title: Communicating with the schizophrenic superego.
abstract: The procedure reported here, which I have called "conversations with superegos," raises a number of important questions, both about ordinary versus psychopathological psychic structure, and about technique. There is no space to enter into a lengthy discussion, but a few brief points may be in order. First, let us consider the issue of psychic structure. I have argued that the superego is a hostile agency within the mind whose operations are essentially inimical to the patient's growth and well-being. (As an element of psychic structure, the superego can be distinguished from the ego ideal on the basis of the associated affect, that is, guilt rather than shame. Similarly, it is possible that the superego may be constructed on the basis of identifications that are different than those that may form the basis of the ego ideal). Further, I have argued that the superego is neither a force for true moral development nor a platform for the voice of the patient's "better" nature, (although it purports to be until challenged). A structure that lies, manipulates, threatens, and appears to be motivated in the end solely by its own continued existence, must certainly be considered suspect as an authority on morality. On the contrary, I see true morality originating in the patient's ego, because in that structure lies the ability to identify with others. One could object, however, that this way of viewing the matter is an artifact of working with a particular patient population. That is to say, it might be the case that in psychotic and borderline psychotic conditions, the superego does function this way, whereas in healthy or neurotic conditions it does not. In a similar vein, it could be argued that a pattern of development that was sufficiently skewed so as to result in psychosis would be more than likely to have been peopled by hostile, punitive, and essentially destructive identification figures, such as could form the basis for a pathological superego, whereas in normal or neurotic development this might not be the case. I would disagree on the following basis: I believe that the course of development is laid out by nature; that is, events like the separation-individuation phase, the oral, anal, phallic, and oedipal phases occur in all of us. It is what happens in the course of that development that will lead either to normalcy or various degrees of pathology. For example, we all project. But it is whether we project an expectation that the next person we meet is a decent, civilized human being or a monster out to destroy us that causes us happiness or pain. That said, my own view of the matter is that the general principal holds for conditions other than the patients reported here, with the difference being one of degree. Where identification figures are essentially benign and foster the development of the self, then their strictures, whether moral or merely practical, would be likely to become assimilated into the ego, without the telltale restriction of reflection and autonomy together with the accompanying guilt that characterize the superego's activity, in which case, we are not talking about superegos at all. What distinguishes psychotic and neurotic development, in my view, is not the issue of whether superego operations are benign or not, but the degree to which the ego is compromised with the resulting formation of fantasy-introjects. I have found, as if it were a principal of physics, that the stronger the ego, the weaker the superego and vice versa. And when some energy of the superego is released, it appears to go directly into the ego without my intervention, though I sometimes ask the "brain's" opinion. The second issue concerns technique. In psychosis, the voice of the superego is very loud, so much so that there are times when I have had to shout to be heard. On the other hand, my patients report that the voice of the ego may be so quiet that the patient hasn't heard it at all, or hears it as a whisper. (ABSTRACT TRUN
authors.forename: R
authors.initials: R
authors.lastname: Levin
mesh_terms: D000328:Adult; D003142:Communication; D003379:Countertransference; D005260:Female; D005619:Freudian Theory; D006167:Guilt; D006801:Humans; D008297:Male; D009813:Oedipus Complex; D011575:Psychoanalytic Therapy; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012565:Schizophrenic Psychology; D013475:Superego; D014167:Transference, Psychology