the patient’s permission, may be most helpful in furthering the
serving and needs nothing more than the advice to “be yourselves.” Patients
do not live in a vacuum, and, by withholding any simple contact, we may do
1954
incalculable harm to the acceptance of treatment by the patient’s family.
foundations for the best acceptance of therapeutic goals and for a frank
know of our intention to see the family, and this may become a test of his
ability to trust our efforts to protect his interests. He finally must be willing to
trust us, and this may well be the first test of that fact.
then. What it has come to mean in the course of time is the organized effort on
the part of the hospital community to enlist the patient’s interest in the
development of participative activities which will bring him into line with
accepted social patterns. It is obvious that this becomes more meaningful the
more he can understand his own difficulties, and as more opportunities open
his society is composed of his family and his work and play setting, and where
he is expected to initiate and carry the greater burden of the trial-and- error
preliminary) phases.
therapy. How best to accomplish this has led to great divergences in views. To
bring into meaningful juxtaposition discrete items from varied aspects of
(for good or for ill); to relate present behavior with childhood’s precursors,
and to relate this material to present behavior—these are some of the devices
material, telling their own stories without need for translation into secondary
of the more recondite material, for although there are still few who practice
1956
“unconscious” material, with a disastrous neglect of the readily available
closest scrutiny of both the more and the less easily accessible material, and
that is necessary for the patient in the way of structural (theoretical) support
to enable him to carry out trial-and- error efforts at personality change, with
the active essential support of his physician. But the term need not mean only
that. At the other end of the spectrum, it may carry a sense of conviction—to
the patient if not to the physician. Conviction naturally makes for more full-
and the physician must guard against contributing to this through premature
meanings. The physician will use that frame of reference best suited to his
own beliefs, derived from his own training experiences. I am not capable of
interpretations that go far beyond the relatively easily visible symbolizations,
extensive and searching use of such material by means not at my disposal, but
it has always seemed to me that the more distant the symbolic reference, the
need to be translated into libidinous activities to tell their story. This already
is parochial. But common sense can work with interpersonal and sociological
relations, and for me this is the most fruitful means for increasing
in treatment. The goals will determine the outlook. For example, when one or
1958
physician will have to make a decision at that point whether to use the new
Actually, in this instance the former may be attempted, keeping the latter in
reserve for use if it is deemed advisable. I consider tentative use of electric
shock in such an instance preferable to the rote application of, say, a series of
interviews spaced at weekly intervals and continuing for from six months to
time allotted, the patient has had ample opportunity to demonstrate the
worth of his new insights and to achieve that sense of self-sufficiency which
does not need the physician’s support. It is my belief that this derives from
the fact that, from the first day of treatment, there is a tacit understanding
attitude—that I expect to do all I possibly can for the patient and that he will
increasingly want to divest himself of my help. If this latter does not happen,
special concern in those patients who, from the earliest contacts, expect
contacts, I do not hesitate to reassure the patient on this score, but at the
same time I underline the objective of self-sufficiency.
patient. We must face the fact that this may not be possible. But even in such
endless associations there should be no letup in the effort toward this goal.
occasion arises, with assistance in finding for the patient in the new locality
patient, and extended this area by removing hindrances arising from special
complex content and by enlarging the opportunities for direct exploitation of
the normal residual assets. The appeal was to the patient’s spontaneity. The
physician must also be spontaneous. I can imagine no greater hindrance to
1960
reputation of being not quite normal! “Treatment” then becomes a cat-and-
mouse game to be thoroughly condemned.[8]
For example, a woman, who had spent an hour expressing her craving for
approval and her certainty that it would never be accorded her, exposed her
problem dramatically when she could not accept the physician’s gesture of
helping her into her coat, and literally ran from the office. Much precious time
in circuitous talking was avoided by direct use of this incident. Should the
therapist have restrained his civilized spontaneity? I think not. The erection
of utterly artificial barriers removes the patient that much farther from life
stressed that people are judged by their behavior, and behavior is a matter for
performance implies also subjective items which antedate and lead to overt
checks on the behavior of the patient, showing at a glance the status of the
patient at any given time and over the longer term. These, supplemented by
nurses’ notes, proved most valuable adjuncts to the physician’s observation.
For outpatients, such records are not practicable or necessary, but the
principle of using the observations of those people who are near the patient is
settings or procedures which can be devised for observing overt behavior and
which will reduce to a minimum the variations introduced by the factor of the
animals by Curt P. Richter and by W. Horsley Gantt, and the human subject by
D. Ewen Cameron. The reader is referred to their voluminous contributions
“Common sense” was a term which Meyer used with some relish and
which has been badly misunderstood. Critics have wrongly assumed that he
1962
used the term in the naive sense, leading one of them to say in rebuttal,
“Psychiatry starts where common sense leaves off.”
procedure can be ignored. It is clear that at any one institution or at any one
objectivity of the results must be the final test of the value of the theory and
method. This leaves Meyer’s psychiatry as eclectic, free to use the method
best suited to the dimensions and qualities of the problem and to the assets of
the physician.
sample of the free development of method under the terms of the Meyerian
conceptions. I have reason to believe that many (maybe most) workers today
employ the same general principles. A catalogue of the variations of method
and their correlation with theory and with the personal assets and needs of
the therapists would be a useful contribution to the goal of consensus—a goal
nearer to the facts. My observations are offered for whatever they are worth,
and in the spirit so well depicted by Adolf Meyer:
best opportunity for new times and new life. So it is with medicine. The goal
of medicine is peculiarly the goal of making itself unnecessary; of influencing
life so that what is medicine today will become mere common sense
1964
tomorrow, or at least with the next generation. The efforts of the worker of
today become so assimilated in the common sense of tomorrow that it must
be our pride to see that it has passed into the real objective nature of the
world about us, no longer burdening our attention, but allowing us or those
after us to do the same for ever new problems, with ever new achievements
and satisfactions.
Mental Hygiene
medical practitioners, hold dear the aim of deriving from the experience of
illness the tools for guarding against recurrence or, indeed, to thwart other
mental hygiene. This is a complex matter at best, and the results are
debatable, since it is difficult to see how any suitable test methods could be
statistical study and (2) to list the concrete therapeutic steps taken to
schizophrenic reactions.
But a fully effective mental hygiene would envisage that of the group,
the society in which the patient is but a member. This task is, perforce, a joint
endeavor of all whose concern is organized society—general medicine,
political science. I cannot see that any generally valid principles have been
demonstrated for society’s stake in the welfare of the individual as well as the
individual’s stake in the welfare of his society. Changing times are making for
changing tools with which the individual expresses his parallel, and in some
ways paradoxical, needs to autonomy and homonymy. New varieties of
demand new efforts at correction. The one thing certain is that this process
will never settle down in the foreseeable future into any static set of patterns
which would simplify personal and social psychiatric theory and practice.[9]
Résumé
1966
achievements were somewhat prefigured in his involvement in, and reaction
to, early family and cultural influences. His father was a Swiss Zwinglian
minister and his uncle a practicing physician. His “psychobiology” was the
effort to integrate the concern for the “spiritual” (mental) and “physical”
represented by these family figures, and molded by the cohesive Swiss
Sherrington, Charcot, Forel, Kraepelin, Freud and his early associates, and
particularly with the American school of pragmatism of William James and his
followers.
For him the psychiatrist was a negotiator, working with the raw
material of observable malfunction, with the purpose of assisting in the
present; and from that creation the opening of new and better (that is, less
threatening and more fulfilling and rewarding) options for the future. This
goal is not unlike the creative artist’s and avails itself of the most diverse
theoretical views and methods. Always comes the ultimate test: Does it work?
practice, for he, rightly, I think, saw that as the historical bane of our science.
Meyerian tradition will likely live, I would single out the integration concept
Bibliography
Angyal, A., Foundations for a Science of Personality, Commonwealth Fund, Harvard, Cambridge,
Mass., 1941.
Cameron, D. E., Objective Experimental Psychiatry, 2nd ed., Macmillan, New York, 1941.
Cameron, N., The Psychology of Behavior Disorders, Houghton Mifflin, Boston, 1947.
_____, and Magaret, A., Behavior Pathology, Houghton Mifflin, Boston, 1951.
Cobb, S., “Monism and Psychosomatic Medicine,” Psychosom. Med., 19:177, 1957.
Diethelm, O., Treatment in Psychiatry, 3rd ed., Charles C Thomas, Springfield, Ill., 1955.
Henderson, D. K., and Gillespie, R. D., A Textbook of Psychiatry for Students and Practitioners, 7th
ed., Oxford, New York, 1950.
Leighton, A., “Introduction to Collected Papers, Vol. IV,” Ment. Hyg., 4:16, 1952.
1968
Lemkau, P., Mental Hygiene in Public Health, 2nd ed., McGraw-Hill, New York, 1955.
Meyer, A., “The ‘Complaint’ as the Center of Genetic-Dynamic and Nosological Teaching in
Psychiatry,” in Winters, E. E. (Ed.), Collected Works of Adolf Meyer, Vol. Ill, p. 1, Johns
Hopkins Press, Baltimore, 1951.
_____, “Monismus als einheitlich kritrich geordneter Pluralismus,” in Winters, E. E. (Ed.), Collected
Works, Vol. Ill, p. 38, Johns Hopkins Press, Baltimore, 1951.
_____, “The Psychobiological Point of View,” in Winters, E. E. (Ed.), Collected Works, Vol. Ill, pp. 429
ff., Johns Hopkins Press, Baltimore, 1951.
_____, Psychobiology: A Science of Man, (Tr. and Comp, by Winters, E. E., and Bowers, A. M.), Charles
C Thomas, Springfield, Ill., 1958.
_____, “Remarks on Habit Disorganizations in the Essential Deterioration, and the Relation of
Deterioration and the Psychasthenic, Neurasthenic, Hysterical and Other
Constitutions,” in Winters, E. E. (Ed.), Collected Works, Vol. II, p. 421, Johns Hopkins
Press, Baltimore, 1951.
_____, “Spontaneity,” in Winters, E. E. (Ed.), Collected Works, Vol. IV, p. 460, Johns Hopkins Press,
Baltimore, 1952.
_____, “Thirty-five Years of Psychiatry in the United States from Present Outlook,” in Winters, E. E.
(Ed.), Collected Works, Vol. II, p. 1, Johns Hopkins Press, Baltimore, 1951.
_____, “The Treatment of Paranoic and Paranoid States,” in Winters, E. E. (Ed.), Collected Works,
Vol. II, p. 517, Johns Hopkins Press, Baltimore, 1951.
_____, “Treatment in Psychobiologic Psychiatry: Its Present Status,” in Fromm-Reichmann, F., and
Moreno, J. L. (Eds.), Progress in Psychotherapy, Grune, New York, 1956.
Strecker, E. A., Ebaugh, F. G., and Ewalt, J. R., Practical Clinical Psychiatry, 6th ed., Blakiston, New
York, 1947.
Syz, H., “The Concept of the Organism-as-a-Whole and Its Application to Clinical Situations,”
Human Biol., 8:489, 1936.
[1] For a good introduction to and a survey of Meyer’s thinking and contributions in the fields of
neurology, psychiatry, medical teaching, and mental hygiene, the interested reader is
advised to turn to the introductions in the several volumes by, respectively, Louis
Hausman, Sir David K. Henderson, Franklin G. Ebaugh, and Alexander H. Leighton.
For a more extensive and detailed treatise on treatment bearing largely the stamp
of Meyer’s influence, see references 6, 7, 21, 22, and 23.
[2] For a historical review of the development of the concept, see references 15 and 24.
[3] This is the monistic explanation Stanley Cobb recently underscored as the total of all psychosomatic
effort.
[4] The most detailed account, still a classic, is to be found in references 19 and 22.
[5] Projective tests may round out the clinical picture with added content details including the
defensive mechanisms, or they may offer a personality profile wholly at variance with
the clinical judgment. This dilemma is of utmost interest and needs further elucidation.
[6] This statement must be taken with the reservation that dream interpretation and the patient’s
acceptance of it are open to the same influences that interpret overt behavior and accept
such interpretation.
[7] For an excellent description of role taking in therapy, see references 3 and 4.
1970
[8] For example (from real life):
Newly admitted patient to the chief physician making rounds: “Good morning, Dr.
____”
Sequel: She recovered from her self-limited illness, but with contempt for this
physician. And why not?
[9] For an account of current efforts in community mental hygiene, see reference 9.
Kurt Goldstein
totality. The organization of this unit depends on the task with which the
organism is confronted and with which it must come to terms. How this is
trend of the organism to realize all its capacities in harmony, in other words,
its nature. The degree to which this realization is fulfilled is dependent upon
the relationship between the organism’s capacities and the demands of the
outer and inner world, that is, on how much the organism can come to terms
1972
with them (p. 197).
best he can, with the demands. In this organization, the process in one part is
activity in the rest of the organism represents the ground belonging to the
definite figure which appears, on face value, as the reaction to the demand.
view has on psychotherapy. How can one justify a therapy that considers one
least briefly what the so- called psychophysical relationship, especially the
special interest of physicians when it became evident that not only so-called
method, or both, in a given case. It was this decision that demanded a search
considerable attention after publication of his book, Das Ich und das Es (The
Ego and the It). Even if this extreme point of view did not find much
interpretation of symptoms, and others which will be discussed later from the
organismic point of view. It also had a considerable influence on the practical
1974
physician’s concept of the role the “psychological” plays in the development
disease. He was well aware of the relevancy of the mind for what is going on
in the body in disease, and he appraised the implication of psychic
concept that the organism is constructed out of parts that only secondarily
are never isolated processes. They are made to appear thus only by the use of
words represent only imperfect descriptions of the facts, that they refer only
to the “figures” in the present process of the whole organism. They represent
processes are determined by the same laws. This is not because the laws are
equal in two different fields; rather, they are the laws of the function of the
organism as a whole, which appear in the same way in the two groups of
condition that we call sickness means (1) determining the significance of the
psychic or physical processes in the development of the condition; (2)
determining the role that psychic or physical phenomena play within the
totality of the clinical picture and the experience of the patient; and (3)
determining by which means—whether the psychological or the physiological
or both —the abnormal condition can be brought back to the “norm,” how the
patient can best regain his health—that is, become able again to realize his
1976
one must define the meaning of sickness within the organismic framework.
Sickness is not simply any modification of the structure or functioning of the
modification may be an anomaly, but the individual with this anomaly may
neither appear, nor feel, sick. (Goldstein, 1943 p. 249) The individual becomes
of the fact that the normal, adequate relationship between the organism and
the demands made upon it, which is the presupposition for the realization of
the organism’s capacities according to its nature, no longer exists.
need not even be real; anxiety occurs also if the individual only imagines that
—in other words, any condition producing such disorder that the realization
of the individual nature becomes essentially impossible.
suffering from it, may demand its elimination, particularly if the symptom
the patient more responsive to the real therapeutic procedure. Reducing pain
or anxiety by medication, shock treatment, and so forth, is justified however
only if one explains to the patient that the elimination of pain does not
represent the real treatment and might conceivably delay the final
improvement.
1978
what can be expected from more intensive treatment in respect to greater or
lesser restitution of the personality, and what that will mean for his future
intention. This capacity will differ, depending upon the degree of the mental
defect caused by the underlying disease.
environment so that it no longer makes demands upon them that they cannot
meet. In doing this, we are only imitating in treatment what would normally
occur passively; for we observe that this change in milieu seems to develop
spontaneously after a certain time, even without treatment. This modification
occurs because the patient, by withdrawal from the world around, eliminates
which were not possible for him previously. (For detailed observations of this
change of behavior, see Ref. 6, pp. 35 ff.) This change of behavior is the result
voluntarily. These demands are eliminated by this sticking to what he can do.
world as compared with his world as it existed before. Life may be more
secure, but one can assume that, if the individual were aware of the
restrictions placed upon it, he would not consider it still worth living.
individual does not recognize this shrinkage of the world and his personality,
get as much personal satisfaction as he needs. He may not recognize that this
“custody” excludes him, in a high degree, from normal communion with his
fellow men. As a matter of fact, should he become aware of his factual position
not realize his vulnerability in this respect—this awareness alone hurls him
back into catastrophe. The occurrence of such shocks during treatment—
1980
when retraining demands that the patient be confronted with tasks he cannot
fulfill—is avoided more or less successfully by the transference situation (see
later).
The situation is different, of course, when we deal with patients who are
against distress and pain. For mentally normal persons suffering from severe
bodily diseases, or for neurotics and psychotics, living under such restrictions
those imposed by the need for bed rest—not only because he feels that they
On the other hand, the person suffering from a chronic bodily illness
may not always be able to bear the restrictions imposed by the procedure
necessary to avoid pain. If such a patient were to become convinced that this
suicide is the only way out—the only means of protecting himself against the
and, particularly, the exclusion from his world. Then we meet the apparent
the patient may, for a certain time, live comfortably with the protective and
defense mechanisms developed during the early years of life against conflicts
conflicts, some suffering and anxiety, voluntarily. The choice lies between this
and the unbearable restrictions. If the patient is able to make this choice, he
may still suffer, but he will no longer feel sick; that is, although he may be
somewhat disordered and stricken by anxiety, he is, at least, able to realize
1982
related to a lofty mental attitude by which the individual has to value what is
essential for his life. “Health” appears thus as a value; its value consists in the
individual’s capacity to actualize his nature to a degree that, for him at least, is
to make the right choice; this choice must bring about a new orientation
which is adequate enough to his nature to restore the sense that life is worth
while.
far as the therapist’s attitude toward the failures of the patient is concerned,
this demand is correct. The therapist must not impose his own values upon
the patient; but that does not mean that the problem of value has to, or even
can, be avoided totally. Freud, for example, believed that therapy should be
based on scientific methods and concepts alone. “All that is outside of science
particularly the nature of his “inborn character.” Here the intrinsic courage of
to his nature, to recognize life’s value in spite of them, and to see a possibility
for self-realization. Therapy may help him to learn that it is possible to meet
the conflicts with “fear” rather than overwhelming “anxiety.”
Second, the capacity for choice depends upon whether the totality of the
suffering from organic brain defects or from schizophrenia. In the latter cases,
the use of the abstract capacity, which is prerequisite for exercising choice, is
reduced. Under these conditions, the patient can only try out the possible
ways of behavior which may best bring about “order” and satisfactory use of
completely from the world and building up his own world—by using his
1984
Finally, the choice is dependent upon past experiences and their
How can we help the neurotic patient to find the new orientation of his
Our first task is to help the patient in his search for the causes which
have previously produced disorder and anxiety. The conflict with which we
are concerned is always a current conflict. There is no doubt, however, that
experiences, physical and psychic alike. Here the protective mechanisms that
the fore in the utterances of the patient has to be scrutinized and used with
the greatest care. What can be uncovered at present does not at all
correspond to the real previous experiences—not even to the fantasies which,
although they may have played a great role in childhood, may not be effective
least to point them out. First, there is the problem of the essential difference
in the structure between the experiences of the infant and those of the adult.
This makes it difficult for the latter to recall the previous experiences.
at the time of the experience and its condition when remembrance has to take
place. As I have explained on another occasion (cf. Ref. 5, p. 317), the feelings
the personality and by the cultural influences under which the child grows up.
1986
believe, the effect of the modification of the child’s behavior brought about by
the personality changes of maturation and by influences from the outer
world. These factors create new patterns which determine the behavior of the
gains new patterns, of which those that appear to be “repressed” actually are
no longer a part. The former reactions have not been repressed; rather, they
they originated, such as, for example, the psychotherapeutic situation, in free
associations, and in dreams; but what now comes to the fore as recollection is
adults and infants experience objects in ways that differ in principle, so also
may adults and children use the same words to describe totally different
experiences. The patient must use the language of the adult when he refers to
infancy and childhood, even when the feelings are recalled more or less
clearly. Thus, when the patient speaks of father, mother, child, sexuality, and
so forth, the therapist must remember that the words may not necessarily
by the anxiety and catastrophes which arise from the patient’s growing
particularly through the treatment of resistance that the patient gains insight
1988
essential in the treatment and retraining of patients with organic brain
lesions. In such cases, the retraining situation itself produces catastrophic
conditions so frequently, even in the everyday life of the patient, that all
therefore have reason to discuss it here from the organismic point of view. I
have come to the conclusion that transference is effective in the treatment of
all diseases, organic or functional; secondly, it always has the same basic
unbearable conflicts and restrictions. Whether the causes of the conflict lie in
an organic or a psychological defect is not relevant to the central issue.
man. Indeed, only if a deeper mutual relationship has been established—if the
degree. With such cases as brain-injured patients, for example, the physician
may not even be able to acquire enough information for retraining the patient
through the usual examinations, because these for the most part require some
evaluating the significance of the defect for the patient’s future because, in
order to evaluate the patient’s potential for improvement and for the eventual
achievement of the highest possible degree of self-realization, the physician
must determine how much of the pattern which developed after injury as a
an evaluation requires deep insight into the patient’s previous personality, his
insight will the physician be able to help an individual who, lacking capacity
for abstraction, cannot grasp the meaning of the procedure and is unable to
check directly whether the instructions he has to follow will be useful for him,
and who further has to learn not to be afraid of making mistakes. This
presupposition of all the effects of retraining is still more important when the
patient is later expected to use what he has learned without being able to
understand whether it is correct or not. The patient will only be able to meet
1990
such demands when he is convinced that not only is the physician capable of
solidarity, a state which I call communion. This state exists also between
(cf. Ref. 9). It usually exists beside, and embedded in, the level of so-called
normally originates in our voluntary act of giving ourselves over to it. The
him only in the milieu, and this must be created by the physician.
But it is not enough that the physician create the environment out of
which communion may develop; he must also participate in the communion.
physician must see him as a human being like himself with whom he can live
in spite of the fact that the patient is deprived of essential human capacities.
defect of abstraction. This brought us insight into the difficulties and the
1992
narcissism—an observation which holds true if one tries to use the methods
he found useful in neuroses.
condition in this illness. Opinions on this subject have changed with the times.
But his assumption, to which mine corresponds, met with little approval in
later interpretations of schizophrenia. Only after careful investigation of
that the intellectual and emotional disturbances are probably only two
organic disease. But such an assumption did not seem appropriate. Looking
with the phenomena in the behavior of organic patients. The results were
illuminating: the comparison showed essential differences between the two
groups.
differences. The pattern which the organic patient shows in his concrete
1994
dedifferentiation of function typical of all organic damages. The
schizophrenic, on the other hand, develops characteristic individual patterns
in his concrete procedure which reveal influences from the patient’s ideas,
feelings, etc. All this pointed to qualitative differences in the origin of the
impairment of abstraction. This origin would be found in consideration of this
development, its mental features, etc., which cannot be given here. It may be
which he cannot fulfill and which send him into a state of anxiety are
eliminated. The organization of our normal world shows a greater
dangers which arise for him out of our world, dangers based on conflicts
between him and our world which may lead him to catastrophe and anxiety?
one in which the original organic unity between infant and mother is
extent this can be achieved depends upon the conditions of the environment,
particularly on the behavior of the mother or other significant persons. Not
only must the various needs of the infant— corresponding to his developing
bear.
mechanisms. (In this stage, the organism can be compared in this respect to
early age, before the disease, under the pressure of special conflicts, breaks
out.
1996
From this point of view, the abnormal concreteness appears as a
agrees with Arieti’s concept.) The assumption that the danger arises from the
world of personal relations, and that the patient tries to withdraw because of
particularly, in situations which are dangerous for the patient; it will be less
evident when there is no danger. We see that the patient does not always
normal intellectual capacities. One has the impression that, although the
situations.
shown—he knows his conflicts. The use of language, important for the
which show clearly that the schizophrenic does not want to understand our
language and changes his own language in such a way that we cannot
understand him.
If we want to establish contact with the patient, we must avoid all topics
careful consideration of the patient’s ideas, desires, tendencies, etc. and avoid
all conflicts as much as possible. The physician’s behavior must make the
patient feel that there is not so much difference between his world and our
world, that he is not so much in opposition to the latter. Thus, he does not
have to be afraid of us. Only then may contact with the physician become less
dangerous. The patient may thus give up his withdrawal, at least in certain
situations, and even be ready to talk about his problems and to accept the
1998
difficult job. It requires not only knowledge, endurance, and courage but also
deep devotion to one’s work. I believe the successes of Klaesi, Frieda Fromm-
Reichmann, Rosen, and others to be the result of such procedure. When Rosen
organic patients.
From our point of view it is understandable that one of the main points
other can patient and physician come as close to one another as is necessary.
Free association should be avoided, as it is apt to increase rather than reduce
understand why his behavior, which might have been necessary before, is no
longer necessary when he has a closer contact with our world. That means a
certain neglect of the contents, which have often been put too much in the
foreground. Frieda Fromm-Reichmann stresses that: “The actual role of the
Alexander says that eliciting memories by free association may be less the
cause of the therapeutic progress than its result. I do not wish to imply that
believe, however, the attitudes are often more important than the contents, a
fact stressed first by Max Friedemann.
infant and parents, by which procedure he shifts his affect against his parents
to his analyst. This displacement enables the patient to become aware of the
conflicts and to learn to cope with them under the protection of the therapist.
material the patient cannot remember under normal conditions but the
2000
knowledge of which is important for the understanding of the origin of the
symptoms; the second is to help the patient regain his health. Often the first
purpose was considered the most significant. No matter how correct that may
be, the second purpose seems to have at least the same, and perhaps greater
importance: to help the patient transform his personality in such a way that
he will be able not only to get rid of old conflicts but to handle new ones.
tasks?
fact that not all analysts will agree with her and some may consider her
states that it is impossible for the patient to live in the setting to which he is
situation through curtailing the “conscious ego function,” thus giving himself
over to infantile reactions and attitudes determined by the pleasure principle.
The author even goes so far as to assume that in this situation the patient
loses not only object relations but the objective world, all his actions in and
out of the analytic sessions being imbued with infantile reactions. I would like
to stress that this state may also exist more or less apart from the analytic
involved. I cannot discuss here the questions of whether this description fits
regression from the phenomena which gave rise to its assumption. They can
be described without it and even in a better, less biased way. I have tried to
show that the similarity between the behavior of an infant and a grownup in
the situation described becomes understandable as an expression of the
process of isolation with which we are dealing in both conditions: in infancy,
due to the lack of development of the conscious behavior, and, in the situation
in which we are interested here, due to the artificial state of mind the patient
is in. Isolation abnormally strengthens the phenomena belonging to the level
2002
ambivalent reactions, etc.; they are all due to modifications of functions
Closer observation shows further that the similarities to infant reactions are
merely superficial. The contents of the behavior may differ essentially from
that of the infant, and when they appear similar—for example, in verbal
very different from what they meant in childhood. The tendency to compare
the behavior of adults in pathological conditions to that of children or animals
pathology and is only too apt to do the same in the interpretation of neuroses.
Patients show deviations from normal conscious behavior above all because
Even if it were possible to bring the adult into an infantile state, which,
as MacAlpine says, concerns the whole personality, we wonder whether this
condition would be useful for therapy. We could not be sure whether what
the patient utters is important for his present conflict and his neurosis.
today, in a mental state in which just that capacity is reduced by which this
decision could be made? One may think that some improvement could be
But is that real improvement? I think acting out has no positive value for the
experiences may be for the development of the present neurosis, the conflicts
must also understand their origin, in particular that they were unavoidable at
the time of infancy but that they no longer apply to the present situation,
however much he may feel the anxiety related to them. He must realize the
present conflict and its significance for his self-realization now and in the
future, he must see which conflicts can be eliminated and which cannot. How
new attitude toward himself and toward the world, and make his choice
2004
The patient will be able to do that only if he can face the problems he has to
deal with—in other words, if his attitude toward them changes from anxiety
into fear. It is one of the paramount tasks of psychotherapy to help the patient
to accomplish this change, and for that he must make use of his abstract
capacity which is preserved in the normal part of his personality. That could
One might think that this transformation of the personality could take
place in a second stage of therapy, after the infantile material has first been
brought to the fore. But such a distinction between two separate stages does
not correspond to the facts. Some infantile conflicts, emotions, and attitudes
emotions and intellectual insight. But during one and the same period of
treatment the patient passes alternately through different stages—always the
one which corresponds to the tasks he has to fulfill —just as does a normal
may arise. The dependence on the analyst may become so strong that one
could fairly speak of a special kind of neurosis with the characteristic fixation
and ambivalence. This situation should be avoided, and this can best be
treatment, leads us to understand why the difficulties with which one is often
occur mildly. One of the significant causes of the usual difficulties is the fact
2006
that the patient is isolated from the physician, who, so to say, remains out of
the game. Consequently, the patient is always afraid to lose the therapist’s
anxiety—that is, he adopts the pleasure principle and clings to the physician
kind of powerful God or doctrine which the physician represents and which
alone can cure him. This is expressed by the patient’s attempt to use analytic
interpretation and terminology, a practice which can prevent him from seeing
the facts. He cannot consider discontinuing treatment; he cannot accept
another therapist; he will consider the slightest deviation from what he has
learned with disbelief. In other words, he does not become free; he does not
learn to master his conflicts himself—the requisite for regaining health.
These difficulties can only be avoided if, from the very beginning, the
because he has learned how to handle difficult problems, but which will be
successful only when the patient shows good will and participates in the
procedure.
communion. Only in this condition can the communication take place which is
necessary to make the patient aware that his problems are not alien to the
therapist, that they are common more or less to all human beings, that—
however different the symptoms may be by which they are recognizable—
they arise basically from the disruption of the mutual relationship between
him and others, the basis of all human existence. He learns further that
human existence —self-realization—always necessitates some sacrifice,
which need not be taken as an expression of a positive value but as the price
the time of treatment, but perhaps as important is the fact that it is still
effective after the treatment has ended.
treated rather like sacraments are affected. I will mention primarily the
2008
attitude toward the use of the couch as one of the most disputed procedures.
Organismic technique states that the patient should not lie down on the couch
influences the number of sessions per week, the duration and cost of the
treatment, the relationship between the patient and the physician outside the
consulting room, and after the end of the treatment, the relationship of the
treatment of both husband and wife—not together but at the same time—
when family problems, particularly sexual ones, are involved.
imply that the patient and the physician play the same part.
With organic patients, the physician is the guide and careful observer
to organize life in the future. But the patient must not play a passive role; he
must understand that he has to be active, must learn to bear difficulties for
the sake of the best form of self-realization.
that is possible. He should at the same time be in close contact with, and keep
his distance from the patient. Important as it is that the patient feel his
closeness to the physician, the latter must not show more affection than the
patient is able to bear at that moment.
the procedure from the beginning. When free associations are used,
periods of free associations should be avoided, the patient should again and
again be brought back to reality, and a synthesis of the results achieved
term. One must experience the state in order to realize what it represents. It
2010
development. It disentangles the individual from many irrelevant experiences
and from many conflicts of the past and present, it makes him free to realize
understanding and accepting each other. The union is based on the normal
drive in man to help and to be helped out of which originates the mutual
concern and thus the guaranty of self- realization in the highest possible
Bibliography
Friedmann, M., “Die Ueberlastung des Unbewussteir in der Psychoanalyse,” Allg. Ztschr. f.
Psychotherapie, 1:65, 1929.
_____, “The Concept of Health, Disease and Therapy,” Am. J. Psychotherapy, 8: 745, 1954.
_____, “The Smiling of the Infant and the Problem of Understanding the ‘Other,’ ” J. Psychol., 44:175,
1957.
_____, “Transference in the Treatment of Organic and Functional Nervous Disorders,” lnternat.
Congr. Psychotherapy, Zurich, 1954.
_____, and Scheerer, M., “Abstract and Concrete Behavior,” Psychol. Monogr., 53 (2) :239, 1941.
Groddeck, G., Das Ich und das Es, Nervous and Mental Disease Pub. Co., New York, 1928.
Vigotski, L., “Thought in Schizophrenia,” Arch. Neurol. & Psychiat., 31:1063, 1934.
2012
Chapter 37
Marvin G. Drellich
Introduction
of superior merit and a few are truly seminal. Obviously a summary of the
historical evolution of these theories will be traced, and those concepts that
Preliminary Definitions
definition given here will be entirely satisfactory only to the author and
perhaps to a small number of like thinkers. This definition will be
2014
Classical psychoanalytic theory is defined as the theory or group of
defined by him and as they have been modified, clarified, and extended both
by him and by numerous others who are closely associated with this body of
knowledge. Classical theory includes all five of the metapsy- chologieal
topographic points of view has come from some analysts who otherwise
elaborations of terms have occurred as the science has evolved. Where major
been formulated, they have been included in the classical theory to the extent
that the new ideas are: (1) consistent with clinical psychoanalytic
observation, (2) consistent with the main body of classical concepts, and (3)
to retain his existing theories, integrate the newer with the older concepts,
and increase the comprehensiveness of the whole.
2016
Formative Influences on Freud’s Theories of the Neuroses
Vienna. A substantial number of his patients suffered from what was then
called hysteria, a broadly inclusive term applied to several disorders that
“Helmholtz School of Medicine,” which held that all functions of the human
organism could be ultimately explained in exclusively physical terms. Brücke
taught that the reflexes are the basis of all activities of the nervous system,
after obtaining his medical degree. From 1882 to 1885 he was house
physician at the General Hospital in Vienna where he rotated through several
taught that all normal and abnormal mental processes could be related to the
structure of the brain and the reflex activity of the nervous system. During the
entire three years of hospital service, Freud was permitted to use Meynert’s
laboratory of cerebral anatomy where the young house physician carried out
research on human brain anatomy. As a result of his years of research in
when Freud requested and was given a grant to travel to Paris for study with
Jean Martin Charcot, the internationally known neurologist. Charcot was not
of symptoms of hysteria. During the six months that Freud studied in Paris,
2018
ideas alone could cause hysterical symptoms to occur, especially when these
explanations for mental disorders were in direct conflict with the exclusively
Private Practice
suffered from hysteria and other psychiatric disorders. Initially he used the
the Weir- Mitchell rest cure. Late in 1887 he began to use hypnosis to remove
symptoms by direct suggestion. About a year later he began to use hypnosis
older, was initially a revered senior colleague but gradually became a fatherly
friend who referred many cases when Freud entered into private practice in
remarkable story of her illness, treatment, and apparent cure to Freud, it had
hypnosis, to their origins, that is, to “traumatic” events in her past life. When
these events were remembered and the associated emotions were re-
herself called it a “talking cure.” Breuer and Freud called it “catharsis,” and it
symptoms.
and Meynert with his growing recognition of the role of psychical factors, his
2020
but he added that conditions of life, including functional sexual problems,
which have a “high psychical significance,” play a part in the etiology of
hysteria.
The years 1888 to 1898 were Freud’s most creative, and after several
false starts he produced the fundamental concepts on which have been built
and finally free association, a technique that he evolved in the years 1892-
1893. He had gathered an enormous amount of data on the current and past
disorders. He could not be content with the sketchy and relatively superficial
correspondence and his preliminary drafts that were sent to Wilhelm Fliess,
the neuroses. Most important is the now universally recognized concept that
there are elements in the human mind, ideas, thoughts, memories, and
associated feelings that are unconscious, that is, entirely outside of conscious
awareness. These unconscious elements are not easily retrieved or brought to
defenses, and so forth) are able to find expression through the symptoms of
neuroses.
A second crucial observation was that sexual factors are the most
the role of sexuality in the etiology of the neuroses was to take another
2022
In 1888 Freud had said that “conditions related functionally to sexual
life play a great part in the etiology of hysteria (as of all neuroses).” Here he
based on Breurer’s Anna O. and several of Freud’s own cases. Their expanded
for the first time. He described the repression of unacceptable sexual ideas
introduced the idea that masturbation plays a crucial role in the etiology of
neurasthenia and coitus interruptus is the pathogenic factor in anxiety
this time (1894-1895) that was to have lasting significance: the first
conflict. The revised anxiety theory was to become a central element in all
2024
psychoanalysis, He advanced his sexual theory in dramatic terms. He asserted
that psychical defenses are in every instance directed against a sexual
always occurred before the age of puberty and was, in fact, the seduction of
the child by the child’s father. In cases of hysteria the patient as a child was a
passive participant in the seduction, while in the obsessional neuroses the
The seduction theory was not destined to be retained for long. As early
seduction theory. He had formulated this theory from the histories of many
patients who claimed to have remembered such seductions. He could not
support the implication that there were so many perversely seductive fathers
to account for the legions of hysterical and obsessional patients. Freud was
discouraged by this reversal and despaired of ever finding the connection
“Freud became aware of the part played by fantasy in mental events and this
opened the door to the discovery of infantile sexuality and the Oedipal
Complex.” He came to realize that his patients’ “seductions” occurred only in
significant element in earliest childhood, and (2) that infantile sexuality is the
consequence of unconscious instinctual drives[2] that remain psychically
active throughout life.
expanded and modified but remains in many respects intact today as the
heart of the classical psychoanalytic theory.
has indicated some of the intellectual antecedents that found their way into
2026
thereby explain the motives and vicissitudes of normal as well as neurotic
thinking and behavior.
None of the five theories is, in fact, inclusive, and no claim has been
made for the completeness of any or all. Indeed, these concepts are most
meaningful and explanatory when taken together, that is, when they are
considered to supplement and clarify each other. These five theories are to a
greater or lesser extent metaphorical concepts. Classical psychoanalytic
clinicians and theoreticians will generally use all five as conceptual tools, but,
a statement of classical theory in all its aspects. Several volumes exist that
that they bear upon our understanding of the etiology and psychopathology
of the neuroses.
this theory has also come to be called the theory of intrapsychic conflict.
were in the patient’s mind but were previously entirely excluded from
sexual traumata were the elements that were repressed, but his sexual
theories were then sidetracked. His concern with adult sexual practices,
2028
intrapsychic conflict. His short-lived theory of childhood seduction was
within the psychological realm, but more important, it led to his discovery of
infantile sexuality and his formulation of the role of sexual instinctual drives in
The dynamic hypothesis then is concerned with the conflict between the
instinctual drives that “propel the organism toward gratification” and the
defenses, the counterforces that oppose the expression and gratification of
these impulses.
sexual in nature. The instinctual drives were described as “the demands that
the body makes upon the psychological apparatus.” These demands produce
instinctual drive. The death instinct has had very little acceptance in the
psychoanalytic community, but the recognition of the aggressive instinctual
drives and of the defenses against them has become an integral part of the
dynamic point of view. It should be noted that the aggressive drives are never
the sexual and aggressive drives because the individual has learned from a
very early age to associate many instances of drive discharge with pain. The
pain includes distressing feelings (anxiety, guilt, shame), physical pain, and
Prohibitions and threats from parents, society, and all other external sources,
whether explicit or implicit, are perceived and remembered. This leads to the
unconscious conviction that the direct expression of drive impulses will lead
hypothesis.)
2030
The opposition to the expression of the instinctual drives is initially the
perceived external threats of pain or danger. Early in life the threats become
internal, generate a sense of greater or lesser danger, and lead to the internal
defenses which are set in opposition to the awareness and the undisguised
excitation are among the unconscious fears that motivate the defenses.
worked out until after the formulation of the structural theory. Within the
dynamic theory it is simply stated that the expectation of pain or injury that is
Now there has been a growing tendency to accept Hartmann’s views on the
viewpoint that most mental activity and subsequent behavior, be they normal
or pathological, involve some degree of intrapsychic conflict.
causes for every mental event, conscious and unconscious. The final overt
manifestation, the dream, the joke, the slip of the tongue, the choice of job, the
choice of spouse, the largest and smallest decision, and, for our immediate
concern, the manifest symptom or symptoms of the psychoneuroses, all are
determined. All are the result of the many unconscious psychic processes that
interact and conflict and thereby determine the final overt manifestations, be
they normal or pathological.
the most direct, though very elaborate and sophisticated, development of the
dynamic concepts.
The conflict theory was the first in which Freud tried to develop a
the neuroses. The symptoms of neurosis are seen to arise out of intrapsychic
conflict. The sexual and aggressive instinctual drives have intensity (see
economic theory) and phase-specific qualities (see genetic theory). The
2032
defenses, which for many years were thought of as repression, direct
exclusion from consciousness, have been recognized to include many simple
and complex psychic activities (see structural hypothesis). The wide variety
discoveries are actually an elaborate fleshing out on the sturdy skeleton of the
dynamic hypothesis.
moving much further away from the neuroanatomical model of the mind. It
economic theory has been called an energy transfer theory. It is one logical
2034
development of the dynamic theory in that it tries to explain the outcome of
intrapsychic conflict in quantitative terms. It is concerned with the intensity
of instinctual drives, the strength of psychic defenses, and the internal and
metapsychology. -
The instinctual drive, defined as the demand that the body makes upon
psychic apparatus in order that actions may be initiated that would permit
the tension to be reduced. When instinctual tension increases it is labeled
not used here in the narrow sense of enjoyment or delight, but rather it
lessening of unpleasure.
tissue from which it arises; (2) an intensity, the quantity of psychic energy
(3) an aim, in all instances satisfaction or gratification; and (4) an object, the
person or thing in the external world that may be acted upon or related to in
such a manner that the interaction will effectively discharge or reduce the
2036
An instinctual drive invests the psychical representation of the external
object with increasing cathexis. This impels the individual to initiate action
toward the real object in order to achieve gratification. Prohibitions and fears
may oppose the motor activity that would permit gratification. Indeed,
prohibitions may even oppose being conscious of the wish to act. This
increase and will seek alternate channels for discharge. This involves a
the drive tension but does so in a disguised manner that conceals the true
nature of the drive wish. Indirect, incomplete discharge is thus possible while
the drive wish remains repressed. The same symptom may also symbolically
opposed and lead to a masochistic cathexis of the object. The object itself may
be changed. A young man may have persistent excessive sexual wishes
directed toward his mother, who had been both sexually provocative and
they may be directed toward another female who in any way can be
unconsciously associated with his mother. Such change of object will often be
a determinant of the choice of the love object in adult life. When the original
drive wish was very strongly opposed, the opposition may also be transferred
to the new object, and sexual inhibitions (impotence) may be the outcome of
any sexual acts directed toward the woman identified with his mother. When
overdetermined; that is, they are the outcome of many psychic elements,
drives, and defenses in prolonged interaction. In the foregoing clinical
examples the elements mentioned were only a few of the many forces that
2038
In 1905 Freud introduced the term “libido,” which he described as the
expression of sexual instinctual energy. At that time he spoke only about the
as the selfpreservative instincts and hence the repressive forces. After that he
referred to the conflict between sexual instincts (libido) and ego instincts. In
1920 he again revised his instinctual drive theory. Here he introduced the
concept of the aggressive instincts, that is, instinctual drives directed toward
the destruction of the object. (See section on dynamic theory for additional
postulates two fundamental drives: (1) the sexual drive, whose energy is
called libido and which is judged to have a somatic source; and (2) the
aggressive drive, whose energy has not been given an acceptable name and
which has not been judged to have a somatic source. The two drives may be in
instances the two drives are fused. This means that the object representation
is cathected and drive wishes initiate actions that serve to gratify both drives
instinctual element.
Freud’s own evaluation of these concepts. He asserted that “the instincts are
the most obscure element of psychological research” and that this theory
must undergo constant alteration with advances in knowledge. Although
many objections have been raised over the years to the energic concept, it has
cannot be emphasized too strongly that the division of drives that we use is
based on clinical grounds and will stand or fall on these grounds alone.”
At this time there remains a distinct need for a theory that deals with
quantification, increase and decrease of tensions, intensity of drives, strength
This is the name that Freud gave to his first published model of the
mental apparatus. In Chapter 7 of The Interpretation of Dreams he described
2040
the psyche as consisting of three systems: the conscious (Cs), the
preconscious (Pcs), and the unconscious systems (Ucs). He theorized a linear,
excitation that could flow from one system to another. In the absence of
internal opposition the flow of excitation will reach the motor apparatus, and
anatomy,” and the psychical systems do not correspond to any location in the
brain. The Ucs consisted of the instinctual drive representations that seek to
discharge their cathexes, that is, to move their excitation into the Pcs and Cs
Unconscious processes are timeless, have little regard for external reality, and
press relentlessly for satisfaction. The mode of functioning of the Ucs is called
the primary process, the tendency to discharge without delay and without
functioning of mental content in Pcs and Cs, takes into consideration the
external realities, prohibitions, appropriateness of objects, and the need for
delay or postponement of gratification.
and it encounters the censoring counterforces that are “located” in the Pcs.
These forces function to control or bind the mobile cathexes that seek to
move into the Pcs and Cs from their origin in the Ucs.
The topographic theory has been summarized here very briefly because
in its original spatial or hydraulic form it has not retained its usefulness for a
substantial number of classical psychoanalysts. The decline of this model has
been accelerated since 1923 when Freud postulated the more sophisticated
classical psychoanalysts.
Current theory retains the concept that mental content may be fully
forces. In this sense the terms are no longer used to designate systems but
2042
almost unanimous acceptance.
content may occupy (figuratively, not spatially) any position or degree along
this continuum. Obviously the three systems of the topographic model do not
takes into account the external realities, judges the appropriateness of objects
and opportunities for satisfaction, and delays gratification in accordance with
The concepts that comprise the genetic theory are widely known and
are popularly associated with Freud because they include many of his most
creative insights into human sexuality. Actually the genetic hypothesis is first
development, with the tasks and problems that are inevitably encountered in
each phase, and with the attempt to solve these problems in the course of
sexuality, especially infantile sexuality, for the genesis of the neuroses. His
2044
psychoanalytic theories). From the ashes of the seduction theory came the
discovery of the sexual fantasies of the child, the concept of infantile sexuality,
all persons from the earliest days of life. The drive originates from somatic
sources and makes demands on the psychic apparatus for discharge of the
In earliest infancy and roughly until the age of 18 months, the infant’s
libidinal tensions originate primarily from the mouth, lips, and tongue. In
addition to being the chief source of libidinal tension, this oral zone is also the
primary organ for gratification of this tension. The only way the infant can
pleasure has logically led to calling the first year to 18 months of life the oral
gradually shifts to the anal zone. The anus and surrounding area make up the
chief erogenous zone. Unpleasure is experienced as the tension in the anal
area associated with the accumulation of feces in the rectum and the
conscious urge to defecate. Pleasure occurs in the anal area when defecation
occurs and anal tension is relieved. Later in the anal phase the retention of
feces and controlled defecation come to be experienced as pleasurable, and
Sometimes in the third year of life the chief erogenous zone again shifts,
this time to the genitals, the penis in boys and the clitoris in girls. This is the
phallic phase of development, when the phallic organs are the sources of
libidinal tension and the organs for achieving pleasure through infantile
phallic phase lasts for about three years, but it must be understood that this is
in no sense an infantile equivalent of adult genital sexuality.
2046
It is essential that we take into consideration the role of object relations
in psychosexual development. In the oral phase the first object of the sexual
drive is the infant’s own body, especially his own mouth. Soon he begins to
the mother, the feeding person, or more accurately the visually or tactilely
object who interferes with gratification. She seeks to assume control of the
anal activity and introduces the issue of discipline. Control and discipline are
issues that are destined to have far-reaching consequences on the child’s
The child becomes concerned with such questions as: Who has control
of my body and its functions? Must I conform, obey, and surrender control to
mother, or may I somehow defy her and retain control of where and when I
defecate? What is the punishment for defiance? What are the rewards for
object relations.
The child’s sexual interest in the parent of the opposite sex and his
rivalrous hostile wish to displace the parent of the same sex are too well
fears, prohibitions) that will shape the character of his or her adult
heterosexual life.
not come to an abrupt end. Under all circumstances there remain elements of
the oral, anal, and phallic libidinal drives that remain active and become
circumstances these partial instinctual drives will serve to enhance and enrich
the adult personality and sexuality. Under unfavorable circumstances the
persistent partial drives or the defenses against them will produce character
2048
Another necessary clarification is that the word “sexual” as used in this
theory and all classical psychoanalytic theories does not have the narrow
use the word “sex” as a very broad and inclusive term to indicate all psychical
they base their criticism on the assumption that “sex” can only refer to adult
In order to understand the value of the genetic hypothesis for the theory
to renounce this level with great reluctance and defer moving on to the
challenges and satisfactions of the next phase, which may seem so much more
difficult to achieve. It follows that the most favorable outcome of any phase of
development occurs when there has been an optimal balance between
specific for the phase of fixation. In a sense a regression is either the process
In 1923 Freud worked out a new model of the mental apparatus. This
theory was expected to have far more explanatory potential than did the
topographic model. This expectation has clearly been realized. The structural
divisions of the human mind. It has been proven to have enormous usefulness
2050
and an almost inexhaustible potential for refined formulations based on
clinical observations.
The structural theory divides the mind into three functional divisions,
the id, the ego, and the superego. These are neither physical structures nor
mental processes that are “grouped” together within each “structure” have
essentially similar or closely related functions, relatively constant objectives,
and consistent modes of operation. Beres has warned against the danger of
reifying or concretizing the psychic structures. Id, ego, and superego are
These structures are nothing more than functional systems; they can only be
instinctual drives. Its contents are totally unconscious. It includes “the sum
total of ‘wishes’ which are the resultant of certain perceptions and memories
of the earlier gratification of basic physiological needs.”
The ego is the structure that includes the widest variety of functions. It
is well to remember that Freud used the word “ego” from the beginning of his
the self, the defensive agency of the mind, and the seat of the self-preservative
The ego includes all the mental elements that regulate the interaction
between the instinctual drives and the demands of the external world. This
It is impossible to say too much about the ego because the major thrust
of classical psychoanalytic theory over the past 40 years has been in the
direction of ego psychology. The latter is the conceptualization of nearly all
that are available to cope with and protect against threats, real or imagined,
2052
drives. Anna Freud is credited with the major role in describing the important
defense mechanisms in the repertory of the ego.
exclude a thought that was once conscious but was too painful and had to be
Isolation is the defense whereby ideas are split off from the feelings that
are associated with and appropriate to them. An obsessional idea such as “my
drive derivative with its opposite. A person may remain entirely unaware of
anal erotic impulses to make a great mess by maintaining a conscious, active
instinctual wish away from the original object and on to an essentially neutral
positions of authority.
his church on Sunday and thereby permit himself to resume his dishonest
business practices on Monday. He “paid the price” and “wiped his slate clean.”
original external hated object and directed toward the self as self-hatred, self-
accusation, and self-deprecation. This is an important mechanism in
2054
has not occurred and that the deceased is still alive is an obvious instance of
denial.
The ego includes many mental elements that are unconscious as well as
the functions of the ego. Initiation and control of motor activity and the
development and maintenance of relations with others (object relations) are
also within the province of the ego. Reality testing is an obvious ego function,
aspect of the ego. It is the structure that represents the ethical and moral
attitudes, the readiness to feel guilt, the unconscious roots of the sense of
conscience. The superego content is the result of internalization of the moral
effectively with the dynamic and genetic points of view. The three psychic
structures are not considered to be fixed or immutable; rather they are
2056
Ego development has not been as thoroughly worked out as has libido
the theoretical scene, but primarily because ego development is a far more
many ego functions: defense, thinking, dealing with reality, object relations,
for additional details see Hartmann and Kris,’’ Hartmann, Kris, and
barrier protects the infant from the multitude of external stimuli that
overstimulation were it not for the dampening by the stimulus barrier. The
barrier serves to protect against the “traumatic situation,”’ the situation in
of the external object (mother) that had been associated with previous
ensues; the infant begins to cry and thrash his arms and legs about. When the
This event includes the earliest perceptions, memory traces, and object
the self and the object representation. In the earliest months it is postulated
identification.
2058
It is the frustration and the failure of the hallucinatory wish fulfillment
that provide the impetus for the activation of the ego functions of
bringing about feeding) and also contribute to the perception of one’s body
and body parts. Primitive perception of reality and focusing of attention occur
of similar events produces memory traces that are the basis for learning from
experience.
of self and mother becomes more distinct, and secondary process thinking,
with ability to endure longer delays in gratification (frustration tolerance),
Before the end of the first year the infant has some sense of the success
separations in the second and third years are part of what Mahler calls the
The crucial question of anxiety is related to these first three years. The
excitation has already been described. The excitation may come from external
increasing drive tension (hunger) and the absence of mother are probably
recorded as unified memory traces; that is, the extended absence of mother
events. Later the mere absence of mother may evoke the association with
increasing drive tension. Before the tension reaches the level of flooding, the
2060
and is fated to have the most lasting consequences.
evoked and new or intensified defenses are set into operation in order to
function. In the oedipal phase a new surge of phallic instinctual drive tension
introduces new dangers. First, the possibility exists that the sexual interest in
the parent will erupt into conscious thought or action, and then the parent of
the same sex will retaliate against such expressions of sexuality. The
punishment is unconsciously conceptualized as castration, that is, loss of the
“offending” organ that is simultaneously, the source of the excitation and also
the organ of expression of the forbidden impulse. In the face of castration
childhood, where motor, intellectual, and social skills are evolved as the child
must meet new demands of the external world. In adolescence the capacity
for efficient regulation and control of sexual drives is developed in response
effectively and to express appropriately the sexual drive and the capacity to
functions continues into adult life, especially in the areas of work and love.
One outgrowth of the increasing concern with ego psychology has been
the special attention that has been paid to normal development and
nondefensive ego functions, the so-called adaptive hypothesis. Since this area
2062
activities. He referred to development of conflict-free ego functions as
autonomous ego development. Many ego functions that arise independent of
functions.
evaluation, but Rapaport has judged them both to have a high likelihood of
survival.
upon all five metapsychological points of view to the extent that each system
permits meaningful and consistent generalizations that can be based, first and
last, on clinical observations. Much of what follows has been discussed in the
sections on the five hypotheses. Here the implications for the genesis of
2064
neuroses will be brought together.
Intrapsychic Conflict
of the ego in the structural theory. This opposition occurs because of the real
or apparent dangers that are associated with the emergence of the forbidden
intact, to avoid pain, to assure stable and gratifying object relations, all of
maintain repression.
sometime in the first year of life when the earliest ego functions appear to
develop and are called upon to oppose the immediate and indiscriminate
discharge of the inborn instinctual drives.
factors are inferred from clinical observations of the result of the conflict, and
there is no intent to suggest that such quantities are measurable in any
concrete sense. When the strength of the drive is greater than the repressive
forces, the drive derivative will reach conscious awareness as a thought, idea,
2066
Repression cannot be expected to be permanent; the instinctual drives
continue to exert a pressure toward discharge, and the repressive functions
between drive and defense, and the conflict has little or no intrusive impact
the regularly recurring tactics for coping with internal conflicts. Depending
are endowed with excessive strength and interfere with direct drive
the strength of the instinctual drive threatens to overcome the defenses, the
2068
occurs as a result of a compromise formation as follows: (1) the drive
derivative and its associated unconscious fantasy wishes find a channel that
disguised form upon the gratifying process in order to make the specific drive
derivative consciously unrecognizable; and (3) the superego imposes an
element of suffering onto the drive expression in order to disguise the fact
drive gratification. These dynamics explain why the symptom is often called
more detailed consideration of the elements that influence the strength and
character of the drives and the ego functions. These influences are regularly
traced back to childhood developmental experiences, especially the course of
simultaneously, and each is profoundly influenced by the other; both are also
influenced by the child’s interaction with the significant persons in his
ego development.)
basis for fixation, although in some instances excessive gratification will also
contribute. Fixation requires that extraordinary or unusually strong ego
2070
defenses be mobilized in order to contain the intense, persistent partial
drives of an earlier phase (which should have achieved relative stability) will
impair the ego’s energy and versatility in coping with the partial impulses of
the current phase.
also to the prominent ego defenses that are characteristic of the specific
phase of fixation.
ubiquitous. (2) Some of the functions of the ego are: (a) to maintain
unacceptable drives may find expression in a disguised form. (3) One form of
elements as punishment for drive discharge. (4) Anxiety is the sine qua non
Anxiety Reaction
floating anxiety and episodes of acute intense anxiety. Earlier this was called
was a purely physiological or toxic theory and has now been replaced by a
psychological theory. The distressing anxiety is caused by the failure of all the
defenses to maintain effective stable control over the instinctual drives.
traits, sexual and work inhibitions, and occasional paranoid feelings, but
neither the neurotic symptoms nor the neurotic character traits are sufficient
2072
to stabilize the conflict, so the patient is rarely free of anxiety.
later phases. Separation anxiety and fear of being overwhelmed by one’s one
feelings derive from traumata in the oral phase. Fear of losing control of
oneself and fear of having no control over the diffusely dangerous external
environment result from anal phase difficulties. Sexual inhibitions and gender
There is some question whether the acute anxiety attack is not only a
Phobic Reaction
or thing called the phobic object or situation. The patient will experience
mounting anxiety as he approaches or comes into contact with the phobic
situation or object.
near a bridge and as he crosses it. As he drives off the bridge there is a sharp
decline in anxiety, and when he can stay away from bridges he may be
diverted from the internal drive and from the realistically threatening
external stimulus and attaches to the otherwise neutral phobic object. To the
extent that the patient can avoid the phobic object he remains generally free
of anxiety.
2074
be avoided the anxiety returns. Furthermore, the phobic object is frequently a
thing of uncanny fascination to the phobic patient. The fascination occurs
qualities that cryptically reveal the feared object and the feared instinctual
drive. The cryptic representation functions in much the same manner as the
manifest dream disguises, but it also reveals or leads to the revealing of the
slept in his parents’ bedroom for more than eight years had frequently
no discharge channel. His fear of closed places in later life was traced in part
to these oedipal origins. The closed place represents first the bedroom from
which he couldn’t escape. It also represents the wish to intrude into the
parental sexual act, not only to separate his parents but also to become a
participant in the sexual act. In some unspecific way he sought to relieve the
Phobias may originate from earlier phase traumas. A young woman had
had a talented, dramatic, overstimulating mother whose behavior toward the
contact. The girl was excited, delighted, and also terrified by these attentions.
When her mother was preoccupied and unresponsive the child was initially
relieved, but later she sought out, with unpredictable success, more
claustrum was the wished for mother who simultaneously loved and
threatened to devour her and also included punishment for the patient’s
2076
unpredictable rejections.
Conversion Reaction
and is naively unable to see through the often tissue-thin disguises that are
intended to conceal the instinctual impulses that are both expressed and
punished by the symptom. For many years the conversion reaction was
which are immature sexual responses and are consistent with the concept of
oedipal phase fixation.
In the past two decades clinical evidence points toward a primary role
for oral fixations and an important but secondary role for oedipal fixations.
The patient shows gross immaturity, constant seeking of love and attention,
and minimal capacity to tolerate frustration. The prominent defense
formation, are that which are regularly evoked during the normal
object relationship, but for the hysteric it persists into later phases and even
into adult life as a mode of relating to others. One consequence is the absence
fantasies are not mature rehearsals for real experiences but rather are
2078
against all the evidence of experience; this is because denial of external
realities is a regularly encountered ego defense.
strivings and ego functions that were more suited to cope with oral phase
issues. Small wonder that the adult heterosexual life has many infantile
features. It betrays strivings for anaclitic gratifications and oral phase ego
Obsessive-Compulsive Neurosis
social, sexual, and work activities, and, above all, will be experienced as alien
and intrusive. The compulsions are the stereotyped recurring acts and rituals
that the patient feels an irresistible urge to carry out. Anxiety is felt if the
the act is carried out in the “proper” fashion and the “correct” number of
times. Checking over and over again to see that the door is locked, that the gas
is turned off, or that the baby is still breathing are obvious examples. Dressing
does not seem alien to him but may be a trial to others. He is a serious,
follower rather than as a leader. He is careful to obey the law and follow the
wishes and orders of others. He is honest, orderly, thrifty, inflexible,
the major issues in this phase has to do with the child’s struggle to retain
control over the evacuation of the bowels and over the pleasure associated
with expulsion and retention. The struggle includes the mother’s attempt to
institute toilet training; she attempts to impose her will as to where and when
the evacuations will occur. When toilet training has been harsh, rigid, and
carried out in an atmosphere of fear and threats, the child will submit out of
fear and will manifest an apparent compliance while concealing profound
rage, resentment, and the need to find opportunities for disguised defiance.
2080
The child will be burdened with unusually strong aggressive and
performance.
obsessional fantasies and keep them unreal and less painful because they are
isolated from their associated feelings. Magic thinking finds a function with
these patients and is the basis of many of the private rituals and fantasied
pacts with fate. Regression to anal erotic forms of pleasure and to primitive,
associated with loss of control of oneself and the unleashing of one’s wide-
Bibliography
_____, (1921), “Contribution to the Theory of the Anal Character,” in Selected Papers, Hogarth,
2082
London, 1949.
_____, (1924), “Influence of Oral Erotism on Character Formation,” in Selected Papers, Hogarth,
London, 1949.
Amacher, P., Freud’s Neurological Education and Its Influence on Psychoanalytic Theory,
International Universities Press, New York, 1965.
Arlow, J. A., “Conflict, Regression and Symptom Formation,” Int. J. Psychoanal., 44:12-22, 1963.
_____, and Brenner, C., Psychoanalytic Concepts and the Structural Theory, International
Universities Press, New York, 1964.
Bellak, L., “The Unconscious,” in Conceptual and Methodological Problems in Psychoanalysis, Ann.
N.Y. Acad. Sc., 76: 1066-1097, 1959.
Beres, D., “Structure and Function in Psychoanalysis,” Int. J. Psychoanal., 46.53–63, 1965.
Blau, A., “A Unitary Hypothesis of Emotion Anxiety, Emotions of Displeasure and Affective
Disorders,” Psychoanal. Quart., 24:7 5-103, 1955.
_____, “The Nature and Development of the Concept of Repression in Freud’s Writings,” in The
Psychoanalytic Study of the Child, Vol. 12, pp. 18-46, International Universities
Press, New York, 1957.
Breuer, J., and Freud, S. (1893), “On the Psychical Mechanism of Hysterical Phenomena:
Preliminary Communication,” in Strachey, J. (Ed.), Standard Edition, Vol. 2, Hogarth,
London.
_____, and_____, (1895), Studies on Hysteria, Basic Books, New York, 1957.
Ellenberger, H. F., The Discovery of the Unconscious, Basic Books, New York, 1970.
Engel, G., “Anxiety and Depression-Withdrawal. The Primary Affects of Unpleasure,” Int. J.
Psychoanal., 43:89-97, 1962.
_____, Identity and the Life Cycle, International Universities Press, New York, 1959.
Fenichel, O., The Psychoanalytic Theory of Neurosis, Norton, New York, 1945.
Flescher, J., “A Dualistic Viewpoint on Anxiety,” J. Am. Psychoanal. A., 3:415- 446, 1955.
Freud, A. (1936), The Ego and the Mechanisms of Defense, International Universities Press, New
York, 1946.
Freud, S. (1925), An Autobiographical Study, in Strachey, J. (Ed.), Standard Edition, Vol. 20,
Hogarth, London.
_____, (1920), Beyond the Pleasure Principle, in Strachey, J. (Ed.), Standard Edition, Vol. 18, Hogarth,
London.
_____, (1924), “The Economic Problem of Masochism,” in Strachey, J. (Ed.), Standard Edition, Vol.
19, Hogarth, London.
_____, (1923), The Ego and the Id, in Strachey, J. (Ed.), Standard Edition, Vol. 19, Hogarth, London.
_____, (1896), “Heredity and the Aetiology of the Neurosis,” in Strachey, J. (Ed.), Standard Edition,
Vol. 3, Hogarth, London.
_____, (1888), “Hysteria,” in Strachey, J. (Ed.), Standard Edition, Vol. 1, Hogarth, London.
2084
_____, (1926), Inhibitions, Symptoms and Anxiety, in Strachey, J. (Ed.), Standard Edition, Vol. 20,
Hogarth, London.
_____, (1915), “Instincts and Their Vicissitudes,” in Strachey, J. (Ed.), Standard Edition, Vol. 14,
Hogarth, London.
_____, (1900), The Interpretation of Dreams, in Strachey, J. (Ed.), Standard Edition, Vols. 4 & 5,
Hogarth, London.
_____, (1905), Jokes and Their Relations in the Unconscious, in Strachey, J. (Ed.), Standard Edition,
Vol. 8, Hogarth, London.
_____, (1894), “The Neuro-Psychoses of Defense,” in Strachey, J. (Ed.), Standard Edition, Vol. 3,
Hogarth, London.
_____, (1933), New Introductory Lectures on Psychoanalysis, in Strachey, J. (Ed.), Standard Edition,
Vol. 22, Hogarth, London.
_____, (1885), “On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the
Description ‘Anxiety Neurosis,’” in Strachey, J. (Ed.), Standard Edition, Vol. 3,
Hogarth, London.
_____, (1885), “Project for a Scientific Psychology,” in The Origins of Psychoanalysis, Basic Books,
New York, 1954.
_____, (1901), The Psychopathology of Everyday Life, in Strachey, J. (Ed.), Standard Edition, Vol. 6,
Hogarth, London.
_____, (1915), “Repression,” in Strachey, J. (Ed.), Standard Edition, Vol. 14, Hogarth, London.
(1915), “The Unconscious,” in Strachey, J. (Ed.), Standard Edition, Vol. 14, Hogarth, London.
Gediman, H. K., “The Concept of Stimulus Barrier: Its Review and Reformulation as an Adaptive
Ego Function,” Int. ]. Psychoanal., 52:243-258, 1971.
Gill, M. M., Topography and Systems in Psychoanalytic Theory, International Universities Press,
New York, 1963.
Gillespie, W. H., “Aggression and Instinct Theory,” Int. J. Psychoanal., 52:155-160, 1971.
Greenson, R. R., “The Classical Psychoanalytic Approach,” in Arieti, S. (Ed.), American Handbook of
Psychiatry, Basic Books, New York, 1959.
, “The Origin and Fate of New Ideas in Psychoanalysis,” Int. J. Psychoanal., 50: 503-516, 1969.
Hartmann, H. (1939), Ego Psychology and the Problem of Adaptation, International Universities
Press, New York, 1958.
_____, Essays on Ego Psychology, International Universities Press, New York, 1964.
_____, and Kris, E., “The Genetic Approach in Psychoanalysis,” in The Psychoanalytic Study of the
Child, Vol. 1, pp. 11-30, International Universities Press, New York, 1945.
_____, _____, and Loewenstein, R. M., “Comments on the Formation of Psychic Structure,” in The
Psychoanalytic Study of the Child, Vol. 2, pp. 11-38, International Universities Press,
New York, 1946.
_____, _____, and _____, “Notes on the Theory of Aggression,” in The Psychoanalytic Study of the Child,
Vol. 3, pp. 9-36, International Universities Press, New York, 1949.
Hendricks, I., Facts and Theories of Psychoanalysis, Alfred A. Knopf, New York, 1939.
2086
Jacobson, E., “The Affects and Their Pleasure-Unpleasure Qualities in Relation to the Psychic
Discharge Processes,” in Loewenstein, R. M. (Ed.), Drives, Affects, Behavior,
International Universities Press, New York, 1953.
_____, “The Self and the Object World,” in The Psychoanalytic Study of the Child, Vol. 9, pp. 75-127,
International Universities Press, New York, 1954.
Jones, E., “Anal Erotic Character Traits,” in Papers on Psychoanalysis, Balliere, Tyndall and Cox,
London, 1948.
_____, The Life and Work of Sigmund Freud, Vol. 1, Basic Books, New York, 1953.
Kaywin, L., “An Epigenetic Approach to the Psychoanalytic Theory of Instincts and Affects,” J. Am.
Psychoanal. A., 8:613-658, 1960.
Kubie, L. S., “The Fallacious Use of Quantitative Concepts in Dynamic Psychology,” Psychoanal.
Quart., 16:507-518, 1947.
Lampl-De Groot, J., “Symptom Formation and Character Formation,” Int. J. Psychoanal., 44:1-11,
1963.
Lewin, B. D., “Phobic Symptoms and Dream Interpretation,” Psychoanal. Quart., 21: 295-322,
1952.
Lustman, S. L., “Introduction to Panel on the Use of the Economic Viewpoint in Clinical
Psychoanalysis,” Int. J. Psychoanal., 50:95-102, 1969.
Mahler, M., “On the Significance of the Normal Separation-individuation Phase,” in Schur, M. (Ed.),
Drives, Affects, Behavior, Vol. 2, International Universities Press, New York, 1965.
Marmor, J., “Orality in the Hysterical Personality,” J. Am. Psychoanal. A., 2:656- 671, 1952.
Rancell, L., “A Further Attempt to Resolve the ‘Problem of Anxiety,’ ” J. Am. Psychoanal. A., 16:371-
404, 1968.
Rapaport, D., “A Historical Survey of Psychoanalytic Ego Psychology,” in Erikson, E. H., Identity
and the Life Cycle, International Universities Press, New York, 1959.
_____, The Structure of Psychoanalytic Theory, International Universities Press, New York, 1960.
Silverberg, W. V., Childhood Experience and Personal Destiny, Springer, New York, 1952.
Stewart, W. A., Psychoanalysis: The First Ten Years, 1888-1898, Macmillan, New York, 1967.
Strachey, J., “The Emergence of Freud’s Fundamental Hypotheses,” in Strachey, J. (Ed.), Standard
Edition, Vol. 3, pp. 62-70, Hogarth, London, 1962.
Van Der Leeuw, P. J., “On the Development of the Concept of Defense,” Int. J. Psychoanal., 52:51-
58, 1971.
Waelder, R., Basic Theory of Psychoanalysis, International Universities Press, New York, i960.
Yankelovich, D., and Barrett, W., Ego and Instinct, Random House, New York, 1970.
2088
Zetzel, E. R., “The Concept of Anxiety in Relation to the Development of Psychoanalysis,” J. Am.
Psychoanal. A., 3:369-388, 1955.
Ralph R. Greenson
Introduction
upon which psychoanalytic practice and technique are based. There is a very
Freud).
psychoanalysis. Others, like Rosenfeld, Boyer and Giovacchini, and Arlow and
Brenner, maintain it is possible to treat schizophrenics with the traditional
psychoanalytic method.
development, noting the major changes in the technical procedures and the
therapeutic processes. I am using the term “technical procedure” to refer to a
2090
technical procedures. A “therapeutic process” refers to an interrelated series
of psychic events within the patient, a continuity of psychic reactions that
was his therapeutic intent that led to the discovery of psychoanalysis. The
changes in his technique were never abrupt nor complete. There would be a
years between 1888 and 1898. Stewart has written a carefully documented
experience that had been cut off from consciousness and that had resulted in
the memory of the event by which it teas provoked and its accompanying affect,
and when the patient had described that event in the greatest possible detail
hypnosis or suggestion. The fact that certain patients, like Frau Emmy von N.,
patient’s resistance was a defense, their “not knowing” was, in fact, a “not
wanting to know” (pp. 269-270).
2092
According to Jones, Freud gradually gave up hypnosis, suggestion, and
pressing between 1892 and 1896 and relied instead on free association. Hints
of this are already mentioned in 1889 in the case of Emmy von N. and later in
Without exerting any other kind of influence, he invites them to lie down
in a comfortable attitude on a sofa, while he himself sits on a chair behind
them outside their field of vision. He does not even ask them to close their
eyes, and avoids touching them in any way, as well as any other procedure
which might be reminiscent of hypnosis. The session thus proceeds like a
conversation between two people equally awake, but one of whom is
spared every muscular exertion and every distracting sensory impression
which might divert his attention from his own mental activity. ... In order
to secure these ideas and associations he asks the patient to “let himself
go” in what he says, “as you would do in a conversation in which you were
rambling on quite disconnectedly and at random.” [pp. 250-251]
Freud also realized that the personal influence of the physician could be
of great value and suggested that the therapist act as an elucidator, a teacher,
and a father confessor. However, he also became aware that under certain
factor that turns the patient-physician relationship into the “worst obstacle”
we can come across.
transference, but they were then considered essentially obstacles to the work.
that book Freud had described the different forms, qualities, and properties
that distinguish conscious from unconscious psychic phenomena. He
clear up each symptom, one after the other. By allowing the patient to do free
2094
association and to choose the subject matter of the hour, the analyst would
then be able to interpret the meaning of the patient’s material and resistances
and thus undo the repressions, leading to filling in the gaps of memory.
It was in the Dora case that Freud first stated that, “Transference, which
most powerful ally, if its presence can be detected each time and explained to
the patient” (p. 117). In a postscript to that case Freud described how the
patient had broken off treatment because he had failed to analyze the
The major shift in the theory of the therapeutic process was the
memories had now become the major goal, and emotional catharsis was
allocated to a secondary position.
The next major changes in technique took place in the years 1911-1915
when Freud published a series of six technical papers. In The Dynamics of the
obstacle and also the greatest ally of the analyst. Psychoanalysis does not
will regress to protect and hold onto his childhood fantasies, now displaced
onto the person of the analyst. The analyst’s task is to permit both the loving
and hateful transference reactions to occur and to resolve them by
The next paper published later that same year described the ideal
attitude of the analyst. He should listen with evenly hovering attention and
should try to avoid gratifying the patient’s infantile wishes by reacting like an
2096
opaque mirror to the patient, reflecting back only what the patient displaces
onto him. The analyst’s personal views and reactions would only interfere
purposes because in it Freud stated that the psychoanalyst should not make
stated as follows:
To ensure this, nothing need be done but to give him time. If one exhibits a
serious interest in him, carefully clears away the resistances that crop up
at the beginning and avoids making certain mistakes, he will of himself
form such an attachment and link the doctor up with one of the imagos of
the people by whom he was accustomed to be treated with affection. It is
certainly possible to forfeit this first success if from the start one takes up
any standpoint other than one of sympathetic understanding, such as a
moralizing one, or if one behaves like a representative or advocate of some
contending party (Pp. 139, 140).
I believe this is the first description of the origin and importance of what
thoroughly effective if given only once. They have to be repeated because all
neurotic patients have a “compulsion to repeat.” Patients will act out in the
singularly valuable. Finally in a successful analysis the patient will replace his
previous neurosis with a “transference neurosis.” This means that eventually
the analyst will become the most important person in the patient’s life, and all
the patient’s neurotic symptoms and attitudes will revolve around the
analyst. It is the resolution of the transference neurosis that insures a
successful analysis.
technique, we see that the central and most important technical procedures
the emphasis on producing alterations in the ego. This was first mentioned in
the twenty-seventh lecture of The Introductory Lectures (p. 455), but the
nature of the alteration and how it could be effected was not described. In
2098
several defensive maneuvers. The ego uses the defenses, which exert an
anticathexis, a counterforce, in order to keep some dangerous impulse,
dirtiness. The defenses operate through the ego, and our major therapeutic
efforts are aimed directly at the ego. Anna Freud’s The Ego and the
Mechanisms of Defense, published in 1936, was the first attempt to place ego
psychology in the forefront of psychoanalytic theory as well as to systematize
In The Ego and the Id Freud stated that by analyzing the transference
fresh portions of the id. Where id was, there ego shall be” (p. 80). Again in
Analysis Terminable and Interminable Freud stated: “The business of the
and psychoses as they relate to psychoanalytic therapy. This subject has been
postulated that the neuroses are the result of a conflict between an instinctual
drive and a defense. This theory is mentioned at many different points in
Freud’s writings, but it is often obscured by the fact that in his early writings ,
the only instinctual drive he described clinically was the sexual drive, and he
used the term “repression” for the concept of defense mechanism in general.
In his Three Essays on Sexuality he very clearly describes his theory of the
against the sexual instinct (which we have already met with in the form of
shame, disgust and morality), and what seems like an instinctive aversion on
sexual matters right into the period of sexual maturity” (p. 164).
2100
will be clarified if one replaces the term “repression” with the concept of
mechanisms of defense.
It was only with the development of the structural point of view that it
impulses (instinctual drives) seeking discharge and ego defenses that arc
attempting to ward off the impulses’ direct discharge or access to
for thoughts and fantasies of instinctual satisfaction. On the other hand, the
that the self- reproaches take on a drivelike quality. All parts of the psychic
superego. The external world may represent and mobilize some instinctual
external world turns out to have become an internal conflict between the ego,
2102
It should be remembered that Freud believed every adult neurosis is
neuroses. It was once thought that all children go through some form of
infantile neurosis; some overcome it, “grow out of it,” while others develop a
neurosis in later life (Fenichel). Anna Freud has stated that perhaps our more
depleted ego and break through into consciousness and behavior. These
Some years ago a young woman, Mrs. A., came for treatment accompanied
by her husband. She complained that she was unable to leave her house
alone and felt safe only with her husband. In addition, she complained of a
fear of fainting, a fear of dizziness, and a fear of becoming incontinent. Mrs.
A.’s symptoms had begun quite suddenly some six months earlier while
she was in a beauty parlor.
The analysis, which lasted several years, revealed that the actual trigger
for the outbreak of the patient’s phobias was the event of having her hair
combed by a male beautician. We were able eventually to uncover the fact
The apparently innocuous event of having her hair combed stirred up old
incestuous longings, hostilities, guilt, and anxiety. To put it briefly, Mrs. A.
had to be accompanied by her husband in order to be sure he had not been
killed by her death wishes. Also his presence protected her from acting out
sexually. The fears of fainting, of dizziness, and of incontinence were
symbolic representations of losing her moral balance, losing her self-
control, soiling her good character, humiliating herself, and falling from
her high position. The young woman’s symptoms had links to the
pleasurable body sensations of childhood as well as to infantile
punishment fantasies.
