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Dr. Ingram has presented us with a thorough and scholarly review of the compulsive personality. With every major change in psychoanalytic theory, earlier ideas are reconceptualized with a new focus and a new emphasis. Each time we look at the elephant from a different perspective, we discover more about him, and gradually we come to know his complexity in ever greater detail. I'd like to present still another view of the beast, this time from the outside in.
There are four levels of description that can be brought to bear in any clinical situation: (1) historical-a recounting of the significant events and relationships in the person's life; (2) observation of behavior-what we note about the individual's behavior in a variety of situations; (3) psychodynamic - the person's motives, fears, and defenses; and (4) structure. My own emphasis is on the critical need to understand the character structure first, and then to interpret behavior and dynamics on the basis of that understanding.
Why are early experiences (that is, historical events) reenacted over and over throughout life? Why do instinctual drives generate a particular pattern of affect and defense, a pattern that is repeated again and again-the dynamic view? Why do the child's resentment over unmet dependency needs and counterdependent and obsessive defenses persist into adult life? Why does anal erotism and all its behavioral correlates persist in the adult character? The Horney view of the genesis of the compulsive disorder is a historical one and is described in dynamic and interpersonal terms. Why does this history carve itself in the personality as in stone? Will uncovering of this interpersonal history be adequate to bring about the changes we seek in treatment, or is something more required for the recovery process? Why is there a blocking of impulse and affect? What generates the fear of insanity - the fear of loss of control or of falling apart? What is meant by “inner untidiness?” As Dr. Ingram points o