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Psycho-analytic study of psychotic and related conditions has led to a better understanding of characteristic reaction patterns of the psychotic ego. Here, as in other areas of psycho-analytic research, deeper knowledge of ego psychology has been paralleled by a more careful handling of the defensive operations of the psychotic ego. This parallelism between the development of theory and the progress of analytic technique is perhaps the most encouraging reward in our wrestling with the difficult problems presented by the psychotic.
Before I proceed to the discussion of my topic I would like to point out that my observations are based on a prolonged study of patients with an active schizophrenic psychosis as well as a number of the so-called latent psychotics. I prefer this term, introduced originally by Bleuler, to the term borderline cases used by other authors. Elsewhere I have discussed at some length the specific problems related to this clinical group. The significance of these cases for our discussion becomes apparent when we realize that they present in statu nascendi or in a light form many reactions which reach full development in a frank psychosis. Moreover, their acting out, especially of aggressive character, interferes to a lesser degree with the therapeutic situation.
As a general principle of our approach I propose the following thesis. Persistence of primitive forms of ego organization in the schizophrenic makes imperative a minute working through of these archaic patterns. With this in mind we will make use of reactions manifesting themselves in the therapeutic process and in the life situation as a whole. In the course of careful elaboration of these reaction patterns we shall present the psychotic ego with a modus operandi more adequate and up-to-date, and tempt it with advantages of such functioning as compared with primitive patterns.
Starting at the roots we find that genetic data concerning the emergence of the ego and the origins of cons