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The great difficulty in understanding the paranoid schizophrenic, and this is the first step in empathizing with him, is the grotesqueness of his delusional world, its excesses and contradictions, which are too strange and extravagant for the unsuspecting observer or listener. This paper is about such a patient and the delusion to which he had tenaciously held since adolescence, to the puzzlement of the many psychotherapists with whom he had been in treatment. In his opinion the delusion was the principal source of his social anxieties; it proved to be indeed the focus from which all his symptoms were proceeding or radiating. It was also only the relentless pursuit of this delusion and its gradual resolution which enabled me to keep him in treatment and socially and professionally active in the face of an ever-threatening ego fragmentation.
Peter* was 30 years old when he started analysis with me five years ago. It was ten years after he had begun his first analysis in the East at the age of twenty. This analysis had to be terminated when he had failed in school, impregnated a girl, and threatened to commit suicide. He was hospitalized for two years, the first eight months as an inpatient and the rest of the time as an outpatient. He then began his second analysis which lasted over four years, and after a therapy-free interval of another four years a third analysis with me.
At the initial interview he appeared to be in a kind of panic which he attributed to his urgent need to secure the help of a psychoanalyst. He said that two analysts in the city, to whom he