Symptom Formation and Character Formation1

To deal with this very broad topic in a single presentation seems impossible. It is not my intention to focus on one clinical constellation. Apart from theoretical reflection, there is a practical consideration, namely the fact that we hardly ever meet with a 'simple' neurosis in our patients. I will therefore try to present a few aspects of the general theme. I do not intend to give a systematic presentation, and in order to make my points I shall elaborate upon themes not strictly falling under the title of this symposium.

It is true that Freud started his psychological investigations with hysterical patients. However, it soon became clear that most patients reveal a mixture of symptoms belonging to different neurotic pictures, for instance a combination of hysterical and obsessional-neurotic, of phobic and depressive constellations.

Freud discovered that the foundation of obsessional neurosis was a childhood neurosis of the hysterical type, and established a close relationship between the symptoms of conversion-hysteria and anxiety-hysteria or phobia, as well as between those of phobias and obsessional neurosis. Moreover, in a number of cases that could be labelled as mainly hysterical neuroses we meet with character traits of a definite obsessional neurotic origin, and the reverse is encountered as well.

Other observations teach us that many patients cannot be classed in a special neurotic category. They show various disturbances: symptoms as well as inhibitions, depressive states, etc., which we usually term 'neurotic disorders', not to mention those with more severe disturbances such as borderline cases, psychotics, and delinquents. In the analysis of neurotic patients we often meet with psychotic mechanisms that may manifest themselves for instance in a kernel of delusions. In addition a mixture of symptoms and character distortions reveals itself in many cases.

In view of these various considerations I intend to try to highlight some as