The Search for Ego Controls: Progression of Play Activity in Psychotherapy with a Schizophrenic Child

Genuine play requires a certain maturation of ego organization and is possible only where achievements of maturation are fairly stable and not excessively invaded by more regressive precursors of thinking. It is a stage in the hierarchy of ego development, lying between impulse on the one hand and secondary process thinking on the other. Ekstein and Friedman have discussed these concepts and illustrated them with clinical material from the treatment of a neurotic, delinquent, adolescent boy,1 and from work with psychotic children.2 It is the purpose of the present communication to present and discuss clinical material from the treatment of a schizophrenic boy in which is seen a comparable progression of rudimentary play during psychotherapy, from chaotic impulse to a compulsive quasi-order.

George was a nine-year-old schizophrenic boy who had apparently been psychotic since early childhood. He was from an eccentric, chaotic Jewish family. His self-employed paranoid father often withdrew; at other times he exploded with profanity. His mother stated that her life was devoted to George and she read everything she could about emotionally disturbed children, yet was seen trying to manipulate him like a large mechanical doll. George spoke of himself in the second and third person, was manneristic, and wore a bandanna around his neck, apparently to collect the spittle that drooled from his mouth, which gave him a most bizarre appearance.