On the Limits of the Effectiveness of Psychoanalysis: Early Ego and Somatic Disturbances

Over the past several years I have had the opportunity to observe a group of infants and children who have suffered from early environmental deprivation and/or significant congenital somatic sensory deficits. This population has proved a fruitful medium for the investigation of the evolution of such elements of psychic structure as the differentiation of a sense of self, the differentiation of objects as existing apart from the self, the establishment of object relations, and the development through processes of introjection and identification of such precursors of the superego as both prohibiting and idealized internal object representations. Although my observations are longitudinal in character, the time span they have covered is much too brief to allow me to make more than very tentative extrapolations concerning the ultimate fate of the subjects. Anything I may say about ultimate analysability is therefore necessarily speculative. The data I have to present do, however, seem to me both to have internal consistency and to be congruent with the findings of others who have worked in the area of very early development.

My observations have underscored the importance of recognizing aspects of psychic development which, from the standpoint of the observer, are distinctly maladaptive and yet are not readily conceptualized in terms of trauma and the necessity to cope with anxiety. That is to say, disturbed behaviour, as defined by criteria such as those used by the average expectable clinician, is not necessarily a manifestation of a compromise between conflicting intrapsychic forces. Another common source of psycho-logically determined behavioural aberration lies in the individual's failure ever to establish appropriate psychic organization because of a deficiency in his age-appropriate experience. To the extent that an abnormal psychic state is based on such an aetiology, it does not involve conflict and defence against anxiety. To the extent that the psychoa