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Dr. Ornstein's case presentation and observations of the interactive processes in the analytic situation provide an opportunity to reexamine some complex and unresolved issues regarding aggression. In the analytic process we have access to symbolic representations of aggression that allow us to infer something about the meaning of aggressive phenomena. Dr. Ornstein's clinical material offers us the type of data from which psychoanalytic conceptualizations of aggression developed. Study of the ramifications in fantasy, dream and symbolic action, of highly specific wishes motivated by aggressive aims, reveal the complex verbal meaning encoded in aggressive behavior that is not available to infant observation and other research methods.
The major theoretical and clinical controversies that surround aggression refer to its nature and origins. Is aggression an intrinsic psychic motivation: a primary, obligatory appetite of an instinctual nature modified by the ego into complex drive derivatives? Or is aggression better conceived of as an instrument of psychic reaction resembling narcissistic rage provoked by external disturbances? There is no consensus on the source of aggression—on whether it is an endogenous instinctual drive continuously seeking satisfaction from the very beginning of life, existing independent of the environment's failures to meet developmental needs or, instead, a reaction to external sources of frustration.