Introduction by Paolo Migone
This paper by Morris Eagle, often quoted and appreciated, has already become almost a classic. It deals with an important issue in psychoanalysis, an issue that has been often used as a reason of splitting among different schools in psychoanalysis: does psychopathology stem from an intrapsychic conflict or from a deficit? According to the former hypothesis, which is proper of the "Freudian" tradition, the classic technique based mostly on interpretation is warranted, while according to the second hypothesis (where psychopathology arises from a deficit, a defect, or a developmental arrest) the use of more reparative or "empathic" techniques, such as those suggested by Kohut's self psychology, are deemed to be more appropriate. An enormous amount of articles and books have been written on this issue. Here Eagle does not take side with neither one pole of this dichotomy, and makes some very acute observations that are critical towards a way of theorizing based mostly on the stereotypes that are typical of those authors who seem to follow only the clichªs of their own psychoanalytic group. Eagle tries to unmask the falsity of this dichotomy, as well as of other dichotomies that characterize many debates in current psychoanalysis.
This paper appeared as chapter 12 ("Developmental defect versus dynamic conflict") of the book by Morris E. Eagle Recent Developments in Psychoanalysis. A Critical Evaluation (New York: McGraw-Hill, 1984; paperback edition: Cambridge, MA: Harvard Univ. Press, 1987); in the Italian edition it appeared as chapter 11 ("Carenze di sviluppo e conflitto dinamico") of the book titled La psicoanalisi contemporanea (Bari: Laterza, 1988). We thank the author and the publishers (McGraw-Hill of New York and Laterza of Bari, for the English and the Italian edition, respectively) for the permissions of publication. This document appears both in English and in Italian.
I have asked Morris Eagle if he wanted to write a brief foreword to this edition in POL.it, in order to know his reflections fifteen years later, and he kindly agreed.
Foreword by Morris N. Eagle to this edition (1998)
Although this chapter on conflict and developmental deficits was written more than fifteen years ago, I believe that the issues addressed continue to be relevant and the central points made in the chapter continue to be valid. It seemed to me then and it seems to me now that there is a false dichotomy between intrapsychic conflicts on the one hand and developmental arrests, defects, and deficits on the other. This is partly so because most frequently the foci of greatest conflict are, at the same time, the areas of developmental deficits and defects. Contemporary psychoanalytic theories have broadened our recognition of the kinds of wishes and fantasies about which people can be conflicted. For example, people can be driven by and conflicted about, not only sexual and aggressive wishes and fantasies, but also wishes and fantasies having to do with merging or total self-sufficiency. But the domination of one's inner life by the latter does not mean that one is suffering from deficits and defects rather than conflicts. Indeed, I think one can say that being preoccupied with and conflicted about, say, fantasies of merging and engulfment are ways of describing a developmental deficit from a dynamic point of view. Or to take another example, so-called structural deficits in, say, tension or affect regulation are likely to be highly associated with intrapsychic conflict and anxiety in particular areas.
The issues dealt with in this chapter are also discussed in a paper entitled "The concepts of wish and need in self psychology" (Eagle, 1990). In a developmental deficit model, one is more likely to think, as Kohut did, in terms of environmental failures or traumas characterized by unmet developmental needs which then bring about deficits, defects, and arrests. Contrastingly, from a dynamic conflict point of view, one is more likely to think in terms of wishes and fantasies that are embedded in conflict and anxiety. I tried to show in my paper that even according to his own logic, what Kohut refers to as needs (e.g., the 'need' for perfect mirroring) are better understood as wishes and fantasies. The point here is that being compelled by certain unrealistic wishes and fantasies, about which one is conflicted and anxious, can also be understood as a developmental deficit. The latter is largely a description of the former from a somewhat different perspective.
Finally, I want to comment briefly on the concepts of developmental arrest and presumed regression to the also presumed point of arrest. As I noted in the chapter, the idea that in pathology an adult is 'arrested' at a stage that is normal for an infant implies that a pathological adult is essentially similar to a normal infant (and vice versa), an untenable assumption that rests on superficial analogizing and the "adultomorphization" and "pathomorphization" of infancy (see Klein, 1981; Peterfreund, 1978). Also untenable is the related idea that in pathology the adult regresses to a state that is normal and universal in infancy. One needs not posit a going back in time in cases of so-called regression. Rather, as Sroufe and Rutter (1984) note, "previous modes of functioning are currently available and are part of the person's ongoing adaptation, at times promoting fit to the environment, though at times compromising growth" (p.21).
From the point of view of treatment, it seems to me that, quite apart from the existence and extent of arrests, deficits, and defects, one should always be alert to the dynamic issue of the context in which manifestations of arrests and deficits intensify and in which they abate. One can then ask such questions as: which conflicts, anxieties, and defenses have been triggered? Which transference reactions have been elicited? Which life challenges have become prominent?
