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DISCUSSION: Dr. Martin Stein thought that it was sufficient to note the importance of the early mastery of breathing and to point to its continuing role in the
personality without separating a preoral phase. Libidinal phases are generally correlated with forepleasure and perverse activity in adult life, and not exclusively with symptoms or fantasies. In some patients expulsion of feces and air are thoroughly entwined in fantasy life and evoke the same defenses. He questioned Dr. Bell's assumption that the organism is a closed energy system without considering the dimensions of time.
Dr. Judith Kestenberg discussed the idea that there is an optimum combination of drives for one individual's own rhythm and suggested that the ratio consists of libidinal, aggressive, and initially neutral energy. A good proportion of neutral energy may prevent early somatic disturbances from having undesirable effects. She took issue with the author's concept of premastery, and suggested that one thinks of the function of organs as a model rather than as a precursor of future ego functions. In the clinical material she believed that the patient's complete shift of cathexis from the anal to the respiratory may be considered a pregenital conversion.
Dr. Max Schur questioned the hypothesis of a permanent coexistence of mental and somatic energy. He reminded the author that in asthma we are dealing with bronchiole spasm and questioned the idea that the same muscles are involved in defecation and early respiration. He also questioned whether content and symbolic meaning should be relegated to a hypothetical preoral phase.
Dr. Bell, in concluding, noted the paucity of Oedipal material, which appeared in her patient only after the pregenital fixations had been worked through.