The Building of an Obsessional Neurosis during the Analytic Treatment of an Obsessional Sado-Masochistic Adolescent Boy

Anna Freud noted that, at his diagnostic assessment, Ronnie, a 13¹/₂ year old boy, was not a true obsessional neurotic. After 4¹/₂ years' analysis I can say that he is not cured of his conflicts nor is his obsessional neurosis fully confirmed. This paper sets out to try to distinguish between the phenomena present in the clinical material and the theoretical implications.

I must therefore try to assess if the difficult, often despairing, frequently tortuous analytic treatment, has clarified the state of Ronnie's mental health. Have I understood the significance of his symptoms in relation to a specific diagnosis? Had there been any permanent shift in his psychic structure? Has the ongoing, collusive, sado-masochistic relationship between the parents and himself proved too great a barrier to complete internalisation of his conflicts? Has his ambivalence remained too out of balance to allow libidinal and aggressive fusion? Has his ego remained too split to provide an economic defence structure or to synthesise his bi-sexual contradictions? Has his adolescent developmental process worked against the re-alignment of his psychic forces? Has the technique been inadequate, the analyst's fight to avoid sadomasochistic involvement too unsuccessful and the counter transference too great to enable Ronnie to gain insight into his internal world and resolve his conflicts?

Undoubtedly little has changed in his parents' attitudes in spite of the P.S.W.'s painstaking work with them. I shall not try to discuss this, noting only that the parental pathology and attitudes prevalent at the diagnostic stage have basically remained the same.

Ronnie, aged 4¹/₂, was taken by his mother to a Child Guidance Clinic because of his appallingly bad relationship with her. The round-faced curly-headed cherub, as described by his psychotherapist, was hard to reconcile with his mother's description. She saw him as torturing his parents, endlessly talking, frequently grunting, unable to occupy himself or ta