by Otto F. Kernberg, M.D.
Studies of patients with severe personality disorders and of children at high risk for psychopathology have shown growing evidence that early exposure to violence as well as physical, psychological and sexual abuse, particularly incest, are significantly more frequent in their background than in those with milder personality disorders and the population at large (Paris 1993). Yet, evidence is also increasing that abnormality of neurochemical and neurohormonal systems may be related to significant aspects of personality pathology, particularly proneness to aggressive and reckless behavior, pointing to the importance of genetic and constitutional determinants of what is somewhat loosely called “temperament” (Stone 1993). Accepting in theory the possibility that both genetic and constitutional factors and environmental and psychodynamic factors may play roles, the question remains how to conceptualize aggression and understand its involvement in the development of severe psychopathology.
I proposed in earlier work (1992) that affects are instinctive components of human behavior, that is, inborn dispositions that are common to all individuals of the human species. I proposed that they emerge in the earliest stages of development and are gradually organized as part of early object relations into gratifying, rewarding, pleasurable affects or libido as an overarching drive, and into painful, aversive, negative affects which are organized into aggression as an overarching drive. Within this conceptualization, affects are inborn, constitutionally and genetically determined modes of reaction that are triggered first by various physiological and bodily experiences, and then by the development of object relations from the beginning of life on.
Rage, within this conceptualization, represents the basic affect of aggression as a drive, and the vicissitudes of rage explain, in my view, the origins of hatred and envy, as well as of anger and irritability as moods. Similarly, the affect of sexual excitement constitutes the core affect of libido, which slowly and gradually evolves out of the primitive affect of elation. Elation is produced by the infant’s early sensual responses to intimate bodily contact with mother.
The proposed theoretical reformulation of the relationship between affects and drives in psychoanalytic theory permits conceptualizing the constitutionally given and genetically determined disposition to intense activation of aggression expressed by means of temperament, that is, the inborn disposition to intensity, rhythm and thresholds of aggressive affect activation. In this connection, cognitive deficits, minimal brain dysfunctions that interfere with the organization of perceptive stimuli and that facilitate the activation of anxiety under conditions of uncertainty, also may contribute to pathological affect activation. A limited capacity for time appraisal and spatial organization, for example, would increase an infant’s sensitivity to separation from mother. Most importantly, traumatic experiences, such as intense and chronic pain, physical and sexual abuse, as well as severe pathology in early object relations would operate through the activation of aggressive affects determining the predominance of overall aggression over libidinal striving, resulting in conditions of severe psychopathology. In short, the artificial separation of nature ver-sus nurture can be reconciled by a concept of drives that considers their constituent affect dispositions as their structural underpinnings.
I assume that from the onset of object relations the experience of the self relating to an object during intense affect states generates an intrapsychic world of affectively invested object relations of a gratifying and aversive quality. The basic psychic experiences that will constitute the dynamic unconscious are dyadic relations between self-representation and object representation in the context of extreme elation or rage. Symbiotic states of mind-that is, experiences of elation within which an unconscious fantasy of union or fusion between the self and object crystallize-are easily associated with the psychic implications of the baby satisfied at the breast and the baby’s elation when in visual contact with mother’s smiling face. That states of intense rage also imply an experience of fusion between self and object under the control of such an intense aversive affect is a conclusion derived from the transference analysis of patients suffering from severe psychopathology characterized by intense aggression.
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