Reply to Carmeli

It was a pleasure to read Ronnie Carmeli's reply and to try to think through some of the links that she made to other thinkers. I would like to share some of my thoughts about them and how their work relates, or does not, to the model I put forward. Her reply also gives me the opportunity to bring in some of the material I had to cut out of the article due to length and I'm grateful for that.

Carmeli begins with the mention of Ghent (1990). His essay has never spoken to me very much. Ghent keeps his discussion on a high level of abstraction and invokes notions like the true self, which put me off. I'm drawn to system-thinking and structure, and the obscurantism in notions like the true self often hide more shallowness than actually illuminating any depths. As Carmeli points out, his main idea is that healthy surrender is “the letting down defensive barriers” along with seeing a perversion of this in masochistic submission. Much earlier, Horney (1937) in her study of masochism already made the distinction between the general tendency to lose oneself in misery and self-destruction vs. losing oneself in healthy ways. In her adaptation of Nietzsche's thoughts on the Dionysian principle she writes:

The obtaining of satisfaction by submersion in misery is an expression of the general principle of finding satisfaction by losing the self in something greater, by dissolving the individuality, by getting rid of the self with its doubts, conflicts, pains, limitations and isolation. This is what Nietzsche has called… the ‘dionysian’ tendency and he considers it one of the basic strivings in human beings, as opposed to what he calls the Apollonian tendency, which works toward an active molding and mastering of life. (p. 270)

I can certainly agree with both Horney and Ghent that behind defensive walls, the idea of losing oneself, of finding oneness with the object, can

become distorted and destructive. However, I don't think there is an easy mapping of surrender and submission onto echoism and masochism, as Carmeli implies. As I show in the article, there is a sequence of altruism, to echoism, to masochism and what can be described as “submissive” behavior exists in all these positions. Altruism is the natural, undefended position in which a repetition with a parent, sibling, or their substitute is possible. Echoism is taking over the place of the parent or sibling imago of death or the good imago and also goes along with the suppression of one's active-egoistic pole and the projection of one's power into another person, a group, authority figure, (etc.)1. Masochism is the return of the masochist's own repressed sadism, from his or her active pole, that unconsciously allows the masochist to identify with the sadist. Berliner (1940, 1942, 1958) divined the repetition of experiencing hate from a parental-substitute which I have aligned with altruism. This can certainly appear as submission since the person is staying with a romantic partner, boss, etc. who gets angry with them, doesn't satisfy the approval they are looking for, can make them walk on egg shells, and with whom they feel it is presumptuous to ask for more respect. Identification with the death or good imago in echoism can be expressed in problems with saying No, helping others who aren't grateful or take advantage of the echoist, and also can be associated with situations in which the individual is not treated fairly and can therefore be called submissive too. As I indicated, these issues center around not having access to aggression to be assertive and put up boundaries. There are also PI defenses that make the echoist expect and fear that other will see them as bad, selfish, be angry with them, or want to leave them. Additionally, a lot of this can simply be expressed as part of the repetition-compulsion in which there is no conscious pain-seeking but one is unconsciously driven to re-live one's ego injuries or give them to others. When it comes to masochism proper, the person is not just paired with someone who doesn't treat them with respect, but someone or something who is actively torturing or tormenting them. Submission with the tormentor ranges from

not standing up for oneself, not leaving and often making excuses for them, to conscious enjoyment of losing all control and giving it to him, of being his plaything, and, if not pleasure in pain, at least some relief in it. My clinical experience shows that the person can't let go of the sadist until they recognize that he represents their own sadism and fulfils their unconscious need for punishment. I will have an example of this shortly.

Carmeli writes that “if the caretaker is a malignant Narcissist and an abuser, the child's devotion turns into submission: The Echoist may turn into a masochist.” After the beginnings of personality are laid down during psychosexual development, the altruist or echoist may find a narcissist who mistreats them later in life2. In this mistreatment, it is possible that the echoist's active-power pole reacts and sadistic and controlling impulses are repressed. In this case, they can form masochism proper in which they projectively identify with the tormenting object. However, these sadistic and controlling impulses need not come from a narcissist's mistreatment. I have worked with many addicts who were in masochistic relationships with a sadist but when we traced their own sadism back, it arose for different reasons. For example, sometimes the parent or parental-substitute was simply impulsive, reckless, thoughtless or careless and this made the individual very angry and feeling impulses to want to control the individual. Sometimes, due to psychic bisexuality, the individual was functioning on both poles and they had simply been mean, cruel, possessive, etc. with a sibling or friend (without being impinged upon or disrespected themselves by this person). The masochist repressed these feelings and is now with a partner, boss, parent, etc. who treats them in the same way as they treated or wanted to treat someone else. Sometimes, the masochist plays this out with the idea of God, fate, or some impersonal or superpersonal being or force who wants “to beat [them] …destroy [them]… break [them] down… [and] will win.”

