Chairman: P. Marty, Paris
Moderator: E. Servadio, Rome

Plenary Session of the 26th International Psycho-Analytical Congress, Rome, 1 August 1969


The paper by Leo Rangell that this Congress is invited to discuss represents the conclusion of research studies carried out over a period of some 14 years. It has, in my opinion, various points of interest.
First of all, there is the model it presents us with, of what happens in what Rangell calls ‘the minor preliminary phase’. This model aims at filling a gap in our representation of what is ‘ normal’ and what is ‘ pathological’ in the development of the intrapsychic process. In fact, we more or less used, for a long time, to consider the intrapsychic conflict as one of systems with minimum and maximum values, rather than go into the aspects of the continual microdynamic alteration and recomposition of the structural balance-for which reason one might say that mental health is comparable not to a state of calmness, but rather to an endless alternation of minor disturbances and just as many minor dynamic readjustments. In this series-Rangell contends-a part of the ego, still on unconscious levels and therefore in an unnoticeable manner, inserts itself according to a precise scheme and through a particular mechanism (Rangell calls it ‘ the decision-making function ‘), to which a central importance is given.
That the intrapsychic mediation, and in a particular way certain ego functions, tended to reduce tensions and to keep the individual in an optimal interior state, had been indicated by Freud. But Rangell wants to show us minutely how that happens much before the tensions in question increase up to the point at which the signal of anxiety is released. We might perhaps say that, in an ideal situation, stress should constantly remain at the level of the minor preliminary phase, or at least at that of the principal phase number 1. Rangell shows how the interventions of the ego do occur in a phase which, although it must strictly be considered one of conflict, precedes and is distinct from principal phase number 2, i.e. from what one has in mind when thinking of neurosogenesis and of symptom formation.
I should like to mention two more points that seem important for the discussion.
The first point is that of the relation between the functioning of the ego in the minor preliminary phase (in regard to its decisionmaking powers) and that of the ego in the very vast field of’ problems of choice and of decisionmaking which play a central role in all forms of human behaviour ‘ (Rangell) as well as in that of a truly and clearly neurotic situation (for example, obsessional neurosis). In the first case we seem to have an extension-within the structure of the ego and with the participation of consciousness-of the ‘normal ‘ decision-making function, whereas in the second case we have a failure ab initio of the basic decision-making function, as well as consequences-especially in the case of obsessional neurosis-that can also limit in specific ways the decision-making faculties of the conscious ego.
The second point concerns the revision of the anxiety theory. When, in 1955, I published the Italian translation of Freud’s ‘ Inhibition, Symptoms and Anxiety ‘ (1926), 1 was impressed by the fact that Freud, contrary to what is often believed, had not really given up his original theory (that of anxiety deriving from transformation of the libido) in favour of the later (second) one (that of anxiety as a danger signal). I realized instead that for Freud it was an insurmountable difficulty to make the two theories agree with each other.
Rangell-preceded in part by other authors, including Ernest Jones many years ago-has tried to show how the irreconcilability that Freud believed he had run into can be overcome. He shows it, however, by linking the problem of anxiety with what takes place in the early stages of the intrapsychic process. The participation of the ego, which, as we have seen, is immanent from the beginning of such phases, excludes as it were in advance (writes Rangell) ‘the unique type of anxiety which, as Freud originally thought, is automatic, direct and without psychic meaning or participation’. However, the above-mentioned immanence of the intervention by the ego can take place inasmuch as it has to face situations of shock, of instinctual congestion, of tension-Jones calls them ‘pre-ideational ‘-situations that are ‘recorded’ as dangerous by the ego, as conditions necessitating the signal of anxiety when the homeostatic balance of the preliminary phase cannot be preserved by the ego’s normal mechanisms of situation-facing and decision-making. At this point the centrality of the decision-making function appears again with regard to the existential phenomenon of anxiety, and to the evolution of it in a unified and psychological sense.
In the course of certain discussions about Rangell’s work that took place at the Psychoanalytic Centre of Rome, varied opinions were expressed about the relation between the concept of the decision-making function of the ego according to Rangell and the well-known ideas on ego psychology of Heinz Hartmann. The immediate and almost obvious observation was that Rangeli deals with the participation of the ego and its decision-making functions in situations which are more or less ones of shock or conflict, while the more original theses of Hartmann concern a conflict-free sphere of the ego. However, at this point a problem arises that is not so much a problem of the function but rather of the freedom-or of lack of freedom -of the ego in its decision-making role.
