O N EARLY ALIENATION FROM THE SELF

Herbert M. Rosenthal

Probably no other psychoanalytic pioneer had discussed "alienation

from the self" (AFS) more extensively than Karen Homey. Nor has any
other analyst, to my knowledge, given this phenomenon a more central
role in the formation of neurosis. However, while discussing AFS in detail,
as well as giving the consequences of this phenomenon, she never gave us
a time point in the development of neurosis at which it appears as an
essential factor, nor did she give a detailed dynamic description of early
childhood development, healthy or neurotic, which could shed light on
the earliest appearance of AFS.
Several object relations psychoanalysts have contributed pertinent mate-
rial to this problem. In this paper we will try to establish a point in the
development of the child when alienation first appears. In addition to
establishing a time p o i n t at which AFS appears in the developing child, our
findings will lead to several far-reaching conclusions, using a combination
of the earlier theory of Karen Homey and the newer ones of the object
relations school.

HISTORY OF ALIENATION FROM SELF

Although the word alienation is a relatively recent one, namely, from the
nineteenth century, the concept of it is much older. Hegel and Marx used
it not in the sense of"insanity," as the French do, but in the sense of a social
defect, "where his own act becomes to him an alien power, standing over
and against him, instead of being ruled by him. "1 As to the concept,
according to Erich Fromm, 2 it is equivalent to the word idolatry in the Old
Testament. As to the concept "alienation from oneself," Fromm writes:

We can speak of idolatry or alienation not only in relationship to other people,

but also in relationship to oneself, when the person is subject to irrational pas-
sions. The person who is mainly motivated by his lust for power does not experi-
ence himself any more in the richness and limitlessness of a human being, but he
becomes a slave to one partial striving in him, which is projected into external
aims, by which he is "possessed."The person who is given to the exclusive pursuit
TheAmericanJournalof Psychoanalysis Vol.43, No. 3, "1983
©1983Associationfor the Advancementof Psychoanalysis

231
232 ROSENTHAL

of his passions for money is possessed by his striving for it; money is the idol
which he worships as the projection of one isolated power in himself and his
greed for it. In this sense, the neurotic person is an alienated person. His actions
are not his own; while he is under the illusion of doing what he wants, he is
driven by forces which are separated from his self, which work behind his back;
he is a stranger to himself, just as his fellow man is a stranger to him. He experi-
ences the other and the unconscious force which operate in them. The insane
person is the absolutely alienated person; he has completely lost himself as the
center of his own experience; he has lost the sense of self.
It is the fact that man does not experience himself as the active bearer of his own
power and richness but as an impoverished "thing," dependent on powers outside
of himself, unto whom he has projected his living substance. 3

Fromm writes about the relationship of one man to another in society:

What is modern man's relationship to his fellow man? It is one between two
abstractions, two living machines, who use each other. The employer uses the
ones he employs; the salesman uses the customers. Everybody is to everybody
else a commodity, always to be treated with certain friendliness, because even if
he is not of use now, he may be later.4

Most important is the question: What is the relationship of the alienated

man toward himself? I quote Erich Fromm again:

Man experiences himself as a thing to be employed successfully on the market.

He does not experience himself as an active agent, as the bearer of human
powers. His aim is to sell himself successfully on the market. His sense of self
does not stem from his activity as a loving and thinking individual, but from his
socio-economic role . . . . That is the way he experiences himself, not as a man,
with love, fears, convictions, doubts, but as an abstraction, alienated from his
real nature, which fulfills a certain function in the social system. His sense of
value depends on his success: on whether he can sell himself favorably, on
whether he can rnake more of himself than he started out with, whether he is a
success. His body, his mind and his soul are his capital, and his task in life is to
invest it favorably, to make a profit of himself. Human qualities like friendliness,
courtesy, kindness are transformed into commodities, into assets of the "person-
ality package," conducive to a higher price on the personality market . . . . The
alienated personality who is for sale must lose a good deal of the sense of dignity
which is so characteristic of man even in most primitive cultures. He must lose
almost all sense of self, of himself as a unique and unduplicable entity. The sense
of self stems from the experience of myself as the subject of my experiences, my
thoughts, my feelings, my decision, my judgment, my action. It presupposes that
my experience is my own, and not an alienated one. Things have no self and
men who have become things can have no self.s
 ON EARLY ALIENATION FROM THE SELF 233

