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작성자  simonshin 작성일  2016.10.09 08:28 조회수 1343 추천 0
 신현근 박사 강의안 - 병리적 타협 형성  
첨부파일 : f1_20161009082810.pdf

과목현대 갈등 이론 (Modern Conflict Theory)

주제Pathological Compromise Formation

내용:  강의안 병리적 타협 형성

교재:  Brenner, C. (1982). The Mind in Conflict. New York: International Universities Press.

 1           Psychoneurotic or, for short, neurotic symptoms were the first examples of compromise formation.

1.1          As early as 1894, Freud demonstrated that an obsessional symptom is a compromise among unacceptable sexual wish, a defense against satisfying that wish, and remorse and self-punishment.

1.2          Within a few years he recognized that the same formula applies to all psychoneurotic symptoms; later, he and other analysts extended it to the understanding of neurotic character traits as well.


2           A case of a psychoneurotic symptom

2.1          Symptom: A fear of flying

2.1.1     A thirty-four-year-old woman was anxious while flying in airplanes.

2.1.2     The feeling of being unable to get to the controls was associated with great anxiety whenever she let herself dwell on it.

2.1.3     The patient went on to say that on one occasion, when she flew in a small private plane, she experienced no anxiety whatever.

2.1.4     On that occasion she sat next to the pilot, in the cockpit of the plane, facing a set of duplicate controls and instruments.

2.2          Components of the psychic conflicts

2.2.1     The drive derivatives    The one of chief importance is the patient’s wish to have a penis.    Her longing for her father’s love is likewise identifiable as an important drive derivative, which was one of her conflict of which her fear of flying was the resulting compromise formation.    She had castrative and murderous wishes toward her father, who she felt, had been faithless to her, as well as his brother.

2.2.2     Calamities    Both depressive affect and anxiety, whose ideational content included castration and loss of love, were components of the patient’s conflict and both appeared, in different measure, in consciousness in the resulting compromise formation, despite the patient’s defensive effort to avoid them,

2.2.3     Defenses    Repression    A defensive reaction formation    A defensive avoidance: phobia    Displacement    An omniscient and omnipotent fantasy   She countered her feeling of irremediable inferiority by an omniscient or omnipotent fantasy.       If she could only have the use of the controls, she would fly the plane to the safety.   Moreover, to the extent to which she believed parts of her fantasy, e.g., that something catastrophic would really happen, she used that conviction as a defense.       It was not that she wished for something which gave rise to unpleasure and to conflict; something was going to happen over which she had no control and for which she had no responsibility to bear.   Thus both defense and drive gratification were involved in the disturbance of the patient’s ability to test realty, i.e., to distinguish fact from fancy in her omniscient-omnipotent fantasy    The same fantasy involved ideas that served to defend against her murderous, castrative wishes, since in her fantasy she appeared as a savior, not as a castrating destroyer.   It should be noted as well that her fantasy of being a savior served a defensive function against the catastrophes of loss of love and castration.   A savior is loved and rewarded, not unloved, banished, and deprived of the penis she longs for   A savior is good, not bad.

2.2.4     Superego manifestations    In addition to her wish to be good, it is evident that, for her, being unloved and castrated were punishments she both dreaded and accepted as necessary for atonement and happiness.    Her suffering, her tears, her unhappiness, and her feeling of helpless incompetence all had in them an element of appeal for forgiveness, for pity, and for love.


3           A case of a neurotic character trait

3.1          A neurotic character trait: Compliant obedience

3.1.1     The patient, a thirty-one-year-old man, felt compelled to do what he was supposed to do, always unhesitatingly.

3.1.2     He deplored this feature of his character, he sometimes castigated himself bitterly for it, but he could not change it.

3.1.3     Despite every effort to behave otherwise, he remained obediently compliant.

3.2          Simplified understanding of the case

3.2.1     The drive derivatives    The patient’s neurotic character trait satisfied a wish for his mother’s love and approval.

3.2.2     Defenses    Being obedient and compliant to mother’s wishes also served a defensive purpose.    It kept him from being aware of his rage at her and from expressing it directly.    The patient was an unusually gentle person altogether.

3.3          Complex features of the obedient compliance

3.3.1     He was compliant and obedient for the entire world, including his mother, to see.    He shared the world’s opinion of him.

3.3.2     His neurotic character trait must be described in detail in order to be properly classified.

3.3.3     It is true that he exhibited in a conspicuous way compliant obedience to his mother’s every wish, but his neurotic character trait include d as well a secret defiance of his mother, a determination to displease her and to be a discredit to her, i.e., to revenge himself on her by disappointing her.

