He asks if schizophrenia is an illness and answers in the negative, since the disorder is not understood in classic Virchowian criterion of cellular pathology.
Though those searching for a biological basis of schizophrenia far outnumber those undertaking psychological approaches, Arieti supports the minority view.
The pre-psychotic schizoid avoids conflict with the parents by passively submitting to their wishes, but he does so without any real zest or ambition, just going through the motions with minimal effort.
The stormy personality, owing to their adaptation, fails to develop true, deep relations with anyone due to their need to maintain a false persona that is always changed based on the perceived expectations of others.
He describes the building of neurotic and psychotic defense mechanisms; the emerging schizoid or stormy personality, and fully developed schizophrenia understood as an injury to the inner self following a series of adverse life events.
This, according to Arieti, "is the basis of the psychodynamics of schizophrenia", a claim that also appears in later writers on child abuse such as Alice Miller and Colin Ross.
He clarifies that the internal maternal image is not based solely on the real mother, but is rather influenced by all relations the patient has throughout his life.
However, even at his own work he was not allowed to make decisions for himself: Ignoring what Gabriel was taught in school, his mother practically told him how to plant every single vegetable on the farm, and how to tend to other needs.
In Part three of Interpretation of schizophrenia Arieti describes how in spite of its efforts to stay in reality, the patient's defenses finally succumb when attacks on the self-image both from outside and within cause the anxiety to become too unbearable.
Arieti maintains that even with the schizophrenic potentiality laid down in early childhood and by genetic predisposition, not all of these cases will develop psychosis, as new defense mechanisms are acquired throughout the life of the individual.
The negative self-image that is dissociated from the conscious mind of the individual may be reactivated by any number of life events, such as entering a into a new relationship, the birth of a child, or a tragic accident, the death of a relative, especially the death of parents, moving out of home, stress at work, the loss of a job, or a promotion at work which destabilizes the individual's sense of competency at his own job, or a combination of several of these factors.
These adverse life events bring the dissociated, negative self image from early childhood into consciousness, causing the person to view themselves as utterly defeated, unlovable, incompetent, worthless, etc.
The dangers are concept feelings, such as that of being unlovable, inadequate, unacceptable, inferior, awkward, clumsy, not belonging, peculiar, different, rejected, humiliated, guilty, unable to find his own way amongst the many different paths of life, disgraced, discriminated against, kept at a distance, suspected, and so on.
In the world of paleological thinking, every happening that is relevant to the schizophrenic's complexes is interpreted as being willed by the projected persecutors of the individual.
Primary process thinking, which is only encountered in dreams and in early childhood by modern man, is adapted by the schizophrenic to reduce destructive anxiety.
Aristotelian logic is abandoned almost entirely, and primary process thinking gains more and more footing as the disease progresses from acute to chronic schizophrenia.
It is less anxiety-provoking than to admit to himself that he sees himself as being worthless and deplorable, and it restores a sense of control, and also helps bolster self-esteem through gross over-appraisal of oneself as an individual who is persecuted because he is exceptional for one reason or another, such as being a savior, a prophet, etc.
He brings up the example of a catatonic patient who, after introjecting the mother's engulfing behavior, believed that by moving he could produce havoc.
In most cases the parental internal images can be corrected if the individual manages to build up healthy, emphatic relationships outside the family nucleus later in life, such as at school, at work, etc.
Unlike most psychiatrists, Arieti, like Sullivan and Bertram Karon, valued the content of the delusions as essential, albeit distorted manifestations of the original complexes by which the patient's destructive anxiety is fueled.
He believed that meeting the schizophrenic in their own world, but not conforming with or reassuring their delusions was essential to gaining the trust of the patient, and building a healthy connection.
As treatment progresses, the patient will more easily let go of their delusions and distortions of reality, allowing the original complexes that fueled their anxiety to be re-examined and processed.
The goal of the therapist is to help guide the patient through the development of this new personality, by providing them with a positive, reassuring and empathic internal image.
He also explores and discusses other methods of treatment, such as insulin shock therapy and psychosurgery, the latter of which he disapproves, maintaining that it is essentially an act of giving up on the patient and resorting to turning him into a lifelong cripple.
The split-off negative image of the parents, and of others are transformed into a "distressing other", in the form of delusions of persecution, and voices heard by the patient.