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In recent years there has been a distinct trend in psychiatric hospitals which emphasize intensive treatment based upon psychoanalytic principles to work with a group of patients (variously diagnosed as suffering from severe character neuroses, borderline states or schizophrenia) who have in common marked ego defects which severely disturb their capacity to function, although they may not have classical symptoms. In addition, as more and more severely maladjusted or unadjusted adolescents are displacing, in hospitals, the previously seen adult neurotics suffering from reactive disorders, the focus of therapeutic attention has had to shift toward the characterological impact of the patients' ego distortions.
Dr. Bychowski's paper offers some interesting new ideas concerning important aspects of these problems, and new insights into the defective ego's task of dealing with early introjects and the maladaptive results of its failure. His concepts have etiologic, diagnostic, and therapeutic implications of considerable usefulness.
The statement that “the degree of concreteness of the introjects, preserved in all their original bipolarity, is a good indicator of the defectiveness of ego structure” suggests a valuable diagnostic approach for the assessment of ego strength, which is essential in planning one's therapeutic approach. These constructions are also useful in understanding the frequent sudden shifts in the transference, in patients' affective states, behavior, and reality testing. Such shifts can often be most confusing and even disruptive in treatment unless one can both understand them and anticipate them.
Furthermore, the formulations regarding the way in which the egos of such patients can be “entangled in contradictory goals and directives [so] that progress toward any attainment becomes impossible,” resulting in the defensive operation of “curbing goal-directed strivings and allowing merely for simple gratifications” in order to maintain a precarious balance,