Self and Others by N. Gregory Hamilton M.D

Author:N. Gregory Hamilton M.D. [Hamilton M.D., N. Gregory]
Language: eng
Format: epub
Publisher: Jason Aronson, Inc.
Published: 1999-11-01T08:00:00+00:00

1See footnote on p. 96.

CHAPTER 12

NEUROTIC AND NORMAL PERSONALITIES

Neurotic and normal personalities are at the whole-object relations level of the diagnostic continuum. All individuals must contend with issues of differentiating self and object, integrating good and bad, and maintaining meaningful human contact. Those with predominately normal or neurotic problems have a sense of resolving conflict within themselves and developing continuity over time.

Neurotic problems, like borderline and narcissistic difficulties, revolve around regulation of love and hate, but the symptoms less often have to do with chaotic behavior and more with guilt, depression, and sadness. When it is realized that the object one wants to hurt, punish, or destroy is one aspect of the complex, loved person, guilt and sadness arise.

People with neurotic character structures can sometimes become extraordinarily dysfunctional, although in a different way from borderline or narcissistic patients. Instead of splitting their world into good and bad, idealized and devalued, they experience positive and negative emotions at the same time, but remain unconscious of some feelings. They repress unwanted affects, manifesting them in their dreams, slips of the tongue, and symptoms, instead of splitting them off and projecting them without any simultaneous manifestation of the unwanted affect.

J.G. was a 43-year-old psychiatric social worker who had partially recovered from a severe depression with the help of antidepressant medication. At the beginning of psychotherapy, he was unemployed, and his marriage verged on collapse. He and his wife planned to live apart for several months in hopes that their mutual recriminations would stop long enough for them to rekindle a satisfactory relationship.

The patient was well versed in cognitive therapies and read about the ways he was self-defeating. He told his therapist he wanted all the help he could get exposing his self-deceptions and rationalizations. He reported how he would lie on the couch all day reading books on self-deception and depression. When his wife returned from work, he would tell her he had learned about his problem and now understood why he had not been able to get a job. His wife typically became impatient and reminded him that if he looked for a job, instead of reading about why he didn’t look for one, he might find one.

The patient filled therapy sessions with similar explanations. He shifted his understanding from a cognitive framework to a psychoanalytic one. The therapist was at first heartened by the patient’s progress in gaining insights into his rationalizations and defenses against success. Over the months, however, J.G.’s insights did not result in more effective functioning. The therapist became bored and disheartened, and eventually found himself wishing to directly encourage J.G. to take action. The therapy reached an impasse.

The deadlock did not change until the psychotherapist expressed his opinion that they had reached an impasse and began to review the situation. J.G. recounted his shift over five years from father of three and breadwinner to househusband and then to depressed neurotic. His account included a description of how he had been publicly humiliated by a staff confrontation at the community mental health clinic where he had worked.

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