ABSTRACT
This chapter presents some clinical examples which illustrate a range of psychotic mechanisms grouped very roughly according to their most prominent features. All the cases were involved in psychoanalytically based psychotherapy, usually of long term, and four were in formal four-time weekly psychoanalysis with experienced psychoanalysts. It illustrates the way in which projective expulsion of unwanted feelings and intentions into an object can distort perception of the container, and lead to re-introjection of a now-dangerous object. It became clear that it was women murderous jealousy of younger siblings that had found expression in this delusional belief, and the likelihood of traumatic perinatal experience was presented by a history of foetal distress and a depressed mother. There are different psychodynamic pathways to paranoid delusional beliefs, and there are individual variations in the subject’s capacity to begin to be able to doubt his own delusional explanations of the psychotic experiences.
