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In the above, I have considered symptomformation in schizophrenia mainly in the light of Freud's new theory of anxiety (1926), (1933) and Hartmann's concept of integrative ego functions leading to an adaptation to inner and external reality (see also Arlow & Brenner, 1964), (1969). A clinical case has been presented to illustrate that five steps can be distinguished in symptom formation: (1) the resurfacing of conflicts; (2) an experience of 'organismic panic'; (3) a disturbance in ego functioning and a loss of the continuous sense of self; (4) thereupon the integrative function of the ego orders and modulates the mental content, so as to find a best possible solution to alleviate the experience of organismic panic; and (5) the symptom formation and an altered sense of self become crystallized in the wake of the best possible solution.
The catatonic, the paranoid, the hebephrenic or the simple symptomatology may be viewed as the best possible solution attained by a patient at a given time. Although some patients show a predilection to one or another type of symptomatology, each of such symptomatologies is expected to be encountered in any given patient in the course of long-term treatment to meet the requirement of a best possible solution.