A good example of man's awareness of his alienation is given by Ibsen's

Peer Gynt, who "would rather go to hell than live in a state of numbness,
isolation, emptiness and nothingness. "6
It is the great merit of Karen Homey to have given the concept of AFS the
psychiatric meaning and importance that it has if we want to understand
modern man's neurotic suffering, z,8 She writes not only about the charac-
teristics of alienation but also about alienation's connection with other
neurotic phenomena. Here, the connection to narcissism is particularly
relevant. She writes:

Finally, narcissism is not an experience of self-love but of alienation from the self.
In rather simplified terms, a person clings to illusions about himself, because and
as far as he has lost himself. 6

This statement also characterizes Horney's view that neurotic phenomena

aggravate each other in vicious cycles and alienation from the self is expres-
sively mentioned among such factors: "Every step in the [neurotic] struggle
for unity makes the neurotic more hostile, more helpless, more fearful,
more alienated from himself and others, with the result that the difficulties
responsible for the conflicts become more acute and their resolution less
and less attainable. "z And, "All the while his increased alienation from him-
self deprives him more and more of the capacity to work on himself and so
get rid of his difficulties. Inertia sets in, taking the place of direct growth. "8
How does alienation from self develop? Homey describes her view point
in the chapter 'q-he Search for Glory":

Only the individual himself can develop his given potentialities. But, like any
other living organism, the human individuum needs favorable conditions for his
growth "from acorn into an oak tree"; he needs an atmosphere of warmth to give
him both a feeling of inner security and the inner freedom enabling him to have
his own feelings and thoughts and to express himself . . . . He also needs healthy
friction with the wishes and wills of others. If he can thus grow with others, in
love and in friction, he will also grow in accordance with his real self.
But through a variety of adverse influences, a child may not be permitted to
grow according to his individual needs and possibilities. Such unfavorable condi-
tions are too manifold to list here. But, when summarized, they all boil down to
the fact that the people in the environment are too wrapped up in their own neu-
roses to be able to love the child, or even to conceive of him as the particular
individual he is; their attitudes toward him are determined by their own neurotic
needs and responses. . . .
As a result, the child does not develop a feeling of belonging, of"we," but instead
a profound insecurity and vague apprehensiveness, for which I use the term basic
anxiety. It is his feeling of being isolated and helpless in a world conceived as
potentially hostile. 9
234 ROSENTHAL

.~

~rO 0 O~

~ r.T.l
~ r.r.1

/
e~
E
e.

o
e-,

N
0
E

/.
O

d
m

Ixlli '~

~0

I .~ ~ ~

m ~

o ~ ~ ~
 ON EARLY ALIENATION FROM THE SELF 235

Figure 1 shows, in a schematic way, how alienation fits into Horney's

theory of neurosis. However, besides all the inadequacies inherent in such
a scheme, it does not show many of the connections described by her. The
reader can find an exhaustive description of alienation from the self and its
consequences in the sixth chapter of Horney's book Neurosis and Human
Growth. 8
While later psychoanalytic authors rarely mention AFS, many writers of
fiction or plays have used the phenomenon as the essential content of their
writings. As an example, one might mention Albert Camus's The Stranger
or the plays by Harold Pinter. I found one place in the literature of modern
object relations theory where alienation from self is mentioned, namely, in
Alice Miller's Prisoners of Childhood. She writes:

in . . . short encounters, the tragedy of an individual destiny can often be seen

with moving clarity and intensity. What is described as depression and experi-
enced as emptiness, futility, fear of impoverishment and loneliness can often be
recognized as the tragedy of the loss of the self, or alienation from the self, from
which many suffer in our generation and society. Through the years of recon-
structive work with my analysands, I think I have come closer to the childhood
origins of this alienation from the self. The observations of early mother-child
interaction, recorded by Mahler, Spitz and Robertson, confirm my suppositions.
On reading Winnicott I felt on familiar ground and encouraged to continue along
this path. Finally, Kohut's studies on narcissism, especially his concept of narcis-
sistic cathexis, helped me to conceptualize the relationships I had discovered) °

She continues to describe both healthy and pathological narcissistic cathexis.

