Psychiatry

Interpersonal and Biological Processes

ISSN: 0033-2747 (Print) 1943-281X (Online) Journal homepage: http://www.tandfonline.com/loi/upsy20

Ambulatory Schizophrenia

Gregory Zilboorg

To cite this article: Gregory Zilboorg (1941) Ambulatory Schizophrenia, Psychiatry, 4:2, 149-155,
DOI: 10.1080/00332747.1941.11022329

To link to this article: https://doi.org/10.1080/00332747.1941.11022329

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 Ambulatory Schizophrenias t
Gregory Zilboorg *

W HEN Bleuler published his monograph on The Group of Schizophrenias in

1911, hardly fifteen years had elapsed since Kraepelin's delineation of his
clinical picture of dementia prmcox. Since Bleuler's views could not have been formed
suddenly, and since his rather imposing book published as the second volume of
Aschaffenburg's Handbuch could not have been written in a day, or even in one year,
it is not unreasonable to assume that both Bleuler and Kraepelin began to formulate
their ideas simultaneously. The history of clinical and theoretical psychiatry toward
the close of the nineteenth century is clearly reflected in the work of both Kraepelin
and Bleuler. Both became active in the eighties; both were influenced by the Leipzig
school of Wundt, whose interests were those of a physiological psychologist and who
stressed the importance of the associativistic characteristics of thinking.

