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Pao, P. (1977). On the Formation of Schizophrenic Symptoms. Int. J. Psycho-Anal., 58:389-401.

(1977). International Journal of Psycho-Analysis, 58:389-401

On the Formation of Schizophrenic Symptoms

Ping-Nie Pao


In the above, I have considered symptomformation in schizophrenia mainly in the light of Freud's new theory of anxiety (1926), (1933) and Hartmann's concept of integrative ego functions leading to an adaptation to inner and external reality (see also Arlow & Brenner, 1964), (1969). A clinical case has been presented to illustrate that five steps can be distinguished in symptom formation: (1) the resurfacing of conflicts; (2) an experience of 'organismic panic'; (3) a disturbance in ego functioning and a loss of the continuous sense of self; (4) thereupon the integrative function of the ego orders and modulates the mental content, so as to find a best possible solution to alleviate the experience of organismic panic; and (5) the symptom formation and an altered sense of self become crystallized in the wake of the best possible solution.

The catatonic, the paranoid, the hebephrenic or the simple symptomatology may be viewed as the best possible solution attained by a patient at a given time. Although some patients show a predilection to one or another type of symptomatology, each of such symptomatologies is expected to be encountered in any given patient in the course of long-term treatment to meet the requirement of a best possible solution.

Although in the illustrative case the anxietyprovoking incident was discreet and readily identifiable, and the anxiety reaction was intense and dramatic, the five steps in symptom formation in schizophrenia are not restricted to these kinds of discreet situations. The same observation can be

made in cases where the schizophrenic symptoms seem to come on stealthily and very gradually. In the latter type of cases, the five steps can be reconstructed in the course of treatment and in addition can be discerned in situ in the therapeutic setting.

In reaching for a best possible solution, or in the symptom formation, the self has undergone reorganization as well. I have suggested that the degree of consolidation of the reorganized self may be used to delineate the acute from the subacute phase of schizophrenic illness. I have attempted to demonstrate that the concept of reorganization of the self is an important one, for it helps to shape our strategy in the treatment of schizophrenic patients.

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