Journal of the American Psychoanalytic Association 6, 1958, No. 3: Arnold H. Modell. 'The Theoretical Implications of Hallucinatory Experiences in Schizophrenia.'

Ten hospitalized patients provided the clinical material for this investigation. The author's aim was to examine existing hypotheses in the light of the clinical data. After presentation of his clinical material he concludes, firstly, that the hallucinatory experiences recreate certain aspects of infantile relations to the parental objects so that an internalized object is now perceived by the patient as an external object. The patient is identified with both subject and object—he takes both active and passive roles. With respect to the nature of the relationship between the self and the hallucinated object Modell separates those instances where direct sexual gratification is achieved from those other instances where the hallucinatory objects have assumed non-eroticized attitudes. In the former group he noted the prominence of genital stimulation in both male and female patients often leading to genital orgasm. Such phenomena when they occur in psychosis may be more easily understood if it is appreciated that the regression which occurs in the ego does not necessarily correlate in a direct fashion with regression of the libido.

Modell observed that male patients heard predominantly male voices whose content concerned passive homosexual wishes. Female patients heard male and female voices with content which indicated both active and passive sexual wishes towards both parents. The material favoured the interpretation that such sexual content was secondary to the narcissistic regression which occurs in the disease. There was no confirmation of the usual theory that the relationship of the voices to the patient was a hostile one. Most of the patients perceived the relationship with the voices as beneficial. This could be thought of as the outcome of an ego regression to a stage when the child relies on the parent to perform certain functions that he later acquires himself. From a metapsychological standpoint an ego identification is reconverted into an object