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MATERNAL INTROJECTION - AND EGO DEFECT
MATERNAL INTROJECTION I:~ AND EGO DEFECT
Peter L. Giooacchini, M.D. Psychoanalytic theory has in recent years focused upon ego operations. This is due not only to the natural continuum that began with an exploration of the id, but also because many of the cases that are being seen by psychoanalysts today require an intensive scrutiny of characterological factors and early object relations. The so-called character disorders, an enigmatic group of patients, have revealed to us many facets of ego structure which in turn have to be expressed in an acceptable and consistent conceptual framework. Freud was, of course, mindful of the problems that we study today in ego psychology and touched upon many of them in various metapsychological papers which culminated in the formulation of the structural hypothesis (1923). Klein (1932) and Jacobson (1954), although they disagree on many fundamental points, both dealt with the early stages of psychic development. Jacobson's formulations about self and object representations have been significant contributions about ego subsystems and an expansion of Hartmann's (1939) pioneer work on ego psychology. The literature has become quite extensive and need not be reviewed here. Experience with analytic patients has taught us about the necessity of understanding ego operations, and the subject has been approached from many different viewpoints. The unfolding of the transference neurosis and its special qualities have become the psychoanalyst's most valuable research tool. In this paper I shall present clinical
Presented to the Chicago Psychoanalytic Society on February 26, 1964. Dr. Giovacchini is Clinical Professor of Psychiatry, University of Illinois College of Medicine, Chicago, and Clinical Associate, Chicago Institute for Psychoanalaysis.
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data, in an abbreviated form, of course. These, I feel, enable us to make cer tain gen etic re constructions which have a bearing on ego development and its psychological di stortions. Here I would like to investigate certain aspe cts of ego structuralization whi ch are associated with the self concept and the mothering function. The case to be presented has many characteristics that are described by Gitelson (1958) wh en he discusses the character disorders. The patient's disturbance and con fusion concerning her role as a moth er also reminds us of Erikson 's (1959) concepts about disorders of ad olescence and what he call ed the identity diffusion syndrome. I
The patient, a woman in her middle thirties who had been married twice, sought analysis because of intense and general feelings of inadequacy as well as an inability to becom e pregnant. Her gynecologist felt that psychol ogical factors must have a bearing on her ster ility sin ce the exa m ina tions of her and her husband failed to reveal any organic factors that might account for her sterility. She reported feeling inferior all of her life ; on several occasions in the past she had re cei ved psychotherap y. It was at the in sistence of her second husband , to whom she had been married only a few months, that she sought anal ysis and decided to see it through. She acknowledged th at intellectually she was capable and , although she had made only average grades in college, she had done so with a minimum of effort. She did not worry about her ap pearance and, in fact, was a fairly attra ctive woman. Her ability to relate to others did not lack char m and she found herself fluent a nd able to make a good impression at social gatherings, Although she was both attractive and sociable, she suffered from the su bjective sen sation of being inferior, clumsy, and ga uc he. She lamented the fact that although of superior intellect she had ne ver accom plished an ything constructive. Social relationships, although satisfa ctory, were transitory and superficial in nature without leading to an y de ep , warm, satisfying emotional bonds. In this regard she felt she was pla ying a rol e, on e she had learned by rote memory and did not reall y feel th e part. Giving a dinner party was "sheer torture" because she felt that she would make a fool of herself by revealing
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her inability to handle what should be a routine task. By this she meant that she was quite literally unable to think of what to serve, how to cook it, how to set the table, and all the other varied details that go along with planning such a social occasion. She had held half a dozen jobs since leaving college and she believed she was fired from all of them because of her incompetence. Though she made good grades in college she did not graduate. There were many reasons for her leaving college when she did but the patient believed that even here it was representative of her general inability to function in any area. Yet, what she spoke or did not have a histrionic melodramatic quality and was accompanied with a good deal of tension, anxiety, and depression. She was extremely bitter about what she considered to be her deficiencies. When faced with a situation she felt overtaxed her she would react with helpless impotent anger and disorganization. These feelings were sometimes accompanied by derealization and depersonalization. At these times she reported having "no way of knowing who I am or what I am." She would helplessly cling to various friends; she had one in particular whom she considered to be a "bulwark of strength, to tell me what to do and how to do it." Her father died when she was six years old and she had only a slight recollection of him. As far as she could ascertain, he was a "nonentity who was completely dominated and submerged" by her "all-powerful mother." (This is a description an aunt gave of him.) Her mother died in a state hospital five years before the patient began analysis. Her early impressions of her mother were of a very powerful, competent woman, who successfully manipulated the family business and brought the family much wealth. They lived in a big house which the mother handled with the efficiency of a capable overseer of a feudal estate. The patient vividly recalled her mother giving orders to a variety of subordinates, running things with an iron hand, and subjugating all of those around her. According to the patient, mother's strengths served to emphasize everyone else's weakness. In the course of the analysis, the patient brought up a good deal of material which permitted one to make inferences about the nature of the mothering relationship. Naturally she could not recall the
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details of her own early experience, but she remembered mother's inability to h andl e a four-year-younger sis ter. Since the family was wealth y, there wer e man y domesti cs who to ok over the co m p le te car e of the two ch ild r en . A lt ho ug h the mother wa s extremel y sk illf u l in the hiring of employees to work in th e business an d to handl e her exten sive social activiti es, the patient felt sh e was obtu se when it ca me to th e sel ection of nurses and go vernesses for th e ch ild re n . Sh e vi vidly r ecalled th e ch aos th at followed the birth of h er yo u nger sister. Sh e cons idered her m other, for exa m p le, to be con fuse d and totally inexperienced in handling th e sim p lest activities of ch ild r earing. She had no id ea how to feed th e baby, h ow to select the la yette, clothe h er, cha nge diapers, or m ake slee p ing a rra ngemen ts. Furthermore, she was un able to in st ru ct or even to select so meo ne to carry o u t th ese fun ction s. The xisu-r devel oped severe ulcerative colitis during ad o le sce n ce a n d be cam e both ph ysicall y a n d em otionall y in ca pacitated , Th e pati errt 's self- evaluat ion corresponded to wh at sh e d escr ibed as the sister 's actu al sta te . A fte r fou r years o f an al ysis th e pat ient becam e preg n an t and ga ve birth to a girl. I wou ld like to co ns id er this woman's reactions to the pregn :lIJcy a nd h er feelin gs a n d ex per ienc es in th e earl y postn atal period. I wi sh to em p has ize h er attitudes abou t m othering and their r elation ship to h er self-esteem . Her self representation as a m other naturally included memories o f experi ences with her own m other which will be correlated with h er reactions to her b aby. During pregnancy she made light o f it and did n ot cons id er it an accom p lish me n t in sp ite of havin g tri ed to co n ce ive for se ven yea r s. She began to d epreciate the bearing o f ch ild re n, whereas previously she h ad lauded it. Sh e further d epreci ated the rol e of woman: since the b earing of a chi ld wa s su ch an animal process, it was not n ecessary th at th e woman possess a ny other abiliti es. She felt h erself to be intelligent but co u ld n ot See wh y it was necessary to have intell ectual ca pa b ilit ies simpl y to b reed. A t this point she ca ref u lly av oided any discussions of what abilities one must h ave in order to care for a c h ild su ccessfull y. A fter a fairl y easy delivery o f a d aughter, she be came obsessively interested in child rearing. As I have noted in sev eral other patients who have h ad similar but less disturbed experiences with their own
