Discussion on Ego Distortion1

I am very grateful to Dr. Gitelson for reporting a clinical case in such detail in his paper, so that we have a clinical basis for discussion. As our psycho-analytic science develops all over the world, the terms in which we discuss our analytic problems become increasingly varied, which leads to much misunderstanding. For example, the term ego distortion does not mean much to me, because in similar cases I am used to talking about borderline states, or borderline psychotics. I think the term narcissistic character disorder is better than ego distortion, but even the former does not make sufficiently clear to me what we are dealing with. I would prefer to describe Dr. Gitelson's case as a borderline psychosis of the schizoid type. The term schizoid implies that we are dealing with a patient who lacks emotions and who uses schizoid defence mechanisms such as splitting, denial and projection in an excessive way.

I would like to explain this in more detail. I am impressed by the very rigid personality of Dr. Gitelson's patient, who does not seem to me to be only narcissistically withdrawn from the external world but to be defending himself against psychotic anxieties of a paranoid type. Dr. Gitelson himself draws attention to the patient's paranoid anxieties and to his aggressive impulses of psychotic strength.2

Generally speaking, I regard most borderline psychotic states as more or less successful defences against acute schizophrenic paranoid conditions, or they might be regarded as unsuccessful attempts to overcome infantile psychotic anxieties.

From Dr. Gitelson's theoretical formulation I have the impression that our concepts do not differ a great deal in this respect.

However, I am not sure from Dr. Gitelson's description how technically he deals with such cases and how much and what he interprets. I miss a detailed description of the behaviour of the patient in his sessions in the beginning of the analysis. I am not convinced that Dr. Gitelson is right in h