I believe one can formulate the events as follows: the combing of her hair
stirred up repressed id impulses which brought her into conflict with her
ego and superego. Despite the absence of obvious neurotic symptoms
prior to the outbreak of the phobias, there were indications that her ego
already was relatively depleted and her id lacked adequate discharge
possibilities. Mrs. A. had had difficulty in sleeping for years, nightmares,
and inhibitions in her sexual life. As a consequence the fantasies mobilized
by the hair combing increased the id tensions to a point where they
flooded the infantile defenses of the ego and involuntary discharges took
place, eventuating in acute symptom formation (Pp. 19, 20).
Freud’s writings on the psychoses were not consistent and were often
obscure and even contradictory. Yet a careful reading of his work does reveal
that he felt there were qualitative differences between the neuroses and the
2104
those who cannot because they suffer from a narcissistic neurosis (pp. 420-
423). Earlier in the Schreber case Freud described how Schreber’s “Subjective
world had come to an end since his withdrawal of love from it.” In his paper
on The Unconscious Freud stated very clearly, “In the case of schizophrenia,
on the other hand, we have been driven to the assumption that after the
process of repression the libido that has been withdrawn does not seek a new
object, but retreats into the ego; that is to say, that here the object-cathexes
By this statement, Freud did not mean only the withdrawal from external
reality objects. He specified repeatedly that “in schizophrenia, this flight
consisted in withdrawal of instinctual cathexis from the points which
represent the unconscious presentation of the object.” Here was the really
crucial differentiation between neurosis and psychosis. Here was the real
basis for the clinical experience of inner and outer world destruction. Here
was the central theoretical construct by which one could understand that
if the ego was a “precipitate of abandoned object- cathexes,” then the
dissolution of those representations must necessarily lead to the psychic
disasters of schizophrenia (p. 93).
be for such patients. Lying on a couch with the analyst out of sight and doing
conflicts that are the cause of the neurosis. To understand the patient’s
pathology and the interactions between the patient and the analyst during
and structural points of view. In actual practice we only analyze our patient’s
productions partially and fragmentarily in a given interval of time.
neither systematic nor complete. Here I shall only attempt to give a working
definition of these concepts. For a more comprehensive survey the reader is
The earliest point of view Freud postulated was the topographical one.
2106
In Chapter 7 of The Interpretation of Dreams he described the different modes
of functioning that are characteristic for conscious and unconscious
phenomena. The primary process holds sway over unconscious material, and
result of the interaction of forces, some working in unison and others working
concurrently in opposition to one another. An example of this is the following:
A young man greets an attractive guest sitting at the family dinner table by
saying: “How nice to see you, Dolores. Every time you come it is like a breast
of fresh air. Oh, I mean it’s like a breath of flesh air.” The first sentence
expresses the young man’s pleasure in a socially acceptable way. The slip of
saying breast instead of breath indicates a breakthrough of sexual feelings
toward the woman. He tries to repair this breach but succeeds only partially.
He represses the breast, but fresh gets turned into flesh. It is only a partial
victory for the antisexual forces within him. The wish to expose and to hide
his sexual desires is vividly demonstrated in his slips. The dynamic point of
and overdetermination.
are based on this hypothesis. An example of economics can be seen in the case
of Mrs. A., whom I described above. Before the outbreak of the patient’s
phobias she was in a state of damned up instinctual tensions, but her ego was
still able to carry out its defensive functions adequately enough so that Mrs. A.
could function without obvious symptoms. At the point of her father’s visit
the hair combing brought back sexual and romantic memories from the past.
In addition, it increased her hostility to her husband. Mrs. A.’s ego could not
cope with this new influx of id strivings seeking discharge. The instinctual
This led to a phobia about leaving her house unaccompanied by her husband.
The genetic point of view deals with the origin and development of
psychic phenomena. It deals not only with how the past lives on in the
present, but also why a specific solution was used in ccrtain conflicts. This
2108
avoid conflict with a strong man. This was his mother’s way of dealing with
his father, which he identified with.
divided into several persisting function units. This was Freud’s last major
—and ask ourselves what does each contribute to the process of being
analyzed and how do these three essential elements interact with one
another. We can now state the aim of psychoanalytic therapy more succinctly.
The analyst attempts to resolve the patient’s neurotic conflicts by reuniting with
the conscious ego those portions of the id, superego, and unconscious ego that
had been excluded from the maturational processes of the healthy remainder of
the total personality.
Free Association
conscious and yet are highly organized in accordance with the secondary
process; they are accessible to the conscious ego and can be put into coherent
The patient is asked to try, to the best of his ability, to let things come up
in his mind and to say them without regard for logic or order; he is to report
things even if they seem trivial, shameful, or impolite. By letting things come
to mind a regression in the service of the ego takes place, and derivatives of
the unconscious ego, id, and superego tend to come to the surface. The patient
moves from strict secondary-process thinking in the direction of the primary
process. It is the analyst’s task to analyze these derivatives for the patient.
been concluded, and we have decided the patient seems to have the capacities
needed to work in the analytic situation. We want to be reasonably certain
2110
that the patient has the resilience in his ego functions to oscillate between the
more regressive ego functions as they are needed in free association and the
more advanced ego functions required for understanding the analyst’s
interventions and resuming his everyday life at the end of the hour.
The patient may report events from his daily life or past history in
misused by the patient or the psychoanalyst (A. Freud). This does not mean
by Lacan, Alexander and French, or Marmor. I agree with Anna Freud who
said that the tools of any trade should be periodically inspected, revised, and
misuses of our technical rules. Some schizophrenic patients cannot stop free
feelings for a person that do not befit that person and that actually apply to
another. Essentially a person in the present is reacted to as though he were a
defenses pertaining to a person in the past have been shifted onto a person in
the present. It is primarily an unconscious phenomenon, and the person
fantasies, attitudes, and ideas or defenses against them. The people who are
reactions (Fenichel).
2112
underreact, or one may have a bizarre reaction to the transference object. The
transference reaction is unsuitable in its current context; but it was once an
reactions are to a person in the present, they fit snugly to someone in the
past.
For example, a young woman patient reacts to my keeping her waiting for
two or three minutes by becoming tearful and angry, fantasying that I
must be giving extra time to my favorite woman patient. This is an
inappropriate reaction in a thirty-five-year-old intelligent and cultured
woman, but her associations lead to a past situation where this set of
feelings and fantasies fit. She recalls her reactions as a child of five waiting
for her father to come to her room to kiss her good night. She always had
to wait a few minutes because he made it a rule to kiss her younger sister
good night first. Then she reacted by tears, anger, and jealousy fantasies—
precisely what she is now experiencing with me. Her reactions are
appropriate for a five-year-old girl, but obviously not fitting for a thirty-
five-year-old woman. The key to understanding this behavior is
recognizing that it is a repetition of the past, i.e., a transference reaction.
[Greenson, pp. 151-153]
past to enter into the treatment situation. Transference repetitions bring into
positive and the negative transference. The positive transference refers to the
different forms of loving and the negative transference implies some variety
of hatred toward the analyst. It should be borne in mind that all transference
surface.
of ego functions and object relations. The patient must have an ego capable of
partial and reversible so that the patient can be treated analytically and still
live in the real world. People who do not dare regress from reality and those
who cannot return readily to reality, like the psychotics, are poor risks for
psychoanalysis. Freud” divided the neuroses into two groups on the basis of
transference reactions and still function in the analysis and in the external
world. Patients with a “transference neurosis” could do this, while patients
intensity and extent of transference reactions in which the analyst and the
2114
analysis have become the central interest in the patient’s emotional life, and
the patient’s major neurotic conflicts are relived in the analytic situation. All
perpetuate it (Gill).
after the treatment is completed. This implies that there is some unanalyzed
neurosis left unchanged.
are not analyzed but gratified and manipulated. The therapist assumes the
role of some past figure, real or fantasied, and gratifies some infantile wish of
the patient’s. The therapist might act like a loving or encouraging parent, or
like a punishing moralist, and the patient might feel some temporary
reactions are, they are not sufficient for producing lasting changes in the
with the analyst. Zetzel and Stone were among the first to stress this aspect of
2116
the psychoanalytic situation. The core from which the working alliance is
derived is the real, nontransference relationship between the analyst and
Ever since Freud’s Dora case of 1905, psychoanalysts have made the
other than transference may occur but tend to treat them as irrelevant or
trivial, at least in their writings. They even acknowledge that interventions
these are mainly considered “parameters” and are to be used sparingly and
then eliminated (Eissler). On the whole both groups ignore the subject.
(Greenson).
The very fact that the concept of transference has, over the years, come
to have this rather precise meaning implies that it was technically and
theoretically necessary to differentiate it from other reactions that are
to the analyst, and, of course, that the type and manner of distortion showed
up the contributions from the past. If there were no real relationship this idea
All object relations consist of some elements of repetition from the past,
basically readily modifiable by both internal and external reality; they are
2118
The terms “transference,” “nontransference,” “transference-free,” and
transference contains some germs of reality, and all real relationships have
them. For this purpose a clinical example may serve better than abstract
definitions.
A young man, Kevin, in the fifth year of analysis, told me hesitantly after
I had made an interpretation that he had something to say that was very
difficult for him. He had been about to skip over it when he realized he had
been doing just that for years. Taking a deep breath, he said: “You always talk
a bit too much. You tend to exaggerate. It would be much easier for me to get
mad at you and say you’re cockeyed or wrong or off the point or just not
answer. It’s terribly hard to say what I mean because I know it will hurt your
feelings.”
I believe the patient had correctly perceived some traits of mine, and it
was indeed somewhat painful for me to have them pointed out. I told him he
was right on both counts, but I wanted to know why it was harder for him to
tell it to me simply and directly as he had just done than to act in an angry
fashion. He answered that he knew from experience that I would not get
exaggerating was a personal criticism and that would be hurtful. In the past
he would have been worried that I might retaliate in some way, but he now
knew it was not likely. Besides, he no longer felt my anger would kill him.
characteristics of his analyst’s way of working and had also quite realistically
predicted that it would be painful for the analyst to have them pointed out.
anger that might kill him were historically rooted carryovers from his
childhood anxieties, inappropriate exaggerations, and therefore transference
his temper outbursts at the analyst, but this alliance could not maintain itself
when it came to more realistic criticism. This only developed in his fifth year
working alliance, transference, and the real relationship. The working alliance
is the nonneurotic, rational, reasonable rapport that the patient has with his
analyst and that enables him to work purposefully in the analytic situation
2120
despite his transference impulses (Zetzel, Stone, Greenson). The patient and
the psychoanalyst contribute to the formation of the working alliance. The
patient’s awareness of his neurotic suffering and the possibility of help from
the analyst impel him to seek out, and work in, the analytic situation. The
positive transference, the overestimation and overevaluation of the
The Resistances
Resistance means opposition. All those forces within the patient that
oppose the procedures and processes of analysis—that is, that hinder the
remember and to gain and assimilate insight, that operate against the
patient’s reasonable ego and his wish to change-—-all of these forces are to
analyst, and the analytic procedures and processes. Freud' had already
every act of the person under treatment must reckon with the resistance and
neurosis, the old, the familiar, and the infantile from exposure and change. It
may be adaptive. The term “resistance” can be equated with all the defensive
and are to be contrasted to the instinctual activities, which seek pleasure and
purposes.
2122
phenomenon to be used for defensive purposes, it must operate through the
ego. This is the rationale for the technical rule that the analysis of resistance
new that is created by the analysis; the analytic situation only becomes the
arena for these forces of resistance to show themselves.
about himself. Some procedures do not add insight per se, but strengthen
those ego functions that are required for gaining understanding. For example,
ego is now able to observe, think, remember, and judge, functions it had lost
in the acute anxiety state. Insight now becomes possible. Abreaction is one of
The antianalytic procedures are those that block or lessen the capacity
for insight and understanding. The use of any measure or course of action
dynamics of the treatment situation in general and also explore the question
of how an analyst listens.
patient. It would be valuable to survey the alignment of the forces within the
patient in the analytic situation (see Freud, pp. 142-144). I shall begin by
enumerating those forces that are on the side of the psychoanalyst and the
2124
1. The patient’s neurotic misery, which impels him to work in the
analysis, no matter how painful.
3. The id, the repressed, and their derivatives; all those forces within
the patient seeking discharge and tending to appear in the
patient’s productions.
All the forces listed above influence the patient to work in the analytic
situation. They differ in value and effectiveness and change during the course
of treatment.
The forces within the patient opposing the analytic processes and
procedures may be broken down as follows:
2. The fear of change and the search for security, which impel the
infantile ego to cling to the familiar neurotic patterns.
2126
7. Impulsivity and acting-out tendencies, which impel the patient in
the direction of quick gratifications and against insight.
8. The secondary gains from the neurotic illness, which tempt the
patient to cling to his neurosis.
These are the forces that the analytic situation mobilizes in the patient.
As one listens to the patient, it is helpful to have this rather simplified division
psychoanalyst should listen. Yet clinical experience has taught us that the way
a psychoanalyst listens is just as unique and complex a procedure as doing
free association is for the patient. Here only an outline will be sketched as a
preliminary briefing.
accomplish these divergent aims (Freud, pp. 111-117). One listens with
significant data if he pays attention and if the patient is not stirring up the
follow the patient’s lead. From the evenly suspended, free-floating position
the analyst can oscillate and make blendings from among his free
All activities that interfere with the capacity to make the oscillations
described above are to be avoided. An analyst should not take any notes if this
interferes with his free-floating listening. Word-for-word notes are obviously
contraindicated since that would distort his main purpose. The analyst is
2128
one must also pay attention to one’s own emotional responses since these
responses often lead to important clues. Above all, the analyst must be alert to
his own transference and resistance reactions since they can impede or help
Confrontation
ego. For example, before I can interpret the reason a patient may have for
avoiding something, I first have to get him to acknowledge that he is avoiding
something. Eventually the patient himself will recognize this, and it will be
unnecessary for me to do so. However, before any further analytic steps are
taken it must be certain that the patient recognizes the psychic phenomenon
within himself that we are attempting to analyze.
refers to those activities that aim at placing the psychic phenomenon being
analyzed in sharp focus. The significant details have to be dug out and
carefully separated from extraneous matter. The particular variety or pattern
Let us take a simple example. I confront a patient, Mr. N., with the fact that
he is resisting and he recognizes that it is indeed so, he does seem to be
running away from something. The patient’s further associations may then
lead in the direction of revealing why he is resisting or what he is resisting.
Let us take the former instance. The resistant patient’s associations lead
him to talk of various events of the past weekend. Mr. N. went to a P.T.A.
meeting at his daughter’s school and felt abashed by the presence of so
many wealthy-appearing parents. This reminds him of his childhood and
how he hated to see his father attempt to ingratiate himself with his
wealthy clients. His father was a tyrant in his dealings with his employees
and an “ass-kisser” with the rich. He was afraid of his father until he left
home to go to college. Then he developed a contempt for him. He still has a
feeling of contempt for him, but he doesn’t show it. After all, it would serve
no purpose, his father is too old to change. His father must be getting close
to sixty, his hair is almost all white, “whatever is left of it.” The patient
becomes silent.
I had the impression that Mr. N.’s associations were pointing to certain
feelings he had about me and it was those feelings which had caused him
to be resistant in the early part of the hour. I also felt that this probably
had to do with contempt and, more precisely, the patient’s fear of
expressing his contempt for me directly. When the patient became silent, I
said that I wondered if he didn’t feel some contempt for another white-
haired man. The patient’s face flushed and his first response was to say: “I
suppose you think I was talking about you. Well, it’s just not true. I don’t
feel any contempt for you—why should I? You treat me very well—most of
the time. I have no idea how you treat your family or your friends. But,
2130
that’s none of my business. Who knows, maybe you are one of those men
who steps on the little guy and makes up to the ‘big shots.’ I don’t know
and I don’t care.”
At that moment I pursued the point. I replied that I felt he was relieved not
to know how I really behaved outside the hour. If he knew he might feel
contempt and he would be afraid to express it to me directly. Mr. N. was
silent for a few seconds and answered that if he imagined me doing
something contemptible, he wouldn’t know what to do with the
information. This reminded him of an occasion a few weeks back. He had
been in a restaurant and heard a man’s angry voice belaboring a waiter.
For a fleeting instant the voice sounded like mine and the back of the
man’s head resembled mine. He was relieved a few moments later to see
that it wasn’t true.
It was now possible to point out to the patient that he was trying to avoid
feeling contempt for me because if he were to do so, he would be afraid of
expressing it, just as he had with his father. It was this specific complex
pattern of emotional responses that had to be singled out for clarification
before one could go on with the further analysis of his resistances.
[Greenson, pp. 38-39]
Interpretation
psychic event. This usually requires more than a single intervention. The
analyst uses his own unconscious, his empathy and intuition, as well as his
something, but he is unaware of the feelings and toward whom they are
directed. His associations to his contempt for his father impel me to clarify
this further, and I point out that he is afraid of feeling contempt and having to
have no idea how you treat your family or your friends. But, that’s none of my
business. ... I don’t know and I don’t care.” This response is so intense that I
feel I have touched something inside him that is on the verge of becoming
conscious.
2132
I then interpret that he is relieved not to know how I treat people in the
when he heard an angry voice belaboring a waiter and for a flash he thought
of me. His relief that it was not me indicates that he would have felt contempt
for such a man. Mr. N. thus validated the correctness of my clarification and
interpretation. I was then able to connect his feelings in the hour to me to the
same specific pattern he had felt to his father —a deepening of the
interpretation.
Working Through
has been given. Working through makes it possible for an insight to lead to
change (Greenson). It refers in the main to the repetitive, progressive, and
In an hour, some two weeks after the session reported above, Mr. N.
reports a fragment of a dream. All he can remember is that he is waiting
for a red traffic light to change when he feels that someone has bumped
himself with his father in terms of sexual competence. It also deals with
people who pretend to be what they are not. Up until this point in the analysis
the patient had no memories concerning the sexual activities of his parents. In
the hour just described Mr. N. stated that he felt sure his mother disliked sex
and his father made use of prostitutes. When I pointed out that this could be a
wish-fulfilling fantasy, Mr. N. fell into a long silence.
the day after they had sexual relations because he felt she must abhor his
sexual behavior.
2134
In the course of the next several weeks Mr. N. became aware of the fact
that alongside of his wish that his wife become sexually free, he had contempt
for her when she was sexually excited. This was connected to a childhood
screen memory of seeing his mother wink slyly at his father when they saw
two dogs copulating in the street. This material was followed by memories of
During the next several months Mr. N. raged at the hypocrisy of most
married adults, “You and your wife included.” It was more honest to pay cash
for sex than to buy sex with marriage and expensive homes. I interpreted this
as contempt covering over an unconscious envy of adults who had a good sex
life. Mr. N. reacted with sullen anger for several days. Only gradually was he
able to realize that he was reacting like a little boy who begrudged his parents
a good sex life. Finally he was able to accept the notion that he could let his
parents have their own sex life, and he was perfectly free to enjoy the sex in
his own bedroom.
All of this work took a period of six months beginning with the dream of
being bumped in his sports car at a red light by a boy on a bicycle. This was
not the end of Mr. N.’s sexual problems, there were many back-and-forth
movements, but progress continued. Eventually the theme of homosexuality
therapy. Only rarely does insight lead very quickly to a change in behavior;
that resist change and to establish lasting structural changes. The interesting
is implied by the concept of analyzing a psychic event. All these steps are
the confrontation or part of the clarification. These steps do not follow in the
exact order described, since each procedure can produce new resistances that
will have to be taken up first. Or an interpretation can precede a clarification
variable is the fact that the imponderables of everyday life can intrude into
the patient’s life and take precedence for psychoeconomic reasons over
2136
everything else that is going on in the analysis. Nevertheless, confrontation,
clarification, interpretation, and working through are the four basic
There are two further important processes that play a role in the
Countertransference
suddenly realized to my dismay that I had been giving a young woman patient
wondered why the patient had so few hostile reactions to me. I then realized
this was due to a countertransference reaction. I did some free association
about it and was able to trace it back to my feelings toward a certain member
was giving her less time than I had previously. I admitted that I had realized I
had been giving her extra time and I was now correcting my error. She was
very curious about the cause of my error. I replied that giving her extra time
had not been deliberate, but that I believed my personal unconscious reasons
did not belong in her analysis. Then we analyzed her many fantasies to my
goings on in the patient that are escaping the notice of the analyst. For
example, the first sign you may have of a patient’s wish to annoy you is a
sense of feeling annoyed for no apparent reason. Finally these few remarks
should not be concluded without stating that all psychotic patients and all
2138
primitive reactions in our patients will stir up countertransference reactions
Just as the patient reacts to his analyst with other than transference
distortions, so does the analyst react to the patient as a real person. Our basic
technical tool is interpretation, and the analyst’s relative incognito and muted
analysts, contend that the technique of “only interpreting” will stifle and
distort the development of the patient’s transference neurosis and block his
insight, plus his concern, respect, and care for the totality of the patient’s
personality, sick and healthy. The analyst must help the patient’s beleaguered
ego distinguish between what is appropriate and distorted, correct and false,
realistic and fantastic in regard to his reactions to people, above all, toward
his psychoanalyst. He must not fall prey to the vocational hazard of one-
upsmanship.
bring the warded off, inaccessible material into the analytic situation. The
working alliance makes it possible for the patient to understand the analyst’s
working alliance is the capacity for relatively conflict-free ego functioning and
analyst of the patient’s judgments put the analyst for the moment on the side
of the patient’s observing, realistic ego. In this the analyst supports the
that the procedure is not antianalytie. It does advance the analysis, it helps
reality testing.
2140
responses. They require more than interpretation and insights. Even most
of our neurotic patients, at different periods of the analysis (for example,
at the height of the transference neurosis), may require such additional
measures. While exact prescriptions for building or strengthening a “real”
object relationship in the analytic situation cannot be given, some general
guidelines may prove helpful.
All our patients, to varying degrees, doubt their judgment perceptions, and
worthiness. If we “only interpret” or “only analyze” we unintentionally
leave them with the impression that their reactions were ‘“merely”
repetitions of their infantile past, and that their behaviour was immature,
wrong or crazy. If part of our therapeutic aim is to increase the patient’s
healthy ego functions and capacity for object relations, it is important that
we confirm those aspects of his behaviour which indicate healthy
functioning. Ry ignoring those undistorted aspects of the patient’s
productions we unwittingly imply that his realistic reactions are
unimportant, hardly worthy of comment, and that all that matters is
understanding the unconscious meaning of his behaviour. . . . Beyond that,
many of our patients need the experience of feeling in ways that “they are
right.” They need the experience of having their appropriate ego functions
and object relationships acknowledged and respected by the analyst’s
proper “handling” of both the transference and nontransference
With this in mind, we want to state our basic propositions: To facilitate the
full flowering and ultimate resolution of the patient’s transference
reactions, it is essential in all cases to recognize, acknowledge, clarify,
differentiate, and even nurture the non-transference or relatively
transference-free reactions between patient and analyst. The technique of
“only analysing” or “only interpreting” transference phenomena may stifle
the development and clarification of the transference neurosis and act as
an obstacle to the maturation of the transference-free or “real” reactions of
the patient. Central as the interpretation of transference is to
psychoanalytic therapy, and about this there can be no question, it is also
important to deal with the non-transference interactions between patient
and analyst. This may require non- interpretive or non-analytic
interventions but these approaches are vastly different from anti-analytic
procedures. [Greenson and Wexler, pp. 27-28]
The term “analytic setting” refers to the physical framework and the
reactions take place spontaneously in neurotic human beings who are not in
psychoanalytic therapy. Yet experience has shown that the classical analytic
2142
setting does facilitate and maximize the appearance of all the different
transference reactions.
papers of Macal- pine, Greenacre, Lewin, Spitz, and Stone have been of
particular value in illuminating the significance of the analytic setting for the
evolution of the various transference reactions.
together repeatedly and alone for a long period of time makes for an intensity
of emotional involvement. The fact that one is troubled and relatively helpless
and the other expert and offering help facilitates an uneven, “tilted”
carry-over from the days of hypnosis and a modification of the attempt to put
the patient to sleep (Lewin, Khan). The diminution of the external stimuli, the
fact that the patient does not see the analyst, that the analyst is relatively
Spitz emphasized other elements that push the patient in the direction
of objectlessness. The patient is lying down and therefore is lower than the
analyst sitting upright behind him, the patient’s locomotion and bodily
that we ask the patient to say everything without discrimination and without
responsibility (Spitz).
the analytic setting. His muted emotional responses, relative incognito, and
the analyst is a treater of the sick, a therapist, also activates the many infantile
antecedents of the doctor in the patient’s fantasy life.
regression toward the infantile neurosis also contribute to the formation and
2144
maintenance of the working alliance. All procedures that become predictable
make for a relative sense of security; and if they are perceived as having a
therapeutic intent, they will create a feeling of trust, which is the core of the
working alliance. Security and trust make it possible for the patient to allow
himself to regress just as they give him the courage to risk discarding a
neurotic defense and trying a new form of adaptation. The analyst’s
the rights, potentials, and dignity of the patient, his concern and compassion,
and his frank and thoughtful commitment to relieving the patient’s neurotic
neurotic patient can turn even the analyst’s gratificatory attitudes into a
frustration; the patient’s mistrust may twist the analyst’s therapeutic concern
into a form of rejection and the analyst’s patience into indifference. The crux
of the matter is the relative strength of the patient’s reasonable ego in regard
to his id, to his superego, and to the external world at a given moment. The
patient’s working relationship to the analyst is dependent upon these factors.
The imponderables of everyday life can play a decisive role. Despite the
fact that the analytic setting is of importance in the therapeutic equation, it
time to overcome the formidable tyranny of the neurotic patient’s past and
Bibliography
Alexander, F., and French, T. M., Psychoanalytic Therapy, Ronald Press, New York.
Arieti, S. (Ed.), American Handbook of Psychiatry, Vol. 1, pp. 419-566, Basic Books, New York,
1959.
Arlow, J. A., and Brenner, C., Psychoanalytic Concepts and the Structural Theory, International
Universities Press, New York, 1964.
_____, and _____, “The Psychopathology of the Psychoses: A Proposed Revision,” Int. J. Psychoanal.,
50:5-14, 1969.
Berezin, M., “Note Taking during the Psychoanalytic Session,” Bull. Phila. A. Psychoanal., 7:96-101,
1957.
Bibring, E., “Psychoanalysis and the Dynamic Psychotherapies,” J. Am. Psychoanal. A., 2:745-770,
1954.
Boyer and Giovacchini, cited in Arlow, J. A., and Brenner, C., Int. J. Psychoanal., 50, 1969.
Breuer, J., and Freud, S. (1893-1895), Studies on Hysteria, in Strachey, J. (Ed.), Standard Edition,
Vol. 2, Hogarth, London, 1955.
Eissler, K. R., “The Effect of the Structure of the Ego on Psychoanalytic Technique,” J. Am.
Psychoanal. A., 1.104-143, 1953.
2146
_____, “Ego-Psychological Implications of the Psychoanalytic Treatment of Delinquents,” in The
Psychoanalytic Study of the Child, Vol. 5, pp. 97-121, International Universities
Press, New York, 1950.
Fenichel, O., Neurotic Acting Out. Collected Papers of Otto Fenichel, Vol. 2, pp. 296-304, Norton,
New York, 1954.
Ferenczi, S., The Elasticity of Psycho-Analytic Technique: Final Contributions to the Problems and
Methods of Psycho- Analysis, pp. 87-101, Basic Books, New York, 1955.
Freud, A., The Ego and the Mechanisms of Defense, International Universities Press, New York,
1936.
_____, “Mutual Influences in the Development of Ego and Id: Introduction to the Discussion,” in The
Writings of Anna Freud, Vol. 4, pp. 230-244, International Universities Press, New
York, 1945–1956.
_____, “Problems of Technique in Adult Analysis,” in The Writings of Anna Freud, Vol. 4, pp. 377-
406, International Universities Press, New York, 1945-1956.
Freud, S. (1937), Analysis Terminable and Interminable, in Strachey, J. (Ed.), Standard Edition, Vol.
23, pp. 209-253, Hogarth, London.
_____, (1912), The Dynamics of Transference, in Strachey, J. (Ed.), Standard Edition, Vol. 12, pp. 97-
108, Hogarth, London.
_____,The Ego and the Id, in Strachey, J. (Ed.), Standard Edition, Vol. 19, pp. 3- 66, Hogarth, London.
_____, (1901), Fragment of an Analysis of a Case of Hysteria, in Strachey, J. (Ed.), Standard Edition,
Vol. 7, pp. 3-122, Hogarth, London.
_____, (1903), “Freud’s Psychoanalytic Procedure,” in Strachey, J. (Ed.), Standard Edition, Vol. 7, pp.
249-254, Hogarth, London.
_____, (1926), Inhibitions, Symptoms, and Anxiety, in Strachey, J. (Ed.), Standard Edition, Vol. 20, pp.
77-175, Hogarth, London.
_____, (1900), The Interpretation of Dreams, in Strachey, J. (Ed.), Standard Edition, Vols. 4 & 5,
Hogarth, London.
_____, (1894), “The Neuro-Psychoses of Defence,” in Strachey, J. (Ed.), Standard Edition, Vol. 3, pp.
43-68, Hogarth, London.
_____, (1915), “Observations on Transference-Love,” in Strachey, J. (Ed.), Standard Edition, Vol. 12,
pp. 157-171, Hogarth, London.
_____, (1913), 'On Beginning the Treatment,” in Strachey, ]. (Ed.), Standard Edition, Vol. 12, pp.
121-144, Hogarth, London.
_____, (1914), On the History of the Psycho-Analytic Movement, in Strachey, J. (Ed.), Standard
Edition, Vol. 14, pp. 3- 66, Hogarth, London.
_____, (1904), “On Psychotherapy,” in Strachey, J. (Ed.), Standard Edition, Vol. 7, pp. 257-268,
2148
Hogarth, London.
_____, (1905), “Psychical (or Mental) Treatment,” in Strachey, J. (Ed.), Standard Edition, Vol. 7, pp.
283-302, Hogarth, London.
_____, (1913), Totem and Taboo, in Strachey, J. (Ed.), Standard Edition, Vol. 13, pp. 1-161, Hogarth,
London.
Gill, M. M., “Psychoanalysis and Exploratory Psychotherapy,” J. Am. Psychoanal. A., 2:771-797,
1954.
_____, Topography and Systems in Psychoanalytic Theory, Psychological Issues, Monogr. 10,
International Universities Press, New York, 1963.
Glover, E., The Technique of Psycho-Analysis, International Universities Press, New York, 1955.
Greenacre, P., “Re-evaluation of the Process of Working Through,” Int. J. Psycho-anal., 37:439-444,
1956.
Greenson, R. R., “The Problem of Working Through,” in Schur, M. (Ed.), Drives, Affects, Behavior,
Vol. 2, pp. 277-314, International Universities Press, New York, 1965.
_____, The Technique and Practice of Psychoanalysis, International Universities Press, New York,
_____, “The Working Alliance and the Transference Neurosis,” Psychoanal. Quart., 34.155-181,
1965.
_____, and Wexler, M., “The Non-Transference Relationship in the Psychoanalytic Situation,” Int. J.
Psychoanal., 50:27-39, 1969.
Jones, E., The Life and Work of Sigmund Freud, Vol. 1, Basic Books, New York, 1953.
Khan, M. M. R., “Dream Psychology and the Evolution of the Psycho-Analytic Situation,” Int. J.
Psychoanal, 4,3:21-31, 1962.
Kris, E., “Ego Psychology and Interpretation in Psychoanalytic Therapy,” Psychoanal. Quart.,
20:15-30, 1951.
_____, “On Some Vicissitudes of Insight in Psycho-Analysis,” Int. J. Psychoanal, 37: 445-455. 1956.
_____, “The Recovery of Childhood Memories in Psychoanalysis,” in The Psychoanalytic Study of the
Child, Vol. 11, pp. 54—88, International Universities Press, New York, 1956.
Lacan, J. M., “Commentaires sur des textes de Freud,” Psychanalyses, Vol. 1, pp. 17- 28, 1953.
1955.
Lewin, B. D., “Dream Psychology and the Analytic Situation,” Psychoanal. Quart., 24:169-199,
1955.
Macalpine, I., “The Development of the Transference,” Psychoanal. Quart., 19: 501-539, 1950.
Marmor, J., “Limitations of Free Association,” Arch. Gen. Psychiat., 22:160-165, 1970.
Menninger, K. A., Theory of Psychoanalytic Technique, Basic Books, New York, 1958.
Novey, S., “The Principle of ‘Working Through’ in Psychoanalysis,” J. Am. Psychoanal. A., 10:658-
676, 1962.
2150
Rapaport, D., and Gill, M. M., “The Points of View and Assumptions of Metapsychology,” Int. J.
Psychoanal, 40:153-162, 1959.
Rosenfeld, H., Psychotic States, International Universities Press, New York, 1965.
Searles, H. F., Collected Papers on Schizophrenia and Related Subjects, International Universities
Press, New York, 1965.
Sharpe, E. F., The Technique of Psycho-Analysis: Collected Papers on Psycho- Analysis, pp. 9-106,
Hogarth, London, 1950.
Spitz, R. A., “Transference: The Analytical Setting and Its Prototype,” Int. J. Psychoanal, .37:380-
385, 1956.
Stewart, W. A., “An Inquiry into the Concept of Working Through,” J. Am. Psychoanal. A., 11:474-
499, 1963.
_____, Psychoanalysis: The First Ten Years, Macmillan, New York, 1967.
Stone, L., The Psychoanalytic Situation, International Universities Press, New York, 1961.
_____, “The Psychoanalytic Situation and Transference,” J. Am. Psychoanal. A., 75: 3-58, 1967.
_____, “The Widening Scope of Indications for Psychoanalysis,” J. Am. Psychoanal A., 2-567-594,
1954.
Waelder, R., Basic Theory of Psychoanalysis, International Universities Press, New York, 1960.
Wexler, M., “Schizophrenia: Conflict and Deficiency,” Psychoanal. Quart., 9:83-99, 1971.
Winnicott, D. W., “Hate in the Counter- Transference,” Int. J. Psychoanal, .30:69- 74, 1949.
[1] A definition of a classical psychoanalyst along organizational lines was considered but did not
prove to be satisfactory. The majority of the members of the American Psychoanalytic
[2] In the United States classical psychoanalysts generally use the term “instinctual drive” to translate
Freud’s word “triebe.” British psychoanalysts, including James Strachey, translator and
editor of the Standard Edition of Freud’s works, translate “triebe” as instinct. In this
essay the American usage will be followed.
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Chapter 38
A. Individual Psychology
Heinz L. Ansbacher
The most important question of the healthy and the diseased mental life is
not whence? hut, whither? . . . In this whither? the cause is contained.
Alfred Adler
2154
He was deliberately an optimist from the realization that
pessimism is virtually a negation of the work of
psychotherapy.
practiced medicine there. From 1902 to 1911 he was associated with Freud in
the initial group that became the Vienna Psychoanalytic Society. He then
developed his own school of Individual Psychology. In the 1920’s he founded
Constancy
public health physician, liberal, and champion of the poor. As a student he had
become interested in socialism and later read before the Freudian circle a
paper on “The Psychology of Marxism.” He introduced the name Individual
which all parts cooperate for a common purpose” (p. iv). After World War I
Adler condemned the Bolshevik terror, wrote a passionate defense against
of social interest. One of his last papers was on “The Progress of Mankind”
(pp. 23-28). Adler’s crowning theoretical achievement was the concept of
always pointed to “the necessity for brotherly love and the common weal” (p.
462), and he appreciated the concept of God as “the dedication of the
individual as well as of society to a goal which rests in the future and which
Change
2156
Adler’s changes were in his theoretical formulations—in the direction
finalistic model.
aggression drive he took again a step away from elementarism and toward
holism in that this was the result of a confluence of several drives, although
“inferiority feeling” he brought in the concept of the self with its subjectivity
and creativity since the feeling was not in a one-to-one relationship to actual
quite foreign to a holistic theory. Only in the late 1920’s did he clarify that this
Writings
Adler’s psychological writings extend from 1907 until his death in 1937.
It is during the second half and increasingly during the last quarter of this
Most of the books of the second period are available as paperbacks, and
articles after his last book have been collected into a volume that includes
also his essay on religion and a complete bibliography of some 300 titles. Of
Relationship to Freud
Freud formed his original circle in 1902 by inviting four younger men to
meet with him one evening a week to discuss problems of neurosis. One of
these was Adler, 14 years Freud’s junior. This group developed into the
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Vienna Psychoanalytic Society, and Adler eventually became its president and
co-editor of one of its journals—just a year before his resignation in 1911.
Freud considered Adler to have been his pupil, which Adler consistently
denied. He would admit essentially only that “I profited by his mistakes” (p.
have used Freud largely as an antagonist who helped him ... by inspiring him
in opposite ways of thought” (p. 627). Ellenberger advises that in order to
understand Adler the reader “must temporarily put aside all that he learned
about psychoanalysis and adjust to a quite different way of thinking” (p. 571).
Systematic Position
ancestral figure of the ‘new social psychological look’” (p. 115); as among
those advancing a “pilot” rather than a “robot,” view of man, where man is
largely master of his fate (p. 597); as probably the first among the “cognitive
always found in a group opposed to Freud. In sum they support the statement
Methodology
Adler was convinced that “a person’s behavior springs from his opinion” (p.
182). “Individual Psychology examines the attitudes of an individual” (p. 185).
On the operational, objective side Adler’s principle was, “By their fruits
2160
ye shall know them” (pp. 64, 283), that is, by overt behavior and its
consequences. In this respect Individual Psychology comes close to
primary processes, inner forces, latent states, inner conflict, emotions that the
individual has to “handle,” and many others, because they are like reifications
within the individual if you only dig deeply enough. Rather it is a context
psychology, in the sense that the meaning of a specific form of behavior can
be determined by regarding it in its larger concrete context of which the
Personality Theory
model of man and personality theory, Adler borrowed from philosophy and
history—aiming toward a better life for all, greater freedom, and greater
humaneness.
evidenced by the cultural products all around us, beginning with language.
Adler quoted from Pestalozzi (1746-1827): “The environment molds man, but
man molds the environment” (p. 28), a sentence later also used by Karl Marx.
Heredity and environment merely supply the raw material that the
individual uses for his purposes. To quote Adler again: “The important thing
is not what one is born with, but what use one makes of that equipment” (p.
86). To understand this one must assume “still another force: the creative
2162
Adlerian psychology looks for the individual’s intentions, purposes, or goals,
which are of his own creation, to understand behavior.
success for one’s endeavors and to develop planful procedures for attaining
the goal, that is, a life plan under which all life processes become a self-
consistent organization, the individual’s style of life.'’ Only in the feeble-
are common to all forms of life. Having the capacity to anticipate the future
and having a range of freedom of choice, man develops values and personal
ideals, that is, mental constructs or fictions, that serve him as criteria of
choice in his movement through life toward a goal of success. The movement
takes the form of a striving from relative minus to relative plus situations —
that the latter must be primary because where there is no prior conception of
our environment this is not likely to find inclusion in our goal or image of
human being. “The sense of worth of the self shall not be allowed to be
diminished.” Adler called this “the supreme law” of life (p. 358).
“Nietzsche’s ‘will to power’ ... includes much of our understanding” (p. ix); he
considered Nietzsche “one of the soaring pillars of our art” (p. 140) and
credited him with “a most penetrating vision” (p. 24). Just as will to power
meant for Nietzsche not domination over others but the dynamics toward
self-mastery, self-conquest, self-perfection, so for Adler power meant
Social Interest
Adler’s most important concept, and the one most specific to him, is
interest, meaning not an interest in the other as an object for one’s own
purposes, but “an interest in the interests” of the other. It includes also the
2164
conception of being attuned to the universe in which we live. '
Adler’s holistic emphasis saw man not only as an indivisible whole but
also as a part of larger wholes—his family, community, humanity, our planet,
the cosmos. Man lives within a social context from which he meets the various
problems.
we have a natural aptitude for acquiring the skills and understanding to live
under the conditions into which we are born as human beings. Human nature
quite different from conformity and superego, leaving room for social
man, how would social living and the creation of the various cultures ever
toward synergy of the personal striving with the striving of others. It is on the
correspond to the four categories created by the two dimensions. The types
are: high social interest, high activity—the ideally normal; low social interest,
high activity—the ruling type, tyrants, delinquents; low social interest, low
activity—the getting type, expecting from and leaning on others, and the
avoiding type, found in neuroses and psychoses; with the category high social
and the individual fashioning of that unity. The individual is thus both the
picture and the artist ... of his own personality, but as an artist ... he is rather a
2166
This then became Adler’s approach to characters in literary works. The
characters in real life “create” themselves. Adler venerated and admired the
became decisive. Recent studies along these lines have dealt with Hamlet, the
casket scenes from The Merchant of Venice, Oedipus Rex, Somerset Maugham,
and Ben Franklin. There are also numerous earlier studies.
Theory of Psychopathology
opinion of one’s own situation and of life and the world in general, involving
innumerable errors. While the “absolute truth” eludes us, we can discern
between greater and lesser errors. The former are more in accordance with
“private sense” (also private intelligence or private logic) and characteristic of
mental disorders is the loss of common sense (sensus communis), and the
himself. His “symptoms” are further creations, his own “arrangements” (pp.
284- 286) to serve as excuses for not meeting his life problems. They assure
him freedom from responsibility. In trying to convey an excuse they are forms
of communication. Since the organism is a unified whole, the autonomic
“organ dialect” (p. 223), actually symbolic acts rather than symptoms.
constructs. As Adler stated, “Every neurotic is partly right” (p. 334). But the
Adlerian school does not accept these adverse circumstances as absolutely
2168
binding. Difficulties can be overcome in one way or another. Thus the patient
is “right” in that there were “traumatas” and all sorts of “frustrations” in his
life, which can easily be construed as adverse “causes.” But he is only “partly
right” in that he was not obligated to construct his life in the inexpedient way
describe man in conflict with himself. What it describes is always the same
self in its course of movement which experiences the incongruity of its life
buys and sometimes sells, but always for the same end of making money. The
related concepts of doubt and indecision are also arrangements of the patient,
creation of a distance between the person and his tasks of life in order to
safeguard the self-esteem when there is fear of defeat. “Once a person has
acquired the attitude of running away from the difficulties of life, this may be
greatly strengthened ... by the addition of anxiety” (p. 276). Lack of social
interest always being involved in pathology, “the anxious person . . . also feels
himself forced by necessity to think more of himself and has little left over for
his fellow man” (p. 277). Anxiety neurosis and all kinds of phobias serve the
purpose of blocking the way and thus cover up the simple fear of personal
defeat. Actually all neurotic symptoms develop out of an effort to conceal “the
hated feeling of inferiority” (p. 304). “The emotions are accentuations of the
actually been pampered, although it is often found also in those who (2) have
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been unwanted or neglected, or (3) suffered from physical handicaps (organ
inferiorities) —the three overburdening childhood situations. The pampered
insecure. “The pampered life style” eventually replaced Adler’s original term
of “the neurotic disposition.”
note who suffers most because of the patient’s condition. . . . There is always
this element of concealed accusation” (p. 81). This accusation “secures some
triumph or at least allays the fear of defeat,” not in the light of common sense,
of course, but in accordance with the patient’s private logic (p. 80).
responsible. This is, of course, a general tendency. But “when the individual
helps it along with his devices, then the entire content of life is permeated by
the reassuring, anesthetizing stream of the life-lie which safeguards the self-
esteem” (p. 271). Later Adler most often used the term “self-deception”
instead of “life-lie.” This idea was taken up many years later by Sartre in his
people with strong inferiority feelings and unrealistically high and rigid
different symptoms which indicate how one or the other individual considers
that he would dream himself into life without losing the feeling of his
personal value” (p. 300).
“Naturally, anyone, who stands for the unity and uniform structure of
each particular case individually” (p. 301). At the same time Adler recognized
Compulsion Neurosis
2172
One of the early Adlerians, Leonhard Seif, had noted that “one could call
virtually any neurosis a compulsion neurosis” (p. 138). The following is a
superiority is diverted into easy channels. (2) This striving for an exclusive
means of relief, once fixed upon, provide the patient with an excuse for failing.
(5) The construction of the compulsion neurosis is identical with that of the
entire life style. (6) The compulsion does not reside in the compulsive actions
menace to the patient’s prestige. (7) The life style of the compulsion neurotic
adopts all the forms of expression that suit its purpose and rejects the rest.
(8) Feelings of guilt of humility, almost always present, are efforts to kill time
other” (p. 137). “All three groups are variants of a single condition: an
extreme superiority complex and [confrontation with social] tasks which call
for more social interest than the patient has” (p. 138).
well within the Adlerian framework. The author considers himself close to
others.
anticipation of one’s ruin to force one’s will upon others and to preserve one’s
“It is always a question of effect upon the environment” (p. 251). Such
paradoxical use of weakness to gain control over others, that is, the attempt
to control others without accepting the responsibility for doing so, has more
recently been recognized and designated by the term “paradoxical
communication” (p. 17).
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useful principle for understanding a patient’s dynamics. But it was in the
context of depression that he originally recommended “to raise the question
one whom they have always slighted. ... In later years, ... a teacher, a beloved
person, society, or the world at large is chosen as the object of this act of
environment” (p. 412) and that suicide is similar. The potential suicide “hurts
252). “The ‘other’ is probably never lacking. Usually it is the one who suffers
Farberow and Shneidman in their The Cry for Help have offered an
other schools by having one case of attempted suicide discussed from various
viewpoints. The viewpoints of Freud, modified psychoanalysis, Jung, Adler
(by the present writer), Sullivan, Horney, George Kelly, and Carl Rogers are
inferiority feelings ... he appears to take literally the ‘all’ in the ‘all or nothing’
proposition so typical of the neurotic. . . . Both the manic and the depressed
never really believe in themselves, do not appreciate others, and are always
eager to exploit others for their own purposes. Both negate reality by the use
of delusion about their prophetic gift: one, by foreseeing that everything will
be wonderful and that he can do anything, the other, that everything will be
Schizophrenia
only “when the individual has, by losing all interest in others, also lost interest
in his own reason and understanding” (p. 128).
that the patient has created for himself, “arise always when the patient wants
something unconditionally, yet at the same time wants to be considered free
2176
from responsibility” (p. 317). The hallucination is a trick to make subjective
impulses appear as something objective. “The coercion toward
and replaces these by apparently strange voices and visions” (p. 259). The life
style of the schizophrenic along these lines has been concisely described by
Kurt Adler.'
weakness for a soaring fiction which can be maintained only at the cost of
reality, human contact, and the whole shared world which gives existence its
factors “as direct linear ‘cause’ of schizophrenia,” and holds instead that “a
teleological factor must be present, namely, a set of personal values which are
largely self-determined and which ‘call forth’ the psychosis” (p. 8). In this
sense schizophrenia is not only a reaction but also “an action, a decision, a
choice” (p. xi). On this basis Shulman gives many practical examples of
treatment that could be followed by any therapist, regardless of his
theoretical orientation.
Adler stressed that the consistent exclusion of the other sex is a matter
2178
constitution he has himself created, although he may have been misled into it
by his inherited physical constitution which makes the deviation easier for
Regarding crime, while Adler wrote quite extensively on the life style
and treatment of the criminal, and crime prevention, the basic theory can be
stated briefly. The criminal, like other failures, fails in social interest (p. 411).
But unlike the others he displays a certain degree of activity, albeit on the
useless side of life; he can cooperate, though, only with his kind (p. 413); and
that ‘force’ him to be a criminal” (p. 413). How well the Adlerian formulations
fit especially the cases of the various assassins of American presidents has
Process of Psychotherapy
is done largely through extending social interest toward the patient, getting
him to see his goal of personal superiority stemming from hidden inferiority
from the past that in any event cannot be altered. The process is one of
patient. It consists in the art of imparting the understanding the therapist has
gained of the patient to him, to make him see the mistake in his life style—
the many incidents during the course of treatment as well as the treatment as
a whole. Not all the phases are always represented. As we see it, the phases
are: (1) establishing and maintaining a good relationship with the patient; (2)
gathering data from the patient to understand him, to have source material
for interpretation, for conceptualizing his life style; (3) interpreting the data;
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consider briefly improvement without insight and somatotherapy. According
to Adler, the criterion of success of treatment is objective. “As soon as the
patient can connect himself with his fellow men on an equal and cooperative
growing older and fatter ... his joints are stiff and he cannot climb so well:
burglary has become too hard for him” (p. 418). Or, since the patient
somehow unknowingly fell into making the more erroneous choice, he may
also improve under certain circumstances without knowing how this came
therapy meet.
the help they find in modern somatic techniques. “Drugs and electroshock
patient and therapist must not clash. “The first rule is to win the patient; the
second is never to worry about your own success” (p. 341). In addition to
friendliness, an important way to win the patient is to make him feel
understood, whereby one also wins his respect. This feeling is generated by
interpretation of the patient’s behavior in a way that is new and plausible to
him.
interpretations with such phrases as, “Would you like me to tell you?” “Could
it be?” “Are you willing to listen?” (p. 274). Sometimes the surprise element is
2182
helpful in maintaining a fruitful relationship, and Adler recommended “to
have a series of dramatic illustrations at one’s disposal” (p. 201).
The therapist must also know that the patient may want to depreciate
him as he has done with others, in order to raise his own self-esteem.
“take the wind right out of the patient’s sails!” (p. 338).
Gathering Data
mistaken goal and methods of striving for it. The exploration is not extended
beyond this point. Not believing in the “causal” significance of past events per
the patient’s “private world.” The idea is to get a representative picture of the
primary family constellation in which the life style emerged, the patient’s
early recollections, his dreams, and so forth, but also in the actual time and
the patient of what happened to him with the question, “And what did you
do?” Often the request is made to describe a typical day. Most importantly, the
Interpretation
The therapist listens to the patient dialectically;” that is, he asks himself
what opposite could be paired with a certain statement. This is based on the
assumption of the self-deception of the patient mentioned before. The patient
sees and recognizes only that part of the situation that is consistent with his
life style, and thus in this sense he is actually unconscious “even when he is
conscious” (p. 217). “While he regards one point, we must look at the other.
He looks at his obstacles; we must look at his attempt to protect his Active
2184
superiority and rescue his ambition” (p. 199). When the patient speaks of his
generosity, the therapist may understand an accusation of stinginess against
others.
the patient’s possible intention and goal. Thus the answer to the question,
“What would you do if you were well?” leads to the interpretation that this
activity may be exactly the one from which the patient is excusing himself by
his symptom.
the paradoxes that the patient created by overlooking the part of the situation
that does not suit his life style. For example, when the wife complains, “My
husband comes home late at night,” the question, “And what do you do?” may
elicit the answer, “I scold him.” From this the therapist gives her the insight
that she “is not merely a victim . . . but a most active participant” (p. 269). This
time an encouragement in telling her that she actually is capable of taking the
above case the wife may from now on receive her husband quite differently
your vanity peeps from the holes in your robe” (p. 232).
forth, actually remaining in the same place, and from this inferring that the
meaning of indecision is the hidden intention to preserve the status quo. It is
accord with the Adlerian position. The author holds that interpretation does
not “uncover” any new “facts” hitherto hidden in the unconscious, but rather
brings “an alternate frame of reference” to bear to facilitate change. The
2186
Confrontation in Adlerian psychotherapy is a technique particularly
confrontation." These questions are most often calculated to make the patient
face the concrete reality, the common sense. For example, a middle-aged man
who had been in psychoanalytic treatment before he came to Adler told him
make a choice on his own. Thus really any interpretation can become a
At times directives are given. When these refer to the symptom, they are
described it, namely, “in such a way that the patient cannot continue to utilize
it (P. 55)” When a patient complained, “There is nothing I like doing,” Adler
would direct him to “refrain from doing anything you dislike” (p. 346-347). To
Adler would say, “Do for a few months more what you have been doing!
Above all, don’t do anything rash!” (p. 101). This is what Viktor Frankl calls
applicable to any behavior. To return once more to the wife of the drinking
husband, one might say, “Go right ahead scolding him each time. But it won’t
Child Psychotherapy
disturbing behavior rather than psychotic abnormality. It does not differ from
and choose alternative ways, that would lead to socially desirable successes.
Dreikurs has distinguished four goals of misbehavior in children: to gain
simple terms, sometimes with gestures. Adler thought that if he did not
succeed in explaining to a child the roots of his mistakes, “I can be sure that I
2188
397). The preferred form of therapy is counseling before a group or in the
classroom situation or smaller group of peers (see below).
Dream Interpretation
dream content,” even in dreams from a single night, and finds, “The
fundamental determinants of dream content remain cloaked in obscurity”
(pp. 308, 309). For the Adlerian the search for determinants would be a
“pseudoproblem” since he accepts “the nearly limitless possibilities of the
creative power” (p. 777) of the individual. However, while specific dream
dream content what kind of person the dreamer would be. Thus challenged,
dreams is bigness, strength, activity and a pleasant feeling tone. Hence we are
willing to ‘predict’ with a considerable degree of confidence that the dreamer
in waking life shows great activity, buoyancy, and optimism, with perhaps
some grandiosity and manic traits. He is also a cultured person and interested
in music. The dreams maintained his frame of mind for the next day’s work.
One might ‘predict’ further, that dreams on subsequent nights would still
If the author of these dreams were a patient, the feeling tone would
same, we might guess that the patient would be manic or depressed. We could
use the dreams to help 11s make him see his basic mistake, namely, the
expectation of associating only with the big and the ultimate, thereby perhaps
missing out on solving the daily problems of life—provided other data would
point in the same direction. The dreams could help in giving the patient
insight into what he is in fact doing and in clarifying to him the available
2190
alternatives of which he had been unaware.
Early Recollections
memorable, and how he acts in it. The earliest recollections are especially
world like this’” (p. 75). A brief description of the technique is to be found in
dishes . . . and not knowing what to do next, I hurled one of my toys into the
street. . . . [Neighbors] who saw my delight at the fine crash it made, and how I
Freud reports that when he first read this story he was merely puzzled.
But years later he found among patients who were jealous of their younger
siblings recollections of throwing things out of the window as a symbolic
gesture of getting rid of the rival. “The new baby must be thrown out, through
the window, perhaps because he came through the window,” brought by the
stork. Thus Freud furnishes a “causal” explanation that is at the same time
elementaristic and generalizing by giving a single “element” a general
characteristic of Goethe.
boy was bored one time, he “experimented” by throwing a dish out of the
window and enjoyed the fine crash it made. The adult Goethe actually
enjoyed even more the applause from neighbors, being “delighted to give
them pleasure.” The impression we receive is that of an active, independent
2192
child who is at first investigative and then sees himself as contributing to the
pleasure of people outside the family in the “big” world. He is giving a show
form. It might then be helpful to show him that he apparently thinks he must
do something extraordinary, sensational, and receive applause from an
audience, and that for him no price is too high to achieve this goal. We might
then point out that this is a quite unrealistic goal, which led him to his present
we have to this extent added to his insight by giving him new concepts that
assumption of the maternal function” (p. 341), and this, in turn, was (1) to
society” (p. 373). This definition is quite consistent with that of mental health
as the presence of developed social interest and common sense (in contrast to
private intelligence).
sense that “the therapist appears as the representative for the human
community” (p. 90). When more than one person is brought into the therapy
groups insofar as they do not seem to offer enough assurance for the
“These groups foster mainly catharsis . . . and very often . . . overt depreciation
of others. . . . There is no sensitivity about the feeling of others in most of
these sensitivity groups” (p. 116). A poorly led sensitivity group “reinforces
2194
fit of ‘honesty’ ” (p. 67).
with, or shortly after, their parents or teachers. The group was at first thought
of as having only the function of a training seminar for teachers in how to deal
with difficult children. But a second function soon became apparent in that
the group actually facilitated therapy. The observers by their mere presence
realized “that ‘no man liveth unto himself alone,’ and that the mistakes of
every individual affect many lives and are of public concern” (p. 491). The
Canz. There were over 30 such centers in operation when they were closed by
therapy beyond the one-to-one ratio, since it always means for the individual
by Kurt Adler and Danica Deutsch, while a recent survey of techniques has
elsewhere.
counselor through its concept of man and its therapeutic aim, which is to get
2196
the individual to relinquish his self-boundedness and turn to the larger world,
“so that he will play his role harmoniously in the orchestral pattern of
society” (p. 399). A recent symposium was concerned with this relationship.
Adlerian Organization
Switzerland, and the United States, publishes the Individual Psychology News
Letter, and holds scientific meetings every three years.
scientific meetings. Teaching and training are offered by the Alfred Adler
Institutes of New York, Chicago, and Minneapolis. New York also has an Alfred
Adler Mental Hygiene Clinic. Graduate training in Adlerian counseling is
States and Canada that sponsor one or more family counseling centers and
arrange for study groups for parents and teachers.
Bibliography
_____, “Individualpsychologie (Alfred Adler),” in Frankl, V. E., von Gebsattel, V. E., and Schultz, J. H.
(Eds.), Handhuch der Neurosenlehre und Psycho- therapie, pp. 221-268, Urban &
Schwarzenberg, Munich, 1957-1959.
_____, “Modem Drug Treatment and Psychotherapy,” J. Ind. Psychol., 15:79-82, 1959.
_____, Die andere Seitc: cine massen psychologische Studic iiber die Schuld des Volkes, Leopold
Heidrich, Vienna, 1919.
_____, et al., Guiding the Child on the Principles of Individual Psychology, Greenberg, New York,
1930.
_____, The Individual Psychology of Alfred Adler: A Systematic Presentation in Selections from His
Writings (Ed. by Ansbacher, H. L., and Ansbacher, R. R.), Basic Books, New York,
1956.
_____, (1912), The Neurotic Constitution, Moffat, Yard, New York, 1917.
_____, (1909), “On the Psychology of Marxism,” in Nunberg, H., and Federn, E. (Eds.), Minutes of the
Vienna Psychoanalytic Society, Vol. 2, 1908-1910, pp. 172-174, International
Universities Press, New York, 1967.
_____, (1920), The Practice and Theory of Individual Psychology, Littlefield, Adams, Totowa, N.J.,
2198
1969.
_____, (1930), The Problem Child: The Life Study of the Difficult Child as Analyzed in Specific Cases,
Dutton, Capricorn Books, 1963.
_____, (1929), Problems of Neurosis: A Book of Case Histories, Harper & Row Torchbooks, New York,
1964.
_____, “Psychiatric Aspects Regarding In dividual and Social Disorganization,” Am. J. Sociol.,
42:773-780, 1937.
_____, (1933), Social Interest: A Challenge to Mankind, Dutton, Capricorn Books, 1963.
_____, (1907), Study of Organ Inferiority and Its Psychical Compensation, Nervous and Mental
Diseases Publishing Co., New York, 1917.
_____, Superiority and Social Interest: A Collection of Later Writings (Ed. By Ansbacher, H. L., and
Ansbacher, R. R.), Northwestern University Press, Evanston, 1964.
_____, (1912), Ueber den nervosen Charakter, 4th ed., Bergmann, Munich, 1928.
_____, (1931), What Life Should Mean to You, Dutton, Capricorn Books, 1958.
_____, and Furtmuller, C. (Eds.), Heilen und Bilden: Aerztlichpadago-gische Arbeiten des Vereins fiir
Individualpsychologie, Reinhardt, Munich, 1914.
Adler, K. A., “Adlerian View of the Present-Day Scene,” J. Ind. Psychol., 26: 113-121, 1970.
_____, “Depression in the Light of Individual Psychology,” J. Ind. Psychol., 17:56-67, 1961.
_____, and Deutsch, D. (Eds.), Essays in Individual Psychology: Contemporary Applications of Alfred
Adler’s Theories, Grove Press, New York, 1959.
Ansbacher, H. L., “Alfred Adler and Humanistic Psychology,” J. Humanistic Psychol, 11:53-63,
1971.
_____, “Life Style: A Historical and Systematic Review,” J. Ind. Psychol, 23: 191-212, 1967.
_____, “Sensus Privatus versus Sensus Communis,” J. Ind. Psychol., 21:48-50, 1965.
_____, “The Structure of Individual Psychology,” in Wolman, R. R. (Ed.), Scientific Psychology, pp.
340-364, Basic Rooks, New York, 1965.
_____, “Suicide as Communication: Adler’s Concept and Current Applications,” J. Ind. Psychol,
25.174-180, 1969.
Ansbacher, R. R., “Sullivan’s Interpersonal Psychiatry and Adler’s Individual Psychology,” J. Ind.
Psychol., 27:85-98, 1971-
Atkins, F., “The Social Meaning of the Oedipus Myth,” J. Ind. Psychol, 22.173- 184, 1966.
Bierer, J., “The Day Hospital: Therapy in a Guided Democracy,” Ment. Hosp., 13: 246-252, 1962.
_____, and Evans, R. I., Innovations in Social Psychiatry: A Social Psychological Perspective through
Dialogue, Avenue Publishing, London, 1969.
Bonime, W., The Clinical Use of Dreams, Basic Rooks, New York, 1962.
2200
Bottome, P., Alfred Adler: Portrait from Life, Vanguard, New York, 1957.
Burt, F. D., “William Somerset Maugham: An Adlerian Interpretation,” J. Ind. Psychol., 26.64-82,
1970.
Chaplin, J. P., “The Presidential Assassins: A Confirmation of Adlerian Theory,” J. Ind. Psychol.,
26:205-212, 1970.
_____, and Rosenberg, R., “Mechanisms of Group Psychotherapy: Processes and Dynamics,” J.
Ahnorm. & Soc. Psychol, 15:406-411, 1955.
Dement, W. C., “Psychophysiology of Sleep and Dreams,” in Arieti, S. (Ed.), American Handbook of
Psychiatry, Vol. 3, pp. 290-332, Basic Rooks, New York, 1966.
Deutsch, D., “Family Therapy and Family Life Style,” J. Ind. Psychol, 23:217-223, 1967.
Dinkmeyer, D., and Dreikurs, R., Encouraging Children to Learn: The Encouragement Process,
Prentice-Hall, Englewood Cliffs, N.J., 1963.
_____, and Muro, J. J., Group Counseling: Theory and Practice, Peacock, Itasca, 1971.
Dreikurs, R., Counseling the Adolescent: Guidebook (Ed. by Peterson, J. A., and Peterson, N. M.),
Vermont Educational Television, University of Vermont, Burlington, 1971.
_____, Group Psychotherapy and Group Approaches: Collected Papers, Alfred Adler Institute,
Chicago, 1960.
_____, Psychodynamics, Psychotherapy, and Counseling: Collected Papers, Alfred Adler Institute,
Chicago, 1967.
_____, Psychology in the Classroom, 2nd ed., Harper & Row, New York, 1968.
_____, Corsini, R. J., Lowe, R., and Sonstegard, M., Adlerian Family Counseling: A Manual for
Counseling Centers, University of Oregon Press, Eugene, 1959.
_____, Shulman, B. H., and Mosak, H., “Patient-Therapist Relationship in Multiple Psychotherapy,”
Psychiat. Quart., 26:219-227, 590-596, 1952.
_____, and Soltz, V., Children: The Challenge, Duell, Sloan & Pearce, New York, 1964.
Ellenberger, H. F., “Alfred Adler and Individual Psychology,” in The Discovery of the Unconscious,
pp. 571-656, Basic Books, New York, 1970.
Farberow, N. L., and Shneidman, E. S. (Eds.), The Cry for Help, McGraw-Hill, New York, 1961.
Ford, D. H., and Urban, H. B., Systems of Psychotherapy, John Wiley, New York, 1963.
Freud, S. (1917), “A Childhood Recollection from Dichtung und Wahrheit,” in Collected Papers, Vol.
4, pp. 357-367, Hogarth, London, 1925.
Furtmuller, C., “Alfred Adler: A Biographical Essay,” in Alfred Adler, Superiority and Social
Interest, pp. 309- 394, Northwestern University Press, Evanston, 1964.
Ganz, M., The Psychology of Alfred Adler and the Development of the Child (935), Routledge &
Kegan Paul, London, 1953.
Goldstein, K., “Functional Disturbances in Brain Damage,” in Arieti, S. (Ed.), American Handbook of
Psychiatry, Vol. 1. pp. 770-794, Basic Books, New York, 1959-
2202
Guerney, B. G., Jr., “Alfred Adler and the Current Mental Health Revolution,” J. Ind. Psychol.,
26:124-134, 1970.
Haley, J., Strategies of Psychotherapy, Grune & Stratton, New York, 1963.
Hall, C. S., and Lindzey, G., Theories of Personality, John Wiley, New York, 1957.
Holt, R. R., “A Review of Some of Freud’s Biological Assumptions and Their Influences on His
Theories,” in Greenfield, N. S., and Lewis, W. C. (Eds.), Psychoanalysis and Current
Biological Thought, pp. 93-124, University of Wisconsin Press, Madison, 1965.
Jones, E., The Life and Work of Sigmund Freud, Vol. 2, Basic Books, New York, 1955.
Kaufmann, W., Nietzsche: Philosopher, Psychologist, Antichrist, 3rd ed., Princeton University Press,
Princeton, N.J., 1968.
Kelly, G. A., The Psychology of Personal Constructs, Norton, New York, 1955.
Levy, L. H., Psychological Interpretation, Holt, Rinehart & Winston, New York, 1963.
Lickorish, J. R., “The Casket Scenes from the Merchant of Venice: Symbolism or Life Style,” J. Ind.
Psychol., 25:202-212, 1969.
Lowry, R., “Psychoanalysis and the Philosophy of Physicalism,” J. Hist. Behav. Sc., 3:156-167, 1967.
McLaughlin, J. J., and Ansbacher, R. R., “Sane Ben Franklin: An Adlerian View of His
Autobiography,” J. Ind. Psychol., 27: 189-207, 1971.
Maddi, S. R., Personality Theories: A Comparative Analysis, Dorsey Press, Homewood, Ill., 1968.
Mairet, P., “Hamlet as a Study in Individual Psychology,” J. Ind. Psychol., 25:71- 88, 1969.
Maslow, A. H., Toward a Psychology of Being, 2nd ed., Van Nostrand, Princeton, N.J., 1968.
Matson, F. W., The Broken Image: Man, Science and Society, Doubleday-Anchor, New York, 1966.
Nikelly, A. G. (Ed.), Techniques for Behavior Change: Applications of Adlerian Theory, Charles C
Thomas, Springfield, Ill. 1971.
O’Connell, W. E., “Adlerian Psychodrama with Schizophrenics,” J. Ind. Psychol., 19:69-76, 1963.
_____, “Psychotherapy for Everyman: A Look at Action Therapy,” J. Existent., 7-85-91, 1966.
_____, “Sensitivity Training and Adlerian Theory,” J. Ind. Psychol, 27.65-72, 1971.
Orgler, H., Alfred Adler: The Man and His Work, Dutton, Capricorn Books, New York, 1965.
Papanek, E., “Re-education and Treatment of Juvenile Delinquents,” Am. J. Psycho-ther., 12:269-
296, 1958.
Papanek, H., “Alfred Adler,” in Freedman, A. M., and Kaplan, H. I. (Eds.), Comprehensive Textbook
of Psychiatry, pp. 320-327, Williams & Wilkins, Baltimore, 1967.
_____, “Psychotherapy without Insight: Group Therapy as Milieu Therapy,” J. Ind. Psychol, 17.184-
192, 1961.
_____, and Ansbacher, H. L., “An Adlerian Case or a Character by Sartre?” J. Ind. Psychol, 21:32-40,
1965.
Rychlak, J. F., A Philosophy of Science for Personality Theory, Houghton Mifflin, Boston, 1968.
Salzman, L., The Obsessive Personality: Origins, Dynamics and Therapy, Science House, New York,
1968.
Shoobs, N. E., “Individual Psychology and Psychodrama,” J. Ind. Psychol., 12:46–52, 1956.
2204
Shulman, B. H., “An Adlerian View,” in Kramer, M., et al. (Eds.), Dream Psychology and the New
Biology of Dreaming, pp. 117-137, Charles C Thomas, Springfield, Ill., 1969.
_____, “The Family Constellation in Personality Diagnosis,” J. Ind. Psychol, 18: 35-47, 1962.
Sperber, M., Alfred Adler, ocler das Elend der Psychologie, Fritz Molden, Vienna, 1970.
Spiel, O., Discipline without Punishment: An Account of a School in Action (1947), Faber & Faber,
London, 1962.
Stern, A., “Existential Psychoanalysis and Individual Psychology,” J. Ind. Psychol., 14:38-50, 1958.
Sundberg, N. D., and Tyler, L. E., Clinical Psychology, Appleton-Century-Crofts, New York, 1962.
Vaihinger, H., The Philosophy of "As If”: A System of the Theoretical, Practical and Religious Fictions
of Mankind (1911), Harcourt, Brace, New York, 1925.
Van Dusen, W., and Ansbacher, H. L., “Adler and Binswanger on Schizophrenia,” J. Ind. Psychol.,
16:77-80, 1960.
Verger, D. M., and Camp, W. L., “Early Recollections: Reflections of the Present,” J. Consult. Psychol.,
17:510-515, 1970.
Watzlawick, P., Beavin, J. H., and Jackson, D. D., Pragmatics of Human Communication: A Study of
Interactional Patterns, Pathologies, and Paradoxes, Norton, New York, 1967.
Wexberg, E., Individual Psychological Treatment (1927), 2nd ed., (Revised & annotated by
Shulman, B. H.), Alfred Adler Institute, Chicago, 1970.
B. Analytical Psychology
The Unconscious
Jung divides the concept of the unconscious in two parts, the personal
i.e., in the inherited structure of the brain. These are the mythological
associations, the motifs and images that can spring up anew anytime
anywhere, independently of historical tradition or migration, [p. 485]
2206
conscious. Thus he maintains there is a relationship or a dissociation of the
conscious and the unconscious. The unconscious may, in the case of a
relationship, appear to be complementary to the conscious, filling out or
the conscious of many images and emotions that have never previously been
experienced consciously.
These basic observations led Jung in later years to speak less of the
unconscious versus the conscious and to refer to their potential for unity, for
which he adopted the term “the objective psyche.” Whitmont summarizes this
development as follows:
Jung has suggested the term objective psyche for that totality of the psyche
which generates concepts and autonomous image symbols. Hence the ego-
centered, subjective consciousness is a partial rather than a complete
manifestation of the psyche. In the views of the psyche which were
prevalent until Jung’s studies became known, psychological functioning
was a meaningful organization only in and through the activity of the ego.
The drives themselves which constitute Freud’s id were regarded as
merely irrational, chaotic and senseless, not even related to a balance
which keeps the organism alive but only striving to satisfy their own
innate needs. Any meaning to be attached to the psychic organism could
therefore be viewed solely in terms of ego rationality. The unconscious
was quasi-attached to the ego as a general receptacle for that which the
ego must repress because it is culturally or personally unacceptable. The
psyche was thus “my” psyche, a part of my subjectiveness.
The term objective psyche replaces and enlarges the earlier concept of the
collective unconscious originally used by Jung to denote a dimension of the
unconscious psyche that is of an a priori, general human character, rather
than merely the precipitate of personal repressed material. Because this
term gave rise to many confusions and misinterpretations—such as the
seeeming advocacy of collectivity or of a mass psyche—he substituted the
term objective psyche in later writings.
2208
The term “complex” was initially used to describe certain emotionally
However, it came to be seen, even during the period of Jung’s association with
Freud, that complexes not only are personal, ego-centered reactions but also
complex). This fact led Jung to postulate a nonpersonal factor in the formation
of complexes. Quite early Jung states:
The work of the Zurich school gives careful and detailed records of the
individual material. There we find countless typical formations which
show obvious analogies with mythological formations. These parallels
have proved to be a new and exceedingly valuable source for the
comparative study of delusional systems. It is not easy to accept the
possibility of such a comparison, but the only question is whether the
materials to be compared are really alike or not. It may also be objected
that pathological and mythological formations are not directly comparable.
This objection cannot be raised a priori, since only careful comparison can
show whether a real parallelism exists. At present all we know is that both
are fantasy-structures which, like all such products, are based essentially
on the activity of the unconscious. Experience must show whether the
comparison is valid. The results so far obtained are so encouraging that
further research along these lines seems to me very well worth while. [Pp.
187-188]
Further research did prove that the comparison was valid, and the use
of the words “type” and “typical” in this early passage shows that Jung was
reaching for a term that could embrace specific observations. The term he
process. The word “archetype” was accordingly adopted, which was observed
to combine patterns of both image and behavior in its configuration.
The term complex denotes the basic structural element of the objective
psyche, and the central element of the complex is the archetype. We shall
see more clearly how complexes manifest themselves if we again turn to
an actual case.
Jung saw in every complex two aspects. The first he called a shell of the
complex, the other the core. The shell is that surface which immediately
presents itself as the peculiar reaction pattern dependent upon a network
of associations grouped around a central emotion and individually
acquired, hence of a personal nature.
of the complex which accounts for its disturbing field effect originates, not in
2210
the personal layer . . .” but in the mythological core.
hallucination, i.e., it never takes the place of reality, and can always be
distinguished from sensuous reality by the fact that it is an ‘inner image’ ” (p.
442).
the Psyche,” he recapitulated, and for the first time, gave full value to the
correspondence or complementarity existing between the archetypal image
and the pattern of behavior. In this paper Jung uses the visual image of the
archetypal image at the opposite pole. Instinct is likened to the infrared area
The Symbol
2212
Ego, Persona, Shadow
ego in a mature person stands between and must mediate between the
keeping with his conscious intentions, while it also meets the requirements
and fits the opinions of society. . . . This mask ... I have called the persona
which is the name for the masks worn by actors in antiquity. . .” (p. 42s).
In relation to the subjective inner world the ego encounters its shadow
aspect, its own weakness and self-doubt, and so it usually has an unpleasing,
at times unacceptable, appearance, often carrying repressed emotions or
thoughts. But it is not always so negative; in fact, it may appear to contain just
those characteristics that the persona lacks and that the ego needs to bring
into consciousness to balance the one-sidedness of the persona. This accounts
for the personal aspect of the shadow, but, since the shadow stands at the
For a man, a woman is best fitted to be the real bearer of his soul-image
because of the feminine quality of his soul; for a woman it will be a man.
Wherever an impassioned, almost magical, relationship exists between the
sexes, it is invariably a question of a projected soul-image. Since these
relationships are very common, the soul must be unconscious just as
frequently—that is, vast numbers of people must be quite unaware of the
way they are related to their inner psychic process. Because this
unconsciousness is always coupled with complete identification with the
persona, it follows that this identification must be very frequent too. [Pp.
470-471 ]
The Self
I therefore distinguish between the ego and the self since the ego is only
the subject of my consciousness, while the self is the subject of my total
psyche, which also includes the unconscious. In this sense the self would
be an ideal entity which embraces the ego. In unconscious fantasies the self
often appears as supraordinate or ideal personality, having somewhat the
relationship of Faust to Goethe or Zarathustra to Nietzsche.
2214
As an empirical concept, the self designates the whole range of psychic
phenomena in man. It expresses the unity of the personality as a whole.
[pp. 425, 460]
self. In differing ways their concepts stress the primary nature of the self as
an archetypal container for the child-mother pair in the first year of life.
Rising out of this unconscious matrix by a process of deintegration, the ego
develops by stages. In later life, beginning in adolescence, the ego learns again
the ego to relate to this numinous content at the same time maintaining a
polite distance from it. Without this axis the ego would be in danger of
Jung maintains that in the second half of life the ego necessarily must
relinquish its exclusive dominion over the psyche and give precedence to the
fateful direction of life in accordance with the self. This frequently leads to
some form of religious conviction wherein the evil power inherent in the
society.
Psychological Types
abilities and limitations of his patients, in terms of their possible behavior and
2216
overwhelming majority have married their polar opposites, although for
friends they tend to pick similar types. It is a little startling to think of most of
us marrying people that we would never pick as friends.
content to let somebody else carry our introverted side or our feeling, we
the unconscious. This shift is usually carried out by projections that are
people, things, and situations. These functions work under the aegis of the
toward the inner world. The extrovert tends to explain things from the point
inner self.
The extrovert is at ease in the outer world— with objects, people, and
outside world— feeling his way with caution, reserve, and fear, as though
In the introvert the energy flows away from the object to the subject.
Unlike the extrovert the introvert’s subjective reaction to the outer stimulus
2218
adaptation. These are sides of the personality that Jung called functions. Most
of us have one or two developed functions, and the other two or three are
relatively unavailable and lie in the unconscious. In assessing the developed
does he think his way out, does he wait for a hunch or intuition, does he use
The superior and inferior functions are equally potent in any individual.
But he can run the superior one, whereas the inferior one runs him. For
example, a thinking type can direct his thinking, but he is very vulnerable on
the feeling side. His feelings are easily hurt and may come up volcanically and
Sensation
They can retain a great many objective, unrelated facts. They are constantly
experiencing the concrete world, and the more extroverted they are, the less
most inarticulate function of all and is best expressed in color or form. Jung
individual’s psychology.”
as long as I get subjective reactions to it. When they cease to come, I go away
by myself and boil these past reactions down to abstractions. Once set down
on paper, or in paint, and put away, I feel satisfied and am ready to meet the
world again.”
Intuition
and is an excellent function for a pioneer. It works when there are no facts, no
moral support, no proved theories—only possibilities. The intuitive is
2220
transiently interested in objects and facts, and then only as stepping stones.
people and to foster its growth. For that reason they do well as stage and
movie directors and as educators. Their thinking is speculative.
vision, he avoids the pitfall of the sensation type, which is to get bogged down
in a welter of facts and details. This is the predominant type among Jungian
analysts.
