Meetings of the New York Psychoanalytic Society

December 19, 1950. THE ROLE OF SYMBOLIC DISTORTION IN NEUROSIS AND PSYCHOSIS. Lawrence S. Kubie, M.D.

The fundamental difference between neurotic and psychotic processes is discussed in terms of impairment of specific symbolic relationships. All symbols are acquired under the pressure of body needs, appetites, and conflicts. Psychic needs are first experienced as sensory events which arise in early percepts of the parts, the products, the needs, and the feelings of the body. At first there is no conceptualized differentiation between the I and non-I. Consequently, an outside world is apperceived and specific symbolic relationships are established between the inner or body world and the outer world. These are such that each can be used to represent the other. At first this relationship is conscious, later it becomes unconscious. Early in the course of development, concepts and their symbolic representations are vague, broad and overlapping, later becoming more discreet and distinct. In all dissociating processes, such as sleep, the hypnagogic state, toxic states, and fatigue, there is a dropping back from later levels of conceptual development to earlier levels. The specific ingredient of the psychopathological process is the impairment in the relationship of the symbol to what it represents. In the psychosis, the distortion between a symbol and what it stands for occurs at the link between the symbol and the piece of the external world which it represents. In the neurosis, the distortion occurs at the link between the symbol and the body and its internal needs and conflicts.

Dr. Heinz Hartmann commented that while the symbolization involved in language was an ego function (secondary process), analytic symbol formation differed in that it referred to a characteristic of the primary process. He noted further that in schizophrenia Freud believed that this particular ego function was impaired, with the result that words were treated as things, not symbols.