Leon Hoffman, M.D., is Chair of the American Psychoanalytic Association's Committee on Public Information, Director of The Parent Child Center of the New York Psychoanalytic Society, a contributing editor for the Journal of the American Psychoanalytic Association and a training and supervising psychoanalyst in adult, child and adolescent psychoanalysis at The New York Psychoanalytic Institute. He has written extensively on Sigmund Freud, women's psychology and children's issues. As spokesperson for the APA, he regularly speaks in public forums about the role of psychoanalysis in addressing both personal and societal concerns in contemporary American culture.

WIE: Can you please define the word "ego"?

LEON HOFFMAN: From a technical psychoanalytical perspective and the way it's used in psychoanalytic therapy, "ego" has a very specific meaning. Freud initially divided the mind into three theoretical constructs: the id, the ego and the superego. The id has to do with the person's passions, the person's wishes: sexual wishes or aggressive wishes. The goal in life is to gain control of these passions and utilize them in the most effective way. We've got all these impulses, and basically the goal is to get a balance between using these impulses and at the same time curbing them in some way. That's how the concept of superego first came into psychoanalytic thinking. Superego forms in the development and socialization of the child, through the interaction with the parents. Take a very simple example: A child wants to eat all of the time, wants to grab everything, and the parent—particularly the mother in early life—will start imposing restrictions. And eventually when a toddler starts to crawl and wants to put his or her hands into an electric socket, the parent is going to say, "No, you can't do that." So "no" is a very important part of child development. There's this constant balance between forces of wanting to do everything right now and other forces saying no, you cannot do this right now, you have to control it. You have to delay gratification. This is where the concept of the ego comes in, because the ego involves your capacities for memory, your capacities for perception and your capacities for controlling your impulses. Freud in fact once said that the first person who spoke a curse, who spoke words instead of hurling a stone, was the creator of civilization. So, I'm angry at you, I'm not going to punch you, but I may tell you that I'm angry with you. That's a very important concept for our understanding of the way the individual develops the ability to live within a social environment. The ego could not exist by itself; the ego can only exist within the context of relationships with other people.

So, the ego is the part of the person's mind that achieves compromises between a variety of opposing forces to develop one's self in the most adaptive way in one's social environment. The ego has to do with adapting to your social situation while at the same time resolving the conflict between your inner desires and wishes and your inner sense of morality. It's like in a marriage when one person says black and the other person says white. You have to resolve that in some way.

WIE: So the main function of the ego is to negotiate between the various instinctual drives and social forces in order to adapt appropriately to the environment?

LH: Yes, "negotiate" is the perfect word.

WIE: How would you define "conscience," and how does conscience fit into psychoanalytic theory?

LH: Well, that's what the concept of superego is. Superego is really one's sense of morality. In psychoanalytic theory, the development of morality is a crucial concept. It starts from day one, from the fact that in rearing children, you have to begin to say "no" very early. At some point the child is put to bed when he or she doesn't want to go to bed. The development of conscience is very much connected with the child learning that his or her passions can't be gratified all the time. And you want to develop a "healthy" sense of conscience—not too strong and not too weak. Oftentimes, if parents are too permissive, the child develops a very strong self-punitive streak because they are frightened that nobody is controlling their impulses. So a simple definition of conscience would be our internalized controls, the way we have learned to regulate our wishes.

WIE: Some developmental theorists speak about there being a qualitative difference between conscience that is based on internalized societal "shoulds" and "shouldn'ts" and fear of retribution—the more traditional Freudian definition of superego—and conscience that is based more on an independent reckoning with our interconnectedness with others and genuine concern for the effects of our actions on others. It could be seen as more of a spiritual conscience than a conformist conscience. Does psychoanalytic theory recognize this kind of distinction?

LH: Well, I would say that, psychoanalytically, these are two extremes of one continuum. Everybody to some extent has an inner sense of control and an outer sense of control. So, for example, there are these catch phrases: "When you're drunk, alcohol dissolves the superego." In other words, you do things when you are intoxicated that you wouldn't do otherwise. Or, "If you're far away from home, your superego stays at home." There's a gradation between controlling our impulses to a greater extent or a lesser extent. Some people need the policeman right there all the time; otherwise they will steal. That's one extreme. And other people are so conscience-ridden that if they pick up a paper clip, they'll feel so guilty they'll have to confess. So I think you have these various gradations. One of the central concepts in psychoanalysis is that the difference between health and pathology is much more quantitative. So I would not say there's such a qualitative distinction between these two kinds of conscience. I would say there's a continuum between those two extremes.

