Forms of “folie-à-deux” in the couple relationship
James Fisher suggests that the various forms of folie-à-deux constitute particularly insidious shared defensive patterns motivated by an intolerance of both separation and closeness in the couple relationship. In an interview in 1995, Meltzer suggested that "mutual projective identification in action" is an important couple phenomenon, which is distinct from the schizoid mechanism that Melanie Klein described. An intimacy premised on the reality of separateness exposes the couple to separation anxieties that are unbearable because they make the Other appear to be alien. In working with couples, it may appear to be overstating the challenge we face as therapists to talk in terms of the psychiatric diagnosis of a folie-à-deux. The phenomenon of a shared psychosis is a well-known, although relatively rare, psychiatric condition. The identificatory aspects concern transformations of the self- for example, grandiosity, psychotic depressive states, hypochondria, confusional states.