Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Elisabeth Geleerd noted the interest in the past two or three decades in the preoedipal preverbal state. Previously it was thought that analysis could only go as far back as the period of development of speech and secondary thinking, but work with psychotics and children has expanded our goals so that in less sick patients preverbal stages are analyzable in the transference as affective states. Disturbances in sleep, oral aggressive and oral libidinal drives are analyzable. In Dr. van der Leeuw's patient, there was a fixation to the undifferentiated phase of ego development. In such cases, transference is not only a repetition of past events and past affective states, but it is also the ground on which arrested development can unfold itself and delayed development can be completed. This is comparable to a sudden spurt in development in the conflictfree sphere in the course of child analysis after working through. However, the maturational process cannot occur if deprivation was too early or too intense or too prolonged. Dr. Geleerd wondered whether the patient's depression was an identification with the mother and an attempt to reach her. The prevalence of depersonalization and fugue in the undifferentiated state appears to be related to estrangement within the self; it results in flight from the object and then in a fantasied re-establishment of union. One explanation of this patient's adolescent difficulties is the common experience of partial regression to the undifferentiated phase in adolescence. In one sense, the patient's creativity might be her reaching out for the love object.

Dr. Augusta Alpert emphasized the clinical picture of maternal deprivation in this case, and then described how the patient might appear as a child of four in a therapeutic relationship. In this fantasy, Dr. Alpert outlined a therapeutic program for restitution and need fulfilment, and for testing the reversibility of the process. As identifications with th