Anna Freud Diagnostic Profile - The Development of the Total Personality

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Now, we left it last time in the section that is called D and it's called development of the total personality. And I think I talked to you a little bit about this when we went to the profile, um, at the beginning in very general terms. What is important in this section is the following. See what it says: Development of the total personality. So far, we have been isolated. Try development, the aggression, the defenses, the ego, the super ego, and of course, we are trying to relate all of these things together. Now, we want, because we have covered all of that, we want to see, um, this in action. And the way you see it in action is by looking at the specific situations that create stressful problems for individuals that have to be dealt with.

What do I mean? This applies to children, to adolescence, and to adults. It applies to anybody. For a child, what would you look at? Well, you look at the entry into a nursery school, for example. How did they react to that? What resources could they display, assuming that it was done reasonably, intelligently, at the right age, and things of that kind. Obviously, you try to put a child in a nursery school at two years of age, he's going to have trouble. He's not ready to separate at that particular point in time. And so that has to be assessed. And you have to know that he, by then, has acquired the capacity to separate from the primary object for a certain amount of time every day, not indefinitely, not for very long times. And we know all of that. We have a lot of information about this. We have run in the past in nursery schools and, as I told you, we wanted to run one year because you learn so much. But you know what the difficulties are? But we may get there one day. In any case, that's a possibility. You look at the birth of a sibling, for example, or you look at an entry into, uh, the elementary school, or you look at the child being sent to camp at a certain age, or you look at critical situations, maybe hospitalization, maybe surgery, and you then can see the total personality in action. You know all the resources are called into action to deal with that problem. And what they tell you about how the child copes with all of these things, of the adolescence, of the adult, is very meaningful. And it gives you a very good feeling for how are the resources used, how many resources can be brought to bear in the situation that you are trying to deal with, and things of that kind.

The same is true of adults. You look at an adult that was fired from his job. A lot of people have been fired recently in this country, and you see how he reacts and what happens, what resources he has, how, what does he do with it? Does he just become depressed and suck, or does he go forward and to plan his life anew and see what else he can do and what else, where else he can go and apply and see? You can look at how an adult reacts to a birth of a child, you know, or to a significant illness, or a hospitalization, or surgery, loss of a friend, things of that kind. And all you do is simply tell them what happened. You know, say somebody that got divorced, which is a common phenomenon in this country. You will ask them a little bit about what happened and how did that happen, and and they will tell you how they feel. Frequently, they come to you because they are feeling very bad about it, or depressed, or angry, or a combination of effects that are very disturbing and very upsetting to people. Other times, you see what is a reasonable response, you know, with an initial perhaps state of confusion and even devastation within limits, but very quickly recovery by calling the ego resources and really handling this in a variety of different ways. So that is what you try to do. You try to see the whole personality in action, and you select critical incidents which they will tell you about. And there's no one that has not, you know, lost a job, or has a child, or, or has a sick child, or have been sick himself, or have been, you know, all of there are all kinds of critical events that you can take a look at at any given age. And that gives you a very good feeling for how the total personality responds to a critical incident.

Okay. Now, there Anna Freud was talking as well. That's where the lines of development come into play. But remember what I told you when we first introduced this idea. I wanted you to read them. I hope you have done that, because it gives you a very good idea that practically anything that is achieved in development has a long time and stages that one goes through at different points in your development and in different phases and at different ages depending on some external events and things of that kind. But they can be mapped quite precisely, and she did that with a few lines of development. The hope was that many more will be developed in good time. But unfortunately, that hope never did materialize for a number of reasons. One of it is, it's difficult to do it. You need somebody with myriad talents and experience to be able to map this thing. And to, uh, the team that was doing this kind of got dissolved because, uh, some people died and other people like me left, and so it became an orphan kind of project, and nobody seemed to have taken it on. But it's a very good idea, and, uh, it gives you a feeling for what you had in mind. Yeah.

