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To the Editor:
Karusu (vol. 55, number 3) attempts to integrate the conflict model and the deficit model, correctly observing that the conflict-deficit dichotomy proposal by Kohut splits neurotic disturbances from characterological disturbances.
However, Karusu bases his integration mainly on the clinical observation that deficiencies and conflicts can occur at various phases of development and maturation. In doing so, he ignores an underlying metapsychological confusion inherent in the duality itself.
The distinction between conflict psychology and deficit psychology, apart from any argument on its clinical merits, confuses theoretical levels of analysis with the nature of reality itself. Clinical data can be interpreted cognitively as structure, or affectively as process. Cognitive deficit and conflict between affects are not mutually exclusive categories but different ways of looking at the same data.
I propose that both psychology and metapsychology are needed to “see through” this clinical duality and many other dualities prevalent in psychoanalysis.