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Kanzer, M. (1968). Ego Alteration and Acting Out. Int. J. Psycho-Anal., 49:431-435.

(1968). International Journal of Psycho-Analysis, 49:431-435

Ego Alteration and Acting Out

Mark Kanzer

SUMMARY

1. Variants of the term "ego alteration" (or modification) have been surveyed in relation to the development of this concept in Freud's writings. The nucleus is to be found in the description of autoplastic adaptive changes within the self-representations and the ego-organization, pursuant upon the use and especially the failure of early infantile defence mechanisms.

2. More normal aspects of ego alteration were gradually recognized and differentiated in relation to reaction formation, identification, and the formation of character traits. Derivative terms came to include congenital and acquired, partial, transitional, reactive, ego-syntonic, ego-alien, advantageous and therapeutic ego alterations.

3. The pathology of ego alteration was described by Freud with metaphors such as ego-splitting, fragmentation, deformation, distortion, depletion, disruption, and disintegration. Certain of these terms have applicability to the self-concept, others to the functioning of the ego system. All have complementary relationships to object (or reality) alteration and the self-regulatory activities of the total personality.

4. Freud regarded ego alteration as a guide to the analysability of the patient, the course of the procedure and the achievement of results in the form of a normal ego. Differentiation of the functions of the id and the superego suggest that in the structural framework, the distinction between a normal and abnormal personality would more fully embrace the factors involved.

5. The problem of acting out and its modification through treatment is reviewed in relation to these perspectives. Acting out is regarded as transference-dominated motility with resistant features (in a narrower sense) and as action impelled by considerations of inner rather than outer reality-testing (in a broader sense). The process of ego (self-, personality-) realteration requires full understanding of the therapeutically-induced influences of the analytic method itself on the course of acting out. In relation to current notions of personality structure and adaptation, the control of acting out through the use of the principle of abstinence is found to be an undesirable extension of the special conditions of the analytic setting to the external world. The therapeutic alliance, on the other hand, presents

inherent mechanisms of control over action which integrate more advantageously the bonds between proceedings within and outside the analytic session. The ultimate success of therapy is reflected in the formation of an autonomous personality which is capable of insightful and appropriate action in external reality.

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