EMOTIONAL DISTURBANCE AND SCHIZOPHRENI,A 75 5. Some Forms of Emotional Disturbance and l\4ost of the psychoanalyticobservationg dga! their Relationship to Schizophrenia in !h-is-pgpel ryi!.b9_ol- -9fr1 SL"ifilir I cJQse_{e_!ati ons !Q_ io d9-9erJonSti zati q n bu! Cineiipe from it in that they were not perceivedas disturb4pces!y-!h-g p-ati_E!! ih sl gc]1t1ype pelsoqliiiy gi,ven_tfr-e_.0ame., jas Helene Deutsch I1lXl! :9 ii ef 1 1i3"q if- I must emphasizethat this namehas nothingto do with Vaihinger's 'fictions' 'As-If.' system of and the philosophyof My oDly Le_a-s*on-lbr Sjgg Jg-u4orieinala label for the type of person I wish to present is that every attempt to understandthe way of feelingand mannerof life Psychoanalyticobservations of a few types of emotionaldisturbances of this type forces on the observerthe inescapableimpression that the are presentedin this paper,and a seriesof casesreported in which the individual's whole relationshipto life has somethingabout it which is emotionalrelationship to the outsideworld and to his own individual's -- - . J.. -_-.-. t'ilg i u *' q grg- g' a!--Ltl--i! ___._._. .lgg l-g:l il" I 9-l-g-t!ryqlqv- ry-l t clql .w-ere tlpglglr.s he d or abs e n t . Su c h di st urb ance s of t he emo t i on al gglqde]!s).Even the layman sooner or later inquires, after meeting 9g9.-1p.p_9-Ts- 'as lifelake v ari o u s foim a: F or ex ampl e, lle_Ig_qe_lUgll q! vggq!.q w h-oare such an if' patient: what is wrong with him, or her? Outwardly the not aware of their lu"_L,[ngqglg$-9g1iyg-@lds and responses,but g:rs,o'r.tlg1f normal. There is nothingto suggestany kind of disorder, whoseemotional disturbance is perceivedeither only by thosearound l behavior is not unusual, intellectualabilities appear unimpaired, them or is first detected in analytic treatment: andjhglg-arq llto_lglyho .l emotional expressionsare well ordered and appropfuLlg.p-_q_t-d,e_spite all co*gle.it_qf !t1-9llS119!isna!_de!e-ql4{'d_et_e_!99!y-91$Ie!!9dbythe I @g-"tlg intan_gibleand indefinableobtrydes dq1*"_"" it person -disturbance 'What in their inner experiences.3n_o,ltgthe latter, the ,{i$glb- .l and his fellows and invariablygives rise to the question, is and fleeting; it may recur.from tigts-.1!si!$ebut yribrtg?' @ only_tr-rconnection with ins_!t!gg!g!s and experiences;or A clever and experiencedman, a patientof mine, met anotherof my 'as it may persistand_Qry-r_a-c_o-n!i-nq_o-!ls,_dislfeASitrg sylqplgp. In addition, patients,a girl of the if type, at a socialgathering. He spentpart of the emotionaldisturbance may be perceivedas existingin the person- his next analytic hour telling me how stimulating,amusing, attractive, 'But ality or it may be projectedonto the outsideworld. In the one casethe and interestingshe was, but endedhis eulogywith, somethingis patient says,'Ig1: halged. I fej! noth lIJg,Evp rythtng __sg9rr_rq UqIgel_I-. wrong with her.' He could not explain what he meant. me.' In the ot-EdTilompfains tEat the world seemsstrange,, q-biectS When I submittedthe paintingsof the samegirl to an authority for -i+------:- ttr{..lyt_!g14 qe_ing_selq ey:ry: tg{"q{1$.s4re-gl. rhose forms his criticismand evaluation, I wastold that the drawingsshowed much of the disturbancein which the individual himself is consciousof his skill and talent but there was also somethingdisturbing in them which 'lgpeJlg!4lization.' defect and complainsof it belongto the picture of this man attributedto an inner restraint,an inhibition which he thought This disturbancehas been describedby many authors. In the analytic could surely be removed. Towards the end of the patient's not too literaturethe readeris especiallyreferred