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In the introduction Dr Freeman says this book describes the psychoanalytic approach to the clinical problems encountered in psychiatric practice. However, it is very much his individual approach based on 35 years' experience in psychiatry and analysis. He presents a theory of psychosis incorporating several concepts. Based on J Hughlings Jackson's model , disease does not create, it sets free primitive and maladaptive modes of physical and mental activity. Thus the positive symptoms of schizophrenia are seen as a reaction to damage to healthy mental life.
A reaction to the damage is the emergence of symptoms reflecting the loss of capacity to discriminate between the mental representations of the self end others. He takes terms used by Blender and Wernicke - transivitism, parts of the self externalised on to the external object, and appersonisation, features of the object remaining in the self, to describe this state. He regards the phenomena transivitism and appersonisation at the heart of the different psychoanalytic theories of psychosis.
Freud's insights on psychosis in the Schreber case are incorporated into the theoretical framework. Freud envisaged a progress from a phase of primary identification, a primitive state of merging with mother, to one where self and object representations are clearly differentiated. When libidinal cathexes with objects can no longer be sustained there is regression to primary identification, as a response to an internal change provoked by sexual arousal or object loss. Thus schizophrenics can be viewed as already in the grip of unconscious homosexual wishes and, especially in adolescence, their conflict with heterosexual wishes leads to an eruption of the psychosis and the dissolution of psychical structures and an ensuing break with reality.
Finally, he considers similarities between psychotic children and certain adult schizophrenics as o failure to maintain, or in children reach, the libidinal cathexes of objects, a view he sha