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THE ANALYSIS OF PATIENTS WITH SEVERE, CHRONIC PSYCHONEUROTic illness characterized by repeated attacks of intense anxiety and a profusion of symptoms provides the incentive for examining anxiety and symptom formation from the standpoint of vicissitudes in the functioning of the ego. This requires consideration of the intrasystemic relations within the ego with particular attention to the generation and perception of anxiety, to shifts in the autonomy of functions of the ego such as judgment, reality testing, and some aspects of cognition, and to splitting of the ego in the defensive process. The impairment of the ego's functioning in relation to anxiety and symptom formation has implications for technique in these cases. These questions of technique are relevant to basic issues concerning the analysis of the ego.
This study is based on the analysis of a group of patients who have in common the experience of traumatic conditions in the first two years of life. Here I use the definition formulated by Greenacre (1967): traumatic conditions are "any conditions which seem definitely unfavorable, noxious, or drastically injurious to the development of the young individual" (p. 128).
The most readily identifiable experiential referents of traumatic conditions in the early life of these patients are disturbances