EMOTIONAL DISTURBANCE AND SCHIZOPHRENIA

5. Some Forms of Emotional Disturbance and

their Relationship to Schizophrenia

Most of the psychoanalytic observations in th_is_pa_per deal

from it in that they were not perceived as disturba_nces byJh~ Q.l:loti~nt

fiTmself.To thl~ spedaTtype c;i(iiersonailtY__I h_ave_given th_t:JilJ.me_,_ ~as
!must.emphasize that this na~~ ha~ nothing to do with Vaihinger's
system of 'fictions' and the philosophy of 'As-If.' My only---reason for
!!,Sing s9 unoriginal a label for the type of person I wish to present is
that every attempt to understand the way of feeling and manner of life
of this type forces on the observer the inescapable impression that the
individual's whole relationship to life has something about it which is
lacking in genuineness and yet outward!)' runs along 'as if' it were
~oiiij?iete. Even the layman-s-ooner- ~;-)~~r i~q~ire~: afte~--~~~ti;:;g
such an 'as if' patient: what is wrong with him, or her? Outwardly .!.!:!._e
person seems normal. There is nothing to suggest any kind of disorder,
beii'avior is not unusual, intellectual abilities appear unimpaired,
emotionalexpre-sSlonsare ~11 o~red and app~opri~i~=~i:ii <leipite all
iiilS:-someihlng intangible and indefinable obtr_udes betwe~~-the-person
~nd his fellows ancf-invanabiy gives ri~~ to th~ q-~esti~~~ ~wti~i- is
---~-

1 Oberndorf, C. P.: Depersonalization in Relation to Erotization <~{Thoui:ht. lnt. J. Psa ..

XV, 1934, pp. 271-295; Genesis of Feeling of Unreality. lnt. J. Psa., XVI. 1935, pp.

296-306
'Schilder, P.: Treatment of Depersonalization. Bull, N. Y. Acad. Mcd .. XV. J9N,
pp. 258-272.
3 Bergler, E., and Eide Iberg, L.: Der Mecha11i.m111.1 der l>t'flt'r.w1111/i;,1ti1111. lnt. /.hchr.
f. Psa., XXI, 1935. pp. 258-285.

con-

~~~-~~~~~i<l___cl~-s~j~Jationshfu~!'()~_d~_perso_~~l_ization _1=iut giffe[i_Qg

Helene Deutsch

Psychoanalytic observations of a few types of emotional disturbances

are presented in this paper, and a series of cases reported in which the
individual's emotional relationship to the outside world an<!_to._hi_s_ QJ\:'n
egoappears-impoverish~d~;:-~bs~i:-s~~hdi~t~~bance~-ofthe emotional
Jife-take-vanous-forms: For example, .!_1!_~~~--l!_t_:_e_ the individu~J-~~~_<l_ are
not aware of their Jack ofp.QflJ!~~~~tiy.e bonds and responses, but
whose emotional disturbance is perceived either only by those around
them or is first detected in analytic treatment: and there are those who
complain. of their emotional d~ft<..~L~11:!_~re keenly distressed by the
disturba~~~-i~-ili~i; inner e;zperiences. _AiQQ"~iihe latter,. the ~i~turb
ance may be transitory and fleeting; it may r~om tirrie to time but
only in connection with certain specifu: situations and experiences; or
it m;y persist and form a cont~nu_os_, ~is!re~sing SYil!P_tom. In addition,
the emotional disturban~~-;n~y be perceived as existing -in the personality or it may be projected onto the outside world. In the one case the
patient says, 'I am changed. I feel nothini-~yeryt_hin_g_~eef!l~ unreal to
me.' In the other, he compfains that the world seems strange! ()_bj~c;t_s
shadowy-;-i1iiman-6eiilg:s-and eveii-fs iheatiTcal a.~<l- ullr~al:-fh~se forms
ort"ile-<li~tiiibance inwh:i~h: the-lri<li~IC!Uaihim~eir"is c"onscious of his
defect and complains of it belong to the picture of ~_degersonalization.'
This disturbance has been described by many authors. In the analytic
1
literature the reader is especially referred to the studies of Oberndorf,
Schilder,2 and Bergler and Eidelberg. 3

~i~_h

75

.J

wton~?'

- -

A clever and experienced man, a patient of mine, met another of my

patients, a girl of the 'as if type, at a social gathering. He spent part of
his next analytic hour telling me how stimulating, amusing, attractive,
and interesting she was, but ended his eulogy with, 'But something is
wrong with her.' He could not explain what he meant.
When I submitted the paintings of the same girl to an authority for
his criticism and evaluation, I was told that the drawings showed much
skill and talent but there was also something disturbing in them which
this man attributed to an inner restraint, an inhibition which he thought
could surely be removed. Towards the end of the patient's not too
successful analysis, she entered this critic's school for further instruction in painting and, after a time, I received a report in which her teacher
spoke in glowing terms of her talent. Several months later I received a
less enthusiastic report. Yes, the girl was talented, her teacher had been
impressed by the speed with which she had adopted his technique and
manner of artistic perception, but, he had frankly to admit, there was
an intangible something about her which he had never before encountered, and he ended with the usual question. 'What is wrong?' He added
that the girl had gone to another teacher, who used a quite different

76

1930s AND 194Os

teachingapproach,and that she had orientedherselfto the new theory

and techniquewith striking easeand speed.
The first impression these people make is of complete normality.
They are intellectuallyintact, gifted, and bring great understandingto
intellectual and emotional problems; but when they pursue their not
infrequent impulsesto g9ltiy,._lygtk they construct, in form, a good
a
piece of work but it is always a spasmodic,if ski!lgd-19ge1it-1q1-qf
prototype without the slightesttrace of originality. On closer observafion, me sameth-ingii-seen-inttreiiaffeAite-relationshipsto the environment. These relationshipsare usually intenseand bear all the earbut even the
marks of friendlhD, lq5, sygp3ghy,and undeJst?nding;
layman soon perceivessomethingstrangeand raisesthe question he
cannotanswer.To the analystrt is soglsfggllbat all theserelationships
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
lacks the necessaryspark to make his impersonationstrue to life.
