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Nierenberg, H.H. (1963). Symptom Formation. J. Amer. Psychoanal. Assn., 11:161-172.

(1963). Journal of the American Psychoanalytic Association, 11:161-172

Symptom Formation

Harry H. Nierenberg, M.D.

Robert Waelder opened the symposium with the statement that we need a periodic recheck of psychoanalytic concepts. Symptom formation is connected with Freud's theory of neurosis, the mainstay of which is that there exists in the neuroses a conflict over sexual drives, repression, and a return of the repressed in distorted form. There is a constant adjustment going on with the ego acting as mediator. If the ego is unable to mediate, a neurosis exists. The reason for failure to adjust is repression. The forces which have been repressed are unable to view with other forces and come to a settlement, therefore repression. To quote Waelder, "Why just a sexual thing and not others? The sexual drives are rebellious, which distinguishes them from the self-preservative urges, which have to adjust themselves to the outside world or a catastrophe would be imminent. They are rebellious because they can be satisfied in fantasy and through autoerotic practices, and are therefore not under the constant pressure to adjust, and can be satisfied symbolically through a symptom formation, for instance. We cannot symbolically satisfy our hunger."

Mortimer Ostow then presented his paper, "Clinical Manifestations of Deviations of Free Libido." He spoke of observations made after the administration of chemical substances to obtain experimental control over psychic states. Reserpine and phenothiazine derivatives (tranquilizers) cause a subsidence of the symptoms of acute schizophrenia and mania. These substances produce a psychomotor retardation, and if given over a long period of time will induce artificially a state of melancholia. The drugs called psychic energizers, monoamine oxidase inhibitors and imidobenzyl derivatives, relieve melancholia and increase psychomotor activity, but in sufficient quantities can produce paranoia, mania, and certain types of schizophrenia or neuroses with excitement.

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