Melanie Klein Today, Volume 1: Mainly Theory

Developments in Theory and Practice

Elizabeth Bott Spillius

• Publisher: Routledge
• Year: 2003
• Print ISBN: 9780415006767
• eBook ISBN: 9781134986682
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Melanie Klein Today, Volume 1 is the first of two volumes of collected essays devoted to developments in psychoanalysis based on the work of Melanie Klein.

The papers are arranged into four groups: the analysis of psychotic patients, projective identification, on thinking, and pathalogical organisation.

Part One
The analysis of psychotic patients

Introduction

The 1950s were an important period in the development of Kleinian practice and thinking because Klein's ideas about psychotic anxieties and defences were tested with severely ill patients, mainly schizophrenics, A further aim was to see whether psychotic patients could be analysed without departures from the essentials of psychoanalytic technique. As in the case of Klein's analysis of children, the analysis of psychotic patients threw up new material and led to the development of new ideas and areas of interest.

Rosenfeld, Segal and Bion were the first explorers in this field (see Rosenfeld 1947, 1949, 1950, 1952 (reprinted here), 1954, 1963; Segal 1950 (reprinted in volume 2 of the present work) and 1956 (reprinted here); and Bion 1950, 1954, 1955, 1956, 1957 (reprinted here), 1958a, 1958b, and 1959 (reprinted here in Part Two: Projective identification)). This remarkable series of papers got off to a memorable start with Rosenfeld's 'Analysis of a schizophrenic state with depersonalization' in 1947 which illustrated many of the ideas that Klein had described in her epoch-making paper 'Notes on some schizoid mechanisms' in 1946. Segal's 1950 paper 'Some aspects of the analysis of a schizophrenic', reprinted in volume 2 of the present work, is particularly striking because it is the earliest account of the detailed psychoanalytic treatment of a hospitalized schizophrenic patient without significant modifications of psychoanalytic technique.

Segal, Rosenfeld, and Bion all agree on the viability of the psychoanalytic method in treating psychotic patients, though Rosenfeld discusses it in more detail than Segal and Bion (Rosenfeld, 1952). All report improvement in their patients, though they also make it clear that the patients were exceedingly difficult to understand. All found impressive substantiation of Klein's views on the paranoid-schizoid position as the fixation point of schizophrenia, and all found much confirmation of her views on projective identification, the early and persecuting superego, the pain of depressive anxiety, and retreat from it to the defences of the paranoid-schizoid position.

But none of these authors stopped at confirmation of Klein's ideas. Rosenfeld became interested in failure to differentiate love from hate and self from other in the paranoid-schizoid position, ideas that he developed in papers on confusional states and on narcissism (1950, 1964, 1971b (reprinted below in Part Four: Pathological organizations)). Segal was stimulated to further study of the part played by success or failure in negotiating depressive anxieties in the development of symbolic thinking and in creativity (Segal 1952 and 1957 (reprinted in this volume in Part Three: On thinking)). Bion, probably the most original of Klein's students and colleagues, began to develop ideas about the differences between normal and abnormal experience of the paranoid-schizoid position which led him to make a distinction between projective identification used to evacuate and fragment mental contents and projective identification as a form of communication that could influence the recipient and could in turn be influenced by him. This took him to a study of thinking which, in various forms and developments, remained the major preoccupation of his psychoanalytic life (Bion 1959 (reprinted here in Part Two: Projective identification), 1962a (reprinted here in Part Three: On thinking), 1962b, 1963, 1965, and 1970).

Three papers illustrate the work of this early period. In 'Notes on the psychoanalysis of the superego conflict of an acute schizophrenic patient' (1952) Rosenfeld gives a detailed account of his adherence to a fully psychoanalytic method of treating schizophrenics as contrasted with the introduction of modifications in technique which were being used at that time in the United States. He goes on to describe some details from a brief analysis of a young schizophrenic man who, in common with other schizophrenic patients, had an exceedingly primitive and severe superego. The reader can hardly fail to be struck by the clinical acumen with which Rosenfeld struggled to understand his patient's bizarre but touching communications. He gives detailed illustration of splitting, projective identification, introjection, ego disintegration through massive projective identification, the patient's difficulties in distinguishing self from object; he draws attention to his patient's primitive envy of the breast and the resources of his mother's body.

Segal's 'Depression in the schizophrenic' (1956) gives poignant clinical illustration not only of splitting and projective identification but also of Klein's observation that the schizophrenic cannot stand the pain of the depressive position and regresses to the defences of the paranoid-schizoid position (M. Klein 1946). In one sequence of material the patient, unable to bear the pain of accepting responsibility for or awareness of having had phantasies of attacking her analyst and her father (her father had committed suicide), enacted the role of Ophelia, picking up and scattering imaginary flowers, and thus stirring up sadness (and sanity) in her analyst and claiming the irresponsibility of madness for herself.