DEVELOPMENTAL DEFECT VERSUS DYNAMIC CONFLICT
(Chapter 12 of the book by Morris N. Eagle, Recent Developments in Psychoanalysis. A Critical Evaluation. New York: McGraw-Hill,1984; paperback edition: Cambridge, MA: Harvard Univ. Press, 1987)
One characteristic of recent developments in psychoanalytic theory, exemplified in the work of Kohut but present in other psychoanalytic writings, is a strong tendency to view at least certain classes of pathology in terms of developmental defects and arrests rather than in terms of dynamic conflict. This is presumably the main characteristic distinguishing the more severe pathologies, such as borderline conditions and narcissistic personality disorders, from the "structural conflicts" of the neuroses. The idea of developmental arrest is often employed literally in the sense that modes of behavior which were presumably normal at an earlier period of development are said to characterize the adults suffering from these more severe conditions. For example, according to Kernberg (1976) the borderline patient's continued use of primitive splitting as a primary defense indicates an inability of the ego (or self) to integrate good and bad, love and hate, because of its failure to grow beyond the developmental stage at which presumably gross affective and evaluative alternations are the rule. Kernberg tells us that the primitive splitting employed by the borderline patient is a normal defensive means of dealing with potential conflict at an early stage of development prior to the emergence of a stable ego structure.
In Kohut's writings one sees clearly the degree to which his self psychology is a psychology of developmental failure and structural defect rather than one of dynamic conflict. Kohut informs us that for the narcissistic personality disorder and others suffering primary from self defects, the primary issue is not intrapsychic conflict, but lack of self-cohesiveness as a consequence of trauma-induced developmental failures. It is as if Kohut were positing a sort of "conflict-free" pathology of the self to parallel "conflict-free" ego autonomy. What Kohut and others (e.g., Stolorow & Lachmann, 1980) propose is that neurosis involves mainly dynamic conflict, while narcissistic personality disorders and other similar pathology consist primarily in structural defects, which develop and can be considered quite apart from dynamic conflict.
The general contrast between developmental arrests and defects on the one hand and intrapsychic conflict on the other is perhaps most fully articulated in a recent book by Stolorow & Lachmann (1980). As they note,
the crucial distinction is between psychopathology which is the product of defenses against intrapsychic conflict and psychopathology which is the remnant of a developmental arrest at prestages of defense... (Stolorow & Lachmann, 1980, p. 5).
For example, in one patient presumably suffering from a developmental arrest, idealization and grandiosity involve mainly an "inability to register and affirm the real qualities of the self or objects..." (p. 64), while for another patient, grandiosity "was defensive in nature. It served to deny his vulnerability and his realistic limitations" (p. 84) [Footnote 1]. Or, to take another example, in one case splitting is seen as a defense against intrapsychic conflict; while in the patient judged to be suffering from a developmental arrest, it is taken as an expression of an integrative incapacity. According to the authors, not only are there prestages of defense in developmental arrest, but also prestages of transference and of the therapeutic alliance. For example, while in classical transferences, the therapist "is experienced as a separate... whole object - a target of displaced affects and conflictual wishes," in prestages of transference, the therapist "is predominantly experienced as an archaic, prestructural self object" (pp. 173-174).
Footnote 1: Actually, this does not seems to mea good example of intrapsychic conflict as it is described in traditional theory. Where is, in fact, the instinctual impulse which is in conflict with Ego and Super-Ego? To the extent that the patient's grandiosity tends to "deny his/her vulnerability and realistic limits", it seems to represent more a compensation against the vulnerability of the Self than a defense against intrapsychic conflict. [In the original edition this footnote is numbered 56]
I do not believe that the above dichotomy between developmental and structural defects on the one hand and dynamic conflict on the other is entirely tenable. Let me indicate the reasons for this position. Most generally, structural defects and dynamic conflict are different aspects of and entail different perspectives on a continuing set of complex phenomena. This is always apparent in Freud's formulations in which dynamic considerations (i.e., of wishes, conflict, and defense) are never replaced by a structural perspective. Rather, both are different aspects of a single complex phenomenon. Thus, when Freud (1940) speaks of "splitting of the ego" in fetishism versus id-ego conflict in neurosis (what Kohut refers to as "structural conflict" between intact structures), he is not contrasting a structural defect with a dynamic conflict. For, in this view the "splitting of the ego" in fetishism is as dynamically determined as the id-ego conflict in neurosis. And for Freud, neurosis is not simply a dynamic conflict between fully intact structures (so that one could, practically speaking, ignore structural considerations) but is, from one vantage point, also a developmental failure. The presence of a neurosis bespeaks, among other things, some inherited, constitutional component an earlier unresolved infantile neurosis, the persistence of infantile wishes, the presence of psychosexual fixations, and a failure of the ego to resolve conflict more adaptively.
While some people may be more disturbed than others and may show a greater degree and wider range of developmental failures, it does not follow that issues of intrapsychic conflict are irrelevant to them. For those with so-called self defects and developmental arrests, there are also conflictual wishes and aims defensively dissociated from the rest of the personality because of the anxiety they would entail. The wishes and aims may center on fantasies and themes of merging, engulfing, and being engulfed, symbiotic union versus separation, etc., rather than primarily Oedipal themes, but they are nevertheless conflict-laden wishes. The general point is that developmental failures and structural defects have dynamic aspects. Indeed, to say that someone is developmentally impaired or has an ego or self-defect means, in part, that certain characteristic wishes (e.g., fantasies of symbiotic merging) are particularly intense and particularly prominent.
