Some forms of emotional disturbance and their relationship to schizophrenia (‘as if’ case) : 1942 : Helene Deutsch

by Julia Evans on January 1, 1942

Author: Helene Deutsch

Title: Some forms of emotional disturbance and their relationship to schizophrenia

Date published: 1942


– The Psychoanalytic Quarterly : Vol 11 p301-321

Available at /authors a-z

– Also in ‘Essential papers on borderline disorders:  one hundred years at the border’

Editor: Michael H Stone

Published: New York, New York, U.S A.: New York University Press, 1986

Quote : Most of the psychoanalytic observations in this paper deal with conditions bearing a close relationship to depersonalization but differing from it in that they were not perceived as disturbances by the patient himself. To this special type of personality I have given the name, ‘as if’.

Quoted by Jacques Lacan

Seminar III: The Psychoses: 1955-1956: from 16th November 1955: Jacques Lacan : Information & availability here : 11th April 1956 : p192-193 of Russell Grigg’s translation : referred to as the ‘as if’ case [See texts on ‘Ordinary Psychosis’ here] : Full quote below

Seminar VII: The ethics of psychoanalysis: 1959-1960: Jacques Lacan : Information available here : session of November 18th  1959 : on p9 of the Dennis Porter translation : referred to as the ‘as if’ case.

Quoted by Other Authors

Interpretation in Reverse : 1996 : Jacques-Alain Miller See here

Quoted as ‘As if’ Case in Recalcati 1999: details here The Empty Subject: Un-Triggered Psychoses in the New Forms of the Symptom: 1999: Massimo Recalcati

Female Psychology – Helene Deutsch 1884-1982

(From American Psychoanalytic Association web-site: here)

Helene Deutsch, the first important woman analyst in the Vienna Psychoanalytic Society, lived a long vital life both in Europe and the United States. Analyzed by Freud, her first analytic patient was Viktor Tausk. Later, she was in analysis with Karl Abraham in Berlin and at the Salzburg Conference, gave her first paper on women, which became “The Psychology of Women’s Sexual Functions.” Criticized by Karen Horney for equating women with masochism, her work has more recently been accepted by feminists because of her attention to problems posed by women’s identification with their mothers. Deutsch formulated a theory of “as if” identification and illustrated it with examples from such fictional works as Mann’s Felix Krull. Arriving in Boston from Vienna in 1935, she played a major role in the Boston Institute as she previously had for 10 years as Director of the Vienna Psychoanalytic Institute.

Her works include the two-volume The Psychology of Women (1944, 1945), Psychoanalysis of Neurosis (1932), Neurosis and Character Types (1965), and Selected Problems of Adolescence (1967). There is a major biography by Paul Roazen, Helene Deutsch: A Psychoanalyst’s Life (1985), and an autobiography, Confrontations with Myself (1973). Her papers are collected by Paul Roazen in The Therapeutic Process, the Self and Female Psychology (1992).

References to works by Sigmund Freud

(Quote from Helene Deutsch’s text, p80)This patient’s myth bore some similarity to the fantasy which Freud called the ‘family romance’ [see footnote below] in which, however, the libidinal relation to the parents though repressed is very powerful. By repudiating the real parents, it is possible partly to avoid strong emotional conflicts from forbidden wishes, feelings of guilt, etc. The real objects have been repressed but in analysis they can be uncovered with their full libidinal cathexis.

[Footnote] Freud designates as the ‘family romance’, fantasies which have in common the fact that they all relate to the ancestry of the person creating them. The typical version of the ‘family romance’ is ‘I am not my parents’ child. Whose child am I then? ‘The usual answer is, ‘I come of a more exalted family’.

1)  Sigmund Freud: Family Romances : 1908 Published 1909: Translated by James Strachey: Standard Edition Volume 9: p235-241:1950  or p217 of Volume 7, On Sexuality: pfl.