Interestingly, Segal gave this paper at almost the same time as Bion's paper 'Differentiation of the psychotic from the non-psychotic personalities' (1957, reprinted here); they had not discussed their respective papers beforehand, but discovered that they were working on very similar lines. Bion's paper focuses on the general theory of pathological projective identification, whereas Segal's paper gives a specific illustration of it. In his paper Bion further develops Klein's view that everyone, however 'normal', suffers from some degree of psychotic anxiety and pathological defences against it and states that all psychotics have some degree of non-psychotic functioning and that it is to this part of the personality that the analyst addresses his interpretations. He describes the minute fragmentation of the psychotic personality, especially of that part of the mind that is aware of reality. Where the non-psychotic part of the personality would use repression, the psychotic part tries to rid itself of the part of the mind that carries out the repression. Projective identification, as carried out by the psychotic part of the personality, involves fragmentation, splitting into many particles, and projection of them which leads to the formation of what Bion calls 'bizarre objects'. The stage is set by the ideas of this paper for the development of his analysis of thinking.

Analysis of psychotic patients was continued after the 1950s by many Kleinian analysts but few papers have been published specifically on the analysability of psychotics or the relevance of Klein's delineation of the paranoid-schizoid position. Interest has shifted to the analysis of narcissistic and borderline patients and to their ways of maintaining their psychic equilibrium.

1
Notes on the psychoanalysis of the superego conflict of an acute schizophrenic patient

HERBERT ROSENFELD

This article was first published in 1952 in the International Journal of Psycho-Analysis 33: 111-31.

In analysing a number of acute and chronic schizophrenic patients during the last ten years, I have become increasingly aware of the importance of the superego in schizophrenia. In this paper I shall present details of the psychoanalysis of one acute catatonic patient in order to throw some light on the structure of the schizophrenic superego and its relation to schizophrenic ego disturbances. I also wish to discuss the controversy about methods of approach to acute schizophrenic patients.

The controversy concerning the approach to schizophrenic patients by psychoanalysis

In discussing the value of the psychoanalytic approach to schizophrenia, we have to remember that psychotherapists with widely different theories and equally different techniques claim success in helping the schizophrenic in the acute states of the disease. The attempt to concentrate on producing a quick therapeutic result in the acute schizophrenic state, irrespective of the method of approach, may be temporarily valuable to the individual patient and gratifying to the therapist; but the more difficult problem is to deal with the chronic mute phase of the disease.¹ The method of approaching the acute schizophrenic patient is important for several reasons. First, we must be sure that we are using a scientific method of investigation and treatment so that we can assess our psychopathological findings correctly. Secondly, our method should be one which can be used in treating a variety of cases, so that it is possible to teach it to our students. Thirdly, our method of approach must also help, not hinder, the treatment of the chronic phase of schizophrenia which follows the acute one. Psychoanalysts have satisfied themselves that psychoanalysis is a method of investigation which serves both treatment and research in neurosis. There is, however, disagreement as to whether psychoanalysis can be used in the treatment of acute schizophrenia. Most American psychoanalytical workers on schizophrenia, for example, Harry Stack Sullivan, Fromm-Reichmann, Federn, Knight, Wexler, Eissler, and Rosen, etc., have changed their method of approach so considerably that it can no longer be called psychoanalysis. They seem all agreed that it is futile to regard the psychoanalytical method as useful for acute psychosis. They all find re-education and reassurance absolutely necessary; some workers like Federn go so far as to think that the positive transference has to be fostered and the negative one avoided altogether. He also warns us against interpreting unconscious material. Rosen seems to interpret unconscious material in the positive and negative transference, but he also uses a great deal of reassurance, a problem which I shall discuss later on in greater detail. A number of English² psychoanalysts, stimulated by Melanie Klein's research on the early stages of infantile development, have been successful in treating acute and chronic schizophrenics by a method which retains the essential features of psychoanalysis. Psychoanalysis in this sense can be defined as a method which comprises interpretation of the positive and negative transference without the use of reassurance or educative measures, and the recognition and interpretation of the unconscious material produced by the patient. The experience of child analysts may help us here to define in more detail the psychoanalytic approach to acute schizophrenics, because the technical problems arising in the analysis of acute psychotics are similar to those encountered in the analysis of small children. In discussing the analysis of children from the age of two and three-quarter years onwards, Melanie Klein has found that by interpreting the positive and negative transference from the beginning of the analysis the transference neurosis develops. She regards any attempts to produce a positive transference by non-analytical means, like advice or presents, or reassurance by various means, not only as unnecessary but as positively detrimental to the analysis. She found certain modifications of the adult analysis necessary in analysing children. Children are not expected to lie on the couch, and not only their words but their play is used as analytical material. Co-operation between the child's parents and the analyst is desirable, as the child has to be brought to his sessions and the parents supply the infantile history and keep the analyst informed about real events. In the analysis of children as described by Melanie Klein, however, the fundamental features of psychoanalysis are fully retained.

