You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This volume is the most current report of the ongoing clinical research of the Reiss-Davis Child Study Center Psychosis Project. The twenty-three essays by Ekstein and his colleagues boldly confront the perplexities involved in a psychoanalytic approach to diagnosis, treatment, and research in the psychotic and borderline conditions of childhood. As in Ekstein's previous reports from the Southard School and Reiss-Davis, the present report is lively with metapsychological considerations of primary and secondary process, psychotic reconstruction, self- and object-representations, and structural and topographical issues. But, more than in previous reports, The Challenge focuses squarely, in concrete clinical terms, on the therapeutic puzzles that remain.
The title at once informs us that hopeful progress in the psychoanalytic understanding of these childhood disorders has moments of despair and frustration. In fact, it would appear that the treatment philosophy of the Reiss-Davis group has been molded out of a willingness to recognize that the capacity to experience despair leads to the ability to comprehend the confusing and quixotic psychic reality of the psychotic child. In this psychoanalytic therapists differ from their nonpsychoanalytic colleagues, who would view the etiology and meaning of childhood psychosis in the language of central and autonomic nervous system functioning or endocrine and metabolic states and treat the psychotic child accordingly. However, when treatment is not directed at well-defined “causes” but rather at the explanation of the mental functioning of the psychotic child, the therapeutic process which evolves becomes the avenue to diagnosis, “the key which opens the door to the inner world of the schizophrenic child is the empathic instrument of the trained observer and therapist.”
Understanding of the psychic structure and functioning of the psychotically ill child requires years (sometimes decades) of coming to grips with his distorted comm