Meeting of the New York Psychoanalytic Society

December 5, 1952. THE FUNDAMENTAL NATURE OF THE DISTINCTION BETWEEN NORMALITY AND NEUROSIS. Lawrence S. Kubie, M.D.

This represents the culmination of a series of attempted formulations beginning with A Critical Analysis of the Concept of a Repetition Compulsion in 1939. The subject of this research is not the totality of the differences between the sick and healthy person, but the essential difference; specifically, what are the criteria by which we can diagnose a single isolated act or unit of behavior as normal (healthy) or abnormal (sick)? Kubie comprehensively dissects the inadequacies, fallacies, and semantic quagmires of the well-known, and explicitly or implicitly accepted, theories on the subject, namely, the phenomenological (symptomatic), the sociological, and the ontogenetic. The last has passed through three period: the Kraeplinian, the Meyerian, and the psychoanalytic. Kubie maintains that the psychoanalytic theory suffers from the same basic limitations that beset the two less sophisticated approaches because it fails to establish a recognizable distinction between psychological illness and health.

In earlier formulations, Kubie stressed the inflexibility and repetitiveness of neurotic behavior. He stated that the repetitiveness stemmed from the fact that neurotic symptoms were in part substitutive (symbolic) gratifications which could never gratify, with the inevitable consequence that no neurogenic conflict can heal itself by reaching satiation. Later, he differentiated between normal repetitive behavior, which is essential for survival and learning, and neurotic repetitions which are automatic and obligatory. In 1949, Kubie came close to his present view: 'Whenever most of the determining psychological forces are conscious the resulting conduct will merit being called normal… On the other hand, where unconscious processes dominate or where conscious and unconscious forces pursue incompatible goals, then the behavior which results will des