Thinking
There are two kinds of thinking—the kind that derives from objective
data and the kind that may be traced to a subjective source. This stamps the
inner image or idea, which has a mythological quality. It has little to do with
objective fact, and is only accepted by the extroverted world when it is
this: Where does it lead back to? Does it go back to generally established
ideas, external facts (as with an engineer), or does it remain an abstraction
and return to the subject—as with many philosophers? Actually both points
extroverted thought saves the introvert thinker from an abstraction that has
to present the image that comes to him from the unconscious, which usually
does not tally with objective facts.
his audience’s reactions. lie is not aware that because his ideas are clear to
him they are not necessarily clear to others. However, this type may have the
power to create ideas that do not yet exist, although certain apparently
unrelated facts may be known. Mendeleev achieved this in his construction of
the table of atomic weights. He left blank spaces for substances that have
2222
Feeling
As I see it this type chooses its friends on the basis of character rather
than interest. According to Jung, the type is commonest among women, where
it is generally considered normal. It occurs less often in men; when it does it is
often a problem. This is because such men do not conform to the stereotyped
This is the type that makes value judgments at their best. Extroverted
feeling values are traditional and generally valid, being determined by social
standards. To quote Jung: “The function is designed not to upset the general
The feeling type has very definite likes and dislikes—an appraising
quality that cuts like a knife and is orderly and consistent. This is what makes
psychology, and in society, but in most other walks of life he is under a severe
The introverted feeling type is very unlike the extrovert. His feeling
introverted thinking type. In order to get his image across, an artistic talent is
helpful. This type tends to break with traditional values, as its premise is very
original, literally original, deriving from the basic historical patterns of the
mind.
J. B. W.
Jungian Therapy
flexibility of any therapy inspired by them. Jung himself used to say he had no
method of psychotherapy and that each analyst had to create his own method.
However, there are certain guidelines that may tell us how a Jungian analysis
2224
may proceed. From the beginning Jungian therapy presupposed the inclusion
2226
instrument of treatment. This constructive countertransference has, of
course, to be most decisively distinguished from such undesirable
countertransference manifestations as unconscious identifications and
projections due to the analyst’s unanalyzed neurotic complexes and
leading to harmful unconscious involvements—in which case further
analysis of the analyst is clearly indicated, [p. 340]
experiences. Some therapists have a separate room in which they keep a sand
table, in which figures and designs may be placed. This may be used as a
I think it is important to say, at the outset, that Jung did not intend or want
to compete with Freud. It was his conviction that an analyst could not
There has been no basic change in Jungian theory coming from any
member or group of the Jungian School. Modifications have been suggested
basic concepts. There has been considerable borrowing and learning from
other schools— from the ego psychologists, such as Erikson, and the neo-
2228
members of the school of existential analysis (daseinsAnalyse), for example,
Medard Boss and Rollo May. Adler sees the Jungian School as comprising
three different Jungian approaches to therapy: “The ‘orthodox’ approach
tends to keep Jung’s concepts ‘pure’ and virtually unchanged, with the accent
chiefly in London, who have tended to revive the old Freudian reductive
concerning the value of group therapy and the use of multiple analysis (that
is, analysis with more than one analyst), especially in training analyses. The
Zurich Institute requires multiple analysis; the London group discourages it;
the New York and San Francisco groups have no formal requirements, but are
friendly to multiple analysis when it seems indicated.
Bibliography
Adler, G., The Living Symbol, Bollingen Series 63, Princeton, 1961.
Bradway, K., “Jung’s Psychological Types,” J. Analyt. Psychol., 9, no. 2: pp. 129-137, 1964.
Henderson, J. L., Thresholds of Initiation, Wesleyan University Press, Middletown, Conn., 1947.
Jacobi, J., Complex, Archetype and Symbol, Bollingen Series 56, Princeton, 1959.
Jung, C. G., “Psychogenesis of Mental Disease,” in Collected Works, pp. 187-188, Bollingen Series 3,
Princeton, 1960.
_____, “The Structure and Dynamics of the Psyche,” in Collected Works, pp. 159–234, Bollingen
Series 6, Princeton, 1947.
Perry, J. W., “Reconstitutive Process in Psychopathology of the Self,” Ann. N.Y. Acad. Sc., 96:853-
876, 1962.
Whitmont, E. C., The Symbolic Quest: Concepts of Analytical Psychology, Basic Books, New York,
1970.
2230
Chapter 39
R. E. Money-Kyrle
Melanie Klein was born in Vienna in 1882 and died in London in 1960.
She had originally intended to study medicine at the Vienna University and
would have done so, had not an early marriage intervened. However, years
later during World War I, she had a second opportunity to recapture her old
interest in a new form. She came in contact with Freud’s work, recognized
what she felt she had been looking for and, from then on, dedicated herself to
it. She started her training with Sandor Ferenczi during the war and, after the
One of her early patients was a very silent child. She tried giving him
toys, discovered she could interpret his play as if it had been verbal
regarded by some as departures from Freud and are still often criticized as
such. Others, including her own teacher Abraham, till his death in 1926,
Since most of the ideas she introduced had their source in her early
papers and were gradually developed and clarified by her in later writings, it
her main publications is given at the conclusion of this chapter. What follows
2232
conception of transference analysis into “pure transference analysis,” a
movement which, in particular, involved the discarding of all forms of
reassurance, on the one hand, and educational pressure, on the other, with
both children and adults. She felt these could only blur what should be
given time. Once, at the beginning of her practice, she was herself alarmed by
the amount of anxiety she seemed to be arousing in a child patient by this
means. But Abraham advised her to persist, and she found that by so doing
she was best able to relieve the anxiety the analysis was evoking. After this
experience, she never had further doubts about the correctness of her
approach.
listed under the following heads: early stages of the Oedipus complex and
between two sorts of identification, introjective and projective, and, lastly, the
ultimately of the life and death instincts. In the first position, this ambivalence
expresses itself mainly in mental acts of splitting and projection. Thus, in her
view, the infant’s ambivalence toward the breast, loving when satisfied,
hating when frustrated, causes him to divide this object into two: a “good”
breast containing projected love that is felt to love the child, and a “bad” one
containing projected hate that is felt to hate him. Both become internalized,
making it possible for him to feel alternately supported and attacked from
within himself. Moreover, the reprojection of these inner objects onto the
external breast, and their further reintrojection, set up benign or vicious
projection of hate are often dealt with by further splitting as a defense, and
word which, on the one hand, avoids the implication that the infant is always
split and persecuted, and on the other, by its spatial analogy, suggests an
2234
attitude that can be abandoned and again adopted at any time.
As distinct from this position, Melanie Klein held that a very different
one begins to be at least temporarily adopted in the second quarter of the
first year, when the infant is integrated enough to relate himself to his mother
his own survival, in the later one it centers more on the survival of his good
objects, both inside and outside himself. And what, in the last analysis, he
fears is that his own destructive and greedy impulses will destroy, or have
later childhood as the fear that his mother, or father, or both may die. Thus, in
mourning and should be distinguished from such other feelings as the sense
of worthlessness or of hopeless confusion that is often mixed with it. In
Melanie Klein’s view, because some persecutory feelings are always involved,
damage in the inner world (sometimes also in the outer), followed by mental
acts of reparation. But if this acceptance is too painful to be borne, various
defenses come into operation. Of these the most usual are a regression to the
paranoid-schizoid position, or a swing into a manic state, in which either the
by it. Among the pioneers in this field, three of her pupils should be
mentioned—Bion, Rosenfeld and Segal—whose example has since been
Although Melanie Klein’s ideas about the origin of the superego and
early stages of the Oedipus complex began to develop before she had
Meanwhile, of course, the fact that the child has two parents related to
each other exerts its influence on his internal objects. Almost from the
beginning of her work, Klein believed she had found evidence of the presence
of an Oedipus complex at a far earlier age than had previously been thought
2236
possible. The child’s rivalry in a triangular situation seemed to begin as early
as the oral stage, so that his father could be internalized as an object denying
him the breast. At the same time, there would also be a “good” father, split off
from the bad one, to be internalized as the donor of, or fused with, the good
breast.
depressive positions with regard to the breast reappear with regard to this
hostile combination are felt to exist, and become internalized. In the second
position, when these two opposite aspects of the combined parents are more
integrated, the child is depressed because his fantasy attacks on the bad ones
the taboos on incest and parricide and tended generally to inhibit sexuality.
But Freud seems to have been well aware that much more remained to be
discovered about it—for instance, about what form it took in women,
whether and how a mother imago entered into its composition, and about its
backward from it, and believed she had contributed to tracing it to its source.
No Kleinian would claim that this task is even yet fully accomplished.
Another of Freud’s concepts, which she also worked on, was that of
identification. Its use in his Totem and Taboo does seem to imply that he had
two kinds of identification in mind. But the distinction was not very clear; and
This concept, as used by her school, appears in two main contexts. In the
elated sense of identification with him. Or, a similar state of elation seems to
2238
to have been injured or made hostile by projective identification can result in
depressive or persecutory hypochondria. He has also traced confusional
states to the same basic cause: The patient does not know who or where he is
explain the emotional affect some patients may produce in an analyst. When
this affect appears to exceed what can be explained in terms of
and, if they are disagreeable emotions, can experience relief by so doing. If the
their next session often dream of needing a lavatory—the angry infant can
soon use the same mechanism as an attack designed to distress the mother.
express feeling through behavior. If so, it must also be supposed that mothers
do just this. And, of course, the same applies to analysts. But, as a rule,
personal difficulties must be overcome before an analyst can expose himself,
a very early form of envy. For some patients behave toward an analyst as if
they wished to destroy any sense of superior equanimity they may suppose
him to possess. Moreover, since their dreams often seem to indicate that they
other patients might have felt love and gratitude, she inferred that it
expressed a very primitive form of envy directed toward the good breast felt
to contain every desired quality that the baby feels he lacks. In this, envy,
which aims at the destruction of goodness, is to be sharply distinguished from
greed, which aims at appropriating it. Everyone knows, of course, that envy is
some people than in others. Freud has also familiarized us with the concept of
penis envy in women—a term that includes both the greedy desire to steal
the penis and the envious desire to belittle it. That the purely envious
component in this could have a forerunner in envy of the breast has seemed
unacceptable to some; but many analysts have since found the concept
2240
therapeutic response. Here the aim is to make the patient aware that he is
envious, and also to expose the many delusions about the supposedly carefree
happiness of other people that his envy causes him to form and that, in turn,
increase it. For, although the amount of constitutional envy possessed by any
individual seems to be unalterable, much can be done to expose and correct
Enough has been said, perhaps, to give some idea of Melanie Klein’s
destruction of his good objects in his own inner world of fantasy. The
therapeutic aim of those who agree with her is first to analyze the defenses
against the reexperience of this position in analysis, and, by so doing, also to
reintegrate the split-off parts of the self, including the destructive elements
responsible for the depression, in order that they can be brought under the
control of the rest of the personality and used ego-syntonically. So far as this
removing much of the superego’s bizarre severity and giving it more the
character of a friendly mentor. (These views on the central role of the
through in the way described is always limited. But it is the aim of Kleinian
analysis and as such has sometimes been criticized as moralistic. That well-
integrated people tend to be more “moral,” if this means having a greater
result was anticipated, nor is any moral pressure put on patients to develop in
process.
which extended and in some cases modified Freud’s work, from which she
always took her departure; she also founded a school and, toward the end of
2242
her life, was much concerned about its definition and its future. It began as a
group of colleagues, mainly in England, who were most influenced by her and
who supported her in controversy, soon included analysts who had been
on. But naturally there were some disagreements and defections, and this
raised the question of who was to be called a Kleinian.
Certainly there are now a large number of analysts who understand, accept,
and apply all Melanie Klein’s theories. But these shade off into others who,
although they understand and accept most of her work, do not understand or
accept all of it. Then there is the complication of those who are good at theory
but perhaps lack the insight to be really good analysts, and conversely of
those who have the insight but are confused about the theory. Moreover,
analysis is a growing science, and many Kleinian analysts have developed
theories of their own. Usually these are extensions of Mrs. Klein’s views, of
which she almost certainly would have approved. But one cannot always be
sure even at this early date, and, of course, the uncertainty will increase with
time as yet newer theories are developed. This is not important in itself
except for the purpose of defining Kleinians, since only the truth or falsehood
The Kleinian School, therefore, has no clear- cut boundary, but its core
It is impossible for any one writer to be wholly fair to all his colleagues,
and in the account that follows allowance must be made for my being little
acquainted with the work of some of them that may in no sense be inferior to
the work of others with whom I am in closer touch. Moreover, there is not
space for more than a selection, so what follows is not a summary of the
original work of Kleinians, but a summary of some samples of this work. Nor,
indeed, is it possible to give more than a sketchy account of the work of any
one analyst.
Riviere, Nina Searl, and others who analyzed children by her methods. This
early group throve under the sympathetic protection, until the time of his
death, of Ernest Jones, who wrote the Preface to the special number of the
Klein’s seventieth birthday. The group also included her early pupils, and of
those who survived to carry on her work, the best known names (in
alphabetical order) are probably Bion, Rosenfeld, and Segal, each of whom
Bion was first known for his work on groups during World War II. Here
2244
one of his major contributions was the hypothesis (invented to explain his
actual experiences) that all groups meet under the influence of unconscious
basic assumptions. Thus there could be the dependent group under the
come under the influence of one or other of these more archaic or, indeed,
psychotic fantasies from the unconscious. Bion also records interesting
observations about the way in which an unorganized group will choose its
leader—often its illest member. Since Bion believed that each discipline
should begin by working out its own concepts for itself, these concepts are
not directly Kleinian, but they are by no means incompatible with Kleinian
theory.
analyzed on strictly Kleinian lines and soon began to publish his results in a
number of papers and books. His theoretical works include a theory of
projective identification. At the beginning of his life the infant projects his
troubles into the breast and gradually reabsorbs (introjects) an object that
can understand and deal with them inside himself. But if there is an excess of
both upon the breast and upon the infant’s own dawning capacity to
understand, which should have been derived from it. This, in very rough
outline, is Bion’s view of the origin of schizophrenia. Much of his work,
elaborated a grid to help the analyst in his task of recognizing the analytic
significance of his patients’ material and the exact moment at which they
were ripe for an interpretation. In still more recent years he has stressed the
“forgetting” his theories, his desires, and his patients before he sees them, so
that each session acquires something of the freshness of an initial interview. If
he does this, relevant theories and memories about his patients will be more
likely to float back into his mind as required and will not forcibly intrude to
Meanwhile, Herbert Rosenfeld and Hannah Segal were the first to apply
a strict Kleinian technique to the analysis of the schizophrenic. That is to say,
they renounced all attempts to play any definite role, either positive or
negative, in his life, did not attempt to educate him, and confined themselves
analyzing a child or a neurotic adult. The difference lay only in the nature of
the transference itself, which does differ markedly from those met with in
2246
classical analyses in that it is a psychotic transference. For example, because
transference role is largely that of the person or object with which the patient
feels confused. Moreover, since the psychotic’s object relations are mainly to
part-objects (breast, penis, and so forth), it is mainly as a part-object that his
begin, and for this reason regresses to the paranoid-schizoid position. For the
same reason his object relationships remain at, or regress to, the part-object
level; and as Hannah Segal was able to show, this is also a reason for his
shared between Bion, Rosenfeld, and Segal, who all approached the problem
from the same Kleinian angle. But apart from these Rosenfeld is probably best
symbol and object symbolized are concretely identified. For example, to the
normal or neurotic musician playing the violin may symbolize masturbation,
Kleinian theory in the social field, special mention should be made of Elliott
such a way as to drain off the “bad” impulses, and consequent persecutory
and depressive anxieties, that might otherwise have impaired the work of the
In a number of other books, less obviously though still in fact under the
influence of Kleinian ideas, Jaques has evolved a method by which the value of
2248
He has made important discoveries, for example, about the role of early anal
masturbation in causing a baby, who feels himself to be deserted, to become
thoroughly confused between breast and bottom and between his own
personality and that of his mother. Meltzer also has an unusually clear grasp
of the stages through which an analysis should pass and in which stage a
given patient is at a given time. Much of this he has recorded in his book The
Psycho-Analytic Process.
Among those whose work has been more exclusively in the applied field
may be mentioned Adrian Stokes, not a practicing analyst, who has written
much on art, and myself, who has contributed to ethics and politics.
It will be clear by now, as I said at the outset, that only a sketchy account
of the work of only a few members of the Kleinian School has been given. The
real work of any analyst is done in the consulting room, and no one else,
except possibly those patients who have collaborated most successfully in it,
analyst’s own analysis are tested again, and where new insights are conceived
and tested in their turn. The work is arduous and fraught with difficulties and
dangers; and in order to endure these without undue strain, the analyst needs
to have acquired a strong sense of the value of his own analysis and so of
analysis in general. This, and the sense of being able to convey it in varying
degrees to his patients, is necessary and sufficient for his peace of mind; and
perhaps never perfectly achieved. The desire to write papers and books,
complex. Some may do it simply because they have a facility for this kind of
work, others from ambition or because they generously want their colleagues
to share their new discoveries, or from a mixture of all these motives and
more. But although writing about analysis can never convey an adequate
impression of how the author does analysis, it is only those who write who
Melanie Klein was a very generous writer who believed her discoveries
to be important (but not herself) and wished to share them as soon as she
could. I think many of her pupils have inherited this motive for publication.
But it is impossible to say how much of the theory that they (and their pupils)
have accumulated since her death is strictly Kleinian in the sense defined at
the beginning of this article. Moreover, the unconscious has a fluidity about it
that is quite foreign to conscious verbal thought, so that it is less easy to be
sure whether anything said about it, even by oneself, is true or more probably
a half-truth, and, of course, the difficulty is greater when assessing what is
2250
accumulating, and new models (or theories) that express it better are likely to
and modified by Melanie Klein; and this will always be so however much it
may in time be hidden under the expanding structure of new theory built
upon it.
which all permanent groups are occasionally subject. I have in mind what
Bion, who first drew attention to it analytically, has called the confrontation of
the mystic with the Establishment. Bion himself discusses various outcomes,
in one of which the group is disrupted or the mystic, or innovator, “loaded
with honours and sunk without a trace.” But perhaps this tragic outcome
results from the group paying too much attention to the supposed originality
of the mystic or the supposed conservativism of the Establishment, and not
one side or the other. It is to be hoped that the Kleinian School will be able to
mobilize sufficient objectivity to deal more successfully with such crises as
Bibliography
_____, Our Adult World and Other Essays, Heinemann, London, 1963.
Isaacs, S., “The Nature and Function of Phantasy,” Developments in Psycho-Analysis, Hogarth,
London, 1952.
Jaques, E., “Death and the Mid-Life Crisis,” Int. J. Psychoanal., 46, 1965.
_____, “Psycho-Analysis and the Current Economic Crisis,” in Psycho-Analysis and Contemporary
Thought, Hogarth, London, 1958-
_____, “Social Systems as a Defence against Persecutory and Depressive Anxiety,” in Klein, M., et al.
(Eds.), New Directions in Psycho-Analysis, Tavistock, London, 1955.
Meltzer, D., “The Differentiation of Somatic Delusions from Hyperchondria,” Int. J. Psychoanal., 45,
2252
1964.
_____, “The Relation of Anal Masturbation to Projective Identification,” Int. J. Psychoanal., 47, 1964.
_____, “On the Genesis of Psychological Conflict in Earliest Infancy,” in Developments in Psycho-
Analysis, Hogarth, London, 1952.
_____, “The Unconscious Phantasy of an Inner World Reflected in Examples from Literature,” and
“The Inner World in Ibsen’s Master Builder,” in Klein, M., et al. (Eds.), New
Directions in Psycho-Analysis, Tavistock, London, 1955.
Searl, N., “Danger Situations of the Immature Ego,” Int. ]. Psychoanal., 10, 1929.
_____, “A Paranoic Mechanism as Seen in the Analysis of a Child,” Abstract in Int. J. Psychoanal., 9,
1928.
Segal, H., “Fear of Death: Notes on the Analysis of an Old Man,” Int. J. Psychoanal., 39, 1958.
_____, “A Note on Schizoid Mechanisms Underlying Phobic Formation,” Int. J. Psychoanal, 35, 1957.
_____, “A Psycho-Analytical Approach to Aesthetics, in Klein, M., et al. (Eds.), New Directions in
Psycho-Analysis, Tavistock, London, 1955.
_____, “Some Aspects of the Analysis of a Schizophrenic,” Int. J. Psychoanal, 31, 1950.
Stokes, A., Greek Culture and the Ego, Tavistock, London, 1958.
_____, Three Essays on the Painting of Our Time, Tavistock, London, 1961.
Harry Guntrip
2254
Forerunners of Object Relations Theory
his name. He would have disapproved of any attempt to create yet another
whole,” but, above all, following the clues provided by the actual pressure of
The clinical material from which the whole of my special views are derived
may be formulated from the general proposition that libido is not
primarily pleasure-seeking, but object-seeking. The clinical material on
which this proposition is based may be summarized in the protesting cry
of a patient to this effect—“You’re always talking about my wanting this
and that desire satisfied: but what I really want is a father” (p. 137).
Freud failed to make the necessary modification of his biological libido theory
that this new object relational concept demanded. In fact, object relations
theory is the development of the personal aspect of Freud’s theory, as distinct
from the physical or biological aspect, and it was really there from the start as
soon as Freud abandoned as impossible to achieve his first attempt to
and the truly psychological, the biological and the personal, alternated
his first formulations. This became marked when, after World War I, he
turned his attention more and more to ego problems. In his last book, An
Outline of Psychoanalysis, the title of the last and unfinished chapter is “The
Freud was the pioneer who said the first, not the last word, but his work
psychoanalysis was making. Ian Suttie of the Tavistock Clinic in Britain, in The
Origins of Love and Hate, rejected instinct theory and held that deep-seated
personality as the raw material of a self or person, and then devoting himself
to the study of all types of psychosis and psychoneurosis in their social
2256
settings and in terms of interpersonal relationships. This kind of theoretical
itself we may even sec it adumbrated by Sandor Ferenczi, whose work at that
earlier date really implied an object relations point of view, with more
personal methods of treatment. It was unfortunate that Ferenczi was before
his time. Freud was not ready for this development and disavowed Ferenczi,
but his work has been recently justified by his pupil, the late Michael Balint, in
that important book, The Basic Fault.' He traced the need of the very ill patient
to regress as far back as the basic fault, the original failure of secure ego
development at the beginning. This can only be remedied, not by a search for
view the personal object relational need transcends the biological needs.
Thus object relational thinking is very far from being synonymous with
Fairbairn’s systematic elaboration of it, and even Fairbairn owed his primary
stimulus to the work of Melanie Klein. At this point we must recognize that
countries showed, over the next few decades, marked divergencies, which are
now, one hopes, becoming more closely studied and better understood. In
and the structural analysis of the biopsyche into the id (the it, impersonal
biological energies, instincts), the ego (the I), and the superego (conscience).
the background, and he dealt mainly with the system ego and its dual
functions of controlling id drives and adapting to the external world.
and clarity without agreeing with him, and I feel that the concept of
refusal to adapt and to preparedness to sacrifice life itself in the service of our
2258
values.
object relations theory can be most clearly expounded. In Britain the great
need therefore only pick out that aspect of it that inspired the fresh thinking
of Fairbairn, Winnicott, and others. Fairbairn acknowledged that it was her
impact on him; and Winnicott told me that it was his training analyst, James
Strachey, who said to him: “As a pediatrician you must hear what Mrs. Klein is
saying.” Even though Strachey as a classical analyst could not accept all her
views, he felt that what she was saying was of great importance. Melanie
Klein did not herself, I believe, recognize how radical was her development
beyond Freud, mainly because Freud himself had adumbrated it. She accepted
his theory of instincts of sex and aggression, even making more of the death
instinct than Freud himself did. Her use of projection and introjection is
absolutely essential for psychoanalysis, but it is its implications for her theory
that concern us here. For Klein the infant’s greatest fear is of his own death
instinct, and he introjects (takes into his inner mental world) the good breast
with an external bad object, which he introjects to control it. Thus he has now
built up in his unconscious a whole internal world of good and bad objects with
is that this concept of instinct has now become really superfluous for
introjection human beings live in two worlds at once, the inner mental world
and the external material world, and constantly confuse the two together. It is
the result of the relationships that develop between the child and his parents.
As Hartmann allowed the superego concept to fall into the background while
giving a very impersonal account of the ego, so Klein allowed the ego concept
to fall too much into the background while giving a highly object relational
account, based on the concept of introjection and the superego, of the hitherto
biologically described unconscious.
Psychoneuroses” (Ch. 2). We may pause to ask how it was possible for two
2260
simply that one is right and the other wrong. It is that the subject matter is
extremely complex, and it was not for a long time that the major problems
involved began to be clarified. For that we have had to wait finally for further
science at all? His determination to make it scientific led him to seek to base it
first on neurology and then on biology, but, in fact, although it could not be
science when it can include at one end atomic physics, and at the other the
exploration of the inner, unconscious, motivated life of personal selves in
Freud worked with the concept of psychic reality, but the object
relations theory has given new depth and certainty to this concept, revealing
criticism of it would be that with Freud it was not yet a truly psychological
concept, but physical energy with a psychic label on it. True psychic energy is
devoted labor. Bronowski’s view that man is both a machine and a self, and
that there are two different kinds of knowledge, knowledge of the machine,
which is physical science, and knowledge of the self, would have been a
godsend to Freud. Bronowski finds knowledge of the self in literature, but
that is only one area in which knowledge of the self is expressed. Its
psychological ideas be reduced to the lower levels of any other science, and
since the Person is the highest product of evolution known to us, the
irreducible science of the nature of man as personal must crown the edifice of
psychoanalytic therapy.
2262
importance for understanding the implications not only of Freud’s original
represents the object relations of the child and parents as persons, and this is
psychic reality. When Sullivan and the American Culture Pattern school
shifted the emphasis from the biological to the sociological, studying the fate
of the individual as a person in his social milieu, they were exploring psychic
reality, subjective personal experience. When in the 1930’s and 1940’s
analysis of the internal psychic world and its developmental processes, she
material of living, but grew wholly out of the quality of the child’s
relationships with the parents, that is, psychic reality. Sullivan closely
approached Klein’s theory here in his view of parataxic distortion. In the
Fairbairn starts at the centre of the personality, the ego, and depicts its
strivings and difficulties in its endeavour to reach an object where it may find
To emphasize the ego and its search for security, which it can find only
by dealing satisfactorily with its bad objects and maintaining reliable
relations with its good objects, is to bring the whole problem of object
relationships into the very center of the psychoanalytic inquiry. It also lifts
theory—that is, a theory of the person, not simply of the organism—and gives
full meaning to Freud’s term “psychic reality,” with psychoanalysis having the
status of psychodynamic science. With Melanie Klein instinct theory still held
the place that should have been held by the ego, for, as Fairbairn later pointed
2264
out, instincts are the instincts of, or properties of a person-Ego since modem
science does not now separate energy and structure (or id and ego). However,
theory was toward placing object relationships at the very heart of the
“endeavour to reach an object where it may find support,” more than a search
for security; nothing less than the ultimate need for self-discovery, for self-
development, for the realization and growth of the potential ego’s full
used, it must imply secure possession of one’s own full selfhood, and this may
the nature of the ego, I accept Fairbairn’s view of its absolute fundamental
“Schizoid Factors in the Personality.” Prior to that his writings fall into two
groups, 1927-33 and 1933-40. In the first period he began as a fully orthodox
unmistakably his basic concern with ego analysis. In his patient’s dreams
various aspects of her ego or total self appeared clearly personified and
differentiated as the little girl, the mischievous boy, the martyr, and the critic.
He compared this with Freud’s structural theory of id, ego, and superego and
The data provided by the case . . . leave no doubt about the existence of
functioning structural units corresponding to the ego, the id, and the
super-ego, but the same data seem equally to indicate the impossibility of
regarding these functioning structural units as mental entities. . . . Perhaps
the arrangement of mental phenomena into functioning structural units is
the most that can be attempted by psychological science. At any rate it
would appear contrary to the spirit of modern science to confer the status
of entity upon “instincts”; and in the light of modern knowledge an instinct
seems best regarded as a characteristic dynamic pattern of behaviour, [p.
218]
superego phenomenon, the little girl and the mischievous boy would be
personalized id phenomena, and the martyr might well be the ego caught, as
Fairbairn to redefine the id in personal or ego terms. At that time he still used
2266
nonpsychological term, and that everything in human psychology must be
presented as an aspect of ego functioning.
It was not, however, until Fairbairn had absorbed the work of Melanie
Klein from 1933 to 1940 that he could work out the full-scale revision of
into the center of the picture. Klein’s analysis of the internalized or psychic
object enabled Fairbairn to proceed to a radical ego analysis. Hitherto the ego
had been treated as a superficial phenomenon “on the surface of the id”
(Freud), developed for the control and adjustment of impulse to the demands
of outer reality. It was more a mechanism than a real self. The term “self”
should connote the dynamic center or heart of the personality, its basic unity
and bad, involved parallel splits in the experiencing ego, since the ego is
libidinally attached in different ways to the different aspects of the original
external object. How real is the internal object and how much it is a part of
the total ego or self are clear in such a dream as that of a sensitive married
woman too easily made to feel guilty. She dreamed that as she was walking
along the street, a tall, dark, stern-faced woman followed her wherever she
went, keeping an eye on her. It was her mother from whom, however, she had
been parted by marriage for over ten years. Sometimes these internalized
state, as when a man woke to see a small boy dart across the room and
disappear up the chimney, and realized he was dreaming. Still more striking
she was still having nightmares of being beaten by her mother. But when very
emotionally disturbed she would beat herself, and as she was doing this in
one session I said, “You must be terrified being punched like that.” She
stopped, stared at me, and said “I’m not being hit. I’m the one doing the
hitting.” I commented “You are both.” She was acting out her split ego, part
established concern about ego analysis enabled him to draw out the
The distinctions Fairbairn made within the overall whole of the complex
2268
ego structure are thus not entities (like parts of a machine) but processes,
differing but simultaneous reactions of a whole personal ego dealing with his
small child’s reactions to parents, and can be used to describe the relatively
enduring structure of the psychic self in its dealings with its object world, its
only theoretical roots in his primary concern about ego analysis, and in
examined before his structural theory can be further developed. The schizoid
problem goes deeper than depression, which is, at least in the classic
objects), and later added Fairbairn’s concept of schizoid to describe the basic
was that the infant psyche developed beyond the autoerotic and narcissistic
level of ego libido, which was its original objectless condition. From an
original primary identification with the object, the infant grew, through
from himself. Thus object libido arose as the ability to feel for others
(primarily the mother). Then when the infant experiences the good object and
the bad object as aspects of one and the same mother, he is caught in an
ambivalent love-hate relationship and guilt. He can neither hate for loving,
nor love for hating, and guilt paralyzes him. This is a psychology of impulse,
and Freud’s scheme of endopsychic structure—id, ego, and superego —
version of the authoritarian parent, to help the ego in its struggles to master
id impulses. I have retraversed this familiar ground because it is essential to
structure.
2270
with the control of impulses in object relationships, a secondary matter, but
in the end with whether he has a sufficiently real ego to be capable of forming
object failed to treat him as real, to “love him for his own sake, as a person in
his own right.” In his 1940 paper Fairbairn described the schizoid tendency to
treat people as less than persons, as things, part-objects, “breasts” to be used,
genuine expressions of affection that would make her a real person to her
baby, robbing him of the chance to feel himself becoming a real person for
her. Such an infant grows up only able to use, not really able to relate to,
people. His inner unsureness of his own reality as an ego is likely to be shown
by role playing, exhibitionism, with little real communication, taking rather
than giving, fearing to give since it may feel like a loss or self-emptying. He
may seek to bridge the gulf between himself and others by “thinking” rather
to his fear that his unsatisfied needs, which the object has failed to meet, had
become so greedy and devouring that his love had become even more
problem is an infantile ego too weak to be able to cope with the outer world,
because he is already split in his growing emotional life by the inconsistency
of his primary parental objects, and becomes a prey to loss of internal unity,
radical weakness, and helplessness. While still partly struggling to deal with
the outer world, he also partly withdraws from it and becomes detached, out
is not a problem of impulse control, but of ego splitting, and it calls for a
superficial part of the ego representing its higher levels and including the
conscious, and (2) a deeper part of the ego representing its lower levels,
highly endowed with libido, the source of affect” (p. 21). He later developed a
describing the basic split as between “a true self put away in cold storage,”
2272
when it cannot find a nourishing environment, and “a false self on a
biological entities existing outside the psychological ego, which they are then
supposed to invade. He regards a human being as whole from the start, and
and conceptualization, in reality they are aspects of a unity. They should not
and superego as control systems. The id is impersonal. The ego and superego
are personal and properly psychological concepts. The person includes the
organism, but in dealing with the person on the psychological level of
when dealing with the biological organism. Organism is a wider concept than
person. There exist organisms without personality, but not personality
reversible, and the personal cannot be dragged down to and accounted for on
mechanisms for sensory perception and action, all the complex machinery the
person needs for dealing with the external world. In nonpersonal organisms
the idea of instinct as drive entity may be more meaningful, but its meaning is
vague and not very useful. In the human being there are no fixed instincts
for action, which operate in ways determined by the state of the personal
2274
whole ego in the medium of object relations. The activity of these biological
energies expresses the condition of the ego; the ego is not in the power of
fixed instincts. Freud’s sex is one of the appetites, like eating, drinking,
excreting, breathing, and so on, although sex is the appetite most easily
involved in human relations. It arises out of biochemical conditions within the
ego reaction to threat.” Anxiety and aggression, fear and anger, flight and
fight, are the twin “ego reactions to threat,” not just to bodily existence but
Thus Fairbairn held that the infant is oral because he is immature, not
psychological level, but the term becomes increasingly meaningless for his
organisms presumably have only that aim. The pursuit of security in the sense
This is exactly what schizoid personalities are found to lack. They suffer
as persons from what R. D. Laing calls “ontological insecurity.” The deeper
one goes into their mental makeup analytically, the more they are found to be
futile, isolated, lonely, and aimless. They experience a craving for close
contact for security’s sake, that is, dependent, which at the same time they
fear because they feel they can do nothing effective to realize it or accept it.
Thus Fairbairn’s work involves a decisive shift of the center of gravity in
ego development and the schizoid problem, as well as the sheer primitive
fears that blocked the infant’s growth emotionally and forced his withdrawal
2276
into himself. He wrote: “I have become increasingly interested in the
has been the emergence of a point of view which, if well-founded, must have
theory of id, ego, and superego to account for present-day enlarged clinical
knowledge, but the model he proposed is too frankly mechanistic to meet our
fully personal.
theories. Thus Bertrand Russell tells us that when a proton and an electron
collide they do not split into more “things,” but disappear into energy, which,
he says, “at any rate is not a ‘thing.’ ” Fairbairn postulates a “pristine, unitary
would modify his view of its nature in one respect. It would be more accurate
to say that at birth there is a “pristine, unitary whole human psyche with ego
potential” that immediately begins to grow into a developing self, a person-
unified, steadily enriched growth of the pristine ego if the infant experienced
only absolutely good object relations. Good object relations simply promote
good ego development. Bion says that in the infant “good experience is simply
digested.” This, however, is impossible in practice, there being no perfect
fact. In the struggle to cope with his mixed experience and difficult outer
world, the infant goes through a series of spontaneous psychic maneuvers that
counterparts (which Melanie Klein called “internal good and bad objects”) for
their easier management. Broadly the infant seeks to see his outer world as
good when it first becomes intolerable by the expedient of taking its bad
2278
aspects into his inner mental world to deal with them there. Bion says that
bad experience cannot be digested and absorbed, but only projected if not
retained as a foreign body. This, however, does not solve his problems. Rather
a patient who said at the first session “I have the best mother on earth,” who
turned out to be the major source of all her problems), and the creation inside
splitting into an external reality self and an internal reality self. Unless the
infant’s real-life object relations are good enough to keep him in genuine
touch with his outer world, he becomes more and more dominated by fear
and retreat into himself, and he loses contact with external reality in a flight
Fairbairn has shown how Klein’s object splitting is paralleled by ego splitting,
them to three main groups that represent the fundamental pattern of our
endopsychic structure. Freud’s scheme was really an early adumbration of
constitution of the human mind have all conformed to a threefold pattern; for
example, Plato’s chariot with a charioteer (of reason) and two steeds, the
many-headed beast of fleshly lusts, and the lion, courage, the fighting
principle, (that is, Freud’s sex and aggression); also the familiar “body, mind,
and spirit,” which is in principle the same as Freud’s id, ego, and superego.
For Fairbairn, however, we must start with a primitive whole ego as yet
undeveloped at birth, which becomes differentiated or split into three aspects
that then function as lesser egos in opposition to each other, because of the
internal bad object, which excites but never satisfies the child’s basic needs,
and which Fairbairn calls the Exciting Object. Thus L.E.-E.O. embodies the
experiences of the baby, insofar as he is deprived of adequate parental love.
superego), an aspect of the infantile psyche in which the baby, not being able
to secure a good object relation with the unsatisfying parents, is driven back
on identifying with them as Rejecting Objects (an internal bad object forming
2280
a further constituent in Freud’s superego). He is thus turned against his own
libidinal needs. A female patient dreamed that she was a little girl feeling
frightened, and she saw me in a room and thought, “If I can get to him I’ll be
safe,” and she began to run to me. But another girl strode up and smacked her
face and drove her away, her own Anti-Libidinal Ego at one with the
punishing mother who was always saying “Don’t bother me.” Thus Anti-L.E.-
R.O. embodies the experience of the deprived infant insofar as he sides with
the critical, angry, denying parent against himself. His anger against his bad
needs that they will not meet. The combination of Anti-L.E. and internal R.O. is
a more precise formulation of the sadistic aspect of the superego, and accounts
for internal self-persecution of the L.E., for which reason Fairbairn at first
called the Anti-L.E. the “internal saboteur” (cf. the patient who beat herself as
her mother beat her). (3) The good or understanding aspects of the parents
are left to form the Ideal Object, which is projected back into the real-life
parent, causing idealized overevaluation of the parents in the external world.
Central Ego (the Freudian ego), the conscious self of everyday living. Thus
C.E.- I.O. embodies the experiences of the child insofar as he seeks to preserve
world.
regarded libido as object-seeking, the primary life drive to object relations and
human relations. Even the Anti-L.E., has a libidinal basis, for this self-
persecuting function of “aggression turned against the self’ arises out of the
infant’s need to maintain object relations even with bad objects, as a result of
himself.
Libido is the primary life drive of the psychosomatic whole, the energy of the
ego’s search for good relationships, which make good ego growth possible.
Energy and structure are not separated as in Freud’s id and ego, which are
replaced in object relations theory by Fairbairn’s dynamic structure and ego
as a reaction to a threat of the ego. (4) The structural ego pattern that
emerges when the pristine ego or psychic unity is lost conforms to a threefold
2282
pattern of ego splitting and of internal ego-object relations: (a) L.E.- E.O., the
primary needy natural self left unsatisfied; (b) Anti-L.E.-R.O., the angry infant
employing his aggression to stifle his own needs as weaknesses; and (c) C.E.-
since bad objects are better than none. (5) Fairbairn regarded Freud’s oral,
anal, and genital stages of development as unsatisfactory, for mouth, anus,
and genitals are biological organs used by the person to make relationships in
both natural and disturbed ways. The anal phase he regarded as nonexistent
training. The child is always using excretory organs. That the earliest infantile
ego is markedly a “mouth ego” is simply due to his immaturity, and later on
genitals may be used maturely or immaturely according to the state of the
psychotherapy.
Psychotherapy
theory. Since bad objects make the child ill, only a good object relation can
make him well, that is, give him a belated opportunity to undergo an ego-
maturing growth in a therapeutic relationship with an analyst he discovers at
understanding, and concerned to enable him to find his own true self.
Repression is carried out, not on instincts, but on internal bad objects, and the
parts of the ego related to them, the ultimate internal bad object states and
deepest psychic disasters being depression and the schizoid condition. The
patient as a therapeutic good object with whom he can regrow his personality
in security, unless the analyst can help him to relive and outgrow his internal
bad object relations in the transference. The analyst must prove capable of
reliably surviving all the patient’s projections of internal bad objects on to
2284
Winnicott distinguishes two levels of treatment, “oedipal analysis” for
with such deep problems the analyst must accept and support the infantile
dependence of the patient. At such depth, as Balint says, the patient may not
rider must ride the horse, not be run away with.” The mother’s “primary
maternal preoccupation” with the baby (which develops during pregnancy
and only fades, in the healthy mother, as the baby grows securely
independent of her) gives her a knowledge of the baby’s needs that no other
person can have. Gradually the securely mothered baby develops a mental
image of mother that, if undamaged, comes to allow the baby to tolerate her
absence for a certain time, and the gap can be bridged by the transitional
object, the cuddly toy that represents mother, the first symbol of relationship.
But if the mother is absent from the baby too long, his mental image of her is
lost, and with it “whatever of ego structure has begun to develop.” This is the
toward and requires one further step for its completion. Broadly speaking
four groups of psychoneurotic conditions are recognized; hysteric, phobic,
Obsessional states represent the effort to maintain total internal control over
all good and bad objects regarded as internalized, and over the suffering
Libidinal Ego. In phobic states the suffering Libidinal Ego takes flight from bad
objects to safe good ones, all of them projected into and seen as part of outer
reality. In neurotic paranoid states the ego treats the good object as internal
and identifies with it, while its bad objects are projected into the outer world,
and the suffering Libidinal Ego hates them there. In hysteric states the
opposite policy is pursued. The good objects are seen as projected into the
outer world where the suffering Libidinal Ego can appeal to them for help
against its bad objects, which are regarded as internal persecutors. One
paranoid attitude toward me and toward everyone. When paranoid his bodily
health was perfect but everyone was against him, and I was only treating him
to get fees out of him. When hysteric his body was full of aches and pains
while he sought frantically for friends in his external world, and I was his one
2286
great hope.
At deeper levels depression and schizoid states take us into the region
of borderline and psychotic cases. Depression is the paralysis of the suffering
objects and the Anti-Libidinal Ego. The schizoid state takes us deepest of all,
arising in its extreme form out of the flight from all bad objects, both internal
and external, and, indeed, from all object relations, into the depths of the
mixed with all the other psychoneuroses and psychoses, but at its worst the
search for a solution can involve one other form of illness that so far has not
play on and reinforce real external bad object relations. It is well to bear in
mind Freud’s caution that we cannot raise anything out of the unconscious
purely by analysis, but must wait until real life stirs it up. But the deepest
schizoid withdrawal and the profoundest regression into apathy, exhaustion,
internal world. One such apathetic patient acted out in the night while fast
mother. I was present on two such occasions when her husband rang me in
the night, and I discovered sears on her back that he had not known were
impulses.
How far can regressive schizoid withdrawal go? Clearly it can go as far
as a fantasied and unconsciously experienced flight back into the womb, and
many myths, dreams, and illness reactions represent just that. Such cases
prolonged hysteric phase, dreamed that she could not cope with adult life
because she had a hungry baby under her apron clamoring for food. She
produced a hysteric conversion symptom of an acute pain in her right
forearm, which she nursed like a baby. She worked through this phase and
became markedly schizoid, aloof, silent, and out of touch. She then had a
prolonged fantasy of a dead or sleeping baby buried alive in her womb, which
led on to a vivid dream of opening a steel drawer and finding inside it a live
baby, staring with wide-open, expressionless eyes because there was nothing
to see. This suggested to me that there is one last ultimate split in the ego, in
the infantile L.E. itself, into a clamoring, orally active L.E. (hysteric), and a
deeply withdrawn, passive L.E. (schizoid). This I have called the Regressed Ego,
2288
sleep, exhaustion, feelings of nonentity, the sense of having lost some part of
the self, the strange isolation of feeling out of touch—in fact, all the marked
schizoid states.
he had not hitherto been able to fit into the conceptual scheme, and he
regarded it as the logical development and completion of his theory.
Furthermore, I had gone beyond him at this point. Whereas he had treated
depression and the schizoid state as equally ultimate psychic disasters, I had
treated the schizoid state as deeper than depression, and he agreed that this
was so. The patient cited who oscillated between hysteric and paranoid
him and saying “You are the guilty man.” When finally this did not yield to
orthodox analysis, and I said to him: “I don’t think you are depressed in the
accepted sense of the term, but seriously afraid of life, retreating from it, and
and said that as soon as he got home, he had, since his breakdown, gone
straight to bed and curled up under the clothes. Fairbairn’s work makes it
when the problems of schizoid regression are solved. It also shows that
aggression is not the ultimate factor that it was classically assumed to be. In
schizoid ego to maintain itself in being at all. As one patient said: “When I’m
Bibliography
Balint, M., The Basic Fault, Barnes & Noble, New York, 1968.
Bowlby, J., Attachment and Loss, Vol. 1, Attachment, Basic Books, New York, 1969.
Colby, K., Energy and Structure in Psychoanalysis, Ronald Press, New York, 1955.
Fairbairn, R., Object Relations Theory of the Personality, Basic Books, New York, 1952.
_____, “Observations on the Nature of Hysterical States,” Brit. J. M. Psychol., 28:144-156, 1955.
_____, “On the Nature and Aims of Psychoanalytical Treatment,” Int. J. Psychoanal., 29:374-385,
1958.
Guntrip, H., Healing the Sick Mind, Allen & Unwin, London, 1964.
_____, Personality Structure and Human Interaction, International Universities Press, 1961.
_____, Psychoanalytic Theory, Therapy, and the Self, Basic Books, New York, ‘
2290
_____, Schizoid Phenomena, Object-Relations and the Self, International Universities Press, New
York, 1968.
Hartmann, H., Ego Psychology and the Problem of Adaptation, International Universities Press,
New York, 1958.
_____, Essays on Ego Psychology, International Universities Press, New York, 1964.
Khan, M., “An Essay on Dr. M. Balint’s Researches,” Int. J. Psychoanal., 50:237-248, 1969.
Medawar, P. B., Induction and Intuition in Scientific Thought, American Philosophical Society,
1969.
Russell, B., History of Western Philosophy, Allen & Unwin, London, 1946.
Sullivan, C. T., Freud and Fairbairn: Two Theories of Ego-Psychology (Preface by Fairbairn, W.),
Doylestown Foundation, Doylestown, Pa. (available from the Director of Research).
Sullivan, H. S., The Interpersonal Theory of Psychiatry, Norton, New York, 1955.
Sutherland, J. D., “Object-Relations Theory and the Conceptual Model of Psychoanalysis,” Brit. ]. M.
Psychol., 36.109—120, 1963-
Suttie, I., The Origins of Love and Hate, Kegan Paul, London, 1935.
Thompson, C., Psychoanalysis: Evolution and Development, Nelson, New York, 1952.
Winnicott, D. W., The Family and Individual Development, Tavistock, London, 1965.
_____, “The Location of Cultural Experience,” in Winnicott, D. W. (Ed.), Playing and Reality, Basic
Books, New York, 1971.
Wisdom, J. O., “Fairbairn’s Contribution on Object Relationship, Splitting and Ego- Structure,” Brit.
J. Al. Psychol., 36:145- 160, 1963.
2292
Chapter 40
Earl G. Witenberg
the modes of thought habitual to men of its time. Thus, the belief in
individualism of the eighteenth and nineteenth centuries is reflected in
Freud’s view of the individual in a fateful struggle with his instincts, and the
advance of the biological and physical sciences left their imprint on his
new mode of thinking that began to become persuasive at the turn of the
century. In physics events were seen to be relational; man in crowds was seen
long in coming, and the line of its development may be seen in the work of
Karen Homey, Clara Thompson, and, indeed, of the whole field of psychiatry,
stated that the only person he knew who could have done what Freud had
Sullivan’s work a flavor peculiarly different from that of other workers in the
field are two elements that are, perhaps, specific to American thinking.
Whether the influence is direct or not, it is clear that the pragmatic climate of
America, noted by de Tocqueville more than a century ago and
2294
conceptualized by Peirce, James, and Dewey, has been influential in his
approach. Sullivan’s thinking is empirical rather than rationalistic. He is more
surrogate and the child is the most telling in any of the psychoanalytic
may approach testability, and if some of the color and richness of human life
means of observation.
What Sullivan did, to a degree more than any other psychiatrist of his
time, was to take note of the rising belief that, as Fichte put it, “the ‘I’ is not a
fact but an act,” and to test that belief in a clinical situation. In Sullivan’s view
people. From the first mysterious contagion between child and mother to the
last personal interchange of the old man at the moment of death, the human
person is a being in process—not a fact but an act. To illustrate the dynamic
nature of this view, we can contrast the common mode of speech when
speaking of the person who exhibits much anxiety (or love, or hate) with the
mode of Sullivan’s frame of reference. The common way of thinking, which
Sullivan might say that he is a person who under such and such circumstances
Leston Havens has remarked that Sullivan has “secretly influenced all of
American psychiatry.” Not so secret is his influence on such writers as Arieti,-
2296
Tension of Needs
interaction between the parent and the infant in regard to the tension of
needs or drives. From birth onward the infant experiences tensions of needs.
There are tensions caused by physiological needs, both general and zonal;
there is the tension of the need for tenderness; there are also tensions caused
by the needs for curiosity, focal attention, activity, and mastery. Also there is
the innate capacity for the tension of anxiety. Sullivan conceptualized tension
transformation so that the organism may maintain itself, that it may maintain
a balance among various subsystems or organ systems, and it may maintain
General needs are needs for food, breathing, and sleep. The zonal areas
are oral, anal, vestibulo-kinesthetic, retinal, and genital. All these needs arise
in the internal physicochemical milieu and are experienced centrally as
tension. As a result of such tension the infant makes certain movements, such
as crying, at first toward the universe at large and later toward the more
specific agents who, experience has shown, may relieve his tension. If his
efforts are successful in producing actions by others that result in the
interaction with others. From the moment of birth the parents are the agents
through whose acts the child’s needs are either satisfied or denied, and in the
significant anxiety in the infant, the basis for “security” is established, and the
achieve the satisfaction of its needs without loss of security. If, on the other
hand, the early experiences through which the self-system is developed lead
states, the person is said to lack security and to be mentally ill. Thus, the need
to satisfy these needs or drives leads to interaction with others, and this
2298
interaction leads to the patterning of a self-system that is interpersonally
to be heeded. To this end Sullivan postulates that the activities of the infant
that signal the presence of tension within him cause a state of tension within
mother that, felt as tenderness, causes her to take steps to satisfy the infant’s
needs. This is the sequence of events that occurs in the case of the fortunate
infant whose signals of tension to the mother result in the feeling of
without the production of anxiety within himself, and the result is the
achievement of security.
The results of the infant’s signaling of his needs are not always quite so
fortunate. If those needs upon which life itself depends are not satisfied, he, of
course, does not survive. Rut there is yet another possibility fraught with
disastrous consequences for him. His signals may result in the satisfaction of
psychosis.
one person and another, in this case the mothering one and the infant. If the
mothering one is anxious for whatever reason (that is, for reasons totally
unrelated or totally related to the signals of the infant), there may be some
interference with the satisfaction of his needs, but by and large they will be
will cause anxiety in the infant. The mechanism by means of which the
infant’s signals may cause anxiety in the mother may be readily imagined and
will, of course, depend upon the existing personality of the mother and her
state of mind at the moment. A mother beset with anxiety about a current
marital problem will be anxious in the interchange with the infant. A mother
with low self-esteem in regard to her womanliness will find her baby’s needs
threatening, since they cause her to face the very area of her anxiety. But the
means by which the anxiety of the mother can cause anxiety in the infant are
less easy to explain. If the infant is newborn with an as yet poorly developed
2300
perceptual apparatus, it may be difficult to understand by what means he will
Sullivan postulates the existence between the infant and the mother of a
experiences the state Sullivan terms insecurity. Thus, lack of security is the
infant to become uncomfortable and to signal this discomfort, but for the
infant there is no relief because the mothering one has no way of relieving it.
Severe psychopathology results from intense anxiety early in life. Severe
anxiety does not convey any information about experience. It erases any
most severe form of anxiety, that associated with the contents of the not-me
personification, is experienced as uncanny emotion, as awe. Dread, loathing,
and horror are terms associated with the state. Less intense anxiety permits a
satisfying the tension of needs; the means for doing this alone are usually at
hand. The usual problem is to alter activity in the direction of lesser rather
than greater anxiety, of greater rather than lesser security. To summarize: the
drives and the ensuing tensions of the individual require the cooperation of
others for their satisfaction. This makes the attempt to satisfy needs an
voice tones, body tensions, and gestures of various sorts in the other person,
and he is the recipient of more or less direct statements of the reaction of the
other person to his needs. Raw events are not directly experienced. How and
what is experienced is essentially a symbolic process that is different at
2302
impressions. It is what William James calls the world of the infant, “blooming,
buzzing confusion.” This is the hypothecated state of experience for the young
infant. Later on in life it may be seen during the acute phase of some severe
called prehension. It is not the mothering one who is prehended first but the
capacity for foresight. The infant prehends crying as action that will lead to
the relief of distress (this is the beginning of appreciation of the “magical
between “good” and “bad” nipple; the former brings relief of distress, the
latter brings additional distress. The development of this ability to identify
than one of the zones of interaction, for example, visual and auditory. There is
no logical or causal connection to the parts into which the original global
experience is broken. The parts are connected by association; there is a more
on his cheek. This form of experience in the parataxic mode, this experience
mode until the child learns the shared meanings of language. At this point
Late in infancy the training for socialization is begun, and for the first
time the infant becomes aware of the appraisal of himself by his parents. If a
particular act is met with anxiety on the part of the parents, the infant takes
in the parataxic mode. Impulses in himself that call forth anxiety in his
parents, and hence in himself, are organized into a concept of himself that he
but result in euphoria are organized into a concept of “good-me.” Since those
impulses, acts, thoughts, emotions, and fantasies that are part of the “bad-me”
2304
concept are regularly associated with the unpleasant emotion of anxiety, the
individual becomes alert to all performances that result in a disturbing
of himself that are issues for his parents, and in so doing may fail to
anxiety. However, some activities may be met with such intense anxiety or
anger that selective inattention is insufficient for psychic safety. For such
they may reveal themselves during crucial periods such as adolescence and
menopause in night terrors, panics, and so forth. The patterns that the person
develops are his self-system. This serves to limit his anxiety by controlling his
awareness. It thereby allows him to function with an apparent security, but it
limits his opportunities to experience the new, the novel and limits the
“Not-me” is not integrated into the self. When the acts or even the very
existence of the child result in total anxious disapproval on the part of the
overwhelming anxiety that the boundaries of the self are eliminated, a state to
which Sullivan applied the term “not-me.” In crucial periods of later life such
During the latter part of infancy the child begins to make repeatable
noises. He has been surrounded from birth with the linguistic signs and
symbols of his parents and others; he experiences them in the prototaxic and
“rehearses” them subvocally and thereby begins the reverie processes that
continue through life. Most thinking occurs preverbally. His first attempts at
some may persist into adulthood and under circumstances of extreme anxiety
may become apparent. It may also become obvious in the production of poets
2306
who have access to this personal language.
chosen by the parents as agents of their own desire and of the culture. This
explains why the magic word “mama” is so often the first word chosen or
alleged to be chosen by the infant for the initiation of speech. Speech is the
now becomes possible. The infant is now a child and has the opportunity to
bring unqualified cooperation from his parents. He begins to learn his social
role via the anxiety gradient. If the degree of anxiety provoked in him is not
too great, it serves as an educational force guiding him in learning required
behavior. Thus, the thwarting of a need results in anxiety that teaches how
and when society permits his needs to be satisfied. The child is now on the
way to becoming a civilized person. If the child is faced with great anxiety,
tension will increase, and the child has the choice of facing disintegration of
play a more active role in the social process. The child begins to discriminate
authority figures and authority situations. If the means of enforcing the
parents’ authority are appropriate and the issues on which the authority is
exerted are consonant with the culture, this will lead to a healthy and
not degrading to the child, and not punishment for punishment’s sake alone.
If the demands of the authority figures are consonant with the culture, if the
child observes that the demands are approximately the same as those made
by his parents on others and on themselves, he will not feel the precepts of
means, the child may begin to protect himself by deceiving himself and his
If the child’s signals for the need for tenderness, approval, or affection
are met with marked anxiety, being made fun of, being taken advantage of, or
being hurt, instead of the tenderness he requires, what Sullivan calls the
2308
“malevolent transformation” takes place. This is a basic confusion in the
relation of stimulus and response, much like turning on the hot water faucet
and receiving a cascade of ice cold water. In the shower it may result only in a
results in the conviction that one lives among enemies and can expect no
that the child is never able to benefit from experience with potentially kind
The nature of the exercise of authority by the parent over the child may
of the same gender as the child is likely to have more patterned responses in
his relationship with the child. The father “knows” how a little boy should be
reared with a certainty he would never assume for that mysterious creature, a
little girl. His own unfulfillment may seek fulfillment in his son. Since he feels
his ideas on how his son should be raised as certitude, he is less open to
observing the child as he really is and hence less likely to be responsive to the
child’s actual needs. The result will be the exercise of authority that is fixed
and irrational, and in marked contrast to that of the parent of the opposite
by the parent of the same sex and excessive tenderness, in contrast, by the
parent of the opposite sex, the result may be behaviorally identical to Freud’s
idiosyncratic to his own family may, for the first time, be compared to the
varieties of relationship of those outside the family. This becomes not only
possible but necessary if humiliation, disapproval, or punishment by the new
For the first time the peculiarities and limitations of his own family are open
to comparison and remedy. He comes under the influence of new authorities,
teachers, recreational directors, and others whose manner of exerting
authority and responding to, say, defiance may be different from his parents,
particularly to the extent that his parents do not reflect the culture. At the
same time the child meets others with a variety of personalities and learns to
accommodate to them. In discussion with his peers, he has the opportunity to
check upon the habits, values, and reactions of the significant persons of his
past and present life, and by comparing them with other adults, he may come
to make some value judgments about them. In questioning for the first time
the infallibility of their judgments, he may revise some opinions of himself
2310
that have come from reflected appraisals. During this period competition is
natural, and with proper intervention by social and school authorities, the
cannot be overemphasized. It is a time for reflection and for revision. For the
first time the child reflects upon the nature of his parents and, as a result, may
bring them down to life size. The altering of his view of his parents makes for
authorities; they learn how many slight differences in living there are; they
learn acceptable and unacceptable ways of being. They learn that what is
valued outside the home may be different from what is valued inside the
home. They learn from authorities other than the parents and the siblings;
the association with peers that makes this possible, that Sullivan states that
child’s life may be denied to him with fateful consequences for the rest of his
life. If his learning of socialization patterns in the home has been very deviant
from the patterns sanctioned by the community, the child is thrust into a
world that will not accept him. In addition to the effect of the resulting social
from experiences with his peers. He will compete, cooperate, and learn social
differences defectively. If his parents disparage the children to whom he is
attracted, his peers will then lose their function of providing a new view of
himself and his parents. A further loss will be the opportunity for a corrective
preadolescence, the individual develops a great need for intimacy. This marks
the emergence of the capacity for love. For Sullivan, love is a state of affairs in
particular state there is a pairing, and a chum of the same sex is selected for
private ones never previously shared. The individual then has the
2312
opportunity to see himself through the eyes of one who is like himself, who
comes from the same age segment of culture, and who does not represent the
another, this period is one in which fantastic ideas about oneself may be
validation in a way not before possible. It also is a time to learn the nature of
intimacy with its ups and downs. While homosexuality may occur, it is not the
may have developed. If the child is not prepared to enter this phase because
persons of the opposite sex. There is a shift from the chum, and the gang
diminishes in importance except as a way of gaining information about this
new lust drive. It is a period dominated by three needs that require major
need for security continues; the need for intimacy, begun in preadolescence,
requires a shift from the partner of the same sex to one of the opposite sex;
and the need for lustful satisfaction, requiring the collaboration of another
person, makes its first appearance. The need for intimacy with someone of
the opposite sex, heretofore a stranger, may result in the shaking of the sense
of security if the movement toward the other is done with an ineptness that
provokes the reflected appraisal of disdain. If the drive for lustful satisfaction
collides with a fear of intimacy of any sort, a turning toward the self, in the
preparation for heterosexual activity, may occur. If the need for lustful
2314
prevent their being discovered; conscious homosexual reveries associated
with severe anxiety; a lifelong search for the “ideal” woman or man; or a
It thus may be seen that the need for lustful satisfaction may be either
sex without the loss of security or self-esteem. The needs that drove the infant
and child into relation with others are problems that have been more or less
competently solved by this time. But the adolescent now finds himself driven
by a tension of need for lust that requires a degree of intimacy that he has not
experienced with a new, and as yet, strange person, who is in some ways
comfortingly like himself and in other ways terrifyingly, and yet happily,
different. If he is able to accomplish the integration between his need for
lustful satisfaction and his need for security and his need for intimacy with a
girl, he creatively organizes three aspects of himself. If he cannot accomplish
—now of lust, now of security, now of intimacy, never of all three. The
successful experiencing of this epoch after negotiating the other
developmental eras makes for true adulthood. The person is now free to grow
in interpersonal situations. His experience is syntaxic. He knows himself as he
there are available to him. He is able to choose rather than having only one
course. The orientation in living, begun hopefully during the juvenile stage,
One is oriented in living to the extent to which one can formulate, or can be
easily led to formulate (or has insight into), data of the following types: the
integrating tendencies (needs) which customarily characterize one’s
interpersonal relations; the circumstances appropriate to their satisfaction
and relatively anxiety-free discharge; and the more or less remote goals
for the approximation of which one will forego intercurrent opportunities
for satisfaction or the enhancement of one’s prestige.
Clinical Application
part of the self not immediately accessible to awareness, and the period spent
rage, hatred, grief, guilt, pride, conceit, envy, and jealousy), dissociation, and
lesser degree by all people; the so-called normal person uses the entire
2316
repertory at one time or another. In mental disorder the person places
extreme dependence on only one dynamism and, as a consequence, effaces a
life (with the advent of language) and shows itself as a preoccupation with
certain words, phrases or sentences that superficially seem to be
sentences are plucked from a childhood situation in which they were used to
propitiate, placate, or mollify a parent or other authority figure. These
substitute for anxiety. The use of the dynamism thus serves to maintain a
direct study and treatment of both hospitalized and ambulatory patients over
sources are in his “Clinical Studies in Psychiatry”; Arieti, Will, Spiegel, and
think of people as possessed of impulses, traits, and goals operating under the
forces of constructs such as id, ego, and superego, but the fact is that human
beings think, feel, and act as organisms responsive to an environment. We
learn nothing about the human being except as we observe and experience
him in an interpersonal field. If we conclude that a man is an “angry person,”
that we don’t describe him from the point of view of the observer alone. The
2318
so-called observer, the psychoanalyst in the present example, is himself part
of the interpersonal field, both as subject and object. His very presence in the
field of the patient either in fact or in fantasy affects the so-called object of his
the disposal of the therapist more of the relevant data, and it frees him from
the inhibition imposed by classical theory of the use of his own emotional
reactions in treatment.
psychoanalyst, from the point of view of field theory we see at once that it is
rather crowded. For the patient the room is peopled with at least the
following: the psychoanalyst as he is, fantastic personifications of people (the
as church and school to the extent that they are manifested in people
significant to the patient. If the consulting room does not yet seem sufficiently
crowded, we must remember that there are also representatives of the same
listing for the analyst, though we would hope that the circumstances of his life
because he does not like to have people staring at him. If the psychoanalyst is
occur to him that the next, though perhaps unexpressed, thought of the
patient is that the analyst is staring at him for much the same reason he
believes others do. As a result the analyst will understand the patient’s
the like. He will be aware of his own emotional reactions to the patient’s
manner and communications, first because they may give him a clue about
the patient’s operations, and second because his feelings, whether expressed
Even the process of the initial history taking, which Sullivan believed
should be extensive, is part of the interpersonal experience for the patient. It
2320
is actually the onset of therapy. Sullivan recommended that the analyst be
formal, frank, and direct and that he inform the patient what he knows about
him from referring and collateral sources. This procedure may allay certain
anxieties in the patient about what the psychiatrist already thinks of him, as
he observes the psychiatrist relating what he already knows. It also serves as
But most important in this stage of history taking is the clarification of the
obtain a social sketch of the patient and his family. During this, data on his
relationship with the psychiatrist will be noted (for example, the first
parataxic distortion of the psychiatrist will probably be with an adult other
than the parent), and tentative experiences with free association may be
provided whenever the patient meets blind spots in his recollections. During
the detailed inquiry the psychiatrist is particularly alert to those areas and
epochs of life in which anxiety is or was a prominent feature, and he seeks to
in each epoch of life are used as the skeleton of the inquiry, and an attempt is
made to determine the types of security operations used at each epoch. In
infancy what was the security operation used when the need for tenderness
was frustrated? During the epoch of childhood was there the ability to enter
—was omitted during the juvenile era, what substituted for the deficiency?
Did the patient have a chum of the same sex during preadolescence? How did
he handle the need for intimacy, the need for lustful satisfaction, and the need
for security with a person of the opposite sex during adolescence? And now in
adulthood does he have self-respect and respect for others? Does he have
adequate kind? If not, what seems to get in the way? In addition to these, his
survey the analyst attempts to make a statement clarifying the issues that
seem to him to have brought the patient to treatment, and by this time these
may have become quite other from the reasons initially noted by the patient
anxiety, and it may be possible to note some of the security operations used
by the patient. Finally the goals of the collaboration are outlined in general
terms.
2322
era will influence each subsequent era. If the appropriate experience was
lacking, the analyst attempts to determine the reason for its omission, and
how the attendant anxiety was handled. The red thread that leads to an
If the patient is pursuing a line of thought and suddenly shifts to another, the
analyst presumes that the patient would have experienced anxiety had he
pursued the original thought. He therefore notes two things: first, the moment
of shift and the content of thought that was interrupted in order that the red
thread of anxiety may again be taken up; second, the kind of security
operation that was used to escape from the anxiety-laden path that was being
primarily interested in anxiety itself but because the presence of anxiety and
the means used to avoid it lead to the possibility of discovering those areas of
the self-system that have been lost to awareness through the operations of
selective inattention or dissociation. For this is the essence of psychoanalysis,
the rediscovery of the self-system in its entirety, to the end that with the
bringing the “bad-me” and “not-me” into awareness, they may be seen as
and practice that is seen in systems that are constructs of a high order of
abstraction and that must, at the same time, deal with human beings and their
everyday lives. Its postulates are few, and its elasticity is great. It provides no
final answers. But what it does with a disarming simplicity is to attempt to
organize the myriad facts about the personality of the human being into a
useful and malleable whole. There are weaknesses in the formulations in the
areas of perception, cognition, and learning. These areas have been and are
shows that no theory could do more than organize these data and show the
Erich Fromm
In the work of Erich Fromm we find the insights resulting from the
his critique of the impact our contemporary social fabric has upon the
personality. Writing in the tradition of dissent, with psychoanalytic
2324
of contemporary culture with a persuasive precision. He combines the
The problems of man that go beyond his relation to his fellow men and
that his self-awareness can lead him to transcend his passive “creatureliness.”
as progress results from the very conflict of his existence, not from innate
drive; for conflict creates problems that demand solution, and each solution
contains contradictions that must be faced and solved at new levels. Man, an
animal, is set apart from nature, yet he is a part of nature and subject to its
existential dichotomies are dependent upon his character and culture. For
Fromm the most fundamental dichotomy is that between life and death (in
leads man to realize that death cannot be escaped and hence must be
life. As a result of man’s mortality he can never achieve all his possibilities.
Man is alone and aware of himself as a separate unique entity, and yet he
of his own making. These are the historical dichtomies. For example,
contemporary man has the technical means for vast material production, yet
he is unable to use them exclusively for his own welfare. These dichtomies are
his life through the unfolding of his powers. Reason, love, and productivity are
faculties peculiar to man, and the development of these is necessary for a full
life.
therefore looks for some unity and for some meaning. Responding with his
mind, his feelings, and his actions, man passionately strives to give meaning
2326
to his existence. This need for orientation of himself in the world and
devotion to his own existence has led him to devise answers varying widely in
content and form: among these are totem- ism and animism, nontheistic
success and prestige, conquest and submission, that can be explained on the
basis of this need for orientation and devotion. This need is the most powerful
While men are alike in that they share the human situation and the
existential dichotomies, they are unique in their way of solving historical
surroundings. For Fromm the ties of the infant to the environment are
one or the other, feelings of isolation and of helplessness grow. With the
anxiety attendant on this lag, the child, and later the adult, attempts to
recapture the primary emotional ties. This process is one of the mechanisms
by which the individual “escapes from freedom of the self.” Man’s fate and his
hope is that he can never recapture the primary ties.
Along with others Fromm holds that the family is the psychic agency of
society. Through its training the family makes the child want to do what he
has to do. Through the agency of the family a core character structure is
2328
formed for each society or culture. The adult personality is a highly
interwoven complex of inborn endowment, early experience in the family,
the family, and the individual shapes character structure. While class
mobility, for example, will not change the character structure of the parents,
has to be understood.
Varieties of Relatedness
Man has to be related to things and to people in order to live. The man
who has a recognition of his true self will have a productive orientation to
living. The person who has enjoyed good early relationships will have respect
and love for himself, will be able to cherish and love others, and will be able to
use his capacities in fruitful work. This is the productive way of living.
Too often man’s relationship to the outside world is not one of loving
technological and economic forces will alter the situation with which the
rise of the Calvinist conscience; the growth of capitalism was made possible
it found necessary.
the core of his character. By permitting the individual to act consistently and
reasonably, his character provides the basis for his adjustment to society. In
2330
live creatively, cannot create. He, nonetheless, does not want to be, cannot be,
completely passive and nonproductive. He wants to transcend life; he wants
Receptive Orientation
The receptive orientation is typified by the person who feels that all that
he does not believe that this is due to his own works. He is optimistic and
helpful but is anxious when the “source of supply” is threatened. He is
of origin is that Fromm sees the attitude as being inculcated by the nature of
the culture and the family (that is, one gets things passively), which then
secondarily is applied to erogenous zones. In Freud the zonal need is primary.
The hoarding orientation is based on the premise that security for the
individual depends upon what he can save or own. He feels there is nothing
new under the sun. He tries to possess rather than to love others. He is
obsessively orderly and rigid. Fear of death and destruction mean more to
him than life and growth. Intimacy is a threat. One gets things by hoarding.
Fromm has shown how this character type was typical of the bourgeois
The basic premise for the exploitative type is the same as for the
receptive type—the source of all good is external to the individual. He cannot
2332
produce. He takes what he can by cunning and thievery. He is pessimistic,
suspicious, and angry. He “steals” his ideas from others. The robber baron of
feudal times, the “adventure” capitalist of the eighteenth century, and the Nazi
society. The existence of a marketplace that places value and measure upon
both people and things is the main condition for its development and
valuable only as commodities to the extent that they are valuable to others.
The goal is to sell one’s self. It is no longer sufficient to have integrity,
ingenuity, skill, and knowledge. As there are fashions in material things, there
mass media. In this time of social mobility and constantly broken ties
between the individual and his neighbor, employer, or colleague, there is an
marketing orientation leaves man alone, alienated from his own feelings and
from his fellow man. Fromm thinks this type of personality is more common
become prevalent in both Eastern and Western Europe. This type of society
requires millions to live with a serious defect without becoming ill. Man is an
confused with the sexual perversion with the same name. It derives from
Unamuno’s description of a general in the army of General Franco; this man
the best known example of this. During World War I he was found in a
dragged away from it. Hitler’s end was really what he unconsciously wished.
2334
Consciously he wanted to save Germany; unconsciously he was working for
its destruction. Behavior in a social context determines any type; needless
his own powers and to realize his own potentialities. He is free and not
expressions of his being are authentic; they are genuinely his and not put into
feeling, in thinking, and in relationship with people. Through love he can unite
himself with the world and at the same time retain the separateness and
this is because they both need closeness to the other, in contrast to the
individual.
consistent with its institutions. It finds this in what Fromm calls the social
society writes its text, for it is inherent in the nature of man that he strives for
happiness, harmony, love, and freedom, meaning, and unity. Since such
circumstances as molding the character of man is to give only one side of the
2336
interaction. The other side of the interaction is the impact of these primary
strivings of individual men upon the structure of the society and the direction
individual is begun in childhood, and, of course, the parents are the main
agents utilized by the society for this task. Since the parents are hardly aware
of their role and are simply doing what is natural for them, the social
character may perhaps more accurately be said to be insinuated rather than
inculcated into the individual. The person receives training in the social
character in all of his interactions, including those associated with oral, anal,
and phallic activity, since in early life these are the zones through which he
makes frequent and immediate contact with his parents. Thus, in a social
habits taught will be those associated with regularity and dependability, not
because the parents are in a state of reaction formation against their own anal
eroticism, but because the culture has taught them the rewards that stem
from preciseness, accuracy, and dependability and the sanctions that stem
individual and his society of the great changes that have occurred in
and our knowledge of nature have become more abstract and more distant
from the experience of everyday human beings. The act and the object of the
act are alien to the doer; now the act often has a life of its own. The man who
helpless person. Man has become a thing as a result of being dependent upon
powers outside of himself. He has become alienated from his state, from his
work, from the things he consumes, from his fellow man, and from himself.
Conformity, not variety, is the order of the day. It is not that he is in such great
2338
Fromm feels that by the use of knowledge gained in the fields of
aware of the crippling effects of their society; this is one of the first steps on
the road to social sanity. As a result man may be able to reassert himself so
that he again occupies the central place in his own life. He will no longer be an
fellow man, or from nature. But such a change must occur in all areas, not
simply in the political area, or the economic area, or in a spiritual rebirth
Basic to Fromm’s approach to the ills of man and his society are two
premises: the first is the concept that human beings have certain needs that
know these needs here and now. He believes that the great philosophical and
religious leaders of the past—Moses, Jesus, Buddha, Lao-Tse, Ikhnaton,
Socrates, and others— described what are more or less the same norms,
though they had little knowledge of or influence over each other. He states he
has observed the same strivings for peace, harmony, love, and solidarity in his
nonalienated person. He relates to the world lovingly and uses his reason to
considers the gift of life the most precious he has. The capacity for this is
inherent in every man and will assert itself as long as socioeconomic and
As yet Fromm has not written directly about treatment techniques and
different from what the patient said or intended to say. His aim is to arrive at
the patient’s unconscious processes as they are going on in the patient at that
time. As a humanist the analyst knows what the patient is experiencing from
his own experience; he can thereby communicate this knowledge in an
2340
therapeutic endeavor. Treatment is designed to increase the self-
formal analysis.
individuality, which must transcend one’s particular culture, is the goal. For
social relativism that assumes that adjustment to the criteria of the extant
culture is the appropriate goal of treatment. In Fromm’s approach the truly
awareness. The goal, then, is the transformation of the personality from its
culture-bound state to its full human range.
Western culture, Fromm has described the essential relationship between the
character orientations held in common by the members of a society and the
He has postulated the existence of basic human needs that are valid for
all men in all cultures, and in doing this he has substituted normative needs
for the relativistic needs that had long been the hallmark of much social
thought. Since our culture is deficient in its ability to satisfy these basic
human needs, Fromm is an eloquent and active critic of our social values and
patient’s ability to adjust to his culture but rather with his necessity to
that the individual may become free. His socio-individual point of view has
permitted Fromm to cast a fresh and vivid light on the questions of love,
incest, motherhood, narcissism, character, and dream theory and practice.
Erich Fromm has made such serious criticisms of our style of life that the
discussion of the issues he has raised will prove to be as important to our
2342
Bibliography
Burnham, D. L., et al., Schizophrenia and the Need/Fear Dilemma, University Free Press, Inc., New
York, 1969.
_____, et al., “An Intensive Study of Twelve Cases of Manic-Depressive Psychosis,” Psychiatry,
17.103, 1954.
_____, Beyond the Chains of Illusion, Trident Press, Pocket Books, New York, 1962.
_____, The Crisis of Psychoanalysis, Holt, Rinehart & Winston, New York, 1970.
_____, Psychoanalysis and Religion, Yale University Press, New Haven, 1950.
Mead, G. H., Mind, Self and Society, University of Chicago Press, Chicago, 1934.
Mullahy, P. (Ed.), The Contributions of Harry Stack Sullivan, Hermitage Press, New York, 1952.
Sapir, E., Language: An Introduction to the Study of Speech, Harcourt Brace Jovanovich, New York,
1971.
Spiegel, R., “Communication with Depressive Patients,” Contemp. Psychoanal., 2: 30, 1965.
Sullivan, H. S., Collected Works of Harry Stack Sullivan, 2 vols., Norton, New York, 1953.
_____, Personal Psychopathology, William Alanson White Psychiatric Foundation, Washington, D.C.,
1965.
Thompson, C., “From and Sullivan,” in Fromm-Reiclimann, F., and Moreno, J. L. (Eds.), Progress in
Psychotherapy, Grune & Stratton, New York, 1956.
_____, “Transference and Character Analysis,” in Mazer, M., and Witenherg, E. (Eds.), An Outline of
Psychoanalysis, Modern Library, New York, 1955.
Will, O., “Schizophrenia and the Psychotherapeutic Field,” Contemp. Psychoanal., 1:1-29, 110-135,
1964.
_____, and Caligor, L., “The Interpersonal Approach to Treatment with Particular Emphasis on the
Obsessional” in Wolman, B. (Ed.), Psychoanalytic Techniques, Basic Books, New
York, 1967.