I would like to recall a phenomenological parallel of Rangell’s contentions about the decision-making function. It comes out of certain research studies, past and present, about dream-processes. Decision-making in dreams has been described, among others, by Thomas French and Erika Fromm in their book, Dream Interpretation. It has also been studied in laboratory conditions in recent years.
I shall now say a few words about Rangell’s work as far as problems of analytic technique are concerned.
Rangell says that ‘the intrapsychic process and the centrality of the decision-making function of the ego within it continue to require the analysing and neutral stance of the analyst in the centre of the analytic operation’. Particular emphasis is thus placed upon the decision-making function of the ego of the analyst-an operation that is expected to be neutral, efficient and ‘normal’ in comparison with that of the patient’s ego.
It is clear that an ideal model is being proposed to us here and that, in the practice of analysis, things do not always happen in such an impeccable way.
Rangell’s theses again open up the way to the unabated discussions about what it is that represents mental health, recovery or normality. It is clear that from a formal point of view, the analyst cannot avoid taking a position when he is called upon to evaluate ‘ the healthy part ‘ of the patient’s ego and to enter into an alliance with it. If at an empirical level, and in many cases such evaluation may be unquestionable, this is not so a priori and anybody might imagine cases in which one analyst would not agree with another.
The last part of Rangell’s work concerns problems that, although they do not aim at such philosophical levels, do, however, go much beyond the limits of psychoanalysis as a psychological theory and as a psychotherapeutic technique. The author here moves on quite difficult ground.
It is very likely that a more thorough study of the decision-making function-and of the innermost secret forces that promote it-may gradually, though indirectly, help man to see his problems from within more clearly, at individual, interpersonal, national and international levels. That may be achieved-as Rangell reminds us without the analyst dreaming, even for an instant, of substituting himself for a sociologist or a politician. Such thorough study could be flanked, it seems, by that suggested by Rangell himself on ‘action’ as distinguished from ‘acting out’, and at this point we can only think with interest of the results that might come out of a motivational inquiry on a large scale, the scope of which would be to evaluate not only the unconscious motives of many choices and forms of behaviour, but also the intrapsychic processes and the decision-making mechanisms that led to this or that choice or action.
Some of Rangell’s views and interpretations concerning current problems of our time-such as ‘the agony and restlessness of the young generation ‘-are of course among the most debatable in his paper.
I confess to my scanty experience in the field of community psychiatry. Thus it would not be appropriate for me to express any scientifically justified comment on its relation to present-day psychoanalysis. It is possible that contributions of this kind may usefully be forthcoming from those analysts who carry out some of their activity in social service or at hospital levels.
Rangell’s exposition in favour of a ‘new psychoanalytic comprehension’ of biological dimensions appears to me of particular interest, since 1 have worked in psychopharmacology for some time and I have somewhat followed the developments of biochemistry and cerebral neurochemistry. You will all remember the sentence with which Freud concludes Chapter VI of his ‘Outline of Psycho-Analysis’: ‘The future will perhaps teach us to influence directly with chemical substances the amount of energies and their distribution in the psychic apparatus.’
I believe I have done-by what you have just listened to-what I could to emphasize the points that in my opinion are most meaningful and suitable for discussion in Leo Rangell’s paper. I hope I have commented on them with the discretion and within the limits becoming one who, destined to be the moderator of others, must also give proof of knowing how to ‘moderate’ himself.


I think that next to organizing an international Congress, the most difficult job for a psychoanalyst is to be a so-called moderator, who does not really moderate much and should try instead to summarize the summaries of other people’s condensed ideas. Well, I’ll try my best.
Dr Schur, regarding what Dr Rangell says about the expansion of the signal concept, pointed out that nowadays we are much better at realizing the complexity of simultaneous processes going on in the mental apparatus. He thinks therefore that it is absolutely logical that conflict should be studied as a multilayered process.
Then comes the business of the metaphors, about which many comments have been made.
