Almost every type of mental suffering is caused either by the management of anger or hatred (which I call bad emotions), or by the management of sadness and　misery (weak emotions). 

 These two kindsof emotions lie behind anxiety, irritation, despair,   depression, apathy depersonalization, hallucination, delusion, and so on. Whenpeoplefeel mentally unbalanced, they generally consult mental health clinics or turn to psychosomatic medicine and are given tranquilizers for the main symptoms. When the symptoms subside, people forget to take their tranquilizers. But subject to repeated stress, the person suffers a relapse. The original causes always remain, ready to generate more problems.

 My own response, drawn from clinical experience and unobjectionable by experienced therapists, is to look for patients' layers of symptom formation, defense mechanisms, and so forth, and remove them as if peeling the layers of an onion and exposing the bad emotions (anger, hatred etc.) and weak emotions (sadness, misery etc.). Everyone has many kinds of emotions, but displeasing feelings always boil down to these two kinds of emotions. All this can be observed more easily in animals, for humans experience more complicated psychic phenomena. In many instances, when an animal meets a strange being, it reacts either by threatening or escaping. The cause of threat is anger and the cause of escape is misery. In humans, defense mechanisms or symptom formation appear as complicated reactions that are not always easy to read because the cerebral cortex has evolved to conceal some animal instincts.

            Fundamental principles of the Integration Theory of Psychoanalysis

  By observing the way people manage bad emotions (anger, hatred etc.) and weak emotions (sadness, misery etc.), we can see that different emotions have their own peculiar natures (characteristics). Regarding anger, consider the following two cases: in one, person A thinks that person B is angry whenever person A is angry. In other case, person A thinks that person B is not angry even if person A is angry. In the former case, one's own anger shows a tendency to diffuse to others. This kind of cognition is observed in animals and humans who are mentally abnormal. In the latter case, one's own anger is not diffused outward onto others but tends to converge on oneself. This kind of cognition is called recognition (formation) and is observed in humans having normal mind.

  Regarding misery, consider two more cases: in one, person A, even when he/she is feeling miserable him/herself, thinks that person B is not feeling miserable. In other case, person A feels miserable him/herself and thinks that person B also feels miserable. In the former case, one's own misery is not gotten across to others and shows the tendency to converge on oneself. This way of cognition is observed in animals and humans who are mentally abnormal. In the latter case, one's own misery is gotten across to others, and shows tendencies to be shared with others. This kind of cognition is called recognition (formation) and is observed in normal human minds.

  Expressing these characteristics of emotions in technical words, traits of diffusion to others in case of bad emotions and traits of convergence to self on case of weak emotions are the contents of cognition of our emotions, and observing these traits indicates abnormality of mind. On the other hand, the traits of convergence to self in bad emotions and the traits of diffusion to others in weak emotions are the contents of recognition of our emotions, and observing these traits indicates normality of mind. These contents are only observations which distinguish normality from abnormality of mind. They are the most important factors lying at the base of suffering fromevery mental symptom and every mental disorder.

            Fundamental principles of the Integration Theory of Psychoanalysis

  How can abnormal mentality characterized by anger (bad emotion) and misery  (weak emotion), be changed into normal mentality? A person needs others in order to gain or sustain the power of a healthy mind. What is that power?  When someone gets angry (the bad self is activated), his/her anger loses its fire if the other person apologizes and improves his/her attitude. When a person feels miserable (the weak self is activated), his/her misery is calmed if the other person tries to share his/her misery. The former is the power of the apologetic object (object-regulatory factor), and the latter is the power of the idealized object (object-regulatory factor).

  How about cases when person B becomes angry with person A? When B's anger (activation of person A's bad object) is adequate, person A introjects the apologetic object and apologizes using the apologetic self (self-regulatory sub-factor), which is identified with the apologetic object. If person B's anger is inadequate, person A should rebel it. Also in this case, person A introjects the rebellious object (object-regulatory subfactor) and uses the rebellious object. Person A's mentality is influenced by how he/she receives warning and reproach for his/her own speech and behaviors. If he/she takes them as blame, that corresponds to diffusion traits of anger, and it leads to abnormal mentality. If, on the other hand, he/she takes them as person B's rebellion, which is the rebellious object, that corresponds to convergence traits of anger, and it leads to normal mentality.

  How about when person B complains of misery (person A's weak object is activated)? In this case, person A introjects the idealized object and should be able to empathize using the grandiose self (self-regulatory factor) which is identified with the idealized object. This is empathic subjectivity. There is noproblem when person B expresses his/her misery with honesty. But sometimes person B takes on a kind of arrogance in the attempt to hide his/her misery. Such cases require great care. Person A cannot empathize person B's misery, because person B is trying to hide it. Person A changes person B's misery intoperson B's anger and uses the rebellious self in order to deal with it. Person A's rebellious self has the peculiar ability to activate the grandiose self (rebellious subjectivity). Unless person A can cope with person B's pride and arrogance, person A must also hide his/her own misery just like person B; otherwise person A cannot deal with person A's anger generated by person B'sarrogance and abnormal mentality is the result.

