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A distinction is drawn between “deficits” and “defects.” A variety of clinical and theoretical issues is discussed with regard to each, including their involvement in conflict. The central thrust of the paper is “diagnostic” in the general sense of attempting to delineate varying elements of mental life. But inevitably such a delineation has technical implications, and these, too, are discussed. The question of how analytic change takes place is necessarily related to our concept of what there is to be changed.
Among the phenomena that become important in any analysis, conflict is everywhere. But it is not everything. In this paper, I shall discuss two other “things” that may become prominent in any particular analysis—defects and deficits—things that themselves get involved in conflict.
I advocate no either-or with regard to conflict, on the one hand, and defects and deficits, on the other. But defects and deficits (as I shall define them momentarily) exist in the real world (and therefore in our patients) and have impacts on the course and the outcome of analyses; hence it is in our interest to conceptualize them clearly.
That, in any case, is my thesis here. But I am well aware that any view of what is in the “real world,” let alone a particular patient's historical real world, is speculative at best, and probably in principle unknowable. So what I shall be doing here is trying out some ideas as they have developed for me in my clinical work—pointing out along the way some of the uncertainties and ambiguities to which they give rise. The