Although the masochist's own sadism is a component, bad conscience and the unconscious need for punishment is also a major part of masochism3. Let me give a clinical example:

Client has had a few sessions of associating some of her current issues back to her controlling and abusive ex-husband. This session she reports that as bad as it was with him, some of her family still talks to him and are friendly with him. I ask client if she's expressed her disapproval and she tells me that she has and that they downplay its importance and express that they want to know how he's doing. Client feigns disbelief with their answers and tells me that “he'll still be fucking with [her] when he's 70 [years old].” Instead of focusing on her relationships with her family and determining how clearly she is letting them know her needs in regards to her ex, I try to determine how she really sees her ex-husband now. I ask client to describe what kind of person fucks with someone until they are seventy and how she sees him now that they've been divorced for a few years. Client tells me that “he won't listen”; “he doesn't care what anyone else wants”; “doesn't see anybody but himself”; “he pushes himself on people”; “he uses everyone, even the kids”; “he is not capable of love”; “he is absolutely disrespectful to everyone but demands respect for himself”; “anyone he says he loves is a possession for him.” I ask client if it feels like anyone can stand up to him or stop him? Client tells me that “short of the police tackling him, nothing stops him.” I repeat the last part as a question “nothing stops him?” Client tells me that “he just doesn't care” and that he “even doesn't care about himself,” and tells me about how he once destroyed everything in their living room. Client appears inside of herself and like she is no longer trying to get me to understand, and echoes herself “he doesn't take anyone seriously… he just doesn't care.”

I turn all of these into E&O statements and ask her to see if anyone comes to mind from her past with them. I tell her that she should

3. I have also seen examples in which an individual's repetition of abuse, rape, and putting themselves in risky situations in which this could happen, came from a primal scene identification with the assaulted/castrated parent by the other parent, romantic partner, etc.

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include herself in the past as well, and to not get hung up on a single statement and to just see who pops into her mind. After I read them, client tells me that she thought of her father and of herself. I ask her to focus on both and to see who gives her a bigger reaction. After BLS, she tells me that thinking of “[her]self feels bigger.” I ask her how big it feels and she opens her eyes wide, puffs out her cheeks a little, and tells me that it's “pretty big.” We discuss that she's in control and she can shut this down at any time if she doesn't feel up to it. She agrees and I ask her to think about the time of her life that she's thinking about and see what memory comes to the fore and to see how her body reacts. After BLS, she tells me that she feels it the most in her throat and that she thinks of after the divorce when she began doing drugs daily. She tells me that she thinks of her disregard for her daughter and “disregarding her feelings and what she needed” and that she “didn't see anybody else but [her]self.” I ask client what her daughter needed. Client answers that “she needed a mother… guidance,” in a very frank way that feels painful. I ask client what she told her daughter when she was reaching out like this to her? Client tells me that she would say that she “needed this time for [her]self” and adds that this “was super selfish” and that she “had total disregard for anybody… but especially for her [daughter].”

I gave examples of how the descriptions of the sadist can often be used to get back to a time the individual saw themselves in the same way in previous work (Pederson, 2018). In Freudian terminology, the sadist can be viewed as part of a narcissistic object-choice in which one is attracted to who one was in the past. The sadist can be viewed as part of the Talion Rule of the unconscious need for punishment in which one deserves to get what one gave, or wanted to give, to someone else. The masochist can also be said to projectively identify with the sadist, with the statements about him as narcissistic, bad, selfish, etc. is how one viewed oneself. The primary thing in this relation appears to be a defense against shame, since guilt must always be conscious, as Freud points out (Pederson, 2015, 2018). As the example above shows, it is better to live with the fear of being eaten by an external threat, who one can escape at times, than to be eaten by one's own bad conscience, which one can never escape.

