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Our Modern dynamic concept of paranoia and paranoid schizophrenia has evolved from Freud's analysis of a patient whom he never met in person: from the analysis of the celebrated Schreber case.1 Nearly half a century has passed since its publication and one may well ask today what would have happened had Freud developed his theory of paranoid delusions on the basis of direct clinical observation, particularly in psychotic children of the symbiotic versus the autistic type, as they were described by Margaret Mahler,2 Mahler and Elkish,3 Mahler and Gosliner,4 Leo Kanner,5 and many others.
It is needless to say that the question cannot be answered on its own merits. All we can do is try to forget, at least for a brief moment, what we have learned from S. Freud,1 S. Ferenczi,6 G. Bychowski7 and many others about the mechanisms of projection of repressed homosexual drives; about the introjection of parental images; the release and externalization of the introject, and so on and so forth. Having thus made our mind a blank (if this is altogether possible), we can try and look at our clinical material in a new light and draw our own conclusions. Once this is accomplished we may try to fill in our amnestic gap again and compare whatever conclusions are suggested by our data with more generally accepted propositions concerning paranoid psychodynamics.
Our first illustrative case is that of a pre-psychotic child and his obsessive-compulsive mother. Mrs. C., the mother, is a frustrated actress, a glamorous woman of 40, married to a rich banker 20 years her senior. The marriage was unhappy from the outset. Mrs. C. saw in her husband a revival of her own compulsive father, and her attitude toward him was one of childish dependence and rebellious defiance. Extra-marital affairs, alcohol, and occasional stage appearances were her outlets from what she felt was the golden cage of her married life. Their only child, Dick, was conceived when she was 36, during one of her affairs with oth