  Let me explain once more the normal mentality of dealing with anger and misery due to arranging mental activities (psychodynamics). Person A's own anger activates the apologetic object and person B's anger activates the rebellious self. The intrapsychic situation in which this cycle keeps going is called the "loop of forgiveness." Person A's own misery activates the idealized object and person B's misery activates the grandiose self. The intrapsychic situation in which this cycle keeps working is called the "loop of help." 

              Fundamental principles of the Integration Theory of Psychoanalysis

  One should have multiple loops of forgiveness and help in order to foster a healthy mind. It is hard to lead a satisfactory social life having only a single loop of forgiveness or a single loop of help, even if one can form a single one loop due to psychoanalysis. A person with only a single loop has poor health of mind and tends to be overcome by the power of abnormal mentality. It is not easy to form more than two loops for each of the loops of forgiveness and help, but everyone should aim at forming multiple loops.

  This can be also explained referring to the fact that the rebellious object and the idealized object have multiple natures. A person generally rebels against another person and tries to make the other person understand the matter more deeply when that other person exhibits unacceptable speech and behaviors. That is the rebellious intervention of therapist against the pathology of patients in psychoanalysis. Additionally, for example, it is observed that relationships between patients and patients' families reach a certain limit of effectiveness and the relationships themselves fail unless they are not improved (see Chapter 9-4: Nature of rebellion). Also, these cases require rebellious intervention having different natures from the above-mentioned. As regards the idealized object, the context of "idealized" presupposes good human natures, in which honesty (pureness) and diligence are especially important. These natures are also introjected from others and are not spontaneously generated. It is necessary to form loops of forgiveness and help in each of these important natures. 

                Fundamental principles of the Integration Theory of Psychoanalysis

  In my clinical experience, it is possible to classify functional mental disorders according to how many loops of forgiveness and help are in patients. That is, the number of loops of forgiveness and help which are present determines mental structure (personality structure).

  In psychosis as schizophrenia and manic-depressive disorders, there are no loops of forgiveness and help. The distinction between schizophrenia and manic-depressive disorders is determined not by normal mentality but by abnormal mentality (temperaments, defensive fluidity, and so on).

  Pathological states (severely disturbed personality disorders), in which eight disorders are included, are classified into two groups which have a single loop―either a loop of forgiveness or of help. One is pathological states of the aggessive system which have a single loop of help, and includes the four disorders of borderline, histrionic, antisocial, and obsessive-abortive personality disorders. Another is pathological states of the fragile system which hasve a single loop of forgiveness, and includes the four disorders of schizoid, schizotypal, paranoid (delusional), and passive-aggressive personality disorders. The distinction between these two groups is made not by normal mentality but by abnormal mentality (temperaments, defense mechanisms, and so on).

  In defensive states (slightly disturbed personality disorders) in which six disorder groups are included, they each have a single loop of forgiveness and help. It includes irritable, obsessive-compulsive, avoidant, and hysterical personality disorders (defensive states of aggressive system), and narcissistic and dependent personality disorders (defensive states of fragile system). The distinction among these six disorders is made not by normal mentality but by abnormal mentality (conflicts, pathological identification, and so on).

  Healthy states of mind have two loops either of forgiveness or help and a single loop for the other one. A person with two loops each of forgiveness and help is in a very healthy state of mind. In order to go to the course of enlightenment, two loops each of forgiveness and help are required.

               Fundamental principles of the Integration Theory of Psychoanalysis

  Needless to say, therapists should be mentally healthy. Mental disorders which could be cured by conventional psychoanalysis are defensive states among the ones mentioned above. Patients in defensive states can intermittently lead social life (work), and they can cure after even a single treatment. That is because they can introject the object regulatory (sub-) factors from not only their therapists but also extra-therapeutic objects. However, it is hard for patients in most pathological states or psychoses to have a social life (work) and for them the only extra-therapeutic objects are their families. Of course, many patients use mental rehabilitation, but rehabilitation alone cannot assure their cure. It is impossible for these patients to cure by only a single treatment unless their family can make major changes. Even if the patients' families participate and cooperate in treatment, they cannot function very well as effective extra-therapeutic objects. Under single treatment therapy, therapeutic relationships lead to mutual hatred or helplessness, and it becomes impossible for therapists and patients to escape from that situation. If double treatment by two therapists are simultaneously performed, thrapeutic relationships become more relative, loops of forgiveness and help are formed more easily, and finally cure is induced. When treatment involves two therapists, their skills cannot be falsified and therapeutic benefits can be known more clearly.

               Fundamental principles of the Integration Theory of Psychoanalysis