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mothers, she b ecame intensely preoccupied with raismg her ch ild properly. She avidly read all of th e recommended books on child d evelopment to learn n ot on ly the facts of emo tiona l and physical maturation but also th e proper psychological handl ing which would produce a health y and happy baby. Her preoccupation went far b eyond wha t one would ordinaril y expec t in a lovin g mother, an d th ere was a str ikin g lack of affec t. She seem ed to pursue suc h in form ation as if she were interested in passing som e kind of exam ina tion or in producing a model ch ild th at would win som e con test. It be came appar ent to both th e pa tie n t and m yself th at she had to be a perfect mother to ob ta in an om n ipo te n t perfe ctionism th at would serve som e inner n eed wh ich had littl e to d o with th e welfa re of her dau ghter. In th e an alysis she in cessantl y asked question s abou t h ow to handle a variety of rather ordinary situ ations th at arose in reference to her daughter. It gr ad u ally b ecame clear th at in spite of all her reading and frantic seeking of advice, she sho wed no more skill or ca pacity to take care o f her ch ild or to rel a te to h er th an she remembered her mother having with h er sister. I cou ld obse rve how fatigu ed and depleted th e pat ient felt , bo th emot iona lly and ph ysicall y. She was exhausted because of th e effort and work she put into th e taking care of one child, even th ough her husband was cooper a tive and th ey had a full-tim e m ai d a nd a n urse. From the sta n d po in t of work alone it was ha rd to under stand wh y she was so exha usted. She th en r eveal ed th e fo llo wing id eas: a goo d m oth er sho u ld n ot rel egat e such fu nctions as feeding, clo thi ng , an d bathing to a dom estic as h er own m o ther h ad done. These th en wer e to be her "d u ties." She also had to be able to relate to the b aby which to h er meant being sensitive to th e ch ild's n eed s an d to b e ab le to p lay with her. \ Vhen faced wi th these self-assign ed func tions which she d efined as motherin g she found h er self to be in a sta te of both panic an d con fu sion. Altho ugh she had r ead co nsiderably abo u t all of th ese ar eas, she felt he r self to be an ex trem ely poor stu de n t who was unable to com pr eh en d wh at she tried to lea rn and certa in ly not abl e to apply it. She agreed th at it should b e sim ple en ough for one of her intellect but in th is regard sh e d escribed her self as an " id io t." For exa m p le, her milk su p ply was such th at she was unabl e to breast-feed th e bab y. Consequently, sh e had to prepare formula. She would have to sta rt
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preparing one bottle immediatel y afte r having fed the ch ild be ca use it would tak e her that long to ge t eve ry th ing ready for th e n ext feeding, At first this was difficult to understand, but once she de scribed h ow sh e prepared the bottles it became apparent wh y it was so tim e and energy consuming, It would take her over an hour to wash a b ottle and this whol e process can be be st su m ma r ized by com par ing it with certain ob sessional rituals, such as a hand-washing compulsion , Then all of th e othe r step s ne cessar y for th e preparing of a formula such as th e mixing an d the heating were handled in the sa me time-con suming fashion . She used similar methods while dressin g and bathing the baby. Still it was not just the meticul ous and the obsessional ritualistic aspe cts that made the taking care of the baby such an arduous task. She often ref erred to what she conside re d to be her lack of kn owledge which made it necessary for her to be extra careful. As noted earlier, she fel t that she had not been able to learn anything from the books that she had read or from th e advice that she had rec eiv ed from friencl s. She was referring then to a feeling of inexperience and clumsin ess in handling tasks with whi ch she had no previ ous acquaintance; nor did she hav e any particular aptitudes or skills to ma ster th em . One of her mo st fr equ ent sim iles was that sh e was lik e a stude n t who had ne ver be en in or seen an automobile and yet was learning ab out its operations from a me chanic's manual. She felt that it would be ver y difficult to learn in suc h a vacuum and then suddenl y to be con fro n ted with an autom obile and expected to take care of it as a sk illed technician. Sh e felt her task to be equally insurmountable because of the lack of any previous experience. It s difficul ties were com pou nded by a n eed to h e a perfect mother, plus the feeling th at she cou ld not learn . Later she co mp lain ed she was un able to respond to th e ch ild 's attempts at com m un ica tion . It was in this area that her fru stration reach ed its greatest intensity and led to bitter self-recriminations, agitation, and depression. The fact that she was unable to play with her baby, that is to think of any particular games that the child might enjoy, led to the deepest dej ection . One day after a fri end came in and was able to get her daughter to smile by playing peek-a-boo, the patient went into a state of intens e rage. She attacked her self for not having been able to think of this game herself, but then r eo
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vea led th at she was n ot acq uainted with it, n ever having it played or seen anyo ne else pla y it with a child. Even coo ing or bab y talk was some thi ng she cla imed was en ti rely fore ign to her, but still she was cr itical of herself because she was not ab le spon ta neously to think of and in vent suc h methods of com m u n ica tion and play for her daughter. She worried whether this would lead to severe developmental defects in her ch ild 's cha racter. Other activ ities suc h as wea n ing fro m th e bottle to a glass, to ilet trai n ing, and even how to han dl e the arrival of a sibling di d not cause her any pa r ticu lar concer n. These func tio ns wh ich she consid ered to be "gro ss" in nat ur e cou ld be handl ed mec ha nis tica lly on th e bas is of her r eadings and from th e adv ice she received fro m fri ends. But no one could tell her of th e innumerable un predi ctabl e situa tion s th at arise in the comp lex re lationship between a mother and ch ild. These demanded an intuitive grasp and subtl e r espon ses. She su m mar ized her situation by re peating, "I don't kn ow how to do." In spi te of this patient's severe problem, there was n ever an y indication th at th er e wer e gross di stu r bances of re ality test ing. R ath er, she emphas ized her in ability to do things, her helplessness and vulnerab ility in facing ped estrian tasks. Then she felt comple tely worthless as if her who le ex istence and self-esteem depended upon being able to perform in this area, an interesting con tr ast to her arrogan t att itude about th e bearing of a ch ild ex pressed in th e pren at al per iod .