Part and parcel of early traumas which presumably led to developmental Éimpairments and structural defects are conflict-laden wishes, longings, and other affective reactions. Clinically, one frequently observes that it is precisely the person deprived of love and empathy who is most conflict-ridden in regard to being loved. For example, very deprived children who are finally indulged (e.g., by a well-meaning child worker or "big brother") will often react with destructive feelings and behavior of one kind or another. (In one case with which I am familiar the mother forbade the trips to a restaurant with the child worker because she had to face the inevitably destructive behavior afterward). It is not uncommon to see children with a history of deprivation react with depression, tears, and rage following indulgence. One can also observe in adult patients who have had a battered and deprived childhood the strong tendency to re-institute conditions of misery and failure after a helpful and empathic relationship has been established, either in or out of therapy. In a recent paper, Bowlby (1981) describes a patient who did not seem to be content until her needling succeeded in making him irritable. This urge to needle became stronger after Bowlby had done something that she felt was kind. Her explanation for her behavior was that "I can't take kindness." Here is someone who was deprived of kindness and now reacts to being treated kindly with hostility because, as Bowlby notes, "in her experience, to become attached to someone could lead only to rejection and further suffering" (p. 19). Bowlby goes on to say:
Once I had become irritable any warm feelings that she might have felt in response to my kindness were snuffed out. Then she felt safe again, though of course terribly isolated" (Bowlby, 1981, p. 19).
The point I am making by all these examples is, to repeat what I have said above, that early traumas, early developmental impairments, and early structural defects are always accompanied by intense and conflict-laden wishes and feelings. The fact is that we have intense reactions (e.g., rage) to experiences of trauma and deprivation and that we are most conflicted in the areas in which we are deprived. As I stated above, it is precisely the person deprived of love who is most conflicted about giving and receiving love. It is as if one of the costs and consequences of trauma is to develop an "allergy" to the very "substance" one needs and of which one has been deprived. Continuing the analogy, such an allergic reaction means that the therapeutic task will be far more complex than compensating for an earlier deficiency.
A subsidiary assumption that is part and parcel of the developmental defect-intrapsychic conflict dichotomy is that the former group of people pursue primarily self-cohesiveness, while the latter is concerned mainly with drive gratification (and the conflicts in which they are implicated). I suggest instead that Gedo (1979, 1980) and G.S. Klein (1976) are correct in their proposal that the integrity and continuity of self-organization is a superordinate aim for all people, quite independent of diagnostic category. For more disturbed people, who are prone to what Kohut calls "disintegration anxiety," this aim is often pursued at the level of sheer intactness of self. For others, the pursuit of this superordinate aim mainly takes the form of striving to resolve and integrate the incompatibilities and conflicts among various subordinate aims (G.S. Klein, 1976).
While satisfaction of basic drives and needs (which are not limited to sex and aggression) generally tends to be self-enhancing and deprivation tends to be self-diminishing, their psychological meaning and consequence cannot be divorced from superordinate issues of self-organization. A main consequence of inner conflict, which entails the experience of wishes and desires linked to basic drives and needs as "ego-alien" and their relegation to the realm of the dissociated, is both the failure to experience satisfaction of specific wishes and desires and the frustration of the superordinate aim of integrity and unity of self-organization. However, the frustration of a specific wish or need in a context of non-conflict will have different psychological consequences. Many people can endure serious frustration of certain basic needs without marked psychological consequences if the frustration is experienced in a context compatible with "self-values." And, as G.S. Klein (1976) notes, issues of sensual craving, gratification, and deprivation are intimately bound up with "self-values."
There is no logical or clinical incongruence between the structural point of view (of which notions of developmental arrest and self-defects are examples) and the dynamic. The integration of the two points of view is made possible with the recognition that whatever one's developmental level and structural limitations, the resolution of incompatibilities is a universal task and the failure to resolve incompatibilities or their attempted resolution through dissociative means weakens the integrity of the personality. Another way to make the same basic point is to say that a self psychology and a dynamic conflict psychology are congruent insofar as degree of self-integrity is intimately linked to the resolution and integration of incompatible aims and motives. What follows is that while the content and nature of conflicts may vary, resolution of conflict will be likely to be therapeutic for all levels of pathology (which is not to say that other factors, such as identification with the therapist, will not also be therapeutic or that other factors will not be especially relevant for certain classes of pathology).
Since the pre-psychoanalytic writings of Janet and Charcot, it has been recognized that both severe incompatibilities and the resort to dissociation as the solution to such incompatibilities weakens the personality. This basic point is echoed in current discussion of the use of "splitting" in borderline conditions. Kernberg (1975, 1976) who has written most extensively in this area, makes the explicit point that the use of splitting tends to erode ego strength.
I have noted above that according to most current writers, the essential factor in the etiology of developmental defects and arrests is early trauma of some kind. Thus, we have already noted that according to Kohut, early lack of empathic mirroring and opportunities for idealization are the primary etiological factors in accounting for lack of self-cohesiveness. Stolorow & Lachmann too, we have seen, link developmental arrests and failures to trauma and deficiencies in early care, including absence of empathic responsiveness, extreme inconsistencies, and "frequent exposure of the child to affectively unbearable sexual and aggressive scenes" (p. 5).
