Comment on Dr Morgenthaler's Paper1

In the short time allotted to him Dr Morgenthaler attempted to further the elucidation of the 'confusional' state as it appears characteristically in the obsessional patient. His dynamic formulation of this condition engenders certain technical interventions which he believes are necessary for its resolution. In some respects, the devices that he advocates are reminiscent of those employed by Freud (1909) in his early attempts to deal with such episodes in the case of the Rat Man.

I would prefer to call this confusional state a 'defence style' rather than a simple 'defence' or a 'disintegration of defences' as Morgenthaler does. It may perhaps be an aspect of that larger category of 'cognitive styles' described by Sandler and Joffe (1965).

It is my impression that such states are complex regressive phenomena composed of many elements. They vary considerably from patient to patient in their manifest features. Admixtures of regression, isolation and denial with supporting fragments of projection, rationalization and/or other even more primitive defences can usually be identified. Another term that seems to me to describe the same category of phenomena is 'pseudostupidity' or 'pseudonaïveté' (Mahler, 1942); (Rosen, 1958), (1963). It seems likely that what Freud described as a 'delirium' of thinking in the Rat Man was an example of an attack of 'pseudostupidity'. Although the Rat Man knew the identity of the one to whom the money for his post office package was due, he preferred to pay the debt to someone else. There are many other examples of such behaviour in this case history. In some instances one wonders whether the patient was even consciously attempting to mislead Freud.

Although 'pseudostupidity' has a certain ubiquity as a character defence there are special reasons why it should be such a regular feature of the cognitive style of obsessional patients. In these disorders where symptoms alternate as vehicles for primary process discharge and of superego