Either-Or Dilemmas

Either-or dilemmas are complex conflicts in which the patient takes it as inevitable that there can be no resolution. The either-or attitude is often unconscious. Either-or dilemmas include intrasystemic conflicts in all three systems as characteristic elements. Either-or dilemmas occur when the antithetical relationship between instinctual wishes is accompanied by a corresponding either-or intrasystemic conflict in ego and superego. To illustrate and to clarify the complexities in either-or dilemmas, the following topics are considered: libidinal alternations in the transference; the clinical phenomenon of being in a hurry; independence versus dependence; conflict between the sensual and affectionate currents in loving; and the libidinal conflicts in paranoid reactions. The central role of conflict between active and passive libidinal wishes is emphasized. The relationship between intrasystemic and intersystemic conflicts in neurosis is illustrated. A discussion of the mechanism of intrasystemic, instinctual conflicts considers first that intrasystemic conflicts appear to be maintained by an obligatory condensation, under primary process. Second, the problem is not a failure of development of integrative functions but a failure of accessibility to the elements of the intrasystemic conflicts that renders the integrative functions useless. Third, the tandem operation of defenses against paired instinctual wishes in intrasystemic conflict leads to the mutual frustration of those wishes. Awareness of the nature of either-or dilemmas and intrasystemic conflicts, and especially recognition of the difference between intersystemic and intrasystemic conflicts, leads to useful technical implications. Most important is the recognition that intrasystemic conflicts characteristically produce the threat of loss and the experience of frustration as free association proceeds.