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The theme of the papers which we are discussing here is so vast that I am impressed by the authors' success in summarizing it. Inevitably such summaries must neglect some aspects of the problems they survey. It is likewise inevitable that the authors should have chosen to dwell more intensively on certain problems that on others.
In my discussion, I shall attempt to point out the areas in symptom formation and character formation where knowledge is scant. If I do so, it is not because I underrate the importance of what we know; I am keenly aware of the great strides which psycho-analysis has made in the four decades since Freud's The Ego and the Id. Nevertheless, many problems invite further study, and I will have to limit myself to a few points suggested by the papers of Dr Lampl-de Groot and Dr Arlow.
The knowledge we have of symptoms is acquired in the process of analysis. In each individual case we deal with a great many aspects of the analysand's life before we can say that we understand the formation of his symptoms. It is well known that the symptom is not an isolated phenomenon; the forces involved in its formation have their reverberations in many areas of the patient's life. Or to put it differently, the symptom is but a crystallization of the patient's various conflicts and of their outcome. We also know that similar conflicts and even similar outcomes of conflicts exist in many people without having led to symptom formation.
Should we not therefore enlarge Freud's formulation of symptom formation, as described by Lampl-de Groot? Indeed, how does a neurotic symptom manifest itself? On the side of the ego, by disturbances of motility, for instance; or by untoward affective states, anxiety, and avoidance of particular situations; or by characteristic disordered thought processes and actions. The role of the ego in symptom formation is thus not limited to defence alone. Some specific, circumscribed ego function