Now, here we give you a few examples as well of what may be like critical incidents that you want to see. Separation from the mother, for example, because the mother has to be hospitalized or go on a vacation or whatever it is. Birth of the sibling, as I told you. Illness, surgical intervention, hospitalization. Entering into nursery school. Entry, the change from the triangular Oedipal situation at home, up to the age of five, into a community of peers during the latency stage. And a similar phenomenon during the adolescent stage, as the child struggles to separate from his primary object and become independent. And there are significant differences. Obviously, the latency child moves into a community of peers, but his primary objects are still fundamental and still primary. When the chips are on the floor and have to be counted, it's the family that is important to that child. You know, say, "Oh, I go with my, you know, seven-year-old friend and my neighbor, they want to go home." You know, now, with adolescence, it's different. They are struggling with the same problem, and that is trying to move from the primary objects to become independent human beings. And they too move into a community of peers. Then the peers acquire a significant, a significant that is enormous, because they can compete with the parents and take the place of the parents. And so the ideas of the group that they join will beat the idea of the home where they grew, at least temporarily. In some cases, and depending who they join, that may be a devastating experience. They may have chosen very bad company, and that can create a lot of problems.

So now, the, the latency children do the same. Not only join a community of peers, they start to look at other adults and start to make comparisons between these other adults and the parents. And the child goes from, "Oh, my dad is the strongest man in the world," or whatever it is that your family is the best, that is. And he knows it's true because his daddy told him, you know, that's what his daddy said. But then they go to school and maybe they come home, and when the father or the mother says something, they say, "That's not true. My teacher says that." That was unheard of before. They were gods. Now the god state is being reduced to the right proportion, and they have been measured very carefully against all the parents and against teachers and other people that start to populate the world. Nevertheless, particularly in early latency, the primary family is the dominant factor. With adolescence, that has changed. They move away from the family in the attempt at becoming independent, sometimes in very dramatic ways, and in very dramatic ways for the balance. Mr. L, come back in time with the ability by then to have become somewhat independent of the primary objects. We have problems with that in our culture because education makes adolescence dependent, wanting to jump out of good from the parents frequently because they pay the tuition. They have to help them with this, that, and the other, and so on. Well, in the past, by 16, 17, 18, when, as we were saying last time, people wasn't going to college or to universities in the numbers that it happens today, but they got me started to work and went on with their lives, then they could become independent. Nowadays, we foster with some of our cultural morals, which are good and necessary, like education, but we foster the dependence for enormous periods of time, and there are people that are in the middle 20s that are still dependent on the parents and not have not achieved the ability to become independent because they can do it, you know. So you take all of this into account, obviously. Yeah.

So now she says the step from play to work. She discussed that a little bit, uh, in one of the lines of development, and it gives you, I think, a pretty good idea of what the assessment of the total personality is trying to do, and where the critical incidents are that if you hear about and you explore a little bit to get a feeling for that. Okay.

And then you go to the assessments of fixation points and of regression. And, um, here I'm going to spend a significant amount of time because I think this is one of the most important points in the assessment of an individual, whatever age. Why? Because the personality gets organized around your fixation points. It's forced to that is an anchor. It's like a boat. Once it drops the anchor in there, it can move so far and nobody very far away from that place. And the mechanism of symptom formation will be related to the stage where you are fixated. The defenses that you use will be related to it. The solutions that you look for have some of these characteristics. The fantasies that you have are determined by where you are fixated, and they will have, you know, whether it is the oral stage or the anal stage or the phallic stage. They, your fantasies will be characterized, if it is the fixation at the oral stage, by oral concerns, or oral fixations, or behaviors that imply a lot of morality or eating, uh, you know, smoking, chain smoking, chewing gum, doing all kind of strange things with with your mouth. Your interest, your ego interests will be as well determined by your fixation point. They will limit what kind of interest you can develop. So, as you will imagine, if all of this is true, and it is, it not only does that, let me add a few more things, but we will go into it with a little more detail, detail. It determines the quality of your object relationships as well. How you are going to relate to your objects and your expectations of your objects are. And so, as you see, that really shapes you up pretty good. It defines who you are, essentially. And that's why I think it is so important, and you can gather so much information, which then is valuable in the treatment of these patients. You have good signposts as to where the problems are, what you have to do, how you have to address them, uh, what is essential for the good, for a good therapeutic success, success with these patients. And obviously, you have to, uh, weigh that in the balance with the resources that the patient has. I hope you include the skills that you have because in order to move people from certain points when they are fixated, when they are significant or the result of traumatic situations, or they have precarious ego resources to deal with this, one can do an enormous amount of damage and create an enormous amount of suffering and even make the life of the patient worse than it was originally. Remember what I told you earlier. Some patients have achieved the best solution that is possible for them. Just because we call ourselves therapists doesn't mean to say that we can improve them. And you need to have the ability to recognize that fact and to recognize when you are in the presence of the patient that the best thing to do is do nothing. You become like an obstetrician that has a mother delivering. He doesn't touch her if she is delivering normally. He says that the best obstetrician is the one that does nothing. Okay? And that's true. He only intervenes if there is some danger that will not be overcome by the forces of nature themselves. At least that was the way it was when I was in medical school. Maybe that has changed and they do all kind of things now.

