Self Preservation and the Preservation of the Self

The calm assurance and optimism that marked the period of ego psychology have given way to our present condition in which psychoanalysis is constantly challenging itself from within its own ranks. The theoretical premises of metapsychology have been considered by some psychoanalysts to be in serious disarray; others consider metapsychology a useless relic of Freud's materialistic intellectual history. There is an active debate concerning what the philosophers call the “placement” of psychoanalysis—whether it is a science or a branch of history, hermeneutics, or linguistics. The impetus for this turmoil does not arise only from philosophical or intellectual considerations but has, I believe, a definite empirical, that is clinical, base; I believe that our patients have been changing and that the model of the neurosis on which some of our theoretical assumptions have been based has in part become antiquated. It is these clinical issues that will be the focus of this presentation.

My assertion that the forms of the neuroses are continually changing is not something that can be proven by a clinician. It would take a sociologist of the stature of Durkheim (1897) to demonstrate for neurosis what he did for suicide—that its frequency transcended considerations of individual psychopathology. Although my opinion is unprovable, I am in agreement with Kohut (1977) that there has been an actual increase in the number