The possibility that maladaptation might be caused by psychological deficits, rather than by intrapsychic conflict alone, was considered as early as 75 years ago, when Ferenczi set out to trace the course of ego development (see Gedo, 1976). In the course of his pioneering studies of syndromes be yond the boundaries of the neuroses, he came to realize that psychoanalysis had no explana tion for the occurrence of catastrophic struc tural changes, such as the breakthrough of ahomosexual libido" in paranoia. In 191 1 Fe renczi concluded that the conflict about ho mosexuality to be found in these patients might not constitute the fundamental element of their psychopathology. Freud's famous dic tum (1905b) that a neurosis is like the unega tive" of a perversion (a photographic meta phor!) characterizes perversion as a structural deficiency. Subsequently, ego psychologists
(Hartmann, 1953) conceptualized the psychoses and alloplastic charac ter problems as conditions of aego weakness/' that is, a failure to develop adequate adaptive/defensive structures (see also Gitelson, 1958).