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The author outlines the evolution of her theoretical concepts of ego development and pregenitality against the background of her accumulated clinical experience and the expanding analytic theory of the past twenty-five years. Therapeutic efforts with extremely difficult cases led to the concept of a permanent predisposition to anxiety determined by early and prolonged traumata in the prenatal and neonatal periods. Particularly noxious were disturbances in the mother and gross impairment of integrity due to anatomic anomalies or extensive disease processes. Later studies elaborated the adolescent and adult consequences of these early extremes and concomitant primitive anxiety: inability to think and act adequately, to synthesize experiences, and make solid identifications; inability to sustain object relationships; diffuse feelings of loss of body integrity, overwhelming anxiety, and erotization of the anxiety itself; and the clinical entities of the perversions and psychopathies. Studies of fetishism emphasized severe disturbances in the developing body ego, distortions in preoedipal development involving overly close dependence on mother or sister, absence of sustaining experiences with father, prolonged confusion in sexual identity, and shattering traumata centering around witnessing various evidences of maternal castration. The feeling of genital fault is so deeply impressed on the body image that only a poor recovery from the basic disturbance is achieved; instead, a severe fixation results which contributes thereafter to a continuing distortion of all levels of subsequent development.
All libidinal phases are normally present in incipient form in the first year of life as part of the biological inheritance of the human infant. The maturational rate of each varies markedly from the rest, and the succession of their maturational peaks underlies what are commonly described as discrete libidinal phases. The timing of these peaks is normally dependent upon bi