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DR. FIASCHE'S DISCUSSION of my paper was most interesting. I am pleased that it stimulated such a wide-ranging and lively discussion. There are several points of that discussion to which I must reply in order to clarify some important issues.
The first has to do with the question of diagnostic appraisal, which Dr. Fiasche feels I made incorrectly. There was a great reluctance on the part of the hospital staff and the first therapist to see the patient as schizophrenic. I believe that she was schizophrenic and that the course of her therapy, with the gradual uncovering of world destruction fantasies and distorted object relations, bore out this appraisal. I meant to convey a description of ego functioning by using the term schizophrenic as I am not particularly fond of diagnostic labels. I have found Bellak's description of ego functioning in schizophrenia1 useful in this regard. Perhaps I could have described this better, but I assumed that the material would convey the psychotic nature of Miss A's functioning. I think that Dr. Fiasche's statements about "psychopathic defenses of hysterical and epileptoid nature" are incorrect, quite misleading, and arbitrary appraisals that only confuse the issues I raised. I am reminded of Rudolf Ekstein's remark, (in replying to comments on patients in his Childhood Psychosis Project) that whenever patients improve, people feel they could not have been psychotic in the first place. It is as if there was no therapy done, just diagnostic error.
Dr. Fiasche believes that I changed a theoretical model into an ideology. He