In regards to Hegel's master and slave binary, I do not see it as mapping onto the egoism vs. altruism binary. Instead, I understand it as expressing the active pole alone. Two egoistic self-consciousnesses “each aim at the destruction and death of the other” and one overcomes fear of death and the other doesn't. The important outcome in Hegel's story is that the master gets to enjoy things “without qualification and without reserve,” he “exists only for himself,” and instead of relations of reciprocity with others, things are “one-sided and unequal.” Hegel points out that in the master's victory over death it is “not an independent, but rather a dependent consciousness that he has achieved.” The slave, by retaining his transference to the perfection of authority, instead of becoming his own perfection/authority in narcissism, continues taking on more knowledge in his profession or work. “The consciousness that toils and serves accordingly attains by this means the direct apprehension of that independent being as its self,” Hegel writes, “shaping or forming the object has not only the positive significance that the bondsman becomes thereby aware of himself as factually and objectively self-existent.” The slave gets to express his own subjectivity through his work. Hegel has stages of self-consciousness (stoic, skeptical, unhappy consciousness) in which the expression of one's subjectivity gets to increase. However, even in early stages, when one is not inventing or innovating something important or new, one's subjectivity can still be enjoyed in the work. I think about the master as a narcissist who is buying homes, cars, and carrying

on in conspicuous consumption, while, for example, the slave might be his mechanic. The narcissist is “enjoying” and showing off his nice car but the mechanic understands how it works and can have some pride in his work. Many of the mechanics I have worked with will “tinker” on things outside of work and come up with their own ways of doing things even if they aren't big innovations (ex. not designing a new type of engine but figuring out their own shortcuts and tricks). By understanding the car, the slave is engaged with it in the way that the narcissist is not. Hegel is clear that what is at stake is forming the discipline to take on more knowledge and “[w]ithout the discipline of service and obedience, fear remains formal and does not spread over the whole known reality of existence.”

Carmeli posits that an individual can be both master and slave and that the narcissistic and echoistic can exist in the same individual. I will turn to the latter idea later on, but I don't think that Hegel's binary allows for the possibility of co-existence. So far as one is an egoist, who is striving to take on the perfection one sees in higher education or training with a more skilled person one is not a narcissist who believes perfection is in oneself. The narcissist who has withdrawn perfection from higher authorities won't go on to learn more. To be precise, they can of course have moments in which they can take on new information but, as Hegel expresses:

Should consciousness shape and form the thing without the initial state of absolute fear, then it has a merely vain and futile “mind of its own”; for its form or negativity is not negativity per se, and hence its formative activity cannot furnish the consciousness of itself as essentially real. If it has endured not absolute fear, but merely some slight anxiety, the negative reality has remained external to it, its substance has not been through and through infected thereby. (Hegel, 1910, section 196)

One must fully face the fear of the perfection of authorities who have higher degrees, more skill, and do better work than oneself and fully puts one's ego ideal upon them to strive for their perfection. If one retains “a mind of one's own” in which one is perfect and only sees the flaws in one's bosses, teachers, or parental-substitutes, then one “shuns death” and will never win truth which takes one being “utterly torn asunder”

by the perfection of the knowledge and skill in the authorities. Although there is certainly death anxiety for an egoist, there is also the death of the ego ideal, or the death of the idea of perfection one strives for, that is also important in the psychopathology in egoism.

In Carmeli's use of Hegel's master and slave binary, she recapitulates the binary of narcissism and masochism. The masochist is seen as the castrated narcissist. The masochist is the narcissist who would be egoistic but is afraid of death. While the echoist may have repressed her active pole due to the death anxiety faced there, I have seen many cases in which it was repressed due to the fury and homicidal impulses that the echoist experienced on that pole. In other words, it was not facing her own death but not being able to face that she would cause the death of the object that led to repression. As I wrote in The Economics of Libido , there is always a tendency to derive Eve from Adam's rib, and relate everything to the principle of power. Even Horney, who otherwise has excellent phenomenology in her discussions, always seems to bring things back to the echoist's power, control, or attempt to rid herself of them. However, there are straightforward cases of echoism that arise from the loss of a loved one, and love and belonging are equal principles to, and not derived from, power. The fact that that restoration impulses were obscured by Klein's thoughts on reparation and hitherto have not been formally paired with destructive impulses as the two fundamental expressions of the id shows how strong this tendency has been.

