Ego functioning during paranoid regression

This paper is based on the psychotherapeutic work with a paranoid schizophrenic man during a period of acute psychotic regression lasting approximately two weeks. The author reviews what seemed to be the precipitating factors in the decompensation, then elaborates descriptively and speculatively on two major aspects of ego functioning during the regression, namely, the experiences of fragmentation and of dedifferentiation. The role that seemed to evolve for the therapist is also discussed as it relates to the aforementioned aspects of ego functioning. Finally, a tentative hypothesis is developed concerning pretense as one possible genetic factor in these ego disturbances.