Thus the essentialcharacteristicof the person I wish to describeis
that outwardly he conducts his life as if he possesseda completeand
sensitiveemotionalcapacity.To him thereis no differencebetweenhis
empty forms andwhat othersactuallyexperience.Without goingdeeper
into the matter I wish at this point to state that this condition is not
identical with the cold19,9s,
9f i9pr9s-9q$inCivid-qll i-4-6m-Grejs

EMOTIONALDISTURBANCEAND SCHIZOPHRENIA

77

thinking and feeling, i-9!!r-ee5pre-ssionof this pasg!_ven!a_s-!4i1y

gd
of the greatestfidelity and thg basestperfi_dy.
.rendersthe personcap-able
ge_for_identifqatio.n.At first the love,
Al1]qhiec_t .W!Ido -as__?._hg
friendship, and attachmentof an 'as if person have somethingvery
rewardingfor the partner. If it is a woman, she seemsto be the quintessenceof feminine devotion, an impressionwhich is particularly impartedby her passivityand readinessfor identification.Soon,however,
the lack of real warmth brings such an emptinessand dullnessto the
emotional atmospherethat the man as a rule precipitouslybreaks off
the relationship. In spite of the adhesivenesswhich the 'as if person
brings to every relationship,@ed
he displays
either a rush of affectivereactionswhich are 'as if and thus spurious,
or a frank absenceof
Lvitv.At the verv first

evident in the emotionallife appearalso in the moral structure.Completely without character, wholly unp.in"ipG[E-iiETii66-meaning
of the term, the morals of the 'as if individuals, their ideals, their
convictions are simply lgec!,ol1g|.-1"qtlg_f95g!,
good g. bjg.
Attaching themselveswith great easeto social, ethical, and religious
groups, they seek, by adheringto a group, to give content and reality
to their inner emptiiffiTn?-esirblisfrEi validity of t heir exisrenCe-Ey
GTerfitnisiastii idhe.enc" ro one philosophy can 6e
,
@.
@![?l'_*lttgtryiil,itfeoem-oq1o-1r,ql-!iiet'iE-denbe-t-ria-da-ry111,the quickly and completelyreplacedby anothercontradictoryone 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 defenseagainstthe realization
accidentalregroupingofthe circleofacquaintances
ofthe like.
of forbiddeninstinctualdrivesfi-the other,a seekingof externalreality
A second characteristic of such patients is tlgltlgggSltllig,
quite
in an effort to avoid an anxietfiaden fantasifuplganalysis disclosesl .
understandable
from what has alreadybeen said. Like the capacityfor
areal F
that in the 'as if individual it is no longer afifict of represgign-but
identification,this suggestibility,too, is unlike that of the hysteric for
v
normal relationship
The apbiieiltv
apparently
lis.
iit-[er!!.
6.. orbu.iec-i
-,.^
' *to the
. . ,world
- . : -n
\ rhe
whom objectcathexisis a necessarycondition;in the 'as if individual
is
the
expressiol
of
and
t
imitativeness
!$Sigt!L
=eg9.notr,q.Jg"*U!9
t--,-...!--=.----.r.
the suggestibility trust be zscribed to passivity and auto:Ir-aton-like
a mimicry which resultsin.anostens-ib-ly
wrth tne
the e
envrronment,
catronwlth
catlon
. .:- <rE_
ident$cation. Uany initlal criffil
acts, attributed ro an eroticT6iigood adaptationto the world of reality despite the absenqeo:Lgble-ct
age,are due insteadto a passivereadinetsto be influenced.
*
1
Another characteristim
'
fi. ttrat aggressive
Further consequpncesof such a relation to life areglgryplelgly
tendenciesare almost completely maskedby passivity, lenffi!@r
passiveattitude to the environmentwith a highly plastic readine"sto
which,however,is readily
c"'gofu
Gt"ltG
Ff< ui-iignais from the outei-w-orldand-to mold opes-elfand,onels
convertibleto evil.
behavior accordingly.The identificationwith what other peopleare
One of these patients, a woman, and the gl!-y_"tr_[{ of one of the

7a

EMOTIONAL DISTURBANCE AND SCHIZOPHRENIA

1930s Al\D 194Os

oldest gg[!g fqgllies in Europe, had been brought up in an unusual

atmosphere.With the excuseof official duties,and quite in accordance
with tradition, tlrlgi3re_ntqdelegltgd-lh-egel-e_.gtd
lgiqin_g.of!!1qir.gtti-ld
to:trang_ers On :ggLaiq..1g,gf&g*dqlt of the week she was brought
. At these meetings th ere was-a fo4q,al
befoje-h9r lpre Lt9_fSl_'a-o-n!tol'
and the new programand other
check of her educationalachievenqgnts,
precep-{ors.
given
Then
g&qt u cool, ceremo-nio3s
iil
h9r
@ry
her
was
returned
todifiG"l,
ihe child
.quarG.t. Stre receiveOl-o
frffith and no ttnderniss tror tre. purents,-nordid punishmentcome
had co-r-r1e
Ai.""tty from them. This virtual lW"*t!ggf..rnlef-p"rents
of her
most
inauspicious
component
Perhaps
the
after
bg1h.
lgr
;eg1
parents' conduct, which grantedthe child only a very niggardlybit of
warmth, was the fact-and this was reinforcedby the whole program
of her education-that their sheerexistlnc.g.BSstr_ongly
_empha_si?
9,
glh gIr
olgt.g@
to
and the pati ent was dri [effi-iiGlfi
egi"lgS yv-qrd

,rt!!gy t_gy,e-r
reg@d

realistiia[y .

In this atmosphere,so lacking in feeling on the part of the parents,

the developmentof a satisfactoryemotionallife could scarcelybe expectedin the child.,Ohowever, that other personsin
n-"*Ug,llg
"Ipgt,
place of the parents. Her situation
the environment would take the
would then have been that of a child brought up in a foster home. In
such children we find that the emotionalties to their o-wnparents;e

Fanitriieoto tffi ttdil;Gqtrt"!

lFiationitrlp te*[-o*-t-49-o-"-41pu,
greaieiaifncuiivperttipqbul rytttt 1r-c*li[ryfcant
develoril-*wiih

-*-^---l-

modlncatrons.
in accordancewith ceremonialtradition, always had
fhG;"ii;;t,
g1gq-ngl"s, each of whom wanted to stand first in the eyes of the
parents and each of whom continually sought the favor of the child.