Since these concepts are basic to my later discussion of my own findings,
they are quoted here in excerpts:

Every child has a legitimate narcissistic need to be noticed, understood, taken

seriously and respected by his mother. In the first weeks and months of life, he
needs to have the mother at his disposal, must be able to use and to be mirrored
by her. This is beautifully illustrated in one of Winnicott's images: the mother
gazes at the baby in her arms, and baby gazes at his mother's face and finds himself
therein.., provided that the mother is really looking at the unique, small, help-
less being and not projected her own introjects into the child, nor her own
expectations, fears and plans for the child. In that case, the child would not find
himself in his mother's face but rather the mother's own predicaments. This child
would remain without a mirror, and for the rest of his life would be seeking this
mirror in vain . . . . Ifa child is lucky enough to grow up with a mirroring mother,
who allows herself to be cathected narcissistically, who is at the child's
diposal-that is, a mother who allows herself to be "made use of,"'as Mahler
(1968) says-then a healthy self-feeling can gradually develop in the growing
child . . . . I understand a healthy serf-feeling to mean the unquestioned certainty
236 ROSENTHAI

~E ~
r,D ~.~ ~-~
O,.q

~r.)
~Z
o~

IN ~ r~
0

O
> E
u~
I

o Z ~ 0
.<
0 .< o~ o

E
ex
o

p~
0 E~ M E~
o~ "O

O
r...e, ,,< / > / // O

o~
m

~q Z
.<
a.
0

o ~ 0

~q
<

0
,q
c~Z
r,D
O~D~
,.q~O
O~q
~o
O~
~r~
 O N EARLY ALIENATION FROM THE SELF 237

that the feelings and wishes one experiences are part of one's self. This certainty
is not something one can gain upon reflection; it is there like one's own pulse,
which one does not notice as long as it functions normally.~1

What happens if the mother not only is unable to take over the narcissistic func-
tions for the child but also, as very often happens, is herself in need of narcissistic
supplies? Quite unconsciously, and despite her own good intentions, the mother
then tries to assuage her own narcissistic needs through her child, that is, she
cathects him narcissistically. This does not rule out strong affection. On the con-
trary, the mother often loves her child as her self-object, passionately, but not in
a way he needs to be loved. Therefore, the continuity and constancy that would
be so important for the child are missing, among other things, from this love. Yet,
what is missing above all is the framework within which the child could experi-
ence his feelings and emotions. Instead, he develops something the mother
needs, and this certainly saves his life [the mother's or father's love] at the time,
but it nevertheless may prevent him, throughout his life, from being himself, u

Besides the quotation given here, I have found little in the literature of
modern object relations theory to be pertinent to this discussion on the
early origins of alienation from the self. However, a schematic diagram
showing the phases of early childhood development according to Mahler, 13
Winnicott, ~4 and others modified after Horner is is given here in Figure 2,
since it might locate more precisely the origins of alienation.

DISCUSSION

Using the quotations given above, we can now consider our question:
When does the alienation process start? It is easy to observe that certainly
very many adolescents with their desire for deafening music and with their
experience of inner emptiness show a picture of classical alienation. But
children of much younger age can already be found educated "to be seen
and not heard," having literally become "things" or robots that are being
made to function only with regard to their marketability, their usefulness
to society.
If we can believe Fromm's description of an alienated society, there is no
reason to believe that mothers should be exempted from the process of
more or less severe alienation that the rest of our society is suffering from. I
am convinced that the reader, just as myself, has observed many mothers
treating their children, including infants, as if they were "things" to be taken
care of; also, the reader has probably observed some mothers using their
children for their own needs, such as to produce what they consider "the
ideal child," in a way similar to the way Fromm's salesman uses the cus-
tomer or the employer uses his employees. As Alice Miller points out, all
238 ROSENTHAL

