Some superego conflicts in the analyst who has suffered a catastrophic illness

This paper, originally part of a panel (in a somewhat different form) on life stresses of the analyst, focuses on some of the superego conflicts of the analyst who has suffered a catastrophic illness. The interplay between ego and superego functioning is examined, particularly in reference to how superego conflicts cause the ego to become subordinated to drive-related aims and to superego demands from which it would ordinarily have more autonomous distance. Some of the issues which are conflictual for analysts who have suffered a catastrophic illness and which have a tendency to be played-out in the treatment include: problems of self-esteem regulation; regressive alteration of identifications; reinstinctualization of identifications and of object relations; alterations in the ego-ideal; disruptions of other narcissistic regulatory processes; and the above mentioned subordination of ego functions, especially in regard to its synthetic, reality testing, and other autonomous capacities. Examples are presented of how these conflicts may be dynamically operative in unconsciousness, how they may enter into consciousness, and how they might be expressed in the treatment.