They were, moreover,-freqlellly :!p-qged. Tf rqtlgh_og!.bSr
whofeahildperson
could
havpserved
who loved her andlvho
hood therewas no one
-----t'

!::!'_-.gr[qt1ls"_iobi99i_r91]sj.

As soon as she was able to conceptualize,the patient immersed

thg pa_tgnts.
Sheattributedto them
herselfintgnsivelyin fantasies.abo-qt
provi{ed
yv,ith
p_oygl-l
was
which
through
she
things unatt_ai1qlle
_dlyr".:
Everythin!-sheabsorbedfrom storiesand legends
io
*' oiCiinary?ortals.
Se elaborateO
iiif6-ttrernyttrq.bqy!!". palg$s. No longingfor_lovewas
they all had the aim of providinga
ever expressedin these.funlqsieg;
with
tlre real parents-sep4rated
meeting
them
hTfiissistic gain. Every' *---'-:.-..
*.

.. :-. -?

\.

'

\r'/t't/
L/

ktL

79

further from the heroesof trer im3g,nation.In this manner there was
----.._
formed in the chitd a parentalmyth, a fantasmicshadowof an oedipr4s
situation which r"tiiliiEd"1n_9;n_U-i-._Us9 far as real persons and
emotionswere concerned.Not only did reatitywhich deniedher parent
ffi-tioiitrips l6adto narcissisticregressioninto fantasy,but this process
gained further impetus from the absenceof any substitutive objectlibidinousrelationships.The frequentchangeof nursesandgovernesses
and the fact that these persons were themselvessubjectedto strict
discipline,actedon orders,and usedall availablemeasuresto makethe
child conform to the demandsof reality, measuresin which a pseudo
tendernesswas consciouslyused as a meansto attain didactic ends,
precludedthis possibility. The child was trained very early to cleanlinessand strict table manners,and the yi-otgn!og-lbJeakq-gf
angerand
rage to which she was subject in early childhood were successfully
Urougiitunder c<introl,giving *ay to an absolutelypliant obedience.
Mirch iif thii-disCffiaiy corltrol was attainedbv app33!to the parents
so that everything the child did which was obedient and proper she
referredto the wish or commandof the pythical father and mother. 4
When she entereda convent school at the ase of eieht. she was
completelyfixedinthe.asifstatein;FEhffidanalysis.
Superficially,there was no differencebetweenher life and that of the
averageconvent pupil. She had the customaryattachmentto a nun in
imitation of her group of girls. She had the most tender friendships
which were wholly without significanceto her. She went devoutly
through the forms of religion without the slightesttrace of belief, and
underwent seductioninto ma@r
or-guittsimplyto be like her comrades.
fadedand disappea{ggwiqhou!ne}v
rttt"fg"nts
Inlipjk_rytt
fa$asi9_*g]459rtqpbge. It disappearedas her parentsbecameclearer
to her as real personsand she devaluatedthem. Narcissisticfantasies
gave way to real experiencesin which, however,she could participate
onlv throughidentification.
{nalysis disclosedthat {bs sqqcessof her earlytrainingin suppressing
instinctual drives was only apparent.It had somethingof the 'trained
icElili
and,likeThe performanceof the circus animal, was bound to
the presenceof a ringmaster.If denialof an instinct was de,manded,
the
complied,but when an otherwiseinclinedobjectgavepe.rmisp3!ien_t
sion for the satisfactionof a drive, she could respondquite without
t#

---

tt(l

/-

lll:|Os ANI)

l94Os

ghililglt, !nggg!'_yill,_!itt!9qplilcalign. The only result of the training

was that the drive never cameinto conflict with the externalworld. In
this respect she behavedlike a child in that stageof developmentin
which its instinctual drives are curbed only by immediate external
authority. Thus it happenedthat for a time the patient fell into bad
ggngly, in unbelievablecontrast.l5-heihome environmeniinO eiriy
training. She got drunk in low dives, participatedin all kinds of sexual
perversions,andTffijust as'Cimiord6ieG fhis underwortAas'in ttte
f,iEti's-tbJect,the ffitic grouF,or the politidal moviment in which she
was later successivelya participant.
She never had occasion to complain of lack of affect for she was
her paientr *u,
.never
. - . . _ consciousof it. The patient's relatiffiiffito
strong enoughto enable her to make them heroesof her fantasy, but
for the creation of a warm dynamic oedipus constellationcapableof
shapinga healthy future psychic life in both a positive and a negative
sensethe necessaryconditionswere obviously lacking.It is not enough
that the parentsare simply thereand provide food for fantasy.T[g_ctrild
t-q,a_c*grtain--e-x!en_t
by ttre libidinous-as-tiyity_.of
L\!J_r1o!ll !9 s-edLrc9.$
the parentsin orderto developa normalemotionallife, mustexperience

ttrE-\t;ilih oT; motGf s uJat;S-wblfasilr-inbieiiconsciousseduc\ tive acts of the loving mother as shecaresfor its bodily needs.It must
with the father and have sufficientintimacy with him to sensethe
)RlaV
'qfather's
masculinityin order that instinctualimpulsesenter the stream
of the oedipusconstellation.
This patient's myth bore somesimilarity to the fantasywhich Freud
'family romance'nin which,
however,the libidinal relation to
7 calledthe
the parents-Tfi6Tffissed
is very powerful. By repudiatingthe real
parents, it is possiblepartly to avoid strong emotionalconflicts from
forbidden wishes, feelings of guilt, etc. The real objects have been
repressedbut in analysisthey can be uncoveredwith their full libidinal
cathexis.
But for our patient there was nevera living warm emotionalrelation\)t aFreud designatesas the 'family romance',fantasieswhich have in common the fact
\\ that they all relateto the ancestryofthe personcreatingthem.The typical versionof
'family romance'is 'I
am not my parents'child. Whosechild am I then?'Theusual
llthe
answer
is, 'I comeof a more exaltedfamily'.
,ii
"
Cf. Deutsch,Helene:Zur Genesedes'Familienromuns'.lnt.Ztschr. f. Psa.. XVI.
1930,pp.249-253"

EMOTIONALDISTURBANCEAND SCHIZOPHRENIA

81

ship to the parentsor to anyoneelse. Whetherafter weak attemptsat

object cathexisthe child lglglned to larcfgqismby a processof regression or never succeededin establishinga real object relation as the
result ofbeing unloved is, for all practicalpurposes,irrelevant.