Now, obviously, there are other things that you have to take into account. It's not quite the same. And you need to know these things to treat the patient who got arrested in a particular stage of development and never moved his drive organization past that point, to treat somebody that went high to the phallic stage and then found massive conflicts there and was forced to regress. You see, that fellow was already there. He knows the way there. He was there once. He showed that whatever happened, he had the resources to move enough of himself there. Unfortunately, once there, something happened that he had to go back. So he was once there. He knows the way there. And you, as a therapist, know that he can go back there because he was once there. And if you can find out what it is that pushed him back, then you can help. You remember that when we were talking of the phases of development, I made, I'm going to do this myself. This is the oral, anal, and phallic stage development starts here. Yeah. And I told you it was like an elastic. Right. When you develop a fixation here, then the elastic, you have to pull very hard to get it over here. But that elastic is under tension. In fact, if something happens here, somebody slaps your hand and you let it go, it goes from the way back to where the fixation point is established, right? And so obviously, we are talking then of the difference between fixation and regressions. How do you distinguish them? I'll be simplistic. I, I hope you read the paper. Did you? So you will have become very familiar with this. If you didn't, I very strongly recommend you read it because it clarifies these things tremendously, and it gives you all the scenarios which I can give you. You know, in a, in a talk like this, with an arrest in development, that is the fixation that is so massive that there is nothing left to move forward. Yeah. So what you will have is somebody that will have to organize his personality right there because he hasn't gone anywhere else. He had never been anywhere else. So that's what he has to do. That's a massive arrest in development. They are very rare, but they do exist, and they create a lot of havoc. Most people don't have a massive arrest which will, in fact, be very damaging to personality development, but they have different amounts of fixations, you know, at different points. And, um, you remember that I gave you a metaphor of an army moving forward through hostile territory, and if they have to leave behind, you know, let's say in Georgia before they move to Florida, a lot of the troops when they get to Florida, they are very badly weakened. And if there is a lot of forces here opposing them, they may have to go back to Europe. Why? Because 200 there and 200 from here is 400. And maybe they can defend a little self, a little better. You remember when we talked about this? Well, this is what we're talking about.

Now, what happens? Let's say that you, for whatever reasons. And you remember that we said that fixations come about by two types of mechanism. One is excessive reflection, and the other one is excessive gratification. Whatever it is, and whichever forms the excessive reflection and gratification takes, once it takes place, it depends on how massive the fixation is quantitatively speaking, how much of your troops have to stay in that process. Yeah. Now, let's say that is not an awful lot, but enough, you left behind enough. But this is a child that maybe the mother will tell you, "Well, you know, it is really a problem, Dr. M. This happened to me millions of times because he's now five and a half. He still sucks his thumb. Never stopped sucking his thumb. We put things in there that tasted badly. We punish him. We whatever. He is not even embarrassed of doing this in front of other people." Some children, where the fixation is not as important, they suck their thumb, but only in the presence of members of the family, people that they are very familiar with. Is somebody that is somebody they don't know? Come, say, "Take the finger out." They already have a callus developing here. Sometimes they have an answer in the damn finger. In any case, so what you see is that something that was normal up to two, maybe even two and a half years of age, is continued as a symptom then through much later years when it is no longer legitimate for a child to be stuck in his tongue all the time. That tells you that that child had a fixation that is obviously significant, and that manifested itself in some behaviors and some symptoms all the way through to the point where you see that the child, if it is a child, if it is an adult, is the same problem. You know, the only thing is that, and in that paper, you would have read that that fixations that are acceptable at a certain age, like sucking your thumb, are not acceptable when you are 30 years old. It'd be very embarrassing to do that. You practically have to be psychotic to do that in front of other people, though I have to tell you that I have known patients in their 20s that talk only that they don't in front of.

