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In previous writings the author expressed the view that the ego's capacity to tolerate anxiety depends on constitutional factors: further, that the ego functions from the beginning, that at the same time introjection and projection operate in disposing of anxiety, and that object relations are established from the first contact with the external world.
The role of the life and death instinct in ego functioning is emphasized. Differing from Freud, the death instinct within should be considered the source of primary anxiety, the fear of annihilation. The struggle between life and death instinct involves the ego. The ego operates in the service of the life instinct. Splitting processes together with introjection and projection represent some of the most fundamental early mechanisms.
Fantasy is the mental corollary to the instincts (Susan Isaacs). Like the instincts, fantasy operates from the onset. The formation of 'internal' and 'external' objects is described. The building up of a world of good and bad internal objects leads to internal persecution as well as to internal riches. This influences ego development in general.
The internalized objects felt by the young infant have a life of their own. Persecution, suspicion, trust, and confidence result from their interaction. All three regions of the mind, id, ego, superego, exerting their influence on each other from the beginning of life. Thus the author's conception, she states, makes it impossible for her to confine her discussion exclusively to the mutual influences of ego and id. The implications of this hypothesis on the whole of psycho-analytic theory are summarized.