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Meltzer, D. (1963). A Contribution to the Metapsychology of Cyclothymic States. Int. J. Psycho-Anal., 44:83-96.
(1963). International Journal of Psycho-Analysis, 44:83-96
A Contribution to the Metapsychology of Cyclothymic States
The historical and psycho-analytic data from five and a half years of analytic work are presented to document the diagnosis and illustrate the psychopathology of a patient in order to demonstrate the metapsychological thesis of this paper. The patient, with a cyclothymic heritage in both parents, with a constitutionally intense and delicately balanced bisexuality, traumatized in the first three months of life by a painful, near-fatal illness, had dealt with the loss of the breast at weaning by a flight to the father which had a certain amount of reinforcement from the environment. This hypomanic state was based on the internal object relationships and defensive operations which are the central theme of this paper, that is, a denigration of the internal breast by an envious oral sadistic theft from it of a penis-like structure, felt as the core of its admired strength, creativity, and understanding, which was then projected onto the father's penis, thereby enhancing its admired
qualities to an exalted degree, making it the object of oral and genital greed.
This fragile elation collapsed at the birth of the next child and was intensified into depression by the subsequent family turmoil and separation, leading to a premature step forward in development in the form of a latency period, too hastily established and excessively rigid and joyless in its obsessional quality. Her subsequent history was encompassed in a repeated progression and regression between this hypomanic organization and the obsessional, the latter characterized by an improvement in her internal objects, brought about either by an internal process (a good coitus between the internal parents) or an external relationship (involving a transference to the good breast, such as her mother's rescuing her from suicide, or a good skiing holiday). But progress beyond this obsessional organization, with its omnipotent control over internal objects, acted out early in relation to the parents during father's drinking period and later acted out in her professional activities, was not possible. Continual oscillation between these two organizations resulted.
I have also tried to show how the pervasive pessimism about the value and purpose of life, as well as the deep feeling of unworthiness ('not-belonging-in-the-family') which nagged at her in childhood, were manifestations of the basic insecurity of her relationship to her good internal object and the related fundamental defect in her reality sense on all levels, good-bad, inside-outside, male-female (Freud, 1925).
Thus I have tried to demonstrate that the hypomanic organization, standing as it does as a first stage in regression from the obsessional organization and a jumping-off place for further regression into the manic-depressive psychosis or a more catastrophic fragmentation into schizophrenia, has as its good objects internally, not whole objects and not uninjured part-objects, but a damaged and denigrated breast and an idealized, exalted penis. The regression has taken place to a pathological state brought about by pathological mechanisms and not to a stage in normal ego-development. I have also shown that the tendency to regress to the hypomanic organization is due in great part to the unintegrated primal oral envy which tends to be set in motion by any internal or external stress. The analytic resolution of this tendency and preparation for development beyond an obsessional organization would therefore largely depend on the successful reintegration of split-off oral envy toward the breast.
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