Um, so what happens? Children, as they grow older, moving to adolescence and even in adulthood, find ways of moving the oral manifestation of the fixation into more socially acceptable behaviors. So, which in, in, in the particular group, for example, you may like gum and chew gum all the time, but you can live without gum, but you're not sucking your thumb anymore, and that's more acceptable for a while. Okay. It's obviously for some people not very acceptable mechanism, and some people feel quite disgusted by it. If it's done, you know, you get people get somewhere in the paper, put it back in the mouth. I have patients that come and put it somewhere, they pick it up. That obviously is not as acceptable, but it's better than something that some, you know what I mean? Or they may become smokers, or it gets disguised into activities that are normal. We all have to eat, but then the eating has a special characteristic. In other words, they may overeat and get to be overweight, or they become bulimic, or they only eat certain types of foods of food, or they have to have a certain type of flavor, or they have to smell in a certain way, and there are all kind of variations, or they smoke a pipe, or they smoke cigars, or whatever it may be. In other words, whatever the fixation is that was originally manifested by one of the component instincts, you remember the component instincts of the different phases, yeah, is exchanged for things that become more appropriate for the age of the child, and then when they become adolescence, more appropriate for the adolescence, and when they are adults, they can hide it. Sometimes real world behind activities that have to be normal because we all have to eat. Only that if you look at how they eat, what they eat, what food means to them, you say, "That's no, no, that is a problem that manifests clearly, is evidence, clear evidence of the fixation that the person has." Okay. The same is true of any other type of component instinct from any other phase. Same is true. Same thing happens.

Now, in other cases, there is another, that's that's a significant massive fixation that is visible all the way through. Right? Other times, it's not as obvious. The mother says, "Well, he used to suck his thumb, but, you know, at some point he gave it up. It was not easy, you know, but he gave it up. And then he only did it by himself. And there was somebody that we didn't know, or a stranger in the house, he wouldn't do it. And then later he went to his room, and I think he still does it. He's now eight, but he doesn't do that in front of anybody. He's trying to control this." There is then a regression back to here. What you will hear is, "The last few weeks, he has gone back. He's sucking his thumb all the day, all day long. Doesn't matter anymore who is there. How many times you tell him that that's disgusting or whatever it may be." You understand what I mean? The manifestation of it that was quiet and not too loud, now suddenly explodes again. Which means to the fixation that manifests itself all the time was added with a regressive movement, an enormous increase on the activity of the component instinct related to that phase of development. So that's a way you can distinguish. In the one case, it has been present all the time, more or less in a uniform manner, it may have changed the form of expression to forms that are more acceptable. In the case of a regression, what you see is an increase of that activity that really gets out of control, you know, in other words, to the manifestation that you could observe also the history of this patient. All of a sudden, you see a recurrence of this manifestation, or some new oral things that come to the fore with a bang, and it's very surprising. Okay.

Now, obviously, all of these things have diagnostic value and have prognostic value. The more primitive the fixation, the more compromised the personality development is. All right? So that if you have a massive fixation at the oral level, you really probably are quite handicapped if it is really very massive. What if it is at the anal stage? Most of the foundation of development has gone well up to the phallic phase. And so much of your ego structure, much of the defense mechanism that you develop, much of the resources that you have in terms of drive that you have to move forward to become normal, have done that drive and remain arrested. And the drive contributes to ego development. If you have a massive fixation, your ego development is being damaged because it's restricted by the fixation in a large number of different ways. All right.