2344
B. The School of Karen Horney
Isidore Portnoy
For more than 15 years Karen Horney worked with, taught, and
psychology. Her own experience and the influence of Erich Fromm and others
the importance of recognizing and dealing with the patient’s resistance; the
recognition that, in spite of resistance, unconscious forces continue to operate
with Freud on many aspects of these concepts, she remained convinced that
the concepts of innate destructiveness and dualities; his belief that the
scientific attitude excludes moral valuation; and, most of all, his pessimistic
philosophy in which . . man is doomed to dissatisfaction whichever way he
turns. He cannot live out satisfactorily his primitive instinctual drives without
He has but the alternative of suffering himself or making others suffer” (p.
377).
Horney viewed man as a social being who can only develop his
also by the specific cultural conditions under which we live” (p. 8). She noted
the fallacy of each culture in assuming its own attitudes and values to be the
standard of normality for all times and places. She recognized the infinite
variety of ways in which cultures differ—in their definitions of health and
illness, in the fears they generate and the defenses they provide against those
2346
fears, in their attitudes toward all aspects of human relating and striving.
suspicion, and begrudging envy into every human relationship” (p. 173).
that are the anlage for the development of neurotic conflict. Thus our culture
emphasizes the importance of success and winning in competition, while it
We are all the children of our culture. We benefit and suffer to various
degrees from the growth-furthering and growth-obstructing aspects of our
culture. The difference between the healthy and the neurotic individual is
always one of degree. The difference between healthy and neurotic forces is,
however, qualitative and basic. The neurotic individual is one in whom
not predictive but an expression of her belief “in the inner dignity and
personality, “the central inner force, common to all human beings and yet
unique in each, which is the deep source of (healthy) growth” (p. 17), the self
“we refer to when we say that we want to find ourselves” (p. 158). She saw
2348
the real self as the source of our capacities for experiencing and expressing
our alive and spontaneous feelings; for evolving our own values and making
choices based on them; for taking responsibility for our own actions and the
without serious inner conflict, giving the individual a solid sense of his
realness, his wholeness, his identity. The constructive forces of the real self
unfold and develop in the process of healthy growing that Horney called self-
realization. This process does not essentially aim at the development of
special abilities, but it involves, “in a central place,” the development of good
human relationships with oneself and with others. It is not a static goal, but a
direction and a process.
interests and ideas; the democratic ideals of mutuality and respect for the
individuality and rights of others. Healthy moving against others includes the
ability and the freedom to oppose, to accept and enjoy healthy friction, to
exercise rational authority, to meet challenges and threats to genuine
convictions and interests. Healthy moving away from others includes natural
with values derived from what Horney called “a morality of evolution” (p. 13),
in terms of which we consider moral that which enhances our healthy being
and growing, and we consider immoral that which obstructs such growing. It
would include an individual’s developing “for his well functioning, . . . both the
and creative work and the varied pleasures of working alone and with others;
the development of special talents; the wish to tap the deep wells of
community and the world at large. Here man accepts his place in the world
and takes responsibility for his role in creating his culture as well as being
2350
created by it.
others and to himself. The process of healthy growing in a young child can
only take place if he feels loved and accepted as the person he actually is; if
grow with others, in love and in friction, he will also grow in accordance with
his real self” (p. 18), on the basis of an inner core of security and self-
needs, are indifferent or hostile to his legitimate needs and wishes, offer
“love” that is smothering and guilt inducing, “guidance” that is coercive and
disparagement, on the other hand. It is always the impact of the whole human
of the world around him, they come to constitute what Horney called the
Horney distinguished the basic anxiety from the Angst der Kreatur, which is
an expression in philosophic terms of man’s awareness of his actual
helplessness toward such inevitable processes as aging and death. While both
involve an awareness of greater powers, only in basic anxiety are those
Basic anxiety compels the child to make efforts to allay his feelings of
of relating in a search for safety. At first these ad hoc strategies have some
flexibility, the child being able to move back and forth between clinging,
2352
opposing, and withdrawing. Depending on the intensity of the basic anxiety,
compulsive character trends, each fostering the growth of its own needs,
The particular neurotic pattern that the child adopts depends on his
compliant child is one whose early years were spent “under the shadow of
somebody” (p. 222), in a family in which affection could be obtained from an
safety by gaining the love, approval, and protection of the powerful persons in
intimacy, feels anxious and excluded when he is alone or when hostility arises
in him or toward him. Hence he inhibits in himself all that could arouse
considerate. He tends to take the blame readily and to judge himself by the
opinions of others.
through affection and closeness, but when these efforts fail he feels
around him, turns his back on the whole area of affection, and strives for
anxious and lost. Sex may be important to him as a means of controlling and
conquering.
that rebellion was not possible. The family atmosphere was one of tightness,
with implicit or explicit demands on the child that he fit in at all costs. He was
2354
allowed little room for individuality and privacy. Such a child will often first
go through periods of compliance and aggression, but eventually he “accepts”
the emotional isolation in his basic anxiety and attempts to achieve safety and
keep his inner life intact by emotionally withdrawing from others. His
primary aims are to be independent, never to need anyone, to feel as little as
possible for or against others. His fear of bondage is so powerful that he has
to squelch feelings and wishes that might move him toward others. He can
find outlets for his need to love in the realm of nature, art, and animals, as
well as in intellectual pursuits where he can maintain his imperturbability
and serenity. Sex may be a bridge to others, but he will cross it only if he can
leave his feelings behind. If he feels that his secret inner world is being
invaded, he reacts with anxiety and retreats to the ivory tower in which he
What is crucial about the compulsive drives for safety is that, whatever
the presenting defensive orientation, the other two continue to operate, less
visibly but just as compulsively. The result is that the neurotic individual is
is the basic conflict, the dynamic core of the neurotic character structure.
their defensive function. The poignancy of all neurotic conflicts derives from
the natural need for inner unity, the threat to such unity due to the
degree of alienation from the real self that has already taken place.
defenses that will provide him with a sense of being unified. These neurotic
getting rid of awareness of conflict. One solution is to make one of the basic
2356
It is axiomatic in Horney’s thinking that all neurotic positions are
value for the individual, and have consequences that are seriously obstructive
alienation from self, a shift of his center of gravity to the outside, increasing
ever being wholehearted and undivided” (p. 183). “He no longer knows
a solution that will not only help him avoid the experience of conflict but will
all that he unconsciously believes he is, could be, or ought to be, a flawless
image of godlike perfection. The focus may be on saintliness, the absolute of
the person’s life. In the next step he attempts to identify with the image as an
idealized self. This idealized self comes to have for the neurotic individual
more reality than his actual self. His center of gravity shifts back to himself, to
express, to prove his idealized self in his actual living. Together self-
idealization and self-actualization constitute a search for glory. Self-
actualization includes activity that derives from neurotic ambition, spurring
Neurotic Claims
of the feeling that he is entitled to have his neurotic needs fulfilled. In these
2358
irrational claims he unconsciously expects and demands that the world treat
him as if he factually were his idealized self. Some of these claims, in neurotic
indignation, self-pity, and abused feelings. Less acute but more serious
reactions to unfulfilled claims are a deep sense of envy, a feeling of being
singled out by others and by life for deprivation, while others are invariably
to them, however, the individual in fact weakens his incentive and ability to
assert and make efforts for his own legitimate rights.
values, he should be, should feel, should think, should do. Disregarding
feasibility, his general human and specific individual limitations, the efforts
required, the arithmetic of reality, the individual “accepts” the premise that
nothing should be impossible for him.
development, but in all neurotic individuals the range of the inner dictates is
seen to be far more vast than cultural dictates or the dictates of rigid political
or religious systems. The focus is on flaws that must be erased and problems
that must be removed through will power. Actually the individual’s concern is
conscious of the real nature and full impact of these dictates. In doing so,
2360
however, he has introduced another factor that further impairs his already
He is not free to feel his true feelings, but must unconsciously persuade
himself that he feels what his shoulds dictate. In this way the inner dictates
constitute the single greatest force producing alienation from the self.
Neurotic Pride
and self-actualizing, satisfying what Maimonides called the “thirst for glory,”
he experiences neurotic pride. Where healthy self-esteem derives from what
the individual factually is and does, neurotic pride is essentially false pride,
since it is invested not only in imagined or exaggerated assets and
which he has no choice and that are, indeed, destructive to him and to others.
evidence in his fantasies and dreams and in all aspects of his living of the
great subjective value that neurotic pride has for the individual. Its great
producing intense feelings of humiliation when they do not fulfill his claims;
he does not fulfill his shoulds. The catastrophic effect of hurt pride may be
experienced in intense anxiety, depression, rage, psychosomatic and acute
psychotic episodes. Instead of these, what may show on the surface are
feelings, and activities that might result in hurt pride. He must also institute
measures for restoring his pride when it has been injured. Revenge is the
most effective and ubiquitous of these measures. By triumphing vindictively
over others, turning the tables on them, hitting back harder, he not only gets
revenge but also vindicates his pride. He may restore his pride by
Self-Hate
2362
When the individual is confronted by his failure to fulfill inner dictates,
his center of gravity has shifted, he is bound to hate and despise his actual
self. To this hatred is added the vindictive rage of the proud self that
impotently needs the actual person for attaining glory and, therefore, feels
has little feeling of kinship or sympathy for himself with which to cope with
are neurotic pride and self-hate, the fact that both in different ways serve the
interest of the search for glory led Horney to group them together as the
major aspects of the pride system.
the form of self-frustration in which the active intent is to frustrate any hopes,
any strivings for pleasure. The feeling is that he does not deserve and has no
right to anything better. Nowhere is the neurotic dilemma more poignant
than in this picture of an individual whose claims express his feeling entitled
to everything, while his self-hate denies him the right to anything. Self-hate
may take the form of self-tormenting in a spirit of vindictive glee. This may be
in masochistic behavior. He is both the torturer and the tortured, his sadism
and masochism being but two sides of one coin. Finally self- hate may be
expressed in self-destructiveness, in which the unconscious intent is to bring
against the despised self. The real nature of self-hate is now clear. In his
The truth is that he feels inferior to others because he hates himself. Horney
viewed this state of inner terror as man being at war with himself. For his
2364
investing still more energy in the fulfillment of his shoulds. Horney viewed
religion, mythology, and the literature of many ages and many peoples
(Goethe’s Faust, Wilde’s The Picture of Dorian Gray, Balzac’s The Magic Skin).
In each a human being in distress reaches for the absolute and godlike and in
return gives up his soul and ends in hell. The hell in the devils’ pact is the
agony of self-hate. The loss of soul is the quieter and deeper despair of
alienation from self. The search for glory has led the individual to become a
Every step in the neurotic development moves the individual away from
the total actuality of himself and the deeper reality of his real self. The
compulsiveness of his drives for safety and his solutions to basic conflict
produce the first step in the alienating process. Externalization cuts the
individual off from major aspects of his being. Every element in the search for
glory leads him further from himself. The need to avoid hurt pride and to
restore pride make him withdraw interest from himself. Above all, the
active moves against the self into the alienating process. It should be noted
that each step in the neurotic development not only increases alienation but
like. More chronic and serious is the “paucity of inner experiences” present to
different degrees in all neuroses. In severe degrees the person lives as if in a
fog, cut off from the turbulent inner life that is not accessible to his
in the person’s efforts to fill the emotional void with activity, food, and sex.
The person may respond with anxiety and dread to this feeling of emptiness
of self-hate.
alienation from the real self. The effects of this process are seen in the
2366
Of all the consequences of the neurotic development, alienation from the real
self was viewed by Horney as the most serious.
The pride system gives rise to two major intrapsychic conflicts. The first
involves all of the forces of the pride system opposed to all of the constructive
forces of the real self. However, since self- realization has been obstructed to
a great degree, the opposing forces are not sufficiently equal in strength to
bring this conflict into the open. This occurs during therapy and will be
The second major conflict is within the pride system itself, between all
the forces driving the individual toward self-glorification and all the forces
driving him toward self-extinction. It arises from the individual’s efforts to
identify in toto with both the idealized and the despised self. The individual
relieves his inner tension by active alienating moves away from himself; by
externalization of his inner experiences, which can become severe enough to
directions of development.
The first of these solutions is the expansive solution (p. 191), in which
the individual identifies with his proud self and attempts to keep from
himself all powers and “rights,” and denies them to others. Vindictiveness is
the crucial motivating force in the sadistic trends that characterize this
2368
hate is directed toward his spontaneous as well as neurotic moves toward
others and the self-effacing trends that he must keep from awareness.
Vindictiveness is his main way of restoring hurt pride and is itself glorified by
him. He uses it to intimidate others into fulfilling his claims. The excitement
and thrill that he experiences in his pursuit of a vindictive triumph may make
this the dominant passion of his life. In the interpersonal phase of the
neurotic development, aggression was his main solution to basic conflict. His
idealized image focuses on omnipotence, invulnerability, and inviolability. He
are chiefly rage and militant rightness. The dominant principle in the
expansive solution is the individual’s drive for mastery of himself and of the
individual identifies with his despised self and attempts to blot out all aspects
of his real self and of his idealized self. His solution to basic conflict was
compliance. His idealized image focuses on goodness, kindness, unselfishness,
and lovableness. He externalizes passively both his shoulds and his self-hate
inner attack as against outer attack. He not only “accepts” his guilt but also
wallows in it and resists efforts to lessen it, since it may be his only remaining
life. He often finds his supreme fulfillment in erotic love. Loving affirms for
him the qualities of his idealized self; being loved means to him redemption
and purification, a reprieve from the verdict of guilt. In this morbid
totally. In this union he secretly reunites with the pride that he has had to
disown in himself and that he can now live out vicariously through his
partner. In his sexual life this solution may produce a severe degree of sexual
masochism.
259). Here the individual attempts to solve his conflict by giving up his search
for glory as well as his striving for self-realization. He attempts to become a
expansive trends remain in the picture are divested of their active elements,
2370
the drives for love and mastery. This individual solved his basic conflict
and commitment. He resists planning toward goals, and his resistance against
in which there is some liberation of energies; and shallow living, in which the
severely alienated and resigned person moves to the periphery of life, loses
his sense of essentials, and fills his life with ceaseless distractions, automaton
Conclusion
While Horney was concerned with the way in which the neurotic
provide the inner dynamism that furthers and perpetuates neurosis. Thus
produce alienation and weakening of the directive power of the real self,
requiring greater reliance on the shoulds for direction. The more severe the
alienation, the more the need to cling to the sense of identity provided by the
idealized self, the more severely alienated the individual then becomes. The
more pride, the greater the self- hate, the more stringent is the need to
reinforce and cling to the glorified self. The more he shifts responsibility to
others in defending against self-hate, the weaker and more remote his real
and particularly important vicious circle relates to the effect of the search for
glory on the neurotic individual’s human relationships. Pride makes him
egocentric, makes him view others in terms of his externalizations and relate
to others on the basis of his claims. Because of these distortions, the increased
development.
Horney felt that “neuroses represent a peculiar kind of struggle for life
under difficult conditions” (p. 11). These conditions were seen to be at first
the other. In her dynamic formulations both healthy and neurotic character
structures are seen as processes in which forces operating in the here and
2372
now support and oppose each other in complex and changing patterns of
all other aspects, to the whole person, and to the world around him. This
viewpoint characterizes not only her work but also the work of other
therapeutic principles and avoided specific rules, believing that each analyst
would naturally evolve his own patterns of being with and working with his
patients. She was characteristically flexible about the use of the couch, the
frequency of sessions, and so forth.
change in the direction and quality of a person’s life, a shift of energies from
place in the matrix of a unique, evolving human relationship. Both insight and
relationship are viewed as essential to helping the patient outgrow his
him of the painful consequences of his neurotic drives while reinforcing the
drives themselves. Behind this may lie a deeper concern about his being
blocked in many areas of his life, which may serve as a constructive incentive
for analysis.
The patient’s most important task in the analytic work is to express all
freely and honestly as possible as they arise in the session. The capacity for
such free association is always limited at first, but evolves as the analysis
progresses. All that the patient experiences is an expression of his present
individual’s attempts to face his inner conflicts and solutions in a search for
inner unity. In dreams externals submerge, and he is closer to the truth of
2374
himself, which he expresses in poetic, symbolic form. This truth includes
involve his feelings about the analytic relationship that he cannot otherwise
he can touch the alive core of himself, experiencing a poignancy and depth of
feeling that he may for a long time be unable to experience in the symbols of
the present. Getting a clearer view of the way in which his problems began
can lessen his judgmental self-accusations and move him to self-acceptance
relationship is not viewed as a repetition of the past. It reflects all that the
patient is in the present, both healthy and neurotic. It is the most “here and
now” experience during the analytic session, and whatever pertains to it,
therefore, has the greatest impact, both for furthering or hindering the
advisable and feasible for the particular patient. He must recognize from the
start that, while his professional knowledge and psychological acumen often
enable him to know a good deal about the patient rather quickly, he cannot
really know this particular person without himself struggling toward deeper,
more meaningful understanding. Having himself experienced the analytic
use his whole being as his primary tool in his work. His first function is to
nonverbally, and to what the patient omits. He observes, listens to, senses,
thinks about, and feels not only what is going on in the patient but also what
and himself in the sessions. It is this, together with his professional skills, that
nonverbal and verbal responses to the patient may take the form of
exploratory questions that encourage and stimulate more associations,
2376
questions and observations concerning the patient’s emotional responses,
with the terrain, can see what is more available for opening up and
penetrating, what the patient can tolerate, and what can best move the
analysis forward.
Another major function of the analyst is to work with the patient toward
removing blockages. Horney preferred this term to resistance because it is
more neutral and allows inclusion of the retarding effects of the analyst’s
participation. The same forces that obstruct the patient’s development also
serve as retarding forces in the analysis. While therapy aims at undermining
the patient’s defenses and understands their positive value, since the patient
must defend what has become the basis for his existence until he has some
new ground to stand on. His defenses operate against his experiencing many
of his feelings, against his developing awareness (particularly of the
changing. His defense of the status quo involves most urgently his need to
the need to deny the real nature of his pretenses and illusions. Blockages
light of his own pride and self-hate and of the distortions arising from his
externalizing. The patient inevitably feels his defenses threatened, his pride
hurt, his claims frustrated. He may also be perceiving and responding to
actual mistreatment, to what the analyst’s neurotic needs bring into the
relationship and the work. The balance of healthy and neurotic motivation in
the analyst is a decisive factor in the progress of the analysis. His periodic
efforts to evaluate change in the patient and in himself help him to become
Finally the analyst has the important function of giving the patient
human help. This does not mean that he interferes with the patient’s
it means is that the analyst gives the patient needed emotional support by his
feeling with and for the patient, his striving to understand him, his
2378
recognition of the patient’s possibilities for healthy growth, and his wish for
the patient to become freer for living a creative and joyous life.
despised self. For Horney “working through” did not mean tracing a present
problem to its infantile roots. In her orientation it means gaining ever deeper
moves forward he is able to see some aspect of his neurotic character, at first
briefly and vaguely. Returning again and again to the problem, his first
specific situations and in more and more areas of his life—in the past and
present, in relation to others, to himself, and to the analyst, in the organic and
sexual aspects of his being, in dreams, and in fantasies. He comes to feel the
compulsive, irrational, insatiable quality of his drives, the grip they have on
him, the functions they serve, the connections between them and his whole
being, and the obstructive effects, particularly of the pride system, on his
begins to question the reality of his illusions and pretenses. Do claims really
bring him what he wants or needs? Does deadening his feelings really make
him less vulnerable? This process of reality testing goes hand in hand with a
process of value testing in which he weighs more honestly the worth of what
he gains from his neurotic drives. What, for example, has he gained by
vindictively going to pieces and was it worth the price? Thus the logical
he is able to exercise some capacity for free and rational choice he experiences
the difference between being an active force in his own life and being driven;
between living affirmatively and being always on the defensive. It is liberating
and exciting to feel the difference, for example, between the natural wish for
sexual fulfillment and the addictive use of sex in the service of neurotic needs
and solutions. As his alienation lessens and he becomes less proud and self-
hating, he feels less vulnerable, less isolated, less hostile. He recognizes that
his being trapped is not inevitable. Taking back externalizations enables him
2380
to see others in less distorted ways. This includes the analyst whom he can
begin to see as an ally and friend in his further struggle. Through all this there
is the incalculable value of sharing his inner being with another person who
believes that “nothing human is alien” to him or his patient. In these ways the
analytic work has helped to mobilize incentives for further growth.
that with the weakening of the obstructive forces, the constructive forces of the
real self have a chance to grow” (p. 348). The analyst has recognized the
patient’s deep longing to return to himself, of his wondering about the reality
and truth of himself, all of these appearing often in childhood memories and
can more directly encourage the patient to see how little he has consulted his
own wishes, determined his own directions in life, taken responsibility for
himself.
Resolution of Conflict
forces, the integrating powers of the real self become stronger and the patient
with his conflicts as they appear in more areas of his being. Facing and staying
comes into focus now is the most comprehensive conflict of all—the central
self-realization and the weakened but still powerful drives toward self-
actualization. It is now the analyst’s major task to keep this conflict in the
essential that the analyst communicate to the patient his understanding that
subsides the patient can enjoy the experience of becoming a real person. He is
ready to become his own analyst and has acquired the incentives and tools for
working toward his further evolution, a task that Horney called our “prime
moral obligation” and “in a very real sense, (our) prime moral privilege” (p.
2382
15).
Bibliography[1]
Azorin, L. A., “The Analyst’s Personal Equation,” Am. J. Psychoanal., 17:34, 1957.
Cantor, M. B., “The Initial Interview,” Am. J. Psychoanal, 17:39, 1957; 17:121, 1957.
_____, “The Quality of the Analyst’s Attention,” Am. J. Psychoanal., 19:28, 1959.
_____, “Human Nature Can Change: A Symposium,” Am. J. Psychoanal, 12:67, 1952.
_____, “The Individual and Therapy,” in “Psychoanalysis and the Constructive Forces in Man: A
Symposium,” Am. J. Psychoanal., 11:54, 1951.
_____, The Neurotic Personality of Our Time, Norton, New York, 1937.
_____, “What Does the Analyst Do?” in Horney, K. (Ed.), Are You Considering Psychoanalysis?
Norton, New York, 1946.
Metzger, E. A., “Understanding the Patient as the Basis of All Technique,” Am. J. Psychoanal., 16:26,
1956.
Rubins, J. L., “Holistic (Horney) Psychoanalysis Today,” Am. J. Psychother., 21: 198, 1967.
[1] Horney’s lectures on psychoanalytic technique, listed under their editors and compilers.
2384
C. The Cognitive-Volitional School
Silvano Arieti
may even be the most important at a human and social level of development.
These are the aspects that enable man to be a symbolic animal and a center of
will.
A stress on cognition and volition does not imply that affects are not
implies, however, that at a human level all feelings, except the most primitive,
are consequent to meaning and choice. In their turn they generate new
meanings and choices. Simple levels of physiopsychological organization,
such as states of hunger, thirst, fatigue, need for sleep, and a certain degree of
however, the motivational factors that are possible only at higher levels of
cognitive development.
avoidance of unpleasure, gratification of the self or the self- image (and not
affection, and love are integral parts of the self and of the self-image, together
with the emotions that accompany these concepts. To think that these
2386
psychoanalysis, and in the general field of psychology has been studied
mainly from the point of view of a relatively small number of automatic or
have rightly stressed that one becomes a person mainly by virtue of relations
mechanisms by which relations with other human beings take place. They
inner self. In other words, they do not show how the external influences and
the intrapsychic mechanisms by which these external influences are
integrated become that part of the human psyche that in the various
terminologies has been called “inner life,” “psychic reality,” “intrapsychic self,”
account; as a matter of fact, the main aim of mental health is to facilitate the
2388
conceptions deriving from English empiricism, American pragmatism, the
however, in the frame of reference of symbolism and choice derived from the
just mentioned cultural influences.
altering man’s behavior and capacity for adaptation, most psychoanalytic and
later a change, and a more reliable one, will occur also in the external
behavior and capacity for adaptation.
science to illustrate the existence of a psychic reality that is distinct from the
reality of the external world. It is one of Freud’s great achievements to have
demonstrated the existence of this psychic reality as an entity in its own right,
an entity that is alterable, but at the same time highly resistant to change.
may represent, substitute for, distort, enrich, or impoverish the reality of the
external world. Although this inner reality, too, has constant exchanges with
the environment, it has an enduring life of its own. It becomes the essence of
the individual. Its organization is what we call the “inner self.”
once the neuronal mechanisms that mediated their occurrence have taken
mental life nothing that has once been formed can perish.
relations, and the feelings associated with these psychological events. Inner
objects acquire a relative independence from the correspondent external
stimuli that elicited them. They progressively associate and organize in higher
2390
universe of symbols. Merely from the point of view of survival, symbolic
function is not so important as other physiological functions, for instance,
object relations become permanent features of inner life. For her, however,
anal, and genital stages. She believes that these stages unfold much earlier in
life than Freud had postulated, and therefore even more than Freud she is
compelled to neglect cognitive forms that develop after the first year of life.
Klein repeatedly refers to unconscious fantasies but does not indicate the
she has been quite nebulous in her description of the structure and
functioning of this inner world. Fairbairn, too, stressed the importance of the
endopsychic structure and its relevance to object relations, but he did not
Classic psychoanalysis has dealt with the highest levels of the psyche in
its formulation of the ego and superego. The superego is seen as an institution
Freudian theory are generally attributed to the ego. However, most ego
cognitive functions autonomous and conflict-free areas and do not see them
as sources of, or direct participants in, the conflict. For the cognitive school
they are not conflict-free but active participants or generators of the conflict.
Some may believe that the cognitive approach deals only with what in classic
psychoanalysis pertains to the ego and superego and ignores the primitive or
2392
dreams, psychoses, or any kind of severe pathology. Some theorists
whose works in the field of cognition are illustrated in other chapters of this
volume: Jean Piaget and Heinz Werner. Piaget’s contributions are very
with classic psychoanalysis are those he made very early in his career when
yet, perhaps even more than Piaget’s, they are pertinent to psychiatric studies
as they take into consideration pathological conditions. Like the works of
Piaget they do not make significant use of the concepts of the unconscious,
Rapaport, and Arieti, Aaron Beck has formulated a theory of cognition, affect,
distorted and lead to the other symptoms that are characteristic of the
2394
The individual’s appraisal of an event, and specifically of its effect on his
experience sadness.
under conditions of stress. The schema give rise to cognitions that appear
“automatic” and plausible to the patient, yet violate rules of logic and reality
testing and resist change. The affects typical of psychopathological syndromes
schema.
Feedback from experimental work (Loeb, Beck, and Diggory) led Beck to
patients.
2396
affect or instinctual drives are central to the pathology. For Barnett^ the basic
problem of the obsessional is avoidance of knowing, or an abnormal need to
hostility.
The secret life exists in varying degrees of awareness and may be kept
isolated in fantasy or acted out. Withholding and fears of exposure may lead
2398
well as a false view of other people’s expectancies and reactions. It is a
reaction on the part of specific individuals to their conceptions of certain
The primordial self is a human psyche that has not yet reached the
complex mechanisms. Most of these functions start at birth or in the first few
months of life and persist throughout the life of the individual.
endowed with awareness, the psyche would not have emerged, and the
physiology of the nervous system would consist only of unconscious
neurological functions.
The most primitive forms of felt experiences are simple sensations and
perceptions such as pain, temperature, perception, hearing, vision, thirst,
discomfort that we call pain; (2) as functions mirroring (or producing analogs
2400
We encounter here a basic dichotomy. On one hand is the awareness of
a particular state of the body or part of the body; that is, the awareness of an
inner status of the organism, the experience as experience. On the other hand
numerous ramifications that deal with cognition. The importance of these two
inner status plays a minimal role. These perceptions make the animal aware
I have also tried to show how not only the simple experiences of inner
status, such as sensations, but also all emotions or affects can be included in
the category of feeling. They are experienced within the organism. They are
that follows the perception of danger and elicits a readiness to flee; (4) rage,
an emotion that follows the perception of a danger to be overcome by fight,
inner status that cannot be sharply localized and that involve the whole or a
large part of the organism; (2) either include a set of bodily changes, mostly
muscular and humoral, or retain some bodily characteristics; (3) are elicited
2402
become important motivational factors and to a large extent determine the
type of external behavior of the subject; (5) in order to be experienced
survive and adjust to the environment. The effect of all these functions tends
thirst. They require some cognitive work. However, this cognitive work is
presymbolic or, in some cases, symbolic to a rudimentary degree.
powerful dynamic forces, but it does not include all the psychological factors
that affect him. Because of the impact of symbolic cognition, man’s needs,
in the making of inner reality. In the human being the memory and recall of
these experiences become connected with higher level functions, especially
after the acquisition of language. Feelings and protoemotions are also part of
personality when they are not well balanced by other emotions. There are
some human beings in whom fear (later changed into anxiety) is the
may become detached (that is, prone to withdraw from frightening stimuli),
2404
the principal protoemotion, the person’s predominant outlook is
conservative, centered on the status quo.
level. The subject (animal or infant) can direct his movements in goal-
After the first year of life the mechanisms of the primordial self remain
the prevailing ones only in the seriously mental defective. The normal child
very soon in life shows precursors of the volitional faculty in his playful
activity and his capacity to imitate. The inability to will makes the young child
psychologists have reported that when animals are kept together in a certain
environment, some assume a dominant and some a submissive role.
behavior of the other animals and consequent interplay are very important.
The preponderance of a protoemotion and of some kinds of presymbolic
childhood can be divided into many substages. In the first six to eight weeks
development of locomotion help the little child to shift the focus of his
figure in his environment is that of the mother (or mother substitute), with
2406
into meanings. He learns to connect them with things, events, or special states
of the organism. That is why children who are deaf or without human
validation, that is, the recognition that a given sound has the same or a related
effect on the mother and on himself, is an absolute necessity to trigger off
From the very beginning, however, language goes beyond its purely
denotative functions. In the course of evolving toward maturity, language and
Freud gave the first description of these two processes, but tried to
differentiate the particular laws or principles that rule the primary process
only. He called the primary process primary because, according to him, it
and more in the function of the libido theory, the primary process came to be
studied predominantly as a consumer of energy.
characteristic would be the fact that it does not bind the libido firmly but
allows it to shift from one investment to another. Some Freudians, however,
for instance, Schur, reassert the preponderantly cognitive role of the primary
process.
prevails for a very short period of time early in life as a normal aspect of
2408
mechanisms (1) that are classified in classic psychoanalysis as belonging to
the id, such as dream work; (2) in the early stages of what Werner called the
most of the time it follows the laws of logic and inductive and deductive
processes. Tertiary cognition occurs in the process of creativity and generally
following sections.
primary cognition. If the social bond with the mother and the other significant
adults unfolds properly, the child accepts promptly from them secondary
cognition, and his potentiality for individual, private, primary ways is to a
The primary self develops the capacity to use symbols not only in order
to communicate with other human beings but also to internalize the external
world and thus to build an inner reality. This internalization may start toward
the eighth or ninth month of life and may precede the onset of language. At
first psychological internalization occurs through images.[2] An image is a
memory trace that assumes the form of a representation. It is an internal
quasi-reproduction of a perception that does not require the corresponding
external stimulus in order to be evoked. Indeed, the image is one of the
earliest and most important foundations of human symbolism, if by symbol
we mean something that stands for something else that is not present.
Whereas previous forms of cognition and learning permitted an
2410
image is with him; it stands for her. The image is obviously based on the
Image formation is the basis for all higher mental processes; it starts in
the second half of the first year of life. It introduces the child into that inner
world that I have called “phantasmic.” It enables the child not only to re-
evoke what is not present but also to retain an affective disposition for the
absent object. For instance, the image of the mother may evoke the feelings
that the child experiences toward her. The image thus becomes a substitute
for the external object. It is actually an inner object, although it is not well
organized. It is the most primitive of the inner objects if, because of their
evoking of the image reinforces the child’s longing or appetite for the
still more gratifying than the image. The opposite is true when the image’s
the unpleasant inner object for the corresponding external one, which is even
more unpleasant.
Imagery soon constitutes the foundation of inner psychic reality. It helps the individual not only
to understand the world better but also to create a surrogate for it. Moreover,
The child who has reached the level of imagery is now capable of
experiencing not only such simple emotions as tension, fear, rage, and
satisfaction, as he did in the first year of life, but also anxiety, anger, wish,
perhaps in a rudimentary form even love and depression, and, finally,
security. Anxiety is the emotional reaction to the expectation of danger, which
is mediated through cognitive media. The danger is not immediate, nor is it
always well defined. Its expectation is not the result of a simple perception or
feeling evoked by the image of the loss of the wished object and by the
experience of displeasure caused by the absence of the wished object. Love at
2412
this stage remains rudimentary. For the important emotion, or emotional
tonality, called after Sullivan’s security, I must again refer the reader to
another publication.
The child does not remain for a long time at a level of integration
the life of the individual. However, at a stage during which language does not
exist or is very rudimentary, they play a very important role. Unless initiated,
process), they follow the rules of the primary process. They are fleeting, hazy,
vague, shadowy, cannot be seen in their totality, and tend to equate the part
with the whole. For instance, if the subject tries to visualize his kitchen, now
he reproduces the breakfast table, now a wall of the room, now the stove. An
have no language and could not tell himself or others, “This is an image, a
dream, a fantasy; it does not correspond to external reality.” He would tend to
of its being experienced. Not only is consensual validation from other people
to distinguish between the two realities, that of the mind and that of the
Another important aspect that the phantasmic level shares with the
individual cannot ask himself why certain things occur. He either naively
accepts them as just happenings or he expects things to take place in a certain
intermediary between the phantasmic and the verbal. At this level there is a
2414
reproduce reality as it appears in perceptions or images; it remains
nonrepresentational. In a certain way the endocept transcends the image, but
other hand, it is not an engram (or exocept) that leads to prompt action. Nor
can it be transformed into a verbal expression; it remains at a preverbal level.
Although it has an emotional component, most of the time it does not expand
mental activity has been inhibited. The awareness of this construct is vague,
For the evidence of the existence of endocepts and for their importance
in adult life, dreams, and creativity, the reader is referred elsewhere.[4] In
with mature language that was not available to the child when the
Endoceptual experiences exist even when the child has already learned
wish to repeat at this point that the acquisition of language (that is, the verbal
the end of the first year of life, even the sensorimotor (or exoceptual) level.
of language (see Chapter 16 of this volume). It is also outside the scope of this
2416
Some of the stages, which some authors call “prelogical” and which I call
childhood, from the age of one to three. It is difficult to recognize because it is,
in most instances, overlapped by secondary cognition. Here are a few
behavior of the child by stating that he is making a mistake or that his mistake
daddy, he puts all these male representations into one category: they are all
daddy or daddies. In other words, the child tends to make generalizations and
calling “wheel” anything that was made of white rubber, as, for example, the
white rubber guard that was supplied with little boys’ toilet seats to deflect
urine. The child knew the meaning of the word “wheel” as applied, for
example, to the wheel of a toy car. This child has many toy cars whose wheels,
Young children soon become aware of causality and repeatedly ask why.
At first causality is teleological: events are believed to occur bccause they are
willed or wanted by people or by anthropomorphized forces.
2418
they only have a propensity to do so. Unless abnormal conditions (either
environmental or biological) make difficult either the process of maturation
or the process of becoming part of the adult world, this propensity is almost
forms, for instance, the image. In dreams and in schizophrenia the second
At the stage of the primary self volition, too, occurs in primitive forms.
Instinctive, automatic, and conditioned behavior persists; but we have also
individual puts into effect whatever he senses the adult wants him to do. I
have illustrated these mechanisms elsewhere, and only a brief account can be
repeated here.
Will starts with a “no,” a “no” that the little child is not able to say but is
able to enact upon his own body. The child enacts a “no” when he controls his
sphincters in spite of the urge to defecate and to urinate. Now he has a choice:
neurologically the ability to inhibit these functions, he still has the urge to
allow them to occur: it is easier and more comfortable to defecate when the
rectum is distended by feces or to urinate when the bladder is full. But during
person (generally the mother) does not want him to. Thus in early childhood
anticipation of how other people will respond to that behavior. Any activity
ceases to be just a movement, a physiological function, or a pleasure-seeking
mechanism on the part of the child; it acquires a social dimension and thereby
becomes an action. The first enacted “no” is also the first enacted “yes”; “yes”
to mother, “no” to oneself. Thus to will, in its earliest forms, means to will
what other people want. As a matter of fact, the child learns to will an
2420
increasingly large number of actions that are wanted by his mother. In other
words, he learns “to choose” as his mother and the other adults around him
At first, the command is not internalized. The child obeys only if the
adult is present. In the absence of the adult the wish or the primitive wish
retains supremacy. When later the child introjects the command (that is, he
obeys even when his mother is absent), another phenomenon occurs, not
always but in several instances, that induces him to disobey even when his
so forth. As I wrote elsewhere, “We must not look upon this almost universal
the environment immediately. They constitute a big ‘yes’ to the self. The
submissive tendencies are always very strong because it is through them that
the child becomes receptive to the environment and allows himself to
experience influences that nourish him and make him grow. Negativism is a
healthy correction. The no period is a decisive turn of the will. Control now no
others. It is the first spark of that attitude that later on will lead the mature
man to fight for his independence or to protect himself from the authoritarian
order. A large number of them, however, retain the enduring mark of their
individuality. Although in early childhood they consist largely of the cognitive
more and more complicated and difficult to analyze. Some of them have
powerful effects and have an intense life of their own; and yet at the stage of
inhabitants of inner reality. The two most important ones in the preschool
age, and the only two that we shall describe here, are the image of the mother
2422
In normal circumstances the mother as an inner object will consist of a
group of agreeable images: as the giver, the helper, the assuager of hunger,
thirst, cold, loneliness, immobility, and any other discomfort. She becomes the
prototype of the good inner object. The negative characteristics of the mother
play a secondary role that loses significance in the context of the good inner
relations with other images, especially those of the parents. Inasmuch as the
child cannot see his own face, his own visual image will be faceless—as,
indeed, he will tend to see himself in dreams throughout his life. He wishes,
will acquire many more elements. However, these elements will continue to
child will no longer be limited to acting and experiencing, but will include also
exists between the concepts of self and of self-image. In this section we shall
focus on the study of the self- image.[8] Also in a large part of the psychiatric
literature the self and the consequent self- image are conceived
predominantly in a passive role. For instance, Sullivan has indicated that the
adults: the child would see himself and feel about himself as his parents,
especially the mother, see him and feel about him. The self cannot be seen,
2424
that adds to the reflected images its own distortions, especially those
distortions that at an early age are caused by primary cognition. The child
self.
connected with one’s body. The body is discovered by degrees, and also the
actions of the body on the not-self are discovered by degrees. The body image
eventually will be connected with belonging to one of the two genders. Self-
identity, or personal identity or ego identity, depends on the discovery of
oneself not only as continuous and as same but also as having certain definite
do, but it is also connected with his capacity to avoid doing what the parents
do not want him to do. Later it is connected also with his capacity to do what
his parents want him to do. His behavior is explicitly or implicitly classified by
the appraisals that hurt him the most or please him the most. These partial,
salient appraisals and the ways they are integrated with other elements will
make up the self-image.
In the primary self, images, such as the ones discussed in the previous
out of some salient features, those that impress or affect the child more, and
does not include all features or even the most important ones. The child does
not respond equally to all appraisals and roles attributed to him. Those
elements that hurt him more and, in rare cases, that please him more stand
often the early self- image was a grotesque representation of the individual.
Unfortunately, in turn, the self- image does change the individual and makes
2426
In normal conditions the image of the mother is made up of only the
are overlooked. However, when the mother has definite and very marked
only of them because they are the parts of the mother that hurt and to which
responded only to the pronounced negative parts of the mother, and the
The answers to this question are only hypothetical. Inasmuch as the negative
parts or characteristics hinder adaptation that may be dangerous from the
or motivation affects the mental process. For instance, if a person has been
experienced as frightening. Every relation with that person may thus accrue
These mechanisms of the primary self continue to exist even later in life
when they could be replaced by the more mature ones of the secondary self.
2428
early in life. At times these constructs are applied to entire categories, such as
all elderly or maternal women, authorities, siblings, and so forth. We may
state that the individual identified a person in his present life with one in the
dissolution with great difficulty but also tends to inhibit the organization of
that previous learning prevents later learning. For instance, we all know that
the knowledge of arithmetic does not prevent the learning of algebra; as a
methods of the secondary self, which are often alien to primitive constructs.
contrast with those of the secondary self, they bring about conflict in the
individual.
severe pathology is found, it is important to study not only content but also
form; it is crucial to understand not only what the individual experiences but
2430
how he experiences it. Is he perceiving in terms of parts or wholes? Is he
modalities varying during the course of the illness or even during the course
life.
They become the repositories of intangible feelings and values. Not only does
every concept have an emotional counterpart, but also concepts are necessary
impossible to separate the two. They form a circular process. The emotional
accompaniment of a cognitive process becomes the propelling drive not only
toward action but also toward further cognitive processes. Only emotions can
other hand, only cognitive processes can extend indefinitely the realm of
nor do they represent reality adequately most of the time. Nevertheless, they
do have an enduring psychological life or a reality of their own as
psychological constructs.
2432
emotions or feelings in general. Certainly thoughts and feelings do not easily
submit to the rigor and objectivity of a stimulus-response psychology.
dismiss most of man as mystical. Thoughts and feelings make up what is most
valuable in man. If this essential part of man requires methods of study that
future studies will reveal the structure of these so far obscure organizations
and configurations.
importance of concepts resides in the fact that to a large extent they come to
constitute the self-image. When this development occurs the previous self-
images are not completely obliterated. They remain throughout the life of the
are integral parts of the self and of the self-image, together with the emotions
that accompany these concepts. These concepts and emotions that constitute
the self are generally not consistent with one another, in spite of a prolonged
To complicate the picture is the fact that many conceptual forms are
conceptual overlay hides the irrational inner structure. One of the aims of
lower levels do not cease to exist. At a very elementary sensorimotor level the
2434
or as an attempt to retain, pleasure and avoid unpleasure, gratification of the
self becomes the main motivational factor at a conceptual level of
his life: immediate danger, which elicits fear, and a more distant or symbolic
danger, which elicits anxiety. However, whereas at earlier levels of
are devices to protect the self or the self-image. Here are a few examples. A
woman leads a promiscuous life; she feels she is unacceptable as a person, but
as a sexual partner she feels appreciated. The hypochondriac protects his self
by blaming only his body for his difficulties. The suspicious person and the
configurations that lead the patient to feelings, ideas, and strategic forms of
behavior that make the self-image acceptable or at least less unacceptable.
2436
Learning has a very important role in the organization of inner reality.
part of inner reality when it becomes integrated with the rest of the psyche
and has an effect that transcends the original experience. Undoubtedly there
this Handbook.
From a general point of view the self (and in particular, the inner self)
can be examined from five different aspects: (1) representational function, (2)
taking into consideration the others. For didactical reasons only we shall
The potentiality of the self can be seen (1) in the way it affects the
behavior of the individual in relation to other people, himself, and the world
in general; (2) in the way it affects itself. In other words, the self feeds on the
external world as well as on itself. Potentiality is also connected with the very
2438
mechanisms by virtue of which all functions of the psyche are related to one
another and synthesized into higher ranks of organization. We have outlined
self exists only in rudimentary form. In the growing and grown human being,
mechanisms developed that had the purpose of decreasing its intensity and
These mechanisms alter and complicate, but do not eliminate, inner life.
reintegrating harmoniously with the rest of the self what was restored to
consciousness.
Volition
have to stress now an aspect of it related to volition, that faculty of man that
feels he must act in a certain way. Why must the mother and father bring
2440
about an internalization of the command? At a very early age the child must
eat two big ice creams? The parental order is a substitution for the
understanding that the immature child lacks. A gap between the required
gap.
all, punishment and reward are a neutralization of the child’s act. The
punishment received, let us say, after eating the second ice cream, neutralizes
the pleasure experienced in eating it. The reward, on the contrary, is a
compensation for the sustained deprivation of the second ice cream. Mother
offers a different pleasantness: her approval, her keeping the child on her lap,
hugging him, and so forth. In the second place punishment and reward are
symbolic or anticipatory of the consequences of the child’s act. Thus the
punishment that the mother inflicts on the child who has eaten the second ice
cream is symbolic of the bad effect that eating excessive ice cream will cause.
The immediate punishment takes the place of the painful condition that the
life resulting from doing the right thing. One of the functions of the command,
therefore, is to anticipate the value of the act in the distant or near future.
The child who knows he has done something considered wrong by the
adults generally feels he deserves to be punished. Unless he is punished the
psychological equilibrium will not be restored. The bad deed has produced a
who gives the command has a quality that I call the imperative attitude. This
imperative attitude is experienced in its totality as a benevolent and
cooperating force, although it has attributes that may not seem positive.
2442
replaced by any of these terms because it contains an element of the
meanings of each of these terms.
and you must do it, no longer because he wants you to do it, but because you
must want to do it. An external power no longer obligates you; now it is an
inner power, what I call endocratic power. If you do not do what you must do,
you will no longer incur only external punishment but also guilt feeling.
a certain way constitutes the Freudian superego; but to a large extent it is also
parents and other authorities engender in the individual not just endocracy
It is difficult for the individual to exert his will since his wishes of
instinctual and/or conceptual derivation or endocratic surplus predispose
largest possible margin of free will; on the other extreme is the catatonic
patient who has lost his will almost completely.” I have described elsewhere
relation between the child and the loving, nonneurotic mother, a state of
deflects one’s personal will. The will of others may remain an external power,
and the individual develops special mechanisms for dealing with it:
that may strengthen the individual’s will but also cripple, deform it, or
paralyze it. This power (external or internal) affects every personal relation
and disturbs it to such a point that a state of trust or communion between two
unequal distribution of power— that is, unequal ability to exert one’s will—
2444
and child, husband and wife, siblings, teacher and pupil, employer and
time implemented not just by conscious mechanisms but also, and in many
cases predominantly, by unconscious maneuvers. Society generally sanctions
the more common unequal distributions of power, which may thus remain
who first realized the importance of power in human life and who advanced
meaningful hypotheses about its origin. In my recent book I discuss the
philosophy of life that he comes to build in his contacts with other human
beings, man becomes aware that a discrepancy exists between the way he
sees himself and the way his thinking makes him visualize what he could be.
visualize but cannot master. On the other hand, he becomes aware of his
finitude. He knows he is going to die, and that the range of the experiences he
is going to have is limited. He cannot be better than he is capable of being, and
he cannot enjoy more than a certain amount of food and sex. Being able to
conceive the infinite, the immortal, the greater and greater, he cannot accept
his limitation. He may feel betrayed by his own nature and may desperately
search for ways to overcome his condition. It often seems to him that a way to
expand the prerogatives of his life is by invading the life of others. He feels his
life will be less limited if he takes away the freedom of others, if he makes
others work for him, submit to him, give up their will for his own. Thus
instead of accepting his limitations and helping himself and his fellow men
live more by making others less alive. The network of rationalizations that
The tertiary self is the human being in the process of creativity. The
2446
consists of specific combinations of primary and secondary forms of
cognition. The important topic of creativity cannot be dealt with in this essay.
Handbook.
(Chapter 13). Here I shall mention two important processes that in various
bronchial asthma.
“the leap” occurs through the intervention of the autonomic nervous system.
changes directly in the central nervous system. Sexual dysfunctions are well-
individual and of others acquire an erotic meaning and may become capable
conflict, or other abnormal states that confer the erotic quality. The erotic
quality is a reductive mechanism, or regression. It may be heterosexually or
2448
some homosexual tendencies, often goes through the following sequence: he
feeling.
culture in determining human conflict. Portnoy has described the role that
Horney has attributed to culture in human neurosis, and Witenberg has done
so in relation to Fromm.
bonds existing among people are determined not only by physical proximity
and biological needs but also by the cognitive ways they use and the choices
psychological difficulties in many ways. We shall discuss this topic here only
conceptualizations are very common. At the same time that the individual is
asked to feel brotherly love for his neighbor, he is urged to compete with him.
Freud was very skillful in uncovering the ways by which the individual
represses in order to escape the punishment of society, but he did not become
concerned with how society represses and transmits that repression to the
2450
individual.
As I wrote elsewhere,
The individual has a double burden to repress: his own and that of society.
How does society repress? By teaching the individual not to pay attention
to many facts (selective inattention); by masquerading the real value of
certain things; by giving an appearance of legality and legitimacy to unfair
practices; by transmitting ideas and ideals as absolute truths without any
challenge or search for the evidence on which they are supposed to be
based; by teaching certain habits of living, etc. The defenses against
objectionable wishes which Freud described in the individual (for
instance, repression, reaction-formation, isolation, and rationalization) can
be found in society, too [Pp. 45-46].
part of deep, unconscious levels of the psyche and operate with little
participation of the conscious self. Because of his scientific achievements,
modern man has gained more freedom from his biological needs but is in
major negative ways by which modern society affects the whole psyche and
especially the will of the individual: primitivization, endocratic surplus, and
Primitivization consists of all the mechanisms and habits that foster the
and aggressive drives, craving for immediate satisfaction, and return to magic
and shamanism.
Deformation of the self has been brought about by the application of the
scientific model to all aspects of life, the actual reduction of people’s feelings
and ideas to numbers, mass production, and consumerism. By being
of reacting, not acting. His will becomes atrophic while he retains the illusion
of freedom. Reaction is confused with spontaneity, promiscuity with romance,
intrusion into one’s privacy with sincerity and comradeship. The self is
deformed and tends to be alienated, and addictive drugs are used to combat
alienation.
the id at the expense of the other parts of the psyche; deformation of the self
warps the ego; and endocratic surplus overburdens and distorts the
for the repression of the id. The superego was an ally of society and of the ego
2452
social origin was not seen by Freud as constricting the will of the individual
and promoting tyranny. For him sexual repression was the ultimate inhibiting
force, and the search for power was not important enough to be considered.
Freud conceived of the ego as that part of the psyche that deals with
reality; but he did not see how “reality”—that is, the social environment—
may warp the ego. Also because of the Victorianism in which he was brought
up, he could not conceive that society itself at times promotes eruption of the
primitive id.
which often act unconsciously. Together with people working in other fields
domains affect the individual and society. Thus psychoanalysis, which was
Bibliography
Arieti, S., “Conceptual and Cognitive Psychiatry,” Am. J. Psychiat., 122.-361.-366, 1965.
_____, “Creativity and Its Cultivation: Relation to Psychopathology and Mental Health,” in Arieti, S.
(Ed.), American Handbook of Psychiatry, Vol. 3, pp. 720- 741, Basic Books, New
York, 1966.
_____, “The Experiences of Inner Status,” in Kaplan, B., and Wapner, S. (Eds.), Perspectives in
Psychological Theory, International Universities Press, 1960.
_____, Interpretation of Schizophrenia, 1st ed., Brunner, New York, 1955. 2nd ed., completely
revised and expanded, Basic Books, New York, 1974.
_____, The Intrapsychic Self: Feeling, Cognition, and Creativity in Health and Mental Illness, Basic
Books, New York, 1967.
_____, “The Meeting of the Inner and the External World in Schizophrenia, Everyday Life and
Creativity,” Am. ]. Psychoanal., 29.115-130, 1968.
_____, “The Microgeny of Thought and Perception,” Arch. Gen. Psychiat., 6:454–468, 1962.
_____, “New Views of the Psychodynamics of Schizophrenia,” Am. J. Psychiat., 124: 453-458, 1968.
_____, “Special Logic of Schizophrenic and Other Types of Autistic Thought,” Psychiatry, 11:325-
2454
338, 1948.
_____, “The Structural and Psychodynamic Role of Cognition in the Human Psyche,” in Arieti, S.
(Ed.), The World Biennial of Psychiatry and Psychotherapy, Vol. 1, Basic Books, New
York, 1970.
_____, “Volition and Value: A Study Based on Catatonic Schizophrenia,” Comprehensive Psychiat.,
2:74-82, 1961.
Arlow, J. A., “Report on Panel: The Psychoanalytic Theory of Thinking,” J. Am. Psychoanal. A.,
6.143-153, 1958.
Baldwin, J. M. (1929), quoted by Piaget, J., The Child’s Conception of Physical Causality, Harcourt,
Brace, New York, 1930.
Barnett, J., “Cognition, Thought and Affect in the Organization of Experience,” in Masserman, J.
(Ed.), Science and Psychoanalysis, Vol. 12, pp. 237-247, Grune & Stratton, New York,
ig68.
____, “On Cognitive Disorders in the Obsessional,” Contemp. Psychoanal., 2:122- 134, 1966.
____, “Therapeutic Intervention in the Dysfunctional Thought Processes of the Obsessional,” Am. J.
Psychother., June 1972.
Beck, A. T., “Cognition, Affect and Psychopathology,” Arch. Gen. Psychiat., 24.495- 500, 1971.
____, “Cognitive Therapy: Nature and Relation to Behavior Therapy,” Behav. Ther., 1.184-200,
1970.
Bemporad, J. R., “New Views on the Psychodynamics of the Depressive Character,” in Arieti, S.
(Ed.), The World Biennial of Psychiatry and Psychotherapy, Vol. 1, Basic Books, New
York, 1970.
Bridgman, P. W., The Logic of Modern Physics, Macmillan, New York, 1928.
Fairbairn, W. R. D., An Object-Relations Theory of the Personality, Basic Books, New York, 1954.
Federn, P., Ego Psychology and the Psychoses, Basic Books, New York, 1952.
Freud, S., The Interpretation of Dreams, Basic Books, New York, 1960.
Guntrip, H., Personality Structure and Human Interaction, International Universities Press, New
York, 1961.
Halleck, S. L., The Politics of Therapy, Science House, New York, 1971.
Hartmann, H., Kris, E., and Loewenstein, R. M., “Comments on the Formation of Psychic
Structure,” in The Psychoanalytic Study of the Child, Vol. 2, pp. 11-38, International
Universities Press, New York, 1946.
Jones, E., The Life and Work of Sigmund Freud, Vol. 1, Basic Books, New York, 1953-
Jung, C. G. (1903), The Psychology of Dementia Praecox, Nervous and Mental Disease Monograph
Series, New York, 1936.
Keniston, K., The Uncommitted: Alienated Youth in American Society, Harcourt, Brace & World,
New York, 1965.
_____, Young Radicals: Notes on Committed Youth, Harcourt, Brace & World, New York, 1968.
_____, Youth and Dissent: The Rise of a New Opposition, Harcourt Brace Jovanovich, New York,
2456
1971.
Levin, M., “Misunderstanding of the Pathogenesis of Schizophrenia, Arising from the Concept of
‘Splitting,’ ” Am. J. Psychiat., 94:877, 1938.
Lifton, R., Death in Life: Survivors of Hiroshima, Random House, New York, 1967.
Loeb, A., Beck, A. T., and Diggory, J. C.,“Differential Effects of Success and Failure on Depressed
and Nondepressed Patients,” J. Nerv. & Ment. Dis., 152:106-114, 1971.
Odier, C., Anxiety and Magic Thinking, International Universities Press, New York, 1956.
Piaget, J., The Child’s Conception of Physical Causality, Harcourt, Brace, New York, 1930.
Schur, M., The Id and the Regulatory Principles of Mental Functioning, International Universities
Press, New York, 1966.
Von Domarus, E., “The Specific Laws of Logic in Schizophrenia,” in Kasarin, J. S. (Ed.), Language
and Thought in Schizophrenia: Collected Papers, University of California Press,
Berkeley, 1944.
_____, and Kaplan, B., Symbol Formation: An Organismic-Developmental Approach to Language and
the Expression of Thought, John Wiley, New York, 1963.
Whorf, B., Language, Thought and Reality, John Wiley, New York, 1956.
Witenberg, E. G., “The Interpersonal and Cultural Approaches,” Ch. 40 A of this volume.
[1] For the intricate relation between feeling, causality, and motivation see Chapter 2 of reference 7.
[3] For a study of the phenomenology of images and the formations of their derivatives—paleosymbols
—see Chapter 5 of reference 7.
[6] This confusion between identity and similarity reacquires prominence in some psychopathological
conditions. It has been studied intensely in schizophrenia by Von Domarus and later by
Arieti.
[7] We must warn the reader about a confusion that may result from the two different meanings given
to the word “image” in psychological and psychiatric literature. The word “image” is
often used, as we did in a previous section of this chapter, in reference to the simple
sensory images that tend to reproduce perceptions. This word also refers to those much
higher psychological constructs or inner objects that represent whatever is connected
with a person; for instance, in this more elaborate sense, the image of the mother would
mean a conglomeration of what the child feels and knows about her.
[8] The vaster concept of the self will be more accurately dealt with in a subsequent section of this
chapter.
[9] I heard the term “advocacy psychiatry” for the first time in a speech delivered by Robert Lifton to
2458
the American Academy of Psychoanalysis in New York City on December 4, 1971
Simon H. Nagler
the eclectic structure of modern psychiatry, although they did not create
major systems of theory and practice. The work of Wilhelm Reich, Sandor
Ferenczi, Otto Rank, and Sandor Rado had a common origin in orthodox
Freudian psychoanalysis. For the most part their contributions were through
controversial figure, even a tragic and ill-fated one. His ultimate activity was
Like Otto Rank he did not consider himself a psychoanalyst in his final phase.
2460
Biographical Sketch
psychoanalysis (1919) and was given the unusual privilege of joining the
Vienna Psychoanalytic Society while but a student. After graduation he
continued his psychiatric studies for two years with Julius von Wagner-
Jauregg and Paul Schilder. Because of his enthusiasm and enormous capacity
for work, Reich quickly rose to importance within the young analytic
movement in Vienna. From 1924 to 1930 he was director of the Vienna
became involved in the highly charged political atmosphere of the period and
studied Marxian theory for its implications for the social causation of mental
illness. He joined the Austrian Socialist party, but left it for the Communist
concepts.
have been a “favorite son” and a most brilliant assistant. Their estrangement
began early in 1927, but its basis is shrouded in controversy. Some maintain
that it was Reich’s efforts to synthesize Marxian and Freudian concepts that
commenting on Reich’s paper on the masochist character, said that Reich had
developed his theory “in the service of the Bolshevist party.” Reich
maintained later that he was never a political participant as such but that he
was interested in the mental health needs of the workers. He helped to open
education, and so forth. In 1929 he made a visit to the Soviet Union, where he
was disappointed with its bourgeois, moralistic attitudes toward sex and
Society. In 1930 he went to Berlin for a personal analysis with Sandor Rado.
He joined the German Communist party there. In discussions with Erich
Verlag, in 1931 and issued pamphlets on sex education for children and
2462
repression and submission to the authoritarian family and state, which breed
mental illness and political totalitarianism. The rise of fascism and the
reaction of the masses led in 1933 to his theoretical work, The Mass
Psychology of Fascism.
was expelled or resigned. The year before the German Communist party had
expelled Reich because his politicalization of sex was compromising,
especially in light of the rising power of fascism. He realized at this point that
sex, psychoanalysis and politics was too much for the authorities to absorb.”
He then went to Oslo, Norway, where at the Psychological Institute of the
claimed to have demonstrated the rise of skin potential with pleasure and its
fall with anxiety. The major target of his later work was the elucidation of the
nature of the energy involved. He was evolving thus the further development
discovered the “bions,” energy vesicles created from organic matter and thus
demonstrating the process of biogenesis. These bions he later related to
through “the Jewish pornographer” to “God Reich creates life.” Reich refused
2464
the United States at the New School for Social Research as an Associate
Professor of Medical Psychology. He taught for two years, giving lectures on
for many years and his eventual burial place at Orgonon. In the fall of 1940 he
took the step that was finally to bring him into disastrous conflict with the
law. He built the first orgone energy accumulator for use in experiments with
cancerous mice. It was based on the principle that organic materials attract
and absorb orgone while metals attract and repel the energy. The
Einstein’s action the result of a communist- inspired plot. Soon after Pearl
Harbor Reich was arrested as an enemy alien, but was soon released. In the
summer of 1942 the construction of the Orgone Institute was begun in Maine.
Many psychologists and psychiatrists sought instruction in Reich’s character
Drug Administration of the orgone accumulator. In 1950 Reich made plans for
effect of the bomb, heal radiation sickness, and immunize mankind against
nuclear radiation. Since the Atomic Energy Commission would put no
write in a highly polemical manner. In 1951 he had a very severe heart attack.
Nonetheless, the next year Reich started a new phase in his work that he
1952 many of his co-workers and students left because they were unwilling
convinced that the President and powerful officials of the air force were
aware of his work and were protecting him by planes overhead, that
2466
spacemen knew how to use orgone energy to run their ships, and so forth. In
the spring of 1953 his The Murder of Christ appeared. Its thesis is that Christ
represents life, which the “armored” man cannot tolerate and so must
The decree of injunction was granted, and in May 1956 he was convicted of
. . should die in a federal penitentiary is shocking, that those who cared were
helpless, and that there were many who knew and who did not care, is tragic.”
Reich’s life and work is sharply divided into two distinct parts by the
its social emphasis along with its biological basis, it was an important
and his prior work are acceptable to the official psychiatric world.
Before the publication of this important work, Reich had made another
controversial contribution in the analytic vein with his The Function of the
potency” to have been the first link in the chain leading to his discovery of
orgone in 1936 and thence to physical and psychiatric orgone therapy. In this
study Reich sought the basis for unsatisfactory analytic results. He concluded
that the reason was the failure of the patient to achieve a satisfactory genital
life. The disturbance in genital function was not merely another neurotic
symptom. In fact, it is the neurotic symptom, and the neurosis is the result of a
2468
Freud’s earliest toxicological theory of anxiety as due to blocked libido.)
This stasis of sexual energy does not occur only in the “actual” neurosis
(Freud), but in all psychic disorders. The goal of analytic therapy then
stasis. Psychic conflict and sexual stasis are directly related. The central
Sexual stasis through social inhabition leads to fixation 011 the parents, and
on a healthy sex life with a beloved partner of the opposite sex, with whom
since through this function of sexuality that part of bioenergy not used in
other activities must be dissipated for the health and happiness of the
inevitable frustration.
The social order determines the character structure it requires for its
activity and survival. In the preface to Character Analysis Reich defined the
defensive ways of behaving manifested early both in analysis and in daily life,
as the how rather than the what, the manner rather than the content of
activity. It is these traits such as argumentativeness, distrust, and the like, that
character, and since, therefore, every analysis deals with character resistance,
2470
time of its formulation. The origin of the difficulty is the thwarting of children
and adolescents through antisexual, authoritarian attitudes that have their
roots in the prevailing social ideologies, however much these claim religious,
in the character armor and muscular armoring, Reich discovered the orgasm
reflex. But even before this he had described the events of the orgasm in his
Although Freud and Abraham wrote briefly on character, Reich was first
case there is “only one technique, which has to be derived from its individual
There are two stages in each analysis. The first is “education to analysis
by analysis,” being for the most part an approach to the character structure.
The second stage begins after much of the character resistance has been
seeking to bring about the genital libidinal fixation. Although Horney and
others considered the first character analytic phase of treatment as the chief
is, the hysterical, the compulsive, the phallic-narcissistic, and the masochistic.
The core of the personality structure is the incestuous wishes and the manner
of their resolution. The rigidity of the ego is due to many factors:
identification with the frustrating person, anxiety aroused by the frustration
the source of later neurotic conflicts and symptom neuroses. The nature of
of the parents, and other factors. Reich stressed this conflict solution as the
source of the latent negative transference so deadly to progress in the
2472
analysis.
threatened release of anxiety that calls forth the renewed activity of the
recognition of character resistance and its early dissolution. The patient must
learn that neurosis can only be avoided by evolving a personality with the
development at which the personality was most decisively shaped and also on
orgastically impotent. The phallus is in the service of hate, not love, as a result
of the rejection of phallic display when the individual was a child seeking
attention and love. This resulted in identification with the rejecting object.
This character type seeks to degrade or destroy the woman for whom he has
contempt. There is none of the passivity of the anal stage.
2474
during the genital stage. The masochist tends to be self-damnatory and
querulous, with a compulsion to torment self and others. Some of these
the sensation of pleasure and its conversion into pain. In truth the masochist
secretly has inordinate demands for love and a very low frustration tolerance.
Thus the masochist appears giving, but this is really the projection of his own
insatiability.
Postanalytic Investigations
Bioenergetics
and discoveries to be his most important and most enduring work. During his
work on the orgasm he was concerned with the nature of the energy involved,
considering it probably bioelectrical. Later in his character analytic work he
recognized that the muscular rigidities were “the somatic side of the process
of repression and the basis for its continued existence.” He noted that in
treatment these rigidities and spasms gave way to spontaneous, soft, and
not impeded, they would quicken and even eventuate in a reflex bodily
convulsion, which he termed the orgasm reflex. Reich devoted the major part
with heated inorganic substances like coal dust and sand. He had reasoned
that if the orgasm formula was characteristic of life, it might also throw light
organized into cells or protozoa. Since most of the bions originated from
distintegrated organic material, Reich speculated on the origin of cancer cells
hypothesis.
While working with the bions in 1939 in Oslo, Reich discovered that
orgone. He later came to consider this energy as cosmic and related to cosmic
radiation. He claimed to have demonstrated the existence of this mysterious
energy visually, microscopically, and thermically. This was the bioenergy he
had sought since student days. Its liberation had been his constant
therapeutic aim, and so he now called his technique orgone therapy. Under
physical orgone therapy, which employed the orgone accumulator and other
orgone devices. It was the orgone accumulator that later led to his
imprisonment.
2476
In 1945 he reported the experimental production of primary biogenesis,
that is, the development of life from earth and water. This was the so-called
Experiment XX. Live cells and protozoa were supposedly produced from
disastrous since many of his assistants developed radiation sickness and the
building and area became radioactive for years. Along with these endeavors
expeditions, and postulated that the origin of galaxies might result from the
confluence of two orgone streams (cosmic superimposition). He thought that
influenced psychoanalytic theory and practice and pointed the way for many
to follow.
was born in Hungary in 1873 of Polish parentage. His father’s bookshop was
the early source of his continued interest in all art forms. He studied medicine
receiving his medical degree in 1894, he spent a year in military service and
then became a staff physician in a municipal hospital in Budapest. As a result
was a neurologist and also served as the psychiatric consultant to the Royal
for people.
on their historic visit in 1909 to Clark University in the United States. In 1910
2478
title was bestowed.
Difficulties for Ferenczi within the movement began with his papers on
This new approach was further elaborated in his book on The Development of
Psychoanalysis, written in conjunction with Otto Rank in 1925. It dealt with
posture. Jones indicated there was a real break with Freud in 1929, but other
authors dispute this. It seems, nonetheless, that at the time of his death in
1933 he was somewhat isolated from the psychoanalytic movement. Freud
wrote to Oskar Pfister that Ferenczi’s death was a “distressing loss,” and that
his memory would be preserved for a long time by “some of his work, his
genital theory, for instance.” Pfister has called him Freud’s “distinguished
champion.” Clara Thompson wrote that Ferenczi “never ceased until his death
in trying to win Freud’s approval,” but “their friendship was severely shaken,
Even in his brilliance and originality, Sandor Ferenczi remained for the
most part within the orthodox analytic framework to whose structure he had
he eventually alienated Freud. Therapy had always been the center of his
psychoanalytic interest.
2480
contents of the three volumes of his selected papers. The first volume, Sex in
Psychoanalysis, covers the years from 1908 to 1914 and reveals his originality
hypnosis; (2) to the knowledge about the development of the sense of reality;
that in hypnosis and suggestion the psychic work is done chiefly by the
subject and not by the hypnotist. The mechanism at work is the Freudian one
person of the hypnotist. Moreover, unconscious sexual ideas are the basis of
the sympathetic capacity to be hypnotized or subject to suggestion. Fear and
love are basic to the hypnotic techniques, and these emotions are certainly
associated with both parental figures. The hypnotist must be able to inspire in
the subject “the same feelings of love or fear, the conviction of infallibility as
those with which his parents inspired him as a child.” Finally Ferenczi
described several striking cases that confirmed Freud’s views that hypnotic
credulity and pliancy are rooted “in the masochistic component of the sexual
this study he set out “to learn something new about the development of the
ego from the pleasure to the reality principle, since it seemed to be probable
that the replacement ... of the childhood megalomania by the recognition of
help of magic gestures, and (4) the period of magic thoughts and magic
words.
for power is a return of the repressed in a yearning for the former effortless
omnipotence. In narcissism or self-love we may always retain the illusion of
development of the sense of reality that the individual was in at the time of
the determining inhibition of the sexual drive—for example, hysteria is
2482
determined by regression to the stage of magic gestures.
psychological rather than the biological aspect of the impulse). Only the
passive male homosexual is truly an “invert” since he feels like a woman in all
other hand, feels like “a man in every respect,” except that of object choice, so
help since his form of satisfaction suits him without any inner conflict. On the
other hand, the active or object homoerotic is beset with conflict and seeks
help.
other hand, has normal oedipal fantasies, is intellectually precocious, and has
strong anal erotism. He often has a history of severe punishment for early
papers fall into two main groups, one with a medical and sexual outlook, the
other devoted to problems of technique. Among the latter papers is the very
final rift with Freud. It was Ferenczi’s intention “to speed up the analytic
predominantly passive. Taking a hint from Freud’s insistence that the phobic
anxiety, and producing new memories that accelerated the analysis. This was
analyzing in a condition of abstinence, produced by “systematic issuing and
2484
These auxiliary measures were not intended to replace the main activity
of the analysis, the search for unconscious and infantile material. “In
fresh distribution of the patient’s psychic . . . energy that will further the
“active” therapy. But when the theoretical implications became clear in the
smoke of the controversy aroused, Ferenczi repudiated his basic alignment
humble toward patients, even to encourage the patient in his free expression
of anger toward the analyst. He encouraged the analyst to soften the analytic
atmosphere. Some neurotics have remained at the level of the child and
require more than orthodox treatment. They need “to be adopted and to
partake for the first time in their lives of the advantages of a normal nursery.”
him and his orthodox colleagues. He challenged the emphasis on heredity and
the Freudian emphasis from the father to the mother, being perhaps the first
to emphasize the crucial nature of the mother-child relationship. He boldly
said children have problems because of bad parents, and patients have
difficulties because of analysts with inadequately analyzed problems. He
stressed the need for thorough analysis of the analyst and for greater humility
and honesty of the therapist. In the largest sense he sought to humanize the
2486
analytic procedure. Clara Thompson wrote of him that he was “all unwittingly
a prophet.”
contributions, one must refer to his ideas on sexuality, which were stimulated
ontogeny with phylogeny in the sex life of mankind. Intrauterine life is a re-
enactment of the oceanic existence of earlier life forms. Emergence on to dry
land was a trauma in the sense of Rank’s concept of birth trauma. Man is
the orgasm, that is, to discharge all emotional tensions as well as sexual
Otto Rank was born in Vienna on April 22, 1884, third child in a
prosperous middle-class Jewish family (Rosenfeld). His life falls readily into
four distinct periods: birth to meeting Freud in 1906; secretary of Freud’s
“Committee,” 1906 to 1926; years in Paris, 1926 to 19,34; 934 to his death on
October 31, 1939, about five weeks after Freud’s death in London.
appearing as, in Havelock Ellis’s words, “perhaps the most brilliant and
clairvoyant of Freud’s disciples.” He was an avid reader in philosophy,
psychology, literature, ethics, aesthetics, art, and history, and he obtained his
Ph.D. degree by 1912. He was always interested in the artist, the hero, and the
Schopenhauer he derived the concept of “will,” which was the core of his
psychology.
He was actively involved with Freud’s inner circle for a decade after
Adler and Jung had severed their personal and theoretical bonds with the
2488
master. During the prestigious years within the charmed circle Rank was
secretary to the Vienna Psychoanalytic Society, helped to establish and edit
was Sandor Ferenczi, who also was critical of the standard Freudian
Nonetheless, Rank was unprepared for and rudely shocked by the storm
precipitated by his publication of The Trauma of Birth in 1924 without prior
At that point Rank went to Paris to allow the storm to dissipate, but this
effectively marked the end of his membership in the Vienna group.
seminars. He also taught and held seminars in New York City. In 1930 his
period that “the ‘will’ focus liberated Rank finally from his Freudian past,
analytic procedure, and from the old psychoanalytic terminology.” During this
period he wrote The Technique of Psychoanalysis, the second and third volume
of which were published in English translation as Will Therapy. He also
Reality.
2490
In 1934, mindful of the gathering political clouds in Europe, he came to
New York, which was to be his final abode, although he traveled frequently to
Philadelphia and other cities to lecture and conduct seminars. In New York he
taught several courses at the Graduate School for Jewish Social Work. He also
this period. After several illnesses he died in New York on October 31, 1939
from an overwhelming infection.
Introduction
Not only was Otto Rank one of the founders of psychoanalysis, but also
he was a forerunner of ego psychology and of the neo-Freudian, eulturalist
(1) the concept of birth trauma; (2) the concept of “will” and the psychology
Freud’s lead, Rank came to “recognize in the birth trauma the ultimate
biological basis of the psychical . . . and a fundamental insight into the nucleus
of the unconscious. . . .” Furthermore, Rank sought to demonstrate that man’s
entire psychical development reveals the importance of the birth trauma and
of human experiences, and the central human conflict is the desire to return
to the womb, which wish arouses anxiety. Weaning is thus another separation
from the mother rather than a frustration of orality. And genital impulses, at
least for the male, are a desire to return to the mother. “The female, on the
other hand, can achieve this goal only through identification with her father
meets its strongest resistance “in the form of the earliest infantile fixation on
the mother.” The analysis allows the patient to separate from the mother
more successfully than in the past. Indeed, “the analysis finally turns out to be
2492
Patients of both sexes make a mother transference. It is the mother libido, as
it existed in the prenatal physiological connection between mother and child,
Why did Freud oppose the development of his own concept? Rank
amends for Freud’s weakest point, that is, his psychology of women, or better,
never completely deviated, certainly not to the extent that the psychologies of
Jung and Adler did. Jung’s constructive attitude and Adler’s social emphasis
not inclined to system building. In fact, Rank considered the Freudian attempt
sense of the word, had come to be the central problem of the whole question
of personality, even of all psychology.” The voluntaristic concept of will
2494
emphasized the factors of choice, responsibility, and autonomy, which were
largely ignored in Freudian thought.
The will is not merely a mediator between instinct (id) and society
(superego), but a dynamic psychocultural entity with roots in biology and the
sociocultural milieu. “Not only is the individual ego naturally the carrier of
higher goals, even when they are built on external identifications, it is also the
temporal representative of the cosmic primal force no matter whether one
calls it sexuality, libido or id. . . . the ego ... (is) the autonomous representative
inhibition, and will. Inhibition arises from the fear and anxiety originally
between instinctive drive and social conditioning, and its formulation permits
form of the creative impulse, not the result of sublimated sexuality. The
creative will principle gradually came to have central importance in his
The latter strongly influences the superego “in terms of the self-constructed
ideal formation and ... a creative sense of the outer world.” So that in the last
2496
as an “evolution from blind impulse through conscious will to self- conscious
knowledge . . . (the) continued result of births, rebirths and new births.” The
individual goes through three phases. In the first stage he wills for himself
what previously has been determined by parental and social demands and his
biological urges. The second period is characterized by a conflict between the
his own ideals, standards, and aims. In the final stage there exists a truly
autonomous ego.
Conformity is the ideal. The second stage, that of conflict, gives rise to the
his own values since that would depend on his own self-acceptance. In
type, the highest integration of will and spirit. Creativity is its expression.
Such an individual can accept his own ideals and values without the
compulsion to impose them 011 others. To be one’s self is the aim and ideal,
individuation and the need for union in a constructive manner, but the
neurotic is frustrated, incapable of integration of the conflictual trends in life,
yet is unable to choose the average way out. He becomes involved in trivia to
fears life and preserves himself by a compulsive relationship with others. But
the neurotic may become the antisocial or criminal type, which Rank
However, Rank relates the neurotic to the artistic, the former being a
2498
of Rank’s objection to the psychoanalytic derivation of creativity on the basis
of sublimation.
present and on what is new in the therapeutic activity rather than on what is
old and repetitious of past patterns of behavior. There is greater concern for
the form of reaction than for the specific content, especially that dealing with
the infantile period.
to shorten the therapy and, by setting the “time limit,” to effect a more
of the therapist. Since the neurotic is more akin to the artistic type of
personality, the therapist might best be of the creative type himself to aid the
without developing guilt feelings. Therapy can only succeed if the relationship
in it is effective in making “it possible for the sufferer to take from the other
individuality and will without guilt. In this light resistance is not an obstacle
than to be eliminated. What is therapeutically effective “is the same thing that
is potent in every relationship between two human beings, namely, will.” No
resistance.
2500
Even hostility in the analysis may be an expression of counterwill
the patient to overcome his life fear and to face separation and individuation.
The recognition of primary fear of life and the fear of death is of great
these fears and success may intensify moralistic guilt. The Rankian therapist
acceptance may arouse death fears, since the neurotic both seeks and fears
close union. However, the increased fear of death (reunion with the mother)
may intensify the drive toward independence, a healthy cycle resulting. The
therapist’s early disclosure to the patient of his death fears helps to minimize
interrelation of the individual and society, rather than their opposition in the
and eventually creative expression of will, accepting and even applauding the
manifestations of will within mutually understood limits, and consistently
the terminal phase of therapy the analyst “is transformed from assistant ego
to assistant reality.” The neurotic views reality as hostile and painful. The
average individual can use reality therapeutically, something the neurotic can
only attain in therapy. “In the last analysis therapy can only strive for a new
attitude toward the self, a new valuation of it in relation to the past, and a new
Biographical Notes
a member of Ferenczi’s informal study group and in time his warm friend. He
was strongly influenced by this pioneer, who was an intimate and favorite of
In 1913 Rado went to Vienna to meet Freud and to hear him lecture on
2502
the Hungarian Psychoanalytic Society. Significantly his first paper before this
Society was on the contributions of psychoanalysis to biological problems,
thus indicating early in his career the very attitude that was later to alienate
Freud, namely, Rado’s insistence that “psychoanalysis must seek to win its
logical place in the system of medical sciences or else . . . float in mid-air.”