2)  Reference to family romance: Sigmund Freud: Three Essays on the Theory of Sexuality: 1905: Essay III The Transformation of Puberty : Section 5. The finding of an object: Translated by James Strachey: Footnote 1 p149 of pfl – Penguin Freud Library – Volume 7, On Sexuality or Standard Edition Volume 7 p123-245, 1949: [p1245]

¹ [Footnote added 1920:] The phantasies of the pubertal period have as their starting-point the infantile sexual researches that were abandoned in childhood. No doubt, too, they are also present before the end of the latency period. They may persist wholly, or to a great extent, unconsciously and for that reason it is often impossible to date them accurately. They are of great importance in the origin of many symptoms, since they precisely constitute preliminary stages of these symptoms and thus lay down the forms in which the repressed libidinal components find satisfaction. In the same way, they are the prototypes of the nocturnal phantasies which become conscious as dreams. Dreams are often nothing more than revivals of pubertal phantasies ‘The Interpretation of Dreams’: 1900a: pfl Volume 4 p632-633]of this kind under the influence of, and in relation to, some stimulus left over from the waking life of the previous day (the ‘day’s residues’). [Strachey notes: see Chapter VI, Section I, of  Some among the sexual phantasies of the pubertal period are especially prominent, and are distinguished by their very general occurrence and by being to a great extent independent of individual experience. Such are the adolescent’s phantasies of overhearing his parents in sexual intercourse, of having been seduced at an early age by someone he loves and of having been threatened with castration; [added footnote: cf. the discussion of ‘primal phantasies’ in Lecture 23 of Freud’s ‘Introductory Lectures’: 1916-1917: pfl Volume 1: p416-418] such, too, are his phantasies of being in the womb, and even of experiences there, and the so-called ‘Family Romance’, in which he reacts to the difference between his attitude towards his parents now and in his childhood. The close relations existing between these phantasies and myths has been demonstrated in the case of the last instance by Otto Rank (1909). [Footnote added: cl. Also Freud’s own paper on ‘Family Romances’: 1909c : p217 onwards: pfl Volume 7, ‘On Sexuality’ and his long footnote to Part (G) of his case of the ‘Rat Man’: 1909d : pfl Volume 9 : p86-88] (Otto Rank: 1909 : Der Mythus von der Geburt des Helden: Leipzig and Vienna: Translated as ‘The myth of the birth of the hero’

Quote from Helen Deutsch’s text, p88 :  Narcissistic identification as a preliminary stage to object cathexis.and introjection of the object after its loss, are among the most important discoveries of Freud and Abraham. The psychological structure of melancholia offers us the classical example of this process.

3)  From Mourning and Melancholia: 1915: Sigmund Freud : p258-259 of pfl: Volume 11, On Metapsychology or Standard Edition: Volume 14 :p237-258: translated by Joan Rivière and revised by James Strachey.

Quote: Thus the shadow of the object fell upon the ego, and the latter could henceforth be judged by a special agency, as though it were an object, the forsaken object. In this way an object-loss was transformed into an ego-loss and the conflict between the ego and the loved person into a cleavage between the critical activity of the ego and the ego as altered by identification.

One or two things may be directly inferred with regard to the preconditions and effects of a process such as this. On the one hand, a strong fixation to the loved object must have been present; on the other hand, in contradiction to this, the object-cathexis must have had little power of resistance. As Otto Rank has aptly remarked, this contradiction seems to imply that the object-choice has been effected on a narcissistic basis, so that the object-cathexis, when obstacles come in its way, can regress to narcissism. The narcissistic identification with the object then becomes a substitute for the erotic cathexis, the result of which is that in spite of the conflict with the loved person the love-relation need not be given up. This substitution of identification for object-love is an important mechanism in the narcissistic affections; Karl Landauer (1914) has lately been able to point to it in the process of recovery in a case of schizophrenia. It represents, of course, a regression from one type of object-choice to original narcissism. We have elsewhere shown that identification is a preliminary stage of object-choice, that it is the first way – and one that is expressed in an ambivalent fashion – in which the ego picks out an object. The ego wants to incorporate this object into itself, and, in accordance with the oral or cannibalistic phase of libidinal development in which it is, it wants to do so by devouring it. Abraham is undoubtedly right in attributing to this connection the refusal of nourishment met with in severe forms of melancholia.

