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Roshco, M. (1967). Perception, Denial, and Depersonalization. J. Amer. Psychoanal. Assn., 15:243-260.

(1967). Journal of the American Psychoanalytic Association, 15:243-260

Perception, Denial, and Depersonalization

Martin Roshco, M.D.

SUMMARY

A case of chronic depersonalization was presented and discussed from the point of view of the ego defects in perception and cognition considered to be either chronically present or regressively reactivated in order for this symptom to occur.

Although it is clearly not a neurotic symptom, or a single phenomenological entity, depersonalization appears to be a compromise formation fulfilling all of the classical requirements of the definition of a symptom (8). It expresses the id drive for oral (aggressive and libidinal) union with the mother's breast, and the ego's efforts to maintain itself against the consequent threat to its sense of self by the nonneurotic defense mechanisms of denial and denial in fantasy with a regressive hypercathexis of the sensory modalities.

Mechanically, there is an ego split with the fantasy of the "bad" (which includes the aggressive) portion of the self being isolated, externalized, observed, and the "good" self being libidinally attached to the maternal love object.

The illusory "visual perception" of the "other self" and any other concretized perceptions create an illusion of external objects to which to relate, thus sustaining a sense of self and allowing the libidinal attachment to take place without overwhelming anxiety.

Diagnostic and prognostic evaluations cannot be made upon the basis of this ubiquitous symptom alone, but only upon a consideration of the total personality structure with all of the usual clinical criteria for such judgments.

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