Institute, of which Abraham was the director. In 1924 Freud appointed Rado
Imago.
along the lines of its Berlin counterpart he had earlier contributed. This move
further alienated Freud, who apparently was less alert to the political
from 1944 to 1955 he was the first director of the newly established
Psychoanalytic Clinic for Training and Research, which was part the
Introduction
During his many years of clinical and educational experience within the
Robert Heath recently wrote, “an insufficiently recognized pioneer among the
sound physiologic data.” This direction was really a return to Freud’s original
psychobiological orientation before his progress toward a more personal
2504
object-relational ego psychology. Rado’s work programmatically was based
Adaptational Psychodynamics
theory, that all desire for pleasure is sexual in origin. In a further critique
Rado considered that in Freudian instinct theory the role of the emotions in
expectation of pain, such as fear, rage, retroflexed rage, guilty fear, and guilty
rage; and the welfare emotions based on present pleasure or the expectation
of pleasure, such as pleasure, desire, affection, love, joy, self- respect and
pride.” Adopting Ferenczi’s formulation, Rado defined adaptive measures as
are social or cultural needs for security, self-esteem, and self-realization. Need
2506
pleasurable or painful tensions, causing appropriate reactions toward
successful control and resultant satisfaction.
been further removed from the brain by Freud’s unconsious mind. Rado
over into the self-reporting range and enter awareness. Conscious activity
ordered units reflecting phylogenesis. In ascending order these units are the
hedonic level, and the levels of brute emotions, emotional thought, and
evolutionary scale. There is little thought for the future. The organism merely
moves toward pleasure and away from noxious influences, which is obviously
of great survival value. Although pain-pleasure physiology is dominant at this
behavior.
parallels the metazoan stage in evolution. Fear and rage appear at this level
and function, like pain, adaptively as emergency emotions. The next higher
level, that of emotional thought, is a tempered development of brute emotion.
2508
Brute fear and rage are moderated, becoming apprehension and angry
At this level there are further differentiation and refinements of the basic
emotions. Learning is increased along with a lengthening of the period of
reward and punishment develop. But the individual is selective, not objective,
seeking to rationalize the controlling emotion.
postulates the “action self.” “Of proprioceptive origin ... it then integrates the
emotional and motor components.” At first the individual considers his willed
organism. ... If (it) could be removed, the residual entity would be neither
2510
its attainment of utility and pleasure.” Owing to our great ignorance of brain
physiology, normal and disordered, we must content ourselves with the
source of threat from within. Such failures of emergency control Rado termed
2512
Class III. Schizotypal disorders
1. Compensated schizo-adaptation.
Schizotypal Organization
behavior.”
(Linus Pauling) of genetic origin will be found to account for them. Since
fulfillment of life and death is its problem”), its deficiency disturbs the total
the fragmentation described clinically. This, in turn, may be the chief source
of the sense of inferiority and the excessive fear of death.
2514
craving, which manifests an extreme lack of self-reliance. Operationally the
schizotypal uses cold intelligence to compensate for lack of warm emotions.
generate tensions beyond the individual’s adaptive capacity, and he may then
Depression
and guilty fear. The latter prevails while most of the coercive rage is
which are but a facade for his bitterness and wounded pride. This is the result
of the puncturing of the postulated pain barrier at the beginning of the
Rado and other authors consider the loss of the love object as representing
self-reliant adult to a frightened, helpless child. Recovery occurs only with the
patient’s regaining of the capacity for true pleasure, not the spurious type that
Homosexuality
the patient has been reduced to despair by the notion of a struggle with an
innate predisposition.
Rado, is to find the reason for the individual’s application of aberrant stimuli
2516
He emphasized the essential heterosexuality of man, based on biological
foundations and the truly universal social institutionalization of marriage
with its early imprinting on the child. The resultant movement toward
homosexual has many patterns,” but the basic dynamic is “fear of the genitals
Psychotherapy
force impelling the patient to deal more successfully with his actual life
situation. “To overcome repressions and thus be able to recall the past is one
thing; to learn from it and be able to act on the new knowledge, another.” The
within the therapy. Rado stressed the need to minimize undue regression in
the therapy and to prevent evasion of the current adaptive tasks. Nonetheless,
reconstruction.”
Freud’s early tie to biology and physiology, and was basically concerned with
the machinery of personal existence and insufficiently with its quality, with
Bibliography
Ferenczi, S., Final Contributions to the Problems and Methods of Psychoanalysis, Basic Books, New
York, 1955.
_____, (1926), Further Contributions to the Theory and Technique of Psychoanalysis, Hogarth,
London, 1950.
_____, (1924), Thalassa: A Theory of Genitality, Psychoanalytic Quarterly, New York, 1938.
Abraham, K., Simmel, E., and Jones, E., Psychoanalysis and the War Neuroses, International
Psychoanalytic Press, London, 1921.
_____, and Hollos, S., Psychoanalysis and the Psychic Disorder of General Paresis, Nervous and
2518
Mental Diseases Publishing Co., New York, 1925.
_____, and Bank, O., The Development of Psychoanalysis, Nervous and Mental Diseases Publishing
Co., New York, 1925.
Guntrip, H., Psychoanalytic Theory, Therapy, and the Self, Basic Books, New York, 1971.
Heath, R. G., Perspectives for Biological Psychiatry, in Cancro, R. (Ed.), The Schizophrenic Syndrome,
Vol. 1, Brunner/Mazel, New York, 1971.
Higgins, M., and Raphael, C. M. (Eds.), Reich Speaks of Freud, Noonday Press, New York, 1967.
Karpf, F. B., The Psychology and Psychotherapy of Otto Rank, Philosophical Library, New York,
1953.
Lorand, S., “Ferenczi, Sandor,” in Eidelberg, L. (Ed.), Encyclopedia of Psychoanalysis, Free Press,
New York, 1968.
Pfister, O., Psychoanalysis and Faith, Basic Books, New York, 1963.
Rado, S., Adaptional Psychodynamics: Motivation and Control, Science House, New York, 1969.
_____, Psychoanalysis of Behavior. Collected Papers, 1922-1956, Grune & Stratton, New York, 1956.
_____, Psychoanalysis of Behavior, Collected Papers, Volume 2 1956-1961, Grune & Stratton, New
York, 1962.
Raknes, O., Wilhelm Reich and Orgonomy, Penguin Books, Baltimore, 1971.
Rank, O., Art and Artist, Creative Urge and Personality Development, Alfred A. Knopf, New York,
1932.
_____, Das Inzest-Motiv in Dichtung und Sage, Franz Deuticke, Leipzig and Vienna, 1912.
_____, Modern Education, A Critique of Its Fundamental Ideas, Alfred A. Knopf, New York, 1932.
_____, The Myth of the Birth of the Hero, Nervous and Mental Diseases Publishing Co., 1914.
_____, Psychology and the Soul, University of Pennsylvania Press, Philadelphia, 1950.
_____, Technik der Psychoanalyse, Vol. 1, Die Analytische Situation (The Analytic Situation), Vol. 2,
Die Analytische Reaktion (The Analytic Reaction), Vol. 3, Die Analyse des Analytikers
(The Analyst and His Role), Franz Deuticke, Leipzig and Vienna, 1926, 1929, 1931.
_____, Will Therapy and Truth and Reality, Alfred A. Knopf, New York, 1950.
_____, and Sachs, H., The Significance of Psychoanalysis for the Mental Sciences, Nervous and Mental
Diseases Publishing Co., New York, 1916.
Reich, I. O., Wilhelm Reich: A Personal Biography, Avon Books, New York, 1970.
Reich, W., Character Analysis, Orgone Institute Press, New York, 1949.
_____, The Discovery of the Orgone: The Function of the Orgasm, Noonday Press, New York, 1971.
_____, The Invasion of Compulsory Sex-Morality, Farrar, Straus & Giroux, New York, 1971.
_____, The Mass Psychology of Fascism, Farrar, Straus & Giroux, New York, 1970.
_____, Selected Writings: An Introduction to Orgonomy, Farrar, Straus & Giroux, New York, 1960.
2520
_____, The Sexual Revolution, Farrar, Straus & Giroux, New York, 1969.
Sachs, H., Freud, Master and Friend, Harvard University Press, Cambridge, 1944.
James L. Foy
Introduction
thinking, a major trend in modern philosophy that has left its imprint on
intimate connection with the developments in psychiatry over the past 100
years. Idealism, pragmatism, vitalism, logical positivism, and linguistic
2522
analysis have all contributed to the climate in which psychiatry has matured
unsettling and contradictory answers, which are so often swept under some
convenient conceptual rug.
psychiatric theory and practice. This is the only instance where a rigorous
philosophical method and viewpoint has had a decisive influence on the
If existential philosophy has left its mark on psychiatry this is only one
of many impacts it has had upon the entire edifice of modem culture. Its
influence has been conspicuous in all the arts, humanities, social sciences,
same time it has revitalized the older humanistic tradition with ideas open to
thinking has been welcomed in both conservative and radical wings. The
in all the controversies of our time: political, social, artistic, and intellectual.
remain suspicious of global systems and catchall labels. The adjective form,
existential, is used more widely and seems a necessary generic term to be
recognizes the unique place and presence of individual human existence and
2524
“Existence” is a word strictly reserved for man and never applied to the being
of other nonhuman things. Warnock describes the existential thinker as
promoting human freedom, the possibilities of action based on choice, and the
become under the staggering limits of his human condition. Olson, in his
useful introduction to the existential mode of thought, indicates the principal
well. These key themes are: values, anxiety, reason and unreason, freedom,
authenticity, the other person, and death.
man, his situation, and his world. Phenomenology is the method of the
since it leads back to the ground of being rather than beyond material
therefore, is the adjective form that pertains to the basic structures of being.
Ontic is an adjective form that pertains to particular beings or entities and the
facts about them.
man and his essential human structures. The compound term “philosophical
2526
the existential texts. This term means literally there-being and it is sometimes
rendered in English as human existence or human reality. It could also be
Philosophical Perspectives
existential thought lie deep in history, and their outline may be discerned in
for the full, bold statements of existential thought in revolt against the
hypocrisies, systems, and utopias of that age. Dostoevsky’s short novel Notes
naturalism.
divided world, a world split between ideal and reality, religion and
Kierkegaard
the early years of this century and translated into all European languages. His
profound, and his influence continues to grow in the human sciences, such as
psychiatry, because of the provocative and heuristic value of his work. This is
2528
not the place to survey his prolific and varied output; however, his role as an
insightful psychologist of human reality deserves special attention. In an early
encounters human reality in its strictly individual and personal form, and not
in its abstract form as man in general. He always writes about my existence in
all its concrete and irreplaceable uniqueness. His self-psychology receives its
most thorough elucidation in his book on despair, Sickness unto Death. This
goes on to elaborate in detail two conscious forms: (1) despair at not willing
insights into the torments of the despairer’s emotional life lend themselves to
a natural psychotherapeutic strategy and procedure.
in which he faced his own complex fate and inwardness and out of the
philosophical reflections by French and German writers during the first half
or more of this century. Gabriel Marcel’s independent, sensitive, humanistic
summarized his life’s work."’ Marcel has had an affiliation with American
philosophy, particularly with Royce and Hocking. His work should be better
2530
intersubjective and participation coincides with familiar existential
preoccupations of therapists. Marcel has reflected deeply on the human
Albert Camus and Jean-Paul Sartre are the most widely known figures in
the French school. It is only in his earliest writings that Camus can be
considered an existential thinker, and his essays The Myth of Sistyphus are
regard to his early novels and plays. Sartre also is famous for his versatility as
psychiatry, perhaps for the reason that it is read for its rich psychological
analyses rather than for its strict ontological speculations. Sartre contributes
Sartre for a time and like him was deeply indebted to Husserl and Heidegger.
Karl Jaspers, the psychiatrist and philosopher, who died in 1969 after a long,
enabled him to publish his General Psychopathology, which has had enormous
2532
significant contribution by him to the ideas of our time. As a philosopher
Jaspers has consistently concentrated upon existential man: his world views,
his boundary situations, his encounter with truth, his search for the limits of
work has a lasting power, and as Stierlin has pointed out, behind some of his
biases, an indifference to Freud, for example, Jaspers had a tough mind that
warned against reducing man to theory, or worse, objectifying him through
Martin Buber and Paul Tillich are two existential thinkers who, though
born in Germany, spent their later careers in other countries, where their
Jew, was an early immigrant to Palestine where he taught until the end of his
life. Mystical thought, theology, education, and philosophical anthropology
were the cornerstones of his productive career. His earliest essay, I and Thou,
is a classic existential text and paves the way for all his subsequent writings.
work. In 1957 Buber visited the United States and lectured at the Washington
and intense interest in psychology and psychotherapy. His popular book, The
existential psychiatry in this country through his own writing, lecturing, and
Heidegger
All of the authors cited above have been affected by the elaborate and
publication in 1927. This work is the single most informing text for existential
developments in clinical psychiatry, psychotherapy, and psychoanalysis. It
introduced a wealth of ideas, some of which have already passed into the
domain of cliché, as in the popular usage of the word “openness”. It has been
both praised and damned for its acknowledged heaviness and difficulty. Its
author has gone on to other philosophical interests, but this book, actually an
incomplete work, has been recognized as the bible of the existential school.
2534
Hannah Arendt and others have attested to the importance of Heidegger
as a thinker of profundity and originality. His reputation has risen to rival that
of Husserl’s, for whom he was an assistant and later the successor in the Chair
not necessarily illuminate his significance for the human sciences. Rather it is
his creative thinking about the being of human being, the analytics of Dasein,
that challenges us to rethink our own theory and practice.
becoming. Dasein always implies the personal pronoun: “I am,” “you are.”
Dasein is essentially its own possibility, but its being is not given for once and
for all, to unfold automatically like things in the organic world. Human
existence discloses itself, questions itself, and chooses itself in its becoming,
and it can be won or lost, it can be gained or forfeited. This is what Heidegger
means by the concepts authentic and inauthentic existence: existence owned
depleting himself. As we will see over and over again, existential thinking
the Cartesian split that has afflicted psychology and psychiatry for centuries.
with a world. There is a worldishness about our very existence. We arc our
horizons, our landscapes, our abodes. Nature and the things out there in the
environment come later and appear as afterthoughts to our immediate
for basic psychiatry, and it has been pursued by the clinicians we will discuss
below. Heidegger himself distinguishes the Umwelt and the Mitwelt. The
Umwelt is the first and a nearest world of the body and its proximate
situation. The Mitwelt is the with-world of coexistence, Dasein’s being with
others, which determines its own hazards and opportunities. There is the
everyday world of the everyday self alongside of everybody else. This is the
ordinary world of the “they” as in “they say it’s going to rain.” The impersonal
self-world relation is the commonplace condition of all of us and leads
2536
directly to an inauthentic realm of conformity, anonymity, and facelessness.
Contrasted with this is the condition of coexistence in openness and the co-
authentic meeting face to face, where our own greatest possibilities are
discovered in our solicitous being with others. The concept of encounter, so
because our becoming is never finished until the moment we die. To live is to
take ownership of the project of our personal existence. According to
of me. When I set a specific aim for myself, for example, the goal of climbing
Mt. Everest, I conceive of it as a possibility that I may or may not achieve
sometime in the future. Until then I let this possibility, in advance, determine
all the steps I take here and now: I undergo a rigorous training, I expose
myself to hardship and danger, I bend my energies toward organizing my
expedition, collecting equipment, recruiting guides—and all this for the sake
of, or to take care of, a possibility that may never be realized but on whose
things and events, and to take direction from them for what should be done
here and now. Above all, he must be able to understand himself, not only in
what he was and what he is, but also in what he can become—and thus move
range of the possibilities of his being. This is the unique concept of being that
Heidegger reveals in human existence and to which he gives the name care.
future. For Heidegger the future is the primary marker and mode of time.
The past is the domain of the being I already am and have been. This is
the fact of my being, marked by a thrownness into the world, a “has been” left
to myself and stuck with my own facticity. The present is the moment as I fall
captive to the world, giving myself away to everyday busyness in time that
2538
If Dasein is a self-disclosing, forward- moving, care-taking, future-
directed being, there is one possibility that always beckons each human
my death that is only mine to die. In his analysis of death Heidegger tends to
see the ontological structure as the most authentic and proper possibility for
to take care of our being. Heidegger would say that no one can take someone
else’s death away from him. “They” say that death will come someday, but not
yet, and the power and certainty of it are denied. As soon as man is born, he is
old enough to die; nevertheless, no one is so old that he does not possess a
future.
These analyses should not be confused with neurotic anxiety and neurotic
guilt. Dread as a basic human mood is elucidated in Heidegger’s essay, “What
exercises.
the past several decades, existential phenomenology has had a much longer
and more powerful effect upon European psychology and psychiatry. This fact
2540
was brought vividly to the attention of Americans with the very significant
publication in 1958 of the book Existence, which has received wide attention.
The editors of the book, May, Ellenberger, and Angel, gathered together
essays on basic approaches and clinical case studies, translated into English
for the first time. This book focused American attention on the contributions
the critical work of Erwin Straus, whose career has bridged European and
his reworking of the concept of the lived world, the world of firsthand
experience and body movement. Because of his lifelong interest in the senses
and movement, he has completed studies of hallucinations, anosagnosia,
papers reveal his existential orientation, especially his paper “The Upright
Posture,” a brilliant elucidation of the “standing” position and the presence of
human existence. At this point in time his teaching has a moderating influence
example and approach; instead, the movement seems to offer a style and
content for criticizing scientific doctrines of man, mind, and behavior. Benda
own practice that placed extraordinary emphasis on crisis, values, and goals.
His method included dream analysis. Sonnemann was one of the first to
2542
scholarly book, Existence and Therapy, is rich with references to the European
existential tradition and has a fine grasp of the historical situation. His
psychiatrists.
and phobic young man illustrates the clinician’s methodical description of his
states are hallmarks of all these studies. Laing’s cases of schizoid states and
schizophrenia are now fairly well known in psychiatry. Boss has published
studies of a variety of sexual perversions. He has also written on the
scientific interest, such as sex research. Farber’s analyses of the uses, misuses,
and abuses of the modern will have influenced May, who expands on their
relevance for contemporary values and attitudes regarding sexuality and love.
An excellent overview of sex and existence has been presented by Van Kaam.
endeavors.
Binswanger
teaching, his books and articles, his administration of a mental hospital, his
example, all serve to illustrate his formative role and enduring influence as an
existential thinker. Born into a family tradition that included many prominent
2544
psychiatrists over several generations, he worked at the sanatorium at
Kreuzlingen, on the shores of Lake Constance. Binswanger is the most
of lived time and lived space), Kierkegaard’s self psychology, Buber’s dialogue
between I and Thou, not to mention essential ingredients from Bleuler and
Freud.
ideas on existential analysis, although he was working out his position from
the early 1930’s. In spite of open difference Freud never broke off warm
personal relations with Binswanger, as was so often the case with Freud and
his dissident disciples.
a number of long case histories that contain the application of his ideas to the
study of lives, rendered in an elegant and admirable style. From Heidegger he
to a future he orders his present and connects it with his past. Binswanger
observed in his patients a core of trouble connected with the loss of direction
and meaning in their lives, which fundamentally meant that they no longer
itself in a particular human being’s daily life, Binswanger searches out the
care is analyzed for his existential worlds. The first and nearest world of the
Umwelt and the world with others in direct relations, the Mitwelt, have been
discussed above. Binswanger adds the Eigenwelt, the world of self in its
world design.
Binswanger’s clinical case studies are, for the most part, histories and
Daseinanalyses of manic and schizophrenic persons. In a number of articles
2546
on mania he first worked out the manic mode of being-in-the-world. In the
flighty and surface world of the manic patient the future holds everything,
and he propels himself headlong into a future brimming over with too many
possibilities. His care is strewn before him recklessly, and his existence is
squandered among a fleeting chaos of things and faces. Manic phenomena
examples. His case studies of schizophrenia are more complex, “The Case of
Ellen West” being the longest and most detailed of them. It has achieved the
status of a classic case, but more than a clinical history, it is a human narrative
of great depth and poignancy. “Ellen West” was not treated by Binswanger
himself. She had been examined, treated, and psychoanalyzed by a number of
letters, all of which he collected after her death. The analysis defies any brief
summary; however, this document demonstrates how Binswanger
irrevocably between an upper, ethereal one and a lower, earthy one. It is the
existential dilemma of the obsessive-compulsive person pushed to extreme
limits and beyond, into psychosis. Binswanger’s other cases, “Lola Voss,” for
example, deserve wider readership. These human narratives are his finest
2548
infrastructure, upon which psychoanalysis or other systems of explanatory
hypotheses could build their theory and procedures for treatment.
abandoned, but rather are taken up in an approach to the patient that has
never be recovered in some global, permanent form of how it really was with
backward again and again to sum up the relevant past. A second time-related
point insists upon the influence that the future has and will continue to have
upon the outcome of therapy. The future is before the patient in his plans,
expectations, anticipations, and chosen goals.
between human saying and human doing. A person puts more of his existence
into what he does than into what he says. Convergence or divergence
2550
between saying and doing is attended to in the therapy. Sixth, the point is
made that decision and action are integral to the process of therapy, and are
accomplished. Action, more than reflection upon past action, is the central
theme of the ongoing process.
In Psychology and the Human Dilemma Rollo May has collected his
articles on existentialism and related problems, and in this book he discusses
with particular attention to its goals. He has some cautionary things to say
pave the way to adjustment and conformity to group norms and societal
manipulation of the patient and, at the same time, seeks a goal in the
fulfillment of personal existence. May would insist that the goal of any
his anxiety and guilt and constructing upon them a responsible commitment
to his unique potentialities. May and Colm have been responsive to the
encountering context of psychotherapy. Coexistence, presence, and openness
underlie the actual relationship between patient and therapist. There are
the encountering ground upon which both participants meet. There is nothing
it.
2552
the meaning of life is not a unitary concept, but rather a reflection of a set of
articulate. The therapist’s role is not to hand over values to his patient, but to
be a detective in the patient’s search for his own values. Jordan Scher, an
American editor and therapist, has written extensively on the existential
stamped with his own broad clinical and social interests and points in the
direction of an existential social psychiatry.
theory and practice. The Swiss psychoanalyst Medard Boss, on the other
method. Boss takes his cue from the later work of Heidegger. His book,
idiosyncratic psychoanalysis.
and the future holds possibilities for more existential inroads into theory and
Bibliography
Allers, R., Existentialism and Psychiatry, Charles C Thomas, Springfield, Ill., 1961.
Ahendt, H., “Martin Heidegger at Eighty,” New York Review 17, No. 6:50-54.
Benda, C. E., The Image of Love, Free Press, New York, 1961.
2554
_____, “What is Existential Psychiatry?” Am. J. Psychiat., 123:288-296, 1966.
_____, “The Case of Ellen West,” in May, R., Angel, E., and Ellenberger, H. F. (Eds.), Existence, Basic
Books, New York, 1958.
_____, “The Existential Analysis School of Thought,” in May, R., Angel, E., and Ellenberger, H. F.
(Eds.), Existence, Basic Books, New York, 1958.
_____, “On the Manic Mode of Being-in-the-World,” in Straus, E. W. (Ed.), Phenomenology: Pure and
Applied, Duquesne University Press, Pittsburgh, 1964.
Boss, M., The Analysis of Dreams, Philosophical Library, New York, 1958.
_____, Meaning and Content of Sexual Perversions, Grune & Stratton, New York, 1949-
_____, The Knowledge of Man, Harper & Row, New York, 1965.
Camus, A., The Myth of Sisyphus, Alfred A. Knopf, New York, 1955.
Colm, H., The Existentialist Approach to Psychotherapy with Adults and Children, Grune & Stratton,
New York, 1966.
_____, “The Therapeutic Encounter,” Rev. Existent. Psychol, & Psychiat., 2.137-159, 1965-
_____, The Ways of the Will, Harper Colophon Books, New York, 1968.
Fisher, A. L. (Ed.), The Essential Writings of Merleau-Ponty, Harcourt, Brace & World, New York,
1969.
Foucault, M., Madness and Civilization, Random House, New York, 1965.
Frankl, V. E., Man’s Search for Meaning, Washington Square Press, New York, 1963-
Friedman, M., “Phenomenology and Existential Analysis,” Rev. Existent. Psychol. & Psychiat., 9.151-
168, 1969.
Heidegger, M., Being and Time, Harper & Row, New York, 1962.
Husserl, E., Phenomenology and the Crisis of Philosophy, Harper & Row, New York, 1965.
James, W., The Varieties of Religious Experience, New American Library, New York, 1958.
Jaspers, K., The Nature of Psychotherapy, University of Chicago Press, Chicago, 1965.
Johnson, R. E., Existential Man: The Challenge of Psychotherapy, Pergamon Press, New York, 1971.
Kahn, E., “An Appraisal of Existential Analysis,” Psychiat. Quart., 31:203-227, 417–444, 1957.
2556
Kaufmann, W., Existentialism from Dostoevsky to Sartre, World Publishing Co., Cleveland, 1956.
Keen, E., Three Faces of Being: Toward an Existential Clinical Psychology, Appleton- Century-
Crofts, New York, 1970.
_____, “Minkowski and Schizophrenia,” Rev. Existent. Psychol, & Psychiat., 3: 195-207, 1963-
Lynd, H. M., On Shame and the Search for Identity, Science Editions, New York, 1961.
Marcel, G., The Existential Background of Human Dignity, Harvard University Press, Cambridge,
1963.
_____, Angel, E., and Ellenberger, H. F. (Eds.), Existence, Basic Books, New York, 1958.
Mendel, W. M., “Introduction to Existential Psychiatry,” Psychiat. Dig. (Nov. 1964) 23-34.
Merleau-Ponty, M., Phenomenology of Perception, Routledge & Kegan Paul, London, 1962.
Moustakas, C. (Ed.), Existential Child Therapy, Basic Books, New York, 1966.
Mullan, H., and Sangiluliano, I., “Interpretation as Existence in Analysis,” Psychoanal. &
Psychoanalyt. Rev., 45:52-73, 1958.
Plessner, H., Laughing and Crying, Northwestern University Press, Evanston, 1970.
Ruitenbeek, H. M. (Ed.), Psychoanalysis and Existential Philosophy, Dutton, New York, 1962.
Sartre, J. P., Being and Nothingness, Philosophical Library, New York, 1956.
Scheler, M., The Nature of Sympathy, Routledge & Kegan Paul, London, 1954.
Scher, J. M., “Intending, Committing and Crisis in Ontoanalysis,” Existent. Psychiat., 6:347-354,
1967.
Schmidl, F., “Psychoanalysis and Existential Analysis,” Psychoanal. Quart., 29:344-354, 1960.
_____, “Sigmund Freud and Ludwig Binswanger,” Psychoanal. Quart., 28:40-58, 1959.
Serban, G., “Freudian Man vs. Existential Man,” Arch. Gen. Psychiat., 17:598–607, 1967.
2558
_____, “The Theory and Practice of Existential Analysis,” Behav. Neuropsychiat., 1:8-14, 1969.
Sonnemann, U., Existence and Therapy, Grune & Stratton, New York, 1954.
Spiegelberg, H., The Phenomenological Movement, 2 vols., Martinus Nijhoff, The Hague, 1965.
Stierlin, H., “Existentialism Meets Psychotherapy,” Phil, & Phenomenol. Res., 24: 215-239, 1963-
_____, “Karl Jaspers (1883-1969),” Rev. Existent. Psychol. & Psychiat., 9:78-86, 1968.
_____, The Primary World of Senses, Free Press, New York, 1963.
Tillich, P., The Courage To Be, Yale University Press, New Haven, 1952.
_____, “Existentialism and Psychotherapy,” Rev. Existent. Psychol, & Psychiat., 1:8–16, 1961.
Van Den Berg, J. H., The Phenomenological Approach to Psychiatry, Charles C Thomas, Springfield,
Ill., 1955.
Van Kaam, A., Existential Foundations of Psychology, Image Books, New York: 1969.
_____, “Sex and Existence,” Rev. Existent. Psychol. & Psychiat., 3.163-181, 1963.
Watzlawick, P., Beavin, J., and Jackson, D. D., Pragmatics of Human Communication, Norton, New
York, 1967.
Weigert, E., The Courage to Love, Yale University Press, New Haven, 1970.
Weisman, A. D., The Existential Core of Psychoanalysis, Little, Brown, Boston, 1965.
Wolff, W., Values and Personality, Grune & Stratton, New York, 1950.
2560
Chapter 43
Joseph Wolpe
been to the neuroses, to other learned habits that do not fit the definition of
neuroses, and to those unadaptive habits of schizophrenics that are based on
2562
to the inadvertent interpersonal therapeutic effects, the effects obtainable by
the deliberate employment of methods based on learning principles. This
(Wolpe, Moore, Sloane, et al.' and in laboratory contexts (Lang, Lazovik, and
Reynolds, Paul, Paul and Shannon, Paul, Mealiea and Nawas).
Among the habits based upon learning that are the natural targets of
The Neuroses
almost always a central component of neurotic habits. While the central role
of anxiety is quite obvious in a great many neurotic patients—those with
is their crux. The stutterer, with only rare exceptions, is found to stutter only
in social situations that make him anxious; the asthmatic or the peptic ulcer
patient has somatic attacks in situations that raise his emotional tension.[1]
When women are frigid or men are impotent, it is usually because of anxieties
that are evoked by features of sexual situations. Most homosexuals have
either interpersonal anxiety toward people in general, with an emphasis on
females, or specific anxiety evoked by women in contexts of physical
intimacy. Similarly anxiety is the wellspring of kleptomania, adult tantrums,
2564
aggressiveness, and disruptive classroom behavior. Adult examples are
of bizarre habits. These latter habits are modifiable by the use of learning
procedures.
Positive Reinforcement
and Martin).
Extinction
2566
cessation of reinforcement must be complete.
experimental environment that the neurotic animal will not eat there even if
he is starving. Rut the animal will eat in a place remotely similar to that in
which he was shocked and where there is only weak anxiety; and repeated
until finally even the experimental cage loses its ability to elicit any anxiety.
While feeding has also been used for the gradual deconditioning of
Retroactive Inhibition
these lapses to the idea that they are the result of anxiety and without organic
significance. In other words, the wrong cognitive response must be replaced
by the correct one. The therapist must repeatedly and forcefully provide the
new association. Each time the new response is evoked, there is an inhibition
of the tendency to perform the old response and a weakening of its habit. This
In recent years there have been many reports (for example, Malleson,
2568
Frankl, Stampfl and Levis, Wolpin and Raines, Wolpe) of the overcoming of
neurotic fears by exposing patients either in reality or in imagination, usually
stimuli. Many of these patients have improved markedly, and some rapidly.
The most widely accepted label for procedures of this kind is flooding.
top level no matter how much stronger the stimulus becomes. But sometimes,
proposed that habit strength may be decreased if the response has undergone
There is a rather widespread belief among people outside the field that
therapist can only proceed rationally if he has a clear and exact knowledge of
the relations between the unadaptive responses and the stimuli that trigger
become worse with the passage of time, generally because the power to evoke
it has spread to a widening range of cues on the basis of second order or
given. Since anxiety is, as stated above, usually the central constituent of
neurotic reactions, the greatest amount of attention is generally given to
identifying its eliciting stimuli. But in the many cases that do not present
themselves as overt anxiety problems, such as frigidity or stuttering, the first
2570
task is to try to establish whether anxiety is a precondition of the presenting
syndrome—as it usually is. Then the antecedents of the anxiety will, in turn,
be determined.
therapist takes a general history of his life and background. He inquires about
early relationships with parents and siblings, special relationships that may
stressful relationships. The patient is asked when he left school and what he
then did and how he got on at each institution or place of employment, both
occupationally and with respect to personal relationships.
The patient’s sex life is then traced from the time of his first awareness
turn, right up to the present time, is examined in detail, both socially and
sexually.
After the anamnesis the patient is given several inventories to fill out.
about general emotional sensitivity. The Fear Survey Schedule (Wolpe and
Lang) lists 108 stimulus situations to which a fear is unadaptive and to which
Unless the patient has been referred for treatment by a physician (and
any suggestion at all that organic disease may have a role in his illness. A
such episodes turn out to be based upon functional hypoglycemia (Conn and
Seltzer, Salzer).
Neurotic Syndromes
great bulk of them, so that very often, sooner or later, the treatment is that
described below for the common phobias and allied reactions. Therefore, this
2572
must receive especially full coverage. But quite frequently a particular
syndrome may deflect the course of treatment in special ways. We shall
enclosed spaces, heights, and darkness. However, numerous stimuli that are
because they are less easy to define—can also be the antecedents of anxiety
difference between the latter group of reactions and the classical phobias,
they are treated by the same methods.
emotional effects of deep muscle relaxation take the place of those of feeding
Edmund Jacobson, two to four muscle groups being dealt with during a 10 to
stimulus controls of the patient’s anxiety responses are also studied. Suppose,
for example, that the patient responds with anxiety to being looked at by
others. It may be found that the anxiety increases according to the number of
people looking at him or according to their demeanor, their age, or their sex,
presumptive awkwardness.
ranked list is called a hierarchy. The items on the list may differ from each
2574
specification on the theme of “rejection.” The items are ranked in descending
order of their anxiety-producing effects.
patient with the subjective anxiety scale. The therapist says, “Think of the
worst anxiety you have ever had and call it 100; then think of being absolutely
calm and call that 0. On the scale from 0 to 100 you can at any time estimate
your ongoing anxiety. And if your anxiety level changes, you can say by how
much.”
close his eyes and to relax as he has been instructed. His anxiety level must be
anxiety. Then one may give the patient one or more single, full-capacity
inhalations of a mixture of 35 per cent oxygen and 65 per cent carbon dioxide
to reduce the anxiety (Wolpe). Lacking facilities for this, one may try the
why muscle relaxation may fail to calm is that it happens to activate a fear of
“letting go.” In that case another anxiety-inhibiting agent must be used.
Having assured himself that the patient’s anxiety level is close to 0, the
therapist says: “Your eyes being closed, I am going to ask you to imagine a
number of scenes. You will imagine them very clearly. The moment the image
that I suggest is clearly formed, indicate it by raising your left index finger one
inch.” After a matter of seconds the finger will go up. The therapist waits
about five seconds; then says, “Stop imagining that scene”; and then, “By how
much did that scene increase your anxiety level?” The patient will reply with a
about 20 seconds before being asked to imagine the same scene again.
2576
In treating the hierarchy given above, starting with the weakest item
you are approaching a man to whom you spoke for 10 minutes at a party the
previous Saturday night. You smile in greeting, but he walks past with a blank
stare.” When the patient’s finger rose to indicate that he was imagining the
scene, I let a period of about six seconds pass before requesting the cessation
of imagining. I then asked the patient by how much the anxiety level rose
during the visualization. He said “15 units.” When the scene was presented a
second time after a period of relaxation, the anxiety rose only 8 units, the
third time 3 units, and the fourth time 0. Then I began presentations of the
next scene on the hierarchy. “It is 5:00 p.m. on your birthday; you have
spoken to half a dozen of your friends and nobody has remembered.” This
was presented repeatedly according to the same rules that applied to the first
scene. It is worth noting that the mention of a specific time (5:00 p.m.)
introduced a gradient of anxiety responses within that particular item: there
was increasing anxiety with increasing lateness and with increasing numbers
situation. Nor is the change confined to the specific social interactions that
figure in the treatment, but to a whole array of similar situations. In other
and unnecessary. Plainly, if the changes noted in the sessions did not transfer
has noted, is the first in the history of psychotherapy to have been vindicated
optimal; and recent observations (Lang, Melamed and Hart) make it likely
that beneficial modifications will evolve before long.
those who do not respond fearfully when they imagine things that they find
fearful in the real world. For them it is necessary to present the relevant
2578
more intimate interactions with the phobic object and later, under guidance,
making gradual approaches himself.
effectively used to inhibit anxiety. Some of these are unable to relax because
by raising his finger that the image is clear, a weak electrical stimulus is
his forearm. This can apparently compete with the anxiety, for in many cases
the anxiety elicited by the scene progressively decreases, with lasting effect.
Scenes are given six or eight times per minute. Another method employs
Agoraphobia
the occasion for the anxiety rather than its immediate stimulus antecedent.
Behavior analysis may show that what the patient really fears is a bodily
patient has frequent attacks of anxiety; and the farther away from possible
help he is when it arises, the more anxious he feels. Therapy will focus on the
pain in the chest. It will first be necessary to insure that there is no heart
disease by sending the patient to an internist. Occasionally negative findings
will entirely reassure the patient. But more often the anxiety response to the
pain persists even after the patient is intellectually convinced that his heart is
normal. Systematic desensitization to the pain, usually on a dimension based
2580
on distance from the center of the chest, will be necessary to effect recovery.
(Neurotic fears of illness are often encountered without agoraphobia.)
takes active steps to indicate how she would like him to change; and if no
amelioration occurs, she is able to consider divorce. The woman with low
separate from the husband; but its projected consequences make it too fearful
this end is to train the patient in assertive behavior. If the marriage cannot be
improved, it should be dissolved. Whatever happens to the marriage, the
treatment of the case cannot be regarded as complete until the patient has
also overcome her fear of being alone (shown by her low self-sufficiency); this
Timidity
fully fit the bill since the subject is also deficient in ways of speech and other
motor behavior toward others. A mode of treatment that brings about change
in both emotional and motor habits is assertive training. The patient is
situations.
The situations that are relevant are varied and often numerous. The
patient, by reason of his interpersonal fears, may be unable to complain about
get up and leave a social situation that has become boring, to chastise a
subordinate, or to express affection, appreciation, or praise. As a first step he
has to be made to realize (if he does not already) that giving voice to his
feelings in such situations is appropriate. He must also understand that it is
anxiety that has been standing in the way, and that in the act of expressing the
other emotions, the anxiety will each time to some extent be inhibited and its
2582
habit strength diminished.
unsatisfactory food. The therapist discusses with him the situation where he
has ordered a steak done rare, which is the way he likes it, and it has arrived
done to a frazzle. The conversation proceeds as follows:
Patient: I wouldn’t say anything to the waiter and would feel irritated, but would
eat the steak.
Dr.: But you would be perfectly within your rights to do so. You have not got what
you have ordered and what you will be paying for. You should ask him to
take that steak back and bring you another, which he will probably do; but if
he is disagreeable, you should complain to the manager.
person” and the patient “plays himself,” so that his errors can be corrected
of this kind “across the board,” in those who have a great deal of anxiety, it is
anxiety is sexual emotional arousal. In all its phases short of ejaculation the
male sexual response is mainly a parasympathetic function. Anxiety interferes
2584
with the sexual response because sympathetic arousal inhibits
begins and what factors increase it. Perhaps the man begins to feel anxiety
the moment he enters the bedroom, or perhaps it is when he is lying in bed in
the nude next to his wife. The basic idea of the treatment is explained to him:
example, he feels anxiety to a minimal extent just lying next to his wife in bed,
This will usually occur after two or three sessions. Then he can go on to the
next stage—perhaps fondling her breasts, caressing her thighs, or lying on top
must not make him anxious by mocking or goading him to achieve any
particular level of performance. Though this may mean her enduring a good
deal of frustration, she may hope to reap the rewards of her patience
eventually.
The details of treatment naturally vary from case to case. Male sex
hormones are occasionally indispensable (Miller, Hubert, and Hamilton,
frequently of great value has been described by Semans. The wife is asked to
manipulate the penis to a point just short of ejaculation and then to stop.
After an interval she does this again, and may repeat it several times. The
the patients have been found to achieve completely normal sexual function,
2586
Where female sexual inadequacy (frigidity) is the problem, two kinds of
women who do not recall ever having known sexual arousal and give no
psychoanalyzed for four years for vaginal spasms that were due to local
ulceration. A gynecological examination is mandatory in every case of
activity. Having done this, one is almost always still left with a negative
by sodium methohexital.
Homosexuality
interpersonal anxiety of the kind that calls for assertive training, with peak
2588
conditioning is that of Feldman and MacCulloch in which approach attitudes
to females are conditioned coordinately with aversion to males.
under the name “covert sensitization.” The patient is asked to visualize the
aid for the treatment of stuttering. A variety of methods have been used in
cases of obsessive-compulsive behavior, including positive reinforcement
habits that arise during adolescence or later. Some cases of anorexia nervosa
2590
drink freely at all times and rewarding prolongation of diurnal retention of
urine. On the first training day the parent waits for the child’s first report of a
desire to urinate. The child is asked to hold it in for, say, five minutes, being
promised a reward of cookies, candy, or soda pop, etc., depending upon his
likes and dislikes. When the necessary time has expired, the promised reward
is given and the child permitted to urinate. The same essential procedure is
followed whenever the child has a urinary urge, and as it becomes clear that
the initial time requirement has become easy for him, it is increased by a few
minutes. The increase must always be small in order to avoid failure or
minutes. This may require an increase in the amount of reward also. All three
of the cases reported by Kimmel and Kimmel stopped bed-wetting within 14
days after the beginning of the treatment, and none of them showed more
In recent years increasing use has been made of social reinforcers for
children’s unadaptive habits. Hart et al., have described deconditioning of the
excessive crying behavior of two nursery school children. The teachers were
told to distinguish between crying due to pain or other appropriate causes
and “operant crying.” They were instructed to ignore each child’s operant
cries, not going to him, speaking to him, or even looking at him while he was
crying (except for an initial glance to assess the situation). If a particular child
was close to a teacher when he began to cry, she was to turn her back and
introduction of the program, operant crying decreased from between five and
ten times per morning to less than two. At this point, in order to substantiate
the hypothesis that the operant crying of these children was truly a function
of social reinforcement, the therapists decided to try to reinstate the crying
to a cry, such as whimpering and sulking. The base line rate of crying was
soon reestablished. After four days’ reintroduction of the policy of removal of
to maintain high grades in his courses. In his living room he could concentrate
for only 20 to 30 minutes before becoming so restless that he could not
continue reading. He would join his wife watching television in the bedroom
that evening. A program was devised for the patient to study according to
new rules in one of the university reading rooms. He was to go to the library
daily for a week and each day read six pages of assigned material, no more
and no less. He was not to study at home. The average time per day spent
studying in the first week was less than 20 minutes, but the student had some
approval to him for following the program exactly. Each following week the
2592
daily reading material was increased by two pages until, after several months,
it reached 60 pages daily. Later, measures were adopted to enable the student
to study at home.
A few further examples can be only briefly mentioned. Risley and Hart
about the room, and squirming and tapping at the desk. Barrish et al. and
and Filipezak, and the treatment of autistic children by Lovaas, Schaffer, and
for a long time argued that a massive effort in behavior modification with
team, has recently provided a brief account of his program for parents.
Lindsley. Much of the clinical pioneering was performed by Ayllon and his co-
had been hospitalized for nine years, had a number of bizarre habits,
the patient’s room. At first she was delighted and arranged them in neat piles.
After two or three weeks, when their number was in the region of 600, they
2594
became unmanageable; and the patient would beg the nurses not to bring any
more. After about six weeks she herself began taking the towels out of her
room, and they did not come back. She ultimately removed practically all of
them, remaining, like other patients, with one or two. Evidently at a certain
stage the massiveness of the hoard had become aversive, so that removal of
above case requires specially trained ward personnel. Once they have been
employed in reasonable numbers, it becomes possible to utilize their services
been established in mental hospitals throughout the United States in the past
decade. The training of such personnel has thus become increasingly
important. It has been greatly aided by two lucid texts, by Schaefer and
use of tokens (Ayllon and Azrin) that the patients receive for the performance
of desired behavior and that they can subsequently spend to obtain objects or
patient to the therapist benefits many neurotic patients, no matter what the
2596
established principles is a surer way to success than any rule of thumb.
more rapidly than psychoanalysis does (on the criteria suggested by Knight).
A large range of controlled studies (such as, Paul, Moore, and Lomont et al.)
have uniformly indicated superior efficacy for specific behavior therapy
substitution is to be expected, has not been borne out (Wolpe, Paul). Neither
relapse nor symptom substitution is seen in patients whose neuroses have
Bibliography
_____, and Azrin, N. H., “Reinforcement and Instructions with Mental Patients,” J. Exp. Anal. Behav.,
7:327-331, 1964.
_____, and _____, The Token Economy: A Motivational System for Therapy and Rehabilitation,
Appleton-Century-Crofts, New York, 1968.
_____, and Haughton, E., “Control of the Behavior of Schizophrenic Patients by Food,” J. Exp. Anal.
Behav., 5:343–352, 1962.
Bachrach, A. J., Erwin, W. J., and Mohr, J. P., “The Control of Eating Behavior in an Anorexic by
Operant Conditioning Techniques,” in Ullman, L., and Krasner, L. (Eds.), Case
Studies in Behavior Modification, Holt, Rinehart & Winston, New York, 1965.
Bailey, J., and Atchinson, T., “The Treatment of Compulsive Handwashing Using Reinforcement
Principles,” Behav. Res. Ther., 7.327-329, 1969.
Bandura, A., Principles of Behavior Modification, Holt, Rinehart & Winston, New York, 1969.
Barrish, H. H., Saunders, M., and Wolf, M. M., “Good Behavior Game: Effects of Individual
Contingencies for Group Consequences on Disruptive Behavior in a Classroom,” J.
App. Behav. Anal., 2:119- 224, 1969.
Birnbrauer, J. S., Burchard, J. D., and Burchard, S. N., “Wanted: Behavior Analysts,” in Bradfield, R.
H. (Ed.), Behavior Modification: The Human Effort, Dimensions, San Rafael, 1970.
_____, “Metronome-Conditioned Speech Retraining for Stuttering,” Behav. Res. Ther., 2.129-150,
1971.
_____, “Studies on the Metronome Effect on Stuttering,” Behav. Res. Ther., 7:197-204, 1969.
Burgess, E. P., “The Modification of Depressive Behaviors,” in Rubin, R. D., and Franks, C. M. (Eds.),
2598
Advances in Behavior Therapy, Academic Press, New York, 1968.
Bushell, D., Wrobel, P. A., and Michaelis, M. L., “Applying ‘Group’ Contingencies to the Classroom
Study Behavior of Preschool Children,” J. App. Behav. Anal., 1:55-61,1968.
_____, “Treatment of Compulsive Behavior by Covert Sensitization,” Psychol. Rec., 16:33-41, 1966.
_____, and Kastenbaum, R., “A Reinforcement Survey Schedule for Use in Therapy, Training, and
Research,” Psychol. Rep., 20:1115-1130, 1967.
Chapman, J., “The Early Symptoms of Schizophrenia,” Brit. J. Psychiat., 112: 225-251, 1966.
Cohen, H. L., and Filipczak, J. A., A New Learning Environment, Jossey-Bass, San Francisco, 1971.
Conn, J. W., and Seltzer, H. S., “Spontaneous Hypoglycemia,” Am. J. Med., 19: 460-478, 1955.
Edelman, R. I., “Operant Conditioning Treatment of Encopresis,” J. Behav. Ther. Exp. Psychiat.,
2:71-73, 1971.
Gath, D., and Gelder, M. G. A., Treatment of Phobias—Desensitization versus Flooding, paper
delivered to the Department of Psychiatry, Temple University Medical School,
November 8, 1971.
Goldstein, A., and Wolpe, J., “Behavior Therapy in Groups,” in Kaplan, H. I., and Sadock, B. J. (Eds.),
Comprehensive Group Psychotherapy, Williams & Wilkins, Baltimore, 1971.
Gottlieb, J. S., Frohman, C. E., Tourney, and Beckett, P. G. S., “Energy Transfer Systems in
Schizophrenia: Adenosine- triphosphate (ATP),” Arch. Neurol. Psychiat., 81:504-
Guerney, B. G., Psychotherapeutic Agents: New Roles for Nonprofessionals, Parents and Teachers,
Holt, Rinehart & Winston, New York, 1969.
Hart, B. M., Allen, K. E., Buell, J. S., Harris, F. R., and Wolf, M. M., “Effects of Social Reinforcement on
Operant Crying,” ]. Exp. Child Psychol., 1:145-153, 1964.
Homme, L. E., “Control of Covenants, The Operants of the Mind,” Psychol. Rec., 15: 501-511, 1965.
Jehu, D., “The Role of Social Workers in Behavior Therapy,” J. Behav. Ther. Exp. Psychiat., 1:5-15,
1970.
Jones, M. C., “A Laboratory Study of Fear: The Case of Peter,” J. Genet. Psychol., 31: 308-311, 1924.
Kimmel, H. D., and Kimmel, E., “An Instrumental Conditioning Method for the Treatment of
Enuresis,” J. Behav. Ther. Exp. Psychiat., 1:121-123, 1970.
Knight, R. P., “Evaluation of the Results of Psychoanalytic Therapy,” Amer. J. Psychiat., ,98:434,
1941.
Lang, P. J., “Behavior Therapy with a Case of Nervous Anorexia,” in Ullman, L. P., and Krasner, L.
(Eds.), Case Studies in Behavior Modification, Holt, Rinehart & Winston, New York,
1965.
Lang, P. J., Lazovik, A. D., and Reynolds, “Desensitization, Suggestibility and Psychotherapy,” J.
Abn. Psychol., 70:395- 402, 1965.
Lang, P. J., Melamed, B. G., and Hart, J., “A Psychophysiological Analysis of Fear Modification Using
an Automated Desensitization Procedure,” J. Abn. Psychol., 76: 221-234, 1970.
Lindsley, O. R., “An Experiment with Parents Handling Behavior at Home,” in Fargo, G. A.,
2600
Behrens, C., and Nolan, P. (Eds.), Behavior Modification in the Classroom,
Wadsworth Publ. Co., Belmont, Calif., 1970.
Lomont, J. F., Gilner, F. H., Spector, N. J., and Skinner, K. K., “Group Assertion Training and Group
Insight Therapies,” Psychol. Rep., 25:463-470, 1969.
Lovaas, O. I., Schaffer, B., and Simmons, J. Q., “Building Social Behavior in Autistic Children Using
Electric Shock,” J. Exp. Stud. Pers., 1:99-109, 1965.
Madsen, C. H., “Positive Reinforcement in the Toilet Training of a Normal Child: A Case Report,” in
Ullman, L. P., and Krasner, L. (Eds.), Case Studies in Behavior Modification, Holt,
Rinehart & Winston, New York, 1965.
Marks, I. M., and Boulougeris, J. C., “Implosion (Flooding)—A New Treatment for Phobias,” Brit.
Med. J. (June 1969) 1:721-723.
_____, _____, and Mahset, P., “Superiority of Flooding (Implosion) to Desensitization for Reducing
Pathological Fear,” Behav. Res. Ther., 9:7-16, 1971.
Marquis, J. N., “Orgasmic Reconditioning: Changing Sexual Object Choice through Controlling
Masturbation Fantasies,” J. Behav. Ther. Exp. Psychiat., 1:263-271, 1970.
Mealiea, W. L., and Nawas, M. M., “The Comparative Effectiveness of Systematic Desensitization
and Implosive Therapy in the Treatment of Snake Phobia,” J. Behav. Ther. Exp.
Psychiat., 2:85-94, 1971.
Miller, N. E., Hubert, E., and Hamilton, J., “Mental and Behavioral Changes Following Male
Hormone Treatment of Adult Castration Hypogonadism and Psychic Impotence,”
Proc. Soc. Exp. Biol. Med., 38:538, 1938.
Moore, N., “Behavior Therapy in Bronchial Asthma: A Controlled Study,” J. Psychosom. Res., 9:257-
Neale, D. H., “Behavior Therapy and Encopresis in Children,” Behav. Res. Ther., 1: 139-149, 1963.
Osgood, C. E., “Meaningful Similarity and Interference in Learning,” J. Exp. Psychol., 38:132, 1946.
Parrino, J. J., George, L., and Daniels, A. C., “Token Control of Pill-Taking Behavior in a Psychiatric
Ward,” J. Behav. Ther. Exp. Psychiat., 2:181-185, 1971.
Patterson, G. R., “Behavioral Intervention Procedures in the Classroom and the Home,” in Bergin,
A. E., and Garfield, S. L. (Eds.), Handbook of Psychotherapy and Behavior Change,
John Wiley, New York, 1970.
Paul, G. L., “Behavior Modification Research: Design and Tactics,” in Franks, C. M. (Ed.), Behavior
Therapy: Appraisal and Status, McGraw-Hill, New York, 1969.
_____, Insight versus Desensitization in Psychotherapy, Stanford University Press, Stanford, 1966.
_____, and Shannon, D. T., “Treatment of Anxiety through Systematic Desensitization in Therapy
Groups,” J. Abn. Psychol., 71:124-135, 1966.
Pavlov, I. P., Conditioned Reflexes (Tr. By Anrep, G. V.), Liveright, New York, 1927.
Risley, T. R., and Hart, B., “Developing Correspondence between the Non-Verbal and Verbal
Behavior of Preschool Children,” J. App. Behav. Anal., 1:267-281, 1968.
Rubin, L. S., “Pupillary Reflexes as Objective Indices of Autonomic Dysfunction in the Differential
Diagnosis of Schizophrenic and Neurotic Behavior,” J. Behav. Ther. Exp. Psychiat.,
1.185-194, 1970.
2602
Salter, A., Conditioned Reflex Therapy, Creative Age, New York, 1949.
Salzer, H. M., “Relative Hypoglycemia as a Cause of Neuropsychiatric Illness,” J. Nat. Med. A., 58:12,
1966.
Schaefer, H. H., and Martin, P. L., Behavioral Therapy, McGraw-Hill, New York, 1969.
Scrignar, C. B., “Food as the Reinforcer in the Outpatient Treatment of Anorexia Nervosa,” ].
Behav. Ther. Exp. Psychiat., 2:31-36, 1971.
Semans, J. H., “Premature Ejaculation: A New Approach,” South Med. J., 4.9:353, 1956.
Serber, M., “Shame Aversion Therapy,” J. Behav. Ther. Exp. Psychiat., 1:213-215, 1970.
Sherrington, C. S., Integrative Action of the Nervous System, Yale University Press, New Haven,
1906.
Sloane, R. B., Cristol, A. H., Yorkston, N. J., Wolpe, J., and Freed, H., Psychotherapy and Behavior
Therapy for Neuroses: A Comparative Study, in print.
Sulzer, E. S., “Behavior Modification in Adult Psychiatric Patients,” in Ullman, L. P., and Krasner, L.
(Eds.), Case Studies in Behavior Modification, Holt, Rinehart & Winston, New York,
1965.
Upper, D., and Newton, J. G., “A Weight-Reduction Program for Schizophrenic Patients on a Token
Economy Unit: Two Case Studies,” J. Behav. Ther. Exp. Psychiat., 2.113-115, 1971.
Wacner, B. R., and Paul, G. L., “Reduction of Incontinence in Chronic Mental Patients: A Pilot
Project,” J. Behav. Ther. Exp. Psychiat., 1:29-37, 1970.
Wetzel, R., “Use of Behavioral Techniques in a Case of Compulsive Stealing,” J. Consult. Psychol.,
30:367-374, 1966.
Willoughby, R. R., “Some Properties of the Thurston Personality Schedule and a Suggested
Revision,” J. Soc. Psychol., ,3:401, 1932-
Wolpe, J., “The Discontinuity of Neurosis and Schizophrenia,” Behav. Res. Ther., 8: 119-187. 1970.
_____, “Neurotic Depression: Experimental Analog, Clinical Syndromes, and Treatment,” Am. J.
Psychother., 25:362-368, 1971.
_____, The Practice of Behavior Therapy, Pergamon Press, New York, 1969.
_____, and Lang, P. J., A Fear Survey Schedule, Educational and Industrial Testing Service, San Diego,
1969.
Wolpin, M., and Raines, J., “Visual Imagery, Expected Roles and Extinction is Possible Factors in
Reducing Fear and Avoidance Behavior,” Behav. Res. Ther., 4:25-37, 1966.
2604
Notes
[1] It should be noted that a great many cases of asthma, migraine, and other “psychosomatic” illnesses
have purely somatic etiologies.
2606
Chapter 44
Abraham Edel
has been little of what would itself be most desirable, cooperation on shared
problems.
That there are many problems in common is clear enough from current
literature. An obvious one lies in the field of value theory. Moral philosophy
directly seeks firm bases for guiding practice, while psychiatry not only seeks
scientific grounds for judging mental health but also is pressed to show that
its conception of mental health does not smuggle in current social standards.
Other common problems concern conceptions of the human being and
disputes about whether the methods that have proved so successful in the
physical sciences can be extended to human action, and psychiatry here is
about the relation of body and mind. Frequently these presuppositions are
cast as reality claims—for example, in psychiatry that the unconscious is a
reality and not a fiction, or that human reality lies in the phenomenological
approach these shared problems following the order indicated and then
conclude with some reflections on the nature of the philosophical activity
involved. After all, there has been controversy not only about what
separation of fact and value (such as, G. E. Moore). This separation has often
relations of the scientific and the ethical. Major energies in philosophy and
2608
status of sheer fiat and to make them responsible to knowledge. Let us
needs, of what is normal and abnormal. The clearest root values in medicine
are the undesirability of pain and of the inability to function. These get
expanded and articulated into an ideal of health as we acquire knowledge of
men’s needs (Edel, ch. 6). The logic of “need” involves a value reference; for
example, even tissue needs imply that if they are not satisfied (e.g., water,
important to note that such knowledge may extend into social conditions for
given states of society, so that a medical critique of social institutions
becomes possible. Thus, the ideal of public health makes possible a moral
pollution. Such judgments are still medical, but as critiques they are only
partial. For they cannot determine that other values may not overweigh the
risks involved: they cannot decide whether to risk a 5 per cent increase in the
incidence of cancer to assure a tremendous increase in electrical ground that
as far as they can on the basis of the knowledge that has been acquired. In
render them more determinate, but it cannot settle them completely for all
kinds of cases.
help such moral judgment because the scope of its established knowledge is
less extensive. But where its knowledge exists we can see the same process of
brain damage to criticize the use of certain drugs and additives, it is operating
with the minimal value criteria given above. Where it brings its knowledge of
the conditions that beget such phenomena as hysterical blindness or psychic
Such knowledge and value judgment are often generalized through the
without end has centered around these concepts. Some insist that their
scientific meaning must be cast as a statistical norm: to judge the normal as
2610
better than the abnormal simply smuggles in conformity to currently
dominant value patterns. Others argue contrariwise that normality means
analysis of these problems is required, but the shift should definitely be such
applies, rather than wholesale argument for one or another general model
If philosophy can help psychiatry in this way, psychiatry can repay the
debt in many different ways. Thus, moral philosophy long remained stuck
with the assumption that a man can get a correct account of his own basic
values only by introspection. When two men thus find themselves in ultimate
value disagreement—one respects all human beings, the other only his own
group or race and regards the rest of humanity as simply a means —there is
no further basis of judging between them (Edel, ch. 3). Here psychiatry, with
opposing impulse. These concepts do not settle issues of moral conflict but
2612
theories of the source and operations of conscience and of the moral
emotions generally (shame, guilt, pride, and so forth; cf. Fromm, Lewis, Lynd,
Piers and Singer). For here, too, it has strengthened the interest in genetic
accounts and removed the apparent intuitive authority that older moral
philosophies assigned to these all too human processes. Such contributions,
which are numerous and multiple in their impact, do not mean basing ethics
How to understand man and his behavior is the second set of shared
and history. Psychiatry is plunged directly into these problems, for as part of
we take “psychiatry” literally as the cure of the psyche, and understand the
and abstract thinking at the other, we might even say that medicine is a part
of psychiatry!
work out some model of the human being. Suggestions are sought from the
many fields whose data and methods are brought to bear upon the inquiry.
then grappled with the consequences for traditional notions of freedom and
forth. Moreover, in the selection of its sources —in what it follows as well as
what it ignores —psychiatry often enshrines specific models of man that are
made the basis of its directives in therapy. Thus, psychiatry at a given time
may have a particular primary focus corresponding to the model of man that
it employs and to the area of human knowledge that has impinged strongly
upon it.
2614
thereby to others. But the central philosophical contribution here is to
evolutionary. The second is the demand for seeing man not merely as
whole, and about the bases and objects of loyalty and obligation rest on
presuppositions about what selves are, how they are related, and what
evidence is required.
focus. The Freudian view focuses on the internal economy of the individual
and the career of instinctual demands and energies. Other people are objects
assessed by the extent to which they satisfy these demands. Freud even
sought to extend this view to group life, tracing the changes in libidinal ties as
needs for the larger group organization emerged. In general, this is a broad
relation of men. In such approaches both what goes on within the individual
and what goes on in society are now dependent phenomena reflecting the
character of a man’s relation to the cosmos (as in religion, for example) might
be seen as a reflection of the type and quality of interpersonal relations. Focus
2616
on groups and institutions, as in sociological approaches, sees the individual
in his whole development as the intersection of roles in the ongoing life of the
society. At times it threatens to reduce the individual to a point of intersection
conditions to provide raw materials for the social shaping. Finally a historical
focus sets all problems of understanding man in terms of a changing process
psychological schools and social and historical disciplines. In the long run
these solutions must be empirical —which model of man will prove more
fruitful in inquiry and in therapeutic guidance. But there are also possibilities
of integrated models, not simply piling model on model in an intellectual
compromise. But most of all, as we shall see shortly, to have related the
models to the different disciplines in the study of man can make us sensitive
to their limited and possibly changing character. For it scarcely makes
which itself had grown as the scientific approach moved on from physics and
biology into the psychological and social sciences. Different philosophical
strategics were employed. Some simply took a moral stand and reiterated the
demand for free will (Berofsky) as the necessary condition for human
responsibility (echoing Kant’s dictum that “I could have acted otherwise” is a
quasi dualism between “action” and “behavior” (Kenny) in which the former
inauthentic or bad faith (Sartre).” Still others adopted the sharp distinction
between the perspective of the spectator and that of the agent, hoping to
show that the legitimate determinism of the spectator’s view is misapplied in
Parallel strategies are found in psychiatric theory with the same end in
view—that of restoring a kind of active and responsible dignity to the human
product of causal drives and forces. It is argued that the patient should not be
2618
emergence of constructive capacities. A new respect is even proposed for the
active forces at work in neurosis, since this represents an effort within a given
the basis for ruling scientific approaches out of bounds in the study of man.
these questions. Such a reckoning obviously has already led us into the basic
methodological controversies about the character and limits of scientific
In the first place the picture of science and its method has undergone
matter and spirit, the logic of measurement has shown that types of order
constitute a whole range of varying strength and degree; the' quest for order
cannot be barred from any domain on dogmatic grounds, but what kind of
receive readings that are not necessarily anticipated or predicted but that will
thereafter aid in control within a given delimited field. And such changes hold
for the physical sciences and their related technologies, for example,
meteorology, space science, geology; they are not novel issues when they
The growth of the social sciences and their methods has done much to
diminish the dogmatic picture of science as a whole. Although behaviorist
2620
for some intellectual purposes. But it cannot be absolutized, since there can
be an observer’s study of the agent at work. How far prediction is possible
to render decision logically inaccessible to scientific study, they have not been
wholly successful. At best what has been shown is that decision can always be
looked at from the agent’s perspective in the context of action. Thus, the
occurrence of action and decision need not constitute absolute breaks in the
that has expanded its self-picture in the light of the growth of contemporary
which questions of general direction are not yet resolved and can only await
the progress of inquiry. For example, we cannot tell how far there will emerge
an integrated model of man to supplant the multiplicity of models that now
a way of looking sharply at one phase of existence that shuts out other phases.
But if the result is simply different selective pictures, we cannot bar the
conflicting picture in which the viewings are incompatible and would distort
incompatibles, but not only do we shuttle rapidly from one to the other but a
unified theory does not seem out of reach.) Even more, types of integration
may come in different patterns: the victory of one model by successful
reduction of the rest, the discovery of fresh terms in which the others are
from the others, and so forth. Certainly the rapid growth of the physical
antecedent dogmatic decision about the forms that interrelation will take.
Within psychiatry there has been ample discussion about the extent to
which inquiry is scientific. No question seems to arise about experiments in
physiology and pharmacology, but the situation of psychoanalysis is
whether there are low-level laws—for example, “Subjects who draw the head
2622
explain adult behavior is to be construed as a kind of temporal “action at a
mental illness (cf. Opler). But this brings with it some of the same
methodological controversies. For example, the phenomenological approach
may interpret culture largely as a system of symbols and use it to look for
basic symbols of the human condition and the structure of the life-world. The
scientific approach will want to see the genetic basis of symbols, how energies
took such form and what causal relations underlie symbolic relations. On a
hoped-for integrated model of man, the meaning of the symbol or the human
act as symbolic can be revealed only in the full cultural, institutional, and
(such as, Ryle). In psychiatry at the moment, the attack is spearheaded by the
theory of mind, or else some theory of the identity of mind and body. Very
often in all of these the debate takes the form of a reality claim. Traditional
sole reality. Psychiatry not merely finds itself arguing that the unconscious is
as real as the conscious, but even has to defend the conscious against the
system and Gerard objects, “That is where you introduce a gremlin, feelings
2624
do not stimulate neurons.” and Alexander replies, “It is observed that the
has had the burden of spanning the dualistic gap, to provide some notion of
Deutsch)."
amount to. For traditional metaphysical systems were cast in terms of reality
claims, each offering its own candidate for the post of the ultimately real. Of
the way the candidate's behave and the policies they adopt when they are
thought (by their supporters) to have won out, there is a definite pattern in
explanation and reduction: those entities are assigned reality that are most
installs the microentities that make a system of the most advanced physics of
presuppositions. All these and other concepts of reality (such as, Hume’s-
phenomenalism) are products of interaction between specific inquiries in the
that have proved successful. That is why the growth of science, the success of
its methods, and its expansion to all areas of inquiry have given such great
then biological form, then historical form; this has involved reconciling the
2626
methods of physics, evolutionary biology, and sociohistorical disciplines, a
task by no means completed (cf. Sellars). Such intrascientific conflicts are the
trespass signs are too busy moving the signs as the forbidden territory is
often blamed for having enshrined the sharp separation of body and mind
(Descartes) carrying with it the sharp separation of method of inquiry in the
debating such issues one is likely to neglect the scientific context of Descartes’
scheme. The strength of his dualism lay in isolating physics from the
interference of the mental, the religious, and the teleological-metaphysical, so
can Galileo be blamed for his choice; as Philip Frank has somewhere pointed
out, it lay not between a simple and a complex physics, but between a simple
physics with a complex theology and a complex physics with a simple
(traditional) theology! Having made his choice, Descartes then projected the
mechanistic program of explaining matter and motion, animal life and all
plated steel between all this and consciousness itself. Although philosophical
be abandoned.
Cartesian, but an expansion of the mental side in such a way as to threaten the
established borders. In short, he added to consciousness, which had
2628
reverberations still continue. There are programs of reduction that maintain
that everything that can be said in terms of the unconscious can be said
equally well without it. Others attempt to apportion the expanded domain of
confused hybrid of the mechanical and the purposive (Peters). We need not
enter into the multiplicity of arguments—logical, empirical, metaphysical,
just a touch of sibling rivalry with consciousness. More typical is the care to
be found, for example, in the 1915 paper on “The Unconscious.” Here Freud
concept that will help explain the range of phenomena that he was so
insightfully reinterpreting. The advance of the problem since then has
followed a typical scientific path, for it consists less in answering the question
in the terms in which it was asked than in weakening, and even transcending,
the types of conflict that they express and in which they play a part. On the
other side of the old divide, consciousness stretches out to bridge the gap by
automatic commitment to the older entities. The problem of the mental and
the physical may yet remain, but the battle of the conscious and the
psychological establishments.
objection is far from fatal that the Freudian unconscious operates purposively
(as in the idea of repressed desires for a goal) and yet interacts causally (as
psychic energies pushing for an outlet). It shows rather that there is an
2630
intermediate domain in human affairs between the clearly purposive and the
borderlands.
philosophical analysis, we get beyond the sheer conflict of reality claims and
come to understand how the mantle of “reality” is the reward waiting for
variables that will turn out to occupy strategic roles in explanation. It is
psychic phenomena? If the latter, does it refer to all psychic phenomena? (But
psychosomatic illness, why not the reverse?) If the principle simply means
that many psychic phenomena spring from the unconscious segment of the
mental, then it would no longer be a basic principle but a secondary
context of the problems from which it emerged, and the way it functions, we
see it in a quite different light. Thus, the principle may have operated first as a
it (feel that way, etc.).” Or the principle may sum up successful lessons in a
second part already sees the first part with a sense of the past. Or again, the
principle of psychic determinism may function in a theoretical attempt to
structure, and so on. All such contexts to which the principle of psychic
2632
determinism may be attached should, of course, be distinguished and
general truth.
the most drastic. It has all the earmarks of a wholesale revolt against the
body and mind, it wants to avoid asking questions about experience in terms
field is strictly accepted in its own terms in the beholding; the relations of its
parts (for example, figure and ground) and the configurations of its elements
are discerned and described. The question of the relation of the
being a spectator to somehow entering into the patient’s world as the patient
sees and lives it. Hence phenomenological case description tends to be rich
and sympathetic, to discover fine nuances in the patient’s world. One would
have expected, however, that in the light of the initial program, the
This is true also for existentialist psychiatry (cf. May, Angel, and
2634
is invariant for human beings. This would contrast with a sociocultural view
However, if the level of search for structure is general enough, it may be that
sociocultural invariants and phenomenological structures converge. But
naturalism would seek the consequences of the shift from animal posture to
man’s upright position, a phenomenological approach would pass over
view of the centrality of standing up in relation to the I and my world and its
sensory relation to the rest of the world. Yet since Straus refers to it as rising
to find the marks of normality within the field. It cannot appeal to different
lines of causation to distinguish the normal from the abnormal, as is done in
—is met with the general argument that the scientist’s measuring is itself
from flickering copies in the human mind. It may be that in the long run
Lukacs’s rebuke to Scheler had a point: when Scheler said we could do a
question of his reality, Lukacs retorted that when the study was done, Scheler
would open the brackets, and there would be the devil standing before him!
philosophical idealism.
2636
philosophy involved in the previous discussion of its relation to psychiatry.
Before going on to this, however, I should like to criticize a quite different
death, for subtle modes of expressing aggression, and for projecting fears and
the doctrine serves as an emotional phoenix ever rising from the ashes. J. O.
social) that the doctrine may have also served (Edel). Thus, Berkeley may
have had the emotional attitude to matter that Wisdom speaks of, but his
cultural, and social—are deemed empty, can one set the projective as the
core. If, however, the thesis is that all philosophy has these psychological
elements, then fresh distinctions would have to be drawn within the
expresses projective and neurotic elements and the kind that is realistic, faces
problems clearly, and so forth. It follows, therefore, that a sound sense of
reflected a state in which philosophy had isolated itself from the contexts of
its problems in the growth of the many fields of human inquiry and the needs
of human direction in practice. Not being simply empirical, and no longer
2638
followed a quite different path. Philosophical ideas and principles do not
constitute an isolated domain developed and certified apart from the realms
that reflect the stage of scientific and social development at given times. To
goals and helps solve the problems of these inquiries. Such clarifying activity
have been organized and inquiry guided, may thus be shaken or even
shattered. New categories—for philosophy may be inventive, sometimes
field and generalizing it— point to fresh modes of inquiry. Indeed, philosophy
in which categories and models taking rise in one area of inquiry, or one
phase of human life, have been generalized, given stricter logical form, and
tried speculatively on other or even all areas of inquiry and human action,
whether descriptive or explanatory or normative and regulative. In this sense
the rapidity of change in all fields, it is not surprising that there will be an
been perhaps more adversely affected, but only because the immediacy of
therapeutic work exerts a greater pressure on it, while philosophy can wait at
2640
leisure for school diseases to run their course! Both have to learn or relearn
Bibliography
Aristotle, On the Soul (Translated by Hett, W. S.), Harvard University Press, Cambridge, 1957.
Ayer, A. J., Language, Truth and Logic, 2nd ed., Dover, New York, 1950.
Bellak, L., et al., “Conceptual and Methodological Problems in Psychoanalysis,” Ann. N.Y. Acad. Sci.,
76:1087, 1096, 1959.
Berofsky, B. (Ed.), Free Will and Determinism, Harper & Row, New York, 1966.
Buber, M., I and Thou (Tr. by Smith, R. G.), T. and T. Clark, Edinburgh, 1937.
Devereux, G., “Normal and Abnormal: The Key Problem of Psychiatric Anthropology,” in Some
Uses of Anthropology: Theoretical and Applied, pp. 23-48, The Anthropological
Society of Washington, Washington, D.C., 1956.
_____, Human Nature and Conduct, Modern Library, New York, 1930.
Edel, A., “The Concept of the Unconscious: Some Analytic Preliminaries,” Phil, of Sci., 31:18-33,
1964.
_____, Ethical Judgment: The Use of Science in Ethics, Free Press Paperback, New York, 1964.
Erikson, E. H., Childhood and Society, Ch. 7, Norton, New York, 1950.
Fenichel, O., The Psychoanalytic Theory of Neurosis, Norton, New York, 1945.
Feuer, L. S., “Anxiety and Philosophy: The Case of Descartes,” Am. Imago, 20:411–449, 1963.
_____, “The Bearing of Psychoanalysis upon Philosophy,” Phil. & Phenomenol. Res., 19:323–340,
1959.
_____, “Lawless Sensations and Categorial Defenses: The Unconscious Sources of Kant’s
Philosophy,” in Hanly, C., and Lazerowitz, M. (Eds.), Psychoanalysis and Philosophy,
International Universities Press, New York, 1971.
2642
Freud, S. (1921), Group Psychology and the Analysis of the Ego, Bantam Books, New York.
_____, (1900), The Interpretation of Dreams, Basic Books, New York, 1965.
_____, (1915), “The Unconscious,” in Collected Papers, Vol. 4, Hogarth, London, 1934.
Hook, S. (Ed.), Dimensions of Mind, New York University Press, New York, 1960.
_____, (Ed.), Psychoanalysis, Scientific Method and Philosophy, New York University Press, New
York, 1959.
Hume, D. (1758), An Inquiry Concerning Human Understanding, Liberal Arts Press, Indianapolis.
Kant, I. (1783), Prolegomena to Any Future Metaphysics, Liberal Arts Press, Indianapolis.
Kenny, A., Action, Emotion and Will, Routledge and Kegan Paul, London, 1963.
Klein, G. S., “Consciousness in Psychoanalytic Theory: Some Implications for Current Research in
Perception,” J Am. Psychoanal. A., 7, 1959.
Kruse, H. D. (Ed.), Integrating the Approaches to Mental Disease, p. 68, Hoeber-Harper, New York,
1957.
Kubie, L., “The Scientific Problems of Psychoanalysis,” in Wolman, B. B., and Nagel, (Eds.),
Scientific Psychology, Ch. 17, Basic Books, New York, 1965.
Lazerowitz, M., The Structure of Metaphysics, Routledge and Kegan Paul, London, 1955.
Lukacs, G., “Existentialism,” in Sellars, R. W, McGill, V. J., and Farber, M. (Eds.), Philosophy for the
Future: The Quest of Modern Materialism, p. 574, Macmillan, New York, 1949.
Lynd, H. M., On Shame and the Search for Identity, Harcourt Brace World, New York, 1958.
Machover, K., Personality Projection in the Drawing of the Human Figure, p. 40, Charles C Thomas,
Springfield, Ill., 1949.
May, R., Angel, E., and Ellenberger, F. (Eds.), Existence: A New Dimension in Psychiatry and
Psychology, Basic Books, New York, 1958.
Nagel, E., The Structure of Science, Harcourt Brace World, New York, 1961.
Opler, M. (Ed.), Culture and Mental Health, Macmillan, New York, 1959.
Peters, R. S., The Concept of Motivation, Routledge and Kegan Paul, London, 1958.
Piers, G., and Singer, M. B., Shame and Guilt, Charles C Thomas, Springfield, Ill., 1953.
Rapaport, D. (Ed.), Organization and Pathology of Thought, Columbia University Press, New York,
1951.
_____, The Structure of Psychoanalytic Theory, International Universities Press, New York, i960.
Ryle, G., The Concept of Mind, Hutchinson’s University Library, London, 1949.
Sartre, J. P., Being and Nothingness (Tr. by Barnes, H.), Part 1, ch. 2 and Part 4, ch. 1, Philosophical
Library, New York, 1956.
2644
Sellars, R. W., McGill, V. J., and Farber, M. (Eds.), Philosophy for the Future: The Quest of Modern
Materialism, Macmillan, New York, 1949.
Straus, E. W., “Psychiatry and Philosophy,” in Natanson, M. (Ed.), Psychiatry and Philosophy,
Springer-Verlag, New York, 1969.
Sullivan, H. S., The Interpersonal Theory of Psychiatry, Norton, New York, 1953.
Szasz, T. S., The Myth of Mental Illness, Hoeber-Harper, New York, 1961.
Van Den Berg, J. H., The Phenomenological Approach to Psychiatry, Charles C Thomas, Springfield,
Ill., 1955.
