Obsessional Disorders: A Developmental Systems Perspective

The paper resumes the discussion of obsessional disorders in view of developments that have followed the 1965 Congress of the International Psychoanalytical Association when the last systematic analytic discussion of the Obsessional Neuroses took place. The paper reexamines principal contributions to that congress in an attempt to understand the failure of psychoanalysis to favorably influence the course of these disorders. It notes the subsequent findings of a burgeoning field of child observation that have called attention to the larger infant-caregiver constitutive system within which the intrapsychic phenomenology of the obsessional neuroses is produced and maintained. It draws attention to the crucial impact of the analyst and his causal theories, insufficiently recognized at the lime, in the co-determination of the course and outcome of analytic treatment and proposes a contextual systems approach to the reconfigured understanding of normal and pathological development.

The paper discusses the special role of cumulative trauma in the infant-caregiver system on the formation of enduring obsessional and compulsive patterns. It suggests that in the traumatic developmental system, endangerment to the self and unbearable pain are ever-present threats lo the child, and protective strategies, including importantly the processes of pathological accommodation, occupy a primary motivational status. It describes the automatic shaping of subsequent experience by the internalization of such processes in template formation. Freud's emphasis on aggression and unconscious guilt in the pathogenesis of the obsessional neuroses system is reexamined in the light of the contextual perspective proposed, and a clinical excerpt is offered to illustrate the thesis of aggression and guilt as contextual products of a traumatic developmental system. Special considerations that enter into the reconfigured analytic treatment of obsessional disorders are proposed, and some observations follow about problems commonly encountered in the new approach.

The paper argues for the systematic extension of the quintessential psychoanalytic tools of empathic-introspective investigation and illumination into the contextualization of inner experience in a fresh approach to the psychoanalytic treatment of these disorders.