The same dglciency which interfered with the developmentof the
emotionallife was also operativein the formation of the superego.The
.
-shadowysjructure of ttre oeAi
wiTFoutever having come to an inttgTafEtl-an<Iunified
superegoformation. One gains the impression that the prerequisitesfor such a
developmentalso lie in strongoedipalobject cathexes.
It is not to be deniedthat at a very early agesomeinner prohibitions
are presentwhich are the precursorsof the superegoand are intimately
dependenton external objects.Jlgrtificqtlon witf the parents!p -the
resolq!r_ol_,9f
complex bringsabout the integrationof these
!lt9_9e-d1gus
elements.Where this i!.abjent, as it was in our patient,-1tlqideilingjltions remain vacillatingand tran-silgfy.Th" representativeswhich go
6;d[t"p
tha
A;science
remain
in
the
ixternal worlg and insteadof
-itre
oeviiib-i-menaofinnei moials,tnereappeiis a persiitJnt ioentincaii.qnr
with eiternai obiecti. in chitdhood,educationalinfluencesexertedan
ilFibitory eFect onine instinctuallife,-particularlyon the aggressions.
li-Tater life, in the absenceof ?n.aOequatesupelggo, s.treshifts-the
ffionsibility foi her behavior to objects in the external wqrld with
whom she identifiesherself.The passivityof this patientas the expressron ol ner suDmtssl
al
As the result of this weak superegostructure,there is little contact
betweenthe eqoandthe supereqo.andthe sceneof all conflictsremains
external, like the child for whom everythingcan proceedwithout frictio.n if it but obey. Pglh the
a.ndthe passive
^epr-1.t"n]|.i9g!0gg[q"
submissionare expresiionsof the patient'scompleteadaptatio.
n to.the
'current
environrhent.:indimpart the shadowyquality to the patient's
'frt!rsonality.
Thdvalue of this link to reality is questionablebecausethe
identificationalways takes place with only a palt of the environment.
If this part of the environmentcomesinto conflictwith the rest, naturally
the patientis involved.Thus it can comeaboutthat the individualcan
be seducedinto asocialor criminalactsby a changein hisidentifications,
and it may well be that someof the asocialare recruitedfrom the group
of 'as if personalities
who are adaptedto realityin this restrictedway.

82

EMOTIONAL DISTURBANCE AND SCHIZOPHRENIA

l930s AND 1940s

Analysis of this patient revealeda genuine infantilism, that is, an

arrest at a definite stagein the developmentof the emotionallife and
character formation. In addition to particularly unfavorableenvironmental influencesit should be noted that the patientcamefrom a very
old family overrun with psychoticsand invalid psychopaths.
Another woman patient had a father who had a mentalillnessand a
mother who was neurotic. She rememberedher father only as 'a man
with a black beard', and she tried to explain as somethingvery fascinating and wonderful, his absencesas he was moved to and from a
sanatariumand an isolatedroom at home, always under nursingcare.
Thus she br{t
him in fa1!-qs-ypy a
"gy!L?rou4$.!91fullq.-re_pfacing
whom
she
later
called
and
with whom she
_qqyq!-e-IiQgq-man,
had all sorts of experiences,eachof which servedto makeher a s_uperThe prototype for the Indian was the fatner's -ile nu.s",
l-qqlqn._9qing.
whom the little girl saw mysteriously disappearinginto her father's
room. The education and 994$LnC of the child were-lelegate$1o
ltlrses, but despitethis she succeededin establishinga strong-ly,libidinous attachmentto tne vifaUni;mat mother. Her tateiiiiiiiionrhipt
fifrGlements of objectlibidinous attitudes, sometimeswarmer, specially in homosexualdirections,but never sufficientlyto changetheir
'as if quality.
in this patient,
the
of her brother
whom she
developedan unusuall
i

model parts .oJttetbody in c-layin order to facilitateher mirror studies.

Iil-tfi"iour.eof veiJstreotiverbfeo
si;G[iiii;

moaeting
ino *u.io,

a brief time under the tutelageof a sculptress.Unconsciously,it was

the fantasyof displayingrepeatedlyher body to the world. [n later years
shecreatedonly large,very voluptuous,matronlyfemalefigures.These
proved to be weak attempts to recreate the mother she had lost in
childhood to her brother. UltimiffiiTfrE aUairOtji?il5dIptilre 6ffi-udi-c
ffibty because she believed her teacher failed to appreciate her
sufficiently.
Most conspicuous in her childhood was a lnoqbg:li5g_ilq,ilgtiqn of
with whom she was for years co.qplglg[idellified, not in
*lglblgltrer
fantasybut by acting out. Disastrouslyfor both, the brother quite early

83

betrayedunmistakabl".-srl q[ u pry"ttgllswhichculminatedin a caThesisterimitatedallherbrother'sbizarreactivities

tatonicexcitement.
and lived with him inTwo?ldbt fantasy.-Oniy
tt..furiiut ouj".t-

riuiciirioui
cittreiii andioi.piu"".ni

condition as the result

psychotic
brother;only later did I recognize
of an identificationwith her
that the etiology of her condition lay deeper.
I believe this patient is similar to the first despitethe differencesin
their development.In the second,i! _g9e-as_!h4t
a d!_sappaiu-t_ment
_shatmgthel
the
my_s-tq!_igus
abthe
that
with
J9,ry9_ttr-q*qt_{9_!{,relationship
i;nce of tfretiGtir made il _ilnpossiblefol Lqg--!itt!egirl tg-[g{-ip-furir a
iu'fitif[te *Iien hei ietaiionship to he1 ag1!._erw-qs.sh-p,fqn,
and that
fuittr-ef rcmmii6hips to objects remained at the stageof identification.
By such identificationsheavertedher intensehatredofher brotherand
transformedher aggressiontowards him into an obedientpassivity in
which she submissivelyidentified herselfwith hm. She developednoother object relationships.Her superegosufferedthe samefate as that ll
of the first patient.The myth of the fatherandthe very early devaluation
f/
of the mother preventedintegrationof her superegoand left her de- l'
pendenton personsin the externalworld.