Both Carmeli and Auerbach emphasize the egoistic fear for one's one life, but what I want readers to understand is how Eros—how love—means that we can have altruistic injuries in which our compassion for the object becomes repressed. I would like to share another clinical example:

During some history taking, client with social phobia and depression talks about his “obsession” with a sport. He says he would “zone everything else out,” “nothing else mattered,” and when he had a bad game, he would have thoughts that he was “lucky” to have gotten on the team and that he was letting everyone ese down. I ask him if there's ever been anything else he has felt this strongly about and repeat some of these thoughts as object statements. Although he first says no, I can tell by some blinking that there was another thought. I encourage him and tell him that even if every statement

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doesn't feel right or he has some misgiving, that he should share who came to mind. He shares about a girl he had liked, beginning in the 7th grade, and how he had “no confidence,” “sleepless nights,” “the biggest crush.” I ask about any regrets he has for not letting her know how he felt. He says that he would have been worried that she would have thought he was “an idiot.” I ask him to see if he could imagine approaching her to do so in his mind's eye and explain that I want to see how powerful his reaction might get. He tells me that he pictures himself “nervous, trembling, shaky, and sweating” and has the sense that she would see him and think “weirdo.” I ask him to stay with this and compare it to his current social phobia and he tells me that they are the same feeling. I ask him to think about the last time he felt worried that people were going to find out that he is a weirdo and he recounts a story. The emphasis is just that the world is divided between long term friends and others who he feels inhibited with and who are about to see that he is very different (in a negative way). I ask him to imagine that it had come out that he is a weirdo and what he imagines would happen. He tells me that he would “develop a reputation” and it feels like even his friends would “turn against [him]” and he ends up “totally alone.” I ask him about his family and he first says that he'd be homeless and all alone, but then pulls back and says that he could picture himself “alone in [his] mom's basement… doing nothing… no one to talk to.” I ask him if it feels right to picture himself there or if it still feels like even his family would turn their backs on him. He pauses and then tells me that he imagines them “turning [him] out” and him being “on the street” because he's “too much of a burden.” He says he imagines that his mom and family would try initially but repeats that he's a burden and that they would feel like “we can't keep doing this.”

In this example, we see that the ego injury came from my patient seeing the social death of his grandfather. Others didn't visit him, saw him as a burden, and akin to a weird outsider and my patient identified with this social death. In other cases, I have also seen the self-reproach of being a burden as a melancholic introjection that came from the altruist's anger towards the object he was helping. The altruist seeks to help the object get out of a rut, leave a bad relationship, or get a better job but the object doesn't change or get better. This causes an ego injury and the altruist identifies with the unchanging and burdened object and now will frustrate those people who seek to help her in this PI4. Along with fully being outside of life in the maternal and the partial death of the paternal, this combined parent phase expression goes along with symbols of literal death or undeath in the form of skeletons, corpses, etc. as seen in the vignette. I had initially included this phase in the article but cut it due to length. I'm glad to have the opportunity to write about it here.

Carmeli suggest that Winnicott and not Green should be credited with

the death imago. Although I cited Winnicott in the article, I put forward Green as getting the closest to the structural approach. However, neither him nor Winnicott defined the death imago as being outside of life, as being paired with an id drive of restoration, as forming character and specific repetitions in (projective) identification with it, nor as being in dynamic relation to the good imago. Neither did they give phase specific expressions of it, nor stage specific examples of individual death (outside of Space and Time) to social death (outside of society, classes, and family/groups). The article sought to complement the place that perfection had in Freud's work with death so that the complexity of structural theory could be appreciated. Winnicott might have touched upon some individual facets of what I put forward, and I won't be surprised if I find other earlier thinkers that have done so too, but if psychoanalysis is to evolve it can only be through systematic thinking that will yield testable hypotheses, and not the valorization of one's favorite analyst nor a particular school.

Carmeli expresses that she is unsure of my use of projective identification and that adhesive identification might be more apt. I can only say that I'm attempting to look at things structurally and that identification with the parental imago, whether it is perfection or death or the further instantiation of the obstructive object or the good object seems best covered by a single term5. I chose clinical examples that show the reversibility of PI so that the statements elicited by how someone else might see one, can be shown to be how the individual had initially experienced a parental substitute. As I wrote in my reply to Auerbach, the psychodynamics of these identifications with imagos is the basis of Freud's concept of character and central for anything that could be called a psychoanalytic theory of personality and motivation.

As with Ghent's binary of submission and surrender, I don't see adhesive identification as offering much that's new. As I quote him in the paper, Freud (1923a) certainly recognizes that people who have had many

loves in their lives have “vestiges of their object-cathexes in the traits of their character” (p. 29). I tried to be consistent in my use of identification and refer to primary identification as what forms a parental imago or internal object and that it is the basis of the superego. Then, secondary identifications are examined from whether the object is put in the place of the ego or of the ego ideal/superego. At the ego level, it is only a matter of imitation and at the superego level identification goes with becoming perfection, death, the obstructive, or the good imago and has a lot more baggage that goes with it. Namely, every identification with the superego object is also a projective identification in which one can pass on the ego injury to someone whose codependency pattern fits, or can be made to fit, with the person. Additionally, the grandiosity, the depersonalization, the compulsive character, the inhibited character, etc. at different levels of superego authority will determine the magnitude of such character traits. Thus, when approached structurally, it seems to me that only one term is needed with the idea of becoming or usurping the place of the imago.

