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Mrs. Isaacs attempts to show by means of a five-month analysis of a four-year-old boy with temper tantrums and 'fits of queer excitement' that (1) 'external and internal reality are intertwined in the symptoms, the developmental history and the analytic responses of an individual', and that (2) 'serious difficulties may be masked by a general appearance of reasonable normality in a patient whose symptoms might easily be considered normal for early phases of childhood'.
The first attempt succeeds through the analysis of the boy's reaction to several 'traumatic' events which occurred after six weeks of analysis. His grandmother was operated on while at the same time his mother and his aunt were hurt in minor accidents. As was to be expected, the reactions of the neurotic boy were determined by his past history and by the latent unconscious conflicts mobilized by these events.
The second attempt is less successful. It seems that Mrs. Isaacs uses the terms 'psychotic', 'paranoid' and 'depressive' much more lightly and in a much broader sense than the average psychiatrist who is therefore not entirely convinced of the 'seriousness' of the boy's difficulties. The same holds true of the interpretations which are given according to the theories of Melanie Klein and which will not convince anybody who does not already believe in these theories. The difficulties of understanding are increased by a partially divergent nomenclature—for instance, Mrs. Isaacs talks about 'projection' where we would say 'transference' and describes the patient's reactions to the 'traumatic events' with words such as: 'These happenings had stirred up in him intense anxieties of a psychotic nature, referring to the primal scene between the internalized parents'—and through a divergent technique. Not only do the indications for interpretation differ from those taught by Freud, but Mrs. Isaacs also believes it necessary to tolerate such acting out during the analytic sessions, as '[the boy] took