to the studiesof Oberndorf,' successfulanalysis, she enteredthis critic's schoolfor further instruc- Schilder,2and Berglerand Eidelberg.l tion in paintingand, after a time, I receiveda report in which her teacher spokein glowingterms of her talent.Several months later I receiveda 'Oberndorf, C. P .: Depersonalization in Relation to Erotizatbn qf Tfunght. I nt. J . l'sa. , lessenthusiastic report. Yes, the girl wastalented, her teacherhad been Int. J. Psa., XVl. 1935, pp. XV, 1934, pp.27l-295; Genesisof Feeling of Unreality. impressedby the speedwith which shehad adoptedhis techniqueand 296-306 '?Schilder,P.: Treatment of Deperxtnalizarion.Bull, N. Y. Acad. Mcd., XV' 19.19. mannerof artisticperception, but, he had frankly to admit,there was pp.258-272. an intangiblesomething about her which he had neverbefore encoun- rBergler, dtr l)cpt'rxtnuli:ttiln.lnl. Ztschr' 'What 8., and Eidelberg, L.'. Der Mechnrtismtrs tered,and he ended with the usualquestion, iswrong?' He added f. Psa., XXI, 1935,pp.2-stl-28-5. (hat the girl had gone to anotherteacher, who useda quite.different 76 1930s AND 194Os EMOTIONALDISTURBANCEAND SCHIZOPHRENIA 77 teachingapproach, and that she had orientedherselfto the new theory thinking and feeling, i-9 e5pre-ssionof this pasg!_ve gd and techniquewith striking easeand speed. !!r-e n!a_s-!4i1y the personcap-able of the greatestfidelity and thg basestperfi_dy. The first impressionthese people make is of complete normality. .renders Al1]qhiec_t .W!Ido -as__?._hgge_for_identifqatio.n. At first the love, They are intellectuallyintact, gifted, and bring great understandingto 'as friendship, and attachmentof an if person have somethingvery intellectual and emotional problems; but when they pursue their not rewardingfor the partner. If it is a woman, she seemsto be the quin- infrequent impulsesto g9ltiy,._lygtk they construct, in form, a good tessenceof feminine devotion, an impressionwhich is particularlyim- piece of work but it is always a spasmodic,if ski!lgd-19ge1it-1q1-qfa partedby her passivityand readinessfor identification.Soon, however, prototype without the slightesttrace of originality. On closerobserva- the lack of real warmth brings such an emptinessand dullnessto the fion, me sameth-ing ii-seen-in ttreiiaffeAite-relationships to the envi- emotional atmospherethat the man as a rule precipitouslybreaks off ronment. These relationshipsare usually intenseand bear all the ear- the relationship.In spite of the adhesivenesswhich the 'as if person marks of friendlhD, lq5, sygp3ghy,and undeJst?nding;but even the brings to every relationship, he displays layman soon perceivessomething strange and raisesthe question he @ed 'as either a rush of affectivereactions which are if and thus spurious, cannotanswer. To the analystrt is soglsfggllbat all theserelationships or a frank absenceof Lvitv.At theverv first are devoid of any trace of warmth, that all the expressionsof emotion - are forrnal, tliat alTinner experienceis completelyexcluded. It is like the performanceof an actor who is technically well trained but who evident in the emotionallife appearalso in the moral structure.Com- lacks the necessaryspark to make his impersonationstrue to life. pletely without character, wholly unp.in"ipG[E-iiETii66-meaning Thus the essentialcharacteristic of the person I wish to describeis 'as of the term, the morals of the if individuals, their ideals, their that outwardly he conducts his life as if he possesseda completeand convictions are simply good g. bjg. sensitiveemotional capacity. To him thereis no differencebetween his lgec!,ol1g|.