WIE: Over the past several decades, many spiritual teachers have criticized traditional religious teachings that emphasize renunciation and self-denial, feeling that they are repressive and life-denying, an archaic throwback to an oppressive patriarchal era that we should strive to move beyond, and that they only promote greater conflict and fragmentation within the self. The late maverick spiritual teacher Bhagwan Rajneesh has gone so far as to say, "Let it all be expressed. Let your biology be satisfied to its fullest. . . . If your biology is completely satisfied, there is no fight between the conscious and the unconscious. You become one whole." My question is: What effect do you think letting the id run wild has on ego development?

LH: That's a huge problem! If the instincts run wild, not only can you not live in society—you can't really live with yourself. It really would lead to enormous problems. It would lead to a total disorganization of the personality. It would be completely inconsistent with the ability to live. I guess the most dramatic example of instincts or id running wild would be somebody in a flagrant manic psychosis, where everything goes. In the sixties and seventies, when people started doing things like primal scream therapy and "letting it all hang out," a lot of people got very, very disorganized. I think this is an example of where the idea of "letting it all hang out" is a distortion of Freudian theory.

WIE: Many contemporary psychotherapists and self-help authors have put a great deal of emphasis on the idea that we all have "wounded egos." They encourage us to get in touch with the wounds and traumas of childhood, to unconditionally love and accept ourselves just as we are, and to stop judging ourselves in order to heal our fragile and damaged egos. At the same time, however, the movement from seeing oneself as a victim to seeing oneself as fundamentally not a victim—as having free will and responsibility for one's own life and choices—is essential for psychological health and maturity. Do you think that contemporary therapeutic approaches that emphasize our woundedness and victimhood are helpful in furthering self-development? Or do you think they run the risk of promoting a kind of developmental arrest?

LH: You see, nobody is whole. But to go to this extreme and say "You're very wounded" could reinforce a kind of masochism—the idea that "I'm a real sufferer," that kind of thing. It's a little bit like the idea of victimhood. Now it is very important to understand the impact that racism in our society has on African American people. And you have to be aware of the impact that homophobia has on homosexuals or the impact that any prejudice has on the sufferer. However, victimhood can take on a life of its own, where everything gets explained by projection: "Oh, it's not my fault. I'm this way because society is prejudiced against me." The goal of any kind of therapeutic endeavor is to help the person realize that they have more control over their life than they acknowledge. So you have to be careful that in focusing on your ego's need to be repaired, you don't reinforce the idea that "I'm a weak, helpless person." The danger is that you can reinforce a passivity.

WIE: Can you describe what the ultimate goal of psychoanalysis is with regard to the ego?

LH: The ultimate goal of psychoanalysis is to help the person to understand, as much as possible, factors from the past that are persistent in the present unconsciously and to gain better control over some of these factors in order to make the best adaptive decisions in the present. Adaptation is a very important issue here, a very important concept.

WIE: What is an optimally healthy ego? What did Freud mean when he referred to "optimal psychological functioning"?

LH: Optimal psychological functioning is where you don't experience too much anxiety, too much pain, you don't get into too much trouble in your social environment, and where you are using your resources as adaptively as possible. It's adaptation to the environment and the balance between the environment and your own inner forces.

WIE: What makes the difference between two people who, despite being in the same environment—let's say a hostile environment—respond very differently? What enables one person to rise above their circumstances and become an inspiration to others, while another person in that same situation is defeated? It seems that there is more involved than just adaptation.

LH: Yes. I was just thinking, "What do you say about someone who was in Nazi Germany?" It probably takes a very unique person to be able to do some of the things that need to be done in that environment. How somebody like that survives, God knows. There's no psychoanalytic answer for that.

WIE: Can you please explain the traditional psychoanalytic understanding of what are called "ego defenses" and how they work?

