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Identity is not a Freudian concept. Theoreticians have defined it in very different ways: as a structure that accounts for narcissism and is part of the ego; as the ability to remain the same despite changes; as a feeling of continuity; or as the sum of representations of the self.

The importance of the notion of identity in the United States is related to its use in ego-psychology, which considers the ego as a relatively autonomous and potentially conflict-free structure. Many theories of identity adapt a portion of Freud's view of the ego. Alongside the Freudian ego, which is a structure defined by its functions, another ego—or identity related to identifications—is posited (whether inside or outside ego-psychology) and conceived of as the outcome of a process of individuation.

The first mentions of the importance of the concept of identity for clinical practice and psychopathology date from the nineteen-fifties. When it first appeared in psychoanalytic discourse, the concept of identity was associated with two approaches. The first was an attempt to extend the Freudian perspective to a general psychology that would include the ego's relationships with the surrounding world and guide research on child development. The second sought to apply psychoanalysis to pathologies, more serious than neurosis, characterized by disturbances of identity. Phyllis Greenacre evoked the internal and external faces of identity, and described their favorable and unfavorable aspects. Ralph Greenson isolated a screen-identity syndrome. Margaret Mahler viewed identity as a facet of development connected with object-relations, symbiosis, and the possibility of separation-individuation.

Two major psychoanalytical theorists have focused on identity. In 1956 Erik Erikson introduced the concept of an ego identity formed during adolescence, which served as a gauge of psychopathology. In 1961 Heinz Lichtenstein proposed giving identity the priority that the libido had for Freud. He considered it the keystone of psychopathology and eventually reframed Freudian metapsychology within a monist perspective that challenged the dualistic concept of identification.

Erikson hoped to explain human development epigenetically; the various stages of his model could not be reduced to the psychosexual level. The ego was not propelled by drives alone but must confront the challenges posed by the environment. Ego identity was the adolescent stage; it took over from various identifications and its successful establishment depended on the resolution of earlier developmental crises. Erikson's ego identity was defined by the unconscious quest for personal continuity, by the synthesis of the ego, and by group loyalties. It reflected an existential dimension of the ego. It was formed through a succession of syntheses of the ego whereby the conflicts of earlier stages were integrated. The opposite of ego identity was a diffusion of identity, a pathological syndrome in which representations of self and object are fluid and unintegrated, and oppositionalism and acting out are manifested. Otto Kernberg used this model as a diagnostic criterion for borderline states.

Lichtenstein looked upon human identity as a permanent dilemma because of the absence of any form of guarantee. The theme of an invariable identity arose from an unconscious imprint derived from the mother thanks to a process of mirror reflection. Variations on this theme constituted the feeling of identity, a creation unique to the child. Pathological developments occurred when themes emerged that were impossible to satisfy yet necessary for the maintenance of identity. In such case a subject could be caught in a paradoxical oscillation between the search for an annihilating other and an isolating autonomy. The principle of identity was the central motivation for the human individual, who was obliged to maintain an identity under more or less continual threat. This principle replaced the reality principle in Lichtenstein's account, and the drives as well as the repetition compulsion were subservient to it. Identity was assimilated to narcissism, described as a primary thematic with secondary variants. It left room for the self, the fourth metapsychological dimension and third paradigm of psychoanalysis. Identity was part of an evolutionist view that rejected dualism of any kind.

Historically speaking, theories of identity were replaced by theories of the self and by the "self psychology" of Heinz Kohut.

These are psychological theories in which the unconscious and libido are secondary. As Freud pointed out, however, unity and synthesis are superficial concepts. Drawing on such criticism, Kohut characterized Erikson's identity as a descriptive psychosocial concept. Edith Jacobson questioned the relevance and universality of so-called disturbances of identity, which she considered exaggerated. Roy Schafer interpreted the emergence of the concept of identity as symptomatic of a subjectivity stripped of a mechanistic and reifying metapsychology and hence in need of reformulation. Merely descriptive theories of identity may be said to belong to the sphere of phenomenology. When the conceptual focus is on identity, the ego is cut off from its libidinal roots. Furthermore, the view that underpins these theories is exclusively developmental and completely rejects any causality based on deferred effects.

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