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Either-Or Dilemmas. Anton O. Kris. Pp. 91-117.
Either-or dilemmas are described as conflicts, characteristically consciously experienced or brought unaltered to consciousness, that are felt by the patient to be insoluble. Invariably associated with intra- and intersystemic conflicts, they are common and pose significant therapeutic difficulties. The usual forms are active genital versus passive libidinal wishes; homosexual versus heterosexual wishes; independence versus dependence; affectionate versus sensual current. Condensation is the mechanism that most often prevents effective free association, with expression of the conflict. The conflict then remains inaccessible to the integrative functions of the ego. Mutual frustration of the paired conflictual wishes describes the dilemma. The dangers and anxieties of each side may be very different. When the conflictual wishes are bound together by obligatory condensation and inaccessible to the integrative function of the ego, efforts to satisfy the wishes of one side without arousing anxiety may bring wishes of the other side into anxiety-arousing status. The most common pair is active genital versus passive libidinal. Kris candidly states his greater confidence in his formulation than in his understanding of the origins of these dilemmas. He finds that all of his patients categorized as psychotic, borderline, or with severe narcissistic pathology demonstrate either-or dilemmas. He proposes that either-or is the inevitable and usual mode of thought until superego development is established. Although preoedipal children can make subtle cognitive differentiations, he does not believe they can sustain them under emotional pressure.