Meetings of the New York Psychoanalytic Society

October 25, 1960. THE PSYCHOTIC CHARACTER. John Frosch, M.D.

The term psychotic character is meant to parallel the term neurotic character, and describes a specific clinical entity, not a transitional phase of an illness. In the search for diagnostic criteria by which the clinical entity can be recognized, the author focuses on the ego functions.

In order to clarify the role that reality plays, it is necessary to distinguish three aspects: the relationship to reality, the sense of reality, and the capacity to test reality. The relationship to reality concerns the individual's capacity to perceive and represent the external world and himself accurately. Pathology in this area is represented in diffusion and looseness of ego boundaries, confusions in identity, hallucinations, etc. The sense of reality is closely related to this and emphasizes feeling as well as sense of reality. Pathology in this area concerns such alterations as depersonalizations, oceanic feelings, etc. The capacity to test reality describes the individual's ability to evaluate the phenomena going on around him. A patient may hallucinate (a disturbance in the relationship to reality), but if he recognizes this as a hallucination he has retained his capacity to test reality. In the psychotic character, the capacity to test reality is relatively well preserved, even though the relationship to reality and the sense of reality may be impaired. Most characteristic of the psychotic character is the transience and reversibility of distortions involving the reality problem. The psychotic character shows diffusion of ego boundaries with consequent preoccupation with problems of identity and the fear of engulfment. Dreamlike states are common and many damaging actions are carried on at these times. Again, the rapid reversibility is a fact which helps to distinguish this from psychosis.

Object relations in the psychotic character do not reach the nonobject primary narcissistic level seen in psychos