South African Psychiatry - February 2019

FEATURE
Neurosis, Freud argues, is the result of a fracture in the
ego’s relationship with its broiling, immoral id while
psychosis is indicative of a warring faction between
the ego and the external world. In neurosis, the ego
avoids the internal pressure exerted by a powerful
wish through repression. The forbidden desire,
however, struggles against this fate and a sign to the
forgotten is created as a compromise. In psychosis,
we witness not only the refusal of new perceptions
from external reality but also the decathexis of the
memory store of lived experience so that it loses its
significance and can no longer be of use. There
is a cost both ways says Freud (1924). A neurosis
contents itself with replacing a piece of reality with
a fantasy which attaches itself to a current situation
lending it a hidden meaning, whereas in psychosis
the ego interrupts its relationship with reality to
the point where a new imaginary world is created
in accordance with wishes as a substitute which
can be patched over the original breach as if it
originated from the outside.
NO ONE WHO TOOK THE STAND DURING
THE ARBITRATION APPEARED TO SUFFER
FROM A PSYCHOTIC DISORDER IN
THE WAY DESCRIBED BY FREUD. IT
IS EQUALLY DIFFICULT TO VIEW THE
MARATHON PROJECT AS A NEUROTIC
PROCESS. YET, THE REALITY TESTING AND
JUDGEMENT OF THOSE IMPLICATED
IN THE DECANTING ALLOWED NEARLY
ONE HUNDRED AND FIFTY PEOPLE WHO
COULD NOT ADEQUATELY TAKE CARE OF
THEMSELVES TO DIE DAILY AND CRUELLY
ON THEIR WATCH. HOW CAN WE BEGIN
TO UNDERSTAND THIS?
In Negation (1925), Freud argues that the earliest
developmental process the infant negotiates
rests on two levels of judgement. The first of these
relates to a fundamental and spontaneous sensory
and visceral process of determining whether an
experience feels good or bad.
TO PARAPHRASE FREUD, IF WE WERE TO
EXPRESS THIS IN THE LANGUAGE OF THE
OLDEST ORAL INSTINCT, THE JUDGEMENT
WOULD READ AS FOLLOWS: ‘THIS
TASTES GOOD. IT IS GOOD AND SWEET.
I WOULD LIKE TO TAKE THIS IN. IT SHALL
THEN BE INSIDE ME. I WANT TO BE THAT
THING. I BE THE GOOD THING. IT IS ME.’
OR, ALTERNATIVELY: ‘THIS TASTES BAD. IT
IS BAD AND BITTER. I NEED TO KEEP THIS
OUT. I WILL SPIT IT OUT. IT SHALL THEN BE
OUTSIDE ME. I DO NOT WANT TO BE
THAT THING. IT IS NOT MY BAD. IT IS NOT
ME.’
THIS NEGATION ARGUES MARILIA
AISENSTEIN (2017) “IS NOT MERELY A
REFUSAL, BUT THE ROOT OF THE SUBJECT.
THE INITIAL “NO” IS A REJECTION WHICH
DISTINGUISHES THE INSIDE AND THE
OUTSIDE AND BRINGS THE “I” INTO BEING.
SAYING “NO” IS FIRST AND FOREMOST AN
AFFIRMATION OF IDENTITY” (P. 204). AN
INFANT INITIALLY ALLOWED THE PRIVILEGE
OF SAYING NO IS POTENTIALLY ABLE TO
INHABIT HIS SKIN AND EMBODY A SENSE
OF SELF.
In these early stages of making a mind a ‘purified
pleasure ego’ is shaped by incorporating that which
is gratifying, nurturing and exciting and ejecting all
unpleasure, discomfort and frustration.
THIS OMNIPOTENCE IS PROTECTIVE
EMOTIONALLY, PSYCHOLOGICALLY
AND COGNITIVELY FOR THE NEWBORN.
IT IS CHARACTERISED BY A STATE OF
UNDIFFERENTIATION.
There is a definitive mix up between experiences
in the form of bits and pieces which belong in
an interior space and those which originate in
an external one: a me and a not-me, and, more
significantly, an illusion of a good me and a bad
not-me. Judgement of experience is based on what
feels good or bad regardless of whether external
events align with the internal landscape. The baby
may very well be wired to attach to caregivers and
make sense of the environment neurologically but
this does not mean that the status quo is being
represented in the mind accurately in terms of
objects and reality being separate and distinct.
THE INFANT TAKES GOOD FROM SUPPLIES
IN THE WORLD OUTSIDE AND, THROUGH
IDENTIFICATION, MAKES THESE PART OF
THE SELF AS IF THE GOOD THING WERE
NEVER OUTSIDE TO BEGIN WITH. THE
‘BAD’ IS SPAT OUT AND ALL THAT IS SPAT
OUT IS PERCEIVED AS BELONGING TO A
DIFFUSE NOT-ME ENVIRONMENT. “WHAT
IS BAD, WHAT IS ALIEN TO THE EGO AND
WHAT IS EXTERNAL ARE, TO BEGIN WITH,
IDENTICAL” (FREUD, 1925, P. 369).
It is because the antithesis between subjective
and objective does not exist initially that our first
experience of the world is confused and draws
sustenance from the realm of wishes and affective
storms. Yet it is essential that the infant is not aware of
this paradox. Of course, this early forging of mental
solids is an illusion. The reality is that what is spat out
begins to assemble as the primitive superego in an
SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019 * 19