The conclusion which our theory would require – namely, that the disposition to fall ill of melancholia (or some part of that disposition) lies in the predominance of the narcissistic type of object-choice – has unfortunately not yet been confirmed by observation. In the opening remarks of this paper, I admitted that the empirical material upon which this study is founded is insufficient for our needs. If we could assume an agreement between the results of observation and what we have inferred, we should not hesitate to include this regression from object-cathexis to the still narcissistic oral phase of the libido in our characterization of melancholia. Identifications with the object are by no means rare in the transference neuroses either; indeed, they are a well-known mechanism of symptom-formation, especially in hysteria. The difference, however, between narcissistic and hysterical identification may be seen in this: that, whereas in the former the object-cathexis is abandoned, in the latter it persists and manifests its influence, though this is usually confined to certain isolated actions and innervations. In any case, in the transference neuroses, too, identification is the expression of there being something in common, which may signify love. Narcissistic identification is the older of the two and it paves the way to an understanding of hysterical identification, which has been less thoroughly studied.

Quote from Helene Deutsch’s P90:

Freud (see below for reference) speaks of ‘multiple personality’ as the result of a process in which numerous identifications lead to a disruption of the ego. This may result in manifest psychopathology, or the conflicts between the different identifications can assume a form which need not necessarily be designated as pathological. Freud refers to a purely inner process of ego formation, and this does not apply to the ‘as if’ identifications with objects in the outer world. However, the same psychological process will also in the ‘as if’ personality on one occasion have a more ‘normal’ resolution and on another a pathological outcome which may be more or less severe.

4)  Freud:The Ego and the ld. London: Institute of Psycho-Analysis and Hogarth Press, 1927. or Sigmund Freud: The Ego and the Id: 1923: translated by James Strachey: Part III, The Ego and the Super-Ego (Ego Ideal): p370 of pfl Volume 11, ‘On Metapsychology’ or Standard Edition Volume 19 p 1-66

Quote: Although it is a digression from our aim, we cannot avoid giving our attention for a moment longer to the ego’s object-identifications. If they obtain the upper hand and become too numerous, unduly powerful and incompatible with one another, a pathological outcome will not be far off. It may come to a disruption of the ego in consequence of the different identifications becoming cut off from one another by resistances; perhaps the secret of the cases of what is described as ‘multiple personality’ is that the different identifications seize hold of consciousness in turn. Even when things do not go so far as this, there remains the question of conflicts between the various identifications into which the ego comes apart, conflicts which cannot after all be described as entirely pathological.

But, whatever the character’s later capacity for resisting the influences of abandoned object-cathexes may turn out to be, the effects of the first identifications made in earliest childhood will be general and lasting. This leads us back to the origin of the ego ideal; for behind it there lies hidden an individual’s first and most important identification, his identification with the father in his own personal prehistory.¹ This is apparently not in the first instance the consequence or outcome of an object-cathexis; it is a direct and immediate identification and takes place earlier than any object-cathexis. But the object-choices belonging to the first sexual period and relating to the father and mother seem normally to find their outcome in an identification of this kind, and would thus reinforce the primary one.

The whole subject, however, is so complicated that it will be necessary to go into it in greater detail. The intricacy of the problem is due to two factors: the triangular character of the Oedipus situation and the constitutional bisexuality of each individual.

Commented by Jacques Lacan

Seminar III : 11th April 1956  : availability here

Ch XIV : p191-193 of Russell Griggs’s translation : quote:

At the beginning of the Schreber case we find a period of disorder, of fertile moment. It presents a whole set of symptoms which, because it has generally been hidden away or, more exactly, because it has slipped through our fingers, has been unable to be elucidated analytically and is most of the time only reconstructed. Now, in reconstructing it we can discover, with very few exceptions, what appear to be the meanings and mechanisms we see at work in neurosis. There is nothing that more closely resembles a neurotic symptomatology than a pre-psychotic symptomatology. Once the diagnosis has been made, we are told that one finds that the unconscious is displayed on the outside, that everything belonging to the id has passed into the external world, and that the meanings in play are so clear that we are precisely unable to intervene analytically.

This is the classical position, and it still has some value. The paradox it contains has escaped nobody, but all the reasons that have been advanced to explain it are of a tautological or contradictory character. They are super-structurations of totally absurd hypotheses. It suffices to take an interest in analytic literature as a symptom to realize this.

