Meetings of the Psychoanalytic Association of New York

May 18, 1970. THE DECISION-MAKING PROCESS: A CONTRIBUTION FROM PSYCHOANALYSIS. (Annual Freud Lecture.) Leo Rangell, M.D.

Although unconscious and genetic factors clearly play a role in decisionmaking, Dr. Rangell noted the absence of psychoanalytic contributions to the problem. He presented a case in which the central symptom was a paralyzing indecision. The patient had a lifelong history of indecisiveness and of not being able to carry through to completion a task or decision. This was especially evident in his love relationships and his work. As a result his marriage was 'sadomasochistic' with vacillating and contradictory feelings toward his wife; his professional history was marked by minimal achievement, failure to make decisive moves, and consequently an avoidance of success despite abundant training. In his work, his goal was to obtain love and approval from his bosses (father figures) to whom he would promise great things but never deliver.

Using this analytic material as a starting point for discussion of this problem, Dr. Rangell turned to his previously described formulation of a critical, 'microdynamic' intrapsychic process, or sequence, in which he differentiates these essential steps: 1, an experimental conflict that occurs prior to the signal of anxiety in which the ego permits a controlled amount of instinctual discharge to take place and samples the resulting reaction of the superego; 2, the reaction of the superego based on a scanning of previous relevant memories; 3, the appearance of signal anxiety, if it is to occur in this particular sequence; and 4, if so, an ensuing intrapsychic 'choice' conflict in which the ego faces the dilemma at hand and the necessity to choose between two competing psychic systems, which brings to the fore the ego function of decision-making. This 'choice' type of intrapsychic conflict is different from the more conventional type of 'oppositional' ego-id conflict. Succinctly, the intrapsychic sequence is: int