A third patient, a pretty, temperamentalwoman of thirty-five with 1i
many intellectualand artistic talents,cameto analysisbecauseshewas
geriesof adventurli. it soon becameclear that, as
. tire.$'af!,e1g-lon-g
the result of a certain combination of circumstances,her interest in
psychonanalysiswas actually U*lnt.elggl il- -llfglulfrt, especiallyin
her profession.While shefrequentlyi;q9k9of her tremendousinterest
in child psychology and in F19ud's i,!e9ry-and iebd- iiiTdlv"ofr-ihGe
subjects,her understa{lnS.9f lnem lvqsexlrqordinalilyjgpgrficial and
her interestentirijli uniEal.More carefulobservationaisltJsiOitrit ttris
vas true not only for all her intellectualinterestsbut for everythingshe
tlid or had evei d-one.Ii-*as surpii.slngto recognizein this woman,who
wirs so indefatigablyactive, a condition so closely relatedto the pseudoaffectivityof the 'as if patient.All her experiences
too were based
on identifications.
werenot so straigniforwaiO
thoughher identi-fications
as were thosebf the othertype of patientwhich is, one mightsay,more
nr()n()Elirmolls
and adheresto but one personor one group at a time,

It4

llrllos ANI) 194(ls

while t[is pjrti"_nltteg so many concurreq!*(9q[ficatiors-or symbolic

representationsof identifications-that her conduct appearederratic.
Shewas, in fact, considered'crazy'Uiitrose wfroffiiltrer. fier triends
however had no notion that her appqrentlyricLlife conge.alg$
a.s-evere
lack of affect. She had come to me becauseof ? wish to ctrangqher
is, to create more peace and haim6ny in riei life by
ffi;"t";-that
iO6nlirvingherself with a' pjrtlglgly,.Lo! td_p{ol$golal per99n{jg,.
After six months the analysisappearedto be unusually succe-ssful.
The patient learned to uililerstarrd many things about hers-elfand lost
her eccentricities.She determinedto becomean analvstand when this
was deniedher, she'c6llapl"A,!!"fy"s Jompletelytact<ingin agect and

-.:8g!g!r.l:{ilt.lojryplvtWOq!-I+msq_e-uply jJlrayerrpfe-elu&s.'

It transpired that prior to analysis she had got into serious financial
difficulties by breaking off various friendshipsand love relationships
and had realized that she would soon have to work. It was with this
intention that she cameto analysis.$1plan was to becomean analyst
by identification with her analyst. When this proved impossible,this
-de6mingly
very irble and activti woman changedinto a compietelypasperson.
sive
From time to time she had extraordinarilyviolent fits of
childish weeping or outbursts of rage, flung herself on the floor and
kicked and screamed.Gradually, she developeda progressivelack of
affect. She became comfti;tefy-negati"v1lir_C
.tnd met dit interpretaiions
iittr, 't tion-t underitand what you miin by tfrat'.
'-At
t*o piointsin this patient's developmentshe had sufferedsevere
trauma. Her father was an alcoholic, and the patient often witnessed
his brutiiiiitreitment
bf thri ;i;ihei. She sided vihementlv with the
iatteiunO, *hen shi was only ."u"n, hud faltasiesjl which sherescued
her mother from her misery and built a little white cottagefor her. She
-sivtiii'enery
penny bnO'workedhard in school to attain this aim, only
to discover that her mother was not merely a passivevictim of her
husbandbut took pleasurein being brutalized.The consequentdevaluation of her mother not only deprived her of her only object of love
but also
of an independent,adequatepersonality.She spent the rest of her life trying to
make up for this lack by creatinga whole seriesof identifications,in
the sameway as the 'as if patients.
Deprived of tendernessand affection in her childhood, her instincts
remained crudely primitive. She vacillated between giviirg lh6e in-

EMOTIONAL DISTURBAAICE AND SCHIZOPHRENIA

85

stincts free rein and holding them in check. Shes:!9d out prostitution
often giving the
of sexualp-e-fv,qnions,
-t!j3:i"., indulgedin a,variety
emerged.frorythele debauchesby idenif"it",llig o{ lvqgqa-nia.!-he
perso-nand achievedbv this meansa
conventional
s9m:
t$gatiatr ]Y!!!ron the particular object. This
depenfint
frnd of sublimaiion,theTorm
resultedin a frequent shifting of her occupationand interests.So loqs
as it was possiblefor her either to retain sucha relationshipor to allow
-herself
very primitive drives she was not aware of
the [ietincation"of
-heitackofdffect.
The following casesof emotional disturbancebear close similarity
'
with the 'as if group but differ in certainrespects.
./ .
A seventeen-year-oldboy of unusual intellectualability, came for \t{

analysisugg*..:*g!gr
gl&r-t_!g5gIg4l!y--ig_d-1*c-o11c1o-9a!9!-.f
feeling. This lack of emotion included his homosexualobjects, about
He was obse*ssiornlly
wiiffi he created all sorts oflg.ugttglgllegg!.
was passivelvoral and anal
He
;9r^upulo,g-s-,_!n9_d9-!1.-ej-ac!3$ry.!ia-Ute.
in his homosexuality.T6e-analysiswas extremelyrich in materialbut
progressedin an emotional vacuum. While the transferencewas frequently representedin his dreams and fantasies,it never became a
conscious,emotionalexperience.
One day I gave him a ticket to--e*!9119lg[.!,":g1e.l.i!-y!i9.!*! was
taRinEp[itlH went to mile6ture and had severeanxiety on the stairs

re"anEEl$

lllisly.I"-ihe,qlahs-

iii6nce,-irre-ililt;;basanto progress.
witha fatherwho
An orilvcfiildTroma highitcuiilied environment,

was strict and ambitiousand a motherwho dedicatedher life to this

sufferedthefateof affecand talentedson,he nevertheless
handsome
he y'
tive deficiency.The fact that h=gw IP_tn31_?-1q9!P!9l9jtt-V!r-tqh
withtenderness
neverneededto seekfor love,thathewasoverwhelmed
n
it11{
to
obtai
y
effo
rt
wittr6uilt vrnsto maktin!
ry-d-bp.g:yll-cltl e
He remainedQSg.lqtg pflg.rftiypi-ttSUlgtUpl
srri,vings
f9r q9q{e_r1qss.
impulses,and becausetherewerefew infantileanxietieswhichwere
in him to
,,..,i;;.ae,t-iiff with ltr"pulg-y-'-!g:{ihi }.4a-no'riotineffim
biiitd up defensemechanisms.

