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The Idea of This paper dates back 18 months, when I first read John Steiner's book Psychic Retreats: Pathological Organisations in Psychotic, Neurotic and Borderline Patients'.1
John Steiner is a Kleinian analyst who works in private practice and was also, until recently, a consultant psychiatrist at the Tavistock Clinic. His book sets out to describe and understand clinical experiences with groups of patients who are ‘difficult-to-reach’2 and ‘make meaningful contact with’.3 The term ‘psychic retreat’ is introduced to refer to ways in which the patient can withdraw from such contact into states which are ‘often experienced spatially as if they were places in which the patient could hide’.4
Such states may appear, consciously or in unconscious phantasy, as literal spaces: a house, cave, fortress, desert. But they may also take an ‘inter-personal form, usually as an organisation of objects or part objects which offer to provide security (and which) may be represented as a business organisation, as a boarding school, as a religious sect, as a totalitarian government or a Mafia gang’.5 The patient appears, as it were, to be in liege to this organization, which may be simultaneously feared and idealized.
In his book, Steiner seeks to trace the origin of such states of mind in the patient's attempts to ward off or gain relief