The Ego in Schizophrenia: Part II. Types and Their Treatment under Consulting-room Conditions

The three main types I have outlined in my first paper (Metman, 1956), set the analyst different tasks. That is to say, the ego-substitute type who is unlikely ever to desire treatment can be ignored as long as he does not present a problem to prison psychiatrists, in which case the conditions would be outside the scope of this study.

The two other types will be considered here in more detail. For purposes of treatment I have distinguished two sub-types within each that I shall mention at the end of this paper. The presentation of the two cases I want to discuss here constitutes a simplification with regard to types for the sake of clarity.

History and Background

A young man, twenty-six years old at the time of his first interview with me, had, since the age of eighteen and a half, been three times in mental hospitals as a voluntary patient. His first breakdown had occurred after six months' work in the mines during the war. Diagnosed as a schizophrenic, he had had several courses of insulin comas. During his last stay in hospital this had been combined with analysis. The psychiatrist who had conducted the treatment had recommended further analysis after discharge from hospital. This advice was based upon an impression of valuable potentialities rather than upon great confidence regarding prognosis, and it had therefore not been easy to persuade the parents to give their consent to an expensive experiment the outcome of which was considered uncertain.

The patient's father, a man of eminence in his sphere but without great wealth, holds a position of authority and prestige, so that the parental home has become a rallying-place for people of a high cultural and intellectual standing. There is an elder brother who is a married professional man; the two younger sisters are studying at the university and have many attractive and intelligent friends. Kenneth, as we shall call the patient, had found life