this may be done with much love, in total unawareness of using the child,
but using the child nevertheless, depriving him in the process of his own
feelings and emotions, rendering him into an isolated, helpless human
being (cf. basic anxiety), squelching his own feelings and desires, and mak-
ing him totally dependent first on his mother and later on rule books,
which tell him what he is expected to feel and to do.
Alienation from the self, then starts in earliest infancy, precisely, in the
attachment phase of development (see Figure 2). However, I do not disagree
with Horney's findings that alienation from the self is an important factor in
the later development of neurosis, but I would like to add, that the process
of AFS starts at a much earlier age, namely in infancy as an attachment-stage
pathological symptom, a fact Homey may not have observed, since she
did not work with young children.
Let us observe, in greater detail, how a baby may be forced into alienation
from himself.
Already in infancy, the child may become an object to be manhandled
and to be possessed. Love may be conditioned to the child's behavior ac-
cording to maternal standards and needs. In that case, the infant must
sacrifice his own needs, feelings, and desires in exchange for acceptance
by the mother figure, thereby losing the struggle for self-fulfillment. He is
squelched in his attempt to preserve his real self before he has even a
chance to fully develop an identity. It is my conviction that by being forced
to disregard his own deepest feelings in order to please his narcissistic
mother, the baby brings about his own alienation from himself. The infant,
unable not to act on what he feels and afraid to act on his feelings that may
cause retribution in the form of his mother's caring, is forced to squelch his
own feelings altogether. It is as if his narcissistic mother had told her infant
child, "You have two friends, namely, yourself and me, and now you have
to choose between the two, since you cannot please both~" Of course, this
process will develop on a totally unconscious level, as a conditioned reflex.
In any event, the infant's realistic helplessness makes his choice of his
mother as his only friend a foregone conclusion. Having thus lost his real
self, the infant needs to find a substitute, to create a "false," an "idealized
self," based on and compatible with his mother's needs. By doing this, the
child just solved his "basic inner conflict," namely, the conflict between his
real and idealized self, by sacrificing his real self for his mother's caringo He
has created the basis for the development of the neurotic personality
described by Homey and schematized in Figure I.
Having placed earliest AFS in the earliest part of the attachment phase of
Mahler's timetable of early child development, I see AFS as possibly the
most far-reaching disturbance of attachment to a coercive, narcissistic
mother. While the lack of attachment may lead to psychotic development,
 ON EARLY ALIENATION FROM THE SELF 239

INFANT~
UNCONDITIONAL LOVE CONDITIONAL LOVE
"GOOD ENOUGH MOTHERING" ORIGINAL BLACKMAIL
I
CONFLICT FREE
I
ORIGINAL CENTRAL INNER CONFLICT
SPONTANEOUS CHILD ADAPTING CHILD
l I
FEELING CHILD ALIENATION OF CHILD
i l
SECURE CHILD INSECURE CHILD
i I
REAL, HAPPY, CREATIVE, CAUTIOUS, UNHAPPY, COMPLIANT,
SPONTANEOUS, SELF-ASSURED INSECURE, FEARFUL CHILD
CHILD l l
REAL, NAPPY, CREATIVE, FALSE SELF
SPONTANEOUS, SELF-ASSURED IDEALIZED IMAGE
ADULT A IDEALIZED SELF
I
(CENTRAL INNER CONFLICT) / ~
PSYCHOANALYSIS SUCCESSFUL / PSYCHOANAL~IS UNSUCCESSFUL
SUCCESSFUL NEUROTIC f EARLY FUNCTIONAL DISTURBANCE
i
GUILT, FEARS, NEUROTIC CONFLICTS NEUROSIS PERS~ALITY PSYCHOSOMATIC PSYCHOSIS
(BASIC CONFLICT)
(INTERPERSONAL CONFLICTS)
(INTEAPSYCHIC CONFLICTS)
[
I
]
DISO~ERS
[
DISORDERS
PSYCHOTHERAPY OR SELF-HELP ~

CRUMBLING I I
SUCCESSFUL SELF I I
SUCCESSFULLY LIVING A ~I~"~ILATEE FUNCTIONAL DISTURBANCE
FALSE SELF ] I r "
NEUROSIS PERSONALITY .PSYCHOSOMATIC
DISORDERSI DISONDERSI
PSYCHOSIS
[
CONTINUED NEUROTIC SYMPTOMS ~ ITRERAPY OR SELF~HELP

FIG. 3. Alienation and development of neurotic personality.

