Comment on Dr Ekstein's Paper1

Ekstein's paper addresses itself to the study of the abnormal which by its distortions and exaggerations reveals the normal from which it deviates. The borderline and the psychotic child hold the key to much of the unexplored. Ekstein's study of schizophrenic adolescents aims at the delineation of definite clinical syndromes. He contrasts omnipotentiality with omni-impotentiality. His main findings are: inability to maintain object constancy, fear of loss of the self, megalomanic fantasy goals to restore self-love and to cover up helplessness; the search for goals is a quasi-search.

I agree with his analysis of the "small promises," and I enjoyed his beautiful description of them. The primary process, he says, "does not lead to the secondary process but ends in a dead-end street." His patients "struggle for very existence," and they have only a "rudimentary mastery of reality." Theresa has only a "feeble bridge between her inner world, her delusional preoccupations and her attempts to communicate with her therapist." She does it by borrowed fantasies.

I will restrict my remarks to the discussion of the material from the structural point of view. Though I agree with much of what Ekstein says, I would like to raise some questions. First, does, as he says, the development of the schizophrenic adolescent really parallel that of an average adolescent? The parallel exists, I think, only in the most general outlines. I fail to see a parallel between the adolescents described by Anna Freud and Ekstein's patients. Nor do I think can Erikson's concept of the identity crisis be applied to them. The schizophrenic adolescent may have the same tasks, but his equipment to deal with them is quite different—it is faulty and insufficient.

This leads to my second question. Were the "germs of destructive illness" which prevent these patients from solving the adolescent problems not also active before? I would assume they were active through latency as well. Are some of t