From the recognition of what Schur himself calls the awareness in the case of anxiety, the awareness of danger, he draws the following logical conclusions. Affects can be conscious or unconscious. The signal concept can be extended to formulas like signal guilt, signal love, etc. And affects and various aspects of cognitive functions are inseparable. He suggests also here a widening of Dr Rangell’s formulation of judgement. Starting from Fenichel’s concept of the dammed-up state, Dr Schur finally agreed in principle with Dr Rangell’s theory aiming at a unified idea or concept of anxiety, and expressed the opinion that any frustration of instinctual demands can be felt as a danger and therefore lead to anxiety. Also, certain somatic manifestations of frustration are similar to phenomenal resomatized anxiety, and are therefore perceived as dangers leading to secondary anxiety which, too, can be somatized; he observed this with severe phobias in frigidity.
Dr Scott pointed out that according to the description there are twelve stages between stimulus and response, which, of course, poses many problems, but he also praised Dr Rangell’s paper, saying that it was the most important he had heard. He also emphasized the fact that in science we study more and more what happens in less and less time, and analysis of a short period shows many types of signal systems. He mentioned also that the distinction between hard and soft associations by itself also poses many problems that an analyst has to study. He then quoted a paper he read at the Copenhagen Congress on multivalence, a description of the difficulties that the ego has in making decisions. But also discharge is as important. For instance, he described the difference when a patient laughs or says, ‘I am about to laugh’.
Then he asked Dr Rangell some questions, and to these Dr Rangell will reply.
Mr Khan praised Dr Rangell’s paper, and he underlined particularly the fact that for many, many years the consideration of conflict has been studied from many angles. He, if I have understood him well, said that the clinical material we have to face in our clinical activities compels us to face dilemmas all the time but also leads to constructive ideas, so that dilemmas and decision-making can be creative, He was very much in favour of metaphorical speaking, in contrast with other speakers.
Dr Lampl-de Groot said that Dr Rangell’s ideas could join those expressed in two papers we have heard at this Congress: those of Eisnitz and Levin, remarking particularly that many of these ideas can be applied to the concept of self, about which, as we know, there has been so much interest at this Congress. Finally-and I am compelled to abridge because of lack of time-she very aptly, in my opinion, emphasized the fact that the decision-making function of the analyst’s ego is indeed a very delicate proposition and is one of our main difficulties in analytic practice, that o trying not to influence the patient in his decisions, while at the same time making plans and decisions of our own.
Dr Garma put two questions to Dr Rangell, and therefore I leave it to him to reply.
Dr Parin pointed out the implications of certain of Dr Rangell’s ideas concerning the social sciences, and he observed that psychoanalytical metapsychology, as we know it and as developed in Dr Rangell’s paper, does not always fit in with the social problems that we are bound to lace. He said that perhaps Dr Rangell went too far in evaluating from his viewpoint the phenomena of society, and that perhaps the best thing that we should do would be to single out different social phenomena one by one and ask ourselves, first of all, what contribution psychoanalysis can make to this or that.
Dr Heimann also very much liked Dr Rangell’s paper and she said that it disposed of a number of obstacles. She emphasized the extension of the signal concept in the realm of affective and cognitive processes, and said very clearly that if one were to define what we call mental health it would be that mental health is not compatible with not finishing a process and being unaware that it is not finished. Finally, after some remarks on the concept of splitting, which she says might be a very convenient thing to do from time to time, she said that Dr Rangell’s paper among other things puts an end to the ‘no conflict’ myth. There is a reality in psychic life, there is never stagnation, there is movement, dynamics, as evidenced by dream life.
Dr Székely was greatly impressed by Dr Rangell’s description of the multiple functions, and he evaluated them. He said they have to be considered at pre-oedipal and oedipal levels too, and he also said he thought very much of the microanalytic approach to these very complicated problems.
Dr Padel, finally, made a few remarks about the general atmosphere, and how the Congress had been run with regard to the presentation of scientific papers and phasing of discussions. He protested against the idea of metaphors, saying that if we are metaphorical we cease to be human beings, and he cited the name of Abraham as an example of an atmosphere that could be created at a Congress. He was very much against, and rightly so, the peril of impoverishing our thoughts by talking in a mechanical way, or about mechanics in psychic life.


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