The Repair of the Unconscious

McDougall, Joyce: Plaidoyer pour une Certaine Anormalité (Plea for a Measure of Abnormality), Paris: Gallimard. 1978.

LIKE MOST ANALYSTS MCDOUGALL has experienced a change in the kind of patient coming to analysis. The "good classical neutotic", if he ever existed, is becoming scarce. Severe character problems expressed through acting out are more common. Long analysis gives the neurotic time to find his psychotic dimension. McDougall also observed that the "good neurotics" with their so called "strong egos" are often inaccessible to the psychoanalytic process while others of more amorphous, narcissistic, projective structures, the so called "fragile egos" are able to make of their analyses fruitful and fascinating adventures for themselves as well as for their analysts.

Since these patients present such diversified symptomatology, McDougall eschews diagnostic terms. She does not believe that there is enough evidence for an organized entity called the narcissistic personality. In this book she describes and discusses patients with perversions, psychosomatic manifestations, narcissistic disturbances, acting out behavior. She calls them "the difficult patients." Through her experience of their powerful resistance to the analytic process, to which they seem nevertheless to cling doggedly, it became apparent that the character armor served the function of protecting their very psychological life, not simply their sexuality, as in the neurotics. For "the difficult patients" symptoms are used as a bulwark against overwhelming anxiety and pain in the face of the threat of dedifferentiation, loss of identity, the fragmenting implosion of the other.

Furthermore, these patients inevitably mobilize, in the analyst, his own psychotic defenses. He may be threatened by a loss of identity, his identity as an analyst. So as not to fall in an interminable frozen, mired situation, to keep pace with the patient who seems always ahead of the analyst's understanding, the latt