-1"qtlg_f95g!, Attaching themselveswith great easeto social, ethical, and religious empty forms andwhat othersactually experience. Without goingdeeper groups, they seek, by adheringto a group, to give content and reality into the matter I wish at this point to state that this condition is not to their inner emptiiffiTn?-esirblisfrEi validity of t heir ex isrenCe-Ey identical with the cold19,9s,9f i9pr9s-9q$inCivid-qll i-4-6m-Grejs , @. GTerfitnisiastii idhe.enc" ro one philosophy can 6e @![?l'_*lttgtryiil,itfeoem-oq1o-1r,ql-!iiet'iE-denbe-t-ria-da-ry111,the quickly and completelyreplaced by anothercontradictory one without loss of affect being either manifestor cloaked by overcompensations. the slightesttrace of inward transformation-simply as a resultof some In the one there is flight from reality or a defenseagainst the realization accidentalregrouping ofthe circleofacquaintances ofthe like. of forbiddeninstinctual drivesfi-the other,a seekingof externalreality A second characteristic of such patients is tlgltlgggSltllig, quite in an effort to avoid an anxietfiaden fantasifuplganalysis disclosesl . understandablefrom what hasalready been said. Like the capacityfor that in the 'as if individual it is no longer afifict of represgign-butareal F identification,this suggestibility,too, is unlike that of the hysteric for 6.. orbu.iec-iiit-[er!!. lis. rheThe apbiieiltvapparently nnormal relationshipto the world v \ -.:- '* .., -,.^ whom objectcathexis is a necessarycondition; in the 'as if individual t imitativenessand is theexpressiol of !$Sigt!L =t--,-...!--=.----.r.€eg9.notr,q.Jg"*U!9 the suggestibility be zscribed to passivity and auto:Ir-aton-like catroncatlon wlthwrth tnethe envrronment,e a mimicrywhich resultsin.an ostens-ib-ly trust . .:-

in Europe, had been brought up in an unusual further from the heroesof im3g,nation.In this mannerthere was oldest gg[!g fqgllies ----.._ trer atmosphere.With the excuseof official duties,and quite in accordance formed in the chitd a parentalmyth, a fantasmicshadow of an oedipr4s with tradition, tlrlgi3re_ntq delegltgd-lh-e- gel-e_.gtd lgiqin_g.of !!1qir.gtti-ld situation which r"tiiliiEd"1n_9;n_U-i-._Us9 far as real persons and to:trang_ers On :ggLaiq..1g,gf&g*dqlt of the week she was brought emotionswere concerned.Not only did reatitywhich deniedher parent befoje-h9r lpre Lt 9_fSl_'a-o-n!tol'. At these meetings th ere was-a fo4q,al ffi-tioiitrips l6adto narcissisticregression into fantasy,but this process check of her educationalachievenqgnts, and the new programand other gained further impetus from the absenceof any substitutiveobject- @ry iil given h9r precep-{ors.Then g&qt u cool, ceremo-nio3s libidinousrelationships. The frequentchange of nursesand governesses difiG"l, ihe child was returned to- her .quarG.t. Stre receiveOl-o and the fact that these personswere themselvessubjected to strict frffith and no ttnderniss tror tre. purents,-nordid punishmentcome discipline,acted on orders,and usedall availablemeasures to makethe Ai.""tty from them. This virtual lW"*t!ggf..rnlef-p"rents had co-r-r1e child conform to the demandsof reality, measuresin which a pseudo ;eg1 after lgr bg1h. Perhapsthe most inauspiciouscomponent of her tendernesswas consciouslyused as a meansto attain didactic ends, parents' conduct, which grantedthe child only a very niggardlybit of precludedthis possibility. The child was trained very early to cleanli- warmth, was the fact-and this was reinforcedby the whole program nessand strict table manners,and the yi-otgn!og-lbJeakq-gf anger and of her education-that their sheerexistlnc.g.BS str_ongly _empha_si? 9, rage to which she was subject in early childhood were successfully an d the pat i en t was d ri [effi-iiGlfi olgt.g@ egi"lgS to yv-qrdglh gIr Urougiitunder c

