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Wolberg suggests that the process of mental cure, spontaneous or induced, parallels normal ego development in that the patient reorients himself to those about him, abandoning unrealistic concepts of himself (guilt, unworthiness) and of others (unprovoked hostility). He offers illustrative case histories in which casual external occurrences seemed to induce a drastic alteration in the picture of the self and of the outer world, permitting the establishment of progressively improving rapport with others. Wolberg's conclusion in essence is that kindness, patience and interest pays off in good therapeutic results.
One can hardly take issue with this stand and one can only regret that Wolberg's evident empathy with the all-too-often forgotten man in the state hospitals is so uncommon a commodity. But one wonders how often such dramatic results ensue from environmental manipulations with the advanced psychotic (such as he uses for illustration). One must certainly question the unqualified generalization that 'even the most pernicious forms of psychoses show a tendency toward spontaneous remission'.
Society welcomes even partial improvement and the capacity to adjust outside the institution even if at a minimal level. This degree of improvement can very likely be effected far more often than is currently the case. But, as Wolberg says in closing, 'a permanent cure involves a real alteration of the ego', and it is questionable whether this happens frequently, either spontaneously or as a result of external manipulations.