Discussion

Dr. Shaw's careful and detailed presentation of a clinical case gives us the advantage of exploring the many layers of psychic function, the multiple determinants of behavior. In this sense, I should like to make a few comments.

If we define the central pathology of Larry to be based on a disequilibrium between the ego and drive impulses, one can then postulate that there is an insufficient defense against aggression and libido. He exhibits an offensive behavior, where there should be a defensive restraint; there is enactment, and acting out within the therapeutic relationship. Thus, it appears, that Larry's ego and superego are relatively weak or unable to stem the invasion of drive expressions. The patient speaks too freely about his fantasy to kill his father, to castrate the therapist, and to have sex with his mother.

These expressions were not the result of analytic work, which intends to free the repressed, but are rather offered with the wish that the therapist should help him to deal with his conscious free-floating fantasies. One would have expected that such wishes would lead to symptom and compromise formations, to displacements to secondary objects. It appears that the one significant defense against the danger of drive invasion into the ego are his ritual formation and his compulsive behavior. These can be understood as an attempt to establish ego control and they give him magic power to achieve it. If we understand these rituals to be a help in finding a restraint against his drives, to protect the ego, to establish a sense of ‘me’ versus ‘not-me,’ then they are not the results of anal conflicts, but function as an assistance to accomplish some integrity.