when
of his ego-ideal
of the depreciation
He untlerwentthi i;;;"
rni.
hediscovcrcdthathisadmiredfatlle-iils un-culii..yated;ndlltiiiido.
t h r c i r t e n e dt o d e p r e c i a t eh i s o w n v a l u e , f o r h e w a s l i k e h i s
r.cirlizalittn

lil;

ll,.l0s

f a t h e r , b o r e h i s n a m e , : r n d h c l r d h i s r c s c r r r h l l l r ' r ct (c) h i r r r r c p c i r ( c t l l y
s t r e s s e db y h i s m o t h e r . T h r o u g h r i g i d i t y a n d s t r i c t n e s s ,i n c l h i c a l a n t l
intellectual demands, he strove to become better than the sclf which
was identified with the father. In contrast to the previous patients, he

gl-objesl1'9ig_lqt !4elq[y lFself ryitlrt !_ele9_

Ilqt"3a-of having
emotionalrelationships
to people,he was split intolwo identificitions:

5n-"*id iriru"r,ove?moiheiana
ttreoitref*iih trtsri;h;;. iG nr.r*u,
g_i;_$g.vle'_C,-""i
fggry!-"*etdsex_ualiZJcl$resqeoqg1v-11"lllgf
narcisgistic.
Unlike the 'as if patients,
!:_:_rrybt999l_leg|< ptfeeling. He
compIeteIy Iac!g_{t_tl"--gqglgg_gl_{g-.$
whi ch would have gi ven w armth
to his emotionallife. He had no relation to a_nJwoman, and his friend-

shipswil[ e_eJL-\-v*q-{_e__qlQ9l_puretv_iljilidi,yt,f
rhe
:'sqgly*s,ex_ual.

t.\t0ilr)\\t

i\Nl I lll.lllr

feelingshe had were of a characterhe woulf,nbJTet himself express.

Thesewere very primitiveaggressions,
the wildest,most infantilesexual drives, which were rejectedwith the declaration,.I feel nothing at
all'. In one way he told the truth; he wasreally lackingin any permissible
feelings,that is, in the tender, sublimatedemotions.
The tendency to identificationis characteristicalso of this type of
affectivedisturbance.Even thoughthis patientdid not completelysink
his personalityin a seriesof identifications,the strongestsectionof his
ego, his intellect, lacked originality. Everything he wrote and said in
scientificmatters showedgreatformal talent but when he tried to produce somethingoriginal it usuallyturned out to be a repetitionof ideas
which he had once graspedwith particular clarity.
TltSlqqgelqf to
g,qllrple_1dg!!93!l_9$qc_c-Uqgdontheintellectuallevel.
puti;a ;fthi. e.oup, i ihirt)"y;;tdffi;ied
fi;th;r
woman who
camefrom a family in which there were many psychotics,complained
about lack_ofemotion. In spite of good intelligenceand peffifity
te3fng, she led a sham existenceand she was alwaysjust what was
suggestedto her by the environment.It becameclear that she could
experiencenothing except a completelypassivereadinessto split into
an endlessnumber of identifications.This condition had set in acutely
after an operation in her childhood for which she had been given no
psychologicalpreparation.on recoveryfrom the anaesthesiasheasked
if she were really herself, and then developeda state of depersonalil
zationwhich lasteda year and turnedinto passivesuggestibility
which
concealeda crippling anxiety.

t)tslllllt\\(

\\l)\(

ltll,(l1'lllil.Nli\ 8;

( ' o r r r r t r o tl to i r l l l l t c s c c i t s c si s ; r t l c c p t l i s l t t t ' b i r n ct cl l ' t h c p r o c c s so l ' .

s r r h l i n r l r l i o lw
r h i c h l c s u l t s b o t h i n : r l i r i l u r e t t l s y n t h e s i z et h e v a r i o u s\
i r r l l r r r t i l ci d c n t i l i c a t i o n si n l o a s i n g l e , i n t e g r a t e dp e r s o n a l i t y ,a n d i n a n
\
i r r r p c r ' l t c t .o n c - s i d e d ,p u r e l y i n t e l l e c t u a ls u b l i m a t i o no f t h e i n s t i n c t u a l J
strivings. While critical judgment and the intellectual powers may becrccllcnt, the emotional and moral part of the personality is lacking.

'l

hc etiolosv of such conditionsis relatedfirst. to-_a devaluationof

of the child's perthc ob.jcctservingas a model for the devElopment
sonality.This devaluationmay have a firm foundationin realityor be
trirccable,for example,to shock at discoveryof parentalcoitus at a
pcriod of developmentwhen the child is engagedin its last struggles
irgrrinstmasturbationand needssupportin its efforts towards sublimation. Or, as in the case of the boy describedabove, the successful
suhlimationmay be interferedwith by a sexualizationof the relationship
to an object who should servethe child as a model for its ego ideal, in
thisinstance,agrosslysexualidentificatioffi
Another cause of this kind of emotional disturbanceis insufficient
stimulusfor the sublimationof the emotions,as the resulteitherof being
giventoo little tenderness,
or too much.
Infantileanxiety may suffera similarfate. Too harshor too indulgent
treatment may contribute to failure in the economicformation of del'cnsemechanismsresultingin remarkablepassivityof the ego. It will
be recalledthat in the caseofthe boy reported,an attack ofanxiety not
only mobilizedthe transferencebut alsoopenedthe way to his recovery.
'as if persone./The questionmust be raisedas to how the tendencyof
aliliEfio identificationwith current love objectsdiffers from the same
tendencyin hysteria.The greatdifferencebetweenthe latter and.the
'as
if distiirtiairCetiEi-in ttre fact that the objectswith which the [ystericSicldntify themsblvesare the objectsof powerful libidinous c4th-

j_v.t"I"il_ry!::,',9"."13[gstllu'{rrr4glll.Igglglru-d
"'"::
so ieprestnts a way out of the conflict. Ig_lq!_!f -pa!ieilts,-3lr---e-grly
ile nCitnC-iTn-fneOevef,opment of .ffe6l."du"" t the i n4e1-c,onflict, the
which
effe?-6T-ilEi-cli r3*tn *poveiilf-ment of th; ffi
d;""Iity
"l
which doesnot occur in hysteria.
