Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Heinz Hartmann opened the discussion with the remark that Freud never felt that his work in the field of psychosis was as complete as his contribution to the understanding of neurosis. However, as early as in the Schreber case, he speaks of the importance of understanding independent ego functions and the differences in defense mechanisms. Dr. Hartmann felt that the similarity of the role of the awakening of infantile instinctual forces in neurosis and psychosis was not clear. Certainly the psychotic cannot find a solution to the instinctual problem without a loosening of the attachment to reality. Dr. Hartmann recalled Freud's example of a girl whose sister dies; she then thinks she can marry her brother-in-law. In the neurotic the wish would be repressed; in the psychotic the sister's death would be denied. The problem focuses on the deficiency of the ego which attempts to solve the conflict. Some ego functions are incompletely developed or become weakened. Psychosis, then, is not simply an outcome of drive and defense, but relates to lost functions of the ego. Occasionally one sees a dramatic detachment from objects ending in a catatonic stuporous state. But this is exceptional. As a rule there is an oscillation between detachment and investment (restitution) of objects. Besides the two alternatives of object cathexis and self cathexis, there is a third possibility—cathexis not only of the aims or contents but also of the functions of the ego. Freud's concept of narcissistic regression is incomplete because the change in ego functions is not described. Their vulnerability is still to be studied. Freud's two-stage description of decathexis and restitution should not be taken too literally, but viewed as an ideal type and schematic description. Many phenomena described as restitutions could perhaps be better understood as the product of remaining ego functions or interaction between these and damaged ego functions. There is also an