Primitive Anxiety And Delusions Of Demonic Influence In Borderline And Schizophrenic Disturbance

Both of the patients mentioned above exemplify the turmoil of primitive anxiety and identity loss contaminated by a persecutory satanic presence. Like the clinical work with these two patients, a fictional analysis of the therapeutic process with Count Dracula would have shaped an interactional struggle to locate satanic aspects of the self and to remain free from fragmentation. The followers of Sullivan as well as the British object-relations theorists have stressed the effects of components of primitive anxiety during the analytic exchange. In Klein’s thinking, psychotic states contain elements of greed and the fantasized destruction of the envied breast, whereas Fairbairn finds oral conflicts and the fear of fusion in even the most regressed schizophrenic’s fantasies. For Sullivan and more contemporary interpersonalists, the primitive anxiety of psychotic states stems from unimaginable dissociated anxieties, while even the most bizarre symptoms serve defensive purposes for the seriously disturbed patient who is invited to join a collaborative inquiry about the dynamics of his or her illness.

Current psychoanalytic theories about severely impaired relatedness have surpassed either simple deficit or conflict models in favor of internalized relational configurations in core psychotic states. With the emergence of overtly psychotic states during analytic work, referential processes about satanic intrusion reflect impending identity loss and enactments of dissociated aspects of primitive anxiety. From an interpersonal perspective, re-created threats of annihilation and identity loss involve mutative, dyadic interactions that exceed either projection or the containment of projections. The analyst’s potential impact on the psychotic or borderline patient’s threatened self-cohesion, therefore, merits as much scrutiny as does the patient’s involving the analyst in the anxieties of nonhuman or demonic relatedness.