I have already noted (and will discuss again later in the chapter) that there is little or no evidence for these etiological claims. I want to highlight here the degree to which the emphasis on trauma and ensuing defect represent a return to the relatively static and exclusive structural emphasis of pre-psychoanalytic continental psychiatry and a giving up of the insights provided by the psychoanalytic emphasis on intrapsychic conflict.
One will recall that the pre-psychoanalytic emphasis was on constitutional factors in accounting both for extent of the incompatibilities and the inability to resolve them in non-pathological ways. It was Freud's contribution (and, in a sense, the beginning of psychoanalysis) that he essentially reversed the causal sequence. That is, it was not that constitutional weakness and relative incapacity for integration produced conflict and dissociation (and thereby, further weakened the personality - though Freud did allow some weight for such assumptions), but that incompatibilities and the use of repression in order to resolve them weakened the personality and left one prey to symptoms. By contrast, the current emphasis on developmental arrests and self-defects, in a somewhat different language, shares the same explanatory form as the pre-psychoanalytic concepts of Charcot and Janet. Thus, Kernberg, for example, wonders whether those characterized by borderline personality organization are handicapped by a constitutionally given, overly intense aggressive drive. And when constitutional factors are not invoked, one need merely substitute for constitutional weakness and hypnoid states the newer factors of arrests and defects which are held to be brought about by early trauma. In other words, what is invoked in the etiology of pathology is not intrapsychic conflict, personal meanings, and fantasised interpretations of ostensible events, but the direct effects of supposed actual events (usually maternal failure - e.g., lack of empathic mirroring of some kind) upon psychological development, relatively unmediated by personal fantasies and meanings. This kind of etiological explanation is similar in form to early Freud's seduction theory and to pre-psychoanalytic accounts. It is a straightforward A causes B account, much as one would say that lack of vitamin D (A) causes rickets (B).
In short, whether the result of heredity or early trauma, what is proposed in much current literature as the core explanation of serious pathology is that one is dealing with a deficient and defective organism. I have referred elsewhere (Eagle, 1982) to the tendency of some current psychoanalytic writers to depict their patients as so infantile and so defective that one wonders how they can function at all. The example I used was Giovacchini's (1981) description of a patient in the following terms: Both visual and auditory modalities were fixated at early post-symbiotic levels and did not undergo confluence as occurs during the course of psychic development and integration" (Giovacchini, 1981, p. 422).
As I stated there,
the synthesizing of ... visual and auditory modalities is a very early and primitive achievement. If Mr. R. has not accomplished this basic developmental task, how is he able to function? However disturbed Mr. R. is, we know from Giovacchini's description that he holds down a job, is married, pays his therapy fees and, generally speaking, carries out many functions expected of adults. How is it possible for someone incapable of synthesizing visual and auditory modalities to do all these things? (Eagle, 1982, pp. 446-447).
As Levine (1979) points out, conceptualizations in terms of developmental arrests and self-defects tend to confirm the patients' fantasies that he or she is, in fact, detective. I would add that these sorts of formulations also serve to preclude the analytic examination of these fantasies, including their defensive function and their enmeshment in conflict. This is a particularly important point to make insofar as so-called defects and arrests are not necessarily transparent but rather involve the theoretical interpretation and judgment that certain behaviors are expressions, often indirect and subtle ones, of underlying developmental defects and arrests. What follows is that if one's theoretical predilections are in a particular direction, one can view a particular set of behaviors as indications of self-defects and developmental arrests, while someone with a different theoretical inclination will give a different diagnostic meaning to these behaviors. I remind the reader of Gedo's (1980) observation, noted earlier, that the Goldberg (1978) case book is replete with instances of self-defects and hardly mentions Oedipal conflicts, while the Firestein (1978) case book dealing with seemingly similar phenomena bas not a word about self-defects, but much about Oedipal issues. And, as Rangell (1980) has noted, the kinds of patients described as narcissistic personality disorders and as suffering from self-defects by Kohut and his followers have long been observed by many analysts who viewed them as neurotic rather than as warranting a distinct diagnostic category.
Treatment Implications of the Defect Versus Conflict Dichotomy
Accompanying the developmental defect-intrapsychic conflict dichotomy are corresponding differential emphases in therapy. If one conceptualizes pathology in terms of unconscious intrapsychic conflict, anxiety, and defense, then therapy consists in helping the patient better deal with conflict through increased awareness and insight and through increasing the ego's province and control. One's aim is to examine infantile wishes and the conflicts, anxieties, and defenses that surround them in the light of current reality so that one can consciously select such options as renunciation or gratification. If, however, one conceptualizes pathology in terms of developmental defects, then the therapeutic aim is some sort of repair of this defect - usually via the therapeutic relationship.
One sees this latter conception of psychoanalytic therapy with increasing frequency in discussion of work with more disturbed patients. In this latter conception, one can no longer say that the basic aim of psychoanalysis is either to make the unconscious conscious or to enlarge the scope of the ego ("where id was, there shall ego be"). One is not as likely to think of therapy as a process in which one gradually owns the wishes that one has disowned, in which one comes to claim as part of oneself "ego-alien" desires and aims that one has disclaimed (Schafer, 1976). Instead the patient-therapist relationship itself - whether described as a "holding environment" or as permitting mirroring and idealizing transferences - in some fashion helps repair the defect, facilitates the building of new structures and the resumption of developmental growth which was interrupted by early trauma. As Stolorow and Lachmann put it,
Kohut's treatment approach aims at permitting the arrested narcissistic configurations to unfold as they would have had the process not been prematurely, traumatically interrupted (Stolorow & Lachmann, 1980, p. 86).
