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This detailed and voluminous text covering the psychoanalytic contributions to our knowledge of the psychotic process is the logical complement to Dr. Frosch's study of the psychotic character. All components of the topic have been examined and considered. There is nothing doctrinaire or partisan about this work — it is always clear that the author has compared various views with his own observations, and that he records his own conclusions. Frosch leaves us in no doubt as to where he stands in this clear and readable account of his work, which is the product of extended study of multitudinous and varied clinical experiences.
A brief summary of Frosch's views follows. He considers “the anxiety in the psychotic process to be” what he has called “basic anxiety” (p. 426). It “ultimately revolves around the problem of survival …. The psychic representations of this fear are those of the disintegration and dissolution of self, i.e., psychic and emotional death…. For the psychotic … the threat of dedifferentiation, with eventual self-disintegration, is very real and may be especially frightening because the possibility of reversal is minimal.”
The nature of the defenses used in reaction to the danger are spelled out (p. 426): “In the psychotic process, where preservation and survival of self and object are the focal point, one … sees regressive dedifferentiation, introjective-projective techniques, projective identification, fragmentation, splitting, massive denial, etc…. Yet the very defenses resorted to may heighten danger, in that they contain within them the possibility of loss of self (e.g., through regressive dedifferentiation).”
“In understanding these ego disturbances [p. 427] we need to be aware of the diffuse ego boundaries which make it difficult for the psychotic to differentiate reality from the inner psychic world … All of this points to a disturbance in the relationship with reality.”
“In looking at the state of the ego and its functions in the psychotic proces