All these experiences can be used for describing the guiding principles of the analysis of psychotics, particularly acute schizophrenic patients. If we avoid attempts to produce a positive transference by direct reassurance or expressions of love, and simply interpret the positive and negative transference, the psychotic manifestations attach themselves to the transference, and, in the same way as a transference neurosis develops in the neurotic, so, in the analysis of psychotics, there develops what may be called a 'transference psychosis'. The success of the analysis depends on our understanding of the psychotic manifestations in the transference situation.

With acute schizophrenic patients we scarcely ever use the analytic couch, and we make use not only of verbal utterances, but also of gestures and play as analytical material. Close co-operation between the analyst and parents or nurses is essential. Another important question is how often and how long at a time the patient should be seen. I have found that acute schizophrenic patients have to be seen at least six times a week, and often the usual 50 minutes' session has seemed to be insufficient. In my own experience it is better not to vary the length of time of the particular sessions, but to give the patient, if necessary, a prolonged session (1 hour 30 minutes) regularly. It is also unwise to interrupt the treatment for more than a few days while the patient is still in the acute state, because it may cause a prolonged setback in his clinical condition and in the analysis.

The analysis of schizophrenic patients has many pitfalls and the inexperienced analyst may find himself unable to cope with the problem analytically. It is in my opinion the very nature of the schizophrenic process which not only makes the analytic task a difficult one but is one of the reasons for the controversy about the possibility of an analytic approach. The answer to the controversy can only be found in practice: namely, by showing that a transference analysis of acute schizophrenic patients is possible; and by examining the nature of the schizophrenic transference and other central schizophrenic problems and anxieties.

I have the impression that the need to use controlling and reassuring methods is related to the difficulty of dealing with the schizophrenic superego by psychoanalysis. Milton Wexler (1951) has contributed to the understanding of this point in his paper 'The structural problem in schizophrenia'. In criticizing the view of Alexander, who denies the existence of a superego in schizophrenics, Wexler says: 'To explain the schizophrenic's conflicts (hallucinations and illusions) wholly as expressions of disorganized instinctual demands that have lost their interconnection, is a travesty of the clinical picture of schizophrenia which often reflects some of the most brutal morality I have ever encountered. Certainly we are not dealing with a superego intact in all its functions, but a primitive, archaic structure in which the primal identification (incorporated figure of the mother) holds forth only the promise of condemnation, abandonment and consequent death. Though this structure may only be the forerunner of the superego which emerges with complete resolution of the Oedipus situation, its outline and dynamic force may be felt both in young children and schizophrenic patients, and if we do not see it (the superego), I suspect it is because we have not yet learned to recognize the most archaic aspects of its development.'

While fully recognizing the importance of the archaic superego, Wexler has, however, deviated considerably from psychoanalysis in his clinical approach. Apparently he did not attempt to analyse the transference situation. He tried to identify himself deliberately with the superego of his patient by agreeing with the patient's most cruel, moral self-accusations. In this way he established contact with his patient which he had failed to do before. The treatment continued while the therapist was taking over the role of a controlling and forbidding person (for example, he forbade the patient any sexual or aggressive provocations which threatened to disturb the therapeutic relationship), Wexler made it quite clear that he also acted in a very friendly, reassuring manner towards his patient.

The patient who had been distinctly helped by Wexler's method was a schizophrenic woman who had been in a mental hospital for five years. The theoretical background of his approach is the attempt of the therapist to identify himself with the superego of the patient. As soon as he has made contact with the patient in this way he feels that he has succeeded in his first task, and he (the therapist) then begins to act as a controlling but friendly superego. He claims that in this manner a satisfactory superego and ego-control is gradually established which brings the acute phase of schizophrenia to an end.

Rosen (1946) described a technique in approaching acute, excited, catatonic patients who felt pursued by frightening figures. He established contact by 'deliberately assuming the identity, or the identities, of the figures which appeared to be threatening the patient and reassured the latter that, far from threatening him, they would love and protect him'. In another case, Rosen (1950) directly assumed the role of a controlling person by telling his woman patient to drop a cigarette which she had grabbed. He also controlled her physically and told her to lie still on the couch and not to move. But towards the end of the session he described, he changed his attitude by saying, 'I am your mother now and I will permit you to do whatever you want.' In Wexler's and Rosen's case it is clear that the particular approach aims at a modification of the schizophrenic superego by direct control and reassurance. Wexler suggests that Knight's and Hayward's success in the treatment of their schizophrenic patients must have been also due to their taking over superego control. It seems likely that all these methods which use friendly reassurance have a similar aim, i.e. the modification of the superego.

Indeed, from this critical survey, it would seem that all these psychotherapeutic methods are aimed at a direct modification of the superego. But I should add that none of the workers I ...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• General introduction
• Part One: The analysis of psychotic patients
• Part Two: Projective identification
• Part Three: On thinking
• Part Four: Pathological organizations
• References to general introduction and other introductory material
• Name Index
• Subject Index