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Why can certain patients with serious physical impairment, mutilation, and paralysis be rehabilitated to the fullest capacity of their abilities while, in others, gross psychoneurotic disturbances interfere, so that they are unable to be readapted? The authors think that, in the latter, before physical impairment occurred, there had been a series of ego inhibitions pertaining to basic motor learning, together with a particular relationship to the love object. Clinically, they find not only chronic depression and difficulties in learning, but inhibition in any activity. This they call 'nucleo paralitico temprano' (NPT). In lethargy there is an ego attempt to encapsulate. The object in the lethargic patient is handled by introjection; hence, the different levels of phobia, hypochondria, melancholia, and, finally, lethargy. In NPT, identification deficits in the object relationship are shown. The object is idealized and omnipotent, and the patient's defense are primarily autistic, symbiotic, omnipotent, and, finally, psychopathic or perverse.
The clinical material shows that transference is very hard to establish in the lethargic patient while in the NPT patient, it is extremely hard to resolve.