Notes on Early Ego Disturbances1

The difficulties of differential diagnosis in cases of severe ego disturbances in early childhood are well known. It is, I believe, generally agreed that it is impossible to distinguish between psychotic, prepsychotic, and just "abnormal" children at the age of two. Whether a child of three or four showing a number of symptoms similar to those of an adult schizophrenic can be diagnosed as psychotic evidently depends on more than this similarity. Even those child analysts who believe in the existence of infantile schizophrenia concede that there are striking differences between the two groups. The supposedly psychotic children do not show the blunting of affect shown by so many adult schizophrenics. They have neither delusions—certainly none of a systematized character—nor hallucinations. In addition to some somatic signs, in themselves capable of different interpretations, it is the general pattern of behavior, namely the isolation those children show in their relationship to people, that seems to justify the diagnosis of schizophrenia.

Isolation is a neutral term. It may result from regression from a stage once reached and later abandoned, or it may be due to an arrest in the ego development. The inability to deal with reality is in itself not a sign of schizophrenia. M. Katan has repeatedly stressed the difference between losing contact with reality and withdrawal from reality. If an ego, whether that of a child or that of an adult, reacts to disagreeable experience by withdrawing from the outer world, such a reaction is an ego defense. Reality is not lost but merely warded off. The ego keeps its reality sense by avoiding contact with reality. The question then arises: What is the nature of isolation is so-called infantile schizophrenia?

To point out that neither regression nor arrest is ever complete seems superfluous. Retardation in the development of some ego functions is, as we know, invariably accompanied by regression of others which have underg