Meetings of the New York Psychoanalytic Society

January 15, 1952. DEFENSIVE INSTINCTUAL GRATIFICATION. Leo A. Spiegel, M.D.

The attempt is made to understand an especially massive and chronic form of acting out. Sachs's theory of perversion as a transference of part of the infantile sexuality to repress other parts as formulated and amplified by Fenichel is discussed. Usually this consists of blocking genital drives by pregenital and partial drives which is termed 'defensive instinctual gratification'. During the analysis of a borderline, unmarried woman of thirty, she developed a transient psychotic episode the main trend of which was betrayal which did not exist except in the instances when she contrived it. The cancellation of two sessions caused her to feel betrayed by the analyst. Asked why she continued treatment if she felt betrayed, she became upset and wondered if she should quit. When she decided not to, she became psychotic, intensely anxious, and dressed like a 'tart'. This represented a defensive instinctual gratification which employed the mechanism of masochistic exhibitionism. She began to masturbate with powerful vaginal sensations accompanied by tender feelings, thoughts and images of the analyst.

This defense process is not considered the same as regression, and it is differentiated from defensive actions pressing 'downward'. Patients who employ defensive instinctual gratification have a wide area of relative lack of differentiation between ego and id. The patient referred to was exposed to fantastic indulgence and deprivation, had difficulties in learning as well as inhibitions in performing her daily ablutions. With a marked discrepancy between instinctual pressure and the possibility of appropriate genital gratification during the Oedipal period, a modicum of safe instinctual gratification is achieved by means of defensive instinctual gratification. Patients utilizing this mechanism do not tolerate the frustration of analysis well, have difficulty in attaining a transference neur