II
The self-image is a n im po rta n t aspec t of th e ego 's str ucture and d istu rban ces of it have become more fr equently obs erved in recent years. \Vhen a per son feel s di ssa tisfied with his self-im age, he feels in ad equ at e an d often helpl ess and vu ln erable. The concep t of selfesteem em p has izes the compar ison between the self-representation and th e ego ideal, as Freud ( 1~ 1 4) pointed out when he spo ke of self -regard. H e further discu ssed how th e ego ideal, which at that tim e was syno ny mous with hi s broader conc ep t of th e superego, det erm in ed one 's satisfaction with the self. H e introduced th e conc ep t of ego d ep iction a nd d em on strated how it was a ca usal factor in
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producing n egative self-estee m . All of these are extrem ely important concep ts indispensable to the understanding of th e charac ter di sorders. The self-image, to repeat , is a self-observation . It contains an awareness of all of the ego's functions, sen sory, executive, synthetic, defen sive, and otherwise. The op eration s of ego systems vis-a-vis external reality and th e id have definitive chara cter istics, which Rosen (1961) calls "style" and which give th e person his individuality. These qualities in turn are largel y determined b y on e's past experiences, especially those with objects. Satisfactory object relationships cause expansion of adaptive methods of re acting and achieving ma stery consonant with reality testing. What is learned therefor e is also fundamental for a person 's individuality, and identity has been defined by some in terms of the special skills that a person po ssesses, often r eferring to a professional or vocational identity. The conce pt of identity is a comp lex one. Many theoretical distinctions conc ern ing the ego and one 's self-appr aisal have b een made and Hartmann (1950) proposed distinguishing between self and ego. Here I am r eferring to only one facet of the more com plica ted rubric of identity sense. I am em phas izing the operational aspects of this patient's self-image, particularl y her attitudes about her ca pacities and abilities to mother. Motherin g is also a complex co nce pt, but this paper will limit itself only to how the patient conce ived of her ad equacy as a mother. Som e adjustive techniques are learn ed b y everyone early in life and are required for ordinary su rv iva l in our cu ltu re. The postp onement of gr a tifica tion is not too soph istica ted an example of a technique th at has to be learned a nd whi ch involves mastery over and control of one's impulses. \Vith further maturation and de velopment both the needs and the techniques re q uired to gratify th ese needs undergo a more refined structuralization, one which is consid ered to belong to the sphere of secondary-process operations. The executive systems develop more efficient and skillful responses be cause of satisfactory experiences with obj ects. Gratifying experiences with objects are incorporated within the memory system and later can be come organized into action units by the appropriate executive apparatus. As functional introjects they contribute to the ego's integration and are hierarchically arranged in
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a con tin u u m fr om simple adjustive techniques to th e com plex, subtle problem-sol ving methods th at are r equired to integrate inner n eed s with com plicated reality tasks. If th e ego do es not ha ve th ese techniques at its di sposal, this will be reflect ed in th e sel f-image wh ich may be ex pe r ienced in man y ways, but one common factor is th e feeling of unworthiness, inadequacy, and helpless frustration. If the outer world requir es a proficiency, to use an ana logy, at th e calc ulus level and one has learned only ar ithme tic, the person will feel weak and h elpless. The task of moth ering is a com plicated on e th at requires a high order of integration and th e executive ego systems have to fu nction at th e "ca lcu lus" level. Benedek (1959) has conceptuali zed parenthood as a d evelopmental phase. She believes that a child re vives the parent's d evelopmental conflicts which lead either to path ological manifestations or to r esolution of conflicts whereby the par ent may reach a new lev el of integration. She also em phasized th e d evelopmental potentials of an object relationship which lead to structuralization through processes of introjecti on and identification . This, in turn, leads to confidence which serves as a defense against fr ustra tions and also makes possible othe r ob ject relation ships in add itio n to th e one with th e mother, "a n d it furthers th e integration of self-re prese n tation wi thin th e value system of 'self-estee m .''' The latter leads to secu ri ty and a po sitive id entity sense in th e ch ild, and lat er in th e parental rol e. The patient constan tly referred to th e fact that she did not kn ow how to do thin gs for her bab y and was unable to be spo ntaneous and to crea te ways of com m un icating in the form of games , fond ling, bab y talk, et c. H er clumsy and time-con suming handling of th e bab y was cha ra cter ized b y com pu lsivi ty and was indicative of gu ilty preoccu pation . Undou b ted ly she possessed th e motor skills a nd coord ination requ ir ed for such tasks, bu t they were now associated with sadistic d est ructive feelings th at n ecessitated extra vigilance as part of th e defens e of reaction form ation . This patient had a frantic need for per fection ism in m an y ar eas, esp ecially mothering, and a n egativ e self-image. I have noted th ese qualities in several other patients too , and have seen a viciou s circle d evelop . These patients, becau se th ey feel so totally inadequat e, can not beli eve th at any thing th ey d o or ach ieve is worth wh ile, at least they can not u tilize an y of th eir acco mplish me n ts for th e enhan cin g
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of self-esteem. As was true with this patient, there was also a minimum of accomplishments. Consequently, in order to feel that anything they did was competent and noteworthy, they set up certain goals to attain. The underlying feeling of infantile helplessness required a perfectionistic behavior of megalomanic, omnipotent proportions to make up for it. The disparity then between the idealized self and the self-representation became enormous, and as they failed in their pursuits of superhuman goals their self-esteem became even lower. Further self-condemnation then led them to strive for even more perfect goals and the whole process repeated itself. In one patient, this process led to a panic state as he saw himself facing the world which was infinitely complex and demanding of one so helpless and base. What he failed to see, of course, was that he himself had set up all of these standards by which he could measure himself so unfavorably. What has been described is a defensive process, a reaction formation, to handle painful feelings of inadequacy. The defense does not work and merely serves to augment the initial negative self-image. This patient's ego defect consisted primarily of an inability to perceive the child's needs. The mother's lack of response and communication compounded by ignorant and disinterested surrogates led to special difficulties when her response to another person, her baby, had to be at its keenest. The rage and frustration, which were reactions to her feeling inadequate, were directed toward her child since it taxed capacities she felt she did not have. At this point, one can raise the general question whether a person who cannot perform a task is unable to do so because he does not have the basic integration, or whether his inability represents an inhibition due to repression. In the latter instance, one is dealing with symptoms that lead to absence of function, a point that Freud (1926) made several different times and in a variety of contexts. One might say this patient's inability to mother could be explained as due to a specific conflict situation, perhaps oedipal in nature, leading the patient to repress her knowledge of maternal behavior because of guilt concerning death wishes toward her own mother. The resultant inhibition would thus be a manifestation of such repression. On the other hand, this patient's difficulties can be viewed as an ego defect occurring in a penon suITering from a rather severe character dis-
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order whose chief symptomatic manifestation is a pervasive feeling of inadequacy. Mothering, according to Benedek (1950), represents an advanced state of psychosexual development, and one can postulate that this woman had never reached such a mature libido position. Conceptually one would have to distinguish between fixation and regression. Here it is possible that this patient, because of an unsatisfactory experience with her mother, never incorporated the functional introjects that would later be required when she assumed the responsibility of motherhood. The above distinctions are overstatements of what was actually observed in this specific clinical instance. In fairly unstructured egos the defense mechanism of repression still operates, and in wellorganized psychoneurotic patients there can still be areas of reduced integration of executive capacities. Positive self-esteem is a manifestation of a well-integrated ego as well as a factor in its further development. The first rudiments of a positive identity sense contribute to structuralization. Since such a child is not anxious and feels loved and therefore worth while (a positive self-image), the synthetic and integrative systems are not disrupted by conflict and frustration. Other positive influences, i.e., satisfactory object relations, continue to be effective and the ego's integrative capacities reach higher levels of structuralization. In turn, such higher states of organization enhance self-esteem further and the identity sense becomes increasingly acceptable.