While under the influence of Wundt ing this trend, Kraepelin overlooked al-
Kraepelin became interested almost ex- most entirely the intimate characteristics
clusively in the formal aspects of patho- of his patients' personalities; their specific
logical thinking. These offered him a individual histories and problems con-
reservoir of symptoms, but his primary cerned him only in so far as they were
interest always was the field of coherent similar to those of a given group of pa-
clinical pictures. In this search for well- tients. The total picture of man's psycho-
defined clinical pictures he was, strictly logical adaptation as a person seems to
speaking, not so much under the influence have escaped Kraepelin's attention.
of what the study of clinical psychiatry It may be fairly said that Kraepelin
offered directly as he was concerned with introduced the scientific principles of
the assumption that since psychiatry deals clinical investigation into psychiatry, but
with diseases it must follow the pattern it is not an exaggeration to add that in
of general medicine: like general medi- doing this he almost discarded the very
cine, it should have a set of distinct dis- object of the investigation: the individual
eases, definitely outlined, properly diag- psychology. It is a mistake to think, as so
nosed and correctly prognosed. In this many seem prone to do, that Kraepelin's
respect psychiatry developed not so much formulations marked a true revolution in
in accordance with the nature of its own psychiatry. As a matter of fact, Krae-
subject matter and its own clinical prob- pelin's contemporaries did not take kindly
lems, but more by imitation of the ex- to his definition of dementia prmcox.
ternal development of clinical medicine, Objections, criticism and incisive rejec-
which offered such a wealth and variety tions were heard from many authoritative
of diseases and disease groups. In follow- quarters. Shortly after Kraepelin's de-
• M.D. Psychoneurological Institute St. Petersburg Russia 17, M.D. College Phys. and Surg. Columbia
N.Y.C. 26; Physician Base Hosp. Russian Army 15-16; First Revolution Petrograd 17; Secy. to Ministry of
Labor Cabinets of Lvov and Kerensky 17; Newspaper Editor Kiev 17-18;U. S. 19, Naturalized 25; Lecturer
Journalism and Theater 19-26; Staff Bloomingdale Hosp. 26-31; Asst. Psychoanalytic Inst. Berlin 29-30; Private
Practice Psychiatry Psychoanalysis 31-; Secy. and Dir. Rsc. Comm. Study of Suicide; Noguchi Lecturer
History of Medicine Johns Hopkins 35; ViSiting Lecturer Psychoanalysis W.S.P. <lM-; Uomm. Hsc. Amer.
Psychiatric Assn. 34; Comm. Legal Aspect~ of Psychiatry; one-time Secy. N.Y. Psychoanalytic Soc.; one-time
Pres. N.Y. Soc. for Med. Hist.; F.A.M.A.; F.A.P.A.; F.A.O.A.; A.A.A.S.; M. N.Y. Med. Soc., Nat!. Comm. Mental
Hygiene, N.Y. Acad. Med., N.Y. Neurol. Soc., N.Y. Soc. elin. Psychiatry, Amer. and Internat. Psychoanal.
Assns., Assn. Rse. N. and M. Disease, Hist. Sci. Soc., Pan ArneI', Med, Assn., Amer. Assn. Hist. Med., Ami'll'.
EthnOl. Soc., etc.; Co-editor The Psychoanalytic Quarterly. .I!'or bibliography. see Reference Lists scction
of this issue.
t Read before The New York Neuro)oljir.al RociAt.y amI t.hp Spction of Npl1I'OJ0P.1' and Piychiatry of the
New York Academy of Medicine. 11 March 1941.
[149 ]
150
scription of dementia prrecox, the Rus-
sian psychiatrist Serbsky trenchantly
summed up the opposition by wondering
about those cases of dementia prrecox
which, according to Kraepelin himself,
recover or show an arrest of the disease,
and which therefore do not end in de-
terioration-dementia. Are those cases,
argued Serbsky, to be considered de-
mentias without dementia?
Nor did these objections appear only
after Kraepelin's formulations. For many
years there have been voices in psychiatry
calling upon the clinician not to overlook
the man behind the disease. There have
been psychiatrists who have insisted that
a mentally sick patient is first of all a
person who flounders-as a result of a
disease, and not merely because a disease
happens to strike him. In the last quarter
of the nineteenth century Schiile said,
"We deal not only with sick brains but
with sick individuals." A number of years
before, in 1817, a French doctor, Fodere,
had stated, "When one has seen a number
of mentally sick persons; one can recog-
nize that there are as many differences
among them as there are characters
among individuals whose minds are
healthy. Any attempt at a minute dif-
ferentiation of mental diseases as such is
useless. Hence, it is truly difficult to
create classes of mental diseases which
will not prove fictitious." And a short
time before Kraepelin, Heinrich Neumann
had despairingly said, "We shall never
succeed in making a true forward step in
psychiatry until we all definitely decide
to throw overboard the whole business of
classification." Despite this suspicion in
relation to classifications, the classifica-
tory trend prevailed in Kraepelin's work.
Since the validity of scientific matters
cannot and should not be established by
a majority vote, it is permissible to state
that Kraepelin's success and popularity.
particularly in this country, may not be
taken as the measure of his scientific
achievement. Kraepelin's formalism, con-
centrating on the description of external
intellectual deviations and of failures in
standardized social behavior, threatened
to eliminate the very foundation of clini-
cal psychiatry: the understanding of the
GREGORY ZILBOORG
personality of the patient in its inner
totality and content.
There were three other innovators who
at this time began to be preoccupied with
the problem of schizophrenia. These
were, in the order of their age, Bleuler,
Freud and Adolf Meyer. Whatever dif-
ferences the final formulations of these
men represent among themselves, Bleuler,
Freud and Meyer had one thing in com-
mon: they laid stress on the ideational
content rather than on the external char-
acteristics of patients. Meyer, following
consistently the study of the psycho-
biological adaptation of man, came to the
conclusion that schizophrenia is not an
organic disease, but a complex form of
adaptation; Bleuler clung to the last to
his conviction that schizophrenia is an
