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Through one detailed case study and a brief historical introduction to the treatment of psychotics, Dr. Jacobson comments on the nature of psychotic conflict and reality. She is primarily concerned with the ambulatory schizophrenic's use of his external world for the purpose of preventing a dissolution of his ego and superego functions. She discusses this particular patient's use of work, professional activities, marital partners, and friends, as a means of “turning external objects into intolerable or desirable, but unacceptable parts of one's own self.” Her case presentations deal with the individual's unwillingness to accept or adjust to reality, and his insistence on changing the external world for purposes of adapting it for his own use in order to prevent a psychotic break.
Jacobson makes valuable observations regarding differences between the neurotic's and the psychotic's use of work. She writes: “Neurotics as well as psychotics may have preoedipal-narcissistic fixations and suffer from severe pregenital and ambivalence conflicts. However, in the case of neurotics, the solidity of their psychic structures, the stability of their defenses—protect them from processes leading to drive defusion and drive deneutralization.” She discusses the transference reactions of the schizophrenic to the therapist in terms of understanding this patient's need—his purpose being to cling to the external world. The discussion lacks some substance, however, and should have been elaborated. There is some comment on countertransference phenomena, but there is a stated unwillingness to discuss them in the frank manner of Searles, for instance. This is a pity, in view of Dr. Jacobson's experience with ambulatory schizophrenics, and I am sure her thoughts and feelings would have been of value, had she permitted herself to speak of them.
On the whole, this book must be viewed in the context of the circumstance of its delivery—A Freud Anniversary Lecture—which of necessity would make it s