Self Theory, Conflict Theory, and the Problem of Hypochondriasis

THE WIDENING SCOPE OF PSYCHOANALYTIC TREATMENT HAS INItiated a controversy in psychoanalytic theory and technique. Central to this controversy is the issue of the place of the self in psychoanalytic theory. Two broad and apparently antithetical positions have been taken. The first position is that radical revision of psychoanalytic theory is necessary to account for new data relating to the self and to explain specific forms of psychopathology, particularly narcissistic personality disorders. The second position, to which I subscribe, is that current psychoanalytic theory is adequate to account for the phenomenology and psychopathology of the self and that therefore an alternative model or an alternative theory is not necessary (Richards, 1979).

The first position is represented primarily by Kohut (1971), (1977) and his followers, whose theory appears to rest on four basic principles: (1) the concept of narcissism as a separate and independent line of development; (2) the centrality of a single metapsychological point of view—the economic—and the stress on contentless mental states; (3) the delineation of two specific self-object transferences, which I view as manifest-content, descriptive designations rather than as having inherent diagnostic, dynamic, and genetic significance; and (4) the overriding importance of empathic introspective modes of observation and the