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Now, obviously, when we are talking of fixation here and referring to drive development and so on, the same is true of the aggressive drive. It applies exactly the same way. You have a child with an anal sadistic fixation, and it will show as an anal sadistic character. It will show in his character, in his interests, in his behavior, in, you know, his ego interests, and you will see that there is a lot of anality involved in his hobbies, his interests, what he reads, the way he talks, the expressions that he uses, the jokes that he makes full of anal content, you know, and maybe he goes into certain poems in there of a certain type. People do all kind of very strange things with these things. So, does it show only that? No, it shows in many other ways. It shows in the quality of the object relationships. Why? Because if they have a fixation to the anal sadistic stages, the only way they can relate to their objects is on an anal sadistic manner. And so the quality of their object relationship will be tainted by these things. And it is from that group that you get a lot of spouse abusers, you know, and you get a lot of elderly abusers and things of that kind. Why? Because their aggression is fixated at that stage, is an anal sadistic type of organization. And when they explode, they explode with violence and in a very aggressive manner. And as you remember, they had never, because they retained so much behind the Oedipal phase, they had never fused libido and aggression in such a way that you will tame the aggression. You remember when we talked of the move from the anal stage to the phallic phase, that it typically aggression and libido fuse, and then it becomes tame, and the child then, from, you know, being a child that if you fall, he's fighting, he kicks the other and really tries to hurt you, he learns that, no, that's not the way you fight with rules. You don't hit anybody on the floor. You don't hit in the back. You know, it becomes a gentleman kind of aggression, you know. But you tell that to somebody who has not fused his aggression with, has not moved to the phallic phase, and you are wasting your time because he doesn't know what you're talking about. He can do it. His aggression is filled with an incredible amount of violence. So, as you see, it will show not only in his behavior, in his ego interests, but in his relationship to the objects as well. And so it's very simple, in reality, when you listen to the patient and the history that he's giving you. You don't even have to ask too many questions. He's telling you, you just have to have an ear to hear. You know, there are people that listen to a symphony and can't know where the violins are. They don't, they have not developed the skill to differentiate between violins and flutes, or violins and oboes, or violas and cellos, and it requires training. Otherwise, what you hear is not sounds good, pretty, you like it. Yeah, I do. But if you check the tree, they have no idea of what the interplay was between the instrument and the orchestra that make that symphony beautiful and really well-structured and well-conceived. Why? Because they are not trained to hear, you know. And so, are they deaf? No. They hear music and they have likes and dislikes. Do they know a damn thing about what the orchestra is doing? No. And that's to therapists as well. They hear noises. But if you don't develop this knowledge and these skills, you really cannot distinguish between the violins and the oboe. And you don't know, you know, music. It's like anything else. And as you know, they say this is a symphony in C major or in D minor or whatever it is, you know, and you think that that's just means that it has so many, you know, don't know what the word is in English for increasing half a tone, the pitch, or diminishing it. In Spanish, it's who knows music here? Sharps and flats. Sharps and flats. The sharps, you increase half a tone. The flats, you go down half a tone. You're in a piano. You're in a different key. You play a string instrument. You think it goes down, and you learn to do that. Well, as I was telling you, the D major and or E minor and so on means that, yeah, there are so many flats and so many sharps in it. But the fact is that composers and people that know music and know the structure of music knows that certain keys, which is what this is called, D major key, to C major key, to C minor or C augmented, whatever it may be. They know that that combination has a particular effect in people, and it may be one that is joyful, or is one that is very sad. And a good composer never uses a key if he's trying to express sadness that conveys joy, because he knows that key can be used. You understand what I mean? You know why he does that? Because he knows what he's doing. He's a composer, for God's sake. That's why he can write music. Well, here we are composers in a different sense as well. And the more you know about these things, the better off, the more you will enjoy what you do. Incidentally, because there is an enormous amount of pressure in listening to music with understanding, just as there is an enormous amount of pressure or listening to patients with understanding. And there is an enormous amount of pressure too when you know that you didn't quite get it, but you know you will get it if you hear it again. Now, some people have that talent in an incredible degree. Yeah. And other people don't have much talent. And talent, you can buy anyway, either you have it or you don't have it. You have some, you can develop for me. You have none. They hope for you as the truth, and they are different. Just to use a metaphor again, music, I don't know music today. You think of Mozart. Mozart, he heard a whole damn symphony and could write it down in memory. He would sit down and write it. And one of the most frightening things that he did for his father, who was a musician, was that once he went to the Vatican, where only in Easter they play something called the Miserere, which is a beautiful piece of music that was kept to the Vatican, generally regarded never published, only the church had it, only the Pope had access to, and they played it in the Vatican at Easter time. There was Mozart with his father, and his father named, wrote to his mother, he used an endearing term, which I don't remember what it was, but essentially saying Mozart had done something terrible. He copied the Miserere as soon as it was finished and has sent it to a publisher, and the Miserere now is public knowledge because Mozart copied it. If he, nobody knew that he did it because nobody could think that he had that kind of facility for music. Right? So he was never suspected. Had he been suspected, they would have excommunicated him right there and then, because that was sacred music, only played one day duration. So, so you may not be Mozart, that you have to be born that way, and there are few people born like that, but you may be born like most of us with enough skills that can be developed. All right. And not to develop them is creeping up to yourself and to your patient. It's not as much fun, you know, to be listening to things that you don't understand and cannot make sense of. It's like music, and that's in a way, what psychotherapy is. It's like music. Either you understand it, or you don't. All right.

