The Synthesis of Self : Volume 2 It All Depends on How You Look at It Development of Pathology in the Cohesive Disorders

The oedipal situation involves much more than an instinctual at­ titude toward a prohibited object giving expression to unconscious wishes. It introduces a whole new way of perceiving the internal and external world and an entirely different orientation to the myriad of life's experiences. A great deal of structural develop­ ment, requiring the negotiation of a sequence of early developmen­ tal tasks, has to have taken place before it is possible to encompass the complex demands of an oedipal attitude. When these early steps are not negotiated, although genital instinctual impulses may be manifested, the structural alignments necessary to enter into an oedipal position cannot be effected and the intrapsychic con­ flicts it engenders are not encountered. The thrust of early develop­ ment has made it essential for a narcissistic perspective to be adopted toward all stimuli and all relationships in order to enable All attachments must of necessity be continuing self-expansion. based upon the narcissistic supplies they contain, which ultimately lead to increasing levels of independence, self-differentiation, and individuation. It is precisely when the component instincts are con­ solidated into a genital drive that a narcissistic orientation can no longer incorporate the representation of experiences needed for the full realization of self-potentials. Were stimuli to only possess sig­ nificance in regard to their narcissistically enhancing attributes, the resulting dependence upon the external world would run counter to the thrust for independence and autonomy.

The Genital Character.- Hysteria.- The Obsessive Disorders.- The Narcissistically Determined, Object-Related Disorders: The Phobias.- 1. The Cohesive Disorders.- A Definition of Cohesiveness.- The Significance of Object-Related Perceptions.- The Development and Function of Fixation Points.- The Object-Related Neurotic Disorders: Hysteric and Obsessive Pathologies.- The Narcissistically Determined Object-Related Disorders: Phobic Pathology.- 2. Hysterical Symptom Formation and Hysterical Character Pathology: Preoedipal Determinants.- Introduction: Symptom Formation.- The Fixation Points in the Development of the Hysteric.- The Grandiose Self and Ego Ideal in the Hysteric.- The Nature of Reaction Formations.- The Preconditions for a Genital Organization and Their Effects upon the Oedipal Conflict.- The Defensive Significance of Hysterical Symptoms and of Hysterical Character Pathology.- 3. Hysterical Symptom Formation and Hysterical Character Pathology: Oedipal Determinants.- Introduction: Castration Anxiety and the Oedipal Conflict.- The Influence of Early Development upon the Structure of Castration Anxiety and the Oedipal Conflict.- The Oedipal Conflict in Hysteria.- The Defensive Organization in the Hysteric.- The Status and Significance of Object-Related Perceptions in the Hysteric.- The Effects of Hysteric Development upon Thinking, Perception, and Adaptation.- Some Implications for Treatment.- Depression in the Hysteric.- 4. Hysterical Symptom Formation and Hysterical Character Pathology: Clinical Material.- Clinical Material.- Discussion.- The Structural Foundation of Thought in Hysteria.- The Structural Foundation of Thought in Other Disorders.- 5. Obsessive Character Pathology and Obsessive Symptom Formation: Preoedipal Determinants.- Introduction—The Role of Aggression.- Early Influences in the Development of the Obsessive.- The Differentiating Structures Maintaining Cohesiveness.- The Fixation Points in the Obsessive.- The Nature of Reaction Formations.- The Effects of the Obsessive’s Development upon Thinking, Perception, and Adaptation.- 6. Obsessive Character Pathology and Obsessive Symptom Formation: Oedipal Determinants.- Introduction—The Anal Influence in Obsessive Disorders.- The Preconditions for the Oedipal Conflict and the Structure of Castration Anxiety.- The Oedipal Conflict in the Obsessive.- The Oedipal Conflict in the Male.- The Oedipal Conflict in the Female.- The Significance of Obsessive Character Pathology.- The Significance of Obsessive Symptoms.- The Significance of the Defensive Organization of the Obsessive.- Depression in the Obsessive.- 7. Obsessive Character Pathology and Obsessive Symptom Formation: Clinical Material.- Clinical Material.- Discussion.- Behavior as a Reflection of Character: A Comparison with Hysteria.- The Structure of Thought in the Obsessive.- 8. The Narcissistically Determined Object-Related Disorders: The Phobias. Pregenital Determinants.- Early Influences in the Development of the Phobias.- The Grandiose Self and Ego Ideal in the Phobic.- Separation-Individuation, Cohesiveness, and the Formation of Differentiating Structures.- The Effect of the Absence of Reaction Formations.- The Composition of the Self- and Object Representational Systems in the Phobias.- The Fixation Points and Their Relationship to Phobic Symptoms.- 9. The Narcissistically Determined Object-Related Disorders: The Phobias. The Significance of the Oedipal Situation.- Introduction: The Conditions Necessary for a Shift from Narcissism to Object Relatedness.- The Preconditions for Object Relatedness in the Phobias.- The Status of Internal Regulation in the Phobias.- The Relationship of the Fixation Points to a Genital Consolidation.- The Nature of the Oedipal Conflict.- The Threat of Loss of Cohesiveness.- Depression in the Phobic Disorders.- 10. The Narcissistically Determined Object-Related Disorders: The Phobias. Clinical Examples and Discussion.- The Object Phobias.- The Self-Phobias.- The Combined Self- and Object Phobias.- Summary.- The Structure of Thought in the Phobic Disorders.- 11. The Cohesive Disorders: A Comparison.- The Self-Representational System.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Object Representational System.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Self-Object Need.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Nature of Anxiety and Repression.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Conflict-Free Sphere.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Transference.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Conscious and Preconscious Systems.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Drive Development.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Regression in the Service of the Ego.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Reality Testing (The Fixation Points).- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Ego (The Process of Play).- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Id (Processes of Love).- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- The Superego (The Process of Work).- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Conscious Motivation for Treatment.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Unconscious Motivation for Treatment.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- Complaints.- The Genital Character.- The Hysterias.- The Obsessives.- The Phobias.- References.