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Rosenfeld, H. (1958). Discussion on Ego Distortion. Int. J. Psycho-Anal., 39:274-275.

(1958). International Journal of Psycho-Analysis, 39:274-275

Discussion on Ego Distortion

Herbert Rosenfeld

I am very grateful to Dr. Gitelson for reporting a clinical case in such detail in his paper, so that we have a clinical basis for discussion. As our psycho-analytic science develops all over the world, the terms in which we discuss our analytic problems become increasingly varied, which leads to much misunderstanding. For example, the term ego distortion does not mean much to me, because in similar cases I am used to talking about borderline states, or borderline psychotics. I think the term narcissistic character disorder is better than ego distortion, but even the former does not make sufficiently clear to me what we are dealing with. I would prefer to describe Dr. Gitelson's case as a borderline psychosis of the schizoid type. The term schizoid implies that we are dealing with a patient who lacks emotions and who uses schizoid defence mechanisms such as splitting, denial and projection in an excessive way.

I would like to explain this in more detail. I am impressed by the very rigid personality of Dr. Gitelson's patient, who does not seem to me to be only narcissistically withdrawn from the external world but to be defending himself against psychotic anxieties of a paranoid type. Dr. Gitelson himself draws attention to the patient's paranoid anxieties and to his aggressive impulses of psychotic strength.

Generally speaking, I regard most borderline psychotic states as more or less successful defences against acute schizophrenic paranoid conditions, or they might be regarded as unsuccessful attempts to overcome infantile psychotic anxieties.

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