hTfiissistic gain. Every-' meeting with tlre real parents-sep4ratedthem sion for the satisfactionof a drive, she could respondquite without *. .. :-. -? *---'-:.-.. \.' ktL \r'/t't/ L/ tt(l lll:|Os ANI) l94Os EMOTIONALDISTURBANCEAND SCHIZOPHRENIA 81

ghililglt, !nggg!'_yill,_!itt!9qplilcalign. The only result of the training ship to the parentsor to anyoneelse. Whetherafter weak attemptsat was that the drive never cameinto conflict with the externalworld. In object cathexisthe child lglglned to larcfgqismby a processof regres- this respect she behavedlike a child in that stageof developmentin sion or never succeededin establishinga real object relation as the which its instinctual drives are curbed only by immediate external result ofbeing unloved is, for all practicalpurposes, irrelevant. authority. Thus it happenedthat for a time the patient fell into bad The same dglciency which interfered with the developmentof the ggngly, in unbelievablecontrast.l5-hei home environmeniinO eiriy emotionallife was also operativein the formationof the superego.The training. Shegot drunk in low dives, participatedin all kinds of sexual -shadowysjructure of ttre oeAi . perversions,andTffijust as'Cimiord6ieG fhis underwortAas'in ttte wiTFoutever having come to an inttgTafEtl-an

Analysis of this patient revealeda genuineinfantilism, that is, an betrayedunmistakabl" .-srl q[ u pry"ttgllswhich culminated in a ca- arrest at a definite stagein the developmentof the emotionallife and tatonicexcitement. The sister imitated all her brother's bizarre activities characterformation. In addition to particularly unfavorableenviron- and lived with him inTwo?ldbt fantasy.-Oniytt..furiiut ouj".t- mental influencesit should be noted that the patientcame from a very riuiciiriouicittreiii andioi.piu"".ni o old family overrun with psychoticsand invalid psychopaths. condition as the result Another woman patient had a father who had a mentalillness and a of an identificationwith her psychoticbrother; only later did I recognize 'a mother who was neurotic. She rememberedher father only as man that the etiology of her condition lay deeper. with a black beard', and she tried to explain as somethingvery fasci- I believe this patient is similar to the first despitethe differencesin nating and wonderful, his absencesas he was moved to and from a their development.In the second,i! _g9e-as_!h4ta d!_sappaiu-t_ment _shat- sanatariumand an isolatedroom at home, always under nursingcare. J9,ry9_ttr-q*qt_{9_!{,relationshipwith the mgthel that the my_s-tq!_igusab- Thus she br{t him in py a i;nce of tfretiGtir made il _ilnpossiblefol Lqg--!itt!e-girl tg-[g{-ip-furir a "gy!L?rou4$.!91fullq.-re_pfacing fa1!-qs-y _qqyq!-e-IiQgq-man,whom she later called and with whom she iu'fitif[te *Iien hei ietaiionship to he1 ag1!._erw-qs.sh-p,fqn, and that had all sortsof experiences,each of which servedto makeher a s_uper- fuittr-ef rcmmii6hips to objects remained at the stage of identification. l-qqlqn._9qing.The prototypefor the Indian wasthe fatner's-ile nu.s", By such identificationshe averted her intensehatred ofher brotherand whom the little girl saw mysteriously disappearinginto her father's transformedher aggressiontowards him into an obedientpassivity in which she submissivelyidentified herselfwith hm. She developedno- room. The education and 994$LnC of the child were-lelegate$1o other object relationships.Her superegosuffered the samefate as that ltlrses, but despitethis she succeededin establishinga strong-ly,libidi- ll of the first patient.The myth of the fatherandthe very early devaluation nous attachmentto tne v€ifaUni;mat mother. Her tateiiiiiiiionrhipt f / fifrGlements of objectlibidinous attitudes, sometimeswarmer, €spe- of the mother preventedintegration of her superegoand left her de- l' cially in homosexualdirections, but never sufficientlyto changetheir pendenton personsin the externalworld. 