organic brain disease; and Freud, while
standing closer to Meyer's point of view,
did not fully reject the possibility of the
organic causation of dementia prrecox.
From the standpoint of scientific orien-
tation, however, Bleuler and Freud are
much closer together than Meyer and
Freud. Strangely enough, both chose as
their point of departure the same aspect
of psychology as Kraepelin: the associ-
ativistic psychology of Wundt. Unlike
Kraepelin, however, both actually concen-
trated on the study of the associative
characteristics of schizophrenic thinking
and on its relationships to the affective
life of the patient. Thus escaping Krae-
pelin's mistake, they came to the conclu-
sion that the schizophrenic actually feels,
that his affects are not gone, that his
delusions and hallucinations are actual
products of affective reactions and that
the apparent absence of affect is only ap-
parent, and that even clinically the affect
may come out in full force and in accor-
dance with all its essential characteristics.
Both rejected or failed to accept the
Kraepelinian dictum that dementia prre-
cox is incurable, and both refused to con-
sider the diagnosis of dementia prmcox
as indicated only in those cases which
displayed a certain type of delusions,
auditory hallucinations and possible signs
of deteriorations. Cases of this type they
considered advanced cases.
The less advanced Cnsel'l have heen
HISTORICAL PERSPECTIVES
noted, but not seriously considered. When
of recent years such cases engaged the
attention of the clinician, they were
usually approached with the euphemistic
labels of borderline cases, incipient schizo-
phrenias, schizoid personalities, mixed
manic-depressive psychoses, schizoid
manics or psychopathic personalities.
Such an attitude is untenable either logi-
cally or clinically; nor is it in the best
tradition of clinical medicine, the level of
which psychiatry has always striven to
achieve. In medicine we do not refuse to
make the diagnosis of pulmonary tubercu-
losis merely because the tubercular pro-
cess has not yet caused a cavity formation
or hemorrhage. We do not refuse to make
a diagnosis of appendicitis merely because
the appendix has not ruptured and no
peritonitis has as yet set in. Nor do we
fail to recognize a pneumonia even though
the process of hepatization is not yet in
evidence. The unspoken but practiced
tradition of psychiatry, however, seems
to insist that only the terminal or pre-
terminal stages of dementia prrecox de-
serve the diagnosis. It is obvious that
this tradition is clinically unjustified and
scientifically misleading, disregarding as
it does the far-reaching and illuminating
studies of schizophrenia by Bleuler and
Freud. Anyone who does consider these
studies from the standpoint of what new
contents they reveal in schizophrenias,
rather than from the standpoint of ter-
minological innovations, will at once ap-
preciate that schizophrenia is not de-
mentia prrecox and that schizophrenia is
a generic name covering a certain type of
psychopathological processes. That these
psychopathological processes should pre-
sent themselves in various degrees of in-
tensity, various stages of development-
from the earliest to most advanced forms
-and in various degrees of overtness of
clinical manifestations, should be self-
understood. We may then speak of schizo-
phrenias in the plural and be so clear in
this respect that a confusion of this psy-
chopathological process with any other
will be avoicien,
It would not then be difficuH to differ-
entiate it from any other process, even in
the presence of organic complications. It
151
would ,not be difficult, for instance, to
recognize a schizophrenia in certain cases
of alcoholic hallucinoses, which ordinarily
one may be inclined to consider as belong-
ing to organic deliria. BIeuler himself,
despite his well-known inclination to see
the source of all, or almost all, evil in
alcohol, suggested that schizophrenia
should not be excluded in certain seem-
ingly purely alcoholic hallucinoses. Nor
would it be difficult to discern a schizo-
phrenia under whatever guise we choose
to consider a pathological phenomenon to
appear: a compulsion neurosis, a border-
line case, an "incipient" schizophrenia or
even a hysteria. "Even a hysteria" is said
with a degree of emphasis, for it is well
known that the differentiation between
hysteria and schizophrenia is at times
highly difficult. It was this difficulty
which apparently caused Charcot to fail
I to take into consideration the contribu-
tions of Hecker and Kahlbaum. One must
admit that Kraepelin did not prove much
more responsive, since he did not give
Kahlbaum's catatonia any recognition un-
til a few years after he formulated his
concept of dementia prrecox, although
Kahlbaum had differentiated catatonia
twenty years earlier.
In order to obtain the necessary per-
spective in the process of differentiating
schizophrenia from other psychopatho-
logical states, we must consider the ide-
ational content and its emotional rationale
as did Bleuler and later Freud.
It is outside the scope of this paper to
go into detailed considerations of differ-
ential diagnoses, and one must of neces-
sity limit one's self to giving but a brief
outline of the outstanding features of
schizophrenia. It must be repeated that
such flagrant symptoms as ideas of refer-
ence, delusional formations, auditory hal-
lucinations, flatness or dullness of affect,
are not considered here. These belong to
the clinical picture of well-advanced
schizophrenias; they are pathognomonic,
to be sure, but they are terminal phe-
nomena and therefore give little mure
ill::lighl than thp. knowledge ot a psychi-
atric classificatory label. Also, these ter-
minal phenomena give one such a sense
152
of finality that they only add to our thera-
peutic pessimism and impotence.
Stated briefly, the psychological picture
of a schizophrenia may not present any
striking appearance at all. The individual
may appear normal in all respects, even
suave and almost worldly; he may some-
times give the impression of a warm per-
sonality. On occasions, admittedly rare,
he may even have a position and keep it,
