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I would like to present some material from a patient suffering from severe and extensive phobias, in order to illustrate some connections between early psychotic anxieties and defences and a common neurotic symptom. I shall try to show that certain paranoid schizoid mechanisms, particularly disintegration of the ego and projective identification, described by Melanie Klein2 in 1946, underlie my patient's phobias.
My patient is a woman in her late thirties who had had severe difficulties from childhood onwards, as far back as she can remember, particularly difficulties in relationships, feeding difficulties, and numerous phobias. By the time she sought analysis she was gravely ill.
Her symptoms, of which I shall mention only a few, could be divided into three categories:
a.Personality disturbances: she often felt depersonalized and unreal. She could form no relationship except on the basis of totally controlling her objects. She could not lead her own life and she was severely inhibited in work. These last two aspects of her personality and their relation to projective identification I described in my paper 'A Psycho-Analytic Contribution to Aesthetics', 3 where this patient is referred to as patient E.
b.Various hypochondriacal and hysterical symptoms, which had led in the past to numerous surgical interventions.
c.Extensive phobias, particularly of crowds, and a phobia of food, leading to such severe anorexia that prior to her analysis the patient had to be hospitalized. She had a great fear of restaurants, i.e. crowded places where one eats food.
In the first two years of her analysis certain features were prominent, especially the violence of her transference feelings and their markedly delusional character, varying between extremes of persecution and idealization. Also, a total inability to bear frustration in any form. She felt that if I were at her bedside giving her food at the moment she woke up, she would be able to eat it: but if she had to wait for it