Rosenfeld states that confusional states in the schizophrenic process play an important role and may be followed by better integration or by deterioration. He offers some clinical examples to illustrate such states in the course of analytic treatment and points out that the confusion involves impulses, objects, and the ego itself. The patient becomes unable to differentiate libidinal from aggressive impulses, 'good' from 'bad' objects.

The paper suffers because of its brevity. The clinical material offered is insufficient and inadequately described and developed, while the theoretical part of the paper is relatively too lengthy and yet poorly organized. The relation of the clinical phenomena to the theoretical conclusions is not established, and the whole problem of therapeutic technique is untouched.