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The analysis is reported of a man whose history revealed an abundance of traumatic situations and a preponderance of regressed pregenital and sadomasochistic strivings. Conditions for the formation of good object relations and healthy identifications were far from favourable. Nevertheless the all-over result was an amazingly positive and ego-syntonic one. Important sublimations were formed, libidinal strivings found acceptable expression, and lasting object relations were established. The report aims at understanding how such successful character formation became possible in such difficult circumstances.
The operative factors are summarized as follows. The patient's capacity for melting together defensive patterns with slightly modified instinctual gratification was an unusual one. His ability to fit his adult sexual life into the frame of the curing-healing-giving compulsion may have preserved him from more serious potency disturbances and allowed him to obtain a substantial degree of gratification. The success of the synthetic function in integrating the wealth of pregenital fantasies into the realm of the ego may be explicable on the assumption that the ego could continually draw energy from the id, neutralizing it and using it for its own purposes. The ego possessed a particular capacity for sublimation based upon the solid structure of its defences but also on this free line of access to the id. His ability to solve his problems in a constructive way seems to have been rooted in some element of magic thinking, of preserved omnipotence. It was as though these regressively revived features of a primitive ego could be mobilized at will for purposes of reconstruction.