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DISCUSSION: Dr. Robert Bak spoke of the hierarchy of delusions; the more intact the ego, the more similar the delusion is to the neurotic symptom and the more its cause is a deflected id wish. The more the ego is damaged, the more the fortification by reality is lost. The more the individuality of the delusion is lost, the more it becomes 'genetic truth' but not 'truth'. In regard to the fixity of delusions, Dr. Bak believes that the fear of dissolution of ego boundaries and disintegration of self is only tangential to the problem. Fixity of delusion is due to the subjective sense of certainty which results from the hypercathexis of the delusional idea and the withdrawal of cathexes from the reality-connections of the object.
Dr. Edith Jacobson emphasized that historic truth is operative in neurotic symptoms as well as in the delusion. In regard to the essential fears of the psychotic, she prefers as more accurate the phrase 'disintegration of psychic structures' to 'dissolution of the self', and feels that the former should be quite separate from 'dedifferentiation of self from non-self'. The psychotic is essentially trapped so that the fear of (and wish for) the loss of object is linked inextricably with the loss of self. In the psychotic the aggressive and libidinal drives are often difficult to distinguish. Dr. Jacobson agreed with Dr. Bak's description of the hypercathexis but emphasized that the question is why (not how). She feels with Dr. Frosch that the attempt at restitution of self and objects through delusion is necessary to forestall emotional death.
Dr. Charles Brenner wondered why the wish to merge with an object is so frightening to the borderline psychotic. Using one of Dr. Frosch's clinical examples, he felt that the anxiety stemmed from intense aggressive devouring wishes rather than from fears of passive regressive merging.