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In the type of patient under consideration, 'the entire psychic apparatus becomes
rigidly integrated into what is preponderantly a defense-oriented pattern of adaptation'. The cases of 'ego distortion' represent a way of life, affecting the entire personality rather than being merely a disturbance of one of the major psychic forces, though a consequence of the distortion is serious disturbance in various ego functions. These patients are pathological character types rather than types of ego disturbance; the picture may be fixation or regression, infantile or schizophrenic. One group is built on the Oedipal conflict, another on pregenital conflicts. The detailed case presentation illustrates Gitelson's thinking and inferences; he sees this patient's distortions as evidence of adaptive capacity and strength rather than ego defect or weakness. This patient achieved an 'energy balance' which may have prevented disintegration. Perhaps these 'borderline cases' are individuals in whom the anlage of the autonomous ego has not been constitutionally injured, in contrast with schizophrenics: strength, therefore, not weakness, is what one should infer concerning their adaptive process. They are perhaps better described as 'narcissistic personality disorders'.