Comments on 'Ego Distortion'

Although I was a participant in the panel on Ego Distortion at the International Congress, Paris, 1957, I did not enter into a discussion of Dr. Gitelson's paper (Gitelson 1958), but rather gave a contribution on the comparison of 'as-if' and 'pseudo as-if' (Katan 1958). Yet Dr. Gitelson touched upon subjects which interested me very much. Therefore I was glad when after the Paris Congress he read his paper before the Cleveland Psychoanalytic Society. I then took the opportunity to discuss especially the clinical material presented by Dr. Gitelson. I did this mainly to make a diagnostic differentiation.

It is clear, from the very beginning of his article, that Dr. Gitelson doubts whether a differentiation can be made between ego distortion and the functioning of the ego in the borderline case. 'If one reviews the clinical phenomena presented in the so-called borderline cases, one finds, in addition to the diffuse clinical picture, one or another or several of the specific "distortions" which have been named by the committee' (Gitelson 1958, footnote 4).

Notwithstanding the confusing clinical pictures, one may try, not only for theoretical reasons but for diagnostic reasons as well, to differentiate between ego distortion and the borderline case. Although there are many overlapping situations, I think of an ego distortion as an early-formed reaction of the ego to certain conflicts. This reaction is not exchanged in any later development for more adequate reactions. It remains visible and will appear when the ego has to face a specific conflict. One can say that after superego formation, the chance of developing ego distortions has disappeared. I have already discussed a few examples such as the 'as-if' and 'pseudo as-if' reaction.

Next, I want to compare the ego distortion with the functioning of the ego in the borderline case. The borderline case appeared to me years ago as a fixation of a prepsychotic development, with secondary ego adaptations in order to