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In 1923 Groddeck wrote: "There you have the essential quality of the doctor, a propensity to cruelty which has been just so far repressed as to be useful, and which has for its warder the dread of causing pain" (p. 8). This astute formulation illustrates the problem of form and content in psychoanalytic perspective. The content of unconscious drives is the all-important determinant of behavior, but its specific functional influence is determined by the form it takes; by its quality, its quantity, its juxtaposition with other drives or other forces; as Groddeck puts it, by "this delicate interplay"—in his example, the interplay of cruelty and dread. It is the multiplication of such delicate interplays that determines personality and character as well as the specific forms of psychopathology. These interplays are mediated by what Rapaport (1960) calls ego structures and by the processes and energies which become available through these structures.
It is my thesis that it is useful to distinguish between form and content, even though they may at times come to stand for each other. The tendency to cruelty, in Groddeck's illustration, represents at the same time the content of the drive and its motivating energy. The fear of hurting another person and the repression of cruelty result from ego and superego intervention. The drive content has been given specific form as a result of processes emanating from ego structures, so that it now exerts its function on behavior: repressed cruelty, dread of causing pain. These structures also determine the "delicate interplay of forces," i.e., the quantitative relationships