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The Psychoanalytic Quarterly, 1950, 19, No. 3, p. 327.
Some of the literature pertaining to the nature of neurotic symptoms in psychosis is reviewed. They are in the main considered either as a defence against the psychosis or as masking the psychosis.
Based on the observation of a patient during treatment which lasted 400 hours, the following formulations were arrived at: (1) The psychotic phenomena and the obsessive symptoms occurred episodically and in a particular sequence following experiences of frustration and deprivation; (2) In each instance the sequence started with an abrupt pause in the patient's behaviour, lasting for a very brief time and followed by a complete draining away of his interest and expressiveness. Subsequently, there appeared schizophrenic phenomena, then self-tormenting obsessional-like phantasies followed by less disturbed obsessional neurotic symptoms which in turn were followed by the appearance of object relationships without symptomatology. (3) The psychotic process, whatever its nature, could apparently be localized to the phenomena following the experience of deprivation and could be described only, in the patient's words, as an 'abrupt emptying'. All the subsequent phenomena in each episode up to the re-establishment of object relations were in the nature of restitution and characterized by what the patient called 'focusing'. (4) The process of restitution seemed to be intimately related to what the patient described as 'his mental image of the analyst'. The re-establishment of object relations was invariably associated with a clear and undistorted 'mental image'. (5) Certain of the symptoms which were associated with getting into difficulties and acting as if the trouble voluntarily brought about occurred only during the periods of 'focusing' and appeared to be an archaic way of communicating the problem by acting it out.
The hypothesis is offered that all the observable symptomatology except for the 'abrupt emptying' is in