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Barton, H.R. Kovan, R.A. (1978). Infantile Ego States and Adult Clinical Practice. Am. J. Psychoanal., 38(3):235-242.

(1978). American Journal of Psychoanalysis, 38(3):235-242

Infantile Ego States and Adult Clinical Practice

Howard R. Barton, M.D. and Robert A. Kovan, M.D., MSP

Psychiatric practice in a community mental health clinic in the central city area requires rapid assessment of cases for proper therapeutic management. As a useful model, we have formulated the concept of correlating adult clinical states with known general ego stages of infanthood. Our patients come in with various degrees of ego regression, which we consider to be recapitulations and reflections of ego states which previously existed in early Iife. By using this correlative tool, we can more quickly grasp the nature of the psychiatric illness existing currently and better plan for crisis treatment.

Schecter1 and Sours2 have summarized and elaborated on the earliest stages of ego development.

During the first month of life, nervous tension rises from unfulfilled biologic needs until the mother feeds and warms the organism, allowing relaxation and sleep. An even balance between tension and relaxation is maintained. Tension becoming too strong would overwhelm the immature nervous system. With the physical help of the mother, inborn stimulus barriers,3, 4 are strengthened, and reflexes are inhibited, relieving unphysiologic strain; thus the infant can survive.

It is conceptualized that energy of biologic needs plus the infant's body plus the mother's body form one undifferentiated mass in the psyche of the infant. Mahler's5 studies indicate that there is no boundary line between the infant's and the mother's body, no sense of the self and nonself. The twosome is psychically represented as still one unit, as it was literally before birth. Since there is no concept of the I and not-l, sensations from the inside of the organism are fused with those arising externally. Energy of needs (libido) is accordingly displaced automatically from inside the soma into behavior that seeks satisfaction from outside objects.


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