Neurotic Ego Distortion1

In the admirable paper with which he opened this symposium, Dr. Gitelson devoted his attention mainly to the clinical aspects of the subject and spoke about human beings in action, whether in the everyday world or in the analytic room; he spoke, that is about the concrete facts from which we have abstracted our theoretical concepts of ego structure and ego function. Furthermore, he gave us specific case material concerning one particular person at sufficient length and in sufficient detail to provide a clear picture of the kind of problem he has in mind, and to enable us to call up analogous material from our own experience.

It would be a mistake, I think, for me to attempt anything similar in this necessarily short contribution. I hope to continue in the clinical orientation which Dr. Gitelson has introduced, but my remarks will be more in the nature of obiter dicta on various aspects of the subject.

We have become very familiar with the idea that in our work as analysts we are likely to find ourselves faced with a formidable task, in that the patient's ego is by no means whole-heartedly on the side of the new ally it has enlisted, but rather contains a powerful fifth column, if indeed it is not dominated by such a force. In this way it has come about that the contrast between the ego-dystonic symptom and the ego-syntonic perversion has become much more blurred than it appeared to be when Freud originally drew our attention to this antithetical relationship. Thus we find ourselves involved in what Alexander long ago described as analysis of the total personality, even in the case of patients with neurotic symptomatology. I think, however, that our symposium relates largely to the problem we are accustomed to call character analysis, which covers a large area of present-day analytic practice, and includes the special case of training analyses.

The reference I made just now to perversion leads me on to another point of similarity between perversions and ego distort