As for their own approach to therapy with developmental arrests, Stolorow & Lachman consistently contrast the goal of analysis of intrapsychic conflict and defenses in neurosis with the goal of promoting "the structuralization of the self representations" (p. 143) in cases of developmental arrest. As to the specific means through which the latter is to be accomplished, to the extent that this issue is addressed, the authors refer to the therapists' empathic understanding and "empathic clarifications" of the patient's need to maintain his or her archaic state, including the use of the therapist as a self object, for the purpose of maintaining self-cohesiveness and stability. According to the authors, "the analyst's empathic clarification of the patient's specific need for archaic self objects promotes differentiation and structuralization" (p. 170). In general, the authors contrast intrapsychic conflict in which early experiences that are defended against are analyzed in the transference with developmental arrest in which the experiences the patient needed but lacked are understood. Finally, in Fairbairn's (1952) conception, therapy helps the patient dissolve the cathexis of the bad object through the good object relation represented by the therapeutic relationship. Whether or not therapy leads to all these desirable outcomes, the point is that this conception involves a basic alteration of the psychoanalytic theory of therapy. Furthermore, this alteration is based on the mistaken notion that in developmental arrests and structural defects (assuming that these are identifiable phenomena) intrapsychic conflict is not a primary issue.
Many recent conceptualizations of therapy suggest that treatment compensates for early traumas and the deficiencies they bring about. I have referred to this elsewhere as a "deficiency-compensation" model of therapy. However, it is likely that the salutary effects of therapy have mainly to do, not with eliminating developmental failures and structural defects, but with ameliorating the effects of the unrealistic anxieties and unresolved conflicts typically accompanying whatever failures and defects are one's lot. Furthermore - and this seems to me a critical point - whatever the level of one's constitutional or historically endowed degree of ego strength or self-cohesiveness, unresolved conflict and accompanying anxiety weaken the personality, and the resolution of conflict and decreases in anxiety strengthen the personality. For example, for someone who shows evidence of a thought disorder, the factors likely to be most relevant and most amenable to change in therapy will probably have to do with the role of anxiety and conflict in eliciting and/or intensifying the thought disorder and the defensive function of this symptom.
I share Gedo's (1980) skepticism toward talk about resumption of developmental growth and the claim that psychotherapy somehow directly repairs developmental impairments and structural defects - whether through "transmuting internalizations" or any other hypothetical process. Rather, as Gedo points out, the effects of such impairments and defects are more likely to be ameliorated through "new functions learned in the context of a satisfying and age-appropriate human relationship" (Gedo, 1980, p. 378). For some patients the new learning consists in such things as more efficient tension regulation, the prudent avoidance of understimulation or disruptive over-excitement, and raising unrecognized biologically based needs (e.g., symbiotic needs) to the level of conscious awareness and attempting to meet them in a manner consistent with one's self-organization. For many patients, as noted earlier, the experience of the therapist as a supportive symbiotic partner sufficiently reduces anxiety to permit the learning of new functions. But I strongly suspect that for all patients help in the recognition and resolution of conflicts is a primary means of promoting increased feelings of intactness and self-cohesiveness.
As adults, we are not simply frozen at "arrested" points in childhood. Hence, it is not at all clear as to what is meant by permitting arrested configurations to unfold as they would have in the normal course of development. No process, physiological or psychological, unfolds in an adult as it would have when we were 1, 2, or 3 years of age. What can such talk mean or refer to? After all, as Loewald reminds us,
the analysis of adults, no matter how much given to regression or how immature they are in significant areas of their functioning, is a venture in which the analysand not only is in fact, chronologically, a grown up, but which makes sense only if his or her adult potential, as manifested in certain significant areas of life, is in evidence (Loewald, 1979, pp. 163-164).
That we do not, as adults, simply resume a developmental growth that was arrested at an earlier period does not mean that growth in adulthood is not possible. As adults, we can experience a deepening and increase in self-understanding and self-knowledge; we can alter our attitudes and our irrational and grim unconscious beliefs; we can become more self-confident and less plagued with anxiety; we can become more forgiving and self-accepting and less self-castigating; and so on. Furthermore, many of these outcomes may follow a renewed struggle with developmental issues which were left unresolved. However, all these changes are age-appropriate ones that occur in the lives of adults. They do not, nor could they, constitute the resumption of a developmental growth process that is characteristic of a 2- or 3-year-old.
As for the "transformation" of archaic configurations... into more mature forms of self-esteem regulation" (Stolorow & Lachmann, 1980, p. 86), we are not told precisely (or even imprecisely) how such transformations occur in treatment. We are merely told generally that the analyst's empathic mirroring and understanding, his permitting the archaic configuration to unfold, and his availability as a self object all work to heal self-defects, promote structuralization and resumption of developmental growth, facilitate separation-individuation, and transform archaic self and object configurations into more mature ones. Given the remarkableness of these claims, it would be important to go beyond these vague generalizations and to learn something about the specific psychological processes which bring about all these changes.
