Psychotic defense processes
Merino, (2011) in her online presentation, outlined the defense mechanisms of distortions for
the psychotic from minor defenses to severe as follows: minor defenses like devaluation when
one links the negative aspects to oneself or others in an exaggerated manner, idealization when
one links the positive aspects to oneself or others in an exaggerated manner and omnipotence
when one behaves in a way that implies that this person is superior to others or has exceptional
power or capabilities; next would be the major defenses like autistic fantasy when one
substitutes social interactions by excessive daydreaming, projective identification when a
person misleadingly projects one’s own feelings, thoughts, or impulses to others, and splitting
off self-image or image of others when a person compartmentalize opposite affect states and
fails to integrate the positive and negative qualities of self or others into cohesive images thus
self and object images tend to alternate between polar opposites; these defenses might evolve
to severe ones as delusional projection when one projects unreal mostly persecutory thoughts,
emotions and impulses to others, psychotic denial when one has gross mutilation in reality
testing and psychotic distortion when one has gross mutilation perceiving reality.
I’m about to go through some theoretical view and practical manifestations of a specific and
main defense mechanism applied by psychotic patients. Particularly, the projective
identification mechanism will be discussed in relation to other important defense mechanisms
such as splitting off, fantasy, idealization, devaluation, omnipotence, and delusional projection.
In a study about psychotic patients’ excessive need to use the defenses of ego splitting and
projective identification, Rosenfeld* (1971 [as cited in Spillius, 1988]), as a Kleinian, tries to
make a review especially about projective identification the main defense mechanism used by
such patients. Klein defines projective identification: ‘By projective identification I mean that
process when part of the ego is split off and projected into an object with a consequent loss of
that part to the ego, as well as an alteration in the perception of the object.’ In her study,
Rosenfeld cites Segal** another major Kleinian, who studied ‘Depression in the schizophrenic.’
The thesis of this paper is that, while schizophrenic patients go through therapy and as they
develop, they arrive at the ‘depressive position’ a state that they can’t tolerate therefore they
project their depressive anxieties as a means to get through with it. Segal states that it’s the
same depressive position defined by Melanie Klein. In the course of the treatment and when
the patient is exposed to an analysis of his case that of paranoid anxieties, idealizing and
splitting processes, the patient starts facing short periods of depressive anxieties occurring
from time to time. It’s the therapist’s aim to get the patient to experience those depressive
feelings, while commonly the patient attempts to dispose those anxieties using projective
identification. Hence the patient usually projects his ego’s depressive part into the therapist
inciting depressive feelings in the therapist. Analysis of the circumstances when part of the ego
had been going through the projected depression should be exposed and explained to the
patient. For further explanation, Segal speaks of a case of one of her own patients, a 16 year old
girl suffering from chronic hebephrenic schizophrenia:
…In a later session the patient showed up very late. By almost by the end of the session, the
therapist proposed a probable reason why her patient didn’t show up on time for that session,
and that was that she was intimidated to come to her therapist believing that the therapist
would ‘suck her blood out,’ directly she responded by protesting that her therapist was pulling
the things inside her out, and this was happening in her dreams too. Afterwards she went on
saying that this was the reason she resorted to the ‘ideal people’ that exist inside her. This
made it obvious to the therapist that her hallucinations were dual in character one excessively
persecutory and another excessively ideal. From previous encounters the therapist was aware
of the fact that the patient created several hallucinations from book characters that she was
sometimes identifying with but mostly consuming in order to produce this hallucinatory world
inside herself. The therapist explained to the patient that she was treating her almost the same
way she dealt with her books embracing as well as using the therapist’s explanations to make
up enjoyable hallucinations that she kept inside herself. She confirmed the therapist’s
interpretation and added that she was immensely exhausting her till death. After that she
looked at her therapist for a long time and went on saying that occasionally vampires fall in love
with their victims and when this happens they tremendously enjoy the sucking of the blood
from their victim very slowly as not to kill the victim instantly. The therapist works closely with
her patient in some following sessions dealing with the girl’s feeling towards her in comparison
to the vampire allegory she previously stated. The patient also compares her love to her
therapist as that of the breast too dangerous just like hatred that holds meanness and hunger.
This manifests itself by letting the therapist talk while she was quietly watching her as
blood/life is drained out of her in small quantities in order to construct amazing things within
herself which she won’t let the therapist know about. In the meantime as assumed by the
patient, the therapist was becoming void and gradually turned to be the vampire that was
taking her life away by sucking her blood, and seizing her ‘good hallucinations’ as well. By doing
so the therapist is haunting her and making threats to end her life. The therapist states that her
patient was terrified to go through healing, and explains that according to the patient healing
signifies being freed from demons ‘exorcised’ which in turn indicates being exposed as being
the vampire from the beginning and consequently she’ll be put to death. She could sense that
fatality was the single ending for this state...