The patients described here might make one suspect that we are
dealing with somethinglike the blocking of affect seen especiallyin
narcissistic individuals who have developedloss of feeling through

Itlt

l1):]Os ANI)

l940s

repression.
personalitytries to simulateaffectiveexnerience,whereasthe indi-if'
vidual with a blocking of affect doesnot. In the analysisof the latter it
can always be shown that the once developedobject relationshipsand
aggressivefeelings have undergonerepressionand are not at the disposal of the conscious personality.The repressed,affectively toned
segmentof the personalityis graduallyuncoveredduring the analysis,
and it is sometimespossibleto make the buried part of the emotional
life availableto the ego.
For example,one patient had completelyrepressedthe memory of
his motherwho died when he was four, and with whom, it was clear,
the greaterpart of his emotionshad beeninvolved. Under the influence
of a very weak but none the lesseffectivetransference,isolatedmemories gradually emerged.At first these had a negativecharacter and
deniedall tenderness.During analysisthis patientshowedalso another
Beforeanalform of emotionaldisturbance,namely,depersonalization.
ysis his self-satisfactionhad been unshaken. He defended himself
againstthe transferencewith all his power. In the analytic hours, when
clear signs of a transferencein statu nascendiwere perceptible, the
patient would complain of suddenfeelingsof strangeness.It was clear
to the perceptio*r.gfa
that in him the qgpg9g13lk[.fj9"*p94$
was due ro a
cj_l!g-e-in catt'"il:Tt ffii-ffi-s
-new
libidinal stream emergingfrom repression,or to a suppressionof
feelings connected with transference.The inner conflict in such an
'as if
instanceof repressionof affect has little similarity to that of an
patient.The analogyrestsonly on the affectiveimpoverishment
in both.
The narcissismand the poverty of object relationshipsso characteristic for an 'as if personbring to considerationthe relationshipof this
defect to a psychosis.The fact that reality testffi-ffifiyfr6inffied
lrom our conceplronof psychosls.
removesthrsconclrtron
Nlaicissistic
idEntificatlonas a pieliminarystageto object cathexis.
and introjectionof the objectafter its loss,areamongthe most important
discoveries of Freud and Abraham. The psychologicalstructure of
melancholiaoffers us the classicalexampleof this process.Jn m-elaninternalized,
hasbeenpsychologically
cholia,theobjectof identification

tydniCiisupareeoctliiG ofrJhEbfrflictwithttreincorp,6raiea
;d
"
gqig_cli9_co-Tplglg
w91ld,ln 'asif paof theexternal
jldependence
tients, the objects artjTepfeifernal aiid all conflicts are acted out in

EMOTIONALDISTURBANCEAND SC]HIZOPHRENIA 89

relationto them. Conflictwith the superegois thus avoidedbecausein

tasiF
itsetfitrrougtt
suborOinates
act thE - - - 1 ego
.*rt
-Y----' - ' i *-*-t*triilervery
';of
Ia
n
i
u
t
t
r
o
ritvwhich'has
the wtshe!_lnqcgmq1anol- -- .
identifica.tton.to
nei"ei Ueenintrojected.
--Fi6m
t"fi; U"ginning,both the personalimpressiongiven by the patientsthemselvesandthe psychoticdispositionin the family, especially
pect a schizin the first two analytilaf
directly
ophrenicprocess.The tracingofthe severepsychicdisturbance
back to the developmentsof early childhoodseemsto me completely
justified, and whether this speaksagainstthe diagnosisof a schizophrenic processmust, for the time being,be left undecided'Mf--o-b-qgr!-114!-the
vations of schizophrenicpatients have g-iven-4g-th!rill-P-I9-s-s!9-4.
sc hi z<ipTiieiii6 proc.i:ii goei l fi iglg b an l a-sifl p-hq9-e-p-efg,reiI -b-tlildq q.p
t ne .teiusian-arroi.t-.-1,;";tu-t wo-vear-oldschizophrenic girl lame to

or

',,;;ri;;;.utut
m-alif

.'-

staie shehad led an

Patients' Her bond to

. ind whoffiTi@Fdut-

ui
vr
r"rE
v ! r q v r v u " ' rlrllrrg
studies,
her
place
residence,
of
these relatronshlps, she-hanged her
stllndlnS,

WOmgn,

was

cxtllllcllllllttllre'

nD 4 rvJurr

rrndher interestsin an almostmanic fashion.Her last identificationhad

lctl her from the home of a well-establishedAmerican family to a
communisticcell in Berlin. A suddendesertionby her object led her
t|rm Berlin to Paris where she was manifestlyparanoidand gradually
tlcvelopeda severeconfusion.Treatmentrestoredher to her original
srilte,but despitewarnings,herfamilydecidedto breakoff the analysis.
'l'hc
girl was not ableto summonenoughaffectto protest.One day she
lroughta dog and told me that now everythingwould be all right;she
rvotrkl imitate the dog and then she would know how she should act.
t(tcntrhcarronwas rera-iftd-6TlfilT-nolongerlimited to humanobjects:
it includedanimals,inanimateobjects'concepts,and symbols,and it
wirsthis lack of selectivitywhich gavethe processits delusionalcharrrctcr. It was the loss of the capacity for identificatloq wit-l'Lhuqan
'
which muttET6.tiUtetne erectionof
ol'r.jccts
for yearshad had a recurrentdream
ffint
irr which in great pain and torment she sought her mother but could not
liltl hc1 ltccirttseshe was always faced with an endlesscrowd of women,
c t r eh o l ' w l t o n t l o o k c d l i k e h e r m o t h e r . a n d s h e c o u l d n o t t e l l t h e r i g h t

EMOTIONAL DISTURBANCE AAID SCHIZOPHRENIA

90

91

193Os AND 194Os

one. This dream reminded me of the stereotyped,recurrent mother

'as '
figuresin the sculptureof the second if patient.
'multiple personality' as the result of a processin
Freudsspeaksof
which numerous identificationslead to a disruption of the ego. This
may result in manifest psychopathology,or the conflicts betweenthe
different identificationscan assumea form which need not necessarily
be designatedas pathological.Freud refersto a purely inner processof
'as if identificationswith
ego formation, and this doesnot apply to the
objects in the outer world. However, the samepsychologicalprocess
'normal'
will also in the 'as if' personalityon one occasionhavea more
resolutionand on anothera pathologicaloutcomewhich may be more
or lesssevere.