LH: Well, from the very beginning of life, you learn particular devices and defenses, or ways of coping with unpleasant situations. People sometimes think about the defenses as something abnormal, but it is a normal part of life and a normal part of the way the mind works. Some defenses are considered to be more mature than others. Denial is an example of an immature defense. Denial is when something happens and you deny it. Let's say a parent dies, and the child doesn't talk at all about it; the child goes on in his merry way and he acts as if everything is normal. That would be an example of denial. Now, there's always a border between pathological and normal, because in everyday life we use denial all the time. I mean, the fact that we're not immortal—we just don't think about that. It's been reported that people with cancer who have denial often have a much better prognosis than people who are just focused in on the cancer—"I'm gonna die, I'm gonna die." So some forms of denial are extremely adaptive and useful.

An example of a defense that is quite useful, and would be considered more mature, is what's called "sublimation." Say a child had a family member who had some kind of sickness, and the child later became a doctor. This is when you change emotional conflicts into something that's socially useful. Intellectualization is another common defense, where you cope with your feelings by learning all about them and you change your feelings into ideas.

WIE: What was Freud's view on the ego defense mechanisms? Did he believe that successful psychoanalysis should lead to the giving up of the defenses?

LH: Well, Freud started out with one theory and then later came to a second theory. In this first theory, the idea was that the cause of pathology was repression and the goal of psychoanalytic treatment was to undo repression. So, for example, if you had some early traumas or sexual fantasies and you repressed them or forgot about them, this was the cause of a neurotic symptom. So the idea was to undo the repression, to undo the defenses. The analyst was like a bulldozer, and come hell or high water the idea was to find out what these old memories were, what these old fantasies were, and make them conscious, and that would cure your neurosis. It then became clear that a lot of the time this was not therapeutic, so by 1926 he developed what was called the "second anxiety theory." What he had come to understand was that it's not just old fantasies or wishes that are unconscious but also these mechanisms of defense that are unconscious. So the goal of analysis became trying to understand the unconscious defense mechanisms that the person is employing. The person may not be aware, for example, that he's using denial to deal with something that's disturbing. So the first goal would be to try to understand the ways in which the person is dealing with stress unconsciously. Freud wrote about the idea that "mental health" involves illuminating a lot of these defenses. He said that the goal of analysis is: "Where id was, there ego shall be." And what that means is: You make everything conscious. If you make the unconscious conscious, that will lead to mental health.

But what I was saying earlier is different from at least the original version of Freud. To some extent, you need defenses. You know people sometimes say, "Oh, he's being so defensive," as if the person is doing something bad. But you need to have that. You can't go to work and start screaming at your boss even though you're furious. That would be an example of appropriate repression. You have to act in a certain way; otherwise you're going to lose your job.

WIE: In many Eastern religious traditions, the highest goal of human evolution is called "enlightenment." One way of defining enlightenment is that it is a condition in which one is utterly awake and in touch with reality exactly as it is. It is a condition in which one is no longer in any way motivated to distort reality to preserve one's self-image or to support any personal bias or agenda. In this view, the ego is seen as a distorting mechanism, as the colored glasses that must be removed if we are to be able to see things as they are and to respond to life with true integrity. Now, one of the central activities of the ego is the "screening" or distorting mechanism that we've been speaking about, by which impressions or information that contradict or challenge one's self-image or worldview are selectively ignored or distorted. My question is: Did Freud think it was possible to reach a state where one is no longer in any way compelled to "screen" anything out in order to protect one's self-image or worldview? Did he think it was possible to attain a condition where one has no need or motive whatsoever to distort reality in any way and, therefore, is able to be completely in touch with reality exactly as it is?

LH: What comes to mind is what Freud said about the goal of analysis being to help the person deal with neurotic misery in order to be able to confront the misery of daily life. The goal of any kind of psychological treatment is to deal with reality as best you can. What you're talking about in enlightenment would be a different view of reality, I assume, from the view of reality from a psychoanalytic perspective—like the idea that there's a higher, metaphysical reality that we try to aspire to. But when I think about reality, I think about it in a very simplistic way, in terms of your real interactions with people, your real interactions with yourself, understanding your body, understanding your relationships with your family and with your friends.

WIE: Enlightenment, in the way I'm describing it, would in no way exclude the tangible realities of our daily experience. What I'm wondering is whether Freud believed it was possible to see everything clearly, to be completely free from distorting defense mechanisms, and completely free from the motive to distort or be deluded. Would Freud have viewed this as an attainable ideal?

LH: Well, he might have called that "ideal health"—even though he believed that was a fiction.