attachment to a coercive, narcissistic mother will lead to a more or less

severe alienation from the self, leading to all the consequences described
in Horney's writings. Furthermore, the consequent stunting of the child's
emotional growth may lead to such severe symptoms as the development
of a narcissistic or borderline personality, while, in the social sphere, he
might evidence all those symptoms described by Fromm in The Sane Society,
quoted earlier. With Homey, I believe that the child's developing neurosis
will, then, lead to further and further AFS and to further and further neu-
rotic entanglement with all the phenomena so brilliantly described in her
last two books. 7,8 According to Horney, the development of neurosis starts
with basic anxiety. This basic anxiety is defined as a "feeling of helplessness
toward a potentially hostile world. "16 In his state of anxiety, the neurotic
develops compulsive strategies, characterized by moves toward, against,
and away from people. These compulsive Strategies, however, are incom-
patible with each other, so that new, auxiliary strategies have to be
employed to cover up their incompatibility-among others a process of
alienation from self. The whole system of defenses to smooth over difficulties
240 ROSENTHAL

in interpersonal relationships then reacts on the neurotic in such a way as

to produce corresponding intrapsychic personality changes, creating a
complex system of neurotic pride reactions.
My own perception of the development of neurosis is in total agreement
with that of Horney, with the minor exception that I believe alienation
from the self to antedate the basic anxiety. Not only do I believe AFS to
develop from the first days of the infant's feelings of frustration- and that it
is reinforced throughout life by additional frustration of feelings-but I
believe also that such an alienation may well lay the foundation for the
basic anxiety that Homey gives as the foundation of the neurotic develop-
ment of the personality. Figure 3 describes this concept in schematic form.
One may wonder why, as in so many early papers on child develop-
ment, the mother's influence is given such exclusive responsibility for the
development of AFS. I believe not only that especially the earliest frustra-
tions of the infant's feelings are responsible for detachment or temporary
repression or active and passing alienation from self-as one may observe
as an acute measure in the reaction of adults to an acute conflict-but also
that they are responsible for a fixation into a state of chronic alienation
from what constitutes the very personality of the infant. Later life and people
other than his mother will reinforce the development of further alienation
if their coercion and pressures make the neurotic's living according to his
own feelings too painful or outright impossible.

CONSEQUENCES OF ALIENATION FROM THE SELF

The most obvious medical consequence of AFS in infancy is the develop-

ment of functional illness of young children. To my knowledge, this area of
pathology has remained totally unexplored and is in need of further study.
In my experience, three symptoms stand out as common to toddlers with
severe AFS:

1. An experience of almost total helplessness and dependency on the

mother figure
2. Early psychosomatic symptoms including enuresis and, rarely, enco-
presis
3. Difficulties in relating to people other than the mother figure

The symptoms of basic anxiety, other than helplessness, namely the feel-
ings of aloneness in a potentially hostile world, usually become apparent
only at a later stage when the child starts to experience the mother figure's
inability to reward him for having sacrificed his real self, i.e., when it comes
to the need of body awareness, of handling body functions, of relating to
 ON EARLY ALIENATION FROM THE SELF 241

others and to bodily pain. Psychosomatic problems are typical for these
children of possessive, overprotective mothers, as Melitta Sperling has
observed already:

After treating twenty children with various psychosomatic disorders, together

with their mothers, I found a certain quality existing in the relationship between
the mother and these children, which, in my opinion, served as a dynamic force
precipitating as well as perpetuating the child's illness. The mother, in every one
of these cases, had an unconscious need to keep the child in a helpless and
dependent state to a degree which I have encountered only in the mothers of
psychotic children. 17

In addition, early depressions are a frequent symptom of childhood

alienation. Another, more theoretical consequence of the early appear-
ance of AFS is that this defense mechanism probably is the earliest one
available to the patient and also is the one with the most devastating and
far-reaching consequences. It consists of a special form of the defense
mechanism of repression, namely, the repression of the infant's most basic
feelings. The AFS thereby deprives the child of his uniqueness, his very
emotional aliveness, allowing him only to grow into a possibly cognitively
and intellectually intact but feelingless tool of his family and society-a
child that is seen but not experienced as a full person. In addition, all the
other symptoms described by Horney as consequences of AFS will, of
course, develop in children, just as they develop in adults.
A less obvious but nevertheless important consequence of early AFS is
shown in Figure 3: the real self is lost in the neurotic process, to be replaced
by the idealized image first and the idealized (false) self later on. I have also
observed how the early-formed idealized image frequently contains all the
values the coercive mother has implanted into her child. The less these
values correspond to those of the child's real self, the more severe the child's
emotional problems are expected to become. Figure 3 demonstrates also
how, by helping to gain back the feelings lost during the early alienation pro-
cess, we set in motion the curative analytic factor of reaching the real self
again. Psychoanalysis, then, would have as a goal the reversal of the early
AFS process, rekindling the central inner conflict under conditions in which
the adult neurotic has a much better chance to, fight for his real self, discard-
ing that "socialized," false self that was pushed on him in his early childhood,
first by his mother figure and, later on, by other authority figures.
There is another point shown in Figure 3 that may be worth mentioning.
Figure 3 shows how, in order to be helpful in the process of reaching the
central inner conflict, the patient needs first to reach a stage of relative sta-
bility as a "successful neurotic" so that he can really experience what he
had given up, when, still an infant, he had to relinquish his very core for
242 ROSENTHAL

