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Tolpin, M. (1970). The Infantile Neurosis—A Metapsychological Concept and a Paradigmatic Case History. Psychoanal. St. Child, 25:273-305.

(1970). Psychoanalytic Study of the Child, 25:273-305

The Infantile Neurosis—A Metapsychological Concept and a Paradigmatic Case History

Marian Tolpin, M.D.

SUMMARY

In Part I Freud's concept of the infantile neurosis as the model of the adult neurosis was discussed. Distinct from clinically manifest neurotic disorders in children, infantile neurosis has been defined as a metapsychological concept which is fundamental to the understanding and treatment of the transference neuroses (psychoneuroses) in which it constitutes the leading pathology of the personality.

In Part II a paradigmatic case history of an infantile neurosis—the phase-appropriate endopsychic configuration associated with the phallic-oedipal level—was presented to illustrate the concept. In the transference neurosis the patient recapitulated the pathogenic events and solutions of childhood that were preserved in the infantile neurosis. The data abstracted from his analysis demonstrated that the underlying structure of a hysterical neurosis was the adult counterpart of the infantile neurosis. External events which reduplicated the first childhood trauma precipitated the outbreak of symptoms in adulthood. The adult neurosis repeated in its essentials the unmastered conflicts on which the infantile neurosis was based. These conflicts,

typically, had their origin in the phallic-oedipal phase of development; at their core was the primal scene fantasy of that phase of personality organization. The ego organization, spared by repression, was left intact despite the intensity of the conflicts, which remained on the phallic level in the absence of significant preoedipal fixations.

The infantile neurosis, the totality of the repressed phase-appropriate conflicts, was pathogenic in this case as a consequence of an unduly prolonged oedipal phase, which was traumatically interrupted. The trauma which shattered the patient's cherished oedipal beliefs led to massive repression of the unaltered beliefs and wishes and the dangers associated with them. The beliefs and wishes continued to proliferate in the repressed enclave of the psyche, influencing the rest of the personality by virtue of transferences which were effected when repression could no longer deal with renewed stresses and fresh traumas. In mid-latency chronic external stress rearoused the full intensities of the oedipal strivings and fears, necessitating additional defenses to augment the repressive mechanism which could no longer contain the recathected infantile neurosis. At that time this internal constellation led to obsessional manifestations. These in association with the continuing chronic stress prepared the matrix on which the new trauma of a severe physical illness could exert a lasting effect on the personality. Although the infantile neurosis was re-repressed after recovery (now without the need for the auxiliary defenses which, had they continued, could have led to permanent ego modifications), a part of the latency child's ego was left with the belief in the reality of the oedipal fantasies; and subsequent development to the adult genital level was halted by the enduring influence of the phallic-oedipal fantasies and conflicts of the infantile neurosis until their opportunity for "resolution" in psychoanalytic treatment.

The case chosen for illustrating the concept of infantile neurosis has the advantage of a paradigm uncomplicated by preoedipal regressions and fixations, but it is not intended to suggest that this is true in all adult neuroses based on infantile neuroses. In most adult neuroses the structure is far more complicated than that outlined above. The paradigm is intended to show the central role of the

infantile neurosis in the transference neuroses (psychoneuroses) in which it constitutes the leading pathology and which, for this reason, makes it eminently suited for psychoanalytic treatment by the basic model technique.

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