Anna Freud6points out that the type of pseudoaffectivityobserved
in 'as if patientsis often found in puberty. I believethat the depreciation
of the primary objects (also typical of puberty) who servedas models
for the egoideal, plays an importantr6le in both. Anna Freud describes
this type ofbehavior in puberty as incurringthe suspicionofpsychosis.
I believethat the reflectionswhich I havepresentedherewill also serve
for puberty. At one time the processwill lie within the bounds of the
'normal' and at another it bearsthe seedsof a pathologicalcondition.
'schizoid', whether or not schizoThe type justifies the designation
phrenialater develops.
Whether the emotionaldisturbancesdescribedin this paper imply a
'schizophrenicdisposition' or constitute rudimentarysyr4p,lcms-of
SfiTopFreniai5 not clear to me. Thesepatientsrepresentvariantsin
the series of abnormal distorted personalities.They do not belong
amongthe commonly acceptedforms of neurosis,and they are lgry!
adjustedto realilty to be calle{ p;ychotic. While psychoanalysisseldom
Succeeds,the practical results of treatment can be very far-reaching,
particularly if a strong identificationwith the analystcan be utilized as
an active and constructiveinfluence.In so far as they are accessibleto
analysis,one may be able to learn much in the field of ego psychology,
especiallywith regard to disturbancesof affect, and, perhaps, make
contributionsto the problemof the'schizoid'whichis still so obscure.
In the great delusionalformationsof the psychoseswe seeprimitive
5Freud:The Ego and the ld. London: Institute of Psycho-Analysis and Hogarth Press,
1927.
6 F r e u d , A . : T h e E g o a n d t h e M e c h u n i s m so f D e f e n c e . L o n d o n : H o g a r t h P r e s s , 1 9 1 7 .

rrnd archaic drives returning from the depthsof the unconsciousin a

dramatic manner. Regressiontakes place becauseth"Jgghut fuilgd.
and assumethat the reasons
We speakof this ut u'Jglgg{j$o'
lirr this failure are psychological,constitution,or organic.Psychoanalysis can investigatethe first of these, especiallyin prepsychoticconditionsto which thesecasesbelong.

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Data
Main entry undertitle:
Essentialpaperson borderlinedisorders.
(Essentialpapersin psychoanalysis)
Bibliography:p.
Includesindex.
l. Borderlinepersonalitydisorder-Addresses,
e s s a y sl,e c t u r e s . L S t o n e ,M i c h a e lH . , 1 9 3 3 II. Series.
R C 5 6 9 . 5 . 8 6 7 E 8 7r 9 8 5
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Viii

C()N'I.ENTS

14. BorderlinePersonalityOrganization,Otto Kernberg

279

15. The Grinker Study, RoyGrinker,Sr.,B. Werble,

and R. C. Drye

320

16. The Typesand Prevalenceof Mental lllnessin the

Biologicaland Adoptive Familiesof Adopted
SeymourS. Kety,et al.
Schizophrenics,

357

17. The Basic Fault, MichaelBalint

385

Part tV. 1970sand 1980s

4ll

Process,
18. A Studyof the Separation-lndividuation
MargaretS- Mahler

433

19. DefiningBorderlinePatients:An Overview,

John G. Gunderxtn and Murguret T. Singer

453

20. The BorderlineSyndrome:Evolutionof the Term, Genetic

Aspects,and Prognosis,MichaelH' Stone

475

with the BorderlinePatient,

21. The Countertransference
Harold F. Searles

498

22. Crossingthe Border Into BorderlinePersonalityand

BorderlineSchizophrenia:The Developmentof Criteria,
Robert L. Spitzer,Jean Endicott, and Miriam Gibbon

527

23. Borderline:An AdjectiveIn Searchof a Noun,

Hagop S. Akiskal,et al.

549

References

569

Name Index

571

SubjectIndex

s73

Acknowledgments

We wish to gratefully acknowledgeAlienistand Neurologrsrfor C. H.

Hughes,"Moral (Affective)Insanity-PsychosensoryInsanity," Vol.
5. pp. 296-315, 1884.
We wish to gratefully acknowledgeJournal of Nervous and Mental
Diseasefor Irving C. Rosse,"Clinical Evidencesof BorderlandInsanity," Vol. 17,pp.669-683,1890.
We gratefully wish to acknowledgeThe PsychoanalyticQuarterlyfor
permissionto reprint Adolph Stern, "PsychoanalyticInvestigationof
and Therapy in the Border Line Group of Neuroses," Vol. 7, pp. 467489, 1938;and HeleneDeutsch,"Some Forms of EmotionalDisturbanceand their Relationshipto Schizophrenia,"Vol. 11, pp. 301-321,
1942.
We gratefully wish to acknowledgeAmericanJournal of Psychotherapy
for permission to reprint the following; Melitta Schmideberg,"The
Treatmentof Psychopaths
and BorderlinePatients,"Vol. l, pp.45-70,
1947;andMichaelH. Stone,"The BorderlineSyndrome:Evolutionof
theTerm, GeneticAspectsandPrognosis,"Vol. 31,pp. 345-365,1977.
We gratefully wish to acknowledgeHuman SciencesPressfor permission to reprint the following from PsychiatricQuarterly:Paul Hoch and
Phillip Polatin, "PseudoneuroticForms of Schizophrenia,"Vol. 23,
pp. 248-276; and John Frosch, "The Psychotic Character: Clinical
PsychiatricConsiderations,"Vol. 38, pp. l-16,1964.
We gratefully wish to acknowledgeThe Menninger Foundation for
permissionto reprint from the Bulletinof the MenningerClinic, Robert
P. Knight, "Borderline Statesin Psychoanalytic
Psychiatryand Psychology,"Vof. 17,pp. l-12,1953.
V/e gratefullywish to acknowledge
InternationalUniversitiesPressfor
permissionto reprint the following: Edith Jacobson,ON THE PSYC'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 acknowledge
InternationalUniversitiesPressfor
pcrnrissiontcl reprint from the Journal of the AmericanPsychoanalytic
A.tsttcitttirn
the following:I-eo Stone,"The WideningScopeof Indi-