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Kestenberg, J.S. (1966). Rhythm and Organization in Obsessive-Compulsive Development. Int. J. Psycho-Anal., 47:151-159.

(1966). International Journal of Psycho-Analysis, 47:151-159

Rhythm and Organization in Obsessive-Compulsive Development

Judith S. Kestenberg

SUMMARY

The observation and the analysis of patterns of thought and movement is a valuable technical aid that can supplement the analysis of defence mechanisms and repudiated wishes. It can also serve as a tool for the reconstruction of genetic determinants of adult psychopathology.

On the basis of reconstruction from analyses and direct observation of children, the following sequence of developmental stages suggests itself:

1. The oral-sadistic phase overlaps with an anal-erotic phase in which sphincter play, and other games characterized by brief intervals of holding and releasing, become a source of gratification.

2. In the anal-sadistic phase in the second year of life the child enjoys holding longer and expelling or throwing.

3. In the ensuing urethral-erotic phase running and dripping rhythms are dominant.

4. There follows a urethral-sadistic phase in which stopping, starting, and aiming are a favoured pastime during urination and play activity.

5. The pregenital phases are succeeded by a state of disequilibrium that is followed by a phase of integration in which pregenital and inner genital impulses are integrated with and subordinated to phallic dominance.

Growth crises occur when several divergent component drives vie with each other. The resulting increase in aggression enhances differentiation. A steady influx of genital impulses promotes integration. The role of the mother during these developmental changes is to anticipate and support more advanced patterns and organizations.

In obsessive development innate predisposition combines with premature and too intense maternal interference to increase aggression in the anal stage of development.

Obsessive compulsive thought processes betray their derivatives from actions in the rhythm with which they operate. Motor patterns which can be observed in obsessive patients correspond to rhythms of tension and release and to rhythms of withdrawal and approach, characteristic for the anal phases of infancy. But rhythms appropriate for oral-sadistic and urethral activities may vie with 'anal' and 'phallic' rhythms in the motility of obsessive patients.

The superego of obsessives acts as a participant in the games of early childhood. Inner urges are confused with external commands and a sequence of doing and undoing perpetuates the rhythms of early anal games. The superego of the obsessive is rhythmic rather than stable. In obsessive development an 'anal' type of integration subordinates phallic trends and genitality in such a way that damming up of genital discharge leads to disintegration, comparable to the state of disequilibrium of the 2½-year-old child.

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