III In contrast, this patient was obviously very angry with her mother. This was highlighted in the transference neurosis when she became aware of oral-sadistic impulses which, in the relatively undifferentiated state of self from outer world, threatened to devour her. This was experienced as agitation and panic and accompanied by fears of me as I represented the primitive maternal imago. At this point she went into a state of dissolution of practically psychotic proportions. She felt unable to do anything and was obsessively preoccupied with the fear of killing her child. Furthermore, she was both angry and "petrified" with what she felt so be my disgust and wish to get
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rid of her. With further regression she made me into an elaborate persecutor and the clinical picture was paranoid. This response to me was in marked contrast to the time when she saw me as a teacher who could supply her with executive techniques to master all problems. That the teacher-student relationship also represented a defense against the above disruptive transference feelings was also true, but for the most part she was attempting to make up for what she considered to be deficiencies in her childhood. When the patient began to reintegrate she idealized me as the omnipotent good object. Mother could only destroy and be ineffective, a regressed transference state characterized by projective defenses, whereas now the idealized external object could be incorporated and make up for her deficiencies. This state, too, had psychoticlike qualities in so far as it was characterized by megalomanic expectations. The student-teacher relationship, on the other hand, was of a subdued nature and did not point to any specific attachment to the analyst. Anyone, then, could assume such a role if he would make himself available (books, husbands, friends). Her destructive and self-destructive transference feelings highlighted the hostile cathexis of the early maternal introject. The "poisonous" internal mother did not enhance instinctual gratification and mothering had to become an "encapsulated" experience. The patient was unable to integrate such an introject and thereby attain a higher state of differentiation. 'Whenever an object relationship is conflictual, and destructive feelings are predominant, its potential for development becomes minimal and instead of progression may lead to regression. Whatever the psychodynamic determinants might be for such a hostile orientation, the earlier such a conflict occurs and the more primitive the stage of psychosexual development, the greater is the likelihood for the occurrence of an ego defect. Ordinarily the mothering imago throughout the course of psychosexual development undergoes a hierarchical elaboration which in the genital phase becomes the basis for the complex interrelationships of mothering. The primitive maternal introject can be considered as representing the potential which later, because of further gratifying experiences, achieves a degree of structuralization that leads to the expansion of sensory and executive ego systems and
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causes them to function with effic iency and con fide nce while relating to the ch ild's n eeds. In this case the maternal con flict, b y not permitting a syn thesis and integration of th e introj ect , depri ved the patient of a potential which later could lead to satisfying a nd satisfacto ry mothering. These developmental d efects have broader impl ications for th e study of the character di sorders. The clinical explorati on of such cases is of value in fur the ri ng our understanding of ego de velopment a nd th e importan ce of object relationsh ip s. S U MMARY
The smoo th fu nc tion ing of perceptual and ex ecutive ego system s is see n to be d ependent up on the synthesis of past functional introjects, A positive sense of id entity is founded upon the operations of exec u tive system s and th e mastery of external situations consonant with th e dictates of the ego id eal. In th e study of the cha racter d isorders on e has the opportun ity to ob serve th e ego wh en such a syn thes is is not achieved and th e self-ima ge is one wh ich is unacceptable to th e patient. T h is patient, who rep oned an unsatisfactory mothering experience, found herself un able to fun cti on and felt inade q uate as a mother. Althou gh th e ego was ab le to functio n ad equa tel y and eve n more than ad equately in man y other r espects, the patient's inability to function as a mother led to negative self-esteem and self-conde mnati on. Early objec t r elation shi ps are essent ial for th e fu rth er structuri ng of th e person al it y. From satisfacto ry re lationsh ips one learns tech n iq ucs a nd ski lls th at becom e useful for th e gra tification of n eed s as well as th e m astery of ex te rna l tasks. This patient indicat ed th at her own defecti ve mothe r ing experience did not lead to th e format ion o f the p roper in tro jects whic h were lat er essen tial for he r to d ra w upon in order to take care of her own ch ild . Althou gh repression lead s to inhibition of fun cti ons and although repressive measures were operating in this patient, it is felt that her difficulties in moth erin g were du e to weakl y established m othering introjects. This was seen as consti tu ting an ego lacuna du e to the absence of a satisfactor y experienc e fr om which th e ego co uld furth er str uc tu ra lize. R epres-
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sion implies that the patient has a well -established memory trace of the experience which, be cause of neurotic conflict, cannot be retained at conscious levels. The distinction postulated here is not an absolute one. What was observed in this patient was a balance between repressive forces and a relative absence of what has been re ferred to as a fun ctional introject. REFERENCES
BEI'EDEK, T. (1959), Parenthood as a developmental phase. [, Am er. Psychoanal. Assn.; 7:389-417. ERIKSON, E. H. (I!JfJ9), Itlrnt.il» and the Life Cycl e [P.\ychological Issues, l\fonogr. I]. N ew York: Int ern ational Univer sit ies Press. FREUD, S. (1914), On n arcissism: an introduction . Sta n d a rd Edition, 14:67-105. London : H ogarth P ress, 1957. - - (1923), The ego an d th e id . Standard Edition , 19:12 -66. Lon don: H ogarth Press, 1961. - - (1926), Inh ibitions, symptoms and anxiet y. Stan dar d Edi ti on, 20:87-174. London: H ogarth Pr ess, 1959. G ITELSO:-l, ~f. (1958), On eg-o d istortion s. Int. ] . Psych o.. A nal, 39:245·257. H ARDIA I' N, H . (1939), Ego Psych ology and th e Problem of Adaptation . New York: International U niversities Press, 1958. - - (1950), Comments on the p sych oan al ytic th eo ry of th e egoo. Th e Psycho analyt ic Study of th e Child, 5:74-96. New York: Intern ational Universiti es Press. J ACOBSON, E. (1954) , The self and the object world. The Psychoan al ytic Study of the Child, 9:75-127 . New York: Intern ational Universities Press. KI.EIN, M. (1932), Th e Psycho-An alysis of Children . London : Hogarth Press, 1937. R OSEN , V. H . (1961), Th e relevan ce of "style" to certai n aspects of defense and th e syn the tic fun cti on o f the ego . lilt . ]. Psych o-Anal., 42:447-457.