doing not very well and not very badly,
but keeping it. Intellectually he may not
appear brilliant, but he will be adequate,
almost always with a cultural bent. He
thinks more than he talks, and a tendency
to be taciturn is most frequent-a ten-
dency often mistaken for a depressive
state. This tendency should not be over-
looked. It is the first sign of autistic con-
templation, or, as Bleuler preferred to
term it later, de-reistic thinking, the out-
standing feature of any schizophrenia.
It must be carefully noted that autistic
thinking is not day-dreaming, although
day-dreaming is one of its variants.
Autistic thinking is a special kind of men-
tation, which while well described by
Bleuler was not fully understood by him;
he tried to gain a clearer insight into it
by attempting to consider the relative
hereditary characteristics of syntomic and
schizoid traits. Bleuler was nearer to an
intuitive grasp of autism when he ex-
pressed his preference for the term "de-
reistic," the thinking away from things.
Schizophrenic thought is really no
thought at all in so far as every thought
is related to some object. Without think-
ing of objects we do not think. Even the
most obscure abstract thinking is related
to things which we group into concepts.
Pathological abstract thinking, when it is
not schizophrenic, is a conceptual think-
ing, as in compulsion neurotics. The in-
terest of the schizophrenic is concentrated
on the word itself and it is the word that
he endows with all the qualities which the
so-called normal person sees mostly in
things, and which the compulsion neurotic
is apt to see mostly in concepts. As a
result, the schizophrenic is apt to appear
bizarre to us, for since the word he uses
becomes the most important link and the
substance of his thinking, he endows the
GREGORY ZILBOORG
word and not the fact with all the affec-
tive values which objects usually have for
us. The schizophrenic may become very
emotional and solemn, even morally en-
thused, about something which would
revolt a non-schizophrenic-normal, or
neurotic.
There are striking examples. When
Fiorenza, the murderer of Mrs. Titterton,
was asked why he killed her, he replied
rather coolly that he did it because he
had fallen in love with her. The actual
concept of love excludes hostility and
murder and connotes tenderness, but
when the primitive sexual impulse is at-
tached to the word itself, when it is the
word which carries the emotional, instinc-
tive energy, there is no connotation of
tenderness, warmth, romance, or any of
the other affective, conceptual elabora-
tions of men. There is only the word
"love," meaning only the word and carry-
ing with it only the primitive impulse.
Hence there appears a certain emotional
flatness, as if the emotions are lacking,
or frozen.
Fish, the sixty-year-old murderer of the
little nine-year-old girl whom he abducted
from her parental home and dismembered
with butcher's tools, was later appre-
hended and executed. He was appre-
hended as a result of a letter he wrote to
the girl's mother six years after her little
daughter's disappearance, in which he
told her that the girl was killed and that
he derived a great deal of satisfaction
from the fact that she died a virgin. The
word "virgin" was all that was apparently
important to Fish. That he stood before
that girl in the nude and had an orgasm,
and that he killed her and dismembered
her, appeared to him a phenomenon apart,
not related to his own life, or to the victim,
or to her parents. Hence there is an
almost sanctimonious, an unctuous, yet
cool, almost affectless emphasis on the fact
that the girl died a virgin-as if the label
"virgin" saved the whole situation.
Both examples happen to be taken from
the records of murderers, but the schizo-
phrenic in point is not always a murderer.
He may be an office clerk, or a physician.
He can and does do a job of work, seem-
ingly weIland without untowardcompli-
FEATURES OF SCHIZOPHRENIA
cations. Occasionally he may betray to
the outside world a certain peregrinatory
trend; he may wish "to get away" and at
times does, and "for some reason" cannot
find another occupation. Such people
either change their occupation and type
of interest frequently, or they spend a
great deal of time trying to figure out
what they should engage upon. They will
study business, "perhaps," or "perhaps"
journalism, or "perhaps" medicine, or
"perhaps" accounting; in their minds they
switch from one type of work to another
with dull, smooth ease, as if they really
do not care. They really don't. Their
minds are on the word "job." The word
means many things, anything, but not
what it actually means to the average
man. It is endowed with a private, per-
sonal and esoteric meaning, understand-
able only if one studies the person very
carefully.
There is an outstanding feature of the
inner life of these persons which must
be noted: they are literally suffused with
hatred. They pre hardly ever free from
its pressure, during their waking hours or
in their sleep. This hatred they may not
express, but it appears under two guises.
As a rule the combination of both usually
presents itself in one person: first, they
are usually tense, almost to the point of
being constantly aware of physical ten-
sion, of "being tied up in knots"; and
second, anxiety, of which they may on
occasion be aware, makes its appearance,
but even when these persons realize that
they are anxious, they perceive it not
as fear, nor as anxiety only, but as an
inner, violent, helpless anger, even rage.
This they explain by saying that they are
angry at themselves for being anxious.
But as often as not they are not aware of
the anxiety, and curiously characteristic
physiological substitutes of it are promi-
nently in evidence: their hands sweat
profusely. They "hate themselves" for
this, but they are unable to help them-
selves. Anxious or not, they are always
inwardly angry. Their anger is diffuse,
seldom directed against any person in par-
ticular. It is as "pure" as their thoughts
are "pure"-seemingly unrelated to defi-
nite .objects. Hence their thoughts give
153
the impression of highly individualized
abstractions without affect, and their
anger gives the impression of a quiescent
