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From observations of patients with incipient schizophrenia, Pious attempts to describe what he believes to be the pathogenic process itself. Usually following an external deprivation, a phase occurs which is characterized as a 'sudden vacuum', 'sudden stillness', or a 'sinister and uncanny hush'. This phenomenon appears to be connected with death from organic illness. Pious reminds us that many schizophrenics die without demonstrable cause and that
chronic schizophrenics have remissions when they develop a serious physical illness.
With the occurrence of the sudden vacuum all evidence of ego functioning disappears, to return later, sometimes on the previous level but at other times on a more primitive, archaic level. The quantity of libido available for ego cathexis determines the height of organizational level to which the ego will be restored.
Pious believes that the structure of the superego determines the occurrence of this pathogenic process. The superego functions to contain and bind aggression. This makes postponement, judgment and action possible. If the superego is defective, mortido floods the organism and libido must then be withdrawn from its attachments in the ego organization to neutralize the mortido. When this happens we have the sudden vacuum. This defect in the superego is the result of a pathological relationship between the patient and his mother in the first months of life. The superego develops from several loci, the earliest of which is an introjection of the loving and protecting mother image. This primary mother image constitutes that elasticity of the superego necessary for the containment of aggression.