Peter L. Giooacchini, M.D. Psychoanalytic theory has in recent years focused upon ego operations. This is due not only to the natural continuum that began with an exploration of the id, but also because many of the cases that are being seen by psychoanalysts today require an intensive scrutiny of characterological factors and early object relations. The so-called character disorders, an enigmatic group of patients, have revealed to us many facets of ego structure which in turn have to be expressed in an acceptable and consistent conceptual framework. Freud was, of course, mindful of the problems that we study today in ego psychology and touched upon many of them in various metapsychological papers which culminated in the formulation of the structural hypothesis (1923). Klein (1932) and Jacobson (1954), although they disagree on many fundamental points, both dealt with the early stages of psychic development. Jacobson's formulations about self and object representations have been significant contributions about ego subsystems and an expansion of Hartmann's (1939) pioneer work on ego psychology. The literature has become quite extensive and need not be reviewed here. Experience with analytic patients has taught us about the necessity of understanding ego operations, and the subject has been approached from many different viewpoints. The unfolding of the transference neurosis and its special qualities have become the psychoanalyst's most valuable research tool. In this paper I shall present clinical
Presented to the Chicago Psychoanalytic Society on February 26, 1964. Dr. Giovacchini is Clinical Professor of Psychiatry, University of Illinois College of Medicine, Chicago, and Clinical Associate, Chicago Institute for Psychoanalaysis.
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data, in an abbreviated form, of course. These, I feel, enable us to make cer tain gen etic re constructions which have a bearing on ego development and its psychological di stortions. Here I would like to investigate certain aspe cts of ego structuralization whi ch are associated with the self concept and the mothering function. The case to be presented has many characteristics that are described by Gitelson (1958) wh en he discusses the character disorders. The patient's disturbance and con fusion concerning her role as a moth er also reminds us of Erikson 's (1959) concepts about disorders of ad olescence and what he call ed the identity diffusion syndrome. I
The patient, a woman in her middle thirties who had been married twice, sought analysis because of intense and general feelings of inadequacy as well as an inability to becom e pregnant. Her gynecologist felt that psychol ogical factors must have a bearing on her ster ility sin ce the exa m ina tions of her and her husband failed to reveal any organic factors that might account for her sterility. She reported feeling inferior all of her life ; on several occasions in the past she had re cei ved psychotherap y. It was at the in sistence of her second husband , to whom she had been married only a few months, that she sought anal ysis and decided to see it through. She acknowledged th at intellectually she was capable and , although she had made only average grades in college, she had done so with a minimum of effort. She did not worry about her ap pearance and, in fact, was a fairly attra ctive woman. Her ability to relate to others did not lack char m and she found herself fluent a nd able to make a good impression at social gatherings, Although she was both attractive and sociable, she suffered from the su bjective sen sation of being inferior, clumsy, and ga uc he. She lamented the fact that although of superior intellect she had ne ver accom plished an ything constructive. Social relationships, although satisfa ctory, were transitory and superficial in nature without leading to an y de ep , warm, satisfying emotional bonds. In this regard she felt she was pla ying a rol e, on e she had learned by rote memory and did not reall y feel th e part. Giving a dinner party was "sheer torture" because she felt that she would make a fool of herself by revealing
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her inability to handle what should be a routine task. By this she meant that she was quite literally unable to think of what to serve, how to cook it, how to set the table, and all the other varied details that go along with planning such a social occasion. She had held half a dozen jobs since leaving college and she believed she was fired from all of them because of her incompetence. Though she made good grades in college she did not graduate. There were many reasons for her leaving college when she did but the patient believed that even here it was representative of her general inability to function in any area. Yet, what she spoke or did not have a histrionic melodramatic quality and was accompanied with a good deal of tension, anxiety, and depression. She was extremely bitter about what she considered to be her deficiencies. When faced with a situation she felt overtaxed her she would react with helpless impotent anger and disorganization. These feelings were sometimes accompanied by derealization and depersonalization. At these times she reported having "no way of knowing who I am or what I am." She would helplessly cling to various friends; she had one in particular whom she considered to be a "bulwark of strength, to tell me what to do and how to do it." Her father died when she was six years old and she had only a slight recollection of him. As far as she could ascertain, he was a "nonentity who was completely dominated and submerged" by her "all-powerful mother." (This is a description an aunt gave of him.) Her mother died in a state hospital five years before the patient began analysis. Her early impressions of her mother were of a very powerful, competent woman, who successfully manipulated the family business and brought the family much wealth. They lived in a big house which the mother handled with the efficiency of a capable overseer of a feudal estate. The patient vividly recalled her mother giving orders to a variety of subordinates, running things with an iron hand, and subjugating all of those around her. According to the patient, mother's strengths served to emphasize everyone else's weakness. In the course of the analysis, the patient brought up a good deal of material which permitted one to make inferences about the nature of the mothering relationship. Naturally she could not recall the
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details of her own early experience, but she remembered mother's inability to h andl e a four-year-younger sis ter. Since the family was wealth y, there wer e man y domesti cs who to ok over the co m p le te car e of the two ch ild r en . A lt ho ug h the mother wa s extremel y sk illf u l in the hiring of employees to work in th e business an d to handl e her exten sive social activiti es, the patient felt sh e was obtu se when it ca me to th e sel ection of nurses and go vernesses for th e ch ild re n . Sh e vi vidly r ecalled th e ch aos th at followed the birth of h er yo u nger sister. Sh e cons idered her m other, for exa m p le, to be con fuse d and totally inexperienced in handling th e sim p lest activities of ch ild r earing. She had no id ea how to feed th e baby, h ow to select the la yette, clothe h er, cha nge diapers, or m ake slee p ing a rra ngemen ts. Furthermore, she was un able to in st ru ct or even to select so meo ne to carry o u t th ese fun ction s. The xisu-r devel oped severe ulcerative colitis during ad o le sce n ce a n d be cam e both ph ysicall y a n d em otionall y in ca pacitated , Th e pati errt 's self- evaluat ion corresponded to wh at sh e d escr ibed as the sister 's actu al sta te . A fte r fou r years o f an al ysis th e pat ient becam e preg n an t and ga ve birth to a girl. I wou ld like to co ns id er this woman's reactions to the pregn :lIJcy a nd h er feelin gs a n d ex per ienc es in th e earl y postn atal period. I wi sh to em p has ize h er attitudes abou t m othering and their r elation ship to h er self-esteem . Her self representation as a m other naturally included memories o f experi ences with her own m other which will be correlated with h er reactions to her b aby. During pregnancy she made light o f it and did n ot cons id er it an accom p lish me n t in sp ite of havin g tri ed to co n ce ive for se ven yea r s. She began to d epreciate the bearing o f ch ild re n, whereas previously she h ad lauded it. Sh e further d epreci ated the rol e of woman: since the b earing of a chi ld wa s su ch an animal process, it was not n ecessary th at th e woman possess a ny other abiliti es. She felt h erself to be intelligent but co u ld n ot See wh y it was necessary to have intell ectual ca pa b ilit ies simpl y to b reed. A t this point she ca ref u lly av oided any discussions of what abilities one must h ave in order to care for a c h ild su ccessfull y. A fter a fairl y easy delivery o f a d aughter, she be came obsessively interested in child rearing. As I have noted in sev eral other patients who have h ad similar but less disturbed experiences with their own