Wegrocki, H. G., “A Critique of Cultural and Statistical Concepts of Abnormality,” J. Abnorm.& Soc.
Psychol., 34:166-178, 1939.
Wisdom, J. O., The Unconscious Origin of Berkeley’s Philosophy, Hogarth, London, 1953.
Notes
[1] There is not complete uniformity in this. For example, while Brenner and Monroe give the principle
a basic role, Fenichel does not even include “psychic determinism” in his extremely rich
index!
Paul Ricoeur
thought that claim to be part of psychiatry are innumerable, but also because
the ethical implications themselves are of such a diverse nature that they are
of the relations between psychiatry and ethics in the most radical terms. At
negation of traditional moral beliefs. But the real problems, those that surpass
ordinary banality, only take shape beyond this first shock. When we no longer
resist, when we no longer seek to justify ourselves, we discover what is
2646
essential—namely, that we must not ask psychiatry and psychoanalysis for an
alternative answer to unchanged questions, but for a new manner of asking
moral questions.
object that Freud’s writings on art, morals, and religion constitute the
extension of individual psychology to collective psychology and, beyond
competent, the highest realm of human existence. Certainly it was during the
last part of his life that Freud’s great texts about culture accumulated: The
Future of an Illusion (1927); Civilization and Its Discontents (1930); Moses and
“Gradiva” dates from 1907; Leonardo da Vinci and a Memory of His Childhood
from 1910; Totem and Taboo from 1913; “Thoughts for the Times on War and
1914; Group Psychology and the Analysis of the Ego from 1921; “A Neurosis of
Ego and the Id, and, above all, the “Papers on Metapsychology.”
The truth of the matter is that these works are not just “applied”
very beginning about art, ethics, and religion, not as a secondary extension of
The question is all the more legitimate in that the first intersection
occurred to me. I have found love of the mother and jealousy of the father in
my own case, too, and now believe it to be a general phenomenon of early
childhood. ... If that is the case, the gripping power of Oedipus Rex, in spite of
all the rational objections to the inexorable fate that the story presupposes,
becomes intelligible, and one can understand why later fate dramas were
such failures. . . . but the Greek myth seizes on a compulsion which everyone
2648
recognizes because he has felt traces of it in himself. Every member of the
audience was once a budding Oedipus in fantasy, and this dream-fulfillment
played out in reality causes everyone to recoil in horror, with the full measure
of repression which separates his infantile from his present state.” In one fell
swoop Freud claims to have found the interpretation for a private dream and
a public myth. From its very beginning psychoanalysis is both a theory of
extend concepts that could have first been elaborated within a sort of
and silences, of speaking and listening, belongs to what we can call the order
this dialectic.
2650
An “Economic” Model of the Phenomenon of Culture
here of opposing civilization and culture to each other. This refusal to use a
distinction that seems likely to become classic is itself very enlightening.
There is not, on the one hand, a utilitarian enterprise to dominate the forces
which can make sense from a point of view other than that of psychoanalysis,
about culture.
that The Future of an Illusion opens. Culture, Freud notes, began with the
But only an economic interpretation can make sense of this task. Here
we reach the unitary point of view that not only holds together all Freud’s
point of inflection that opens it to the tragic within culture, the essay
advances with a calculated simplicity. Culture’s economy appears to coincide
with what we could call a general “erotics.” The goals sought by the individual
diverging figures of the same Eros. It is the same “erotics” that binds group
together and that brings an individual to look for pleasure and flee suffering
—the triple suffering that the world, his body, and other men inflict upon him.
2652
Culture’s development is, as is the growth of an individual from infancy to
adulthood, the fruit of Eros and Ananke, of love and work. It is the fruit of love
It seems then that it is the same Eros that animates the search for
individual happiness and that wants to unite men into ever vaster groups. But
the paradox quickly appears: as a struggle against nature, culture gives men
power heretofore conferred on the gods, but this resemblance to the gods
could undoubtedly account for certain tensions between the individual and
society solely on the basis of this general “erotics,” but we cannot account for
the grave conflict that makes culture tragic. It is easy, for example, to explain
that family ties resist being expanded to larger groups. For every adolescent
the passage from one circle to the other necessarily appears as rupturing the
oldest and the narrowest tie. We understand, too, that something about
feminine sexuality resists this transfer of the privately sexual to the libidinal
energies of the social tie. We can go even further in the direction of conflicting
inextricable as these conflicts may be, they still do not constitute true
antagonism. We can even say that, on the one hand, the libido resists with all
its inertial force the task that culture imposes upon it to abandon all its
previous positions, and, on the other hand, that the libidinal tie of society so
feeds on the energy deducted from sexuality as to menace it with atrophy. But
all this is so little “tragic” that we might even dream of a sort of truce or
settlement between the individual libido and the social tie.
So the question arises again: why does man fail to be happy? Why is
It is here that the analysis changes direction: consider what is laid down
for man, an absurd commandment, love his neighbor as himself; an
impossible demand, love his enemies; a dangerous order that squanders love,
rewards the wicked, and leads to loss for anyone imprudent enough to apply
it. But the truth that is hidden behind this unreasonable imperative is the
The element of truth behind all this, which people are so ready to disavow,
is that men are not gentle creatures who want to be loved, and who at
most can defend themselves if they are attacked; they are, on the contrary,
creatures among whose instinctual endowments is to be reckoned a
powerful share of aggressiveness. As a result, their neighbor is for them
not only a potential helper or sexual object, but also someone who tempts
them to satisfy their aggressiveness on him, to exploit his capacity for
work without compensation, to use him sexually without his consent, to
seize his possessions, to humiliate him, to cause him pain, to torture and to
2654
kill him. Homo homini lupus, [p. 111].
The instinct that so perturbs the relation of man to man and that
recognized, the death instinct, the primordial hostility of man for man.
With the introduction of the death instinct the whole economy of the
essay is recast. While the “social erotic” could consistently appear to be the
culture can no longer appear as the extension of a conflict that could be better
silent and ambiguous at the level of an individual life and psyche. Certainly
Freud had forged his doctrine of the death instinct as early as 1920 (Beyond
and so forth). In 1930 Freud saw more clearly that the death instinct
remained a silent instinct “in” the living being and that it only became
sense that we said above that the interpretation of culture becomes the
revelator of the antagonism of instincts.
better why the death instinct is, in the psychological scheme of things, both an
another. It is mingled with Eros when it takes the form of sadism, and we
doubling the object libido, sometimes overloading the narcissistic ego libido.
extent that Eros serves first to unite the individual to himself, then the ego to
its object, and finally individuals into ever larger groups. As it is repeated
from level to level, the struggle between Eros and death becomes more and
more manifest and attains its complete meaning only at the level of culture:
2656
But this is not all, for in the last chapters of Civilization and Its
death instinct, the interpretation of culture and the dialectic of instincts were
check. The cultural interpretation is pushed so far that Freud can affirm that
the express intention of his essay was “to represent the sense of guilt as the
happiness due to the reinforcement of this feeling. He cites the famous words
If, therefore, the sense of guilt is the specific means by which civilization
holds aggressivity in check, it is not surprising that Civilization and Its
that it turns back against the ego. But its whole “economy” only appears when
him to watch over it, like a garrison in a conquered city” (pp. 123—124).
Thus the economic, and, if we may say so, the structural interpretation
of the sense of guilt depends upon a cultural perspective, and it is only within
the framework of the structural interpretation that the diverse partial genetic
murder of the primeval father and the instituting of remorse can be situated
economic interpretation:
Whether one has killed one’s father or has abstained from doing so is not
the really decisive thing. One is bound to feel guilty in either case, for the
sense of guilt is an expression of the conflict due to ambivalence, of the
eternal struggle between Eros and the instinct of destruction or death.
This conflict is set going as soon as men are faced with the task of living
together. So long as the community assumes no other form than that of the
family, the conflict is bound to express itself in the Oedipus complex, to
2658
establish the conscience and to create the first sense of guilt. When an
attempt is made to widen the community, the same conflict is continued in
forms which are dependent on the past; and it is strengthened and results
in a further intensification of the sense of guilt. Since civilization obeys an
internal erotic impulsion which causes human beings to unite in a closely-
knit group, it can only achieve this aim through an ever-increasing
reinforcement of the sense of guilt. What began in relation to the father is
completed in relation to the group. If civilization is a necessary course of
development from the family to humanity as a whole, then—as a result of
the inborn conflict arising from ambivalence, of the eternal struggle
between the trends of love and death—there is inextricably bound up with
it an increase of the sense of guilt, which will perhaps reach heights that
the individual finds hard to tolerate. [pp. 132-133]
Examining these two texts has not yet told us anything specific about
ethics, but a framework has been assembled wherein the ethical problem can
considered as a whole. We can say two contrary things about this theory of
culture. On the one hand, to the degree that all processes of culture are
viewed from the economic point of view, we can say that psychoanalysis is a
reductive theory. We will consider this interpretation at the end of this essay.
But we must also say in an inverse sense that the supremacy of the economic
point of view could only be established by the intermediary of an
language to those forces that by themselves are mute. The conflicts between
instincts that are at the root of these cultural phenomena can only be
approached, in effect, within the cultural sphere where they find an indirect
expression. The economics passes through a hermeneutic.
we said at the beginning of this chapter, when psychoanalysis turns its gaze
culture.
2660
adds a new topography (id, ego, superego) to his first topography
(unconscious, preconscious, conscious) that allows him to account for the
ethical phenomenon are not so much places as roles in a personology. Ego, id,
and superego are expressions that denote the relation of the personal to the
anonymous and suprapersonal in the founding of the ego. The very question
becoming conscious, that is, lucid, present to oneself, and attentive to reality.
According to the title of one of the chapters of The Ego and the Id, the second
topography has its end in “The Ego’s Relations of Dependence” (Chapter 5).
These relations of dependence are master-slave relations: dependence of the
ego on the id; dependence of the ego on the world; dependence of the ego on
the superego? Freud gives a very revealing synonym for it in the third chapter
of The Ego and the Id. He says, “ego ideal or superego.” The New Introductory
experience. It resists our actions like Socrates’ demon, which says “No,” and
condemns us after the action. Thus not only is the ego watched, but also it is
mistreated by its inner and superior other. We need not emphasize that these
structure of obligation, but from clinical experience. This split between the
observer and the rest of the ego is revealed in a greatly exaggerated way in
As for the ideal it is described as follows: the superego “is also the
vehicle of the ego ideal by which the ego measures itself, which it emulates
2662
and whose demand for ever greater perfection it strives to fulfill” (pp. 64-65).
At first glance it may seem that no pathological model presides over this
to, of forming oneself in the image of, of having the same content as a model?
The preceding text does permit such an analysis. But Freud is always more
attentive to the character of constraint than to the spontaneity of the
responses that the ego gives to the demands of the superego. Moreover,
placed with the two preceding traits, this third characteristic takes on a
coloration that we can readily call pathological in the clinical and the Kantian
sense of the word. Kant spoke of the “pathology of desire”; Freud speaks of
idealization.
the latter. In effect, the ego oppressed by the superego is in a situation vis-a-
vis this internal stranger analogous to the ego confronted by the pressure of
its desires. In terms of the superego we are “foreign” to ourselves. Thus Freud
We must not ask of psychoanalysis what it cannot give: the origin of the
ethical problem, its founding principle; but what it can give: the source and
such as the father? The advantage of a thought that begins by rejecting the
primordial character of the ethical ego is that it displaces our attention to the
process of interiorization by which the external becomes internal. That way
not only the proximity with Nietzsche is discovered, but also the possibility of
limitation of his point of view is the counterpart of its coherence. If the ethical
phenomenon first appears in a wounding of desire, it is justifiable by a
general erotics, and the ego, prey to its diverse masters, again falls under an
description, in turn, calls for an explanation that can only be genetic. If, in
the influence of parents, educators and so on, we learn still more of its
significance if we turn to those who are its sources” (p. 67). This declaration
2664
character of the cogito or its ethical dimension. Genetic explanation takes the
For one thing the proposed genesis does not constitute an exhaustive
explanation. The genetic explanation reveals a source of authority —the
are the same and it becomes the vehicle of tradition and all the time-resisting
One thing that strikes every reader of Freud’s first writings is the
lightning character of his discovery of the Oedipus complex, which was
complex receives its intimately personal character from the discovery that
Freud made through his own self-analysis. But at the same time its general
aspect of the Greek legend, the myth, in return, attests to the fatality that
adheres to the individual experience. Perhaps it is within this global intuition
could exhaust) of all the Freudian attempts to articulate the ontogenesis, the
because within him lies “the obscure memory that he himself had meditated
the same deed against his father because of his passion for his mother” (p.
2666
224). This is a brilliant and decisive comparison, for if Oedipus reveals the
aspect of destiny, Hamlet reveals the aspect of guilt attached to this complex.
It was not by accident that as early as 1897, Freud was citing Hamlet’s words,
Now what gives the individual’s secret a universal destiny and an ethical
character, if not the passage through institutions? The Oedipus complex is the
progressive renunciation of it” (p. 210). Thus the repression that belongs to
everyone’s history of desire coincides with one of the most formidable
cultural institutions, the prohibition of incest. The Oedipus complex poses the
great conflict between civilization and instincts that Freud never stopped
commenting on from “ ‘Civilized’ Sexual Morality and Modern Nervous
Illness” (1908) and Totem and Taboo (1913), to Civilization and Its
point.
obsessional neurosis. But, in truth, Totem and Taboo only provides the
of human history.
and the history of the species is furnished by the structural kinship between
this parallel: “(1) the fact that the prohibitions lack any assignable motive; (2)
the fact that they are maintained by an internal necessity; (3) the fact that
they are easily displaceable and that there is a risk of infection from the
prohibited object; and (4) the fact that they give rise to injunctions for the
performance of ceremonial acts” (pp. 28-29). But the most important reason
and recalls Saint Paul, Saint Augustine, Kierkegaard, and Nietzsche. Taboo
puts us in a place where the forbidden is attractive because it is forbidden,
2668
(p. 32). The primitive clearly presents the psychic life’s ambivalence. What
finally appears in fear is the force of desires and the “indestructibility and
agencies. The father figure in the Oedipus complex and the passage from
biological relations to “group kinship” in totemic organization require an
expression of this authority more than its ultimate origin. The psychology of
temptation to which the theme of emotional ambivalence belongs only makes
more evident the lack of an original dialectic of desire and law. What is left
In order to fill this gap Freud had to posit a real Oedipus complex at the
murder of the father figure, which brings into play not only an old-fashioned
force. In mythical terms how could the prohibition against “fratricide” arise
from a “parricide”? In unmasking the father figure in the alleged totem, Freud
has only made more acute the problem that he wanted to resolve, namely, the
of the father there is no prohibition, and without the “parricide” there would
be no stopping of the jealousy. But these two ciphers of jealousy and parricide
are still ciphers for violence. Parricide puts a stop to jealousy, but what
contract with the father, but this only explains at most the prohibition against
killing, not the prohibition against incest. That requires another contract, a
convenant between the brothers. By this pact they decide not to repeat their
jealousy of the father; they renounce that violent possession that was the
motive for the murder. “Thus the brothers had no alternative, if they were to
live together, but—not, perhaps, until they had passed through many crises—
to institute the law against incest, by which they all alike renounced the
2670
women whom they desired and who had been their chief motive for
dispatching their father” (p. 144). And a little further on: “In thus
guaranteeing one another’s lives the brothers were declaring that no one of
them must be treated by another as their father was treated by them all
fate. To the religiously-based prohibition against killing the totem was now
added the socially-based prohibition against fratricide” (p. 146). With this
renunciation of violence under the spur of discord, we are given all that is
necessary for the birth of institutions. The true enigma of law is fratricide, not
parricide. With the symbol of the pact among the brothers, Freud has met the
3. We are now ready to take the last step, that is, integrating the clinical
description and the genetic explanation in an economic point of view such as
we have presented at the beginning of this essay at the level of the global
phenomenon of culture.
effort of the new theory of agencies is to inscribe authority within the history
putting the Oedipus event and the advent of the superego into relation and of
stating this relation in economic terms.
2672
identification comes to the fore: “Identification is known to psychoanalysis as
the earliest expression of an emotional tie with another person.” This is how
a model is emphasized, but this relation itself divides into a wish to he like
and a wish to have and to possess. “It is easy to state in a formula the
distinction between an identification with the father and the choice of the
father as an object. In the first case one’s father is what one would like to he,
and in the second he is what one would like to have. The distinction, that is,
depends upon whether the tie attaches to the subject or to the object of the
ego. The former kind of tie is therefore already possible before any sexual
identification endeavours to mould a person’s ego after the fashion of the one
that has been taken as a model” (p. 106). Freud never more vigorously
synthesis of The Ego and the Id. The question that dominates its third chapter
is: how can the superego, which from a historical point of view stems from
parental authority, derive its energies from the id according to an economic
is sublimation from the point of view of effects, and introjection from the
appears as a postulate in the strong sense of the term, a demand that we must
accept from the beginning. Consider the following text:
When it happens that a person has to give up a sexual object, there quite
often ensues an alteration of his ego which can only be described as a
setting up of the object inside the ego, as it occurs in melancholia; the exact
nature of this substitution is as yet unknown to us. It may be that by this
introjection, which is a kind of regression to the mechanism of the oral
phase, the ego makes it easier for the object to be given up or renders that
process possible. It may be that this identification is the sole condition
under which the id can give up its objects. At any rate the process,
especially in the early phases of development, is a very frequent one, and it
makes it possible to suppose that the character of the ego is a precipitate
(Niederschlag) of abandoned object-cathexes and that it contains the
history of those object-choices. [p. 29]
libido, at least in the economic sense of a regression from object libido to the
2674
“When the ego assumes the features of the object, it is forcing itself, so to
speak, upon the id as a love-object and is trying to make good the id’s loss by
saying, ‘Look, you can love me too—I am so like the object!’ ” (p. 30).
question arises, and deserves careful consideration, whether this is not the
universal road to sublimation, whether all sublimation does not take place
through the mediation of the ego, which begins by changing sexual object-
libido into narcissistic libido and then, perhaps, goes on to give it another
Freud’s whole effort from here on is to make the identification with the
new. But this negative response to a question that has not itself been affected
prescribes nothing follows first from its theoretical status, then from its
a therapeutic technique.
pleasures and pains. Therefore, we cannot expect anything else from this
enterprise than a critique of authenticity. Above all, we cannot ask it for what
2676
falsifications of desire that inhabit the moral life. We have not founded a
political ethic, or resolved the enigma of power, because we have discovered
—as, for example, in Group Psychology and the Analysis of the Ego—that the
and pains in our lives. Because psychoanalysis cannot pose the question of
moral legitimation, it must limit itself to a sort of empty marking of the place
instinct is working on a higher level, although we must say that the energy
invested in new objects is the same energy that was formerly invested in a
sexual object. The economic point of view only accounts for this connection,
not for the new value promoted by this process. One postpones the difficulty
by speaking of socially acceptable goals and objects, for social utility is a cape
of ignorance thrown over the problem of value raised by sublimation.
accused in the first place. This is why it is fruitless to ask psychoanalysis for
an immediate ethic without conscience first having changed its position as
regards itself. Hegel saw this before Nietzsche and Freud. In criticizing the
recognize its own finitude, its equality with the judged conscience, so that the
depth that the catharsis of desire is nothing without the catharsis of the
judging conscience.
only from its theoretical status, or even from its discoveries concerning
morality, but also from its technique in that it is therapeutic. This therapy
implies in principle the neutralization of the moral point of view. In the essay
2678
entitled “Remembering, Repeating and Working-Through,” Freud insists that
psychoanalysis is not just, or not even principally, a purely intellectual
interpretation, but work against resistances and a “handling of” the forces
resistances may in practice turn out to be an arduous task for the subject of
the analysis and a trial of patience for the analyst. Nevertheless it is a part of
the work which effects the greatest changes in the patient and which
transference: the name “psychoanalysis” applies only “if the intensities of the
transference have been used for the overcoming of resistances” (p. 143).
Oedipus is to have already killed his father and married his mother. But the
drama of recognition begins beyond this point, and this drama consists
man. In a sense I always knew it, but in another sense I didn’t; now I know
who I am.”
First, that it takes place entirely on the plane of speech. Therefore, we are
faced with a strange technique. It is a technique according to its work
that it only attains or handles these energies through and across the effects of
established disorder?
If, therefore, veracity is the sole ethical value implied by its analytic
technique, psychoanalysis is bound to practice, as regards every other ethical
veracity is still something. It contains the seed for new attitudes issuing from
2680
Certainly the vulgarization of psychoanalysis tends to draw a sort of
babble about everybody’s libido from this disoccultation, which has nothing
to do with working through, with the work of truth. The vulgarization of the
results of psychoanalysis, apart from its technique and its work, even tends to
induce reductive schemes and to authorize saying the first thing to come to
mind about all the eminent expressions of culture: “Now we know that all the
(Entzciuherung). But this is the price modern culture must pay to have a
become one of the media through which our culture seeks to understand
itself. And it is unavoidable that we should only become aware of its
positions that have not undergone its questioning in their depths, even
did not Freud define culture as the sacrificing of instincts? Once set off on this
orgasm? But the conscience that poses this question, and that attempts to
enclose Freud within this ethical either-or, is a conscience that has not
The Freudian revolution is its diagnostic technique, its cold lucidity, its
laborious search for truth. It is a mistake to attempt to change its science into
epicureanism, when it really only turns the unpitying gaze of science on the
sly conduct of moral man. Here is our misunderstanding: we listen to Freud
changing our knowledge of it and by giving us the key to some of its ruses.
Freud can indirectly change our ethics because he is not directly a moralist.
2682
For my part I would say that Freud is too tragic a thinker to be a
of the necessary character of these conflicts constitutes, if not the last word, at
least the first word of a wisdom that would incorporate the instruction of
this tragic knowledge to reach the threshold of a new ethic, which we should
stop trying to derive directly from Freud's works, an ethic that would be
but at this price, it rejoins that reconciliation whose law was pronounced by
Bibliography
Freud, S., Civilization and Its Discontents, in Strachey, J. (Ed.), Standard Edition, Vol. 21, Hogarth,
London.
_____, The Ego and the Id, in Strachey, J. (Ed.), Standard Edition, Vol. 19, Hogarth, London.
_____, Group Psychology and the Analysis of the Ego, in Strachey, J. (Ed.), Standard Edition, Vol. 18,
Hogarth, London.
_____, “Mourning and Melancholia,” in Strachey, J. (Ed.), Standard Edition, Vol. 14, p. 249, Hogarth,
London.
_____, “On Beginning the Treatment,” in Strachey, J. (Ed.), Standard Edition, Vol. 12, pp. 121-144,
Hogarth, London.
_____, New Introductory Lectures on Psychoanalysis, in Strachey, J. (Ed.), Standard Edition, Vol. 22,
pp. 64-65, Hogarth, London.
_____, Three Essays on the Theory of Sexuality, in Strachey, J. (Ed.), Standard Edition, Vol. 7, p. 198,
Hogarth, London.
_____, Totem and Taboo, in Strachey, J. (Ed.), Standard Edition, Vol. 13, pp. 1- 161, Hogarth, London.
2684
Chapter 46
Kenneth E. Appel
personal and social life. Ideally it should help the tolerance and endurance of
pain and suffering, the maintenance of health, and the prevention of illness.
Standards and values, the need to belong, the need for togetherness, the need
to feel worthwhile and of value, the desire to be cared for— all of these are
important in human life. They are the concerns of psychiatry and are related
to religion as well.
Religion has many aspects and a varied history." The various parts of
emphasize emotion, belief, conviction, and dogma. In these they find security,
James wrote of the will to believe. St. Augustine stressed the will rather than
the intellect. G. F. Moore thought the essence of religion was the conservation
Catholicism emphasizes help from the group, from authority, from history,
that exists in the world of nature. Bertrand Russell, in his Free Man’s Worship,
stoic struggle and devotion to duty in the face of the destructive forces of
nature and man, which most people would find was essentially religious.
2686
Rabbi Kagan quotes from the Talmud that even if a man denies God and yet
affirmations of the reign of reason and the hegemony of science have not
and science and the inevitability of progress to bring about security and relief
from fear and anxiety. The self- assurance of Victorian thinking and
nuclear, astro, and mathematical physics. The present was called “The Age of
responsibility. For Tillich anxiety is the reaction to the threat of non- being,
capacity to bring the future into the psychological present. Allport writes of
becoming “as an integration of the past into the present.” Niebuhr says man,
and behavior that contribute to effectiveness and health. Religion, beneath its
weigh, smell, or hear. People seem to get well because of relationships with
hope, love, and justice are such forces. They have been manifested in the
medical profession at its best and are related to religion. The doctor who
engages in an active and tireless search to heal his patient is exemplifying
these constructive forces, and the patient somehow comes to identify with
him and becomes inspired to join the search. Inspiration and aspiration
promote health. They are factors that cannot be neglected in medicine and
psychiatry. A devoted and dedicated physician or priest is able to tap and
mobilize resources for growth and life in the individual (eros, agape).
2688
time in the Middle Ages the primitive demonological conception of illness
held sway, however, particularly in connection with the mentally ill. “Thou
shalt not suffer a witch to live” seemed to be a religious injunction that Judeo-
to overcome sin. Judaism knows about Yetzer Hara and Yetzer Hatov, the
struggle between good and evil, but there is the belief that Yetzer Hatov, the
good, will be victorious. Catholicism offers the weight of tradition, authority,
faiths are often great allies in the struggle to overcome the destructive forces
Paul stated succinctly the problem of conflict with which much psychiatric
thinking is concerned: “For the good that I would, I do not; but the evil which I
would not, that I do.” In the Judeo-Christian scriptures there are many
statements such as the following that deal with the problems of suffering,
Psalms 91 and 46
1 Corinthians 13
assumed distinctive roles in society as time went on, but they continued to
share common goals. In order to clarify this belief, in 1947 the Group for the
Advancement of Psychiatry made a statement that they believed in the dignity
and integrity of the individual and that the major goal of treatment was the
the home and its influence on the individual and the problem of ethical
training. They emphasized the important role religion can play in bringing
about an improved emotional, moral, and physical state. Methods of
psychiatry help patients achieve healthy emotional lives so that they may live
in harmony with society and its standards. Psychiatry does not actually
conflict with the morals and ethics of religion, but frees the person to assert
2690
the morality and ethics that stem from a pattern of conscious affirmation,
real conflict between psychiatry and religion. It was felt that in practice
confirms the fact that beliefs and devotions affect not only physiological
functions of the body, as Dr. Wolff and others have shown, but also the social
There has been a growing realization that the fields of religion and
with illness in both general and mental hospitals; students can learn more
familiar with the basic religious thinking of people today. One hundred
million people in the United States are church members. What do they
believe? How does it affect their points of view, their outlooks on life, their
accentuation of illness when punitive and rigid religious and moral concepts
and this process of identification is very important. The patient gradually sees
the physician tackling difficult problems, no matter how hopeless they seem,
2692
procedure to follow, what is the thing to do, what are the possibilities, what
be done. The patient gradually takes over. Doctors who are patient,
or love impulses, or eros, of the patient —of the patient’s id. When standards
are deficient and defective, therapy consists in helping the individual develop
new guiding principles or ego ideals. This can come through identification
with “causes,” with friends, or with the therapist. The relationship with the
therapist is vital for the patient, and perhaps the most health-producing
factor is the spiritual quality of maturity, care, and supportiveness on the part
of the psychiatrist. Religion, too, is concerned with what is deeper than the
intellectual, with forces within and beyond the individual. In experiences with
prayer groups and healing services, there is contact with forces within and
beyond that has helped people to realign their personalities in the direction of
health.
thinking and feeling of the times and be ready to use these resources that are
patient. This psychiatrist did not recognize the need for suffering and
only to endure their suffering but also to come through their illness with
stronger personalities than before they became ill. Collaboration of clergy and
James and Bergson pointed out long ago. I believe that the basic factor is
2694
probably the emotional relationship between the therapist and the patient,
the care, love, devotion, and interest on the part of the therapist, and the faith
the patient has in him. When St. Augustine went to Milan as a teacher of
Western religion) was his human relationship with the kindly Ambrose. This
to psychiatry.
of the survival of society. This is one of the myths that has developed, as a
violence all over the world, have not yet jolted humanity hard enough for it to
and sharing with others positive personal and social values are essential not
only for health and happiness but also for survival. And this is the eternal
lesson of religion, whatever its form. Psychiatry and religion can cooperate
and supplement one another in helping people with emotional and mental
substitute for psychiatry. They both contribute to the health and fulfillment of
the individual.
Bibliography
Auden, W. H., The Age of Anxiety, Random House, New York, 1947.
Barnett, L., The Universe and Dr. Einstein, Harper, New York, 1948.
Boisen, A. T., Religion in Crisis and Custom, Harper, New York, 1955.
Boulding, K., The Image, University of Michigan Press, Ann Arbor, 1956.
Braceland, F. J., “Clinical Psychiatry Today and Tomorrow,” in Braceland, F. J. (Ed.), Faith, Reason
and Modern Psychiatry, Kenedy, New York, 1955.
Donic.er, S. (Ed.), Religion and Human Behavior, Association Press, New York, 1954.
Ginsburg, S. W., “Religion: Man’s Place in God’s World,” in Herma, H., and Kurth, G. M. (Eds.),
Elements of Psychoanalysis, World Publishing Co., Cleveland, 1950.
Heuss, Rev. J., “Our Imperfections,” in McCauley, L., and McCauley, E. (Eds.), A Treasury of Faith,
Dell, New York, 1957.
Hubben, W., Four Prophets of Our Destiny, Macmillan, New York, 1952.
Jung, C. G., Modern Man in Search of a Soul, Harcourt, New York, 1934.
2696
Kagan, H. E., “Psychiatry and Religion,” Minnie K. Landsberg Memorial Foundation, Cleveland,
1952.
Kegley, C. W., and Bretail, R. W. (Eds.), The Theology of Paul Tillich, Macmillan, New York, 1952.
Kew, C. E., and Kew, C. J., You Can Be Healed, Prentice-Hall, Englewood Cliffs, N-J-. 1953-
Lamprecht, S. P., Our Religious Traditions, Harvard University Press, Cambridge, 1950.
Long, E. L., Jr., Religious Beliefs of American Scientists, Westminster, Philadelphia, 195-
McCauley, L., and McCauley, E. (Eds.), A Treasury of Faith, Dell, New York, 1957-
Michalson, C. (Ed.), Christianity and the Existentialists, Scribner’s, New York, 1956.
Noveck, S. (Ed.), Judaism and Psychiatry, Basic Books, New York, 1956.
Oates, W. E., Religious Factors in Mental Illness, Association Press, New York, 1955.
Oppenheimer, J. R., Science and the Common Understanding, Simon & Schuster, New York, 1954.
Outler, A. C., Psychotherapy and the Christian Message, Harper, New York, 1954.
Stace, W. T., Religion and the Modern Mind, Lippincott, Philadelphia, 1952.
Tillich, P., The Courage to Be, Yale University Press, New Haven, 1952.
White, E., Christian Life and the Unconscious, Harper, New York, 1955.
_____, The Way of Release: For Souls in Conflict, Marshall, Morgan & Scott, London, 1947.
White, V., God and the Unconscious, Harvill Press, London, 1952.
Whitehead, A. N., Science and the Modern World, Macmillan, New York, 1925.
Wise, C. A., Pastoral Counseling, Its Theory and Practice, Harper, New York, 1951.
Zilboorg, G., “Some Denials and Affirmations of Religious Faith,” in Braceland, J. (Ed.), Faith,
Reason and Modern Psychiatry, Kenedy, New York, 1955.
Kenneth E. Appel
James R. MacColl, III
Cox and Malcolm Boyd. Even participation in religious rituals and services by
the young and lay people has been developed. Teilhard and Pope John have
2698
behavior of men and women, coeducational dormitories in educational
all these changes in acting and custom create great strains and disruptions in
church services and rituals are seen. The older generation and the young
develop nonunderstanding. The increased number of elderly create new
problems in living and loneliness in society. There is more need for new,
and conflicts cause new and unexpected tensions and produce new
Thus new emphases in religion (both in theory and practice) and in medicine
made to tap the positive and viable forces in these people. For example, many
protective facade that amounted to deception in trying to reach and talk with
many young people as in former days. A great deal of helpfulness exists among
these groups—helping one another. Dr. Peabody long ago wrote that the care
of the patient started with caring emotionally for the patient.
Experiments with folk music in religious services are tried. There are
folk masses. English may be substituted for Latin. There is great interest in
Indian and Oriental thinking and religion with its many practices of
The little Haiku lines of Japanese poetry picture aspects of nature that
sharing of beauty and the friendliness of nature seen in the seasons, the birds,
and the flowers that do not hurt, humiliate, or maim, but that are healing.
2700
So, although religion in many ways has become secular and interest in
traditional practice and beliefs has lessened, there still remain positive
aspects that have always been emphasized in the heart of religion. Religion
fellowship with the unconventional and the outcasts. He has been able to
compassion—not formal, not blame, not critical, not rejecting, not derogatory,
exclude and reject people and has been able to work with those whose
conduct and impulses one does not customarily approve or condone. There is
much writing about God is dead, following Nietzsche and Bishop Robinson,
yet the essential creativeness and fellowship that exist remain as positive
forces in human nature and the community. Leo Rosten’s Trumpet for Reason,
James Michener’s America vs. America and The Drifters all tackle these
problems from different points of view.
Persons are important in that they are all bound together in a universal
The new thinking about religion has resulted in many new emphases
and practices among the clergy and laity of Judeo-Christian persuasion. There
The motivating factors are to bring about attitudinal and institutional change.
1.
2702
traditional sense. His prime concern is effecting change,
hitting at the causes of our problems; he is far less concerned
with treating victims. One result of this is the emergence of
more specialized forms of ministry.
a. Ordination.
All these changes are closely linked with social psychiatry, for
Heart:
David Grayson
Good manners is the art of making those people easy with whom we
converse. Whoever makes the fewest persons uneasy is the best bred in
the company.
Jonathan Swift
The web of our life is of a mingled yarn, good and ill together; our virtues
would be proud if our faults whipped them not; and our crimes would
despair if they were not cherished by our virtues.
William Shakespeare
2704
Living by Grace
Power to Become
Self-Love
He was like a cock who thought the sun had risen to hear him crow.
George Eliot
Benjamin Franklin
La Rochefoucauld
Wilde
Kindness
2706
’Till in Heaven the deed appears—
Pass it on.
David Garrick
John Oxenham
Selfishness is the only real atheism; aspiration, unselfishness, the only real
religion.
Zangwill
Bibliography
Bachelder, L., The Understanding Heart, Peter Pauper Press, Mount Vernon, N.Y., 1966.
Berman, R., American in the Sixties, Free Press, New York, 1968.
Boyd, M., Are You Running with Me, Jesus? Avon Books, New York, 1965.
Harris, T. A., I’m OK—You’re OK, Harper & Row, New York, 1969.
Henry, L. C., Best Quotations for All Occasions, Fawcett, New York, 1966.
Hopkins, J. (Ed.), The Hippie Papers, Signet Books, New York, 1968.
McElroy , P. S., Quiet Thoughts, Peter Pauper Press, Mount Vernon, N.Y., 1964.
Jack Bemporad
but certainly, above all, as the age of secularization. The one assumption that
2708
curious malaise. It can be seen in the sudden popularity of the Jesus
movement, of Far Eastern religions and mysticism, and in the rage for
astrology; it is evident in our literature, which has come to be dominated by a
art and in the rising tide of drug use that seems to cut across all ages and
classes. Certainly it is evident in the burgeoning crime rates everywhere and
technological man at any rate, seems to have become one long quest for
meaning; a journey in search of values that seems to grow more intense as the
between Judaism and psychiatry, for these two disciplines could serve as an
example of the tension that exists today between faith and science. While they
have many common characteristics, they differ in some views on the nature of
man, a fact that has had wide-ranging implications not only for the treatment
of the mentally disturbed but also for the emotional and spiritual lives of all
Some of these differences are inherent in the very nature of the two
emotionally disturbed. Its main task is to care for and treat individuals
norms and standards of the scientific method in their theory and practice. It is
important also to note parenthetically that many psychiatrists maintain that
beliefs that are neither empirically derived nor subject to any empirical test.
Judaism affirms the existence and unity of God, has a prescribed ritual that
makes both moral and ceremonial demands, and subscribes to certain basic
ideas about the being and nature of God, creation, revelation, and redemption.
It has a specific view on the nature of man and the good life.
these beliefs enable one to interpret and give significance to life. If there are
experiences that seem to contradict or be antagonistic to these fundamental
beliefs, for example, the reality of evil in the world, Judaism attempts to re-
establish and justify the faith that these experiences seem to threaten.
Psychiatry, on the other hand, is bound primarily by the standards of
2710
scientific method, and its duty is to follow the facts wherever they lead.
at the center of importance the spiritual and intellectual life and emphasized
values and purpose rested in a natural order of the universe, they now came
to rest solely in man. Soon this mechanism extended itself to the domain of
the self, and man found himself an anomaly with respect to nature. The rise of
spiritual importance. Whereas in the classical and medieval world man had
viewed himself as the image of God and as the culmination of the order and
hierarchy of the objective value structure of the cosmos, the man of the
judges only those experiences that natural science can deal with as real and
all other experience as subjective and illusory, a view that allows no place for
tendencies of the natural sciences, it has been led to an inevitable clash with
religious ideas.
psychiatry has, for the most part, chosen the path of the natural sciences.
will overcome as a neurotic phase, just as so many children grow out of their
2712
many psychiatrists, not only fails to take religion seriously and accord it its
proper sphere but also suffers from the etiological fallacy that the origin of
primitive state and, unlike other areas of human intellectual pursuit, did not
keep pace with the general development of Western culture or attain the
heights of the arts and science. It is simply prejudice on Freud’s part to affirm
that religion can only be infantile neurosis or nothing. Why should religion be
works, The Intrapsychic Self. In one of the best arguments against the
the whole world what a child experiences in his early personal relationships
with his mother or father, when every act or object is willed by significant
adults in his life.
that show that religion, while not having its origins in childhood neuroses,
every feeling, object, or condition of his life. Just as his parents willed his
his existence, the feelings of hope and trust which he earlier associated with
his mother were experienced in a larger context.”
Thus religion can be seen from its origin as a set of cognitive constructs
that prolong hope in the survival of the individual and of the small social
group to which he belongs. Later, of course, hope is expanded further and
(soul) or on general human progress. Faith comes to mean two things: not
only belief in the existence of the divinity, but also trust or confidence.
Religion is thus not just a way of interpreting the world, but of hoping.
2714
The immediacy and simplicity of primitive life, Arieti continues, was
primitive life each object or function had a separate god, the same god later
became responsible for many objects or actions. Whereas the dieties were
and lost in history, its significance was very great. Arieti states, “The principle
of teleologic causality still applied (i.e., the world is this way because the gods
willed it this way), [but] the gods are seen as more and more separate from
the reality of man.” They became “a third reality,” different from either the
physical level; that is, it separated the gods from things. It remained for
Judaism to effect the even greater revolution, the change from paganism to
course, we have no historical proof of the existence of Abraham, the first Jew.
His myth, however, represents the beginning of a very long trend in Judaism
against religious concretization and other primitive mechanisms . . . the
Hebrew God loses human characteristics and becomes far superior to any
other reality. The third reality is conceived as having preceded any other
fused with moral life. This was known as the prophetic period, and it was
distinctive in that the third reality now became not only precedent to
existence and superior to other realities but also the moral standard and
guidance for man. All religious history to the present day, including the rise of
2716
also of hoping, drawing strength for the future, and fighting despair. The
function of religion as emotional sustenance and inspiration has been ignored
first only the obsolete and objectionable expressions of the same and then of
was not the case. The most significant transformation in religion was from
was not science that did away with this idolatry and polytheism, but
prophetic religion.
away with the gods in nature and by doing so, changes man’s relationship to
God. Prophetic religion is characterized by the idea that man’s relationship to
God is moral in character; it believes that God makes a moral demand on man.
God is understood as pure spirit, separate from the natural world, and no
rain, harvesting), worship was aimed at appeasing these natural forces. But
when God is seen as beyond nature, then man’s relationship to God is not one
statement of this opposition occurs in the Book of Micah. It is the year 701
B.C. and Jerusalem is surrounded, her doom imminent. The people are
confused and do not know what to do. How should one propitiate God to
avoid the calamity? How shall one appease or influence Him? “Shall one come
before God with burnt offerings, with calves of a year old? Will the Lord be
pleased with thousands of rams, with ten thousand rivers of oil? Shall one
give his first-born for his transgressions, the fruit of his body—will the
sacrifice of children appease God’s anger?” Micah’s answer echoes down
through the centuries. “It hath been told thee, O man, what is good and what
the Lord doth require of thee. But to do justly, love mercy and walk humbly
with Thy God.” All the pre-exilic prophets fought against sacrificial
relation to God can be a spiritual one. God is set over against nature as the
only true Being, who stands in relation to man as an imperative to action. The
contrast between God as a force in nature and God as a transcendent spiritual
2718
being is clearly illustrated by an incident in the life of Elijah, the prophet.
Elijah went up upon the mountain to seek God and was confronted by a
shattering wind and then an earthquake and after that a fire. But God was not
to be found in any of these, for God was not a force of nature. After all these
natural forces there came a still, small voice. The still, small voice, the inner
voice that is the conscience of man, this was Elijah’s communication with God.
Once God was seen as a transcendent, unique spiritual being, then the
concepts of man and nature became fundamentally different. First of all, the
concept of a unified and transcendent God gave rise to the concept of man as
transcending nature. Man became not only a natural but also a spiritual being.
This can be seen in the creation story. God creates man as a “thou” having a
special place in the universe. Eichrodt describes the difference between man
and nature quite rightly when he states,
The idea of one transcendent God transformed not only the concept of
man but also the concept of nature, and far from being vulnerable to scientific
act to understand and transform it. This is a crucial point, for it made moral
action possible.
It likewise made science possible, for as long as nature was full of gods,
all separate powers, it could never be consistently apprehended. But with the
concept of God as a transcendent creator and the universe as his creation, the
idea of cosmos became possible. The world became the matrix of creation, the
arena in which one acted to actualize the ideal. Man realized that he had the
power to act and transform the universe rather than be helpless before it.
I have gone into such detail on this point because I want to indicate the
original creative perspective of the Biblical view, which is totally missed by
Freud and many other psychiatrists who deny any upward growth or
states, “Insecurity of life, and equal danger for all, now united men into one
society, which forbids the individual to kill and reserves to itself the right to
kill in the name of society the man who violates this prohibition. This, then, is
2720
death that must be avoided. Man must be protected against his drives by the
state. There is a growing despair in Freud, culminating in the view that sees
civilization as the veneer that is incapable of ever really doing much against
Fromm, in his Psychoanalysis and Religion, tries to defend Freud but also
power over man, but of man’s own powers,” or again, “God is the image of
There is a bifurcation between the good and bad aspects of man’s nature, each
note that Fromm reverses himself on this fundamental issue when he begins
to discuss idolatry and monotheism. He states,
We forget that the essence of idolatry is not the worship of this or that
particular idol, but is a specifically human attitude. This attitude may be
described as a deification of things, of partial aspects of the world and
man’s submission to such things in contrast to an attitude in which his life
is devoted to the realization of the highest principles of life, those of love
and reason, to the aim of becoming what he potentially is, a being made in
the likeness of God. It is not only pictures in stone and wood that are idols.
Words can become idols, and machines can become idols; leaders, the
state, power and political groups may also serve. Science and the opinion
of one’s neighbors can become idols, and God has become an idol for many.
[1]
worship of the created, and in trying to define idolatry he inverts his own
theory by saying that man must become what he “potentially is, a being made
in the likeness of God.” But isn’t God, according to Fromm, merely a projection
of man? How then can man be an image of God, when God is an image or
idol, (that is, something man creates or projects) that he then has no ground
for defining idolatry and thus contradicts himself.
The basic question here then is not whether psychiatry and psychology
only or are also making assertions about the ontological status of the
reference of these phenomena.
This issue has been clearly raised by Martin Buber in his reply to Jung.
Buber criticizes Jung for maintaining that “God does not exist independent of
the human subject,” and states that the controversial question is therefore
2722
statements to which a super psychic reality corresponds and psychic
statements to which none corresponds. The science of psychology, however,
itself if it does so. The only activity that properly belongs to the science of
(p. 135).
is one area where he is very close to a religious position, and that goes to the
very essence of the nature of religion in general and Judaism in particular.
is not God, but as Hosea says, the works of his hands or the projection of his
fears. The crucial task for Judaism is how man can transcend his natural
status. How can he become a moral and spiritual being? The religious life for
doctrine of the good life, Judaism makes specific assertions about man’s
help its patients to live “better lives.” Therefore, implicitly it accepts man’s
freedom, the capacity to change and the capacity to redirect one’s life. Also
as the dignity of man. Here it borrows from the religious tradition and most
specifically from Biblical teaching. The belief in freedom is the belief in moral
responsibility, and such responsibility requires the formation of character.
2724
redefining of the facts; not a static entity, but a dynamic, creative, self-
transcending process. Deterministic explanations cannot explain that element
impinge upon man. In fact, it is this very process that makes it possible for
change.
position, one that makes him no more than a high form of animal bound to his
desires and determined by prior causes, has led us to that most dreadful of
views on man: the automaton. This is the view that man can be manipulated
for the rise of modern totalitarianism and the use of the propaganda and
brainwashing techniques, which have gained such currency today. It is this
distinguishes him from the rest of nature and mediates the circumstances and
causes that impinge upon him. Thus his goals and ideals are included in his
he is really mentally rehearsing his action and considering what its effects
would be. The more self-aware he is, the more his reflection will be to the
point and thus bring about a change in his environment in terms of his aim
and goals.
idea of the good that man is trying to actualize. Bather than being a static
itself actualized in the act. The element of dissatisfaction is here to the point:
man is aware of a distinction between what he is at present and what he
would like to be. Change comes from the fact of an idea or ideal goal that is
contravened the tyranny of fate. Unlike the philosophy of the ancients, which
could never separate good and evil from their interrelationships with fate,
Judaism has always asserted the value of repentance—not only for the self-
healing of the soul, but also in order to transform the future and transcend
the past. Judaism affirms that historical reality is incomplete and, therefore,
2726
redeemable. The past may have taken place in fact, but its meaning is not
decided until the end of history. If a past act causes us to reconsider and
The first people to talk seriously about repentance were the prophets.
The prophets said that it was the end goal that makes the past and present
discovered this and thus discovered freedom. A man who can repent is a man
who is free. This is the key meaning of the story of Jonah. Unlike the stories of
Noah and of Sodom and Gomorrah, where the righteous are saved and the
wicked are destroyed by the decree of God, the meaning of Jonah is that God
maintains: The people of the city have repented, they have put on sackcloth
and ashes. They have changed their ways, and if they have changed their ways
they force me to change my ways. The doctrine of repentance came with the
prophets, and it meant that man’s action can affect God so that he could annul
His decrees and thus eliminate the power of fate. It became man’s task to
bring God into the world, to bring the kingdom of God about on earth, and
thus it made man free.
these mechanisms have always found one of their chief vehicles and supports
to be religion.
This point has been well defended by Arieti in The Intrapsychic Self.
In a similar way, we may state that religious methods, results and values
are different from those derived from pure secondary processes. The
religious value consists in giving people faith in the survival of man and
man’s ideals. Religion becomes an incentive to greatness of the spirit. It
offers new insights . . . which open up new dimensions of understandings
and feelings. These new dimensions, although they are abstractions
constructed at higher psychological levels, need the support of lower
mechanisms. We should not make the common mistake of considering the
new insights and aims of religion irrational or primitive, just because they
are partially founded upon primary process mechanisms.
2728
secondary processes, but often makes insights possible that are in opposition
to prevailing attitudes or conventions of the historical period in which they
take place, and that therefore might be repressed. A good example of this was
support their mission of bringing the message of justice and love to the
people.
certitude, confusion into clarity, hesitation and cautiousness into courage and
as a reality by the subject. Therefore of all creative processes, it is the one that
seems closest to the psychotic experience. It is a loss of reality, but as we have
Although Arieti concedes that the value of the mystical experience for
humanity could be denied on the basis of all the wars, persecutions, hate, and
prejudices that have resulted from “illuminations and revelations,” he replies,
“Results such as these are obviously not to be valued. It must be said that
when religion leads to these results it fails, just as bad poetry fails—except
that in the failure of religion the consequences are much more harmful. On
the other hand, good religious insights become norms for generations to
eliminated the supernatural and replaced rite with ethical behavior alone.
“Faith in survival is thus based only on the ethical behavior of man and on
question.”
to childish emotions and needs. Rather it lies at the very depths of the human
self once he begins to ask himself the question of the why of existence. The
quest for religion begins when man searches for the meaning of his existence,
when he seeks the purpose and significance of his life, and when he judges
2730
suddenly become radiant. For no longer should we be alien accidents in an
indifferent world, uncharacterized by-products of the blindly whirling
atoms; and no longer would the things that matter most be at the mercy of
the things that matter least.
Bibliography
Arieti, S., The Intrapsychic Self, Basic Books, New York, 1967.
Buber, M., Eclipse of God, Harper & Row, New York, 1952.
Eichrodt, W., Man in the Old Testament, Allenson, Naperville, Ill., 1951.
Fromm, E., Psychoanalysis and Religion, Yale University Press, New Haven, 1950.
Montague, W., Belief Unbound, Yale University Press, New Haven, 1930.
John W. Higgins[2]
most diverse. This variety cannot be decried when it reflects the richness and
complexity of the interaction between the two. The differences, however, are
also products of factors which limit any approach to the topic. These include
gross levels: (1) the level of conflict, (2) the level of pacification, and (3) the
from an individual’s own experiences, are often rife with prejudice, overt or
covert. As a result, quite before any issues are identified, attack and defense
may begin. At best, the essential issues have not always remained clear. They
2732
established doctrines of either or both fields.
World View
theories have become not only bludgeons but also victims in what are
essentially philosophical arguments. As Philip comments, “It is possible to
maintain either that science can only give a partial interpretation of the truth,
129). Excursions into this kind of conflict are facilitated by a denial that
psychiatric theory rests on any preconceived system of ethics and the
officially without moral values not because it rejected these values but
because it carried them implicitly and inherently as everything human carries
them” (p. 49). It can be asserted that the truth or fallacy of a belief in God does
that
object of devotion” (p. 21). Those who could agree with one of these might
well quarrel with the other. The more or less orthodox undoubtedly would
find neither acceptable. If respect, although not necessarily belief, is given to
the opponent’s first principles, at least the lines of reasoning can be followed
and the conclusions weighed.
2734
Differences among Schools of Psychiatric Thought
treat mental illness; neither is there usually an optimal degree of clarity about
the essentials of the theories in the other schools. This expectable state of
complex in neuroses, and deal in a critical manner with other concepts such
as resistance and transference (ch. 9). In the succeeding chapter they propose
about the psychological matters are clearly capable of being waged outside
the arena of psychiatry and religion. That, for instance, dealing with
psychosynthesis was discussed long ago by Freud (p. 394). The malleability of
The remedies for such conflicts are clear thinking and an adequate
symbols, rituals, and beliefs are fully capable of being invested with neurotic
chagrin among some who seem to accept them as casting doubt on the
validity of religion. Yet, the fact remains that these psychiatric findings do not
proposed wholly to explain some or all of its aspects. Caution on this very
2736
that concept must be a most important one” (p. 147). Despite this statement,
the general sense of Freud’s writings about religion is expressive of his
religious person will maintain that questions of religion cannot be fully dealt
with only in the psychiatric frame of reference, but require also the historical,
theological, and other frames. (For a more thorough, critical review of Freud’s
by Philip.)
The almost endless debates around psychic determinism and free will
psychiatry. Part of the difficulty appears to have arisen out of equating free
that they are not wholly contradictory concepts. For example, Pope Pius XII,
energies may exercise pressure upon an activity does not necessarily signify
that they compel it” and their force is not to be regarded “as a kind of fatality,
and escaping completely from the control of the conscience and of the soul.”
Determinism does not say that causal factors of the past, nor even of
recent past, compel a neurotic course in an individual for the rest of his
life. It says merely that the individual’s total makeup and probable
reactions at any given moment are strictly determined by all the forces,
early and late, external and internal, past and present which have played
and are playing on him.
2738
The absence of a concise, universally applicable description of
general. This deficiency has allowed the incursion of various notions into
is that some moral damage will be dealt the patient. It would be invalid to
could come to a patient from contact with a physician who may assume a
position of great direct or indirect influence on him. All psychiatrists must
differences in world view. The psychiatrist must maintain the right of inquiry,
but the closer his treatment approaches indoctrination to his points of view,
the farther it gets from good psychiatric treatment. (Novey has given an
most:
It is out of the question that part of the analytic treatment should consist of
advice to “live freely” —if for no other reason because we ourselves tell
you that a stubborn conflict is going on in the patient between libidinal
desires and sexual repression, between sensual and ascetic tendencies.
This conflict is not resolved by helping one side to win a victory over the
other, [p. 375]
force of conscience. There are intricate issues here which would require a
separate treatise (for example, Zilboorg). This question has been dealt with in
a general way by, for example, distinguishing between guilt and guilt feelings
Although these efforts may not have produced the final answer, most
psychiatrists would disclaim that they function as “forgivers.” Yet they would
maintain that their patients often present hypertrophied senses of guilt which
depending upon the theoretical orientation and the goal of the therapy.
Dilution of Concepts
2740
a religion or school of psychiatric thought is. How “liberal” any group can
become and still maintain its identity is a matter which its members must
Denial of Conflict
air of agreement which disappears in practice. For example, it can be held that
psychiatrists deal with the mind; the clergy, with the soul. Another position is
be made. In the early stages of study groups and colloquia, this is not
uncommon.
Selective Acceptance
in whole or part, based on how little they seem to threaten the concepts of the
psychology can seem more consonant with certain religions than one which
includes an interest in and a certain respect for the irrational. Related to this
is an antipathy for the unfamiliar in psychiatric terminology and methods of
the best known examples of this are to be found in Jung. Recent reappraisals
of Jung from the theological viewpoint support the notion that initial
The level of argument means that interaction whose aim is fostering the
2742
psychiatry and religion overlap or appear to overlap. In a general but
simplified sense, this overlapping is the concern for the behavior of man, his
motivations, ideals, and limits, and his relations with other men. Each deals
with such matters within different frames of reference— how different will
depend on the psychiatric theory and religion in question. This difference in
frame of reference has often led to the assumption that the concepts of the
one would be either inimical or useless to the other. Consequently, there has
been the tendency for either to lay exclusive claim to a particular domain and
more or less to neglect what the other had to say except to engage in conflict,
as previously described.
difference in terminology which has effectively obscured the fact that, upon
study, a number of the concepts, some of the ways of formulating problems,
and some of the approaches to solution are strikingly similar. The clear
other field.
virtues. Those who are prepared to become acquainted with this literature
will find potentially useful data for speculative research on the adaptive
functions of the ego. The utilization of such information need not be linked to
acquiescence to theological belief. At the end of a paper in which he explores
in more detail some of the interplay suggested here, Mailloux sounds the
ignorance are overcome, psychiatry and religion can represent one of those
areas where true division provides an opening to new depths of knowledge.
Appendix
Since the author’s untimely demise many events have transpired, but
2744
discoursed in this chapter. Presently the nations of the world are in conflict or
in fear of it; our own nation is in an ugly mood and hatred and destruction are
rampant. Both religion and psychoanalysis are having identity crises, and this
is not the time, nor is it the overall mood, for this chapter to be rewritten with
any promise of permanency. The same problems that concerned Dr. Higgins
under his various subheadings are still being debated and unfortunately are
still unsettled.
general unrest. Catholicism has been depleted and saddened by the desertion
of some brilliant minds from its clerical ranks. Psychoanalysis is fractionated
and in some places denigrated as attention is more and more being focused
England. Some traces of it are appearing on our own West Coast and
meanwhile they will cause some havoc. It is wise, therefore, to let Dr.
Higgins’s chapter stand as it is, for he covers the essentials to which we must
Francis G. Braceland
Bibliography
Braceland, F. J., Faith, Reason and Modern Psychiatry, Kenedy, New York, 1955.
Day, F., “The Future of Psychoanalysis and Religion,” Psychoanal. Quart., 13:84, 1944.
Freud, S. (1916), A General Introduction to Psychoanalysis (Tr. by Riviere, J.), Garden City, New
York, 1943.
_____, (1925), “The Resistances to Psychoanalysis,” in Collected Papers, Vol. 5, p. 163, Basic Books,
New York, 1959.
_____, (1913), “Totem and Taboo,” in Strachey, J. (Ed.), Standard Edition, Vol. 13, Hogarth, London,
1955.
_____, (1919), “Turnings in the Ways of Psychoanalytic Therapy,” in Collected Papers, Vol. 2, pp.
392-402, Basic Books, New York, 1959.
Fromm, E., Psychoanalysis and Religion, Yale University Press, New Haven, 1950.
Hartmann, H., Ego-Psychology and the Problem of Adaptation, International Universities Press,
New York, 1958.
Knight, R. P., “Determinism, ‘Freedom,’ and Psychotherapy,” Psychiatry, 9:251, 1946; reprinted in
2746
Knight, R. P., and Friedman, C. R. (Eds.), Psychoanalytic Psychiatry and Psychology,
International Universities Press, New York, 1954.
Mailloux, N., “Psychology and Spiritual Direction,” in Braceland, F. J. (Ed.), Faith, Reason and
Modern Psychiatry, p. 247, Kenedy, New York, 1955.
Marling, J. M., “Opportunities for the Catholic Psychiatrist,” Am. Ecclcsiastical Rev., 135:73, 1956.
Novey, S., “Utilization of Social Institutions as a Defense Technique in the Neuroses,” Int. J.
Psychoanal., 38:2, 1957.
Nuttin, J. (Tr. by Lamb, G.), Psychoanalysis and Personality, Sheed, New York, 1953.
Parcheminey, G., “The Problem of Ambivalence,” in Bruno De Jesus-Marie, P. (Ed.), Love and
Violence, Sheed, New York, 1954.
Pope Pius XII, “Discourse to the Delegates of Fifth International Congress of Psychotherapy and
Clinical Psychology,” Acta Apostolica Seclis, 45:278, 1953; English tr., Linacre Q.,
20:97, 1953; excerpts in Furlong, Francis P., “Peaceful Coexistence of Religion and
Psychiatry,” Bull. Menninger Clin., 19:210, 1955.
Vanderveldt, J. H., and Odenwald, R. P., Psychiatry and Catholicism, McGraw-Hill, New York, 1952.
_____, “The Sense of Guilt,” Proc. Inst, for Clergy on Problems in Pastoral Psychology, Fordham, New
York, 1955.
philosophy. But the task facing the West of coming to a greater understanding
of the East has become imperative in this era, and, therefore, any attempt that
may contribute to such understanding should be welcomed, despite the
What do we want? What does the Orient want? What do we, with our
method?
observe a great many wolves being predatory and we make the inductive,
“universal” statement that “all wolves are predatory”; from this proposition
we deduce that any particular wolf we may see thereafter is also predatory.
Such a universal proposition, however, refers to particulars only—not to the
The spiritual method teaches that behind the world of seen particulars
2748
particulars in their significance for the total at once. Wolves are thus seen as
necessary part-events of the economy of nature, of the world, and of the
cosmos.
his environment and thus feels challenged to make his environment, for his
individual histories. From time out of mind, the Orient believed that the world
tragicomedy, and that the environment existed only as the stage for the
all ought not be. The Occident assumed that all suffering could be eliminated
it would be easy. The result was that man became a servant of his servants
(his machines and his money) and was plagued with a feeling of
meaninglessness. What started with optimism is about to end in pessimism.
are differences between things, the gain of the one entailed the loss for
another: when a spider joyfuly eats up a fly caught in its web, the fly is
subjected to the agonies of dying. But, according to the Orient, this world is
not primarily a “natural world”; it is, above all, a moral order. When a man
plays his role in this world of moral tragicomedy well, he may be spared
further agonies; and a man who no longer lives in delusion about himself and
the world, and who uses his knowledge with compassion to become a
“liberated” soul, will not be born again into this relative world (by way of
reincarnation) but will have passed beyond all pain and pleasure, birth and
death. Thus the Orient starts with pessimism and ends in optimism.
For the Occident, religion does not seem to be a necessity, but the
scientific-historical method does. For the Orient the scientific method seemed
2750
to be of little value, but religion always was considered a practical necessity.
All this is about to change. Before Freud physicians believed that organic
disease may cause emotional distress; after Freud it was seen that emotional
Freud never followed up this line of thought into metaphysics, his discovery
and the Oriental’s religious desire for liberation from worldly misery evolved,
disease and misery was found by both to be the unhealthy (though socially
conditioned) living of the individual. The Occident came to discover the
dreams in terms of the life pattern of the individual as he had acquired it from
wealth, lust, compulsive duty and the longing for liberation by the Yoga
In other words, the problems were the same. But the Occident used the
Hinduism
living are called together “Trivarga.” If, on the other hand, after many
reincarnations, after many trials and tribulations, successes and failures, and
2752
the sufferings connected with satiety, a man finally aims at liberation
(moksha) from the bonds of his existence altogether, he pursues the path of
“Apavarga.” Let us consider first the ways of Trivarga, following fairly closely
Trivarga
Artha (Wealth)
path of Matsya-Nyaya, the path described in the Artha Sastras as the Law of
the Fishes. This is the law of savage, competitive living among the creatures of
the ocean, and, when pursued by men, leads to an imitation of the pitiless
laws of nature, unalleviated by moral and religious scruples. Seven ways are
described, known as Saman, Danda, Dana, Bheda, Maya, Upeksha, and Indra-
Jala. Since for sane religious living a knowledge of the laws of irreligious living
religious life, these seven ways will be considered briefly, as they form the
contrasting background against which the desire for religious living arose.
Saman and Danda are the chief aims.” Nevertheless, there are auxiliary
methods that are important for the “Dark Secrets of the Crooked Way” (p.
123)—or for psychoneurotic, psychopathic living.
Dana. Dana is the method of flattery and bribery, of giving gifts to one
whom you like, because he is weak, and not to another whom you dislike,
because he is strong.
Bheda. Bheda is the method of divide and rule, of giving gifts to the
weaker, ingratiating him to you and separating him from his stronger
superiority, while under its cover one follows the Law of the Fishes. Maya,
which makes much use of name-calling, may also be called the method of
anathematizing.
Upeksha. Here a man does not acknowledge the truth when it would
2754
obligation. We are like the man who wore bells on his ears and, whenever he
was about to hear something disagreeable, shook his head and heard nothing
but his own tune. Upeksha is the method par excellence of the fundamentalist
who brooks no disturbance of his preconceived interests but rings his bells
statements, etc.
The “Seven Dark Secrets of the Crooked Way” have been described here
What is the cure for these conditions? First, individual and/or political
diagnosis needs to be made; second, its etiology found; then its prognosis;
and finally its therapy needs to be outlined. In ancient times the cure was
hoped for in the appearance of the Cakra-Vartin, the Great World Savior, the
that they believed that with him they might achieve the millenium, without
him only disaster would overtake them. This “ideal” contrasts sharply with
the ideal of the saint, who only wishes to show the right way of living in order
to save himself from his own propensities toward Matsva-Nyaya living, as
psychotherapy: the therapist tries to show the “castrating” patient that such
living will destroy him, as well as the people of his environment, and that in
his own interest healthy living is preferable to living according to the Law of
Kama
progress and final absolution lay with his lust and greed. In terms of modern
psychotherapy that would mean that man’s sufferings come primarily from
sexual and economic maladjustments. The latter stem from his inherited
animal propensities and his desire to continue as an animal in civilized
society, following the Law of the Fishes. His sexual maladjustments are also
end and, by his early conditioning, also without end of “variation.” Hindu
2756
consequences in the Kama Sutras, in which four stages are distinguished:
jambha, moha, stambha, and vasa.[5]
Stambha signifies the paralysis of the will— man’s will is now stupefied
Vasa. The infatuated man is now humbled, wholly subject to his desires.
According to this description, the sensuality of the man himself deprives him
In Hindu philosophy jambha has been compared with the flowers that
are arrows, moha with a bow, stambha with the bait, and vasa with the hook
that catches the fish that has taken the bait. This is an accurate description of
Dharma
Hinduism asserts that every man determines his own destiny. His deeds form
his character and hence have consequences for him (rather than only for
others), and these “fruits” are reaped by him either in this or in a future life.
Society brings to every man’s attention what his duties are, what role he is
expected to play in the society in which he is born, according to the merits (or
2758
what he found himself to be, although as a result of his former actions (which,
in turn, appear to be metaphysically determined). The primary interest was in
Vivekananda (1863-1902):
Psychology is the science of science. ... To control the mind you must go
deep down into the subconscious mind, classify and arrange in order all
the different impressions, thoughts, etc., stored up there, and control them.
This is the first step. By the control of the subconscious mind you get
control of the conscious.
It is indeed true that psychoanalysis is the best way ever devised to get
the parental environment. Thus infantile sucking, biting, anal, phallic, latency,
and pubertal phases are shown to exist in each individual. This psychosexual
man living in terms of artha and kama rather than a healthy dharma.
answer of Oriental religion is No. It says that man’s mind develops still further
—not owing to its own laws, but as enlarged and purified by love,
compassion, and the voice of conscience. Here is the parting of the ways of
depend on them?
Apavarga (moksha)
one of the three castes, he will ordinarily fulfill his dharma first as a student
2760
see definitely emerge man’s ultimate goal on earth, his Apavarga.
which a man might adjust himself to his environment. But the religious mind
does not rest here. As a matter of fact, even in the earliest times, ultimate, so-
within himself, and anxiety is the most characteristic symptom of our age.
Indeed, it is precisely because Western man, at the close of the Middle Ages,
shelved (but had not solved) eschatological questions that he became
materialistically so successful. But what does this avail if the man himself did
not change? And it is precisely because he did not pay attention to his inner
psychoneurotic anxiety.
an extent never even hoped for in previous generations, it has solved many an
urgent problem and is, indeed, preparing man for a new form of living. But,
among analysts, at least Freud and his followers did not tackle eschatological
questions. It is here that metaphysics in general and Hindu metaphysics in
reality is the basis of all false living. It gives rise to innumerable ambitions, all
eventually failing ever to be satisfied because there is no ultimate reality to
this personal ego, this “I” of daily language. It is the inscrutable power of
“false seeing,” of the Divine Maya, that conjures up this ego, and ever
directly, the absolute “I,” the Brahman, the ultimate source of all existence.
And he finds that the Ding an sich behind his subjectivity, the Atman, is the
same as the Ding an sich behind objectivity, the Brahman—that his real I is
not the personal I of the relative world but the impersonal I of Brahman.
Indeed, if we ask ourselves, “What are we intended for here?” the Hindu
answer is, and has always been, “To discover our identity with the Absolute.”
2762
It is impossible to do justice here to the metaphysical achievements of
mind, has added to our knowledge of the mind, and psychoanalysis is the
most formidable method yet discovered for the penetration of the mind’s
for the Yoga systems (the disciplines of Hinduism) and that the Yoga method
of meditation and contemplation has become obsolete. Modern
world interpretation are designed to show man his role and significance in
the cosmic play of things, leading to his liberation. Obviously only a healthy
mind can possibly live up to the demands of such a metaphysics. If a man
will be difficult to acquire for an orthodox Hindu. Such facts, however, should
not deter an earnest seeker after truth from integrating both methods into his
Buddhism
significance for us here, as they are more closely related to the Western
agnostic way of thinking.
mystery of the self or the brotherhood of man. The great appeal that Buddha’s
teaching had for the masses was its emphasis on the brotherhood of man, and
living. These desires can be and are removed by the Eightfold Noble Path of
Buddha— right views, right aspiration, right speech, right conduct, right
2764
prognosis, and proceeding to therapy. Buddha’s therapy leads to the
extinction (or nirvana, “blowing out”) of a man’s worldly desires and the
Buddha lived from about 560 to 480 B.C. Buddhism attained its peak in
India under King Asoka (about 274-237 B.C.) and was eliminated from Indian
soil about A.D. 1250. In the meantime Buddhist monks had spread his gospel
far and wide—into Ceylon, Tibet, and China, and to Japan where it gave rise to
even more in its doctrine of dependent origination than in its emphasis upon
the brotherhood of man. In this doctrine Buddha teaches: (1) that all things
are conditioned; (2) that all things are for that reason impermanent, subject
to change—as all things must change when the conditions upon which they
depend change; (3) that for that same reason there can be nothing permanent
continuity there is, is by way of the inexorable law of the wheel of woe.
this comes to be; and there is nothing besides that which I empirically know
similarly of a musician- patient: “He never tried in his search after that
transcendental and supernatural secret of the Absolute and did not recognize
that the great secret of the transcendental ... is that it does not exist.”
basically offers more to the modern, objective mind than does Buddhism.
an orderly divine play; that man depends not only on cosmic but also on
supracosmic forces, whatever they may be called; that the world is not only
relative but absolute; that man is really God manifesting himself as man. This
conception of man as God-in-man (or God-as-man) sets man free to use his
2766
ego as a representative of the universal “I,” and releases his ego from the
continuous sway of its own ever doubting mind (his personal consciousness);
lust, drives him into a life of artha or kama; or the sway of the superego (his
collective consciousness), which drives him into a life of compulsive duty (or
Taoism
and at about the same time—Taoism, founded by Lao-Tse (604-531 B.C.), and
Tao Teh Ching is the main book of Taoism—Teh meaning virtue; and
prestige, and possessions (Karen Horney) form his ambition, but not living
with the Tao. What is the Tao? It is the metaphysical conviction that man
“belongs” to the law of the universe, will come to grief if he selfishly tries to
assert an anticosmic, separate existence, but will be reunited with the whole,
following the laws of natural simplicity, will be humble and unassuming and
“feed” the tree of all life by unselfish action. Obviously Lao-Tse taught in
terms of his time the eventual misery of the psychoneurotic and, in contrast
to this, the happiness of the Teh, the man of healthy living. He taught it in
and psychotherapy.
Confucianism
primarily religious, not moralistic. He did, however, claim that only by the
discovery of moral righteousness and order would we be able to discover the
cosmic order of Yang (heaven), Yin (earth), and their inseparable cooperation.
2768
the moral law that prepares a man to discover the divine “unity” of the
“universe.”
order. The two following quotations from Kung Fu-Tse show the closeness of
the basic scientific attitude of Confucianism with the modern
psychotherapeutic procedure:
laws of health, and then you will be able to live a sane life in an insane world
—and you will discover that what seemed an insane world is really a world
progressing toward sanity and morality, which always existed but had to be
discovered by your first living a sane life yourself.
combine its religion with scientific discoveries. But the attempt to see the
unity of purpose in all living may be in progress and foreshadow a new era.
eventually will arise: is there nothing more to the human than his id, his ego,
(not to be confused with the demands of the superego) reveals what role we
However valuable such attempts may be, we must ask ourselves again and
whose command do we abide here?” And the very attempt to answer these
questions will lead us sooner or later to seek out what answer Oriental
religion can provide and whether it will help to free us from the widespread
thralldom of meaninglessness.
Bibliography
Akhilananda, Swami, Mental Health and Hindu Psychology, Harper, New York, [Reviewed in Am. J.
Psychother., 6(4)-.772, 1952.]
2770
Burtt, E. A., Man Seeks the Divine, Harper, New York, 1957.
_____(Ed.), The Teachings of the Compassionate Buddha, New American Library, New York, 1955.
Muller, F. M., Indian Philosophy, Vedanta and Purva-Mimamsa, Vol. II, p. 59, Susil Gupta, India,
1952.
_____, The Six Systems of Indian Philosophy, Vol. I, p. 8, Susil Gupta, India, 1951.
Nikhilananda, Swami, Ramakrishna, Prophet of New India, Harper, New York, 1948.
Prabhavananda, Swami (Tr. by Isherwood, C.), The Bhagavad-Gita, Harper, New York, 1944;
reprinted in paperbound ed., New American Library, New York, 1954.
Reik, T., The Haunting Melody, p. 344, Farrar, Straus, New York, 1953.
Vivekananda, Swami, Complete Works, Advaita Ashrama; Mayavati, Vol. VI, pp. 27, 30, Almora,
Himalayas, 1947.
_____, The Yogas and Other Works, Ramakrishna-Vivekananda Center, New York, 1953.
Zimmer, H., Philosophies of India, Campbell, Joseph (Ed.), Bollingen Series, Pantheon, New York,
1951.
Notes
[2] The brilliant young author of this chapter died suddenly February 23, 1968. Only 47 years of age, he
was a rare combination of a skillful psychoanalyst and a deeply spiritual man and was
able to integrate his knowledge and his social concerns without jeopardizing his identity
as a physician. The editors have done well to let his chapter stand as is, for no one with
his particular combination of skills has yet appeared on the horizon to replace him.—
Francis J. Braceland.
[3] “Religion” will generally mean, here, the body of beliefs, practices, and doctrines of the Christian
tradition: by “psychiatry” will be meant especially, although not exclusively, the body of
facts and theories about human behavior which have evolved primarily from the
psychological treatment of mental illness. The more particular radiation of interest is
from the Roman Catholic Church on the one hand and Freudian psychoanalysis on the
other. This statement is not made in a restrictive sense but is simply to make explicit the
influences which affect the selection of certain examples, and to some degree inevitably
affect the view of the whole topic.
[4] Deceased.
[5] The above and following paragraphs have been drawn in part from Heinrich Zimmer. For a fuller
description see Ref. 16.
2772
Chapter 47
Leon Edel
acting out of this irrationality. As psychiatry has addressed itself from the first
—from ancient times—to the study and treatment of mental states, so
literature has depicted them with great imaginative power. We need only
remind ourselves of the passionate and prophetic Cassandra and the horror
of her visions; the violence of Lear’s rage at the moment of the disintegration
of his world; the sleepwalking and madness of Lady Macbeth; or the eternal
question of Hamlet’s sanity. Nor should we forget Dostoevsky’s “idiot” or, in
These are literary cases that not only reveal an intense and powerful
observation of mental states; they also represent remarkable intuitive
visions, and in their use of symbolic language, they seem to talk in fables and
mysteries. They have been regarded, like Cassandra, as irrational but also as
gifted with extraordinary insight. Out of this was born, long ago, the
examples, for varieties of mental being and has made psychiatrists aware of
demonology, the occult of the Middle Ages, or the theories of mental being
during the Age of Reason—when the “unreasoning” began to be shut away
from society. We must remember that The Rake’s Progress ends up in Bedlam.
It was perhaps no accident also that the celebrated Jean Martin Charcot,
teacher of both Freud and William James, should have been an authority on
demonology, or that Jung should have conducted studies into the history of
alchemy, or that William James, all his life, pursued psychical research in a
2774
scientific way.
Writers have always felt some sense of mystery in their creations. They
material they put down on paper; they have known that at a given moment
they seem to be able to bring out of dim recesses whole trains of lost
associations and memories. They have been aware of their power to take the
clutter of life and bring some kind of beautiful order into it. In the East,
centuries ago, Buddha spoke of the mind and of the imagination as consonant
with life itself. He said, “All we are is the result of our thoughts. It is founded
modern psychology tends to bear them out— we find ourselves well on the
road to the discoveries of Sigmund Freud and what he spoke of as the
suspect he was also speaking of everything that comes into the mind, even the
irrational; and I do not think he was saying Cogito ergo sum—“I think,
therefore I am”—the celebrated dictum of Descartes that gave so pronounced
repudiated the guidance of the senses. The Age of Reason distinctly felt that
man’s senses tend to mislead, that they interfere with and prevent the
observing of reality.
Reason. Within that movement we can discern a great “inward turning” that
ultimately created the intellectual and artistic climate for Freud’s discoveries.
Goethe argued that the novel is valid only when it portrays man’s inmost
thoughts; no other form of literature, he said, can more effectively give us
romanticism both in his poetry and in his drawings, found symbols for inner
states and cultivated a personal mythology. Coleridge, in glimpsing peripheral
ambivalences, its mythic landscapes quite as real and often more real than the
of the “stuff of sleep and dreams” adding, “but Reason at the Rudder,” and
Lamb characterizes the difference between night dream and the fantasies of
the artist by saying that artists dream “being awake.” So, too, writers as
2776
dream world that they lived with old submerged and disguised realities of
the fact that hypnosis could touch hidden depths and, long before Charcot and
Freud, tried in his amateur way to give aid to a mentally ill friend by
never deal directly with daytime experiences. He explained how they are
of a story,” he wrote, “I find that I dream at night, never by any chance of the
story itself, but perhaps of trying to shut a door that will fly open, or to screw
something tight that will be loose, or to drive a horse on some very important
journey, who unaccountably becomes a dog and can’t be urged along.” He
added: “I sometimes think that the origin of all fable and allegory, the very
book on dreams, there occurred a series of movements that were the logical
consequences of romanticism —a bursting of the bonds of the rational and
the observed—as if the Western world were preparing for the journey into
the unconscious. “Realism” and “naturalism” had had their day, but to this
period belongs (in literature) the development of the Symbolist Movement
rational way psychological or human time, and man’s feelings for the occult.
