Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Bernard Brodsky told of one of his patients, inadequately treated in a previous therapy, who, in spite of major provocation, never became frankly psychotic. Both in the earlier treatment and in his treatment there were many times when the patient's reality testing was impaired, but there was always a point beyond which he did not go. Also the impairment was always transient. The patient showed the reversibility which Dr. Frosch stressed.

Dr. Walter Stewart suggested that the reason for confusion in this area has been the lack of adequate organizing concepts. Directing his comments to the two aspects of Dr. Frosch's paper, a metapsychological description and a nosological suggestion, he stated that the reversibility of the impairment of reality testing could be understood in terms of a split in the ego, with oscillating cathexis of the archaic ego attitudes and the reality testing functions. The mechanisms of depersonalization, emotional surrender, and deanimation provide a defense against the failing capacity to postpone discharge. These two mechanisms, and others of which we are yet ignorant, may account for the patient's capacity to ward off further regressive differentiation and psychosis. He questioned the accuracy of the term psychotic character.

Dr. Robert Bak also took exception to the term. He understood that it was not to include pre- or post-psychotic states, alcoholic psychoses, etc. The capacity to test reality in neuroses and psychoses was elaborated by Freud in his concept of the split in the ego. The area involved is important, and it is hard to see how Dr. Frosch would deal nosologically with a focal paranoid fantasy. He questioned the author's comments on etiology. Perhaps, as with the term pseudohereditary, we could say these patients have pseudotraumas. It is true there is often poor parental care because of the parent's illness. There is also often severe mental pathology in the family relationships, suggesting a here