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mothers, she b ecame intensely preoccupied with raismg her ch ild properly. She avidly read all of th e recommended books on child d evelopment to learn n ot on ly the facts of emo tiona l and physical maturation but also th e proper psychological handl ing which would produce a health y and happy baby. Her preoccupation went far b eyond wha t one would ordinaril y expec t in a lovin g mother, an d th ere was a str ikin g lack of affec t. She seem ed to pursue suc h in form ation as if she were interested in passing som e kind of exam ina tion or in producing a model ch ild th at would win som e con test. It be came appar ent to both th e pa tie n t and m yself th at she had to be a perfect mother to ob ta in an om n ipo te n t perfe ctionism th at would serve som e inner n eed wh ich had littl e to d o with th e welfa re of her dau ghter. In th e an alysis she in cessantl y asked question s abou t h ow to handle a variety of rather ordinary situ ations th at arose in reference to her daughter. It gr ad u ally b ecame clear th at in spite of all her reading and frantic seeking of advice, she sho wed no more skill or ca pacity to take care o f her ch ild or to rel a te to h er th an she remembered her mother having with h er sister. I cou ld obse rve how fatigu ed and depleted th e pat ient felt , bo th emot iona lly and ph ysicall y. She was exhausted because of th e effort and work she put into th e taking care of one child, even th ough her husband was cooper a tive and th ey had a full-tim e m ai d a nd a n urse. From the sta n d po in t of work alone it was ha rd to under stand wh y she was so exha usted. She th en r eveal ed th e fo llo wing id eas: a goo d m oth er sho u ld n ot rel egat e such fu nctions as feeding, clo thi ng , an d bathing to a dom estic as h er own m o ther h ad done. These th en wer e to be her "d u ties." She also had to be able to relate to the b aby which to h er meant being sensitive to th e ch ild's n eed s an d to b e ab le to p lay with her. \ Vhen faced wi th these self-assign ed func tions which she d efined as motherin g she found h er self to be in a sta te of both panic an d con fu sion. Altho ugh she had r ead co nsiderably abo u t all of th ese ar eas, she felt he r self to be an ex trem ely poor stu de n t who was unable to com pr eh en d wh at she tried to lea rn and certa in ly not abl e to apply it. She agreed th at it should b e sim ple en ough for one of her intellect but in th is regard sh e d escribed her self as an " id io t." For exa m p le, her milk su p ply was such th at she was unabl e to breast-feed th e bab y. Consequently, sh e had to prepare formula. She would have to sta rt
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preparing one bottle immediatel y afte r having fed the ch ild be ca use it would tak e her that long to ge t eve ry th ing ready for th e n ext feeding, At first this was difficult to understand, but once she de scribed h ow sh e prepared the bottles it became apparent wh y it was so tim e and energy consuming, It would take her over an hour to wash a b ottle and this whol e process can be be st su m ma r ized by com par ing it with certain ob sessional rituals, such as a hand-washing compulsion , Then all of th e othe r step s ne cessar y for th e preparing of a formula such as th e mixing an d the heating were handled in the sa me time-con suming fashion . She used similar methods while dressin g and bathing the baby. Still it was not just the meticul ous and the obsessional ritualistic aspe cts that made the taking care of the baby such an arduous task. She often ref erred to what she conside re d to be her lack of kn owledge which made it necessary for her to be extra careful. As noted earlier, she fel t that she had not been able to learn anything from the books that she had read or from th e advice that she had rec eiv ed from friencl s. She was referring then to a feeling of inexperience and clumsin ess in handling tasks with whi ch she had no previ ous acquaintance; nor did she hav e any particular aptitudes or skills to ma ster th em . One of her mo st fr equ ent sim iles was that sh e was lik e a stude n t who had ne ver be en in or seen an automobile and yet was learning ab out its operations from a me chanic's manual. She felt that it would be ver y difficult to learn in suc h a vacuum and then suddenl y to be con fro n ted with an autom obile and expected to take care of it as a sk illed technician. Sh e felt her task to be equally insurmountable because of the lack of any previous experience. It s difficul ties were com pou nded by a n eed to h e a perfect mother, plus the feeling th at she cou ld not learn . Later she co mp lain ed she was un able to respond to th e ch ild 's attempts at com m un ica tion . It was in this area that her fru stration reach ed its greatest intensity and led to bitter self-recriminations, agitation, and depression. The fact that she was unable to play with her baby, that is to think of any particular games that the child might enjoy, led to the deepest dej ection . One day after a fri end came in and was able to get her daughter to smile by playing peek-a-boo, the patient went into a state of intens e rage. She attacked her self for not having been able to think of this game herself, but then r eo
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vea led th at she was n ot acq uainted with it, n ever having it played or seen anyo ne else pla y it with a child. Even coo ing or bab y talk was some thi ng she cla imed was en ti rely fore ign to her, but still she was cr itical of herself because she was not ab le spon ta neously to think of and in vent suc h methods of com m u n ica tion and play for her daughter. She worried whether this would lead to severe developmental defects in her ch ild 's cha racter. Other activ ities suc h as wea n ing fro m th e bottle to a glass, to ilet trai n ing, and even how to han dl e the arrival of a sibling di d not cause her any pa r ticu lar concer n. These func tio ns wh ich she consid ered to be "gro ss" in nat ur e cou ld be handl ed mec ha nis tica lly on th e bas is of her r eadings and from th e adv ice she received fro m fri ends. But no one could tell her of th e innumerable un predi ctabl e situa tion s th at arise in the comp lex re lationship between a mother and ch ild. These demanded an intuitive grasp and subtl e r espon ses. She su m mar ized her situation by re peating, "I don't kn ow how to do." In spi te of this patient's severe problem, there was n ever an y indication th at th er e wer e gross di stu r bances of re ality test ing. R ath er, she emphas ized her in ability to do things, her helplessness and vulnerab ility in facing ped estrian tasks. Then she felt comple tely worthless as if her who le ex istence and self-esteem depended upon being able to perform in this area, an interesting con tr ast to her arrogan t att itude about th e bearing of a ch ild ex pressed in th e pren at al per iod .
