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All the discussants note that denial, counter-depression and hypomanic elements predominate in this group of accident victims. By contrast, suicide victims tend to have been masochistic, immobilized and depressed. Dr. Bacon's interpretation of the identity crisis fits a number of our cases, although not all of them.
Dr. Stengel is correct in pointing out that our formulations are only hypotheses which point toward further research efforts. It is true that we have sidestepped the issue of “aggression” deliberately. We are trying to feel our way toward a psychoanalytic view of action, one of the weakest areas of psychoanalytic theory. So far the aggression concept has not been extremely helpful. To illustrate: Suicide by shooting oneself in the head is “aggressive”; accidentally driving one's car into a tree at high speed is also “aggressive.” Our pilot studies indicate that the character and life situation for these two types of deaths are quite different—and in some ways opposite.
Professor Stengel reminds us of the multiplicity of factors involved in “cause” and the lack of adequate emotional relationships in some self-destructive persons. He points in directions which we intend to follow. This paper is only a first step toward a comprehensive description of the psychology of accidents.
Dr. Miller's comments on faulty reality testing are especially pertinent to the problem of fatal accidents. Fantasies of power and omnipotence are regular features of patients who have survived near-fatal accidents. These individuals seem to have peculiarly intimate body-ego relationships with their automobiles. Dr. Miller's insight concerning “the point of turning from a depressive to a manic phase” is most perceptive, and strengthens one of our formulations: that the crucial factor which suicide-prone and accident-prone individuals have in common is a weakness of the integrating and synthesizing functions of the ego which allows two distinct patterns of activity and passivity to co-e