290 PSYCHOTHERAPY : SCIENTIFIC AND RELIGIOUS chap.
The recognized difficulty of psychoanalytic treatment in schizophrenia is that in this disease the libido is withdrawn from objects to the ego ; hence the childish ideas of megalomania, the infantile habits, the revival of auto-erotic forms of gratification, the recklessness in regard to cultural requirements and the utter disregard and carelessness of the external world. This adhesiveness of the libido to the ego is termed narcissism, as mentioned above. According to recent contributions from the psychoanalytic standpoint on schizophrenia, it would seem that the view is held that in the narcissistic psychoses the hereditary factor has to be taken into account. Thus Clark35a suggests that in these conditions the hereditary endowment may include something defective in the ego's capacity for meeting or adapting to its environment; and, again, that there may be an inherited tendency on the part of the instinctual development itself, also, there may be lacking the urge to pass beyond the limits of narcissism to attain higher levels of gratification (such as sustained object-cathexis).
From the above it is evident that schizophrenia and allied conditions are not amenable to psychoanalytic treatment as ordinarily carried out, for such reaction-types do not readily lend themselves to the formation of that strong transference to the analyst which is so essential in ordinary analysis. In this connection Alexander6 points out that in all cases in which we have to assume that the ego itself is undeveloped and lacking those faculties which differentiate the adult ego from the childhood ego, the capacity to estimate, to accept and reject, to endure tension and deprivations, the psychoanalytic technique cannot be used with advantage because it forces the ego to cope with a problem which it is unable to accomplish.