the indispensable security of maternal support. Another aspect of the neu-

rotic process becomes clearer if we accept the existence of an early AFS:
namely, that childhood rebellion, such as temper tantrums, may be regarded
as remnants of a fight to maintain a maximum of still available aspects of
the real self, while the propensity of younger people to use drugs may be
seen as an attempt to deaden the pain of societal attack on the residuals of
the real self. Looking at childhood rebellion in this way, psychoanalytic
therapy may help the child to use his fighting strength in a more constructive
way to regain greater assertion of what is real in him.
Finally, there is a need to stress that not only AFS but also all other
aspects of neurotic development are more or less partial and never com-
plete. Therefore, in each person there exists a mixture of part-real and part-
idealized self, successful and unsuccessful neurotic, and his AFS may be
more or less severe. In addition, the schema of neurotic development, given
in Figure 3, and its treatment are fraught with the faults and rigidities of all
such schemata and should be used only for clarification and approxi-
mation of the topics discussed here, rather than as absolute reality.

SUMMARY

Drawing from the description in the literature and my observations, alien-

ation from the self may be seen to be the forerunner of the formation of an
idealized (false) self-image. Starting from the premise that the formation of
the idealized image starts during the process of separation and individua-
tion, 18 the development of at least some alienation from the self would have
to occur, at the latest, during this period and probably much earlier. The clin-
ical evidence cited in this paper strongly implies that early alienation from
the self occurs as a disturbance of the earliest days of the attachment phase
of infant development; the evidence also implies that the disturbance is
more severe the more of his real self the infant has to sacrifice in order to
accommodate himself to his mother's needs. The greater the disparity be-
tween his mother's and his own needs, the more blindness to his own needs
the child must develop in order to form a self-image acceptable to both his
mother and himself. The consequence of this repression in earliest child-
hood of his real feelings, self-awareness, and self-expression is the formation
of basic anxiety and of functional illness in general. However, the details of the
development of these functional disturbances as consequences of early alien-
ation from the self need much further exploration and clinical confirmation.

REFERENCES

1. Marx, K. Der Historische Materialismus. Die Fruehschriften, Leipzig: S. Landshut

and D. P. Mayer, 1932, Bd. 11, p. 25 (Das Kapital).
 ON EARLY ALIENATION FROM THE SELF 243

2. Fromm, E. The Sane Society. New York: Reinhart, 1955.

3. Ibid., pp. 123-124.
4. Ibid., p. 139.
5. Ibid., p. 141.
6. Ibid., p. 143.
7. Homey, K. Our Inner Conflicts. New York: Norton, 1945, p. 18.
8. Homey, K. Neurosis and Human Growth. New York: Norton, 1950, pp. 155-
175.
9. Ibid., pp. 18-21.
10. Miller, A. Prisoners of Childhood, The Drama of the Gifted Child and the Search
for the True Sell New York: Basic Books, 1981, pp. 30-31.
11. Ibid., pp. 30 and 31.
12. Ibid., pp. 34-35.
13. Mahler, M. On Human Symbiosis and the Vicissitudes of Individuation. New
York: International Universities Press, 1968.
14. Winnicott, D.W. Maturational Processes and the Facilitating Environment:
Studies in the Theory of Emotional Development. New York: International
Universities Press, 1965.
15. Homer, A.J. Object Relations and the Developing Ego in Therapy. New York
and London: Jason Aronson, 1979.
16. Homey, K. New Ways in Psychoanalysis. New York: Norton, 1939, pp. 74-75.
17. Sperling, M. Psychosomatic Disorders in Childhood. New York and London:
Jason Aronson, 1978, p. 17.
18. Rosenthal, H.M. Disturbances in the natural development and recognition of
self (unpublished manuscript).

Reprint requests to Herbert M. Rosenthal, M.D., 641 La Cruz Road, Santa Fe, NM 87501.