Discussion

PERPHAPS THE MOST USEFUL contribution I can make to the discussion of this interesting paper is to formulate the nature of the child's illness and the progress of his therapy from my particular vertex, hoping that it will be understood to imply no attempt to amplify or correct what is written. The method used, skillfully holding together in one therapist's hands the three roles of psychotherapist, manager of the hospital situation, and advisor to the parents, is very impressive but makes for some difficulty in following the transference events. So I will not attempt to do that but will only speak of Jimmy's psychological situation.

This child seems to me, in the wisdom of hindsight, to have broken down with a hypochondriacal psychosis (a variant of depressive illness, of the type manifest in Schreber's first breakdown) under the stress of an exploding family situation, the major factors being the sister's incipient paranoia, the parents marital difficulties and the prospective move which would take him away from the one object of love, Johnny. These impending disturbances impinged upon a personality which had achieved a false stability by means of severe splitting-and-idealization of self and objects. His malevolent self had been projected into his sister so that his tolerance of her persecution was based not on masochistic submission (her slave) but on guilt and sympathy for her (much as was the Wolf-man's relation to his sister, also later to be paranoid). Jimmy's omnipotence, increased by his parents' concurrence in his self-idealization, also was manifest in his guilt toward Patrick, whom he would have hated much as Mary had hated him, had he been born sound. The "apple of father's eye" and mother's "sweet as sugar and honey" boy was later shown to be an angelic self-image, Christ-like in his attempt, under multiple stress, to take into