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With the evolution of psycho-analysis, Freud's tripartite structure of the mind, Id, Ego and Super-Ego-Ideal, has expanded to reveal on the stage of the inner world a cast of six.
Super-Ego-Ideal, has become the internal parents, mother and father. Identification with their creative sexuality provides the energising force for the development of the individual's adult bi-sexuality. The baby at the breast of the mother is the third character. The Ego becomes the little-boy—little-girl self, whose complacent peace of mind is fruitfully disturbed by the difference between their immature state and that of the parents. The sixth member is the part of the self in rebellion against the family, frequently split into a delinquent gang, or it appears as a ‘big brother’ who offers an alternate way of life, challenging parental superiority with his own ‘seniority’. The temptation to the little-boy—little-girl self to join with him when in pain from frustration is then the focal point of emotional conflict.
This structure of six characters also applies to the physician's mind. But his mental health relative to the patient's is assumed as the basis on which help is sought and offered. For the doctor's work to be fruitful, it must be done in identification with his own internal parents, attending to his practice as to a family. It is the resonance between the figures in his own internal world and his patients — fathers, mothers, babies, boys and girls — that this chapter discusses.
When the doctor visits a pleasant but ailing old lady who stirs the emotions linked to his own mother, grown old and approaching the end of life, the essential significance of the encounter is generated through her symbolic link with the physician's inner-world mother. The old lady's request for help can be welcomed as an opportunity to repay a debt of gratitude both to the external real mother, and to the internal. But an element of persecution may be dominant when a burden of unwelcome responsibility inte