'as if quality. in this patient, the of her brother whom she A third patient, a pretty, temperamentalwoman of thirty-five with 1i developedan unusuall i many intellectualand artistic talents,came to analysisbecause she was . tire.$'af!,e1g-lon-g geries of adventurli. it soon becameclear that, as the result of a certain combination of circumstances,her interest in ychonanalysis model parts.oJttet body in c-layin order to facilitateher mirror studies. ps was actually U*lnt.elggl il- -llfglulfrt, especiallyin Iil-tfi"iour.eof veiJstreotiverbfeo si;G[iiii; moaetingino *u.io, her profession.While shefrequentlyi;q9k9 of her tremendousinterest a brief time under the tutelageof a sculptress.Unconsciously, it was in child psychology and in F19ud's i,!e9ry-and iebd- iiiTdlv"ofr-ihGe the fantasyof displayingrepeatedly her body to the world. [n later years subjects,her understa{lnS.9f lnem lvqsexlrqordinalily jgpgrficial and shecreated only large,very voluptuous,matronly female figures. These her interestentirijli uniEal.More carefulobservation aisltJsiOitrit ttris proved to be weak attempts to recreate the mother she had lost in vas true not only for all her intellectualinterests but for everythingshe childhood to her brother. UltimiffiiTfrE aUairOtji?il5dIptilre 6ffi-udi-c tlid or had evei d-one.Ii-*as surpii.slngto recognizein this woman,who ffibty because she believed her teacher failed to appreciate her wirs so indefatigablyactive, a condition so closelyrelated to the pseu- 'as sufficiently. doaffectivityof the if patient.All her experiencestoo werebased on identifications. were Most conspicuous in her childhood was a lnoqbg:li5g_ilq,ilgtiqn of thoughher identi-fications notso straigniforwaiO *lglblgltrer with whom she was for years co.qplglg[idellified, not in aswere those bf the othertype of patientwhich is, onemight say, more fantasybut by actingout. Disastrouslyfor both, the brother quite early nr()n()Elirmollsand adheresto but one personor one group at a time, It4 llrllos ANI) 194(ls EMOTIONAL DISTURBAAICE AND SCHIZOPHRENIA 85 while t[is pjrti"_nltteg so many concurreq!*(9q[ficatiors-or symbolic stinctsfree rein and holdingthem in check. Shes:!9d out prostitution representationsof identifications-that her conduct appearederratic. indulgedin a,variety of sexualp-e-fv,qnions, often giving the Shewas, in fact, considered'crazy'Uiitrose wfroffiiltrer. fier triends -t!j3:i"., o{ emerged.frorythele debauchesby iden- however had no notion that her appqrentlyricLlife conge.alg$a. s-evere if"it",llig lvqgqa-nia.!-he t$gatiatr ]Y!!!r-s9m: conventionalperso-n and achievedbv this meansa lack of affect. She had come to me becauseof wish to ctrangqher ? frnd of sublimaiion,the Torm depenfint on the particularobject. This ffi;"t";-that is, to create more peace and haim6ny in riei life by resultedin a frequent shifting of her occupationand interests.So loqs iO6nlirving herself with a' pjrtlglgly,.Lo! td_p{ol$golal per99n{jg,. as it was possiblefor her either to retain sucha relationshipor to allow After six months the analysisappeared to be unusually succe-ssful. -herself the [ietincation"of very primitive drives she was not aware of The patient learned to uililerstarrd many things about hers-elfand lost -heitackofdffect. - her eccentricities.She determinedto becomean analvstand when this was deniedher, she'c6llapl"A,!!"fy"s Jompletelytact