In contrasting treatment of neurosis and treatment of developmental arrest, Stolorow & Lachmann observe that in the former, reconstruction of the past will alert the therapist to satisfactions the patient will wish to repeat in the transference, while in the latter, reconstructions will alert the therapist to traumata the patient will strive not to repeat. The point I raise here only briefly is the one more fully discussed in dealing with the work of the Mt. Zion group [now called San Francisco Psychotherapy Research Group] (see Eagle, 1984, Chapter 9) [Footnote 2]. That point is that the form of treatment which Stolorow & Lachmann reserve for developmental arrests is, according to the Mt. Zion group, applicable to all psychoanalytic psychotherapy. According to the Mt. Zion group , the assumption that patients seek to repeat or obtain in the transference the gratification of infantile wishes is simply not an accurate description of what goes on in treatment with any patient. Instead, they suggest and present impressive evidence for the idea that all patients seek "conditions of safety," one critical aspect of which is the assurance that the therapist (or perhaps more accurately, the patient-therapist interaction) will not repeat earlier traumata. In other words, what Stolorow & Lachman suggest as specifically and differentially appropriate for developmental arrests, the Mt. Zion group highlights as an essential ingredient of all psychotherapy.
Footnote 2: Concerning the Mt. Zion group (now called San FranciscoPsychotherapy Research Group), see Weiss J., Sampson H. & the Mount Zion PsychotherapyResearch Group, The Psychoanalytic Process: Theory, Clinical Observation,and Empirical Research. New York: Guilford, 1986; Weiss J., Unconsciousmental functioning. Scientific American, 1990, 262, 3 (March): 103-109;Weiss J., How Psychotherapy Works. Process and Technique. New York:Guilford, 1993. [Footnote by P.M.]
Etiological Claims and False Developmental Assumptions
I want to note some additional difficulties that characterize current discussion of developmental arrests and defects. The emphasis on early periods of development has led to unbridled speculations regarding supposed events and processes in infancy and childhood. Such speculations are often of an etiological nature or may simply refer to what presumably goes on in early development. What they all have in common is that, remarkably enough, they are entirely based on clinical work with adult patients and make no reference to empirical studies with infants and children, let alone long-term longitudinal evidence.
Consider, for example, the extraordinary fact that all the evidence Kohut and his followers adduce to support their etiological notions regarding defects in the self are derived from the production of adults in treatment. Or consider some examples from Stolorow & Lachmann (1980). First, "a... characteristic of the very young infant's experience is his inability to integrate or synthesize representations with different affective colorations" (p. 4). But there is not a word on the nature of the evidence that leads to this conclusion We are not told how Stolorow & Lachmann have become privy to the nature of the young infant's experience. It is worth noting in passing that to the extent that there is reliable evidence available regarding the young infant's cognitive capacities, it indicates that he or she has a far greater integrative and synthesizing capacity than is suggested by all the recent speculations regarding early splitting and other related characteristics (e.g., see Stern, 1985).
As for the second example, in discussing traumatic deficiencies in early care having to do with absence of empathic responsiveness, extreme inconsistencies, and "frequent exposure of the child to affectively unbearable sexual and aggressive scenes," Stolorow and Lachmann conclude that
when traumata such as these interfere with the structuralization of the representational world, the individual remains arrested at, or vulnerable to, regressive revivals of archaic, or more or less undifferentiated and unintegrated self-object configurations (Stolorow & Lachmann, 1980, p. 5).
To the extent that one can decipher the jargon, what is being proposed here is a causal proposition regarding the effects of early experiences upon subsequent development without a shred of evidence.
The question that arises in all these instances is the nature of the evidence regarding these supposed actual events, let alone their purported effects on subsequent development. One finds in the current literature all sorts of descriptions of early deprivations, parental pathology, etc., all based, as noted, on adult productions and accounts. But, as Rubinfine (1981) cautions,
under no circumstances are we ever justified in using our creative fictional "constructions" about origins of pathology in the first year of life to serve as data for theorizing about early psychological development (Rubinfine, 1981, p. 394).
As for the adult patients' memories about purported early events, I remind the reader of Freud's (1899) warning, after noting that certain memories may have been falsified, that
&&it may indeed be questioned whether we have any memories at all from our childhood; memories relating to our childhood may be all that we possess. Our childhood memories show us our earliest years not as they were but as they appeared at the latter period of arousal. In these periods of arousal, the childhood memories did not, as people are accustomed to say, emerge; they were formed at this time (Freud, 1899, p. 321n.).
