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Some analyic observations gleaned in over six years of contact with more than three hundred cases of lobotomy are reported. The lobotomized patient cannot associate freely in a meaningful manner; neither can he enter into a transference relationship in the usual sense. His dreams have the character of direct wish fulfilment like those of children. Several lobotomized patients are described to illustrate personality changes brought about by the operation.
Ferenczi thought that in psychosis a pathogenic process in the brain threatened the ego nucleus. Following lobotomy this narcissistic threat is answered with a constriction and hypercathexis of the ego boundaries—to borrow Federn's terminology. The aspontaneity and lack of initiative in the lobotomized person is thus not only a defect, but also a defense against the fearful experience of being unable to master reality.
The emotional asymbolia caused by lobotomy drains away a psychic dimension. The forebrain, in the part it plays in gross functional representation, is an important instrument in the integrity of the preconscious system. The defensive hypercathexis and constriction of the ego boundary which follow lobotomy enable the psychic apparatus in some cases to ward off flooding by id derivatives. At the same time schizophrenics who have no one to accept them after the operation cannot make an adjustment outside a hospital.