No one so far as I know has traced the “climate” in which Freud worked on his
dream studies; but we know that in all the arts the “inward-turning” was
key book, like Darwin’s Origin of the Species. From the period just before the
Freudian work, and in the immediate decades that followed, we can date “the
modern movement” in art and the direct insemination of surrealism by
Andre Breton journeyed to Vienna and dedicated his first book to Sigmund
Freud. Author of the surrealist manifestoes, Breton would for years seek to
find verbal equivalents for the inchoate stuff of the unconscious, through
automatic writing, through recording of consciousness at hypnagogic
2778
Interdisciplinary Problems
their author’s imagination. We can never know Hamlet’s blood pressure, nor
his blood chemistry; nor can we usefully say he was paranoid or schizoid or
structures of words are part of symbol and myth. Psychiatry on its side offers
literary criticism and literary biography valuable guidelines and insights into
forms and structures—the novel, the play, the poem—in which the artist
embodies personal and social symbols and myths. In psychoanalysis personal
the substance of fiction, poetry, and drama offer much material by which the
because he was extrapolating from meager data, had within them useful
catharsis, he went beyond to see how far art represents a territory between
psychoanalysis has its limitations in such application: it has yet to explain the
genesis of art; and he carefully placed this question among the unsolved
2780
who have aroused in the world a particular curiosity. A corollary field is the
study of the process by which such individuals have been enabled to create.
physically active and seek the world, rather than withdrawing from it in order
their writing desk. It has particular value for interdisciplinary study because
we find in it the verbalization of so much of man’s inner landscape. Human
curiosity usually leads us to seek the personality of the poet once we have
been excited by his poem—or by his novel or play. The literary work suggests
mysteries; it offers, as T. S. Eliot puts it, the “objective correlative”' of the
immediate source, the human vitality and the mind, the dream-making
symbols and myths that have gone into its production. The biography that
celebrates a statesman or a general may be concerned with certain of his
memory, association, craft, tradition (and much more) out of which the
questions of privacy, even when they are not bound by the oath of
Hippocrates; they know that they cannot map all the stages of creativity. The
artist scarcely wishes to offer his life history as appendage to his created
work. At best all we can hope to do is obtain glimpses of the imagination in
imagination, and the particular myth that these symbols express, the
psychiatrically oriented biographer is writing the only kind of biography that
can be said to have validity. Biographers of James Joyce, who have accepted
that writer’s own legend and myth (which was that of a world hostile to
Joyce), have simply chronicled the illusions by which the Irish writer lived
and defended himself. With the knowledge of what life patterns are, and how
invaded in this kind of biography, for our concern is not with his little daily
doings (although these, too, may illustrate character and personality), but his
protagonist, Stephen Dedalus, in his conflict between the flesh and the devil,
and the manner in which this is told in the novel; and its readers have been so
2782
dazzled by the virtuosity of the writing that they fail to see that the young
the facts of his own boyhood and youth, he expressed their truest meaning,
the deepest modes of his being. This kind of biography, far from being
gratuitous, helps us to arrive at truth, the truth of which Goethe wrote when
deceived himself in telling his personal story, as all writers must. The
Dr. Phyllis Greenacre, in her study of Charles Darwin entitled The Quest
for the Father, draws a valuable distinction between the roles of the
psychoanalyst who wishes to write biography and the psychoanalyst engaged
for this purpose. The personal involvement and neutrality of the therapist
permit the patient to be drawn almost irresistibly into reproducing, toward
specific content) which have given rise to his difficulties. In this setting, the
analyst can help the patient to become feelingly aware of the nature of his
individual who is in a good state of balance.” From this, Dr. Greenacre is led to
define, both for the psychoanalyst and for the literary biographer, the precise
difference between the writer who works with the living subject and the
patient formed out of direct confrontation and the transference situation, the
“psycholiterary” biographer, if one dares to combine the two, “approaches his
involved in it. Further, the study is made for the purpose of extending analytic
[and we might insert also literary] knowledge and is not sought by the
subject.”
This helps us clear the ground. It suggests to literature that the Boswell
2784
type of biography may need to be reexamined, for the Boswells know their
subject and author requires close scrutiny. One would have to examine, for
instance, the large biography that Lawrance Thompson wrote of Robert Frost;
or that planned by Carvell Collins of William Faulkner; or the one proposed by
personal emotional life—they have felt a special affection for him from the
very first. They then devote their energies to a task of idealization, aimed at
enrolling the great man among the class of their infantile models—at reviving
in him, perhaps, the child’s idea of the father. To gratify this wish they
being to whom we might feel ourselves distantly related. That they should do
this is regrettable, for they thereby sacrifice truth to an illusion, and for the
biographer who uses his subject as an expression of anger and hate rather
than of love for the “infantile model.” This explains the school of “debunking”
biography, which arose with Lytton Strachey and resulted in the wholesale
The best, the most objective, biography is the one that recognizes the
biography that uses its evidence in a “scientific” way. Boswell’s stated desire
to show us his subject, warts and all, conforms to the scientific ideal of most
biographers. Yet their countertransference soon blurs the lines and alters the
image, as Freud predicted. What are biographers to do? One hardly can
propose they undergo a prolonged psychoanalysis; but they might seek the
counsel of the psychiatrist, and recognize that it is precisely here that
psychiatrist who feels a need to write a biography rather than a case history
2786
insofar as his talents permit, of literary art. Such a psychiatrist, we would
hope, has himself been sufficiently analyzed to be able to avoid the dangers of
modalities of the creative act. And then psychiatrists often fail to translate
their special language into the discourse of everyday life. They write, after all,
in the language of their profession, rather than in that of the unindoctrinated
Ernest Jones’s life of Freud in which he writes of Freud as a child during the
Darker problems arise when it dawned on him that some man was even
more intimate with his mother than he was. Before he was two years old,
for the second time, another baby was on the way, and soon visibly so.
Jealousy of the intruder, and anger for whoever had seduced his mother
into such an unfaithful proceeding, were inevitable. Discarding his
knowledge of the sleeping conditions in the house, he rejected the
unbearable thought that the nefarious person could be his beloved and
perfect father.
Surely it never “dawns” on a two year old that some man “is even more
into the consciousness and awareness of the child material that according to
Freudian theory exists (we may speculate) in his unconscious. The use of
words such as “jealousy” and “seduction” in relation to a two-year-old, even if
verisimilitude. A more skilled biographer would say that Freud, years later,
may have felt that in his infantile experience he had undergone a period of
child into the family. And even though he had felt, in the intuitive ways of
childhood, that somehow his father was involved in the event, lie had
concealed this thought that his parent, who seemed to him an ideal and
powerful figure, would deprive him of the place he occupied in the very
center of his mother’s life. In some such way the psychoanalytical ideas can be
translated into the language of everyday life.
writers. In the old days these slips would have been ignored; today they can
Henry James I first began to pay attention to the unusual sibling rivalry
between the novelist and William, his psychologist brother, when I noticed
2788
that Henry had made an error in giving his brother’s birth date, in a book
entitled Notes of a Son and Brother. Such errors, I suppose, are not always
significant; nevertheless, Freud alerted us to them, and I was led from this slip
of the pen to its context, and ultimately to observing that what had always
been described as an unusually affectionate relation between two men of
chose second sons as his heroes (William was fifteen months older) and
usually relegated older brothers to wars, where they were killed off, or sent to
mental institutions; and upon the younger rival then fell the mantle and
guardianship of family name and honor. The image the world originally had of
Henry and William James was that of peers in their creative kingdoms. What
was important was to see the many levels of this relationship: the overt
affection and concern of the two, their roles in the cultural life of America and
Europe, their consistent development, yet each working out his own destiny
(he being my subject) but from William’s as well. In this way I offered an
interpersonal study. And since what occurred between these brothers was an
situation into the Jacob and Esau story of the Old Testament, extending the
life of a genius and deal with its pathology, or try to show that certain
study of creative process. But there is more to be said about the “reductive”
nature of any psychological or biographical probing of a writer and his work.
If the psychoanalytical student of literary creativity spends his time (as I have
had occasion to observe) snorkeling around the base of the iceberg seeking to
see what is submerged without looking at the glittering exposed mass visible
to the world, then, indeed, the process is reductive. We can always find id
explanations for this or that part of a talented life and say that an individual’s
“orality” or his “cannibalism” has made him keep his large grasp on life in
order that he may consume it. The early essays in “applied” psychoanalysis
are filled with this kind of inquiry. Nevertheless, it is the visible shape of
genius that has encountered the world, and it is the relationship between the
submerged and the visible that should be the focus of our study. The inquiry
of Thomas Mann in The Magic Mountain into man’s way of passing through
illness into health is an example in fiction of the nonreductive method: that is,
the recognition that it is not necessarily the bellyache that inspires the poem,
2790
but the poet’s determination to overcome the bellyache. Most art of the
transcendent kind represents a drive to health, not to illness; and while one
age-old will to perpetuate the human spirit and the human consciousness.
Psychoanalysis, and the larger field of psychiatry, could do a great deal to help
of art that may seem highly idiosyncratic are in reality products of alienation
and madness, derived from man’s destructive side. If we could say with
greater assurance that the truly “sick” work of art is profoundly pathological,
it might not be praised for the wrong reasons. This would require a large
measure of delicacy and insight; and I am certain that most critics today
difficult to see the pathology of a book like Mein Kampf and to recognize how
contagious such pathology can be. But it is more difficult to deal with the
experience with natural experience and dwells on the excremental and the
obscene in ways that degrade life and only record profound morbidity. In this
one must distinguish with great caution between the need for education and
for evaluation while making clear censorship is not intended.
Creative Process
The study of creative process need not be gone into in any detail here; a
large literature is available on the subject. What we can say is that psychiatry
and psychoanalysis has opened up new avenues of insight into the ways in
works of art. What is not sufficiently realized is that any direct “imitation” of
life is essentially an act of journalism; and that the imaginative
making capacities. Works of art are much more than dream: they are dream
that has been given conscious shape by the verbal, the rhythms and patterns,
the color and tactile senses of the artist, depending on his medium. Some
2792
psychiatrists have tended to regard a novel or a poem as if it were a dream.
the writer or painter with the art of the past, and the ways in which the gifted
landscape. How delicate and complex the study of creative process invariably
similarities through symbol and metaphor to arrive at the new. The body of
knowledge available to us in Freud, Jung, Kris, Arieti, Schachtel, Greenacre, to
then they tend to regard symbols as having fixed meanings when they draw
history, which unostentatiously lets us into the secret of man’s life,” and
Henry James observed that “the artist is present in every page of every book
writings of Jung have had particular appeal to literary criticism because of his
study of the nature of myth and archetype. His search for parallels between
2794
of his ideas is to be found in the critical theorizing of Northrop Frye,
particularly in his Anatomy of Criticism (1957) where he observes that
study of the ways in which the artist projects himself through literary forms.
The creative imagination and the artist’s dream work can take psychiatry
beyond diagnosis and therapy in offering projections of extraordinary cases
of a highly individual kind. The disciplines are enabled thus to work toward a
better knowledge of human creativity when it takes the form we describe as
Bibliography
Arieti, S., The Intrapsychic Self, Basic Books, New York, 1967.
Dickens, C., Selected Letters (Ed. by Dupee, F. W.), Farrar, Straus, and Cudahy, New York, 1960.
Edel, L., “The Biographer and Psychoanalysis,” Internat. J. Psychother., 42:4-5, 1961.
_____, The Life of Henry James, 5 vols., Lippincott, New York and Philadelphia, 1953-1972.
Eliot, T. S., “Hamlet,” in Selected Essays, new ed., Harcourt, Brace, New York, 1950.
Freud, S., "Leonardo da Vinci,” in Strachey, L. (Ed.), Standard Edition, Vol. 11, pp. 107, 130,
Hogarth, London, 1957.
Greenacre, P., The Quest for the Father, International Universities Press, New York, 1963.
_____, Sigmund Freud: Life and Work, Basic Books, New York, 1960.
Kris, E., Psychoanalytic Explorations in Art, International Universities Press, New York, 1952'
Ross, N. W., Three Ways of Asian Wisdom, Simon & Schuster, New York, 1966.
2796
Chapter 48
Bruce Mazlish
broadened beyond mental illness into a kind of general psychology can it,
even in principle, become available for significant use by historians and social
scientists.
psychiatry has put it, “In our century a scientific revolution has taken place:
medical thought.”
highly attractive for the historian who attempts to use it in his own work.
mental processes, and the “laws” that hold good in that realm, in the course of
such a conclusion.
historical ones. In fact, it has often been noted that psychoanalysis deals with
personal history. In any case, as Hans Meyerhoff has so well illustrated, both
psychoanalysis and history deal with materials from the past, seek to
Although its explanations are not offered in lawlike formulas, but rather in
2798
terms of a holistic reconstruction, psychoanalysis approaches its materials
with a general theory of its own (initially derived, of course, from clinical
a systematized science.
can give the historian a means other than his mere intuition or common-
groups. And since motive is a key factor in much historical explanation, the
historian finds himself more and more drawn to the use of psychoanalysis in
demographic, and economic fields as well for its materials and theories.
Apparently around 1910 his interest in the subject came first to flood tide,
culminating in the publication of Leonardo Da Vinci in that year and
A word about the latter first. It is usually not mentioned in the context of
2800
attention was caught by Schreber’s Memoirs (published in 1903). By the end
of the year he had finished his new manuscript. In this work Freud made his
one could use such materials, penetrating through their censored and
distorted nature. While Schreber was essentially a “patient,” that is, mentally
ill, Freud showed how to work with materials removed from the clinical
situation itself.
this context, also appealed to a “memoir,” but this was only a short childhood
memory, inserted almost accidentally into Leonardo’s scientific notebooks.
The memory concerning what Freud called vultures, added to various books
excursions into the field of biography” (though we might wish to qualify this
statement by adding the controversial work, in collaboration with William
need summarizing here. Unlike the Schreber that followed, it dealt with a
dead person as well as a historically famous one. It has also aroused a good
deal of controversy. For example, Freud made the mistake of accepting as the
translation for nibbio, Italian for “kite,” the German word for “vulture,” and
then proceeded to offer recondite myths about vultures to confirm his general
analysis. So, too, as the eminent art historian Meyer Schapiro has pointed out,
Freud took as particular to Leonardo’s paintings (for example, the raised
finger of John the Baptist) what was, in fact, common to all the iconography of
respond to these and other criticisms, and the interested reader must be
referred to that magisterial book. For our purposes we need not pass final
judgment on Freud’s work here, but merely note that it was a pioneering
approach are highlighted in the last work in this genre to which he lent his
2802
1939 (though held back from publication at that time). Most commentators
are willing to agree that the Introduction is by Freud and that the rest is
based on conversations Freud had with Bullitt; they also feel that Bullitt, in
the writing, distorted some of Freud’s views and removed all the subtlety of
his interpretations.
treats its subject—a highly creative political leader—as if he were nothing but
a clinical patient. By its emphasis on the pathological, the book shows how
but also pioneered its application to historical materials. One other work of
he opened the way for others to learn by his work and to carry on further in
the direction he had set.
always teetered on the edge of reductionism. The next thing to note is that the
shift in emphasis in psychoanalytic theory, from concentration on id
although often for the same data (for example anima and animus instead of
2804
Jungian analysis might be applied to individual life histories; and it has been
setting has had more resonance than Jung’s work among historians and social
scientists. Partly this may be because social scientists are much concerned
public characters.” Emerging from this data with the postulate that politicians
were in search of power and that their “most important private motive is a
takes place has turned out to be a more involved problem than was originally
thought, with the intervening links difficult to trace in the case of actual,
functioning politicians. Nevertheless, Adler’s influence, mediated through
lesser degree, historians as well. Thus, Alexander and Juliette George, in their
exemplary study, Woodrow Wilson and Colonel House, weave much of their
interpretation around the notion that Wilson’s repressed hostility toward his
father found displaced expression in many of his political struggles, where his
“taste for achievement and power” could find satisfaction. Needless to say, the
taste for power was rationalized in terms of a lofty idealism: Lasswell’s
“rationalization in terms of public interest.” The Georges conclude that in
them to analysis of group phenomena rather than individual life histories, one
can mention the highly suggestive book by O. Mannoni, Prospero and Caliban:
2806
—as highlighted by the uprising in Madagascar in 1947. He sees the colonizer
as asserting superiority to overcome his fears of inferiority and projecting his
own unconscious fears onto the natives. The latter, in turn, have a
dependency complex, derived from their cult of the dead, that conditions their
relations to the colonizers. The contact of these two personality types, and
Mannoni seeks to analyze in detail. Although he claims that “if one had to
development seen in Durkheim, Cooley, Mead, Lewin, and Sapir that “reached
take Sullivan and Fromm as the prototypes for what was involved.
organism, although he is biologically rooted; (2) man is “not a fact but an act,”
that is, he develops and changes in a continuous process; and (3) his psychic
states, for example, anxiety, are the result primarily of interpersonal relations
(which are determined largely by his particular society and its socialization
processes ) rather than intrapsychic conflict.
favored the study of man in society and developing over time, in contrast to
per se, although his work undoubtedly affected the climate of opinion in
which they worked. Perhaps this was because, in spite of its differing
theories separate from the orthodox Freudian ones with which to work.
2808
the lines of Sullivan’s thinking was the work of an analyst, not an historian:
Erich Fromm’s Escape from Freedom. The influence of this wide-ranging book
by the Nazi phenomenon of the time, the book has enjoyed numerous
reprintings.
Fromm conveniently states both his intention and his thesis at the very
beginning of his work. He intends the book to be part of a broad study
“concerning the character structure of modern man and the problems of the
(although it must be noted that by 1955 Fromm, in his Sane Society, turned
against Sullivan). Fromm’s thesis is that “modern man, freed from the bonds
of pre-individualistic society, which simultaneously gave him security and
limited him, has not gained freedom in the positive sense of the realization of
his individual self; that is, the expression of his intellectual, emotional and
sensuous potentialities. Freedom, though it has brought him independence
and rationality, has made him isolated and, thereby, anxious and powerless.
This isolation is unbearable and the alternative he is confronted with are [sic]
either to escape from the burden of his freedom into new dependencies and
submission, or to advance to the full realization of positive freedom which is
thesis, is Arthur Mitzman’s The Iron Cage.) However, Karl Marx seems to be
the outstanding influence. Passages in Escape from Freedom seem to read
how capitalism “helped to sever all ties between one individual and the other
and thereby isolated and separated the individual from his fellow men.”
state of oneness with the natural world.” Fromm describes this earlier state
belonging, must be broken. The result is that the individual now feels his
freedom as isolation, as “a curse.” Two resolutions are open to him: he may
2810
turn to authority and slavishly submerge himself in a group, that is, “escape
from freedom”; or he may embrace the “one possible, productive solution for
the relationship of individualized man with the world: his active solidarity
with all men and his spontaneous activity, love and work, which unite him
again with the world, not by primary ties but as a free and independent
individual.”
the twentieth century the escape from freedom into authoritarianism took
specific shape in Germany. In short, he offers a sort of psychological history of
modern times.
asserts without much real use of hard historical data that medieval man, in
spite of many dangers, “felt himself secure and safe.” This hardly accords with
other views of the medieval period, where anxiety seems endemic. If 1348-
1349 is still “medieval” (and Fromm makes no effort to be precise), then one
must reckon with the psychic consequences of the Black Death, as William L.
also to assume a “middle class” in the medieval period; most historians would
societies, such as Great Britain and the United States, than to latecomers to
than with concrete historical data, and historians have accordingly resisted
following it.
2812
Thus, whatever its own limitations as history and therefore
with other individuals in a social and historical setting. Above all, he has
problem, but the hold it has over a whole people has to be understood on
Sullivan and his co-workers. It also opens the way for a truer fusion of
psychoanalysis, sociology, and history.
the other side Reich emphasized the social, insisting on the unique
symptoms, but on the patient’s total character structure, seen as the result of
Fascism (1933), Reich turned to Marxism as the key to the social factors and
tried to fuse Marx and Freud. In this book Reich attempted to delineate an
2814
that sexual repression under capitalism is surplus repression, that is, the
equivalent of Marx’s surplus value. He also analyzes the “performance
Against Death, eschews Marcuse’s Marxism, but carries even further his
“psychohistory.” Not since Freud himself has the impact on history been so
great.
Sullivan and his school helped prepare the way for Erikson, but it is
opened the way in theory for Erikson’s work. As is well known, attention was
now centered on the interrelationship of id, ego, and superego processes, and
stress placed on the defensive and adaptive functions of the ego. Normality
breakdown, and the personality was seen more as a functioning whole than
as a bundle of neuroses; hence reductionism was more easily avoided.
simple, clear terms his “Theory of Infantile Sexuality.” Here he tried to show
how id, ego, and superego processes interrelate during all the stages of
he deals with the orthodox stages of oral, anal, phallic, and genital in terms of
what he calls “zones, modes, and modalities,” thus freeing them from a
2816
predominantly biological orientation. Implicit, too, in this essay, though more
fully developed in the later chapter, “Eight Ages of Man,” are Erikson’s stages
age, adolescence, young adult, adulthood, and mature age, where the
individual is presented with such antinomies as “trust versus mistrust,”
“autonomy versus shame,” “initiative versus guilt,” and so on. Although such
stages carry with them the danger of being applied mechanically, they offer, if
given stages are elaborated upon by culture, with varied and different results.
American, German, and Russian national character. In Young Man Luther and
in Gandhi’s Truth Erikson really practiced what he preached and gave full-
scale examples of what he intended by psychohistory (though at first he did
not use the term). Thus, much of Erikson’s effect on historians has resulted
from the fact that he united theory and practice to an unusual degree, and in a
sociology that has had the greatest influence on Erikson. Third, he studied his
historical materials closely (though some historians disagree with the way he
does this), adding to the usual historian’s insight his own psychohistorical
methods derived from a secure base in clinical data; that is, the same analysis
as manifested in the historian himself. For these and similar reasons many
here. In Young Man Luther and Gandhi’s Truth he calls attention to the way in
which the great leader, solving his own problems—primarily an identity
2818
crisis —offers a solution also to the problems of many others in his time and
society. The identity crisis, then, has become a heuristic way of looking at
leaders and groups, and a number of historians and political scientists have
been inspired in their work by this notion. By choosing religious leaders who,
in addition, became political leaders, Luther and Gandhi, Erikson has also
the child (where a failure here can mean schizophenia) all the way to Gandhi’s
Such theories as those above, however, give little indication of the actual
impact of Erikson’s work on historians. The major impact comes not from
such large-scale ideas but from Erikson’s precise and detailed application of
the two in psychohistory that has opened up a whole new field of endeavor,
Freud’s work, it has drawn inspiration from the contributions of some of his
coverage, the general lines of evolution. Now we need to consider what lies
One problem clearly is in the area of training. A few analysts are turning
to graduate work in history; there seems no inherent problem here except
psychoanalytic side, however, will presumably “pick up” their history from
private reading and study, with all the attendant dangers of amateurism and
superficiality. From the social science and history side, the dangers of
social scientists; it remains to be seen how appropriate these courses will be.
(In addition, one ought to note the possibility of collaboration between
2820
himself have the experience of treating a few patients in therapy, under
supervision? Is adequate funding available to the social scientist for these
kinds of experience? Such problems as these, and related ones, are not to be
talked about.
generally dead, or at least out of reach, the clinical analyst’s resort to free
association and dream analysis, for example, is simply not available. Are
documents.
actual political decision to exterminate six million Jews? To link the two we
need a general historical explanation, and this may not be easy. In general, a
linked to a major event that he has helped create: the Reformation, Nazism,
nonviolence, or the 1936 Purge; and this is surely one reason why life
histories have attracted the first real efforts in psychohistory. Nevertheless,
explanation remains.
2822
concerned with falls into the realm of group phenomena. How can
psychohistory resolve this basic dilemma?
One solution is to proceed with the effort to link the life histories of
great leaders with the mass phenomena they seemed to have evoked. In so
doing we seek to understand more about the society and history of a period in
nuclear group shaping the individual. The family, of course, is itself a changing
oedipal complex. At the moment the best work on this particular subject has
been done by an anthropologist, Anne Parsons, but psychohistorians should
soon have more to say about it and related concepts. Meanwhile, however,
basic work on the history of the family is seriously under way, with Philippe
political scientists have been trying to talk about group identity. Historians
history.
The task for psychohistory seems, therefore, to develop each of its parts
2824
prepared the way for advances in psychohistory. In the future, however, such
advances would seem to be most realistically expected from the collaboration
would take the form of a true fusion of thought and effort, reflected in
professional training, and manifesting itself in important steps forward in a
Bibliography
Ackerman, N., and Jahoda, M., Anti-Semitism and Emotional Disorder: A Psychoanalytic
Interpretation, Harper, New York, 1950.
Adorno, T., et al. The Authoritarian Personality, Harper & Row, New York, 1950.
Alexander, F. G., and Selesnick, S. T., The History of Psychiatry, Harper & Row, New York, 1966.
Aries, P., Centuries of Childhood (Tr. By Baldick, R.), Knopf, New York, 1962.
Blanchard, W. H., Rousseau and the Spirit of Revolt: A Psychological Study, University of Michigan
Press, Ann Arbor, 1967.
Brown, N. O., Life against Death, Wesleyan University Press, Middletown, Conn., 1959.
Bushman, R., From Puritan to Yankee: Character and the Social Order in Connecticut, 1690-1765,
Harvard University Press, Cambridge, 1967.
Cohn, N., The Pursuit of the Millennium, Seeker & Warburg, London, 1957.
_____, Warrant for Genocide, Harper & Row, New York, 1966.
Demos, J., “Underlying Themes in the Witchcraft of Seventeenth-Century New England,” Am. Hist.
Edixger, L., Kurt Schumacher: A Study in Personality and Political Behavior, Stanford University
Press, Stanford, 1965.
Eissler, K. R., Leonardo Da Vinci: Psychoanalytic Notes on the Enigma, International Universities
Press, New York, 1961.
_____, “On the Nature of Psycho-Historical Evidence: In Search of Gandhi,” Daedalus, 97:695-7,30,
1968.
_____, “The Problem of Ego Identity,” J. Am. Psychoanal. A., 4:56-121, 1956.
Freud, S., and Bullitt, W. C., Thomas Woodrow Wilson, Twenty-Eighth President of the United
States: A Psychological Study, Houghton Mifflin, Boston, 1967.
Friedlander, S., L’Antisemitisme Nazi. Histoire d’une psychose collective, Editions du Seuil, Paris,
1971.
George, A. L., and George, J. L., Woodrow Wilson and Colonel House, John Day Co., New York, 1956.
Greenstein, F. I., Personality and Politics, Markham Publishing Co., Chicago, 1969.
Hunt, D., Parents and Children in History: The Psychology of Family Life in Early Modern France,
Basic Books, New York, 1970.
Isaacs, H., “Group Identity and Political Change: The Houses of Muumbi,” paper presented to
Psychohistorical Study Group, American Academy of Arts and Sciences, October 16,
2826
1971.
Keniston, K., The Uncommitted: Alienated Youth in American Society, Harcourt, Brace & World,
New York, 1960.
_____, Young Radicals: Notes on Committed Youth, Harcourt, Brace & World, New York, 1968.
Künzli, A., Karl Marx: Eine Psychographic, Europe Verlag, Wien, 1966.
Kurth, G., “The Jew and Adolf Hitler,” Psychoanal. Quart., 16.11-32, 1947.
Lancer, W. L., “The Next Assignment,” Am. Hist. Rev., 6.3:283-304, 1958.
Lifton, R. J., Death in Life: Survivors of Hiroshima, Random House, New York, 1967.
_____, History and Human Survival, Random House, New York, 1970.
_____, Revolutionary Immortality: Mao Tse-tung and the Chinese Cultural Revolution, Random
House, New York, 1968.
Mannoni, O., Prospero and Caliban: The Psychology of Colonization (Trans, by Powesland, P.),
Frederick A. Praeger, New York, 1956.
Mazlish, B., “Clio on the Couch: Prolegomena to Psycho-History,” Encounter, 31: 46-54, 1968.
_____(Ed.), Psychoanalysis and History, rev. ed., Grosset & Dunlap, New York, 1971.
Meyerhoff, H., “On Psychoanalysis and History,” Psychoanalysis and the Psychoanalytic Review, 49,
Mitzman, A., The Iron Cage: An Historical Interpretation of Max Weber, Knopf, New York, 1970.
Parsons, A., “Is the Oedipus Complex Universal? The Jones-Malinowski Debate Revisited and a
South Italian ‘Nuclear Complex,’ ” Psychoanal. Study Soc., 3:278-328, 1964.
Pye, L., Politics, Personality, and Nation Building: Burma’s Search for Identity, Yale University
Press, New Haven, 1962.
Reich, W. (193.3), The Mass Psychology of Fascism, 3rd ed., Orgone Press, New York, 1946.
Riesman, D., The Lonely Crowd, Yale University Press, New Haven, 1950.
Robinson, P. A., The Freudian Left, Harper & Row, New York, 1969.
Schapiro, M., “Leonardo and Freud: An Art-Historical Study,” J. Hist. Ideas, 17: 147-178, 1956.
Simmel, E. (Ed.), Anti-Semitism: A Social Disease, International Universities Press, New York, 1946.
Strachey, J., “Editor’s Note,” in Standard Edition, Complete Psychological Works, Vol. 11, p. 60,
Hogarth, London, 1953.
Strout, C., “Ego Psychology and the Historian,” Hist, & Theory, 7:281-297, 1968.
Waite, R., “Adolf Hitler’s Anti-Semitism: A Study in History and Psychoanalysis,” in Wolman, B. B.
(Ed.), The Psychoanalytic Interpretation of History, Basic Books, New York, 1971.
Weinstein, F., and Platt, G. M., The Wish to Be Free, University of California Press, Berkeley, 1969.
2828
Chapter 49
Bernard Kaplan
Since there has been but a limited number of distinct generative ideas in
the history of thought, it is not surprising that some kind of comparative
rudimentary form.
men as Freud, Piaget, Wallon, and Werner have much in common when
approach of Heinz Werner has been chosen for exposition here. This choice
with Werner for more than fifteen years, is most familiar with and most
Every key “catchword,” A. O. Lovejoy reminds and warns us, has been
the writings of different thinkers, but also in the works of the same thinker at
2830
such catchwords. Encrusted with multiple connotations deriving from their
employments within a single discipline, they are each likely, exposed to the
kind of analysis for which Lovejoy was justly famous, to unfurl at least a
dozen different meanings, including a number at odds with each other. It is
not germane to attempt to lay bare these multiple meanings here. What is
relevant is that different conceptions may underlie the usage of a key term,
even in the writings of the same thinker. In the latter case, this is sometimes
Often a change ensues as one becomes clearer about one’s subject matter.
considerably from the more customary ones; and some of these divergences
partly infected Werner’s early writings, despite his explicit rejection of them.
forth, fully formed and immutable, at a particular time, or as if it had not since
undergone modification. Furthermore, the position as advanced in Werner’s
with that taken, jointly with the present author, in Symbol Formation; nor is
the position sketched in that work identical with the one toward which we
were working at the time of Werner’s death. The approach changed over
time; hopefully, it also developed. Although space precludes the tracing of all
2832
an heuristic principle, a way of looking at phenomena in the “interest of
reason.”
extension, any kind of change over time, for example, change with age, was,
by the fact itself, developmental.
formulated not only so that it entailed orthogenesis, but also so that its
integration. Such a formulation did not commit one to the view that any
2834
mental development such as Werner had envisaged and had taken initial
steps to realize. It still did not seem to permit a comparison and
that he had become a child once again. It still seemed to bar a comparison and
developmental ordering of the modes of functioning of higher primates, of
of the modes of functioning of adult human beings in the different worlds that
they inhabit (for example, the dream world, the fantasy world, the everyday
our unilinear time scheme. Only in this way, it appeared, was it possible to
encompass the range of phenomena Werner sought to encompass, without
over time. The main consequence of the progressive attempt to render the
concept of development context-free is that development becomes a manner
of looking at phenomena, a new way of representing phenomena, rather than
for not only in the formation of personality, but also in the formation of a
percept; not only with regard to the conception of self, but also with regard to
conceptions of space, time, number, and causality; not only with regard to
individual behavior, but also with regard to cultures taken as organic unities;
not only with respect to time-bound series, but also with respect to patterns
2836
of organization or to modes of functioning, regardless of time of occurrence.
Primitivity
the concept of “primitivity” freed from its bondage to time. Just as the
functioning typical of the dream state as primitive relative to that of the alert,
2838
motives underlie the diverse forms of primitive mentation.
Formal Parallelism
on, one would expect that forms of life, modes of being-in-the-world, types of
Polarities in Orthogenesis
environment system the ends of the organism or the functions toward which
it is directed, the means by which it executes its functions, the consequent
structure of its transactions with its surrounds, and its capacity to maintain
its integrity and to adapt itself to internal and external vicissitudes. With
regard to these various aspects, prescinded from the total organism-
distinguished, are not sharply differentiated, and in the latter, functions are
less undifferentiated from each other (as in the dream state), and in the latter,
they are distinguished and “freely combinable.” With regard to the structure
2840
advanced acts or products are segmented, with clearcut parts subordinated to
maintain its integrity and to adapt itself to inner and outer vicissitudes, one
isolated modes of functioning (“ideal types”) and the ordering of these modes
in terms of the orthogenetic principle, he has the additional aim of utilizing
the course of a life career or in varied circumstances at any one period in the
life career. Individuals observed in the course of human ontogenesis do not
progression in ontogenesis. This, however, should not lead one to believe that
2842
Developmental theorists do not distinguish types of men, but rather
mentation. However, the actual conditions of existence, the society into which
theorists fully accept the doctrine of “the psychic unity of mankind.” However,
they do not confuse unity with homogeneity or capability with actuality.
Psychopathology
overdetermined; for example, the goal of securing esteem or love may not be
distinguished from the goal of securing nutrition. One is oriented toward the
acting, so important for establishing the cardinal distinction between self and
nonself and for separating the different “spheres of reality” in which the
uncontrolled incursion of activities into domains from which they had been
2844
excluded through higher level controls, for example, personforming activities
to collapse similarity into identity, to confuse the symbol and the referent,
and so on.
Goldstein'" has described as “the loss of the abstract attitude” and what Arieti
has described in terms of “Von Domains’ principle.”"' Since the mode of
One may cite the following remarks by the psychiatrist, Harold Searles:
“From a phenomenological viewpoint, schizophrenia can be seen to consist
Reiehman, Hill, and other authorities in the field” (p. 261). There is only one
and psychology by Darwinism, has been the “law of continuity.” This law,
dogmatically rather than methodologically maintained, has led some
2846
different levels of organization, not only with regard to different species, but
also with regard to the domain of human behavior. Different forms of life have
irrespective of how these differences have come about. This is also the case
for the human being, not only in the course of ontogenesis, but also in the
signals; (3) reflective or detached knowing about objects and events. The
the distinctive capacity for symbolization, which is among the human being’s
Explication of Concepts
Symbolization
primitivity among the young and of pathology among the old. Due mainly to
to designate things as they are. With the increasing recognition that all
knowing transcends the so-called sensory given has come the realization that
and, in fact, enters into the very constitution of his world of objects."
2848
The essence of the activity of symbolization—and this core is clearest
“radical metaphorizing.”
terms the “law of concrescence” operates with ideal significations like the
part-whole relationship, relationship of resemblance, and so on, not yet
distinct activities and with the correlative stabilization of the domains of the
subjective and objective, symbolizing becomes relatively autonomous, and
the self becomes aware of its symbolic activity. The individual is capable of a
distinction between vehicle and referent and can recognize the differences
Language
course of his vital and intellectual activities. As is the case with other
instrumentalities, the functional structures of a language are grasped in use
before they are articulated for and by reflective thought. Like other
2850
subserves, but it also shapes those activities. Finally, as other
instrumentalities, a language, capable of the most refined uses, may be only
Speech is an activity that may occur without the use of language; language, on
the other hand, is an instrumentality that may be understood and used
shapes and guides, that activity, and the agent who executes it.
number and kind seem to vary with the investigator and his principal area of
inquiry, as well as with his penchant for specification; but one may follow the
circumscribed significance in the social code, he uses them without regard for
their customary meaning and mainly to exhibit his feelings. Such words may
affective equivalence among the situations. The lack of concern for the
linguistic code reveals itself in forms of utterance that are agrammatical and
2852
psychological order of the ideas rather than in the grammatical order of the
language” (p. 268). In this usage, one scarcely requires an interlocutor and is
play with sounds, words, and phrases, with relative or total disregard for the
semantic values of these forms. Relationships of assonance and alliteration
verbalization which can admit neither the constraints of meaning nor those of
the circumstances are present to the individuals involved. “It follows that
affairs. It is with this usage that symbolization truly meets language. That
organization of reasons” (p. 273). In this usage, one cannot neglect the subtle
grammatical features of the linguistic instrument. To use Sapir’s formulation,
2854
one seeks to give each of the elements in the flow of language “its very fullest
that is, where the duality between what is literally stated and what is meant is
toward the rules involved in any employment of language. Hence, the student
of poetry, seeking to make explicit the syntax of poetry, is also engaged in a
2856
It is also important to emphasize that these usages are manifested on
curse words is quite different from affectivity expressed in sarcasm; the ludic
child is not on the same level as the representative activity of the poet.
There are two prejudices that have often interfered with an adequate
comparative developmental approach to symbolization and language usage in
psychoanalysts who would limit what they call “true symbolism” to a process
of unwitting realization of unconscious meanings in sensuous or tangible
form. For this group, language used to represent states of affairs and to
repressed wishes of the individual in disguised form would have that status.
This prejudice is clearly ungrounded and has been recognized as baseless
fused with perception and action, to the most advanced, where it comes into
its own.
The second prejudice is a more subtle and insidious one and more
developmental theory. This prejudice, often implicit, would have it that the
human life. It is therefore led to assess all performances and to evaluate their
“developmental status” in terms of this putative aim. Characteristically those
precise and exact linguistic symbols as, by the very nature of the case itself,
primitive or pathological or, at the very least, “regressed in the service of the
2858
ego.” For many of them, no matter how they mask it, art, play, poetry, and
Once again, it is neither a fact of history nor an induction from the study
regard for the rules of formal logic. Without denying the usefulness of such an
assumption as a “fiction” of the investigator, introduced in the “interest of
reason,” one must strongly question any thesis that would attribute to a
analysis.
toward experience from the one which governs Western man qua scientist.
nonliterate man had been misrepresented by himself and others in that they
had not distinguished clearly between physical impossibility and logical
These points could be glossed over in the present context were it not for
the fact that the same issue has arisen concerning the interpretation of
pathological language usage. The problem has been well posed by one of the
leading investigators of schizophrenic language, Maria Lorenz. She writes:
variance with the impression obtained from a spontaneous talk with the
patient. . . . Certain kinds of demands, implicit in test situations, seem to
2860
precipitate reactions of irritability, frustration, defensiveness, which quickly
meaning of his response. The pathology may lie less in an inability to think
(p. 608). Similar arguments have been advanced by one of the leading
European investigators of pathological symbolization and language, Jean
Bobon.
performance, so long as one does not impute to the patient logical errors or
directed toward Arieti’s use of the Von Domarus principle, it is only fair to say
that Arieti has typically shown himself to be aware of the need for caution in
utterances.)
but rather the differentiation and perfection of all of the orientations, and
their harmonious integration in the functioning of the individual.
2862
of the demands of the situation, the intentionality of the individual issuing the
product, the relevance of the production to the individual’s ends, and so on.
on words (in intended wit), nor the personification of time (in a sonnet) are
occasionally written and sometimes also thought that a means or activity was
Rosenfeld’s patients, one may remark, “The Russians were our allies” (p. 459)
because one docs not distinguish in thought and experience between the
that the individual has adopted, an awareness of the context of the act, and so
on.
and inferences drawn by the various investigators quoted. In any case, sincc
the citations will be merely illustrative, they may serve their function even if
the specific inferences are open to question.
2864
mature form than in terms of a rudimentary manifestation where its specific
features are likely to be obscured. Symbolization has been characterized as
the capacity to represent, that is, the ability to take items of experience or to
prescinded from its natural ties with one or another “posture of the mind”
and one or another mode of giving form to the flux of impressions, the activity
consider those attitudes and ways of forming a world that one finds in
and qualifications, one may regard some of the aphasias, apraxias, and
Thus, one may find the inability to transform heard sounds into words,
although the patient can still entertain concepts; or one may find that a
concept it normally represents; again, one may find patients who are capable
of prepositional thought but who are unable to re-present their thoughts in
broader scope, they would have to be included—for their own sake, as well as
for purposes of comparison and contrast— with phenomena of
psychopathology proper. Important as they are, however, they cannot be
proper, one need not dwell on a point which every serious student of such
phenomena has emphasized; that is, disturbances of symbolization in
2866
psychiatric cases are not simply consequences of an impairment in the
capacity to represent per se, but are, rather, part and parcel of a more
appearance, what is substantial and what is ideal, what is felt or imagined and
what is taking place. Here all experiences are on a par; one no longer has
control over his various intentionalities and is on longer able to allocate his
moncntary impressions into domains of subjective and objective, that is, the
seen, the fantasied, the thought, and the performed. A patient may
which intensity of experience and in which affective relevance are the sole or
main determinants of the “real” and “objective,” and hence one to which
disturbed patients.
perceiving and loses its distinctive status as the means of representing the
affairs to which the addressor wishes to call the addressee’s attention; the
context, or situation in which the communication takes place; the scene, or
locus of the referent, insofar as the referent is not part of the context; and,
finally, the medium, the means (one or more) by which the addressor conveys
2868
In both the relatively undifferentiated mentality of early childhood and
other and, paradoxically, far less integrated with each other than is the case
activity plays an enormous role, the world has become a diversified and
stratified realm. There are people in it who are distinct from himself and from
inert objects. They live their own lives. Some are close to him; the
himself, and in this way make them part of his thought world; he thus can
closest to him do not share his memories and are not privy to his feelings,
fantasies, and fleeting thoughts. If he wishes to make these known, he must
express them by means that allow him to communicate them to others, being
Through his multiple transactions with his social and, in large measure,
adult comes to represent to himself a domain of social objects, all not only
his feelings, hopes, and fears about these objects from the objects themselves
and to perceive and classify them in ways that other members of his
attitudes that he has in regard to them from the objects themselves as socially
be viewed in other ways, that is, aesthetically, religiously, and so on. These
ways of viewing are, however, sharply distinguished from the pragmatic-
causal, and he does not confuse the relations thus established among objects
“place” from that pre-empted by the everyday things and events with which
he has direct and immediate commerce. Through an activity of symbolically
2870
mediated hypostatization, he can and does build up in the matrix of society
purely intellectual objects and relations, which concrete objects and events
can become the objects of his thought and reference as well as of the thought
and reference of others.
In his communication to others, the adult takes account not only of his
latter situations, he makes a sharp distinction between context and scene and
recognizes the necessity to provide an ideal, symbolically delineated locus for
with him the nonpresent situation to which his symbolic utterance pertains.
experienced by him, to locate them in one or another region of his world, and
to think and communicate about them, especially when they have vanished,
the normal adult uses chiefly the linguistic instrumentality, which he shares
images and is immersed in the child’s affective, ludic, and practical life; it is
used mainly as a means of expressing feelings and demands, as a thing with
and with particular addressees, but he is also capable of using the medium in
an ideal manner to represent objects and events, to symbolize how he feels
various parts of the medium, not only the referential values of lexicon and
syntax, but the expressive values as well. Even in poetry, where he may be
interested in the aesthetic properties of linguistic sounds, he must recognize
that he can “alter the sounds of words no farther than the [common] sense
would follow,” on pain of excommunication. Archibald MacLeish has
succinctly put it: “If you want the sound of lurk instead of lark in your sonnet
you can write it down but your bird will disappear. If you want to play
2872
sonorous games with I’amour, la mort, and la mer you may: but you will still
have love, death, and the sea on your hands with no possibility of escape. . . .”
In sum, the principal medium of representation and communication is, for the
situations of quite a different kind from those in which the adult is capable of
with relatively few referents, and these highly charged and infused with
personal meanings, which he is unaware are not shared by others; is
restricted to a few concrete contexts; does not clearly take into account the
these scenes if requested to do so; and, finally, does not sharply distinguish
the medium of language from his other media, from his context of utterance,
and from his affect and action. For a detailed treatment of the ontogenetic
progression, the reader is referred to Symbol Formation.
extreme cases at least, the psychotic often manifests such higher levels of
kind than the primitivity of the child, just as it is of a different kind than the
socially adaptive primitivity of men in technologically backward societies.
one need not elaborate either on the fusion between the patient and his
schizophrenia and related disorders. In the first instance, the patient tends to
feel fused with, incorporated within, or threatened by invasion from, the one
2874
the unstable linkage of the patient with such composites dissolves.
levels of functioning.
the patient’s intentions, that is, his attitudes, purposes, and meanings with
representing his feelings and wishes to another; in the main, his posture is
egocentric-affective, and he is prompted unwittingly to express or enact his
diffusely felt rage, fear, love, or desire to control the objects of his world, and
the like. Since he has little control over his attitudes, they are liable to be both
labile and inflexible; for example, Searles reports one patient who suddenly
paused in the midst of vicious paranoid tirades against him to ask him in a
calm and friendly manner for a light for her cigarette (p. 543).
commentary or illustration. The factors in play here are, in large measure, the
same as those that enter into the patient’s relation to his addressees. Due to a
syncresis of wishing, remembering, imagining, perceiving, and so forth, and
terms are especially illuminating in those cases where the critical faculties are
still operative but have become to some extent dissociated from percept
formation. For example, Alberta Szalita refers to one of her patients, who
I was reaching for the cup of coffee, her face looked different than before. I felt
that my sister was handing me the cup. I had to move closer to check whether
her office, claimed to have seen a witch there moving her arms. He later
remarked, “You need not tell me that there is no witch on the ceiling—I know
that as well as you do. But I really felt it” (p. 59).
2876
mythopoetic construction of reality: the unwitting transformation of feeling
the equation of parts with wholes, attributes with things, and so on. The
despite the fact that these authors do not directly concern themselves with
merit of avoiding the “naive realism,” which would take as given to primitive
functioning.
and between the patient and referents. It is noteworthy that, on one hand, the
patient often cannot exclude the context, even when it is irrelevant to the
communication situation; on the other hand, that he frequently takes no
remarked, “My concentration is very poor. I jump from one thing to another.
If I am talking to someone they only need to cross their legs or scratch their
heads and I forget what I am saying. I think I could concentrate better with
my eyes shut” (p. 104). Another patient remarked, “I can’t concentrate. It’s
conversations! It’s like being a transmitter. The sounds are coming through to
me but I feel my mind cannot cope with anything. It’s difficult to concentrate
on any one sound. It’s like trying to do two or three different things at one
time” (p. 104).
dissociated from the socially defined context, the following case is illustrative:
to her feet, with her face convulsed, and scream obscenely. The content of
these comments was usually to the effect that a fat old woman was in bed
having sexual intercourse with a man who did not belong to her. She, the
patient, was not going to continue to bring home her pay-packet to keep them
in this situation—and she was not going to scrub the floors either” (p. 273).
Such dissociation may be due in part to the tendency of the patient
2878
the referent of the communication would normally be located. This
dissolution is one of the major determinants of the bizarre appearance of
in the scene and conflates it with his current context. The normal person’s
temporary immersion in affective memories and fantasies is an
ideality’’ bars him from distinguishing items of his experience as things and
actions. Thus words and gestures which the normal person would take as
having merely representational values may, for the patient, be experienced as
incarnate objects and efficacious actions; and ordinary objects and actions
notes, one’s own body. Such interpenetration allows the patient to construct
his own forms and to imbue these with a significance that they have for him
alone, although he may feel that this significance is obvious to anyone; hence,
in part, the emergence of neologisms, neomorphisms, glosso- lalias, and the
like.
2880
disintegrative processes may lead also, in the extreme, to a radical
dissociation between the patient and the communal symbols systems. He may
themselves, may appear to him alien, external, or thrust into him from
may be a word-salad.
severely disturbed schizophrenic, used the statement “The Russians were our
allegorically; rather it appears that he gave this utterance the personal value.
“A person who may appear to be your friend for a while can turn against you,
and you might do that to me.” One may say in this connection that, although
one cannot conclusively rule out an awareness of an allegorical intention, it
seems likely here that the patient infused his vaguely sensed horror of being
conventional symbols, one of Bobon’s patients drew the eye of a fish, which
he believed not only gave him access to his past states, but also which he felt
would also be efficacious in allowing others access to unknown realms. Again,
for Mme. Sechehaye’s patient, Renee, the drawing of a circle with a point in it
was both plurisignificant and profound in personal meaning; the point in the
actions, one may mention Schilder’s patient, who believed she could destroy
2882
that whenever his analyst made an interpretation he literally put himself into
the patient’s mind. For another example, one may take Bobon and
of a city and you sense that the atmosphere of the city has changed . . . when
you say the name of a person, you influence him in the same way; my name
influences me in a certain way when it is pronounced, how it is pronounced,
would stop all influx of aggressive elements against his person by turning his
back to this influx, arms dangling and palms turned toward the rear. He
would purify himself by allowing his arms to hang, palms turned toward his
body, fingers spread. A rotary movement of his body and elevation of his
because there are always words which attract bad things.” Thus, this patient
would use “tection” instead of “protection” because “tection is protection in
the good sense. I take half of the word because protection is the bad
meaning.”
drawings and in words. In one instance he started out with the discrete
2884
communal media and in construction of his own vehicles of symbolization
that would further reveal the tendencies toward dedifferentiation and
and Bobon and others, works that are relatively unknown in America.
Dreams
he and his followers have tended to convey the impression that the latent
that the outcome of analysis is temporally prior in the formation of the dream,
such a notion must be rejected by those holding to a comparative
primarily a formal point of view and highlights the similarities between such
Hypnagogic Phenomena
2886
phenomena were susceptible to quasi-experimental control and that they
could thus provide an excellent way of examining in slow motion the manner
the main, Silberer was more concerned with imaginal representation than
with linguistic forms in hypnagogic states.
procedure, but was oriented toward such “linguistic forms.” In one instance,
he dozed off as he was thinking of those very narrow views of cognition which
observe the thinking process from a remote vantage point. This “thought” was
realized in an image of a long road that at the same time looked like a pencil
telescope; there was someone looking through it. At the same time the
thought “It’s a tunnel potential” was uttered. In the hypnagogic state, there
was a vague feeling that the author wanted to say “tunnel vision” and was
aware that “potential” was somewhat tangential to what he was trying to say.
In another instance the author had just read a passage in a work where
a cautious alienist had discussed a theme to the effect that one could not be
very sure concerning the nature of thought organization in schizophrenia in
colleague say “It’s unjective to throw soap” in a tone which suggested that the
colleague was once again railing against his bete noir.
normal adults in a somewhat more orthodox, but still far from clean,
experimental fashion are discussed in detail in the author’s joint work with
Bibliography
2888
Abrams, Meyer H. The Mirror and the Lamp. New York: Oxford University Press, 1955.
Allport, Gordon. Becoming. New Haven, Conn.: Yale University Press, 1955.
Arieti, Silvano. “Special Logic of Schizophrenic and Other Types of Autistic Thought,” Psychiatry, 4
(1948), 325.
_____, “Autistic Thought,” Journal of Nervous and Mental Diseases, 3 (1950), 288-303.
_____, “Some Aspects of Language in Schizophrenia,” in Heinz Werner, ed., On Expressive Language.
Worcester, Mass.: Clark University Press, 1955.
_____, “The Loss of Reality,” Psychoanalysis and the Psychoanalytic Review, 48 (1961), 3-24.
_____, “Volition and Value: A Study Based on Catatonic Schizophrenia,” Comprehensive Psychiatry,
2 (1961), 74-82.
_____, “The Microgeny of Thought and Perception,” Archives of General Psychiatry, 6 (1962), 454-
468.
Balken, Eva Ruth. “Psychological Researches in Schizophrenic Language and Thought,” Journal of
Psychology, 16 (1943). 153-176.
Barbu, Zevedie. Problems of Historical Psychology. New York: Grove Press, 1960.
Barfield, Owen. (1927) Poetic Diction. London: Farber and Farber, 1951.
Bernheimer, Richard. The Nature of Representation: A Phenomenological Inquiry. New York: New
York University Press, 1961.
Bertalanffy, Ludwig von. Modern Theories of Development. London: Oxford University Press,
1933.
_____, “On the Definition of the Symbol,” in Joseph Royce, ed., Psychology and the Symbol. New
York: Random House, 1965.
_____, “General Systems Theory and Psychiatry,” in Silvano Arieti, ed., American Handbook of
Psychiatry, Vol. 3. New York: Basic Books, 1966.
Bion, W. R. “Language and the Schizophrenic,” in Melaine Klein, et al., eds., New Directions in
Psychoanalysis. New York: Basic Books, 1957.
Boas, Franz. The Mind of Primitive Man (1911). New York: Collier Books, 1963.
Bobon, Jean. Introduction historique a I'etude des neologismes et des glossola- lies en
psychopathologie. Paris: Masson, !95s.
2890
_____, Psychopathologie de I’expression. Paris: Masson, 1962.
_____, and Pierre Roumeguere. “Du geste et du dessin magiques au neo- graphisme conjuratoire,”
Acta Neurologica et Psychiatrica Belgica, 57 (1957), 815-829.
Boyd, William C. “The Contributions of Genetics to Anthropology,” in Sol Tax, ed., Anthropology
Today: Selections. Chicago: Phoenix Books, 1962.
Brunswik, Egon. “Ontogenetic and Other Developmental Parallels to the History of Science,” in H.
M. Evans, ed., Men and Moments in the History of Science. Seattle, Washington:
University of Washington Press, 1959.
Cairns, Dorian. “The Ideality of Verbal Expressions,” Philosophy and Phenomenological Research,
39 (1941), 453- 462.
Cameron, John L., et al. “Clinical Observations on Chronic Schizophrenia,” Psychiatry, 19 (1956),
271-281.
Cassirer, Ernst. Das Erkenntnisproblem in der Philosophic und Wissenschaft der neueren Zcit. 3
vols. Berlin: B. Cassirer, 1906, 1907, 1920.
_____, (1932) The Philosophy of the Enlightenment. Boston: Beacon Press, 1955.
_____, “Le langage et la construction du monde des objets,” Journal de Psychologie, 30 (1933), 18-
44.
_____, The Problem of Knowledge. New Haven, Conn.: Yale University Press, 1950.
_____, Philosophy of Symbolic Forms, Vol. 1. New Haven, Conn.: Yale University Press, 1953.
_____, Philosophy of Symbolic Forms, Vol. 2. New Haven, Conn.; Yale University Press, 1955.
_____, Philosophy of Symbolic Forms, Vol. 3. New Haven, Conn.: Yale University Press, 1957.
_____, The Logic of the Humanities. New Haven, Conn.: Yale University Press, 1961.
Chapman, Loren J., et al. “Regression and Disorders of Thought,” Journal of Abnormal and Social
Psychology, 63 (1961), 540-545-
Clive, Geoffrey. “Notes toward a Topography of the Irrational since the Enlightenment,” Journal of
Existential Psychiatry, 15 (1963), 177-204.
Collincwood, R. G. The Idea of History (1946). New York: Oxford University Press, 1956.
Cornford, Francis M. Plato’s Theory of Knowledge. New York: Liberal Arts Press, 1957.
Critchley, MacDonald. “The Evolution of Man’s Capacity for Language,” in Sol Tax, ed., Evolution
after Darwin, Vol. 2. Chicago: University of Chicago Press, 1959-
Davie, Donald. Articulate Energy: An Enquiry into the Syntax of English Poetry. New York: Harcourt
Brace & Co., 1958.
Davy, Georges. “La psychologie des primitifs d’apres Levy-Bruhl,” Journal de Psychologie, 27
(1930), 112-176.
2892
De Laguna, Grace. Speech, Its Function and Development. New Haven, Conn.: Yale University Press,
1927.
Deutsch, Karl. “Mechanism, Organism, and Society: Some Models in Natural and Social Science,”
Philosophy of Science, 18 (1951), 230-252.
Dilthey, Wilhelm. Pattern and Meaning in History, H. P. Richman, ed., New York: Harper &
Brothers, 1962.
Eliade, Mircea. The Sacred and the Profane. New York: Harcourt Brace & Co., 1959-
Feibleman, James K. “Theory of Integrative Levels,” British Journal of the Philosophy of Science, 5
(1954), 59-66.
Firth, James R. “Modes of Meaning,” in James R. Firth, ed., Papers in Linguistics 19-34, 1952.
London: Oxford University Press, 1957.
Flavell, John, and Juris Draguns. “A Microgenetic Approach to Perception and Thought,”
Psychological Bulletin, 54 (1957), 197-217.
Freeman, Thomas. “On the Psychopathology of Schizophrenia,” Journal of Mental Science, 106
(1960), 925-937.
Geertz, Clifford. “The Growth of Culture and the Evolution of Mind,” in Jordan Seller, ed., Theories
of the Mind. Glencoe, Ill.: The Free Press, 1962.
Gelb, Adhemar. “Remarques generates sur l’utilisation des donnees pathologiques pour la
psyehologie et la philosophic du langage,” Journal of Psychologie, 30 (1933), 403-
429.
Glass, Bentley, Owsei Temkin, and William L. Strauss, Jr. Forerunners of Darwin. Baltimore, Md.:
The Johns Hopkins Press, 1959.
_____, Language and Language Disturbances. New York: Grune & Stratton, 1948.
_____, “Concerning the Concept of ‘Primitivity,’” in Stanley Diamond, ed., Culture in History: Essays
in Honor of Paul Radin. New York: Columbia University Press, i960.
Gulley, Norman. Plato’s Theory of Knowledge. New York: Barnes and Noble, 1964.
Hallowell, A. Irving. “The Recapitulation Theory of Culture,” in A. Irving Hallowell, ed., Culture and
Experience. Philadelphia: University of Pennsylvania Press, 1955.
Harris, Dale B., ed., The Concept of Development. Minneapolis, Minn.: University of Minnesota
Press, 1957.
Hazard, Paul. The European Mind: 1680-1715 (1935). Cleveland, Ohio: World Publishing Co.,
1963.
Head, Henry. Aphasia and Kindred Disorders. 2 vols. New York: Macmillan, 1926.
Henel, Heinrich. “Type and Protophenomenon in Goethe’s Science,” PM LA, 71, 651-669.
Hughes, H. Stuart. Consciousness and Society (1958). New York: Vintage Books, 1961.
_____, Kindersprache, Aphasie und allgemeine Lautgesetze. Uppsala, Sweden: Almqvist, 1941.
Jones, Ernest. “The Theory of Symbolism,” in Ernest Jones, ed., Papers on Psychoanalysis. Boston:
Beacon Press, 1961.
2894
Kaplan, Bernard. “Radical Metaphor, Aesthetic and the Origin of Language,” Review of Existential
Psychology and Psychiatry, 2 (1962), 75-84.
_____, “Developmental Aspects of the Representation of Time.” Unpublished paper read at Fourth
Annual Meeting of the New England Phychological Association, November 13,
1964.
Kluback, W. Wilhelm Dilthey’s Philosophy of History. New York: Columbia University Press, 1956.
Kraepelin, Emil. Vber Spraclistorungen ini Traum. Leipzig, Germany: Engelmann, 1906.
Kubie, Lawrence. “The Distortion of the Symbolic Process in Neurosis and Psychosis,” Journal of
American Psychoanalytic Association, 1 (1953), 59-86.
Kuntz, Paul G. “Mythical, Cosmic and Personal Order,” Review of Metaphysics, 16 (1963), 718-748.
Langer, Susanne K. Philosophy in a New Key. Cambridge, Mass.: Harvard University Press, 1942.
_____, “Understanding Language without Ability to Speak: A Case Report,” Journal of Abnormal and
Social Psychology, 65 (1962), 419-425.
Levi, Albert W. Literature, Philosophy and the Imagination. Bloomington, Ind.: Indiana University
Press, 1962.
Levy-Bruhl, Lucien. How Natives Think. London: George Allen & Unwin, 1926.
Lorenz, Maria. “Expressive Behavior and Language Patterns,” Psychiatry, 18 (1955). 353-366.
_____, “Problems Posed by Schizophrenic Language,” Archives of General Psychiatry 4 (1961), 603-
610.
Lovejoy, Arthur O. Revolt Against Dualism. London: George Allen & Unwin, 1930.
_____, The Great Chain of Being. Cambridge, Mass.: Harvard University Press, 1936.
_____, Essays in the History of Ideas. Baltimore, Md.: The Johns Hopkins Press, 1948.
Magnus, Rudolf. Goethe as a Scientist (1906). Translated by Heinz Norden. New York: Collier
Books, 1961 109.
Manuel, Frank. Shapes of Philosophical History. Stanford, Calif.: Stanford University Press, 1965.
Marcuse, Herbert. Reason and Revolution (1941). Boston: Beacon Press, 1960.
McGhie, Andrew, and James Chapman. “Disorders of Attention and Perception in Early
Schizophrenia,” British Journal of Medical Psychology, 34 (1961), 103-115.
Mead, George Herbert. Movements of Thought in the Nineteenth Century. Chicago: University of
Chicago Press, 1936.
2896
Meyerson, Ignace. “Review of Levy-Bruhl, Lucien, La Mentalite primitive,” L’Annee Psychologique,
23 (1922), 214-222.
Nagel, Ernst. “Determinism and Development,” in Dale Harris, ed., The Concept of Development.
Minneapolis, Minn.: University of Minnesota Press, 1957.
Nowottny, Winifred. The Language Poets Use. London: Athlone Press, 1962.
Ogden, C. K., and I. A. Richards. The Meaning of Meaning. New York: Harcourt Brace, 1923.
Piro, S. Semantica del linguaggio schizofrenico. Naples: Acta Neurologica Policlinico, 1958.
Price, Kingsley. “The Work of Art and the Postures of the Mind,” Review of Metaphysics, 12 (1959),
540-569.
Ramzy, Ishak. “From Aristotle to Freud,” Bulletin of Menninger Clinic, 20 (1956), 112-123.
Rapaport, David. “Dynamic Psychology and Kantian Epistemology,” Unpublished paper, 1947.
Reid, Louis Arnaud. Ways of Knowledge and Experience. London: George Allen & Unwin, 1961.
Russell, Edward A. Form and Function: A Contribution to the History of Animal Morphology.
London, John Murray, 1916.
Rycroft, Charles. “Symbolism and Its Relationship to the Primary and Secondary Processes,”
International Journal of Psycho-Analysis, 37 (1956), 137-146.
Schilpp, Paul A., ed., The Philosophy of Ernst Cassirer. Evanston, Ill.: Library of Living Philosophers,
1949.
_____, The Nonhuman Environment: Its Normal Development and in Schizophrenia. New York:
International Universities Press, i960.
_____, “The Differentiation between Concrete and Metaphorical Thinking in the Recovering
2898
Schizophrenic Patient,” Journal of the American Psychoanalytic Association, 10
(1962), 22-49.
Sechehaye, Marguerite. ‘“Affects’ et besoins frustres vus a travels les dessins d’une schizophrene,”
Acta Neurologica et Psychiatrica Belgica, 57 (1957), 972- 992.
Shute, Clarence. The Psychology of Aristotle. New York: Columbia University Press, 1941.
Stankiewicz, Edward. “Problems of Emotive Language,” in Thomas Sebeok et al., eds., Approaches
to Semiotics. The Hague: Mouton, 1964.
Storch, Alfred. Das archaisch-primitive Erleben und Denken der Schizophrenen. Berlin: Springer,
1922.
_____, “Die Welt der beginnenden Schizophrenic und die archaische Welt,” Teitschrift fur die
gesamte Neurologie und Psychiatrie, 127 (1930), 799-810.
_____, and Jean Bobon. “Le ‘druses eerites et dessiniees (Kontaminationen, blendings); pathogene
de certain neo- morphismes.” Acta Neurologica et Psychiatrica Belgica, 50 (i960),
529-550.
Toulmin, Stephen. The Philosophy of Science. London: Hutchinson University Library, 1953.
_____, Les Origines de la pensee chez I’enfant. Paris: Presses Universitaires de France, 1947.
Werner, Heinz. Comparative Psychology of Mental Development (1940). 3d ed. New York:
International Universities Press, 1957.
_____, “Change of Meaning: A Study of Semantic Processes Through the Experimental Method,”
Journal of General Psychology, 50 (1954). 181-208.
_____, “Microgenesis and Aphasia,” Journal of Abnormal and Social Psychology, 52 (1956), 347-353.
_____, “The Concept of Development from a Comparative and Organismic Point of View,” in Dale B.
Harris, ed., The Concept of Development: An Issue in the Study of Human Behavior.
Minneapolis, Minn.: University of Minnesota Press, 1957.
2900
_____, and Bernard Kaplan. “The Developmental Approach to Cognition: Its Relevance to the
Psychological Interpretation of Anthropological and Ethnolinguistic Data,”
American Anthropologist, 58 (1956), 866-880.
_____, Symbol Formation. John Wiley & Sons: New York, 1963.
Wheelwright, Philip. The Burning Fountain. Bloomington, Ind.: Indiana University Press, 1954.
Whitehead, Alfred N. Symbolism: Its Meaning and Effect. New York: Macmillan, 1927.
Anatol Rapoport
concepts are organized; for instance, on the particular way objects are
categories are of necessity too crude to capture the infinite variety of events
that constitute “objective reality.” Thus a con- tent-bound language may
concepts we form, and this structure may or may not correspond to the
structure of reality.
2902
abstracted from perceptions, its structure is entirely transparent. In the exact
relating the area of a circle to its radius, A = πR2. It says that whatever be the
radius of a circle, the ratio of the area to the square of the radius is always
specified with infinite precision, the area can also be specified with infinite
observable world, because there are no perfect circles and because physical
eighteenth century and consequently the immense social changes that came
and the like. Implied in each physical law are predictions of what will be
2904
fixating the specific meaning of “truth” in the context of scientific discourse,
times it is discovered that certain conditions had not been taken into account.
At times the formulation of the laws is modified to bring them into closer
correspondence to reality.
the exact sciences. Assertions in that language leave no doubt about what is
asserted (and consequently what must be done to test the assertions) and,
moreover, bind the assertions into logical interdependence, the organic
The role of the exact sciences in technology is obvious. Their role in the
have come to depend more and more on refined observations made possible
scientific medicine stems from the conception of the living body as a material
system and of its living process as a complex network of physical and
chemical processes that preserve a certain dynamic balance. The balance can
in principle be described by certain limits within which the parameters of the
process may vary. Disease can be defined in terms of deviations from these
limits. If the deviations are reversible the “normal state” can be restored.
2906
Otherwise, death eventually occurs, which means that the dynamic processes
structure and function, the same methods and conceptualizations apply to its
The cleavage that still persists between psychiatry and other branches
of science, including scientific medicine, is rooted in the Cartesian mind-body
of knowledge we obtain through our senses about the external world. For the
events; for instance, nervous activity perceived “from the inside” as it were,
rather than from the outside. From this point of view “thoughts,” “concepts,”
“memories,” “emotions,” and the like are assumed to be the subjective aspects
The qualification “in principle” frees the adherent of this view from the
necessity of demonstrating its validity in each specific instance. He is content
2908
corroboration of the reductionist hypothesis must depend on a tacitly
assumed linkage between mental activity (not directly observable) and
would subsume all living processes (not only behavior) under “goal-directed”
ones, to be clearly differentiated from mechanical (not goal-directed)
are time courses of the variables. Thus, if the totality of these magnitudes and
the relations among them are taken to be the description of a system, then
each instantaneous state of the system is, in a way, the “cause” of the
immediately succeeding state. “Causality,” then, when analyzed completely,
turns out to be acting “here and now” without reference to future states or
“goals.”
laws. In particular, the early contentions of the vitalists that the energetics of
nonequilibrium steady states. It has been shown that nonliving systems can
also be regulated by homeostasis as long as they are permeable to exchanges
2910
A much more serious difficulty in the way of extending the mechanistic
view of nature (to include at least some aspects of living behavior) became
on by other than philosophical motives. The need was for machines that could
of other machines that transcended the limitations of the human muscle. This
Servomechanisms
demanded. Even in the early days of the industrial era, however, certain
simple cybernetic devices were known. Steam engines had governors that
controlled the speed of the flywheel by automatic action triggered by a critical
speed. In the thermostat, another familiar device, the source of heat is turned
off when the column of mercury in the thermometer reaches a critical height
and turned on when it sinks below it. When the rudder of a ship is set in a
certain position, the ship will eventually assume a prescribed course, since
there will be a torque on the hull as long as the ship is not on the prescribed
course.
2912
system of closed loops, called feedback loops, a servomechanism responds
not only to the environment but also to its response to the environment, to
behave in some ways like living organisms, then living organisms can be said
the inputs and translating them into outputs. The structure of this “nervous
As a rule inverse problems are harder than direct ones, and their
solutions often are not unique. That is, a great many arrangements can give
the same transfer function, so that even its precise determination does not
2914
arbitrarily chosen, or chosen for their supposed importance in human
behavior. In some situations, however, the transfer function itself is an object
inputs and the outputs in precise mathematical terms. When this can be done
such situations are singled out for study, not because they are necessarily
our disposal and so can serve as stepping stones in the development of the
following a target by moving a lever. The input (the motion of the target) is
can at least make guesses about structural features in the nervous system
and dilations. This is essentially a “tracking” task. From these oscillations the
corresponding transfer function has been computed. As the gain of the system
(the decrease of intensity due to the contraction divided by the increase of
unstable, and the pupil oscillates at its “natural” frequency. This frequency is
calculated from the transfer function and turns out to be about 72 cycles per
2916
Since oscillations are clinical manifestations of a wide variety of
Information Theory
telecommunication.
what the signals are made of or signify. A signal can be sent by producing an
what could have been said. In much the same way the probability of an event
is associated not with the event itself but rather with the whole context in
which the event could occur. Thus the probability of drawing a particular ball
from an urn depends on the number of balls in the urn. Hence it is not the ball
in question that determines the probability but the number of balls that could
that message being selected from all the possible messages that could have
been sent
2918
flows over power lines or oil flows through pipes. It makes sense to speak of
telecommunication become “coding”) quite in the same way that one speaks
telecommunicative device. It is that, of course, in the literal sense and has long
One way of doing this is by pumping information through the individual, that
is, by making him a link in a telecommunication channel, a transducer. For
between rate and accuracy.) Now the amount of information per signal can be
varied at will by varying the number of signals from which selections are
made, by varying the relative frequencies with which the different signals are
possible to have the same average amount of information per signal in several
even greater importance, however, were the discrepancies that could not be
accounted for by the channel model. These led to the design of more refined
Automata
2920
In addition to its central role in telecommunication, information theory
some respects our thinking organs may not function on the principle of
computing machines.
neurons.[1] Suppose we picture a neuron as a unit that can exist in only one of
two possible states—“firing” and “nonfiring.” (This is not factually correct, of
or cell body of the summed activities of other neurons, transmitted via axones
suppose that some of the terminal buttons are inhibitory; that is, their activity
subtracts from rather than adds to the firing potential impinging on the
neuron. These characteristics are sufficient to represent any conditionality of
be included.
2922
The behavior of automata has been shown to be capable of far greater
machines do not just perform specified listed operations in order; they are
their operations; for example, “Add column 6 to column 13, compare the
result with the last entry in column 2; if the sum is greater, extract square
root of column 10, otherwise proceed to step 7, etc.” Computing machines can
solve logical problems such as this one: If bandits don’t drink beer only if the
sun shines and the moon is in the first quarter, and if, whenever the sun
shines, shrimps cannot whistle unless the moon is either in the second or
third quarters, and if bandits drink beer at the same time when shrimps do
not whistle only when gophers go skating in the moon’s last quarter, it being
understood that when the last-mentioned does not occur it does not mean
that bandits cannot drink beer if shrimps whistle or that shrimps must
whistle if bandits do not drink beer; what may or must be the phase of the
moon when gophers go skating on a cloudy day while the shrimps remain
silent?
complicated). It had been almost taken for granted, until the theory of
automata showed otherwise, that “thinking” is necessarily a different sort of
activity from what machines are able to do. Indeed, machines had been
habitually looked upon as strong but stupid. In some circles an argument
whether computers “really” think. The theory of automata has shown that
once we have described the thinking process with sufficient precision, we can
build an automaton to simulate it. Nor does the simulated thought process
need to be rigid. For the rules of inference can be made to change in
“turtle” that persists in following white lines randomly drawn on the floor
seems to have an “aim in life.” It seems even more lifelike when it is observed
“spanked.”
who insist that “machines can’t think.” It is always possible to keep revising
the definition of “thinking” so as to keep it in the residual area of what has not
yet been successfully simulated. But this sort of procedure may be a
2924
in thinking, we find that the practical difficulties are enormous. Whereas, in
the case of cybernetic and information theory approaches, it was possible to
we must postulate the existence of specific units and specific relations among
them. The basis of the theory is the correspondence between the fundamental
“not,” and the like. In this way every logical function consisting of binary
may interpret as “neurons.” Even if the real neurons obligingly acted in every
way like those automaton units, it would be all but inconceivable with our
the separate contiguous facets of its complex eye with the aid of a neural
model essentially of the McCulloch-Pitts type. The responses were sufficiently
simple so that they can be fully analyzed; yet they contain sufficient
contiguous facets, (2) the relative intensity of the successive stimuli, and (3)
the time interval between the presentations. To account for all these aspects
of behavior (remarkably consistent), Hassenstein and Reichhardt have
which only a few are required to serve each pair of facets. As a consequence
of this arrangement the prediction is made and verified that stimuli impinging
consecutively upon facets separated spatially by more than one facet do not
interact with each other. By and large the model is mainly an explanatory one;
Naturally one expects rather more from a model. If, for example, the
postulated arrangements were identified anatomically or at least indirectly
2926
response is to be distinguished from ordinary complexity of response. A
response may be marvelously complex in the sense of having many
. . .” and so on. The few hundred neurons of the ant must be sufficient to
provide it with all the conditionality at its disposal. This relatively small
number reflects the circumstances that, although the behavior of the ant may
seem quite complex, the conditionality of its behavior patterns must be rather
neurons.
single unit may radically change the entire behavior pattern of the automaton.
the analogy applies) should characterize the living brain. We are constantly
impressed by the plasticity and adaptability of living behavior. Specific
failures traceable to specific excisions are still exceptions rather than the rule.
living organisms are not mathematically precise; nor are they necessarily the
most direct and efficient. They are “adequate,” with wide error margins.
Moreover they are often recognized as responses to “fuzzy” stimuli. An object
2928
construction of networks of elements designed to recognize patterns, that is,
gross features of events regardless of perturbations. Examples of this
many others. Work along these lines is clearly inspired by the ambitions of
automation technology. One can well imagine a typist-automaton that takes
oral dictation; that is, is able to recognize words regardless of accent, vocal
response relations are not specified, but only their probabilities. Experiences
removed from each neuron, and so forth. Given such gross statistical features
and certain assumed laws of synaptic transmission, the activity of such a net,
resulting from some initial input, can also be calculated. For example, given
neuron and the probability distribution of their targets, the “critical input”
can be established, one that if exceeded results in the spread of excitation
through the net and if not exceeded results in a dying away of the initial
excitation.-
even more heat from the furnace until something would “give.” But if a
servomechanism switched its connections whenever some variable exceeded
2930
a certain limit, it would have ultrastability. In the case of a thermostat we
unstable, the rise of temperature would switch the connections and make it
certain voltages are exceeded, the connections are randomly shuffled until
connections will be switched until the right ones for the situation are found.
The principle of learning thus exhibited is that of random search and fixation
pattern recognition.
will strengthen the still tenuous links between physiology and theories of
mental phenomena.
with the reasoning). Then it can be presented in a language the computer can
branch of mathematics where the variables can assume only either of two
values, 0 (representing “false”) and 1 representing “true”). The variables,
“bandits drink beer”; s for “the sun is shining”; mi for the “moon is in the i-th
quarter”; g for “gophers go skating.” The denials of the propositions are
relations among propositions. These are “∧,” meaning “and”; “∨,” meaning
“and/or” → meaning “implies”; and parentheses for punctuating sentences.
