In many cases of schizophrenia the disorder does not manifest itself, at least in its initial stages, with obvious symptoms. Some cognitive alterations may appear to be within the normal range or not distinguishable from those occurring in neuroses and character disorders. Usual psychological tests may also fail to show evidence of cognitive impairment. However, people who knew the patient well can recognize the difference in him. His attitude toward life has changed.

Although primary process mechanisms continue to function in these children for a period of time longer than in normal circumstances, the primary process is eventually overcome and to a very large extent is replaced by secondary process mechanisms.

Because the early experiences have made the future patient awkward socially, clumsy in his activities, and somewhat inadequate in coping with life in general, his defects become more evident in adolescence and later, when he has to deal with a greater range of situations.

The fourth, psychotic, period of schizophrenia covers the whole psychosis, from its onset to termination.

The schizophrenic patient to be reported in detail in this chapter was never seen by the author, nor discussed in supervision with other colleagues. This chapter illustrates how much, in some instances, we can learn about the psychodynamics of schizophrenia from the special perspective of a close member of the family.

What is schizophrenia? How can it be recognized, interpreted, and treated?