To the extent that Bick and Meltzer's use of “disintegrated, disorganized” maps on to depersonalization, they are onto something similar to what is traditionally called masochism (Meltzer, 1975, p. 295). However, Meltzer's descriptions of adhesive identification appear to mainly describe individuals who are “sticky,” with values that are “very external” and who are “looking in the mirror of other people's eye all the time, copying other people, imitating, fashion conscious, preoccupied with manners and social forms and social status” (Meltzer, 1975, p. 297). This notion is problematic for me in two ways. First, this was already part of Horney's “moving toward” type that relates to her account of the Dionysian principle and masochism. She writes:

In sum, this type needs to be liked, wanted, desired, loved; to feel accepted, welcomed, approved of, appreciated; to be needed, to be of importance to others, especially to one particular person; to be helped, protected, taken care of, guided… we find here inhibitions in regard to being assertive, critical, demanding, giving orders, making an impression, striving for ambitious goals. Also, because his life is altogether oriented toward others, his inhibitions often prevent him from doing things for himself or enjoying things by himself. This may reach a point where any experience not shared

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with someone— whether a meal, a show, music, nature— becomes meaningless. Needless to say, such a rigid restriction on enjoyment not only impoverishes life but makes dependence on others all the greater. (Horney, 1939, p. 51-53)

As I said in the article, Horney and others who wrote about masochism already grouped all the relevant phenomena together. My use of the term echoism goes along with understanding the passive pole in its own terms and not defining it as castrated egoism or deficient narcissism (Pederson, 2015). Additionally, as has been said before, Horney was not a Neo-Freudian but a neo-Adlerian and she severed the ties to the id drives, ego and object drives, and had an atomistic conception of the individual that gave primacy to belief instead of seeing beliefs and ideals as being underpinned by drives and imagos. Although Bick and Meltzer's Kleinian orientation is closer to my own, I don't see adhesive identification as providing anything beyond what Horney, Freud, and other writers on masochism have observed in passive pole dynamics.

This brings me to the second problem with Meltzer's description, which is that the pre-occupation with the external, with one's image, and social status is also something we can say about some types of narcissists. The concept of adhesive identification does not offer anything with it to differentiate between what I see as issues between active vs. passive forms of narcissism and echoism, it doesn't differentiate between different types of altruists/echoists, nor does it offer any phase-specific descriptions. I titled my article as “towards a structural psychoanalysis” because I only offer the beginnings of such a project there. I agree with Meltzer that ego identifications, imitation, or mimicry are very important in the passive pole and I have given this idea a parallel status to the importance of mastery in the active pole. However, the work to be done in this area is to determine the mimicry that is part of altruism and the type of mimicry coupled with PI echoism in the different phases. Then, following the intermixture of Eros and death in the active pole, its participation in the narcissism there needs to be disambiguated from passive pole instantiations.

Carmeli, following Meltzer, also brings up the idea of two-dimensional space being involved in the articulation I offer of depersonalizations as vanishing to the outside of life. I heartily agree with the importance of

the move from 2d to 3d space, as well as different relations to subjective time, when conceptualizing psychopathology. However, when a patient vanishes or moves outside of life to another dimension/space, they do not describe the experience of their body there as being 2d. Moreover, in other cases of depersonalization at this stage, patients first describe themselves as going into a 3d ball (a literal ball, a crumpled-up piece of paper, etc.) before they vanish. I mention in the article that black holes have shown up in my clinical work and they, along with geometrical shapes, seem to me to be examples of 2d phenomena that would be part of an earlier stage. I cannot agree with Carmeli's conjecture here.