In the above stated part of the analysis by Segal, she intentionally illustrates, analyzes and
exposes the processes of depressive anxieties, idealizing and splitting that the young girl was
going through and so often projecting mostly the bad parts of her ego into the therapist as to
shield her own split ego. The patient was so often using projective identification trying to get
rid of her anxieties: ‘Then she gave me a long look and said that sometimes when vampires
were in love they would not kill their victim outright but do so slowly, by degrees, enjoying the
sucking enormously.’ The patient is projecting her depressive anxiety into the therapist, once
being a vampire herself who will drain the therapist’s blood slowly till the therapist dies and
another time of therapy/cure that will help her get exorcised thus leading to death. The
therapist could realize that the patient’s hallucinations were dual in character one persecutory
and another ideal and both were excessive in nature. She felt persecuted by the therapist as
she was sucking her blood off that she had to fly to the ideal people inside her. This shows
severe splitting of self-image compartmentalizing opposite affect states and failing to integrate
the positive/idealization and negative/devaluation qualities into cohesive images. Her
hallucinations were focused at one point on her sucking life from the therapist to construct
good things inside herself then it all changes into that the therapist or therapy persecuting or
exorcising her to kill or put her to death: ‘…and I slowly became the vampire sucking life out of
her, taking away her good hallucinations, persecuting her and threatening to kill her.’ By doing
so, she proposes that the therapist is haunting her and making threats to end her life. The
patient goes on with her delusional projection as she assumes to be the vampire all from the
start and she’ll be put to death and her delusions are of course of a persecutory nature. She
could sense that fatality was the single ending for this state. Either way she’s afraid to face
reality therefore she employs projective identification to avoid experiencing depression which
eventually will put her face to face with the guilt feeling that goes hand in hand with
depression.
Furthermore, Segal combines her theoretical assumptions and clinical practice to illustrate how
harmful can an excessive use of projective identification become when exercised by a psychotic
thus making clear demonstration of how the self and object relation is sabotaged and how
parts of the self when dealing with outside and inside reality become split off thus severely
compartmentalized. Whereas Rosenfeld stresses the attacks made by the psychotic patient on
the therapist who is the link of the inside and outside reality of the patient, and the designated
aim of envious projective identification; through this process the patient loses the ability to
discriminate between the self and the object leading to omnipotent fantasies of owning and
becoming the object.
Segal*** mentions that the schizophrenic patient ceases the ability to handle symbols when
this symbol retrieves its original object equivalence, that is it becomes almost the same or one
with it. The ego-object relation, that is troubled, leads to this confusion between the
symbolized thing and the symbol. The compartmentalized ego projects parts of itself together
with the internal objects onto an object with which it will identify itself. A confusion between a
part of the ego and the object will lead to dimming out the discrimination of the self and the
object, also another confusion will occur between the object which is symbolized and the
symbol that is utilized and made up by the ego. Segal, considers that in order to sustain ‘normal
symbol formation’****, it is important for a person to make a distinction between the self and
the object depiction; taking into consideration that the introjection of objects experienced as
distinct from the self is the foundation of ‘normal symbol formation’. When projective
identification is overused within the psychotic progression, distinction between the self and the
object is demolished. This initiates the mystification between reality and fantasy and a
regression to concrete thinking because of a deficit in the ability of symbolization and symbolic
thinking.
According to Rosenfeld, (Rosenfeld, 1971 [as cited in Spillius, et. al., 1988]) along the
therapeutic process the patient attacks the therapist who is the target in projective
identification, and whenever the transfer occurs between the patient and the therapist the
patient tries to attack the therapist who is the link between the patient and the reality that
exists inside and the outside of the patient. Thus when a patient goes forth in his therapy, this
patient makes a ‘negative therapeutic reaction’ which comes out so violent looking like he
intends to destroy and diminish the importance of all that he had obtained beforehand,
ignoring the suicidal threat of such a response. The therapist’s fine aspects are faced with
aggressive envy on the part of a number of patients; these patients develop a variety of
defenses in opposition to this primal envy at the same time as the patients’ internal saner part
endures these envious responses as intolerable and undesirable. Splitting off and projection of
the envious part into an outside object is one of the defenses, and afterwards the external
object converts into the patient’s envious part. Melanie Klein’s description of the splitting off
and projection of bad parts of the self is exemplified in this sort of defensive projection
identification. Omnipotent fantasies of the patient going into the well-liked and envied object is
associated with defense against envy as well, hence the patient claims to be the object by
occupying its position. When the patient reaches the extent of full projective identification with
an envied object, the envy is completely declined nevertheless to emerge again in case the self
and the object are detached once more. Segal***** emphasized that in an early narcissistic
connection with the mother, projective identification was utilized by the patient as a denial
mechanism against realizing that the self and the object are detached. If the patient is aware of
this separation then he would undergo reliance on the object and consequently experience
anxiety (Mahler, 1967 [as cited in Rosenfeld, et. al., 1971]). In turn when the goodness of the
object is distinguished, this reliance on the object provokes envy. Both of the hostile emotions
brought out by frustration and any alertness of envy are hindered by the omnipotent
narcissistic object relations, especially omnipotent projective identification. Segal supposes that
projective identification used by the psychotic patient is less often a defense against separation
anxiety and more that of a defense against extreme envy that is directly connected to the
narcissism of the patient. She****** proposes ‘If too much resentment and envy dominates
the infant’s relation to the mother, normal projective identification becomes more and more
controlling and can take on omnipotent delusional tones. For example, the infant who in
fantasy enters the mother’s body driven by envy and omnipotence, takes over the role of the
mother, or the breast, and deludes himself that he is the mother of the breast. This mechanism
plays an important role in mania and hypomania, but in schizophrenia it occurs in a very
exaggerated form.’