('orrrrtrott proccss father, bore his name,:rnd hclrd his rcscrrrhlllr'rcct() hirrr rcpcir(ctlly lo irll lltcsccitscs is ;r tlccp tlislttt'birncctll'thc ol'. ttl synthesizethe various stressedby his mother. Through rigidity and strictness,in clhical antl srrhlinrlrliolrwhich lcsults both in :r lirilure \ irrllrrrtilc inlo a single,integrated personality, and in an intellectual demands, he strove to become better than the sclf which idcntilications \ the instinctual was identified with the father. In contrast to the previous patients, he irrrpcr'ltct.onc-sided, purely intellectualsublimation of J strivings. While critical judgment and the intellectual powers may be- 9ig_lqt !4elq[y lFself ryitlrt !_ele9_gl-objesl1'- Ilqt"3a- of having emotionalrelationships to people, crccllcnt, the emotional and moral part of the personality is lacking. he wassplit intolwo identificitions: 'l 5n-"*id iriru"r,ove?moiheiana ttreoitref *iih trtsri;h;;. iG nr.r*u, hc etiolosv of suchconditions is relatedfirst. to-_ a devaluationof fggry!-"*etdsex_ualiZJcl$resqeoqg1v-11"lllgfg_i;_$g.vle'_C,-""i thc ob.jcctserving as a modelfor the devElopmentof the child's per- narcisgistic. sonality.This devaluationmay havea firm foundationin realityor be Unlike the 'as if patients, trirccable,for example,to shock at discoveryof parentalcoitus at a !:_:_rrybt999l_leg|< ptfeeling. He pcriod when the child is engagedin its last struggles co m pI e te I y I ac!g_{t_tl"--€gqgl gg_gl_{g-.$ wh i c h w o uld hav e gi v en w armth of development to his emotionallife. He had no relation to a_nJwoman, and his friend- irgrrinstmasturbation and needssupport in its efforts towards sublima- ships tion. Or, as in the caseof the boy describedabove, the successful wil[ e_eJL-\-v*q-{_e__qlQ9l_puretv_iljilidi,yt,f:'sqgly*s,ex_ual. rhe feelingshe had were of a characterhe woulf,nbJTet himself express. suhlimationmay be interferedwith by a sexualizationof the relationship Thesewere very primitiveaggressions, the wildest,most infantile sex- to an object who shouldserve the child as a model for its ego ideal, in .I ual drives, which were rejectedwith the declaration, feel nothingat thisinstance,agrosslysexualidentificatioffi all'. In oneway he told the truth; he wasreally lackingin any permissible Another cause of this kind of emotionaldisturbance is insufficient feelings,that is, in the tender, sublimatedemotions. stimulusfor the sublimationof the emotions,as the resulteither of being The tendency to identificationis characteristicalso of this type of giventoo little tenderness,or too much. affectivedisturbance. Even thoughthis patientdid not completelysink Infantileanxiety may suffera similarfate. Too harshor too indulgent his personalityin a seriesof identifications,the strongestsection of his treatment may contribute to failure in the economicformation of de- ego, his intellect, lacked originality. Everything he wrote and said in l'cnsemechanisms resulting in remarkablepassivity of the ego. It will scientificmatters showedgreat formal talent but when he tried to pro- be recalledthat in the caseofthe boy reported,an attackofanxiety not duce somethingoriginal it usuallyturned out to be a repetitionof ideas only mobilizedthe transferencebut alsoopened the way to his recovery. which he had once graspedwith particular clarity. TltSlqqgelqf to 'as question how the tendencyof if person- g,qllrple_1dg!!93!l_9$qc_c-Uqgdontheintellectuallevel.