Clinical and Theoretical Aspects of "As If" Characters

Samuel Atkin, in his introductory remarks, stated: "Helene Deutsch's clinical observations of the 'as if' character in 1934 proved to be a notable event in the development of psychoanalysis. In spite of the relative rarity of these cases in psychoanalytic practice, Deutsch's presentation takes its place alongside the great case studies of Sigmund Freud in advancing psychoanalytic nosology and theory.

"Deutsch's characterization of her patient proved to have a value far transcending psychological portraiture or character typology. With the keen discernment and penetrating judgment of a great clinical observer, she presented a group of character traits and a description of behavior in certain vital areas of ego functioning which, in their interrelationship, added up to a unique and distinct mental type that proved to have great implications for normal and abnormal psychological theory and that presaged some of the major developments in psychoanalysis in subsequent decades.

"One has only to list the salient characteristics of her case to see how she focused with prescience on the interrelated psychological faculties belonging normally to a definite developmental stage—i.e., the two-year-old level. This obligatory interrelationship is only now being more definitely established in psychoanalytic studies. Deutsch described (a) the primitive stage of object relations without object constancy; (b) the poor development of the superego with objective anxiety still predominant; (c) the prevalence of the primary identification process; (d) the lack of a sense of identity; (e) the emotional superficiality and general poverty of affect, of which these patients are unaware; and (f) the lack of insight. This lack of insight, prominently featured by Helene Deutsch, is one aspect of the narcissistic state of these patients. It is also a consequence of their underdeveloped or disturbed reality function which devolves on the state of object cathexes. Their reality testing is suff