Discussion of Herbert A. Rosenfeld's Article, The Need of Patients to Act Out During Analysis

Dr. Rosenfeld has discovered a fundamental fact about acting out, in his relating of the nature of the patient's acting out with the nature of his turning away from his primal objects in the early infant situation.

The distinction made by Dr. Rosenfeld between, on the one hand, the infant, capable of strong love and hate, and on the other hand, the infant who cannot make such emotional

discrimination, is of the greatest theoretical and practical importance.

The deep splitting and intense depressive anxiety which characterize the patient capable of love and hate, is consistent with organized psychic activity, even when the patient is acting out. But the underlying psychic confusion which accompanies failure to discriminate between good and bad objects leads not just to anxiety about the analysis of acting out, but its replacement by confusional states.

The importance of these confusional states can be seen especially clearly in those agitated depressions which are at the boundary between psychotic depression and schizophrenic states. Analysis of the commonly excessive acting out is inevitably followed by severe confusional states and outbursts of intense anxiety.

It may well be that these confusional states are particularly characteristic of the borderline depressive-schizophrenic states, since it is precisely at the point where the infant is learning to cope with ambivalence—that is, at the transition from the paranoid-schizoid position to the depressive position—that a failure of capacity to distinguish between good and bad objects is most likely to occur.