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Jacobson points out that psychotic and borderline states failing to utilize normal ego defences revert to more archaic operations. One such method is the use of memory 'defects'—extensive childhood amnesias and a forgetting of current events. Such occurrences suggest the presence of denial of external and internal reality. Jacobson presents case material to support her views on the part played by denial in psychoneurotic and psychotic states. In one case the patient, in addition to repression, employed denial, introjection, and projection. In this way he disclaimed the existence of id and superego. By the projection of these systems he externalized internal conflicts.
Comparing denial and repression, Jacobson says that while repression succeeds in dispelling the ideational representations of the drives from the preconscious, denial can only ignore the fact that these very drives have already become preconscious. She suggests that the presence of denial is accompanied by the substitution of instinctual for structural conflicts; it is this change which can be observed clinically in psychotic states. To find an answer to the question how denial acts with respect to internal dangers Jacobson puts forward the idea that denial presupposes an infantile concretization of psychical reality, which permits persons who employ this defence to treat their psychic strivings as if they were concrete objects. For Jacobson the defensive processes leading to infantile amnesia have a preliminary stage of denial. In certain cases this can have pathological consequences, as in the patient cited, in whom denial was closely associated with introjective and projective mechanisms.
Jacobson points out that, just as denial may be compared with repression, so may primitive forms of identification be compared with later and mature identification. She suggests that denial, introjection, and projection all operate, economically, with large quantities of deneutralized energy. Defence in n