Narcissism and Defensive Processes in Schizophrenic States

The purpose of this paper is to examine once again the processes of defence in schizophrenic states and their relationship to the various forms of mental activity which underlie the clinical phenomena. The concept of defence was introduced by Freud (4) as a result of his study of dreams and psychoneurotic symptoms. In both groups of phenomena he described the unconscious mental conflict which occurs between instinctual wishes on the one hand and ethical and moral standards on the other. As long as the defensive forces maintain the upper hand dreams adequately protect sleep and anxiety does not become a source of distress in waking life. However, once the defences have become inadequate anxiety leads to further measures which end in symptoms. The model upon which symptom formation is based is that of the dream. Both are compromises between conflicting forces and their mental representation is such as to keep their real significance unconscious.

Psychoneurotic symptoms are the equivalent of unconscious mental conflicts. Can the same be said for the signs and symptoms of schizophrenic reactions? One method of studying this problem is to examine the defensive processes which occur in these classes of mental illness and observe their relationship to the symptom complex. However, the relationship of symptoms to the repressed in schizophrenic states is only one aspect of a more general question. This concerns the manner in which the defences interact with the mental processes which lead to the cognitive disturbances and to the other signs which are characteristic of this group of diseases. It is this topic which will be the principal subject matter of this paper.

I

The first patient is a nurse of 21 years old who was admitted to hospital on account of the sudden appearance of psychotic symptoms. She announced that she was due to be married (quite untrue) and that she was being desexualized by machines in the operating theatre. When she arrived in