This is a very well written and very stimulating report which accomplishes the exceedingly difficult job of portraying a therapeutic relationship of some three years in a few pages. Rosenfeld's purpose is to point up certain of the mechanisms encountered in analyzing a schizophrenic person and to demonstrate that depersonalization is only quantitatively different from the more serious and severe manifestations of ego disintegration. The clinical data are very lucidly described. The author demonstrates convincingly that the patient's attacks of depersonalization, as well as her psychotic states, are related to current deprivations and that in their content they re-enact childhood situations which were evidently experienced by the patient as very traumatic. The symptomatology is beautifully described, including such phenomena as withdrawal, ego splitting, development of paranoid feelings and ideas, and others. Rosenfeld's selection of the patient's descriptions is excellent. His comments concerning technical difficulties are all too brief, but nevertheless very much to the point.
The paper has some shortcomings which are unfortunately all too frequent in clinical reports. For example, there is too much use of theoretical concepts in the clinical description. Such concepts as regression, fixation, resistance, transference, defense and others, have definite usefulness in the final formulation but become unclear when they are employed as descriptions and leave the reader to guess what actually occurred. It is particularly important to bear in mind that there is, as yet, no complete agreement as to the applicability of these concepts to the schizophrenic state. It is, in a sense, begging the question to use the concepts as if they were clinically established facts, instead of presenting the material in such a way as to permit a modification of the concepts, development of additional concepts, or the demonstration that the concepts are applicable. Another fault in this paper, and other clinical reports, lies in the omission of certain concepts in the formulation and summary section. The concept of restitution in schizophrenia is not referred to, nor are many of the basic psychoanalytic concepts, such as the Oedipus.
These faults are not as marked in this paper as they are in many other clinical reports. The clinical descriptions are sufficiently clear to enable the reader to draw his own inferences and compare them with those of the author. The report merits careful study. It is to be hoped that Rosenfeld will publish additional reports and further clinical material about this interesting analysis.