Obsessional Disorders: a system perspective

Bernard Brandchaft

Obsessional Disorders: a system perspective

Freud (1926, p.258), at the age of 70, concluded that the problem of obsessional neurosis, which he regarded as "unquestionably the most interesting and rewarding subject of analytic research", had not been mastered. This opinion might well have been delivered today for the illness remains tormenting not only to those who suffer from it, but to those who try to understand and treat it psychoanalytically. Psycho-analysis was built on the study of hysteria and obsessional neurosis, but "obsessional neurosis has actually become more perspicacious and familiar to us than hysteria, and we have learnt that it displays certain extreme characteristics of the nature of neurosis most glaringly (1916)". "No other mental phenomenon displays with equal clarity the human quandary of relentless and unceasing battles between innate impulses and acquired moral demands", Anna Freud noted (Nagera, 1976 p.9).

Discouragement with the results of Freud’s efforts to treat obsessional neurosis has had a profound effect upon the subsequent history of psychoanalysis. It undermined confidence in psychoanalysis more generally, bringing an end to the "golden era" it had enjoyed at the close of the Second World War, and its effect continues in the diminished support for psychoanalysis in psychiatric training centers and the general population.

The therapeutic impasse calls for the re-examination and reconfiguration of the human quandary that generates such tenacious psychological morbidity. A half century after Freud’s (1917) paper, Anna Freud deplored the scarcity of original findings, and characterized the main bulk of publications after Freud "as merely amplifying and corroborating". She emphasized that the psychoanalytic descent into obsessional neurosis would have to await the creation of new conceptual maps (Nagera 1976, p.9).

This paper will endeavor to reconsider the primitive strata of experience within which obsessional formations have been laid down and become resistant to change: It will propose a developmental systems perspective for understanding the predisposition and focal psychopathology.

The full text (in the italian traslation by M. Garuglieri) has been published in Psichiatria e Territorio, vol. XV, N 1 (1998).

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