ABSTRACT
Cases encountered in clinical practice rarely conform to the textbook descriptions of the classical neuroses. They may be combinations of different types of neurosis in varying proportions; but more frequently physicians are now being visited by patients who have no definite symptoms, or who might be hard put to it to say quite why they need help. The disorder in these persons, to put it briefly, is not that the ego’s control of psychic activity is endangered by some alien force,—instead the ego itself is involved by the morbid process. Individuals who were once termed “psychopaths” or “eccentrics”, or considered afflicted with “moral insanity”, belong to this group of patients. But these are only the most flagrant examples, for the designation covers in addition cases of complete or incomplete infantilism, cases of persons who are inhibited in their love life or in their work, individuals who pursue futile modes of behavior in vital matters, others who are disturbed in their emotional or volitional life, yet others who are limited in their social contact to certain determined patterns, or who find themselves repeatedly in the same frequently abnormal situational difficulty, and many more. Of all these persons, as of neurotics, it may be said that something takes place in their illness which makes inroads upon the personality; but besides this, the personality itself, the permanent mode of reacting, seems irrational and inconsistent. These individuals are not what they wish to be, and in many cases, what they might be. There is no sharp demarcation between the “normal” and the “neurotic”; even more the province of pathology now under discussion overlaps extensively the field of the normal. Indeed, it might be well to omit all reference to “disease” in describing these disorders, and to speak instead of “inefficiency”. But in the absence of any objective criteria of “efficiency”, this suggestion is of no particular advantage either. 400Psychoanalysis can most successfully interpret those elements in this group of disorders which are analogous to neuroses; and if psychoanalytic therapy succeeds in transforming a character disorder into a neurosis, which can then be treated further according to the familiar principles, this must be accounted a triumph. In cases of this group which differ from the neuroses, psychoanalysis has not as yet gone beyond the preliminary steps.
