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The obsessive or compulsive neurosis, according to Kasanin, represents a link between neurosis and psychosis. The competence of the ego is limited by preoccupation
with fantastic fears and magic and grandiose operations of defense. The vacillations between attitudes partially adjusted to reality and demonic wishes and fears deprived of their emotional cathexis calls forth typical symptoms of indecision and elaborate ceremonies by which the compulsive neurotic defends himself against the danger of harming or destroying others and being harmed or destroyed by them.
Kasanin illustrates these concepts by a detailed case history. In the first year of psychoanalysis only a certain amount of alleviation of symptoms was reached without insight into the dynamics of the condition. After this year the patient's entrance into the army accelerated the pace of analysis. The external pressure revealed an abundance of secret autistic preoccupations that encumbered the patient's reality adjustment with fantastic expectations. They originated in his early childhood when the emotional barrenness of an unhappy family life between an erratic, undependable father and a severe, rigid mother left the helpless child in unbearable loneliness. In the destructive atmosphere of this early environment the child developed an extraordinarily ambivalent relationship with death wishes against those he depended upon and a fantastic anxiety of retaliation, which made him withdraw from all intimacy into autoerotic fantasies. In particular his concepts of sexuality became imbued with castration fears and imaginations of other deadly dangers. The revelation of these fantastic childhood fears led to a correction of their character-distorting influence and opened the channels for development towards adulthood.
Kasanin confirms Freud's concept of the obsessional neurosis as a 'fixation on an anal-sadistic level of sexual organization with severe castration anxiety'. The author succeeds in illumina