Now, I know some of you have to go at six. All right. And then is that's that's the right time to finish it. Yeah. Let me move on. Now, when you talk about fixation, you can say, and people again, depending on the level of the skills, will say, "Oh, he's fixated to the anal stage." And that's okay. You are making a good statement if, if you add the data to show that he's fixated to the anal stage. But is that all you say? You are being a, a very poor musician. You really have to listen more carefully and say, "Yeah, that's the anal stage, but it's being played by the flute." And here you have to do the same. You say, "Yeah, it's a stage which is such and such component instinct that is really at the basis of this fixation," and that is extraordinarily important. Because psychoanalysis and human conflicts are based on the idea that some of our drives get into trouble with the environment, with the culture, and they have to be replaced. In other words, psychoanalysis is a theory of conflicts. And if you're going to help that patient, and you are stuck at the anal sadistic stage, you can go past to where really the conflict is behind that facade of the anal sadistic stage. And that is whatever component instinct is still the one that is really involved in the fixation. And if you don't know that, you never get to it. You can never interpret the conflict. You can never find where it came from, why it became a conflict, why is he's using these defenses against you. Stay on the outside of the tree. You don't know the tree. You understand what I mean? Now, it's better to say, "Yeah, it's a tree," than to say that's like how it is, something with leaves and so on. But then you have to go in there and take a leaf and say, "Yeah, this is a leaf. It's of this type, and it has so many lobes, and I can see, you know, that whatever it is that you can describe about it." So it is important to not only say, "is fixated at the oral stage," but then say, "What in the oral stage is it sucking? Is it biting? You know, is it leaking? What is it?" And the fantasies are swallowing, the fantasies are are infinite. Now, you look at the object relationships, as I told you, because sometimes that's the only place where you see it. In other words, the patient shows the fixation point only in terms of his ability to relate to objects, in the quality of his relationship. His oral is probably, as I told you earlier, clinging, demanding, feels hopeless and helpless, doesn't think he can do it. He wants to be fed. He feels like an infant does during the oral stage. He has no resources. Only that this is now a 30-year-old man or woman, quite capable, possibly very intelligent, that still is feeling as he was a nine-month-old baby or 15 months old, you know. So you look at the object relationship as well.

Now, what do you look at? I told you already, behavior. Games that children play, they have meaning. Comics that they bring to you. The answer clinic. We had comics in the waiting room for kids, and they always came with comics, and some of us have resistance, and sometimes it is, but frequently it's a means of communication. If you look at the comic, you say, "By golly, he's describing his family. He's talking about his family. He's telling you, you know." So you open your eyes and your ears, and and then you see and hear. Now, so his play, what kind of play he engages in, fantasy play, his attitudes, his ego interests, his fantasies whenever they are available. And children will frequently play active fantasies. So you don't even have to ask. He's going to play actively. With adolescents and adults, you may have to ask and say, "Well, what? Yeah, you said you masturbated, but what is the fantasy that you use, or what is a typical fantasy that you use?" And then they will tell you, and the content of that fantasy is strictly related to the fixation points. So you will have, what is a fantasy? Let's say that is somebody who is an oral person. Probably the fantasy involves oral sexual activities, fellatio, whatever it may be, you know, talking, whatever it is that this person has in his mind. And so it goes, so it goes with any one of them, or the symptoms that the patient has, they usually tell you very quickly what the fixation is like.