II
The self-image is a n im po rta n t aspec t of th e ego 's str ucture and d istu rban ces of it have become more fr equently obs erved in recent years. \Vhen a per son feel s di ssa tisfied with his self-im age, he feels in ad equ at e an d often helpl ess and vu ln erable. The concep t of selfesteem em p has izes the compar ison between the self-representation and th e ego ideal, as Freud ( 1~ 1 4) pointed out when he spo ke of self -regard. H e further discu ssed how th e ego ideal, which at that tim e was syno ny mous with hi s broader conc ep t of th e superego, det erm in ed one 's satisfaction with the self. H e introduced th e conc ep t of ego d ep iction a nd d em on strated how it was a ca usal factor in
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producing n egative self-estee m . All of these are extrem ely important concep ts indispensable to the understanding of th e charac ter di sorders. The self-image, to repeat , is a self-observation . It contains an awareness of all of the ego's functions, sen sory, executive, synthetic, defen sive, and otherwise. The op eration s of ego systems vis-a-vis external reality and th e id have definitive chara cter istics, which Rosen (1961) calls "style" and which give th e person his individuality. These qualities in turn are largel y determined b y on e's past experiences, especially those with objects. Satisfactory object relationships cause expansion of adaptive methods of re acting and achieving ma stery consonant with reality testing. What is learned therefor e is also fundamental for a person 's individuality, and identity has been defined by some in terms of the special skills that a person po ssesses, often r eferring to a professional or vocational identity. The conce pt of identity is a comp lex one. Many theoretical distinctions conc ern ing the ego and one 's self-appr aisal have b een made and Hartmann (1950) proposed distinguishing between self and ego. Here I am r eferring to only one facet of the more com plica ted rubric of identity sense. I am em phas izing the operational aspects of this patient's self-image, particularl y her attitudes about her ca pacities and abilities to mother. Motherin g is also a complex co nce pt, but this paper will limit itself only to how the patient conce ived of her ad equacy as a mother. Som e adjustive techniques are learn ed b y everyone early in life and are required for ordinary su rv iva l in our cu ltu re. The postp onement of gr a tifica tion is not too soph istica ted an example of a technique th at has to be learned a nd whi ch involves mastery over and control of one's impulses. \Vith further maturation and de velopment both the needs and the techniques re q uired to gratify th ese needs undergo a more refined structuralization, one which is consid ered to belong to the sphere of secondary-process operations. The executive systems develop more efficient and skillful responses be cause of satisfactory experiences with obj ects. Gratifying experiences with objects are incorporated within the memory system and later can be come organized into action units by the appropriate executive apparatus. As functional introjects they contribute to the ego's integration and are hierarchically arranged in
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a con tin u u m fr om simple adjustive techniques to th e com plex, subtle problem-sol ving methods th at are r equired to integrate inner n eed s with com plicated reality tasks. If th e ego do es not ha ve th ese techniques at its di sposal, this will be reflect ed in th e sel f-image wh ich may be ex pe r ienced in man y ways, but one common factor is th e feeling of unworthiness, inadequacy, and helpless frustration. If the outer world requir es a proficiency, to use an ana logy, at th e calc ulus level and one has learned only ar ithme tic, the person will feel weak and h elpless. The task of moth ering is a com plicated on e th at requires a high order of integration and th e executive ego systems have to fu nction at th e "ca lcu lus" level. Benedek (1959) has conceptuali zed parenthood as a d evelopmental phase. She believes that a child re vives the parent's d evelopmental conflicts which lead either to path ological manifestations or to r esolution of conflicts whereby the par ent may reach a new lev el of integration. She also em phasized th e d evelopmental potentials of an object relationship which lead to structuralization through processes of introjecti on and identification . This, in turn, leads to confidence which serves as a defense against fr ustra tions and also makes possible othe r ob ject relation ships in add itio n to th e one with th e mother, "a n d it furthers th e integration of self-re prese n tation wi thin th e value system of 'self-estee m .''' The latter leads to secu ri ty and a po sitive id entity sense in th e ch ild, and lat er in th e parental rol e. The patient constan tly referred to th e fact that she did not kn ow how to do thin gs for her bab y and was unable to be spo ntaneous and to crea te ways of com m un icating in the form of games , fond ling, bab y talk, et c. H er clumsy and time-con suming handling of th e bab y was cha ra cter ized b y com pu lsivi ty and was indicative of gu ilty preoccu pation . Undou b ted ly she possessed th e motor skills a nd coord ination requ ir ed for such tasks, bu t they were now associated with sadistic d est ructive feelings th at n ecessitated extra vigilance as part of th e defens e of reaction form ation . This patient had a frantic need for per fection ism in m an y ar eas, esp ecially mothering, and a n egativ e self-image. I have noted th ese qualities in several other patients too , and have seen a viciou s circle d evelop . These patients, becau se th ey feel so totally inadequat e, can not beli eve th at any thing th ey d o or ach ieve is worth wh ile, at least they can not u tilize an y of th eir acco mplish me n ts for th e enhan cin g
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of self-esteem. As was true with this patient, there was also a minimum of accomplishments. Consequently, in order to feel that anything they did was competent and noteworthy, they set up certain goals to attain. The underlying feeling of infantile helplessness required a perfectionistic behavior of megalomanic, omnipotent proportions to make up for it. The disparity then between the idealized self and the self-representation became enormous, and as they failed in their pursuits of superhuman goals their self-esteem became even lower. Further self-condemnation then led them to strive for even more perfect goals and the whole process repeated itself. In one patient, this process led to a panic state as he saw himself facing the world which was infinitely complex and demanding of one so helpless and base. What he failed to see, of course, was that he himself had set up all of these standards by which he could measure himself so unfavorably. What has been described is a defensive process, a reaction formation, to handle painful feelings of inadequacy. The defense does not work and merely serves to augment the initial negative self-image. This patient's ego defect consisted primarily of an inability to perceive the child's needs. The mother's lack of response and communication compounded by ignorant and disinterested surrogates led to special difficulties when her response to another person, her baby, had to be at its keenest. The rage and frustration, which were reactions to her feeling inadequate, were directed toward her child since it taxed capacities she felt she did not have. At this point, one can raise the general question whether a person who cannot perform a task is unable to do so because he does not have the basic integration, or whether his inability represents an inhibition due to repression. In the latter instance, one is dealing with symptoms that lead to absence of function, a point that Freud (1926) made several different times and in a variety of contexts. One might say this patient's inability to mother could be explained as due to a specific conflict situation, perhaps oedipal in nature, leading the patient to repress her knowledge of maternal behavior because of guilt concerning death wishes toward her own mother. The resultant inhibition would thus be a manifestation of such repression. On the other hand, this patient's difficulties can be viewed as an ego defect occurring in a penon suITering from a rather severe character dis-
