The author maintains that, contrary to the opinion held by some psychoanalysts, the schizophrenic patient defends himself by his schizophrenic reaction against repressed unconscious impulses. It is best to think of schizophrenia as a defense against anxiety rather than as a nosological category. He quotes Fromm-Reichmann to disagree with her: 'The schizophrenic patient himself, as a rule, is aware of the content meaning of what he communicates about his inner experience in his private world, no matter how cryptic his communications may sound to the listener'. Barahal believes that the ego of the psychotic has to defend itself against the unconscious by a global distortion of reality. When assessing prognosis, one should be governed by an assessment of ego strength and weakness rather than by diagnosis. The various defensive attitudes of the extremely vulnerable patient should be countered by appropriate reassuring attitudes on the part of the therapist. Ego interpretations should not be made until insight is gained into the affects guarded against.