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From experience in prolonged intensive treatment of thirty-eight psychotic children and their parents at the Judge Baker Guidance Center, the authors offer hypotheses regarding the cause of childhood schizophrenia. Most of the parents had 'as if' personalities. At birth the child became involved in the anxieties and defensive structures of the parents, who could not recognize that the child had a separate identity. Anxiety over having a child was experienced by the parents as anxiety over some highly cathected part of the parent's self, with which the child was then identified. The child was then confined within the limits of this fragmented identity. The authors believe this to be the cause of the schizophrenic reaction in the child, who is caught in an ambivalent position and responds to the primitive anxieties of the parents while reacting to their unconscious death wishes. The child's alternate panic and blocking out of stimuli is its way of attempting to relieve tension, perhaps because the parents did not act as an adequate stimulus barrier in their role as auxiliary ego for the child. The psychotic child's behavior, no matter how bizarre, has meaning. The therapists were more active in treatment than is usual with neurotic children in order to overcome the child's fear of annihilation and to set definite limits. Eventually the child incorporated the therapist's ego and repeated with him patterns of behavior established with the parents. Identification with the therapist was the beginning of evolution of the patient's identity. However, this can only occur after the parents have been able to relinquish their pathologic tie to the child. The authors make no mention of constitutional factors or of the distinction between symbiotic and autistic psychosis.