The Immature Personality in Clinical Medicine
The dependent male or female patient repre-sents the personality disorder most frequently en-countered in clinical medicine. On superficial ex-amination one might think that some of these fe-male patients would fall under the classification of hysteria. However, upon closer scrutiny one finds that the infantile personality has experienced trau-matic events at an earlier age than the hysterical patient, resulting in a lack of integration of all sub-sequent events. Hence, sexuality cannot be inte-grated into genitality. In contrast, the hysterical personality has encountered its major traumatic events at the time of the oedipal situation, while true mastery prevails for previous experiences. However, both types, the infantile person and the hysterical personality, have factors in common. Exhibitionism, dramatization, diffuse eroticism, domination through suffering, and desire to con-trol, are outstanding. The areas of major gratifi-cation in the infantile personality are connected with intake functions, and manipulative ap-proaches and social techniques are designed for liv-ing in symbiosis. Hostile identification, imitation, and copying are therefore techniques of choice. The previously described external security systems are used to compensate for internal insecurity. In group situations the original family role of child or sibling is perpetuated, enabling these patients to apply techniques learned in childhood for the management of family members, thus obviating: the need for generalization and adaptation to so-cial situations prevailing in adult life.
Dependency requires control of hostility. Since infantile personalities cannot express tension ver-bally and in interpersonal relations, hostility has to be repressed, or expressed in terms of actions. In the former case tension states ensue, while in the second instance actions become destructive to self and the persons with whom the patient lives. In turn, the childhood history of such patients is characterized by a dominant mother (35) who used withdrawal of affection as a conditional means of education, concentrating upon herself the func-tions of authority, ideal model, and source of af-fection, or, by one or two punitive parents who gave affection only in conjunction with punish-ments. The common traumatic factors in these childhood constellations can be identified as con-sisting of erroneous timing and dosage of frustra-tion and rewards, inasmuch as either indulgence and over-gratification or deprivation and frustration made integration impossible.
Psychotherapy with Infantile Personalities
In applying traditional methods of adult psycho-therapy to treatment of infantile characters, one discovers that these methods are unable to promote maturation. The infantile character is chronologic-ally adult but emotionally a child who has scarcely ever experienced successful personal relations. Hence, necessary foundations for utilizing insight therapy are missing, inasmuch as experiences re-main isolated and integration does not take place. Verbal, gestural, or other symbols are not connected with affects and feelings, and consequently symbols have little merit for self-expression, although they can be manipulated in a manner similar to man-agement of gadgets or objects. Since insight therapy operates only when interpersonal relations and symbolic expression for the sake of communica-tion have been established, insight therapy with infantile characters is accepted on a nominal basis only. Words, sentences, and interpretations are memorized or forgotten, and like all other experi-ences they remain isolated and do not affect the functioning of the organism as a whole.
In experimenting with therapeutic methods to be used with infantile personalities (33, 34, 35) the criteria employed for assessment of results had to be based on evidence of maturation. If, after prolonged period of treatment, the patient started to integrate life experiences and began to function as a more independent unit, the method could be considered to have fulfilled its purpose. Psycho-therapy can be defined as a corrective experience which enables the patient to develop his growth potentialities. In applying this principle to infantile characters, the issue of psychotherapy becomes one of reeducation, in which benevolent firmness is absolutely essential. Therapy with infantile characters is not short, but long, usually requiring years. The frequency of interviews depends upon external circumstances and the needs of the individual case. Some patients, for example, at first cannot tolerate intense personal relations, while others sur-vive only if symbiosis is immediately established. If necessary, treatment can be interrupted for several months if certain experiences seem vital for growth and are conflicting with time and place of therapy. No rules as to external criteria of therapeutic management can be established, inasmuch as they usually constitute crutches helpful in alleviating the anxiety of the therapist rather than having a bearing upon the patient.