The first above example from Stolorow and Lachmann also illustrates another difficulty of much current writing, which is characterized by the tendency to conceptualize adult pathology in terms of presumably normal stages in infant and child development. Thus, in the above example, an adult's difficulty with positive and negative affective evaluations is taken to represent an arrest at a similar normal stage in infant development. One finds that this sort of thinking completely underlies Kernberg's (1975) discussion of splitting. Splitting, Kernberg tells us, is the infant's normal manner of coping with positive and negative affects, given his limited integrative capacity. It is the continued defensive use of such splitting, Kernberg goes on, which then characterizes the borderline adult. However, as Peterfreund (1978) so cogently points out in referring to those fallacies as the "adultomorphization" of infancy and the "tendency to characterize early states of normal development in terms of... later states of psychopathology" (p. 427), adult pathology is not simply the persistence of normal infant processes. Or, to state it in reverse fashion, infant behavior is not the same nor even essentially similar to adult pathological behavior. The normal infant is not an arrested or defective version of the completed adult, but an organism whose responses are highly adaptive, given its capacity and level of organization. This is perhaps the most basic and most serious problem with the conceptualization of adult pathology in terms of arrested development. It perpetuates the fallacious idea that certain adult pathology is essentially a "freezing" of, or regression to, a particular normal stage of development. It draws on vague analogies between purported infant states and adult pathology without shedding light on either.
Consider as a case in point the frequent analogy drawn between adult narcissistic behavior and feelings (e.g., self-centeredness, a feeling that everything is coming to them, an unrealistically grandiose view of their abilities and achievements) and presumed infantile narcissism. As Peterfreund points out, given the infant's world and capacities, his seemingly narcissistic behavior is normal behavior and bears little essential similarity to the narcissistic behavior of adults, which is characterized by its own motives and processes. To link the two represents superficial analogizing and "a confusing adultomorphization of infancy" (Peterfreund, 1978, p. 436). Other examples of both adultomorphization and what can be called "pathormorphization" (Milton Klein, 1981) of infancy, cited by Peterfreund, include Mahler's (1968) characterization of early infancy as "normal autism" and Melanie Klein's (1932, 1921-58) positing of the "paranoid-schizoid" and "depressive" positions of infancy.
Similar superficial anagogic and confused thinking often enter discussions of regression. As Peterfreund cautions,
when complex biological systems break down they do not necessarily retrace the steps by which they develop, and one must be cautious about viewing the products of a breakdown as representing steps in normal development (Peterfreund, 1978, p. 439).
While a man who has suffered a cerebrovascular accident and is therefore unable to speak may be said to be suffering from aphasia, one would not want to say that he is in "the same state as an infant of two months who cannot speak." Nor would one "characterize a normal two-month old infant as in a 'normal aphasic' state of development." Nor would one describe the man who suffered the cerebrovascular accident as having "'regressed' to an earlier state of 'normal aphasia"' (Peterfreund, 1978, p. 439).
What is clearly suggested in recent discussions of developmental arrest is that the functioning of individuals so afflicted either remains at or, under appropriate precipitating conditions, regresses to states and stages of functioning which were normal at earlier periods of development. This state of affairs is a highly unlikely one. Rather than reflecting a particular earlier level or state of development, pathology is characterized by a particular dysfunctional direction of development, which may bear varying degrees of (mostly superficial) similarity to those earlier periods, but which is certainly not to be equated with these earlier states and which certainly entails radical different processes and capacities. The very concepts of developmental arrest and development defect, if they are to be theoretically coherent and meaningful, must be clarified and elucidated in their own right (e.g., the particular direction of development taken in specific areas; the specific nature of "defects" in ego functions) rather than rest on superficial and misleading analogies with earlier periods of development. I want to note my conviction, however, that even when that is accomplished one will still find that not only are considerations of dynamic conflict and structural defects not incompatible, but that they are simply different perspectives on the same general phenomenon.
I come to one final way in this discussion in which current formulations of developmental arrests do not represent accurate accounts of the nature of development. The implication in many clinical and theoretical descriptions is that problems and issues associated with later stages of development do not make their appearance until earlier stages are successfully negotiated. This is most frequently presented in terms of pre-Oedipal and Oedipal issues. For example, Kohut (1977) writes that Oedipal issues and "structural conflicts" do not surface until earlier pre-Oedipal concerns having to do with self-cohesiveness have been resolved.
I believe that this is an inaccurate conception of how development proceeds and I also believe that it is contradicted by clinical evidence. With regard to the latter point, it is a common clinical experience to observe in patients with a predominance of pre-Oedipal constellations - whether these are described as self defects or schizoid or even schizophrenic - the presence of typical Oedipal conflicts and anxieties (e.g., castration anxiety, guilt and anxiety regarding incestuous wishes, etc.). In such patients, Oedipal conflicts often trigger and are but they saturated with unresolved pre-Oedipal issues and concerns, nevertheless remain characteristically Oedipal in nature. (It should be noted that in typically neurotic patients, too, pre-Oedipal issues are re-aroused and re-intensified at late-Oedipal and post-Oedipal periods - such as adolescence - albeit in less intense degree and although dealt with in a less pathological way.)
The point is that even in instances of developmental defects or arrests, it is not the case that psychological development on all fronts comes to a standstill as is implied in Kohut's descriptions and formulations. This is an inaccurate model of how development proceeds. Rather, what is more typical for people with developmental defects in certain areas is that they are more poorly equipped to deal with later developmental challenges (that is, challenges characteristic of later developmental stages) and later developmental issues are more soffused with earlier unresolved issues. But, and again this is the critical point, all of development in all areas is not held in abeyance awaiting the correction of the defect or arrest. For example, among severely disturbed adolescent (whether described as borderline, schizoid, or narcissistic disorders) issues and problems having to do with sexual gratification, reawakening of Oedipal conflicts, intimacy, heterosexual and homosexual fears, independence, vocational choices, and so on, make their appearance and become prominent. After all, rapid physical growth, endocrinological and other physiological changes, altered social demands and pressures, and other radical changes are as characteristic of adolescents with self disorders as they are of normal adolescents.