Melaine Klein, (Spillius et. al. 1988) supposed that projective identification is like fantasy, in this
fantasy the bad parts of the self detach from the remaining of the self; the bad components
and the self both were projected into either the mother or her breast to take over and own her
in a way that she’ll be embodied as the bad self. Nevertheless, Klein believed that the good
parts of the self were projected also, to boost the ego and the welfare of the object relations;
but this procedure didn’t bring forth successful results.
Klein states that a very troubled personality is mainly created when the patient extremely uses
the defenses of ego splitting, projective identification, fragmentation, introjection and
idealization and especially that of splitting and projective identification. She also declares that
‘the introjection of the good object, first of all the mother’s breast’ is a ‘precondition for normal
development’.
References within the primary reference of Spillius, 1988 (cited at the end of this document)
*Herbert Rosenfeld- ‘Contribution to the psychopathology of psychotic states: the importance of
projective identification in the ego structure and the object relations of the psychotic patient’
HERBERT ROSENFELD This article was first published in 1971 in P.Doucet and C.Laurin (eds)
Problems of Psychosis, The Hague: Excerpta Medica, 115–28
**‘Depression in the schizophrenic’ HANNA SEGAL This article was first published in 1956 in the
International Journal of Psycho-Analysis 37:339–43. The thesis of this paper is that, in the course
of development, schizophrenics reach the depressive position and, finding it intolerable, deal
with it by projecting their depressive anxieties.
***Segal’s paper ‘Some aspects of the analysis of a schizophrenic’ (1950)
****In her paper ‘Notes on symbol formation’ (1957) Segal suggests the term ‘symbolic
equation’ for this process: she writes: ‘The symbolic equation between the original object and
the symbol in the internal and external world is, I think, the basis of the schizophrenic’s concrete
thinking.’
*****‘The psychopathology of narcissism’ Segal’s Paper, (1964)
******In her paper ‘Object relations of an acute schizophrenic patient in the transference
situation’ (1964) Segal tried to trace the origin of the envious projective identification in
schizophrenia.
**Original text from: ‘Depression in the schizophrenic’ HANNA SEGAL This article was first
published in 1956 in the International Journal of Psycho-Analysis 37:339–43. The thesis of this
paper is that, in the course of development, schizophrenics reach the depressive position and,
finding it intolerable, deal with it by projecting their depressive anxieties.
Segal, H. (1956) as cited by Rosenfeld, 1971, withinin Elisabeth Bott Spillius (1988) Melanie Klein
Today, Volume 1, London: Institute of Psycho-Analysis. Retrieved from
http://www.slideshare.net/carinh/melanie-klein-today-1:
‘…The next day she came extremely late, about ten minutes before the end of the session, and
when I suggested that she was afraid to come lest I should suck her blood out, she immediately
started complaining of my dragging things out of her, doing it even in her dreams. Then she
added that perhaps it was because of this that she had to fly to the ‘ideal people’ inside herself
(we knew by then that she had two kinds of hallucination, one of an extremely persecutory and
one of a very ideal character). In the following hour she came on time and continued to talk
about the ‘ideal people’ inside her. I knew from earlier material that many of her hallucinations
were based on characters from books which she used literally to devour in order to create
inside herself a hallucinatory world based on the characters from the books, with some of
which she also identified. I interpreted to her that she treated me in a manner similar to that in
which she treated books, taking in my interpretations and using them to create pleasurable
hallucinations inside herself. She said that she knew that, and added that she knew she was
draining life out of me. Then she gave me a long look and said that sometimes when vampires
were in love they would not kill their victim outright but do so slowly, by degrees, enjoying the
sucking enormously. In the next few sessions we could get at her various feelings about me in
the situation of vampires. She had felt that her love for me, like her love for the breast, was as
dangerous as hatred in its cruelty and its greed, and that by being silent and making me talk she
was sucking my life blood by slow degrees and building something wonderful inside herself that
she was not sharing with me. Whereupon I was becoming emptied, and I slowly became the
vampire sucking life out of her, taking away her good hallucinations, persecuting her and
threatening to kill her. She dreaded cure because cure to her meant being exorcized, and being
exorcized meant that it would be discovered that it was she who was the vampire to begin with
and that she would be made to die. She felt that the situation could only end in death…’
References
Merino, L. (2011) 15 common defense mechanisms - SlideShare. Retrieved from
http://www.slideshare.net/Lucia_Merino/15-common-defense-mechanisms
Spillius, E. B. (1988) Melanie Klein Today, Volume 1, London: Institute of Psycho-Analysis.
Retrieved from http://www.slideshare.net/carinh/melanie-klein-today-1