Now, there are, and I should warn you about this, some temporary forms of regression, particularly in children, not so much in adults, but you can occasionally see it in adults as well under very dramatic circumstances. But in children, regressions are easy. In fact, most young children regress in the evening when they feel sleepy and they become cranky and cry easily and become difficult. You say, "What the hell is going on?" I'm just tired, and he's being regressive, and so is becoming demanding and clinging. The same is true if they get hurt, or they are sick, or are in pain, or things of that kind. But the moment the pain disappears, or they fall asleep and wake up the next day, that behavior has disappeared. It's a temporary form of regression. Very typical of children, not so typical of adults because we have more resources. But in very dramatic situations, adults can become regressive. We talked the other day when we were discussing here mourning and losses, or some situation of that type where the patient becomes so regressed that it's unbelievable sometimes. In fact, they develop what is a wishful hysterical psychosis. All right.

We talked about, um, the difference between fixation and regression. How the fixation, you can identify because past the stage where that activity of that component instinct was normal, past that stage, you still see that activity. So you say it has been fixated at that stage, and within that stage, if it is talking in some, you know, what it is that's all something, yeah, or what if it is biting, or spitting, you know, whatever it may be. And the regression is something that comes later on, and these minor sort of manifestations of the fixation also development suddenly become like a loud group of 20 sopranos, you know, singing in a very loud voice. And that's the difference. Why? Because the regression on the aggression came back to that stage and now have reinforced the activities of that stage. Now, that's interesting. Because, as you will imagine, when you are seven or eight or nine, your ego has developed tremendously and has acquired super ego and a lot of attitudes in terms of how do you deal with certain impulses, particularly anal sadistic aggressive impulses, but not only. And so when the child regresses massively to such a stage and starts to behave in such a manner, he can't help that. And the family will be horrified. But a part of him is as horrified as the family is. He can't help it. He will continue to behave that way. But now his ego has a horror of these impulses, which he, he didn't have when he was going through the phase, because that's normal for the phase, and your cognitive development is not opposing any of that. Once you go higher up and you say, "You don't [ __ ] in your pants, you know, that's only babies do that, and you are doing that." There is a part of you. You, it is it, you have to accept it. You know, it's like a toothache. What are you going to do? It's there. You go to the dentist and try to remove it. It is there. So you can say to the pain, "Go away." He can say to his soul, "Go away." And will probably then develop alternative defenses to ignore it, deny it, repress it, you know, do whatever he can with it because he's very embarrassed. But a part of him will be horrified of the fact that he's now behaving in this gross manner to which he already has enormous objections in his own interjection, his super ego. You understand what I'm saying? So that complicates the life of his children tremendously. Okay.

See what else is worth telling you about this. Oh, yeah, it is important when you are told, "Well, six months ago, he developed all this again, and he's doing all his soiling again. He had been clean and dry for so many years, and now look at this. We don't know what to do." And he said, he says, family will say, "He's not embarrassing them about it," which may be true, but frequently it's not, because then they tell you that he's hiding it or trying to hide it, which means there is a part of him that obviously is not happy with what is happening, but what is he going to do, you know? And, um, but what is important then is to look carefully at what was it that was happening around that time that may have induced that regression. And that may be environmental factors, unfavorable environmental circumstances. It's like when the elastic goes all the way to here, something happens here that slaps your hand, and it comes back all the way. And it may be the divorce in the family, fights between the parents, the birth of a sibling, God knows what. Something obviously induced a regression. It's important to know what it is, when it took place. Sometimes it's in the environment, sometimes it's a developmental conflict. In other words, it's internal. No factor on the outside world that can explain it. But the developmental conflict that the child was going through might explain why he took the aggressive move, took the leap.

