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Psychoanalytic Quarterly, Vol. XVII, 1948, No. 2, p. 226.
An organic brain disease interferes with the adaptive process of the ego, leaving a patient more vulnerable to assault both from without and from within. The ego will be overwhelmed unless new defence mechanisms are erected. The above applies to the artificially induced organic state produced by shock treatment. The personal variations in reactions to the organic defect are described and demonstrate the individual psychological factor in the clinical syndrome. Several case histories are given. The authors conclude: (1) a practically complete dissolution of the ego. This leads to regression to an archaic narcissistic ego as a defence. The regression to a more primitive ego structure with its disruption of ego boundaries, or body image produces anxiety with a feeling of disintegration. Simultaneously a disintegration of ego defences occurs. This permits a welling up of previously repressed inner impulses. New repressions must take place or partial integration at a more primitive level of defence. In a successful case the ego realigns its defences on an even higher level of integration.