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Bychowski, G. (1966). Obsessive Compulsive Façade in Schizophrenia. Int. J. Psycho-Anal., 47:189-197.

(1966). International Journal of Psycho-Analysis, 47:189-197

Obsessive Compulsive Façade in Schizophrenia

Gustav Bychowski

The extended scope of psycho-analysis in the last two decades has enabled us to gain some insight into the structure of a large group of patients known to clinical psychiatry under the vague name of 'borderline' and, more recently, 'pseudoneurotic schizophrenia'. For reasons which will become apparent in the course of this presentation, I prefer to call them 'latent psychotics'. Among them a relatively large group displays an obsessive compulsive symptomatology which under analysis may melt away and thus reveal the hidden psychotic core.

Clinical experience shows that a similar eruption of the psychotic core occurs independently of psycho-analysis under the impact of various psychological and biological factors. Comparison of psycho-analytic observations of a number of these patients allows for certain general conclusions and formulations. I shall try to present them here and shall illustrate them with some clinical observations.

We find that in this personality structure the infantile ego organization remains in its original archaic form, with but few modifications. Specific characteristics of this ego structure call for specific defence mechanisms and reaction patterns, and we see them displayed in the symptomatology of these patients. When the defences fail to fulfil their function, both the original and secondary reaction patterns break through and manifest themselves in compulsive acting out. The latter may take the form of psychotic deviations.

I shall now list some of the characteristics of the underlying ego organization, their specific manifestations, and preferred defence mechanisms.

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