Like Auerbach, Carmeli appears to be concerned about my lack of counter-transference statements. As I shared in the reply to Auerbach, I certainly work with counter-transference, but the vignettes in which I work with the transference the patient has to others allows for more precision with capturing the specifics of the repetition. As a case in point, Carmeli mentions confusion about my use of PI for the example of longings to dissolve or merger with the object (whether it is a person, the environment, etc.). I was able to have my patient anthropomorphize the universe and describe how it might see him in this state and he gave me “you're exploding… I'm trying to gather you up… I'm a jar and trying to contain you, trying to repair you, fix you.” He was able to say these statements about his father, get into the altruistic ego injury it had caused him to see his father this way and the id impulse of affection that went with it. I worked with the transference my patient had to the environment and saw no evidence that the transference involved me, so I don't believe my counter-transference feelings would be relevant to this specific symptom. Moreover, working extra-transferrentially allows the patient to directly make the link to who he has identified with himself and therefore there's not the same suspicion that I am offering interpretations of who I think it is and representing these interpretations as curative.

I wrote in the article that I saw this patient as in echoistic PI already, and that in this PI he got the further ego injury of seeing his father in a bad place, which was tied to the affectionate id impulse of hugging. Thus, my patient identified with the good parental imago, then as this imago for which he felt compassion because this overstimulating id affection was repressed. Then his compassionate, affectionate feeling was projected into the environment/universe while my patient identified with

his father's longing to explode and merge with the universe. In other words, he identified with his father's explosion and dissolution and then identified projectively with the universe who would be the one to try to gather him up and fix him as my patient wanted to do with his father. Now, I could be wrong, and my patient's compassion for his father might be part of a combined parent phase and not from a previous PI with the good imago. In other clinical instances, I have seen the PI of this phase go along with wanting to merge and become one with the environment or object. However, this may also be an example of the multiple instances of identification/introjection that Klein has written about. If the latter is the case, then perhaps it would be better to term this secondary PI, with the idea that primary PI is becoming the imago and secondary PI is the further projection that involves ego injuries incurred while in primary PI. Regardless, I will definitely write about future findings here and share the relevant clinical material.

Lastly, Carmeli ends with an invocation of paradox over dialectics, and with the caution that there are no pure types. I work with many borderline and low-functioning patients and I certainly see pure types of narcissism and echoism. Even though my other higher functioning patients are less of the pure type, I wouldn't change my statement that echoism requires the suppression of the active pole. Instead, I think that there are two important ways of thinking about these differences. First, in the article I sketched a political typology in which the passive pole is represented by socialism in primary narcissism and the liberal in secondary narcissism. In the era of secondary narcissism, I indicated that more competition and power comes into the passive pole, just as more cooperation and desire for belonging comes into the active pole. Thus, I take the pure types I see to be examples of regression from secondary echoism to someone who is only functioning in primary echoism. Second, I see that more of my high functioning patients have gone past the maternal and paternal phases, and the shame that defines them, to form a post-oedipal guilt conscience. As I've written about in past work, overcoming the paternal Oedipus complex leads to a further phase of the sibling imago in which more self-assertion comes into the passive pole and more belonging comes into the active pole (Pederson 2015, 2018). The altruist feels guilt in that he owes it to himself to be more assertive while the egoist feels guilt in a better sense of equality with others that indicates

more belonging with them. Resolution of the paternal Oedipus complex and having consolidated this phase takes emphasis off the ego and object drives of the earlier phases and can give the individual more resilience after disappointments in love, regrets in work, and other ego injuries occur. Third, in the article I draw attention to the re-transcription of authority from the paternal to the maternal imago . Lacan (1993, 2007) has a concept of foreclosure which is similar, but it is tied to psychosis. To my mind, Bergler's re-transcription allows for the conceptualization of borderline states in which the intermixture of the drives at the paternal phase is lost and to which a further psychotic defense may or may not be added.

In the article, I further made a note that my clinical experience indicates that the non-universal, combined parent phase does not seem to follow this bisexual suppression of one pole. I surely see people who seem very much in strong conflict with themselves and are conscious of their ambivalence, but they are rare. It is more common for me to hear unconscious conflict between the two poles and for the person to not be aware of this because the striving on one of the poles is dissociated. Higher-functioning echoists, in contrast to those who are conscious of their opposing, bipolar desires, simply have access to more assertiveness on their passive pole because they had family conditions that allowed for the full internalization of the superego.

In my view, Carmeli's valorization of paradox over dialectic represents the hermeneutic approach to psychoanalysis that has been around since the 60s. It allows for the discussion of dualities, and then paradox is used to shore up some of the contradictory elements in the issues that one is discussing. I disagree that dialectics are “opposed” to psychoanalysis and, as has been noted by many, Freud has many forms of dialectical thinking in his work. In my view, it is paradox that is at odds with psychoanalytic thinking and has stunted more rigorous and precise formulations in its model of mind.