but inwardly fuming volcano, of impul-
sive behavior not related to any specific
intellectual content.
A certain part of their personality seems
to be set aside for the practical purposes
of the motions of living. They appear nor-
mal, they go to business, they see people
and follow the cultural pattern of social
congress rather smoothly, except that
while having a number of acquaintances,
they have almost no intimate friends.
Those few intimate friends do not enjoy
their confidences, for they do not confide;
the basis of their friendships seems mostly
playing and drinking together. Alcoholic
propensities are very frequent in such
persons.
Their erotic life is also rather simple in
appearance. Sexual experiences and love
are definitely separated. If attracted to a
woman, they seem to know and are even
prone to profess with considerable empha-
sis that it is all "only physical," that they
are not in love; yet they are very fre-
quently pathologically jealous. Their
jealousy is combined with intense fanta-
sies ranging from sheer hatred to wishes
to kill both the imaginary rival and the
object of their sexual interest. If they
happen to be married, they are either
impotent with or not interested in their
wives, and they seem to prefer casual
extra-marital relations or masturbation.
Such a man may masturbate even while
in bed beside his wife, "not wishing to
wake and bother her." The masturbatory
activities are most frequently accom-
panied with no sexual fantasies at all-
"pure" sensation-or, if fantasies are
present, they are usually about a variety
of perversions, mostly of a sado-maso-
chistic nature-such as tying a woman
up, biting her, cutting her to pieces, gag-
ging her, covering her with dirt, or even
killing her.
As far as therapeutic results are con-
cerned, these persons are not hopeless.
A number of them show only improve-
ment, which at times is considerable;
some are apparently cured; others either
remain untouched or show a tendency to-
154
ward ,episodic exacerbations. The therapy
of choice is psychoanalysis, which in these
cases is usually tedious, slow, and pro-
longed; at times the treatment proceeds
almost as an eventless series of mono-
logues interspersed with as seemingly
endless silences of "impotent rage," with-
out content or change.
It will be noted that I have been speak-
ing here of men. I do not know whether
as a result of fortuitous circumstances my
experience has been limited only to men
of this psychological variety, or whether
this psychopathological state is met with
mostly in men. My observations include
extremely few women of this type, and
these have shown a greater tendency to-
ward agitated and more vivid depressive
trends. One must add that all such cases,
men and women but particularly men,
are very frequently preoccupied with
thoughts of suicide, and they are just as
apt to kill someone else as to kill
themselves.
They seldom, if ever, reach the point
of hospitalization, although it would be
most desirable to have special hospitals in
which the treatment of such patients
could be undertaken partially or totally
on an intra-mural basis.
Since these patients seldom reach the
point at which hospitalization appears
necessary, either to the relatives or to the
psychiatrist, and since they appear "to
walk about life" like any other "normal"
person-although they remain inefficient,
peregrinatory, casual in their ties to
things and to people and tenatious only
in their inability to be productive and
independent-they pass as "difficult
people," as "problem children." Adult or
adolescent, they are irresponsible enough
to remain dependent and strong enough
to appear sound of mind and limb-al-
though hypochondriacal Gomplaints and
tendencies to minor chronic ailments,
such as endless colds, are not infrequent.
Such individuals remain more or less on
the loose in the actual or figurative sense,
outwardly and inwardly: hence the sug-
gested designation of ambulatory schizo-
phrenias.
A careful and detailed study of these
GREGORY ZILBOORG
schizophrenias is indicated. This is ex-
tremely difficult, however. They seldom
reach the psychiatrist's office for many
reasons. First, they are considered by
both the laity and the medical profession
as merely weak people, "poor personali-
ties," "psychopathic personalities," what-
ever these words may mean. Second, only
those of the more or less well-to-do, semi-
leisure class come to the attention of the
psychiatrist. Third, only when they hap-
pen to get into trouble are they thrust
upon the psychiatrist. I say "thrust
upon," because it is extremely difficult to
achieve anything when they are already
in real trouble; they are then too far ad-
vanced or even out of the therapeutic
jurisdiction of the psychiatrist. For not
infrequently they are sexual perverts,
transvestites or fetishists or both, and too
fixed on the pathological level to be dis-
lodged from it. Or they are criminals,
mostly murderers, in relation to whom
the psychiatrist can only play the role of
psychiatric expert witness.
While unconscious homosexuality plays
an enormous role in the psychology of
these people, it seldom becomes overt.
Unless they ultimately commit suicide,
they almost invariably get into trouble
with the law. I have in mind men who
are apprehended for exhibitionism, for
cutting women's hair, for stealing their
fur-pieces, for masturbating on women's
clothes while standing in line in post
offices or railroad ticket offices or theatres.
Or, as has been repeatedly stated, they
commit murder. While these murders do
have all the appearances of premeditated
acts, a careful study of the records avail-
able invariably shows their impulsive
nature, in which an apparently autono-
mous part of the personality seems to act
independent of the rest of the personality
functions.
The nineteen-year-old Volkman, mur-
derer of the little girl whom he first raped,
comes to mind. Volkman committed his
criminal act in the manner of a dull
trance, as if in a walking slumber, from
which he did not emerge until the very
moment of his execution at Sing-Sing.
There was neither passion, nor remorse,
nor intellectual appreciation, in his crimi-
AMBULATORY SCHIZOPHRENIAS 155