- The must be raisedas to e./- fi;th;r puti;a ;fthi. i ihirt)"y;;tdffi;ied woman who aliliEfio identificationwith current love objectsdiffers from the same , e.oup, camefrom a family in which there were many psychotics, tendencyin hysteria.The greatdifference between the latter and.the complained 'as about lack_ofemotion. In spite of good intelligenceand peffifity if distiirtiairCetiEi-in ttre fact that the objectswith which the [ys- te3fng, she led a sham existenceand she was alwaysjust what was tericSicldntify themsblvesare the objectsof powerful libidinousc4th- suggestedto her by the environment.It becameclear that she could "'"::j_v.t"I"il_ry!::,',9"."13[gstllu'{rrr4glll.Igglglru-d experiencenothing except a completelypassive readiness to split into so ieprestnts a way out of the conflict. Ig_lq!_!f -pa!ieilts,-3lr---e-grly an endlessnumber of identifications.This condition had set in acutely ile nCitnC-iTn-fneOevef ,opme nt of .ffe6l."du"" t the i n4e1-c,o nfl ict, the after an operation in her childhood for which she given effe?-6T-ilEi-cli r3*tn *poveiilf-ment of th; ffi d;""Iity which had been no "l psychologicalpreparation. on recoveryfrom the anaesthesiashe asked which doesnot occurin hysteria. if she were really herself, and then developeda state of depersonalil The patients describedhere might make one suspectthat we are zationwhich lasteda yearand turnedinto passivesuggestibility which dealing with somethinglike the blocking of affect seen especiallyin concealeda crippling anxiety. narcissistic individuals who have developedloss of feeling through Itlt l1):]OsANI) l940s EMOTIONALDISTURBANCEAND SC]HIZOPHRENIA 89

repression. relationto them. Conflictwith the superegois thusavoided because in if' personalitytries to simulateaffective exnerience, whereas the indi- tasiF - .*rt *-*-t*triilervery act thE egosuborOinates itsetf itrrougtt vidual with a blocking of affect doesnot. In the analysisof the latter it ' -'i-Y----- I- ---1';of identifica.tton.tothe wtshe!_lnqcgmq1anol - aniuttroritvwhich'has-- . can always be shown that the once developedobject relationshipsand nei"ei Ueenintrojected. aggressivefeelings have undergonerepression and are not at the dis- --Fi6m t"fi; U"ginning,both the personalimpression given by the pa- posal of the consciouspersonality. The repressed,affectively toned tientsthemselves and the psychoticdisposition in thefamily, especially segmentof the personalityis graduallyuncovered during the analysis, in the first two analytilaf pect a schiz- and it is sometimespossible to make the buried part of the emotional ophrenicprocess. The tracing ofthe severepsychic disturbance directly life availableto the ego. back to the developmentsof early childhoodseems to me completely For example,one patient had completelyrepressed the memory of justified, and whether this speaksagainst the diagnosisof a schizo- his motherwho died when he wasfour, and with whom, it was clear, phrenicprocess must, for the time being,be left undecided'Mf--o-b-qgr- the greaterpart of his emotionshad beeninvolved. Under the influence vations of schizophrenicpatients have g-iven-4g-th!rill-P-I9-s-s!9-4. !-114!-the of a very weak but none the lesseffective , isolated mem- q q.p sc hi z

5Freud:The Ego and the ld. London: Institute of Psycho-Analysis and Hogarth Press, 1927. 6Freud, A.: The Ego and the Mechunismsof Defence. London: Hogarth Press, 1917.

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Library of CongressCataloging-in-Publication Data Main entry undertitle: Essentialpapers on borderlinedisorders. (Essentialpapers in ) Bibliography:p. Includesindex. l. Borderlinepersonality disorder-Addresses, essays,lectures. L Stone,Michael H., 1933- II. Series. RC569.5.867E87r985 616.89 85-l-s184 ISBN 0-8147-7849-6 ISBN 0-8147-7850-X (pbk.)