Now, I have to tell you that we assume as analysts that there are occasions where even people that doesn't have established fixations will regress very badly, and that's true. That's what happens in very traumatic situations. It happened in concentration camps where people knew that they were going to be gassed and die and were starving to death, and became, some of these people became extraordinarily regressed, and that is not abnormal. I already told you that all of these fixations change the facade as you grow. You try to become adapted to what is acceptable. Otherwise, you get embarrassed constantly, you know, by the people in the in the environment pointing out to what you're doing and things of that kind. So, you try to hide it. With some people, there is a very interesting way of hiding it. It goes into the sexual life where it becomes a sickness that only he and his partner know about, you know. So it's never shown except in the sexual life, and so the manifestation, and that's an interesting situation because many perversions or semi-perversions are of that type, you know, they are hidden behind the four pleasurable activities of couples and things of that kind. So it's important to keep your ear open to all of these things because sometimes it is disguised pretty much in that way.

Now, obviously, if you have a challenge, the phallic phase, he has all kind of fantasies and castration anxiety and nightmares, and he regresses. All of these fantasies disappear. The fantasies that come back to the core are the ones that are anal sadistic. That stage. In other words, he lost the high level of achievement, and the conflicts at the higher level are gone because his life has gone backwards, and that is obviously important and significant, and you have to pay attention to them. So you don't observe any longer the fantasies and the anxieties and the conflicts that are typical of the phase that he has abandoned. That disappears. It's gone because he moved backwards. So it's no longer there.

Now, the other thing that happens with fixation is, I was telling you that they influence ego development. They influence everything. So take a child that has, and it's not an oral fixation or fixation gets here reasonably clean. He still would have the conflict of that phase, which is mostly for a boy, a lot of castration anxiety, you know, and the fear, what will happen to, what is the difference between people, how did people lose it, and things of that kind. Same for girls, how come I don't have it, kind of thing. Well, if that child hasn't got an early fixation, his fear of, if you become, and he will become symptomatic because that's a developmental conflict, and he produces symptoms until it gets resolved. He will produce, let's say, phobias of knives, or he can go to the barber that will cut his hair. He goes into a panic if he goes to the barber because he cuts hair, and of course people say, "Oh, you're going to cut your ear," and so on, and not very good. So the anxiety corresponds to that level. If it is somebody that has an oral fixation, but is not a complete arrest, but he moved a lot of his libido to the phallic phase, he will have the same castration anxiety. But now the fear is not that scissors are dangerous or knives are dangerous. The fear is that animals bite and can take your finger off or your hand off. It's rarely, if ever, referred to the sexual organs, but it's, it's the expression of the anxiety is not at the high level. See, a phallic boy is interested in knives and scissors, see, that cut, to penetrate and do things like that. An oral boy doesn't have that interest. And of course, the interest and the fear go together. Yeah. The knife becomes dangerous. Then an oral fixated boy, you have moved enough to the phallic stage, will express his castration anxiety in oral terms, you know, and that's how you can see that the fixation point influences the ego development and the form that the concrete acquires in the higher level. They get kind of tainted by this. Stronger the fixation, the stronger that you will see the impact of that phase in the higher level of development. So that's something that you need to, uh, to take a look at.

Now, just to end, let me just tell you that some people get some fixation here or here or there, and that's it. Okay, fixated, fixatedly fixated. Older people get fixations everywhere. You know why that is the case? It's different for everybody, but it may be very conflictual home situations, whatever, very unfavorable developmental circumstances of the child that lead to fixations everywhere. Then what you see is a very mixed picture, and obviously that's not very good to have fixations at every level. It's worse than to have one point where you are fixated, except if it is at a very primitive oral level. You know, generally speaking, most people have fixations in different places which are not too excessive, because we go through all the phases, and it's very rare that we can traverse all this territory where there are conflicts without any signs of the conflicts. You understand what I mean? H, but it's, it's a quantitative matter that is important. Some minor signs of fixation at different phases don't mean a damn thing. If you are talking, you are thinking quantitatively, it has to be somewhat significant, and you have to see the influence of that in the rest of development, you know. And I think that for the time being, that's about as much as we will do with fixation and regression for today. If you read it, I think you would have understood most of what I said without much difficulty. If you didn't, you should have just people have a chance to breathe. I can do perhaps to make the reading a little easier.