ABSTRACT
In recent years there has been an increasing awareness amongst analysts that behind the neurotic aspects of the patient’s personality there lies hidden a psychotic problem which needs to be dealt with to ensure real stability. This was particularly highlighted by Bion in his seminal paper on the differentiation of the psychotic from the non-psychotic part of the personality (1957). However, I do not feel that this is still fully recognised. In the course of a periodic review of the progress of my analytic practice, and particularly of my patients’ habitual modes of communication, I became aware that certain among them whom I thought of initially as being only mildly neurotic, some of whom were also analytic candidates, revealed during the course of treatment phenomena familiar in the treatment of autistic children. These patients were highly intelligent, hard-working, successful and even prominent professionally and socially, usually pleasant and likeable, who came to analysis either ostensibly for professional reasons or because of a failure to maintain a satisfactory relationship with a husband or wife. It gradually became clear that in spite of the analysis apparently moving, the regular production of dreams, and reports of progress, there was a part of the patient’s personality with which I was not in 174touch. I had the impression that no real fundamental changes were taking place. There is an obvious parallel with what Winnicott has called the false self (1960), and which Rosenfeld has termed “psychotic islands” in the personality (1978), but I do not think these terms quite do justice to what may be described as an almost impenetrable cystic encapsulation of part of the self which cuts the patients off both from the rest of their personality and the analyst. This encapsulation manifests itself by a thinness or flatness of feeling accompanied by a rather desperate and tenacious clinging to the analyst as the sole source of life, with an underlying pervasive feeling of mistrust, and a preoccupation with the analyst’s tone of voice or facial expression irrespective of the content of the interpretation. There is a constant expectation of hostility and a tendency to become quickly persecuted at the slightest hint of the analyst’s irritation or disapproval. Consciously the analyst is idealised as an extremely powerful and omniscient figure who also occurs in this guise in the patient’s dream. As a concomitant, the patient denies his persecutory feelings in spite of the evidence subsequently given by dreams and other analytic material. For example, one patient offered to raise her fees as she felt so well, and I accepted her offer. The next night she dreamed of a large white vampire bat and of a baby wriggling to escape from a tube being put into its foot for a blood transfusion. It was obvious that although she had offered to raise the fees herself she experienced me as a vampire-like breast which was sucking her dry instead of filling her with life. Nevertheless her fear of me led to a firm denial of her persecutory feelings.