Where does it spring from? From the fact that the world of objects is in some way affected, captured, induced, by a meaning in relation with drives characteristic of the psychoses? Is the construction of an external world distinctive of the psychoses? However, if there is any way of equally defining neurosis, this is it. When do we decide that the subject has crossed over the limits, that he is delusional?

Take the prepsychotic period. Our President Schreber is living out something in the nature of perplexity. He gives us in living form this question that I was saying lies at the bottom of every form of neurosis. He is prey to strange forebodings – he indicates this to us after the event. He is abruptly invaded by this image which would seem to be the least likely to enter the mind of a man of his kind and his style, that it really must be rather pleasant to be a woman succumbing to intercourse. This is a period of confusion and panic. How are we to locate the border between this moment of confusion and the point at which his delusion ended with the construction that he was in actual fact a woman, and not just any woman, but the divine woman, or more exactly God’s fiancée? Is there anything here that is sufficient for locating the onset of psychosis? Certainly not. Katan reports a case [Maurits Katan : Further remarks about Schreber’s hallucinations : The Psychoanalytic Study of the Child : 1950 : Vol 5 p175-211] that he saw declare itself at a much earlier period than Schreber’s, and about which he was able to form a direct idea, having come onto the scene at the turning point of the case. It was the case of a youth at the age of puberty, whose whole pre-psychotic period the author analyses very well, while conveying the idea that there was nothing in this subject of the order of accession to anything that would realize in him the virile type. Everything failed. And while he did try to conquer the typically virile attitude, it was by means of imitation, of a latching on, following the example of one of his friends. Like him and following him, he engaged in the first sexual maneuvers of puberty, namely masturbation, which he subsequently renounced under the injunction of the said friend, and he began to identify with him for a whole series of exercises that were called exercises of self-conquest. He behaved as if he were at the mercy of a severe father, which was the case with his friend. Like him, he became interested in a girl who, as if by chance, was the same one his friend was interested in. And once this identification with his friend has gone quite a way, the young girl will readily fall into his arms.

Here we obviously find the ‘as if’ mechanism that Mrs. Helene Deutsch has stressed as being a significant dimension in the symptomatology of the schizophrenias. It’s a mechanism of imaginary compensation – you can verify the usefulness of the distinction between the three registers – for the absent Oedipus complex, which would have given him virility in the form, not of the paternal image, but of the signifier, the name of the father.

Once the psychosis has broken out, the subject will conduct himself in the same way as before, as an unconscious homosexual. No meaning emerges that is fundamentally different from the pre-psychotic period. All his conduct in relation to the friend, who was the pivotal element in his attempt at structuration at the time of puberty, can be rediscovered in his delusion. When did he start to delude? When he said that his father was pursuing him to kill him, to rob him, to castrate him. All the contents implied in neurotic meanings are there. But the essential point, which isn’t highlighted, is that the delusion began the moment the initiative came from the Other, with a capital O, when the initiative was founded on a subjective activity. The Other wants this, and above all he wants this to be known, he wants to signify it.

As soon as there is a delusion, we enter at full tilt upon the domain of inter-subjectivity, where the whole problem is to know why it’s fantasized. But in the name of fantasy, omnipresent in neurosis, attached as we are to its meaning, we forget its structure, namely that it’s a question of signifiers, of signifiers as such, handled by a subject for signifying aims, signifying so purely that the meaning very often remains problematic. What we have encountered in this symptomatology always implies what I indicated to you last year in relation to the dream of Irma’s injection – the inmixing [inmixation : a term used by Damurette and Pichon for the semantically different ways the subject’s participation in an event or action can be described by a verb alone or by one of the verbs, “faire,” “voir”, or “laisser” plus and infintive: e.g., “opérer,” “faire opérer,” “voir opérer,” and “laisser opérer.” See ‘Essai de grammaire de la langue française : vol 5 p791-817] of subjects.


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Julia Evans

Practicing Lacanian Psychoanalyst in Earl’s Court, London



Further posts:

Some Lacanian history here

Of the clinic here

By Helene Deutsch here

By Sigmund Freud here

Notes on texts by Sigmund Freud here

By Jacques Lacan here

Notes on texts by Jacques Lacan here

Translation Working Group here

Use of power here