Abnormality in normal development. A concept of symptom formation in childhood.

Abstract

Several developmental points of view are revised in order to stress a basic coincidence in regard to ego formation and object relationships in spite of the evident discrepancies and differing research lines. From the classic Freudian approach in regard to symptom formation the shift towards an understanding of the normality of basic conflicts with its corresponding anxieties is being emphasized. Normality and pathology become relative terms in child development, and may or may not acquire the significance of a structured pathological system, whereas symptoms can be either normal or abnormal according to circumstances. The basic core of symptom formation relies in the interplay of conflictive ego-object relationships. The starting point is the undifferentiated primitive ego that, through interaction with inner and outer objects strengthens and enlarges itself. Discrimination is the developmental aim for which the mother-child relationship is of paramount importance. Parental objects being primary structuring figures, the earlier conflicts stem from hampered maturational processes due to this pathological situation when it occurs. Thus, the importance of body ego, body image, parental figures and the correlated object relationships must be stressed. From the psychosomatic point of view and on the basis of symptom formation being an end result of conflictive primitive object relationships, three schematic types of somatization are described: the hysterical, the hypochondriacal and the psychotic ones. Several abridged clinical cases are presented.