We can now represent the entire information given in the problem by the
following “sentences” written in the language of symbolic logic:
b → s ∧ m1
s → (w → m2 ∨ m3)
b ∧ w → g m4
2932
symbols in accordance with specified rules. The result of these operations
g ∧ s̅ ∧ w̅ → m4
the sun is not shining, and the shrimps do not whistle, the moon must be in
We can say, therefore, that to solve the problem the computer must be
presented with it in a language it “understands.” The “grammar” of that
language (in this case the rules of operation of symbolic logic) is built into the
could be translated from one language to another word by word. For then the
only “rules” that would have to be programmed would be those that link each
word in one language with its equivalent in another. As is well known,
however, the problem is vastly complicated, not only by the fact that most
words have more than one meaning but also by the fact that grammars of
even closely related languages are different. On the other hand, substituting
whole sentences will not do, since the number of possible sentences is
reading has never been spoken or written before.) Thus, the problem of
automatic translation is that of giving a complete description of a grammar of
grammatical rules that enable a human being, only a few years after birth, to
associating words with their referents; for language is much more than
branches of mathematics (for example, set theory, symbolic logic, the theory
of semigroups, etc.) deal not with measurable quantities but only with
2934
rigorous rules of symbolic transformations. The term “mathematical” is
justified in view of the definition of mathematics as a contentless language of
minute sequentially produced units, for example, words selected from the
certain statistical regularities. The smaller the units, the less are the statistical
alphabet are very nearly the same, regardless of source. The frequencies of
larger units (for example, words and phrases) will, of course, be more
dependent on the source or content. Nevertheless, certain statistical features
common to all large corpuses can be abstracted also on these levels. G. K. Zipf
particularly stressed the repeated observation of the following relation. Let
most frequently occurring word, etc. To each rank corresponds the actual
close to 1 and, in almost all cases, somewhat larger than 1. This rank-
frequency relation (in other contexts the rank-size relation) was observed in
a great many widely disparate situations and was attributed by Zipf to an
underlying universal law, which he called the principle of least effort. Zipf’s
justification of the law and its consequences was often extremely vague and
cannot be considered as a significant theoretical contribution. Nevertheless,
has remained fruitful. The point is that these statistical profiles are
texts have been decided by such comparisons. The validity of these methods
depends on the circumstance that, although an individual may well exercise
voluntary control over detailed actions, in the large his patterns of behavior,
2936
verbal output “reveals” his identity in the same way as his handwriting or the
include the “semantic” features of a verbal output. Part of its task is the
coding procedure has been designed and the “content” translated into a
compared in the same way as spectra of different light sources. In this way
Moreover, a great many other words, especially those with strong emotional
overtones, can also be so characterized. Thus, from a subject’s associative
by its three coordinates on the three axes. The semantic differential has been
used in comparative studies of such semantic spaces characterizing different
The evolution of physical science illustrates this process most clearly. The law
2938
of conservation of energy, first established in classical mechanics, was later
“amount of order” (or disorder). There are also dangers lurking behind
theories are often used as explanatory props rather than as raw material for
the way the term “theory” is used in natural science, it would be rash to
consider the construction of such theories altogether useless. After all, the
(to the theorizer himself, as well as to his audience) that precision has been
achieved when, in fact, concepts that are precise in proper contexts have been
muddled by metaphorical transformations of meanings.
feedback the “restoring force” is always opposite to the error, so that the
feedback loops also have their place, where it is required that the system pass
2940
As long as the variables represent real measurable quantities and the
variables may be populations, gene frequencies, etc., and where the “forces”
the same spirit, speak of homeostasis in economics, where the variables are
prices, interest rates, trade volumes, etc. In these instances the concept of
the illusory impression that powerful and rigorous methods are being applied
to the study of man.[2]
who, in the days before the advent of physical science (and often afterward),
“explained” the physical, the biological, and the social universes by picturing
grandiose verbiage.
biology, along with all the dangers of speculative promiscuity. The formal
convert heat energy fully into mechanical energy without other changes
accompanying the process. Stated in another way (as the famous Second Law
2942
the total entropy can never decrease; it keeps increasing until the system is in
Second Law (an argument for vitalism!) since such systems tended, at least in
as the Second Law demands. Since no living system is isolated from its
environment, the argument rested on a non sequitur. At any rate E.
Schroedinger pointed out that life must “feed on negative entropy,” by which
is meant simply that organisms must ingest substances rich in “free energy,”
in other terms, low in entropy.[3] In metabolism this free energy becomes
“degraded”; that is, entropy increases, and this surplus of entropy, dumped in
excretion upon the outside world, “pays” for the decreases in entropy
(increased organization) that the organism effects within itself. In this way
its relevance for information theory is far from evident. A clear connection
from the environment (an isolated system). By sorting them he can “increase
the order” in the system and so lower its entropy in apparent violation of the
nature of the demon’s intervention. He showed that if the Second Law does
hold, the demon himself (being part of the isolated system) must suffer an
the rest of the system. This conclusion is simply a logical consequence of the
assumption that the Second Law does hold. The remarkable feature of
information” that the demon must utilize in his operation and the resulting
per degree, where k, the so-called Boltzmann’s constant, is 1.37 × 10-16 ergs
per degree. Thus a transformation factor connecting entropy and information
was established, analogous to the transformation factor connecting a unit of
2944
determining the position or the velocity of a molecule.
systems on the molecular level are now being actively investigated. There the
chapter, for example can be stated with as much precision as the weight of the
paper it is printed on. In a way this is true but irrelevant to the informative
be sure, the “information” of any verbal output can be measured in this way
by reference to the statistical distributions of its units—say, letters, or
corpus. Thus one bit of information is gained by someone who is told the
outcome resulting from a toss of a fair coin; one bit was gained by Paul Revere
when he saw two lights appear in the tower of the Old North Church. What
the last-mentioned “bit of information” meant for the American Revolution is
is actually greater than that conveyed by a meaningful text of the same length,
“A has received so many bits of information and has thereby lowered his
entropy (increased his internal order) by so many units.” The statement can
acquire meaning only if it is shown just how A has utilized this information
and how the decrease of entropy was compensated by an increase elsewhere.
However, the seductive power of metaphors is great, as evidenced by an
abundance of loose talk about the relation of “entropy” and “information” in
human affairs. So far extrapolations of the information-entropy identity to
Do Machines “Think”?
2946
philosophical and ethical import. Crudely put, the fundamental question is
between living and nonliving systems another step toward the unification of
machines cannot do. However, the limitations are more difficult to spell out
than the achievements. The difficulty is that, once the limitations are
specifically spelled out, ideas are suggested on how to overcome them. It has
been said that a computer cannot compose a poem or a quartet. Promptly
objection that these products are not really works of art, because they have
made ones.
because the processes are “preprogrammed” are not conclusive. The analogy
between information processing by man and by machine rests on the
complexity between the two kinds of processes is not sufficient reason for
dismissing the analogy. Nor are arguments about “free will,” supposedly
possessed by man but not by the machine, relevant to the issue, if what is
wanted is evidence to resolve it one way or another. Our conviction of having
“free will” stems from a metaphysical (or religious) position or is induced by
There remains only the ethical basis for distinguishing between man
and machine. The real meaning of the questions “Do machines think?” or “Are
2948
oriented and should be frankly posed and recognized as such. It has
substantial ethical import in a civilization where the lives of human beings
everything men can do.” This sort of comparison turns attention away from
man’s intrinsic worth, which, unlike his instrumental worth, resides not in
what he can do but in what he is, namely, man. The fact that we communicate
with other human beings without knowing analytically how this is done; the
fact that we ascribe consciousness to other human beings, not on the basis of
manifestation of certain values, and the adherence to these values is the only
Conclusions
interest, the basis for integration becomes even firmer and a hope emerges of
extending the integration to include those aspects of the life process that have
Those who attempt to realize such integration borrow from these latest
When such specification cannot be made, the heuristic value of the ideas
2950
adapt the general ideas emerging from mathematical analysis to theories of
behavior. The value of such adaptations is an open question. They may be
words, “free will” being the verbal antithesis of “strict causality.” The
irrelevance of such conclusions to science need hardly be pointed out.
namely, that events may be affected by being observed. These effects have
that leads to discoveries. Such thinking may well start with consideration of
The line between fruitful and sterile ideas is hard to draw. Some wild
March of that year, and the book came out as a memorial volume.
2952
engineering and cybernetics, are not entirely unrelated to the meanings of the
corresponding common usage words. But common usage words are also
heavy usage words; that is to say, they are rich in marginal, metaphorical
various contexts is greatest among those who are impressed but not
disciplined by the spirit of the exact sciences. Whereas in information theory
and has been utilized by quacks and charlatans to exploit the gullible. A
notorious result of this practice was the “dianetics” fad that swept the United
States in the 1950’s. Dianetics was an amalgam of vulgarized notions lifted
guaranteed not only to cure mental and emotional disorders but also to raise
the intelligence of customers to genius levels. No better example is needed to
magic.
much to the practice of the healing art as to the scientific infrastructure that
done, the transplant of ideas may bear fruit. After all, the ideas of cybernetics
are themselves transplants. Their origin was in biological science. They are
the “organismic” ideas that had been banished from classical mechanics and
science was justified. The soil of early physics could not have nourished these
concepts. Only when this soil was sufficiently enriched could the seeds sprout.
Cybernetics, rooted in the physical sciences, is the result. Now the young
shoots may be ready for transplantation back to the biological and behavioral
2954
sciences where they belong. The only question is whether the present soil in
Bibliography
Afanasyeva, L. G., and Petunin, Yu. I., “Teoreticheskiy Analog Obrabotki Impulsnoy Informatsii
Neyronom” (“Theoretical Analysis of the Processing of Impulse Information by a
Neuron”), Kihernetika, 3: 74-81, 1971.
Allanson, J. T., “Some Properties of a Randomly Connected Neural Network,” in Cherry, C. (Ed.),
Information Theory, Academic Press, New York, 1956.
Ashby, W. R., Design for a Brain, John Wiley, New York, 1952.
Bar-Hilliel, Y., “Semantic Information and Its Measures,” Tr. 10th Conference on Cybernetics, Macy
Foundation, New York, 1955.
Brazier, M. A. B., “How Can Models from Information Theory Be Used in Neurophysiology,” in
Fields, W. S., and Abbott, W. (Eds.), Information Storage and Neural Control, Charles
C Thomas, Springfield, Ill., 1963.
Brillouin, L., “Maxwell’s Demon Cannot Operate: Information and Entropy, I,” J. Appl. Phys.,
22:334, 1951.
Cannon, W. B., The Wisdom of the Body, Norton, New York, 1939.
Echols, H., “Genetic Control of Protein Synthesis,” in Fields, W. S., and Abbott, W. (Eds.),
Information Storage and Neural Control, Charles C Thomas, Springfield, Ill. 1963.
Hassensteix, B., and Reichhardt, W., “Systemtheoretische Analyse der Zeit-, Reihenfolgen- und
Vorzeichenauswertung bei der Bewegungsperzeption des Rüsselkäfers
Chlorophanus,” Ztschr. Naturforsch., 11b: 513, 1956.
Helstrom, C. W., “Detection Theory and Quantum Mechanics (I),” Information and Control, 10:254;
(II), Information and Control, 13.156, 1968.
Hiltz, F. F., “Analog Computer Simulation of a Neural Element,” Tr. Inst. Radio Engrs., BME-9, 1:12-
20, 1962.
Hyman, R., “Stimulus Information as a Determinant of Reaction Time,” J. Exper. Psychol., 45:188,
1953.
John, E. R., “Neural Mechanisms of Decision Making,” in Fields, W. S., and Abbott, W. (Eds.),
Information Storage and Neural Control, Charles C Thomas, Springfield, 1963.
Kornblum, S., “Sequential Determinants of Information Processing in Serial and Discrete Choice
Reaction Time,” Psychol. Rev., 76:113, 1969.
McCulloch, W. S., and Pitts, W., “A Logical Calculus of the Ideas Immanent in Nervous Activity,”
Bull. Math. Biophys., 5:114, 1943.
Mazzetti, P., Montalenti, G., and Soardo, P., “Experimental Construction of an Element of a
Thinking Machine,” Kybernetik, 1:170, 1962.
Meyerhof, O., “Thermodynamik des Lebensprozesses,” Handbuck der Physik, 9: 238, 1926.
Narasimhan, R., “Labeling Schemata and Syntactic Description of Pictures,” Information and
Control, 7:151, 1964.
2956
Nasu, M., and Honda, H., “Fuzzy Events Realized by Finite Probabilistic Automata,” Information
and Control, 12:284, 1968.
Osgood, C. E., Suci, G. J., and Tannenbaum, P. H., The Measurement of Meaning, University of
Illinois Press, Urbana, 1957.
Rapoport, A., “Ignition Phenomena in Random Nets,” Bull. Math. Biophys., 14:35, 1952.
Rosenblatt, F., “The Perceptron: A Probabilistic Model for Information Storage and Organization
in the Brain,” Psychol. Rev., 65.386, 1958.
Rutovitz, D., “Pattern Recognition,” J. Roy. Statistical Soc., Ser. A., 129:504, 1966.
Shannon, C. E., “A Symbolic Analysis of Relay and Switching Circuits,” Tr. Amer. Inst. Elec. Engrs.,
57:713, 1938.
_____, and Weaver, W., The Mathematical Theory of Communication, University of Illinois Press,
Urbana, 1949.
Sperry, R. W., “Orderly Function with Disordered Structure,” in Von Foerster, H., and Zopf, G. W.
(Eds.), Principles of Self- Organization, Pergamon, New York, 1962.
Stark, L., and Cornsweet, T. N., “Testing a Servoanalytic Hypothesis for Pupil Oscillations,” Science,
127:588, 1958.
Szilard, L., “Ueber die Entropieverminderung in einem thermodynamischen System bei Eingriffen
intelligenter Wesen,” Ztschr. Physik., 53:840, 1929.
Toch, H., and Hastorf, A. H., “Homeostasis in Psychology,” Psychiatry, 18:81, 1955.
Von Neumann, J., “The General and Logical Theory of Automata,” in Jeffress, L. A. (Ed.), Cerebral
Mechanisms in Behavior: The Hixon Symposium, John Wiley, New York, 1955.
Whitehead, A. N., Science and the Modern World, Pelican Books, New York, 1948.
_____, and Schade, J. P. (Eds.), Progress in Biocybernetics, Vol. 2, Elsevier, Amsterdam, 1965.
Zipf, G. K., Human Behavior and the Principles of Least Effort, Addison-Wesley, Cambridge, 1949.
Notes
[1] This work was anticipated in the context of electrical switching circuits by C. E. Shannon.
Subsequently J. Von Neumann gave an extensive and lucid exposition of the theory in a
general context.
[2] For an extensive critique of the use of the homeostasis concept in psychology, see, for example, H.
Toch and A. H. Hastorf
[3] Schroedinger’s fortunate phase has become a byword and has made facile speculation in biological
thermodynamics fashionable. The basic idea, however, was already formulated 20 years
earlier.
[4] The “hit” is a unit of information, the amount conveyed in a decision between two equally probable
alternatives.
[5] In strictly limited contexts some progress in constructing a theory of semantic information has
been made.
2958
Chapter 51
edition of his classic with “Personality as System”; Karl Menninger based his
psychiatric questions and applications, are indispensable for this study. With
special gratification the present writer may cite the agreement of the two
In the sciences from physics to the biological and social sciences and the
humanities, the paradigm of an analytical-elementalistic-summative approach
reached its limits wherever problems circumscribed by notions like “system,”
“wholeness,” “teleology,” and the like appeared and demanded new ways of
thinking. This was the case in physics as the limitations of classical theory
were discovered; in the life sciences with the innumerable problems of order
and organization of parts and processes in the living organism; in psychology
with the problems of personality; in the social sciences with the problems of
organizations both natural (family, tribe, and the like) and formal (an army or
bureaucracy). Similarly technology transcended the traditional fields of
(mechanical, electric, chemical, etc.) engineering and had to meet both in its
2960
“hardware” and "software” with essentially new requirements of
communication and control,'’ man-machine systems, system analysis of
up to the social problems and international relations. And the surfeit of social
criticism, new philosophies, counterculture, and social utopias, in its
with the world view of yesterday and the search for a new one.
psychology in the first half of the twentieth century was dominated by the
concept of the reactive organism, or, more dramatically, by the model of man
expanding economy of the “affluent society” could not subsist without such
manipulation. Only by manipulating humans ever more into Skinnerian rats,
opportunists (or bluntly speaking, into morons and zombies) can this great
society follow its progress toward an ever increasing gross national product.
As a matter of fact,” the principles of academic psychology were identical with
Since the present article was first written (1964), a number of fashions in psychology and
psychiatry have come and gone without, however, essentially changing the predominant “robot”
or “zoomorphie” model of man. It may be helpful for the present exposition briefly to enumerate
the major currents that, partly with sensational success, have appeared in the intervening period.
1. Ethology, the comparative study of animal behavior, was broadly used for the
zoomorphie theory, that is, the reduction of human to animal modes of behavior. It is obvious
that all too much of human behavior has biological roots; and few periods of human history have
more vividly experienced the bestiality of man under the thin veneer of so-called civilized
society. It is not a new discovery that, as man is an animal, more specifically an anthropoid ape in
his anatomy, histology, biochemistry, physiology, and so forth, he also shares many behavioral
2962
mechanisms with his animal forebears and relatives. Study of his “biological drives,” sex and
them. However, a “reductionist” theory, the contention that man is “nothing but” a naked ape,
was certainly not the intention of the pioneers of ethology, who, like Lorenz, emphasized man’s
uniqueness expressed by obvious facts like culture, tradition, history, and the like. Such reticence
was alien to works of a sensationalist nature, which, on the basis of often most specious
arguments, derived great popular success from the zoomorphic doctrine. Probably this success
originated in the masochism of contemporary society thus finding alleviation of guilt feelings.
Modern atrocities, criminality, and the like are more easily excused and tolerated when they
come from man’s biological, irresistible “aggressive drives.” Similarly sex research and manuals
for sexual practice belong to the same trend to discard what specifically “human” may be left in
this technical and commercial but otherwise inhuman age.[2]
Charlotte Bühler, Matson, and others, exerted a thoroughly admirable influence by emphasizing
the specifics of human psychology, the necessity of considering the healthy not the sick as the
basic model, the investigation of the human life course, the emphasis (as against the supposedly
solely normal, utilitarian behavior of the average American in commercialized society) on self-
realization, “peak experience,” “being cognition,” and so forth. The reaction against the emotional
emptiness of our society is equally understandable. Soon, however, the movement submitted to
commercialism. Encounter groups and the “Human Potential Movement” became an industry run
by practitioners (called “trainers” in a significant and revealing appellation) with highly
questionable credentials. While in part using respectable techniques of group therapy,
“humanistic psychology” became big business that, with T-groups, sensitivity training, nude
marathons, and the like, offered a way out of the boredom of affluent society and a shortcut to an
emotional “high,” with sometimes devastating results. At the same time the alleged “humanism”
became “zoomorphic” in a somewhat modified way. Salvation was sought in the “group,” and
consequently the individual was reduced to the lowest common denominator, becoming an
psychology and the techniques of social engineering.-'' In this somewhat roundabout way
commercialism and dehumanization, deplored as the worst outgrowth of industrial mass society,
were reaffirmed by voluntary, well-paying customers.
3. The well-known illnesses of present society were frontally attacked by the advocates of
the counterculture and Consciousness III. The criticism of corporate society and the
psychological wasteland of our times was appropriate enough. The remedies proposed: drugs,
rock music, beards, bell-bottom trousers, commune living, and exotic religions—and this is the
rather complete list of what the counterculture has to offer for saving humanity—were juvenile
and silly. Not only rock festivals and students’ protests but also the counterculture as a whole
seems on the wane, after a surprisingly short life span for a worldwide “revolution” with highest
aspirations to remodel society.
4. And here the circle closes. For apparently the latest major development (as of February
1972) is the success (with supposedly 200,000 copies sold) of Skinner’s recent book, Beyond
Freedom and Dignity, which is the revival or rather the reiteration of old-fashioned behaviorism.
It disregards that in the meantime animal experimentation has demonstrated that even rodent
behavior in wildlife situations does not follow the conditioning scheme. Conventional learning
theory presently seems to apply to laboratory artifact (positive reinforcement in the Skinner
cage, classical conditioning in nonsense- syllable learning, and similar techniques in advertising)
but neither to natural animal behavior nor to the normal psychological development of the
child.’’ Behavior therapy seems successful in certain pathology, especially bed-wetting, but it is
more dubitable whether the same principles apply to the education of Einsteins, Mozarts, and
even of ordinary citizens. Nevertheless, behaviorism came back with a vengeance and a high
measure of intolerance with Skinner’s most recent work.
There is no need to enter into a discussion of Freedom and Dignity that is of an essentially
philosophical or possibly verbal nature. But it would appear that Skinner has never seen a Gothic
cathedral, or even the skyscrapers of New York, never heard music from Beethoven’s Ninth to the
2964
cheapest rock hit, never thought about his own laboratory, books, and university—and never
made the somewhat trivial observation that rats, pigeons, and apes just don’t do any such tilings.
It is well in its place to look at the animal world for the first beginnings of language, use of tools,
tradition, and the like. But human psychology cannot possibly ignore that the world of culture (of
symbolic activities, to use this writer’s phraseology) is something new, an emergent that cannot
lie reduced to the levels of conditioning and learning theory.[3]
Such a survey of the past eight years is useful because it shows that the kaleidoscopically
changing fashions and fads in psychology (and psychiatry) actually did not alter the basic
presuppositions or paradigm of American psychology. The patient on the couch, the rat in the
Skinner box, the stickleback aggressively defending his territory, the T-group undergoing
sensitivity training (preferably in the state of nudity), and the drug experience certainly are
rather different “models of man.” But they agree in the basic paradigm, namely, the neglect or
“bracketing out” of what is specifically human; the consequent reduction of human to animal
behavior; further, the environmentalism seeing human behavior as a product of outer factors
counterculture, as the prevailing theory may be), but never seeing specifically human or
individual factors; and the resulting manipulation by psychoanalysis or conditioning or
sensitivity training or folk music and drugs. A new paradigm is demanded to effectuate a
“revolution” in this and other sciences and in practical life and society as well.
The enormous threat contained in Skinner’s latest work is that his is not a program or
project to undo Freedom and Dignity, but a description of what is widely realized in the thought
control exerted by the mass media, television, commercial society, and politics. The question
whether or not the “controllers” consciously followed the academic theory of passive and
operant conditioning is inconsequential, although one would suspect that they often do.
health should be improved when basic needs for food, shelter, personal
direct shock effects such as combat neuroses. In contrast, the affluent society
originating not from repressed drives, from unfulfilled needs, or from stress
but from the meaninglessness of life. There is the suspicion’ (although not
delinquency has appeared; crime not for want or passion, but for the fun of it,
for “getting a kick,” and born from the emptiness of life. As Erich Fromm
2966
recently asserted, boredom is “the illness of the age” and the root of its
regarding basic principles. This discomfort and the trend toward a new
(Sorokin), and others. In the variety of these currents there is one common
Therefore, the reason for the current interest in general system theory
In the past few decades scientific developments have taken place that
can be subsumed under the general title of “systems research.” They concern
a broad front in the scientific endeavor encompassing biology, psychology,
cybernetics, information theory, game and decision theory, and others. These
theoretical approaches are paralleled by developments in applied science
appeared that go under the name of “systems research” (or some variant) and
the field, the following works are suggested: von Bertalanffy, Klir, Buckley,
Gray et al., Miller, Rapoport.)
considerations:
1. Up to recent times physics was the only “exact” science, that is, the
only science permitting explanation, prediction, and control
within a highly developed conceptual (mathematical)
framework. With the rise of biological, behavioral, and social
sciences, the need for similar theoretical constructs became
apparent. Simple application of physics does not suffice for
this purpose. Hence a generalization of scientific concepts
became necessary.
2968
2. The encounter with biological, behavioral, and social problems has
shown that traditional science cannot account for many
aspects that are predominant in these fields. Interaction in
multivariable systems, organization, differentiation, self-
maintenance, goal-directedness, and the like are of
fundamental importance in biological, behavioral, and social
phenomena. These aspects cannot be bypassed by declaring
them to be “unscientific” or “metaphysical” by decree of a
physicalistic and obsolete metaphysics. Hence generalization
of scientific concepts implies the introduction of new
categories.
Freud. And in the present status of psychology and psychopathology the need
feedback circuits of this type. Applied to the living organism, the feedback
regulations that maintain variables constant and direct the organism toward
a goal, and are performed by feedback mechanisms; that is, the result of the
reaction is monitored back to the “receptor” side so that the system is held
2970
systems in general or in defined subclasses of systems, irrespective of the
principles of system theory are not limited to material systems, but can be
systems, that is, systems maintained in the exchange of matter with the
environment, by import and export and the building up and breaking down of
entropy” is possible with the transfer of matter. Hence such systems can
phenomena. In some cases either model may be applied, and the equivalence
psychiatry. Within the space available only a small selection of key concepts,
biology. On the European continent this was developed by the present author
2972
in the 1920’s, with parallel developments in the Anglo-Saxon countries
(Whitehead, Woodger, Coghill, and others) and in psychological Gestalt
theory (W. Köhler). It is interesting to note that Eugen Bleuler followed with
similar trends were active in many fields of the behavioral and social sciences.
These tendencies joined in the formation of the Society for General Systems
Research (1954), which since has tried to serve as a unifying agency for such
studies.
the machine theory of organism, the cyclic theory of history, the positivistic
theory in philosophy of science), the modern system concept has a long
history. In biology and medicine one may trace it to Claude Bernard and the
that the idea of a science of systems could emerge only at the present state of
scientific development.
phenomena of life are found only in individual entities called organisms. Any
organism is a system, that is, a dynamic order of parts and processes standing
capacities.
2974
The Active Organism
intrinsically active system. Reflex theory has presupposed that the primary
element of behavior is response to external stimuli. In contrast, recent
covers animal behavior and does not cover an essential portion of human
behavior at all. The insight into the primary immanent activity of the
systems in the brain stem has emphasized this fact. Natural behavior
problems, and the healthy child and adult are going far beyond the reduction
reduced to primary or secondary drives. All such behavior is performed for its
own sake, deriving gratification (“function pleasure,” after K. Buhler) from the
performance itself.
2976
rapidly changing society.
and so on. The model of the passive organism is a quite adequate description
behavior is different.
Homeostasis
Bühler:
regulations, that is, regulations not based upon fixed mechanisms but taking
of growth, development, creation, and the like. We may also say that
preservation and survival and their secondary derivatives, as is the case with
where it becomes silly. The martyr’s death at the stake is explained “by
to risk his life because “losing valued social status may be more upsetting.”
Such examples show to what extremes some writers are willing to go in order
to save a scheme that is rooted in economic- commercial philosophy and sets
2978
The homeostasis model is applicable in psychopathology because
Differentiation
to be one of synesthesia (traces of which are left in the human adult and
which may reappear in schizophrenia, mescaline, and LSD experience) out of
“holophrastic” (W. Humboldt) language and thought, that is, utterances and
and articulate speech. Similarly the categories of developed mental life, such
as the distinction of “I” and objects, space, time, number, causality, and so
Thus “I” and “the world,” “mind” and “matter,” or Descartes’s “res
cogitans” and “res externa” are not a simple datum and primordial antithesis.
They are the final outcome of a long process in biological evolution, mental
development of the child, and cultural and linguistic history, wherein the
perceiver is not simply a receptor of stimuli but in a very real sense creates
his world. The story can be told in different ways, but there is general
agreement that differentiation arose from an “undifferentiated absolute of
self and environment”. The animistic experience of the child and the primitive
(persisting still in Aristotelian philosophy), the “physiognomic” outlook, the
2980
experience of “we” and “Thou” (still much stronger in Oriental than in
Western thinking), empathy, and so forth were steps on the way until
full distinction between “public objects” and “private self” is certainly not
achieved without naming and language, that is, processes at the symbolic
level; and perhaps this distinction presupposes a language of the Indo-
Germanic type.
“Organisms are not machines; but they can to a certain extent become
mechanisms cause large changes in the total system. In this way a hierarchical
“layers” that take the role of leading parts. Particulars and disputed points are
beyond the present survey. However, one will agree that, in gross
from reptiles to mammals, and (3) certain “highest” centers, especially the
motoric speech (Broca’s) region and the large association areas that are found
2982
only in man. Concurrently there is an anterior shift of controlling centers, for
example, in the apparatus of vision from the colliculi optici of the
that of conscious perception and voluntary action; and that of the specific
Thus it is clear that stratification exists both in the brain and in mental
processes, and that these correspond in some way, but the particulars present
processes (of the cortex jointly with the arousal system), being “conscious”
while the majority is not, is completely unknown. The Freudian distinction of
“unconscious” is not only a cellar to put in what has been “repressed” but also
the fountainhead from which “creative” processes—in science, art, religion,
Freudian thought and practice would have been different if the fact was
recognized that the Freudian is but one version of the theory of the
“unconscious.” Furthermore, the “unconscious” comprises both the lowest
intrapsychic level (“primary process,” “animal drives,” “instinct,” and the like)
a fact, but it leaves many problems whose exploration would widely exceed
the frame of the present article. In any case it is certainly incorrect when
disturbances.
follows:
2984
regions are less highly differentiated in man than in lower mammals and
monkeys.) This presumably is the reason why man’s evolution is almost
exclusively on the intellectual side. The ten billion neurons of the cortex
made possible the progress from stone axes to airplanes and atomic
bombs, and from primitive mythology to quantum theory. However, there
is no corresponding development on the instinctual side. For this reason
man’s moral instincts have hardly improved over those of the chimpanzee.
Regression
that the child is not a little schizophrenic but a normally functioning, though
primitive, being. “The schizophrenic will regress to, but not integrate at a
lower level; he will remain disorganized” (p. 475). Regression is essentially
organization.
Boundaries
Any system as an entity that can be investigated in its own right must
boundaries exist only in naive observation, and all boundaries arc ultimately
dynamic. One cannot exactly draw the boundaries of an atom (with valences
sticking out, as it were, to attract other atoms), of a stone (an aggregate of
molecules and atoms that mostly consist of empty space, with particles in
environment).
2986
established before the “I”, “Thou”, and “it” are named. Psychopathology shows
the paradox that the ego boundary is at once too fluid and too rigid. Syncretic
for insecurity of the ego boundary; but within his self-created universe the
schizophrenic lives “in a shell,” much in the way animals live in the “soap
that is, his world widely transcends biological bondage and even the
limitations of his senses. To him “encapsulation” (Boyce)—from the specialist
Symbolic Activities
world not of things but of symbols.” We may also say that the various
functions that “motives in animals will not be an adequate model for motives
in man” (p. 221) and that human personality is not finished at the age of three
or so, as Freud’s instinct theory assumed.
2988
stem from the root of creative symbolic universes and therefore cannot be
values and specific human values is that the first concern the maintenance of
the individual and the survival of the species, the latter always concern a
symbolic universe.
schizophrenia also are essentially at the symbolic level and are able to take
Goldstein’s discussions.
This is the ultimate reason why human behavior and psychology cannot
directed toward objective goals and realization of values, which mean nothing
else than symbolic entities that in a way become detached from their creators.
2990
considerations apply to “character disorders” like juvenile delinquency that,
quite apart from their psychodynamics, stem from the breakdown or erosion
psychohygienic factor.
psychopathology.
liberate France. Piercing sensations; a great mystic like St. Teresa reported an
any schizophrenic’s. This is not to play on the theme “genius and madness”;
but it is apt to show that not single criteria but integration makes for the
difference.
“products of their brains.” But our normal world also is shaped by emotional,
but that schizophrenia has subjective elements that run wild and that are
disintegrated.
The same applies at the symbolic level. Scientific notions, such as the
earth running with unimaginable speed through the universe or a solid body
sense” and are more fantastic than the “world designs” of schizophrenics.
Nevertheless, the scientific notions happen to be “true”; that is, they fit into an
integrated scheme.
2992
free use of symbolic anticipation, decision, and so forth. This emphasizes the
hierarchy of functions, especially the symbolic level superimposed upon the
within the given cultural framework, So far as we can see this criterion
and leaves room for the culture dependence of mental norms. What may be
more important than “digging the past” will be insight into present conflicts,
attempts at reintegration, and orientation toward goals and the future, that is,
symbolic anticipation. This, of course, is a paraphrase of recent trends in
Conclusion
not contradict him. On the other hand, it should be recognized that the “model
of man” in systems terms is totally different from the still widely dominant
“robot model” of neobehaviorism and other modern currents as enumerated
in the beginning of the chapter. It was our intention to show that the system
concept in this field is not speculation, is not an attempt to press facts into the
2994
psychophysically neutral. Physical and physiological terms
such as action potentials, chemical transmission at synapses,
neural network, and the like are not applicable to mental
phenomena, and even less can psychological notions be
applied to physical phenomena. System terms and principles
like those discussed can be applied to facts in either field.
2996
It would be difficult to review briefly the numerous publications in
1. The study of the intrapsychic self, that is, of the human psyche in its
totality, is essentially a systems approach. So are
Menninger’s vital balance and unitary concept of mental
illness. In contrast to behavioristic and Freudian theories
(the latter essentially are limited to the primary process),
Arieti’s “types” or rather levels of cognition (primary as in
the child, primitive, and schizophrenic; secondary in
conceptual thinking; tertiary in creative processes) is a
pioneering attempt toward a conceptual construction of the
whole human psyche. Arieti’s persistent effort to introduce
“cognition” into psychiatry (as he justly complains, “almost
completely ignored by classical psychoanalysts”),
corresponds with what has been discussed here under the
label of symbolic activities. Combined with available insight
into the evolution of the brain, this is perhaps as far as we
may presently go. The task of the future (apart from further
refinement) may be in establishing the isomorphism of the
neurophysiological and mental aspects by means of a
“psychophysically neutral” general system theory.
2998
approach not only in the way of formal and learned
programs but also in practical implementation; medical
education and educational administration; functionalism in
sociology, political science, and other fields.
3000
implication, psychiatry) that it lacks consistent development
and the cumulative nature that is characteristic of science. In
any legitimate science results—empirical and theoretical—
when once established, remain so and are accumulated in a
continual evolution. Galileo or Mendel are still uncontested
authorities, however much quantum mechanics and
molecular genetics have transcended their discoveries. In
psychology, in contrast, we seem to see kaleidoscopically
changing fashions. It is an arena of contesting “schools,”
theories convincing only to their author and his pupils, or
limited to a particular professor, university department, or
movement, and too many ephemeral and sensationalist fads.
rather than contradictory; that is, they present essentially similar models or
paradigms in different languages (similarly as the same mathematical
with the complex problems in modern society; it carries the danger of making
the human individual ever more into a small wheel of the social
3002
creativity and its manifold manifestations, ranging from evolution in its
highest human creativity and culture; and (5) as a consequence of the latter,
Bibliography
Alexander, F., The Western Mind in Transition: An Eye-witness Story, Random House, New York,
1960.
Allport, F., Theories of Perception and the Concept of Structure, John Wiley, New York, 1955.
Allport, G. W., Becoming: Basic Considerations for a Psychology of Personality, Yale University
Press, New Haven, 1955.
_____, “The Open System in Personality Theory,” J. Abnorm. & Soc. Psychol., 61: 301-310, 1960.
_____, Pattern and Growth in Personality, Holt, Rinehart and Winston, New York, 1961.
Anderson, H., “Personality Growth: Conceptual Considerations,” in David, H., and von Bracken, H.
(Eds.), Perspectives in Personality Theory, Tavistock, London, 1957.
“APA Weighs Pros, Cons of Encounter Groups,” Psychiat. News, May 1970.
Appleby, L., Scher, J., and Cummings, J. (Eds.), Chronic Schizophrenia, Free Press, Glencoe, Ill.,
1960.
Arieti, S., “Contributions to Cognition from Psychoanalytic Theory,” in Masserman, G. (Ed.), Science
and Psychoanalysis, Vol. 8, Grune & Stratton, New York, 1965.
_____, “The Microgeny of Thought and Perception,” Archiv. Gen. Psychiat., 6: 454-468, 1962.
_____, “The Present Status of Psychiatric Theory,” Am. J. Psychiat., 124:1630-1639, 1968.
_____, “Schizophrenia,” in Arieti, S. (Ed.), American Handbook of Psychiatry, Vol. 1, Basic Books,
New York, 1959.
_____, “The Structural and Psychodynamic Role of Cognition in the Human Psyche,” in Arieti, S.
(Ed.), World Biennial of Psychiatry and Psychotherapy, Vol. 1, Basic Books, New
3004
York, 1970.
Berlyne, D. E., Conflict, Arousal, and Curiosity, McGraw-Hill, New York, 1960.
_____, “Recent Developments in Piaget’s Work,” Brit. J. Educ. Psychol., 27:1-12, 1957.
Bertalanffy, L. von, “A Biologist Looks at Human Nature,” Scientific Monthly, 82:33-41, 1956.
(Reprinted in Daniel, R. (Ed.), Contemporary Readings in Psychology, Houghton
Mifflin, Boston, 1959; Reflexes to Intelligence: A Reader in Clinical Psychology,
Glencoe, Free Press, 1959.)
______, Biophysik des Fliessgleichgeivichts (Tr. by Westplial, W.), Vieweg, Braunschweig, Germany,
1953.
______, “Body, Mind and Values,” in Laszlo, E., and Wilbur, J. B., Human Values and the Mind of Man,
Gordon and Breach, London, 1971.
______, “Comments on Aggression,” Bull. Menninger Clin., 22:50-57, 1958. (Reprinted in Sarason, I.
G. (Ed.), Psychoanalysis and the Study of Behavior, Van Nostrand, New York, 1965.)
______, “An Essay on the Relativity of Categories,” Phil. Sci., 22:243-263, 1955.
______, “General System Theory,” Main Currents in Modern Thought, 11:75-83, 1955.
______, General System Theory—A Critical Review,” General Systems, 7:1-20, 1962.
______, General System Theory: Foundations, Development, Applications, rev. ed., George Braziller,
New York, 1973.
______, “History and Status of General Systems Theory,” in Klir, G. (Ed.), Trends in General System
Theory, John Wiley, New York, 1971.
_____, “The Mind-Body Problem: A New View,” Psychosom. Med., 24:29-45, 1964. (Reprinted in
Matson, F. W., and Montague, A. (Eds.), The Human Dialogue, Free Press, New York,
1967.)
_____, (1928), Modern Theories of Development (Tr. by Woodger, J. H., 1933), Harper Torchbooks,
New York, 1962.
_____, “On the Definition of the Symbol,” in Royce, J. (Ed.), The Symbol: An Interdisciplinary
Symposium, Random House, New York, 1964.
_____, “An Outline of General System Theory,” Brit. ]. Phil. Sci., 1.134-165, 1950.
_____, “Principles and Theory of Growth,” in Nowinski, W. W. (Ed.), Fundamental Aspects of Normal
and Malignant Growth, Elsevier, Amsterdam, 1960.
_____, Robots, Men and Minds: Psychology in the Modern World, George Braziller, New York, 1967.
_____, “The Significance of Psychotropic Drugs for a Theory of Psychosis,” World Health
Organization, AHP, 2, 1957.
_____, “Some Biological Considerations on the Problem of Mental Illness,” in Appleby, L., Scher, J.,
and Cumming, J. (Eds.), Chronic Schizophrenia, Glencoe, Free Press, 1960.
(Reprinted in Bull. Menninger Clin., 23:41-51, 1959.)
_____, “Some Considerations on Growth in Its Physical and Mental Aspects,” Merrill-Paimer Quart.,
3:13-23, 1956.
3006
_____, “System, Symbol and the Image of Man,” in Galdston, I. (Ed.), The Interface between
Psychiatry and Anthropology, Brunner/Mazel, New York, 1971.
_____, “Theoretical Models in Biology and Psychology,” in Krech, D., and Klein, G. (Eds.), Theoretical
Models and Personality Theory, Duke University Press, Durham, 1952.
_____, “The Theory of Open Systems in Physics and Biology,” Science, 111:23-29. 1950.
_____, “The World of Science and the World of Value,” Teachers College Record, 65:496-505, 1964.
(Reprinted in Bugenthal, J. F. T. (Ed.), Challenges of Humanistic Psychology,
McGraw-Hill, New York, 1967; Shoben, E. J., Jr., and Goldberg, S. (Eds.), Problems in
Contemporary Education, Scott, Foresman and Co., Glenview, Ill., 1968.)
_____, “Zu einer allgemeinen Systemlehre,” Blatter fiir Deutsche Philosophic, 18:3-4, 1945.
_____, Hempel, C., Bass, R., and Jonas, H., “General System Theory: A New Approach to Unity of
Science,” Human Biol., 2.3:302-361, 1951.
_____, with Hilgartner, G. A., and Koch, S., “Author-Reviewers Symposia: Robots, Men and Minds, L.
von Bertalanffy,” Phil. Forum, 9:301-329, 1971.
_____, with Rapoport, A., General Systems, Yearbook of the Society for General Systems Research,
Society for General Systems Research, Washington, D.C., 16 vols. since 1956.
Bethe, A., “Plastizitat und Zentrenlehre,” in Bethe, A. (Ed.), Handbuch der normalen und
pathologischen Physiologic, Vol. 15, Springer, Berlin, 1931.
Boguslaw, W., The New Utopians, Prentice-Hall, Englewood Cliffs, N.J., 1968.
Bruner, J., “Neural Mechanisms in Perception,” in Solomon, H. (Ed.), The Brain and Human
Behavior, Williams & Wilkins, Baltimore, 1958.
Brunswick, E., “Historical and Thematic Relations of Psychology to Other Sciences,” Scientific
Monthly, 83:151-161, 1956.
Buhler, C., “Basic Theoretical Concepts of Humanistic Psychology,” Am. Psycholog., 26:378-386,
1971.
_____, Psychologic im Leben unserer Zeit., Knaur, Munich and Zurich, 1962.
_____, “Theoretical Observations about Life’s Basic Tendencies,” Am. ]. Psychother., 13:561-581,
1959.
Cannon, W., The Wisdom of the Body, Norton, New York, 1932.
Cantril, H., “A Transaction Inquiry Concerning Mind,” in Scher, J. (Ed.), Theories of the Mind, Free
Press, New York, 1962.
Carmichael, L. (Ed.), Manual of Child Psychology, 2nd ed., John Wiley, New York, 1954.
Cassirer, E., The Philosophy of Symbolic Forms, 3 vols., Yale University Press, New Haven, 1953-
1957.
Demerath, N. J. Ill, and Peterson, R. A. (Eds.), System, Change and Conflict. A Reader on
Contemporary Sociological Theory and the Debate over Functionalism, Free Press,
New York, 1967.
3008
Frankl, V. E., “Das homoostatische Prinkip und die dvnamische Psychologie,” Ztschr. f. Psychother.
Med. Psychol., 9:41-47, 1959.
_____, The Will to Meaning: Foundations and Applications of Logotherapy, World, New York, 1969.
Freeman, G., The Energetics of Human Behavior, Cornell University Press, Ithaca, 1948.
Fromm, E., “The Erich Fromm Theory of Aggression,” New York Times Magazine, February 27,
1972.
Geertz, C., “The Growth of Culture and the Evolution of Mind,” in Scher, J. (Ed.), Theories of the
Mind, Free Press, New York, 1962.
Gilbert, A. R., “On the Stratification of Personality,” in David, H., and von Bracken, H. (Eds.),
Perspectives in Personality Theory, Tavistock, London, 1957.
Goldstein, K., “Functional Disturbances in Brain Damage,” in Arieti, S. (Ed.), American Handbook of
Psychiatry, Vol. 1, Basic Books, New York, 1959.
Gray, W., “The Contributions of Ludwig von Bertalanffy to Modern Psychiatry,” in Laszlo, E. (Ed.),
The Relevance of General Systems Theory. Papers presented to Ludwig von
Bertalanffy on His yoth birthday, Braziller, New York, 1972.
_____, “Ludwig von Bertalanffy’s General System Theory as a Model for Humanistic System
Science,” XIII International Congress of the History of Science, Subsection “History of
_____, Duhl, F., and Rizzo, N., General Systems Theory and Psychiatry, Little, Brown, Boston, 1969.
Grinker, Roy R., Sr., “Biomedical Education as a System,” Arch. Gen. Psychiat., 24:291-297, 1971.
_____, “An Essay on Schizophrenia and Science,” Arch. Gen. Psychiat., 20.1-24, 1969.
_____, “Goals for the Future of American Psychiatry,” Mount Sinai J. Med., 38: 226-242, 1971.
_____, Toward a Unified Theory of Human Behavior, 2nd ed., Basic Books, New York, 1967.
Hacker, F. J., “Juvenile Delinquency,” Hearings before the U.S. Senate Subcommittee Pursuant to S.
Res. 62, June 15- 18, 1955, U.S. Govt. Printing Office, Washington, D.C., 1955.
Hall, A., A Methodology for Systems Engineering, Van Nostrand, Princeton, 1962.
_____, and Fagen, R., “Definition of System,” General Systems, 1:18-28, 1956.
Hebb, D. O., “Drives and the C.N.S. (Conceptual Nervous System),” Psycholog. Rev., 62:243-254,
1955.
Henry, J., Culture against Man, Random House, New York, 1963.
Herrick, C., The Evolution of Human Nature, Harper Torchbooks, New York, 1956.
Holst, E. von, “Vom Wesen der Ordung im Zentralnervensystem,” Naturioissen- schaften, 25:625-
631, 641-647, 1937.
Howard, J., Please Touch: A Guided Tour of the Human Potential Movement, McGraw-Hill, New
3010
York, 1970.
Kavanau, J. L., “Behavior of Captive White-footed Mice,” in Willems, E. P., and Raush, H. (Eds.),
Naturalistic Viewpoints in Psychological Research, Holt, Reinhart and Winston, New
York, 1969.
Klir, G. (Ed.), Trends in General Systems Theory, John Wiley, New York, 1971.
Kment, H., “The Problem of Biological Regulation and Its Evolution,” General Systems, 4:75-82,
1959.
_____, and Smythies, J. R. (Eds.), Beyond Reductionism. The Alpbach Symposium, Macmillan, New
York, 1970.
Krech, D., “Dynamic Systems as Open Neurological Systems,” Psychol. Rev., 57: 283-290, 1950.
Kubie, L., “The Distortion of the Symbolic Process in Neurosis and Psychosis,” J. Am. Psychoanal.
A., 1:59-86, 1953.
Kuhn, T. S., The Structure of Scientific Revolutions, University of Chicago Press, Chicago, 1962, 2nd
ed., 1970.
Langer, S. (1942), Philosophy in a New Key, Mentor Books, New York, 1948.
Lashley, K. S. (1929), Brain Mechanisms and Intelligence, Hafner Publishing Co., New York, 1964.
Leibowitz, L., “Desmond Morris is Wrong about Breasts, Buttocks, and Body Hair,” Psychology
Today, February 1970.
Lersch, P., and Thomae, H .(Eds.), Handbuch der Psychologic, Vol. 4, Personlichkeitsforschung und
Personlichkeitstheorie, Hogrefe, Gottingen, 1960.
Lorenz, K., On Aggression, Harcourt, Brace & World, New York, 1963.
_____, “Rats, Apes, Naked Apes, Kipling, Instincts, Guilt, The Generations and Instant Copulation. A
Talk with Konrad Lorenz,” New York Times Magazine, July 5. 1970.
Luria, A., The Role of Speech in the Regulation of Normal and Abnormal Behavior, Pergamon Press,
New York, 1961.
Luthe, W., “Neuro-humoral Factors and Personality,” in David, H., and von Bracken, H. (Eds.),
Perspectives in Personality Theory, Tavistock, London, 1957.
Magoun, H., The Waking Brain, Charles C Thomas, Springfield, Ill., 1958.
Matson, F. W., The Broken Image, George Braziller, New York, 1964.
May, R., Angel, E., and Ellenberger, H. (Eds.), Existence: A Neiv Dimension in Psychiatry and
Psychology, Basic Books, New York, 1958.
Meir, A., “General System Theory, Developments and Perspectives for Medicine and Psychiatry,”
Arch. Gen. Psychiat., 21:302-310, 1969.
Menninger, K., “The Psychological Aspects of the Organism under Stress. Regulatory Devices of
the Ego Under Major Stress,” J. Am. Psychoanal. A., 2:67-106, 280-310, 1954.
Reprinted in General Systems, 2:142-172, 1957.
3012
_____, Ellenberger, H., Pruyser, P., and Mayman, M., “The Unitary Concept of Mental Illness,” Bull.
Menninger Clin., 22:4-12, 1958.
_____, Mayman, M., and Pruyser, P., The Vital Balance, Viking, New York, 1963.
Merloo, J., The Rape of the Mind, World, New York, 1956.
Miller, J. G., “Living Systems: Basic Concepts,” in Gray, W., Duhl, F. J., and Rizzo, N. D. (Eds.),
General Systems Theory and Psychiatry, Little, Brown, Boston, 1969.
_____, “Towards a General Theory for the Behavioral Sciences,” Am. Psychol., 10: 1955.
Milstein, M. M., and Belasco, J., Educational Administration and the Behavioral Sciences: A Systems
Perspective, Allyn and Bacon, Boston, 1972.
Mumford, L., The Myth of the Machine, Harcourt, Brace & World, New York, 1967.
Murray, H. A., “The Personality and Career of Satan,” J. Soc. Issues, 18:36-54, 1962.
Nuttin, J., “Personality Dynamics,” in David, H., and von Bracken, H. (Eds.), Perspectives in
Personality Theory, Tavistock, London, 1957.
Offer, D., and Sabshin, M., “The Concept of Normality,” Ch. 8 of this volume.
Opler, M. K., Culture, Psychiatry and Human Values, Charles C Thomas, Springfield, Ill., 1956.
Piaget, J., The Construction of Reality in the Child, Basic Books, New York, 1959.
Rapaport, D., “The Structure of Psychoanalytic Theory,” Psychol. Issues, 2, 1960, Mono. 6.
Rapoport, A., “Systems Analysis,” in Sills, D. L. (Ed.), International Encyclopedia of the Social
Reich, C. A., The Greening of America, Bantam Books, New York, 1971.
Rizzo, N. D., “The Court Clinic and Community Mental Health—Systems Theory in Action,” in The
Seventh Annual John W. Umstead Series of Distinguished Lectures, North Carolina
Department of Mental Health, February 5-6, 1970.
_____, “Recent Applications of General System Theory in Schools and Courts,” XIII International
Congress of the History of Science, Subsection “History of Systems Analysis,”
Moscow (U.S.S.R.), August 18-24, 1971.
Rothacker, E., Die Schichten der Personlichkeit, 3rd ed., Barth, Leipzig, 1947.
Royce, J. R., The Encapsulated Man, Van Nostrand, New York, 1964.
Schaxel, J., Die Grundziige der Theorienbildung in der Biologie, 2nd ed., Fischer, Jena, 1922.
Scher, J. M., (Ed.), Theories of the Mind, Free Press, New York, 1962.
Shannon, C. E., and Weaver, W., The Mathematical Theory of Communication, University of Illinois
Press, Urbana, Ill., 1949.
Sheldon, A., Baker, F., and McLaughlin, C. P. (Eds.), Systems and Medical Care, M.I.T. Press,
Cambridge, 1970.
Skinner, B., Beyond Freedom and Dignity, Alfred A. Knopf, New York, 1971.
_____, “The Flight from the Laboratory,” in Marx, M. (Ed.), Theories in Contemporary Psychology,
Macmillan, New York, 1963.
Sorokin, P., “Reply to My Critics,” in Allen, P. (Ed.), Pitirim A. Sorokm in Review, Duke University
3014
Press, Durham, 1963.
Stagner, R., “Homeostasis as a Unifying Concept in Personality Theory,” Psychol. Rev., 58:5-17,
1951.
Syz, H., “Reflections on Group—or Phylo-Analysis,” Acta Psychotherapeutica, 11: 37-38, 1963.
Szasz, T., The Myth of Mental Illness, Hoeber-Harper, New York, 1961.
Tanner, J., and Inhelder, B. (Eds.), Discussions on Child Development, Vol. 4, Tavistock, London,
1960.
Thumb, N., “Die Stellung der Psychologie zur Biologie. Gedanken zu L. von Bertalanffy’s
Theoretischer Biologie,” Zentralblatt Psychotherapie, 15.139-149, 1943.
Toch, H. H., and Hastorf, A. H., “Homeostasis in Psychology: A Review and Critique,” Psychiatry,
18:81-91, 1955.
Werley, H. H., “Health Research and the Systems Approach,” Symposium given March 1, 1971,
Center for Nursing Research, Wayne State University, Detroit, Michigan.
_____, “The Concept of Development from a Comparative and Organismic Point of View,” in Harris,
D. (Ed.), The Concept of Development, University of Minnesota Press, Minneapolis,
1957.
_____, and Kaplan, B., Symbol Formation, John Wiley, New York, 1963.
Whyte, L., The Unconscious before Freud, Basic Books, New York, 1960.
_____, Wilson, A. G., and Wilson, D., Hierarchical Structures, Elsevier, New York, 1969.
Young, O. R., Systems of Political Science, Prentice-Hall, Englewood Cliffs, N.J., 1968.
Notes
[1] The reader is referred to Grinker’s article, “The Relevance of General Systems in Psychiatry” in
Volume 6 of this Handbook. As is well known, Grinker’s efforts in the field go back to
conferences he started in 1951. The fact that the present contribution and that of Grinker
were written in the same spirit, but independently, may lead to some overlapping, but
hopefully also to further elucidation.
[2] It would seem that no previous time need to learn lusty sex “from the book.” The frescoes in
Pompeii’s lupanar were professional advertising rather than visual aids in sex education.
[3] According to Skinner,"' culture “is a set of contingencies of reinforcement” (p. 182). This may well
be true for American popular culture where an entertainer draws some $30,000 for an
evening, or a boxer a couple of millions. But how this statement may apply to a Mozart
whose “reinforcement” mainly was getting tuberculosis and being seated at the lackey’s
table or, for that matter, to any creative person— including even university professors,
who certainly would do better applying their IQs to the used car or other business—is no
less wondrous to this writer than Mozart’s work itself.
3016
PART VI
Henry Brill
Introduction
writer knows of no psychiatry that can get along without them. Great
psychiatrists at least from the time of Pinel onward have expressed such
dissatisfactions, and today the complaints and the suggested solutions are at
least as numerous and more sophisticated than ever before. Some authorities
thing as mental disorder, while others insist that there is only one type of
further classified. Still others would replace all existing systems with new
3018
Nevertheless, it is fair to say that for all practical purposes clinical
years has been to work toward a convergence among all existing psychiatric
systems, and much progress has been made in this direction through the
World Health Organization’s eighth edition of the International Classification
of Diseases (ICD-8), and further progress is expected in the next edition, which
is now in preparation (ICD-9). The problem is far less difficult than might be
series of arbitrary inventions that have been created and destroyed in endless
succession. This is distinctly not true. It is a matter of common knowledge
that such terms as mania, melancholia, and paranoia were already in common
use in classic Greek and Roman times. Other terms such as neurosis and
neurasthenia were added in the course of time, and although much was tried
and abandoned, what has survived the centuries has a vigor that speaks of
some real usefulness in what is perhaps the most pragmatic and empirical of
and the functional disorders. Most of this has been accomplished during the
last 150 years, and all of this is common to the major classifications
worldwide.
Another factor that tends to bring the various systems into alignment is
that they must all meet the test of practicability in actual operation. Six
generally acceptable:
3020
position that it is futile to indulge in “last ditch battles” about
an exact definition of a type of neurosis or a subgroup of
schizophrenia. In the present state of our knowledge such
definitions must be taken more as conventions than as
absolute truths, although they do have operational
significance and, if generally accepted, provide a valuable
medium of communication. ICD-8 has not hitherto had such
a glossary, but the World Health Organization is now
preparing one.
Let us now examine some of the definitions of important terms that are
Definition of Terms
standardized terminology, but as Crowson points out this is not the case.
Even at the most expert level one finds considerable variation in usage of
classification, while others reserve the term to describe the general science
and theory of classification.
adopted:
scientific naming. It should be noted that these are names, not of things, but of
concepts; thus schizophrenia is, strictly speaking, the name of a concept of a
3022
synonyms are mentioned. In ICD-8 there is also only one primary term for
each classified condition; but a large number of synonyms are listed as
inclusion terms, and to further assist in defining the various entities ICD-8
also lists for them a series of exclusion terms, names of conditions that are
those required to assign them to the group, but this is not true of members
and that some systems that began as artificial conventions were subsequently
3024
defined somatic demonstrable pathology. But these statements are really
objections to the principle of artificial classification, and they are based on the
and the various specific infections. It is noteworthy that the term “diagnosis”
was used for these disease names long before their nature was understood.
classification.
common is well stated by Lorr, Klett, and McNair as follows: The psychiatric
condition to another the two cannot be really different, or briefly stated, that
continuity among things signifies identity. This position seems to ignore the
continuity is the statement that mental illness does not exist altogether
because one can find all possible transitional states between mental health
3026
and mental illness. The argument is that this situation is peculiar to
psychiatry, and, therefore, the medical model that applies in other specialties
is not appropriate for psychiatry. The fallacy in this logic is the mistaken
because they are, in fact, found in the biological sciences generally, and it is
worth noting that the theory of classification and nomenclature has perhaps
had its most intensive development in relation to botany and zoology. In this
in its basis to characters which can be counted or measured,” and the reasons
that he presents will be familiar to any psychiatrist who has been concerned
with classification in that field. He also calls attention to an “academic trend
over the last fifty years ... of a progressive deprecation of the importance of
produced the effect that young (recently graduated) botanists and zoologists
(have) less real systematic knowledge than at any time in the last hundred
familiar in the field of psychiatry as are the reasons he gives for thinking that
the trend will be halted, and this includes the indispensability of classification
3028
characters are rarely coincident in their distributions. His comment on the
“splitters” who would create endless subcategories and the “lumpers” who
brief then it would seem that we must be careful in discussing the problems
of psychiatric nomenclature and classification to distinguish between those
remedy within that discipline, and those that are or seem to be inherent in the
classification of all biological data, and are far less likely to do so.
one may class the arguments that psychiatric classification can be misused to
hospitalize the rejected, to label them in such a way as to express the bias of
society, and to stigmatize them and that it can be used as a punishment for
classification are also highly traditional in psychiatry and date back at least to
the time of Pinel. Whether one wishes to condemn a practice merely on the
question.
shall see the important role that they play in the development of such systems
earlier versions it has probably had more extensive actual use than any other
United States and also used in a number of other countries in North and South
America. Stengel pointed this out in his masterly review of national systems.
Among the advantages of DSM II are its glossary[1] and its convertibility
to the World Health Organization’s system since it uses the same code
numbers and, for the most part, uses the same or similar terms. This has
become steadily more important as the WHO system has been more widely
adopted in Europe and elsewhere.
3030
The changes in DSM II as compared with DSM I are quite extensive and
between the APA classification and that of the WHO. The changes were also
moved too far from previously established classification systems. The next
that the alignment with DSM II will not be disturbed. Nevertheless, some
during use; new conditions and new requirements have developed and new
data of classificatory significance have emerged, as will be shown further on
in this chapter.
As already noted the terms in DSM II are generally the same as those in
ICD-8, but differences remain, and these have been identified by marking with
an asterisk DSM II items not found in ICD-8 and closing between squared
brackets ICD-8 items listed in DSM II but “to be avoided” in actual use. A
second significant difference between the two systems is the order of listing
of some of the items or groups of items. For example, DSM II lists the forms of
mental retardation first, while ICD-8 lists the organic brain syndromes first.
The Arabic numerals that comprise the numbering system of ICD-8 have been
retained in DSM II, but their sequence has been broken by the
the 310-315 series (the mental retardations), followed by the 290-294 series
(the psychoses associated with organic brain syndromes). Then comes the
listed previously).
In ICD-8 the terms are listed in numerical order starting with item 290
(senile and presenile dementia) and ending with item 315 (unspecified
mental retardation). Several unused numbers left at the end of the ICD-8
psychiatric series have been used for additional terms in the APA Manual,
of its own presentation, DSM II has identified eleven main groups of items
with Roman numerals, thus it opens with item I (mental retardation and
All of these changes were adopted in order to make the APA system
(DSM II) compatible with that of the WHO (ICD-8) and interconvertible with
it, and at the same time have it be acceptable in American practice. The
history of the collaborative efforts between the APA committee and the WHO
3032
representatives that preceded the publication of DSM II is fully described in
the opening pages of that publication.
Nomenclature.”
The primary categories listed are borderline (310), mild (311), moderate (312), severe
(313) profound (314), and unspecified (315), and each of these is to be followed by an
additional phrase identified by a decimal digit specifying one of ten broad categories of
associated conditions of etiological or pathogenic nature, as follows:
.0 infection or intoxication
.5 chromosomal abnormality
.6 prematurity
.0 delirium tremens
.5 alcoholic deterioration
.6 pathological intoxication
3034
.9 other alcoholic psychosis
.0 general paralysis
.2 epidemic encephalitis
.0 cerebral arteriosclerosis
.2 epilepsy
.3 intracranial neoplasm
.5 brain trauma
.2 systemic infection
.4 childbirth
.2 brain trauma
.3 circulatory disturbance
3036
.4 epilepsy
.7 intracranial neoplasm
295 Schizophrenia
.0 simple
.1 hebephrenic
.2 catatonic
.3 paranoid
.4 acute episode
.5 latent
.6 residual
.8 schizo-affective
.99 other
.0 involutional melancholia
.2 depressed
.3 circular
.8 other
.0 paranoia
.1 [reactive excitation]
3038
.2 [reactive confusion]
300 Neuroses
.0 anxiety
.1 hysterical neurosis
.2 phobic
.3 obsessive-compulsive
.4 depressive
.5 neurasthenic
.6 depersonalization
.7 hypochondriacal
.8 other
.0 paranoid
.1 cyclothymic
.2 schizoid
.3 explosive
.4 obsessive-compulsive
.5 hysterical
.6 asthenic
.7 antisocial
.81 Passive-aggressive
.82 inadequate
.0 homosexuality
3040
.1 fetishism
.2 pedophilia
.3 transvestitism
.4 exhibitionism
.5 voyeurism
.6 sadism
.7 masochism
303 Alcoholism
.2 alcohol addiction
.9 other alcoholism
Drug dependence of several distinct types are listed, namely, those due to natural and
synthetic drugs of morphinelike action; the barbiturate group; other hypnotics,
sedatives, or tranquilizers, cocaine, cannabis; other psychostimulants; and
hallucinogens.
Ten main topographical subtypes are listed. They include skin, musculo-skeletal,
respiratory, etc.
This is a list of symptoms most often found in child psychiatry, although most of the terms
are not limited to any age group (speech disturbance, specific learning disturbance, tic,
enuresis, encopresis, etc.).
DSM II lists five types under this heading— those of infancy, childhood, adolescence, adult
life, and late life. ICD-8 differs in that it lists only the last three types at this point and
places the first two under behavior disorders of childhood.
This is a heterogeneous series of terms that include marital maladjustment, social and
occupational maladjustment, and dyssocial behavior. The ICD-8 calls this category “social
maladjustment without manifest psychiatric disorder.”
This is a series of terms such as “diagnosis deferred, boarder, experiment only.” In ICD-8
3042
such terms are listed under a section “special conditions and examinations without
sickness.”
The main strong points and the chief criticisms of the specific categories
of DSM II may be listed as follows.
Organic brain syndromes. All the so-called organic mental disorders are
listed here according to etiology in an order that is largely standard for
with the older literature. DSM I’s distinction between “acute” and “chronic”
has been dropped or very much subordinated, and the organic disorders have
been condensed into a single etiological list. In addition, the names of the
“acute brain syndrome associated with alcohol intoxication” has now been
has been almost eliminated from the designations of the individual forms
classification, but this is based on the relative ease with which the syndromes
can be defined and not on a real understanding of pathogenesis. For example,
the mechanism of hallucinations and delusions in the senile or the paretic are
still no better understood than are those of a schizophrenic, and while the
often occurs in the amphetamine psychoses. This observation has led some to
feel that the psychic phenomena of all types of psychosis are identical and of a
different order than the somatic ones, and this opinion brings to mind the
3044
Cartesian philosophy that mind and body operate on different planes. This
dualism may reflect also a deep religious feeling that equates the mind with
the soul and views the soul as incorruptible. Such dualism is not usually
senile dementia, but such states are often seen as different in nature from the
organic psychoses with secondary systems even if the behavior problems are
identical in both instances. This has lead to endless futile rhetoric about the
fallacy that this term has some intrinsic and inherent meaning other than the
they are worse than futile because the word “psychosis” does not have a clear
and rigorous definition, a characteristic that it shares with other essential
A question has recently been raised with respect to the separation of the
psychotic and the nonpsychotic forms of OBS on the ground that one should
not make such a basic distinction between cases of lesser and greater severity
where the basic illness is the same. Other questions have also been raised, but
it now seems that changes in the OBS groups are likely to be limited to those
dementias.
known and of unknown etiology. In DSM II this is the first major division,
while it is the last in ICD-8. This part of the classification now appears to be
one of the most satisfactory sections, whereas it was previously one of the
least acceptable.
ICD-8 and are widely recognized in European psychiatry. Whether these last
represent a nosological entity remains a fundamental issue in classification
and one that future research will have to solve; at this time opinion remains
firm on both sides of the question.
For a long time critics have claimed that the classifications listed too
possible to abbreviate the list and the number of divisions remains at ten or
3046
more.
simple, and childhood types are generally accepted, and the main differential
diagnosis is between the affective disorders and schizophrenia; the
During the preparation of DSM II criticism against this part of the APA
undifferentiated, schizo-affective, and residual types, and these are again the
focus of considerable discussion, but for the moment they remain either in
DSM II or ICD-8 or in both. Another criticism had to do with the use of the
origin of the symptoms. As a result the term “reaction” that was also widely
cases are of endogenous origin and felt that “reaction” implied that all cases
are exogenous; hence they considered the term insufficiently neutral for a
classification.
very incisive paper that this distinction is itself vague and does not really
clarify the theoretical question.
difference between cases that suffer only depressive or manic attacks and
those who have both types of syndromes in the course of time. A distinction is
thus being made between monopolar and bipolar affective disorders, and this
paranoid states and no longer grouped with the affective disorders, but so
many depressed cases show paranoid elements that issues about their proper
classification continue to be raised from time to time. Finally one cannot but
continue to be concerned about the great disparity in the proportion of cases
3048
through improved nosology.
a group have been as well recognized as other major psychiatric divisions, but
the subdivisions have remained somewhat vague and subject to shifts from
time to time that do not show any clear line of evolution in any specific
hypochondriasis.
tendency for symptoms to shift from one category to another, and that lack of
and some cases seem to show a transition from neurosis to psychosis. Finally
the hysterical psychosis, long rejected in American nosology, is now again
as do many psychoses, while some forms are far more suitable for
disorder. The other major change is the introduction of the new term
3050
groups them together as personality disorders and adds to the title the very
significant words “and certain other nonpsychotic mental disorders.” This
where such problems play an important role. There is, for instance, much
doubt whether homosexuality necessarily constitutes a form of mental
disorder, and the nature of the problem in some of the other forms of sexual
course, can deny that mental disorder is often a cause or effect of dependence.
has been the expression of a similar trend to purge the classification of items
that label deviant behavior in and of itself as a form of mental disorder. ICD-8
contains essentially the same categories under “other nonpsychotic mental
lifelong, fixed, relatively mild, and have some of the qualities of a major
varieties. However, the way in which these conditions have been grouped,
and the terms used for such grouping, are still open to controversy. Although
the manifest content of these controversies relates to principles of nosology,
there can be no doubt that the issue of stigma injects heat into the discussion,
and it is with respect to those who are seen as socially deviant in behavior
that the controversy is sharpest. In these cases medico-legal issues are
involved, and some of the forms of personality disorder are seen quite as
such cases the controversy has to do with which of two unwilling types of
facilities, namely, jails or mental hospitals, will have to deal with a given case.
codes of behavior and with various legal sanctions, and further developments
3052
The Psychophysiological autonomic and visceral disorders. Also known as
European as well as American medicine, and in both DSM II and ICD-8 the
origin.”
next, since all three are used extensively in child psychiatry where efforts at
the other parts of the Manual. As the title indicates, one essential
disorder. It has been argued that many of these syndromes may last for years,
leaving the term “transient” open to debate. Furthermore, this category fails
DSM II characterized partly by the fact that the duration of the disturbance
lies between that of the transient situational disturbances and the psychoses,
neuroses, and personality disorders. The patterns of behavior are also fairly
abbreviated form. This category, together with the two preceding ones,
for administrative use. These two major groups include various conditions
3054
not considered to manifest psychiatric pathology. Included in the first group
are various forms of maladjustment and dyssocial behavior, while various
the second. This category is not found in Section V of ICD-8, which uses no
code numbers above 315, while DSM II uses numbers 316, 317, 318, and 319
for this purpose. These categories are considered useful even though their
Code Numbers
minor exceptions the names and their code numbers in this list are the same
as the ones in ICD-8. If one examines the list it will, however, be noted that the
DSM II series is not presented in numerical order. Thus the list is headed by
the 310-315 series (the mental retardations), and these are followed by the
290-294 series (the psychoses associated with organic brain syndromes), and
these are followed by Section 309, the nonpsychotic organic brain syndromes,
after which comes a section containing items numbered 295-298. The Arabic
numerals represent the order of items as they are listed in Chapter V, the
superimposed on the Arabic numerals that identify each name in the list.
decreasing importance, while the higher values are attached to the major
302.6 (sadism), and 302.7 (masochism) under the major ICD-8 heading of
302 (sexual deviations), which lists specifically only four forms, ending with
numerical listing, it is possible to drop items that are not locally acceptable
without breaking the overall classification pattern, and this has been done
3056
with respect to 298.1 (reactive excitation), 298.2 (reactive confusion), 298.3
which are marked “to be avoided in the U.S.” This was done because of a
modifying phrases. These are designated by a fourth digit that can be used to
brain trauma in DSM II would be identified by the code number 293.51, and
Finally it may be noted that the ICD classification system allots three
digits for designation of major disease categories and a fourth digit, a decimal
digit, for specification of additional details within each category. DSM II adds
a fifth digit (in the next decimal place) to provide for qualifying phrases and
In spite of this flexibility both systems provide for only one disorder or
schizophrenia have been given specific names, but these have not achieved
general recognition, and for practical purposes the practice of the past has
been to select one diagnosis on the ground that it is the underlying, the
presenting, or the most serious one. This was felt to be necessary because
there are no names for most of the possible permutations of such disorders,
and if they were created it would not be feasible or useful to deal statistically
with such a large number of entities. The use of multiple diagnoses would
solve this problem, but this was long impractical for similar reasons.
Computer technology has now removed many of these limitations, and DSM II
states that multiple diagnoses should be used where indicated, and this
Manual for the first time “encourages the recording of such diagnosis as
picture.
In summary, one may say of the code numbers that they may be
3058
Nosology of This Handbook
shows many variations and such variations occur regularly in textbooks and
at virtually all levels of psychiatric communication. In part they are required
part they simply illustrate what has been clearly enunciated by Jaspers,
namely, that no classification is equally suitable for all purposes, and thus for
under which one might assign many of these cases to such categories as
neurosis” that are not found in the currently accepted nomenclature. Such
variations, however, will only rarely cause any problems, and for practical
purposes the context will enable one to translate the terms into those of the
can be seen from the fact that it is still the practice in some countries for each
be to resurvey all that had been done in the past and attempt to recast the
quite regularly at ten-year intervals. Even more difficult is the problem of new
categories that have not yet been formally placed in the classification, as is the
obviously must be given recognition long before the official classification can
incorporate them. All of this means that deviations from the formal
system to be used for normal clinical records from which public health data
must be developed.
Conclusion
clinical usage, and in one or another form are utilized throughout the world.
3060
They all derive from the same evolutionary process and stem from a common
psychiatric literature; this is clearly reflected in their structure. The main
unchallenged, and with the passage of time the list of organic causes grows
This issue has been raised most recently with respect to the role of drug
abuse in psychiatric disorder; however, it remains without answer even in the
case of the amphetamine psychoses, where the cause- effect relation appears
quite clear-cut. The irregularity of response pattern, the lack of anatomical or
concepts of etiology are severely limited when they are closely examined and
In spite of these and other limitations, progress has been made within
has always been active; it is one of the most traditional parts of psychiatry
and has been a safeguard against dogmatism, but one doubts that even the
most vigorous current critics would wish to sweep away all classification and
medical model are frequently expressed and have had considerable recent
attention, but they are by no means new, as will be seen from such little
the other hand, it is probably correct to say that a large number of mental
laboratory will open up great new vistas in this field; this view is shared by
some who reject the medical model and expect that it will be replaced by a
social model of mental disorder. For some this expectation is so strong that
there is a real danger that it could lead them into seeing the event before it
3062
world is still inclined to wait for firm evidence that any proposed replacement
to what we now have, and that conviction will come from performance rather
than from debate. Indications are that progress will be relatively slow and
will be built on the foundations of previous work rather than on
better basis for public health studies, and, last but not least, a better basis for
treatment.
Bibliography
Adams, H. B., “Mental Illness or Interpersonal Behavior?” Am. Psychol., 19, 1964.
Aurelianus, C. (Ed. by Drabkin, I. E.), On Acute Diseases and Chronic Diseases, University of Chicago
Press, Chicago, 1950.
Ban, T. A., and Lehmann, H. E., Experimental Approaches to Psychiatric Diagnosis, Charles C
Thomas, Springfield, Ill., 1971.
Burgess, L. G. (Ed.), Current Medical Information and Terminology, 4th ed., American Medical
Association, Chicago, 1971.
Committee on Nomenclature and Statistics, Diagnostic and Statistical Manual of Mental Disorders
(DSM I), American Psychiatric Association, Washington, D.C., 1952.
_____, Diagnostic and Statistical Manual of Mental Disorders (DSM II), American Psychiatric
Association, Washington, D.C., 1968.
Feinstein, A. R., “Boolean Algebra and Clinical Taxonomy,” New Eng. J. Med., 269: 929-938, 1963.
Fleck, S., “Labelling Theory,” N.Y. State District Branch Bull., May 1969, p. 1.
Howells, J. G., Nosology of Psychiatry, Special Report to the Society of Clinical Psychiatrists, Claver
Press, Ipswich, 1970.
International Classification of Diseases (ICD-8), 1965 revision, World Health Organization, Geneva,
1967.
Jenkins, R. L., and Cole, J. O., Diagnostic Classification in Child Psychiatry, Psychiatric Research
Reports of the American Psychiatric Association, Report No. 18, Washington, D.C.,
October 1964.
Kant, I., The Classification of Mental Disorders (Tr. and ed. by Sullivan, C. T.), Doylestown
Foundation Paper, Doylestown, Pa., 1964.
Katz, M. M., Cole, J., and Barton, W. E., The Role and Methodology of Classification in Psychiatry,
3064
Public Health Service Publication No. 1584, National Institute of Mental Health,
Washington, D.C.,1968.
Lewis, A., “ ‘Endogenous’ and ‘Exogenous’: a Useful Dichotomy?” Psychol. Med., 1: 191-196, 1971.
Lorr, M., Klett , J. C., and McNair, D. M., Syndromes of Psychosis, Pergamon Press, New York, 1963.
Menninger, K ., Mayman, M., and Pruyser, P., The Vital Balance, Viking, New York, 1963.
Moriyama, I. M., “The Classification of Disease, a Fundamental Problem,” J. Chronic Dis., 2:462-
470, 1960.
Odegard , O., “Reactive Psychoses,” Acta Psychiatrica Scandinavica, Suppl. 203:23-28 (undated).
Office of Health Economics, Prospects in Health, Paper No. 37, White Crescent Press, London,
1971.
Rather, L. J., Mind and Body in Eighteenth Century Medicine, a Study Based on Jerome Gaub’s De
regime mentis, University of California Press, Berkeley, 1965. Savory, T., Naming
the Living World, John Wiley, New York, 1962.
Scheff, T. J., “Schizophrenia as Ideology,” Schizophrenia Bull., National Clearing House for Mental
Health Information, no. 2, Fall 1970.
Stengel, E., “Classification of Mental Disorders,” Bull. W.H.O., 21:601-663, 1959. Veith, I., Hysteria:
The History of a Disease, University of Chicago Press, Chicago.
Notes
[1] The World Health Organization is now preparing a glossary for ICD-8, which will go far toward
making this document more effective. The glossary should be available by 1974.
Ian Stevenson
of information we want about patients and in our ideas of how we can best
obtain this information. We also have learned the limitations of verbal
communications. We now notice not only what the patient says but also his
manner of saying it, for this may show what his words conceal. And we have
learned that, when two people talk together, what they say depends not only
upon what they want to tell each other but also upon what they think about
each other. In what follows I shall discuss first the information a psychiatrist
3066
usually wishes to obtain in an initial interview, next how the psychiatrist’s
relationship with the patient influences what the patient tells him, then the
psychiatrist’s optimal attitude, and finally some techniques that can increase
great as those that the last 60 years have brought. This will require, among
other things, that each of us challenge constantly his own habits and remain
unwilling to practice, for the rest of his lifetime, only whatever his teachers
have taught him.
I shall discuss the psychiatric interview chiefly with regard to the initial
The psychiatrist should obtain first what the patient usually most wants
discussion of this can lead easily into talk about the patient’s early
environment and thence toward his family history. From this may naturally
follow an account of the patient’s own earlier life—his personal history.
in initial interviews, and only two items deserve further emphasis. First, much
We should try to imagine what the patient has experienced and now
experiences. We should try to see the world as he sees it, but we can do this
with regard to the purpose they serve the patient in adapting to other people
or to other forces within himself. In short, we enter into detail so that we may
know both what functions are disturbed and how these functions relate to
disadvantage, the careful study of how the patient lives. Only by entering into
his daily life, as it were, can we come to appreciate the subtle but
cumulatively powerful relationships between the patient and others close to
3068
him. And usually only such an appreciation will permit us to dissect the
respective contributions of the patient and those around him to the strain he
experiences.
While listening to the history, the psychiatrist should not only attend to
the bare facts of peoples, places, and events as chronicled by the patient; he
must also study the meaning of these events for the patient and the attitudes
that the patient showed to them then and, if those have changed, the attitudes
the psychiatric examination. The patient’s recital of his complaints and his
history contributes valuable data about the illness. But that illness is a
vulnerabilities of the patient. As the patient talks, the psychiatrist should scan
him and his remarks for signs that certain events or topics are of special
importance to him. The signals that reveal such events or topics deserve a
brief review.
that bother him most. More often than is usually done, we should ask for this
reasonable and valuable answers. But we cannot ask a patient to tell us about
his marriage, his parents, or his employer and expect that the words he
returns us can alone contain all we need to know. Several factors are
responsible for this difference. In the first place our society strongly
emphasizes the importance of other persons having a good opinion of us. For
psychiatric patients this becomes especially important, since they usually
portray himself (