I recently treated a very disturbed young man who reacted with thinly disguised castration anxiety whenever he engaged in behavior which could be seen as adult and as supplanting father (e.g., at mother's request, carrying out a chore at home which father typically did, but which the patient could now do) and reacted with a sense of entrapment whenever his girlfriend's behavior could be construed as a demand that he make a long-term commitment to her. Now, despite his severe pathology and developmental arrests, these above reactions are not unlike patterns one commonly sees in neurotic patients. That is not where the basic differences lie. What is distinctive about my patient is the way he reacted to his ambivalence toward and conflicts surrounding his relationship with his girlfriend, which included dissociation and feelings of depersonalization (i.e., chronic "fuzziness" and inability to remember and report), obsessive homosexual thoughts and fears, and a recurrent dream in which he is being "smothered" and is "slipping into black nothingness." The dream, in particular, reflects the saturation of Oedipal conflicts with primitive, pre-Oedipal fears and fantasies.
I also recall a hospitalized, actively schizophrenic patient I treated suddenly announcing in a group therapy session that he would volunteer for castration surgery if that was necessary to cure his illness. He then went on to make clear his belief that his incestuous wishes were the source and cause of his "craziness," that he experienced his craziness as a castration anyway, and that if he went directly to the heart of the matter by getting castrated he might get better and recover. Now, a good deal of this material is obviously Oedipal in nature. The patient is not unique in this regard. What is striking, of course, is the blatant conscious and untamed appearance of incestuous wishes and the direct, undisguised link between such wishes and actual (not displaced or symbolic) castration expectations.
To return to the basic point, whether or not clinical accounts or pathology in terms of "structural defect" are correct, such a point of view is not incompatible with dynamic considerations. Recent emphasis on developmental arrests, self-defects, borderline conditions, and so on have highlighted certain considerations and certain dimensions of personality and of psychopathology which have tended to be ignored in traditional theory. Thus we are much more likely now to be aware of the overriding importance of separation-individuation and "narcissistic" dimensions, including differentiation between self and other, degree of self-integrity and self-cohesiveness, ability to relate to the other as a separate other, and regulation of self-esteem. And this, I believe, is a real contribution. However, these dimensions are likely to be important for all people, in varying degrees and in different ways. There are likely to be, for example, different forms of separation-individuation challenges at different periods in one's life. In short, it is not the case that one group of people is governed by a psychology of aims, impulses, and inner conflict, while another group is governed by a psychology of self and the pursuit of self-cohesiveness [Footnote 3]. As I have argued, such pursuit cannot be divorced from issuesof gratification of basic instinctual drives and needs, and for all people the integrity of self-organization is a superordinate aim and is pursued at different levels.
Footnote 3: Mitchell (1979) argues that this division of areas of applicability represents, at least in part, an attempt of escaping the accusation of heresy within the psychoanalytic community through the "strategy consisting in keeping the metapsychological frame of reference of drive theory, while creating orthodox concepts at the diagnostic level"(p. 182). This kind of "psychodynamic ecumenism" is declared through "strategies of complementarity, in Kohut, the attempt of hierarchically integrating the various concepts, in Kernberg, and the designation, by both, of a new form of psychopathology to which now it possible to apply "the formally heretical theoretical lines (p. 188). [In the original edition this footnote is numbered 57]
Further, whatever defects one has, whether constitutionally given or the result of early traumas, what further weakens the personality is the existence of excessively intense and pervasive conflicts and other incompatibilities which, through their failure to be resolved, threaten one's sense of self-coherence and self-integrity. This idea has been central to psychoanalysis from Freud's earliest writings to G.S. Klein's (1976) recent "exploration of essentials." Furthermore, recent apocalyptic claims notwithstanding, unresolved conflicts and incompatibilities and the defenses and anxieties accompanying them are the appropriate material for therapeutic intervention. That is, the resolution and integration of unresolved schisms in the personality is the major therapeutic means through which one strengthens the self and ameliorates so-called self-defects.
There is no need for a dichotomy, certainly not a radical one, between a psychology of developmental arrests and one of dynamic or structural conflict. Rather, at each developmental stage one is challenged by the need to resolve and integrate various kinds of incompatibilities, including the incompatibilities among adaptational modes appropriate to different stages. How well one faces these tasks as well as how successfully one integrates one's various needs and aims both reflects and determines the subsequent quality and integrity of one's self-organization. Of course, one's success in resolving incompatibilities reflects one's integrative capacity which, in turn, is undoubtedly influenced by, as noted earlier, constitutional predispositions and early experiences. But it is unlikely that a particular set of early experiences - whether consisting of failures of empathic experiences or opportunities for idealization - would have a determinative and decisive influence on something as complex as integrative capacity.
In any case, issues of conflict, self-organization, and ego functions, including integrative capacity, are all inextricably linked.
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