nal assault on the child or in his coming years have elapsed after the completion
to his death in the electric chair. Similar or interruption of the treatment.
behavior characterized Fiorenza until the Suffice it here to say that the shallow-
very last moment; he did not seem even ness of affect so conspicuous in the ex-
puzzled. Nor was Fish. While in the ternal aspects of the clinical picture
death house, Volkman and Fish, and should not be mistaken either for the
probably Fiorenza, showed their emo- absence of affect or for some special
tional attitude toward their crime and mysterious disturbance of what is called
forthcoming execution in an excessive, the "emotional sphere." In actuality,
seemingly endless masturbation, almost when the patient is viewed from within,
within the view of the prison guards. This rather than from without as the Kraepe-
is a typically schizophrenic reaction in linian tradition unfortunately requires,
which the instinctual impulse, primarily the emotional sphere appears in a dif-
sexual, acts as a safety valve for anxiety, ferent light. The emotion appears lacking
as "pure" sensation without the affective in the schizophrenic only because that
and intellectual elaborations within the part of his personality which deals with
total personality of a civilized man- external realities of life and which is
which are recognized as love, actual or known under the technical name of Ego
fantasied. plays a minor role in his life, particularly
References to this criminal, murderous if he is an ambulatory schizophrenic. It
type are made here because of the rather acts more as a perceptive registering ap-
intimate knowledge of them gained paratus. It registers whatever happens
through the study of certain records automatically, and it does not seem inte-
which were made available by Governor grated with his affective, instinctual life.
Lehman for the purposes of psychiatric Hence realities are not facts, but words.
research. But this does not mean that the His real thinking becomes mere feeling,
majority of these ambulatory schizo- pure apperception. Consequently the
phrenics are capital criminals. Some of schizophrenic is de-reistic and his im-
them are quiet, unobtrusive, ineffective pulses are primitive, direct, unintegrated.
people, who look "for a place in life" and The problem, theoretical and practical,
who seem to be chronic failures whenever is that of affective re-integration, which
they undertake to do something, or before is the major task of therapy in such cases.
they undertake to do anything. Some of This was touched upon some time ago in
them reach even a point where they par- my report on "Affective Reintegration in
tially soil themselves, while on the ana- the Schizophrenias." 1 Such integration
lytical couch or while walking in the bids fair to be quite successful in ambula-
street. The psychoanalyst, who through tory schizophrenias, although it is labori-
the very nature of the psychoanalytic ous and prolonged. Unfortunately, as has
been already stated, the present status of
therapy cannot miss such phenomena, is
our medico-legal prejudices and cultural
the only one who knows of such things, misconceptions keeps these schizophren-
and it is very striking to observe the ics from the psychiatrist, and unless they
indifference, the almost unembarrassed reach the electric chair, they play the role
serenity, with which these patients relate of a psychopathic ballast in their sur-
or face their behavior of this type. roundings-without benefit of or to psy-
A detailed report of individual cases of chiatric knowledge, and without service
this order must await some future oppor- to the community.
tunity. The intimate quality of the gen-
NEW YORK CITY.
eral psychotherapy of psychoanalysis of
such persons precludes the possibility 1 Zilboorg, Gregory, Affective Reintegration in the
Schizophrenias. Archi'll. Neurol. and Psychiat.
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