3.3.4     His life-long attitude can be adequately described only by saying that, while he would do and be what his mother wanted him to be in order to please her, he would never enjoy it and would never succeed at it, so that, in the long run, he would disappoint and disgrace her. 

3.4          Conviction and affects

3.4.1     Another feature of the patient’s compliance was the feeling that, try as he might, he could never succeed in what in what he hoped for, i.e., he never could be his mother’s favorite.

3.4.2     This conviction appeared in consciousness as a feeling of indifference about whatever he was doing.

3.4.3     He unconsciously wished he were both a baby, like his younger sister, and a girl, like both the siblings whom his mother preferred to him.

3.4.4     As is to be expected, this wish, from early childhood on, was associated with intense castration anxiety and depressive affect.    

3.5          Components of the psychic conflicts

3.5.1     Drive derivatives    One can identify a number of childhood drive derivatives as components of the patient’s pathogenic conflict.    He wished to be his mother’s favorite, he wished to be a girl and a baby to accomplish this end, and he wished to revenge himself on his mother for not loving him best.

3.5.2     Affects    These drives aroused both anxiety and depressive affects associate with the calamities of object loss, loss of love, and castration.

3.5.3     Defenses (A dual role)    Obedient compliances, gentleness, and good deportment served an important defensive function as well as the function of gratifying his wish for love, both in fantasy and in love.    Repression also played a dual role.   He forgot what he learned in order to spite her mother, i.e., for purposes of drive gratification, while he repressed many painful memories of childhood to avoid unpleasure.

3.5.4     Superego manifestations    As for superego manifestations, the very essence of his character trait was to be good.    Good deportment, desirable, socially acceptable interests, conformity to parental standards of morality – all were part of his charter trait of obedient compliance. 

3.6          Data presented

3.6.1     Only enough data have been given to document the existence of various components of the conflict of which obedient compliance was the consequence and to illustrate how those components appear in actual, clinical material, i.e., to show what sort of data support the theory of conflict which is the subject of my expression.

3.6.2     Every situation in which analysis progresses satisfactorily will furnish material in abundance to support what I have said about the components of conflict that give rise to neurotic symptoms or neurotic character traits and how these components blend and interact with one another to produce pathological compromise formations.


4           A pathological compromise formation

4.1          A compromise formation is pathological when it characterized by any combination of the following features:

4.1.1     Too much restriction of gratification of drive derivatives.

4.1.2     Too much anxiety or depressive affect.

4.1.3     Too much inhibition of functional capacity.

4.1.4     Too great a tendency to injure or destroy oneself.

4.1.5     Too great conflict with one’s environment.

4.2          It must be obvious that the matter of setting the limits just referred to is an arbitrary one.

4.2.1     There is no sharp line that separates what is normal from what is pathological in psychic life.

4.2.2     The two shade into one another imperceptible degrees, just as is the case with illnesses or diseases of the sort commonly called physical or organic.

4.2.3     Infectious diseases, each of which is caused by a specific organism, offer a useful parallel, precisely because they seem, at first glance, to be so very different.

4.2.4     Even the case of infectious diseases, in which etiology and diagnosis is relatively simple, certain, and disease-specific, there is no sharp line between what is normal and what is pathologic, between health and illness.    There is always a gradient from the one to the other, whether the gradient be gentle or steep.    There is never a discontinuity.

4.3          It must be understood that to say there is no sharp line between what is normal and what is pathological is not to belittle the difference between mental health and mental illness.

4.3.1     The difference between illness and health is the difference between suffering and pleasure, between terror and confidence, between failure and success, between death or mutilation and life.

4.3.2     Mental illness is not a trivial matter that many ill-informed, though well-intentioned persons assume it to be.

4.3.3     There is no difficulty in distinguishing a substantial degree of psychopathology from what is, by general agreement, psychically normal.

4.3.4     My point is that the difference is one of degree only, however great the difference may be and however great is the practical significance to the individual.

4.4          Freud’s theories

4.4.1     Freud asserted that psychopathology does not consist in a disruption or fragmentation of psychic functioning, that it consists instead in disturbances in the balance among its several elements, disturbances he characterized as quantitative rather than qualitative ones (1990).    As he put it then, it is the balance among the systems Ucs., Pcs., and Pcpt.-Cs. that is disturbed in mental illness, just as it is, he thought, in dreams and in prapraxes (1990).

