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Our understanding of the psychoses has made remarkable progress during the past forty years. Attention was first directed to specific aspects of the psychotic ego, and the deterioration of the reality function. These descriptive researches into personality structure were indispensable. It was justifiable to enquire how one could differentiate clinically between a psychotic and a patient suffering, say, from homosexuality or fetishism, when they presented analogous thematic material in the course of treatment. But it was essential not to let the individual dynamic, or 'drama', fall into the background, only to be referred to for form's sake, or clinical psycho-analysis would have fallen victim to the same major infirmity as has affected other contemporary psychiatric systems. Clinical work has therefore come to be centred more and more on the study of object relations, which includes the libidinal and aggressive cathexes, anxiety and ego-defence mechanisms, both in their development and in their encounter with the activity of the cathected object.
Psycho-analytic treatment of children and adults has shown that certain special modifications of object relationships may be observed at a very early age, even if the psychotic symptomatology appears only much later. It is therefore legitimate to consider the origin and nature of such anomalies. And this compels us to envisage a number of theoretical problems, still subjects of discussion amongst psycho-analytic theorists. Thus the relationship between object and instinct still provokes considerable controversy. The existence, for instance, of a period in the life of a child, during which the mind is not yet organized, is still disputed by some theorists.
We are always obliged, in fact, to combine three lines of approach:
i.The reconstruction of the past by studying the change of structure which leads, at the phenomenological level to the elaboration of memory-screens or imaginative products of the same value. We mus