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The clinical approach to be explored, and the concept of narcissistic defense developed in a recent paper,6 are related aspects of a general theoretical framework for understanding the dynamic processes which operate in schizophrenia. This understanding, derived from experience with schizophrenic patients, appears to be of vital significance for their treatment.
In my discussion of the narcissistic defense, it was hypothesized that the excessive self-love and self-preoccupations of schizophrenics serve as a cloak for self-hatred. Their pathologically narcissistic behavior is patterned very early in life into a primitive defensive system against the discharge of high accumulations of mobilized frustration-aggression. The ego is sacrificed to prevent the release of destructive impulsivity in action that would injure the object.
In support of this theory, I illustrated the manner in which schizophrenic patients release frustration-aggression when their narcissistic defense is joined, and how the defense relaxes as this frustration-aggression is drained off in feelings and language in the treatment sessions. When these people experience the kind of psychological relatedness which meets their maturational needs, undischarged frustration-aggression emerges as the basis of their manifest clinical illness.
The tendency of the schizophrenic patient to accumulate destructive impulsivity in his ego appears to be connected with two pathogenic