4.4.2     Until 1926 he equated psychic conflict with psychopathology.    Conflict, he said, is a consequence of a failure of repression, which was his word, at that time, for defense.    As long as, or to the extent that one’s defenses hold fast, one is free from conflict and psychically normal, he thought.    It is the failure of repression, according to Freud’s views before 1926, which gives rise to neurotic anxiety and conflict.    Thus, prior to 1926, Freud and his colleagues made a sharp distinction, at least in principle, between psychic normality, which was believed to be synonymous with no psychic conflict, and psychopathology, which was synonymous with psychic conflict due to failure of repression.

4.4.3     Even after Freud (1926) had revised his theory of anxiety and conflict, there remained a tendency among analysts to maintain Freud’s earlier view, at least with respect to distinction between normality, or health, and pathology, or illness.    Analysts persisted in the belief that what is normal is free from conflict and that, conversely, conflict is a sign of pathology, even it only a premonitory one.


5           Brenner’s theory

5.1          Every neurotic symptom and every neurotic character trait is a compromise formation.

5.2          Each is a consequence of psychic conflict, originating in childhood, the components of which include drive derivatives, anxiety and depressive affects connected with the calamities of childhood, defense, and superego manifestation.

5.3          Each is characterized by an excessive degree of inhibition, unpleasure, lack of gratification, self-destructiveness, and/or social disharmony.

5.4          Certain consequences follow from this definition which are worth emphasizing because they are frequently neglected or overlooked.


6           A symptom is never just one component of the conflict of which it is a consequence.

6.1          Not a drive derivative

6.1.1     An obsessional ritual is never properly described as a masturbation equivalent.

6.1.2     An impulse to masturbate can never be more than one of the components of a ritual.

6.1.3     The symptom itself is always a compromise formation among impulse to masturbate (drive derivative), defense, superego manifestations, and anxiety and depressive affect.

6.1.4     Any generalization about such rituals must take this fact into account.

6.1.5     So must one’s practical, clinical work with any patient who suffers from such a symptom.

6.2          Not a defense

6.2.1      A symptom is never a defense.

6.2.2     Defense is only one component of a symptom.

6.2.3     Masochism is not a defense against object loss, any more than obsessional neurotic symptoms are a defense against something worse, e.g., a psychosis.

6.2.4     One must never overlook the role of defense in symptom formation, but a symptom is never a defense and nothing else.

6.3          Not a superego manifestation

6.3.1     Neither is a symptom ever just self-punishment, just remorse, or just atonement.

6.4          Combination

6.4.1     A symptom is always a combination of elements that includes all the components of conflict which go to make every compromise formation.

7           A symptom is never the cause of anxiety or depressive affect.

7.1          One of the most important features of the psychic conflict is that conscious anxiety as part of the symptom is an indication that a patient’s defensive efforts are insufficient or inadequate to the task of avoiding unpleasure in connection with whatever drive derivatives are the instigators of conflict.

7.2          Both anxiety and depressive affect are always related to drive derivatives of childhood origin when they appear in consciousness as part of a pathological compromise formation.


8           Ideational content of anxiety or depressive affect

8.1          Neither symptomatic anxiety nor symptomatic depressive affect is ever without ideational content.

8.2          The free-floating anxiety and contentless anxiety are misnomers.

8.3          Freud’s assertion (1895a) that anxiety without content is clinically observable in some patients is a statement derived early clinical experiences from which he drew conclusions that have been subsequently discredited.

8.4          He thought at that time that in some individuals unhygienic sexual practices can give rise to attacks of anxiety which have no psychical determinants and hence no psychological or ideational content.

8.5          This explanation of his patients’ anxiety attacks has since proved to be unsubstantiated by available data.


9           Distinctions between neurotic symptoms and neurotic character traits

9.1          In extreme cases the distinction seems easy to make.

9.2          Not all cases are so easy, however.

9.3          To add to the difficulty in distinguishing neurotic symptom from neurotic character trait, many of the latter are not ego-syntonic, as one might suppose a character trait should be.

9.4          In fact, neurotic symptom and neurotic character trait are often undistinguishable descriptively as they are dynamically.

9.5          My own conclusion is that it is a fruitless task to try to distinguish between neurotic symptoms and neurotic character traits.

9.5.1     The similarities between them are much more far-reaching and significant than are the differences.

9.5.2     In addition, I do not see much value in making the distinction when one can do so.


10       Value of diagnostic headings

10.1       A symptom or, for that matter, a neurotic character trait, is a particular compromise formation.

10.2       The more thoroughly one studies pathological compromise formations on the basis of psychoanalytic data, the more evidence one has to support the view that there is little to be gained, either practically or theoretically, from classifying pathological compromise formations under the customary, traditional headings.

10.3       There is much to be gained from describing each such symptom or character trait as fully and in as much detail as possible with an idea to indications of the nature and origin of the components of the conflicts of which it is the consequence.

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