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order whose chief symptomatic manifestation is a pervasive feeling of inadequacy. Mothering, according to Benedek (1950), represents an advanced state of psychosexual development, and one can postulate that this woman had never reached such a mature libido position. Conceptually one would have to distinguish between fixation and regression. Here it is possible that this patient, because of an unsatisfactory experience with her mother, never incorporated the functional introjects that would later be required when she assumed the responsibility of motherhood. The above distinctions are overstatements of what was actually observed in this specific clinical instance. In fairly unstructured egos the defense mechanism of repression still operates, and in wellorganized psychoneurotic patients there can still be areas of reduced integration of executive capacities. Positive self-esteem is a manifestation of a well-integrated ego as well as a factor in its further development. The first rudiments of a positive identity sense contribute to structuralization. Since such a child is not anxious and feels loved and therefore worth while (a positive self-image), the synthetic and integrative systems are not disrupted by conflict and frustration. Other positive influences, i.e., satisfactory object relations, continue to be effective and the ego's integrative capacities reach higher levels of structuralization. In turn, such higher states of organization enhance self-esteem further and the identity sense becomes increasingly acceptable.
III In contrast, this patient was obviously very angry with her mother. This was highlighted in the transference neurosis when she became aware of oral-sadistic impulses which, in the relatively undifferentiated state of self from outer world, threatened to devour her. This was experienced as agitation and panic and accompanied by fears of me as I represented the primitive maternal imago. At this point she went into a state of dissolution of practically psychotic proportions. She felt unable to do anything and was obsessively preoccupied with the fear of killing her child. Furthermore, she was both angry and "petrified" with what she felt so be my disgust and wish to get
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rid of her. With further regression she made me into an elaborate persecutor and the clinical picture was paranoid. This response to me was in marked contrast to the time when she saw me as a teacher who could supply her with executive techniques to master all problems. That the teacher-student relationship also represented a defense against the above disruptive transference feelings was also true, but for the most part she was attempting to make up for what she considered to be deficiencies in her childhood. When the patient began to reintegrate she idealized me as the omnipotent good object. Mother could only destroy and be ineffective, a regressed transference state characterized by projective defenses, whereas now the idealized external object could be incorporated and make up for her deficiencies. This state, too, had psychoticlike qualities in so far as it was characterized by megalomanic expectations. The student-teacher relationship, on the other hand, was of a subdued nature and did not point to any specific attachment to the analyst. Anyone, then, could assume such a role if he would make himself available (books, husbands, friends). Her destructive and self-destructive transference feelings highlighted the hostile cathexis of the early maternal introject. The "poisonous" internal mother did not enhance instinctual gratification and mothering had to become an "encapsulated" experience. The patient was unable to integrate such an introject and thereby attain a higher state of differentiation. 'Whenever an object relationship is conflictual, and destructive feelings are predominant, its potential for development becomes minimal and instead of progression may lead to regression. Whatever the psychodynamic determinants might be for such a hostile orientation, the earlier such a conflict occurs and the more primitive the stage of psychosexual development, the greater is the likelihood for the occurrence of an ego defect. Ordinarily the mothering imago throughout the course of psychosexual development undergoes a hierarchical elaboration which in the genital phase becomes the basis for the complex interrelationships of mothering. The primitive maternal introject can be considered as representing the potential which later, because of further gratifying experiences, achieves a degree of structuralization that leads to the expansion of sensory and executive ego systems and
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causes them to function with effic iency and con fide nce while relating to the ch ild's n eeds. In this case the maternal con flict, b y not permitting a syn thesis and integration of th e introj ect , depri ved the patient of a potential which later could lead to satisfying a nd satisfacto ry mothering. These developmental d efects have broader impl ications for th e study of the character di sorders. The clinical explorati on of such cases is of value in fur the ri ng our understanding of ego de velopment a nd th e importan ce of object relationsh ip s. S U MMARY
The smoo th fu nc tion ing of perceptual and ex ecutive ego system s is see n to be d ependent up on the synthesis of past functional introjects, A positive sense of id entity is founded upon the operations of exec u tive system s and th e mastery of external situations consonant with th e dictates of the ego id eal. In th e study of the cha racter d isorders on e has the opportun ity to ob serve th e ego wh en such a syn thes is is not achieved and th e self-ima ge is one wh ich is unacceptable to th e patient. T h is patient, who rep oned an unsatisfactory mothering experience, found herself un able to fun cti on and felt inade q uate as a mother. Althou gh th e ego was ab le to functio n ad equa tel y and eve n more than ad equately in man y other r espects, the patient's inability to function as a mother led to negative self-esteem and self-conde mnati on. Early objec t r elation shi ps are essent ial for th e fu rth er structuri ng of th e person al it y. From satisfacto ry re lationsh ips one learns tech n iq ucs a nd ski lls th at becom e useful for th e gra tification of n eed s as well as th e m astery of ex te rna l tasks. This patient indicat ed th at her own defecti ve mothe r ing experience did not lead to th e format ion o f the p roper in tro jects whic h were lat er essen tial for he r to d ra w upon in order to take care of her own ch ild . Althou gh repression lead s to inhibition of fun cti ons and although repressive measures were operating in this patient, it is felt that her difficulties in moth erin g were du e to weakl y established m othering introjects. This was seen as consti tu ting an ego lacuna du e to the absence of a satisfactor y experienc e fr om which th e ego co uld furth er str uc tu ra lize. R epres-
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sion implies that the patient has a well -established memory trace of the experience which, be cause of neurotic conflict, cannot be retained at conscious levels. The distinction postulated here is not an absolute one. What was observed in this patient was a balance between repressive forces and a relative absence of what has been re ferred to as a fun ctional introject. REFERENCES
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