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Book designby Ken Venezio pro98l6sc Viii C()N'I.ENTS Acknowledgments 14. BorderlinePersonality Organization, Otto Kernberg 279 15. The GrinkerStudy, RoyGrinker, Sr., B. Werble, and R. C. Drye 320 16. The Typesand Prevalenceof Mentallllness in the We wish to gratefully acknowledgeAlienist and Neurologrsrfor C. H. Biologicaland AdoptiveFamilies of Adopted Hughes,"Moral (Affective)Insanity-Psychosensory Insanity," Vol. Schizophrenics,Seymour S. Kety,et al. 357 5. pp. 296-315, 1884. 17. The Basic Fault, MichaelBalint 385 We wish to gratefully acknowledgeJournal of Nervous and Mental Diseasefor Irving C. Rosse,"Clinical Evidencesof BorderlandInsan- Part tV. 1970sand 1980s 4ll ity," Vol. 17,pp.669-683,1890. 18. A Studyof the Separation-lndividuationProcess, We gratefully wish to acknowledgeThe PsychoanalyticQuarterly for MargaretS- Mahler 433 permissionto reprint Adolph Stern, "PsychoanalyticInvestigation of and Therapy in the Border Line Group of Neuroses," Vol. 7, pp. 467- 19. DefiningBorderline Patients: An Overview, 489, 1938;and HeleneDeutsch, "Some Formsof EmotionalDisturb- 453 John G. Gunderxtn and Murguret T. Singer anceand their Relationshipto Schizophrenia,"Vol. 11,pp. 301-321, 20. The BorderlineSyndrome: Evolution of the Term, Genetic 1942. 475 Aspects,and Prognosis,Michael H' Stone We gratefully wish to acknowledgeAmerican Journal of Psychotherapy 21. The Countertransferencewith the BorderlinePatient, for permission to reprint the following; Melitta Schmideberg,"The Harold F. Searles 498 Treatmentof Psychopathsand Borderline Patients," Vol. l, pp.45-70, 1947;and Michael H. Stone,"The BorderlineSyndrome: Evolution of Personalityand 22. Crossingthe Border Into Borderline theTerm, GeneticAspects and Prognosis," Vol. 31,pp. 345-365,1977. BorderlineSchizophrenia: The Developmentof Criteria, Robert L. Spitzer,Jean Endicott, and Miriam Gibbon 527 We gratefully wish to acknowledgeHuman SciencesPress for permis- sion to reprint the following from PsychiatricQuarterly: Paul Hoch and of a Noun, 23. Borderline:An AdjectiveIn Search Phillip Polatin, "PseudoneuroticForms of Schizophrenia,"Vol. 23, 549 Hagop S. Akiskal,et al. pp. 248-276; and John Frosch, "The Psychotic Character: Clinical References 569 PsychiatricConsiderations," Vol. 38, pp. l-16,1964. NameIndex 571 We gratefully wish to acknowledgeThe Menninger Foundation for permissionto reprint from the Bulletinof the MenningerClinic, Robert SubjectIndex s73 P. Knight, "Borderline Statesin PsychoanalyticPsychiatry and Psy- chology,"Vof . 17,pp. l-12,1953. V/egratefully wish to acknowledgeInternational Universities Press for permissionto reprint the following: ,ON THE PSY- C'HOANALYTIC THEORY OF CYCLOTHYMIC DEPRESSION, pp. 228-241,l97l; and Edith Jacobson,THE SELF AND THE OB- .ll:CT WORLD. pp. 49-69,1964. We gratefullywish to acknowledgeInternational Universities Press for pcrnrissiontcl reprint from the Journal of the AmericanPsychoanalytic A.tsttcitttirnthe following:I-eo Stone, "The WideningScope of Indi-