The author discusses the special aspects of his psychoanalytic work within a prison setting, and maintains that he is able to establish psychoanalytic space within this setting in spite of what might be thought to run counter to the analytic process. He cites the work of Aichhorn, and Freud's preface to Aichhorn's study. He utilizes his experiences within the prison setting to explore the fate of aggression in individuals manifesting psychopathic behavior and, in general, borderline states with a tendency toward impulsive action. He notes the recourse to economic solutions, in which extreme excitation is followed by discharge as a protection against a psychotic disorganization. This is combined with the use of aggressive impulses to maintain both the object and the subject within the framework of external reality. Aggression, in this context, even auto-aggression, has as its aim the preservation of the ego, and, in some cases, the aim of suicide is to protect the integrity of the ego. The mastery of the object by aggression leads to an effacement of representation and a psychic
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silence—for that reason a "defect" or failure of mentalization is often spoken of in these patients. However, some rather rich and intense psychological processes in these individuals are simply masked.
Balier emphasizes the presence of phobias, a practically constant element in psychopathic personalities and other impulsive borderline states, and the role of projective identification in the development of these phobias. These are very primitive phobias, called by some "pre-phobias," the direct heirs of night terrors or anxiety hysteria, distinct from the neuroticphobias such as that of Little Hans. Claustrophobia, with a fear of engulfment, is a central theme and is exacerbated by the prison setting itself. Balier delineates various aspects of the personality characteristics of these patients, emphasizing the dyad of activity-passivity, latent homosexuality as a defense against a phallicmother, and a desperate search for the father, often with the absence, failure, or weakness of the actual father in the family history. There are strong phallic-narcissistic elements also, with emphasis on force and domination, and an anal-sadistic ego ideal that emphasizes a macho image, honor, and contempt for women. Episodic perversions are also characteristic. The frequent association with substance abuse seems a means to reduce the tension.
Two fundamental aspects stand out, whatever the sometimes complex, sometimes impoverished, clinical aspects. One is that the attempts at psychic organization are tentative and precarious, and are more like "arrangements" or compromises than structure. Second, there is always in the background a degree of free, unintegrated aggression, kept more or less apart by splitting, that maintains an excellent perception of external reality. The discharge of this aggression in action is thus often an act that prevents psychotic disintegration before the precarious narcissistic organization. The author is skeptical of those therapeutic approaches that emphasize reliance on the "neurotic part" in the makeup of these patients, for he sees this neurotic aspect as a defense against more primitive aggressive aspects. He believes that in such a therapeutic approach there is a risk of the development of an "as if" personality that would leave the archaic aggressive aspects split-off and unintegrated.
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Wilson, E., Jr. (1992). Revue Française De Psychanalyse. XLIX, 1985. Psychoanal. Q., 61:152-153