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The theme of this paper is that the differentiation of the psychotic from the non-psychotic personalities depends on a minute splitting of all that part of the personality that is concerned with awareness of internal and external reality, and the expulsion of these fragments so that they enter into or engulf their objects. I shall describe this process in some detail and shall then discuss its consequences and how they affect treatment.
The conclusions were arrived at in analytic contact with schizophrenic patients and have been tested by me in practice. I ask your attention for them because they have led to developments in my patients which are analytically significant and not to be confused, either with the remissions familiar to psychiatrists, or with that class of improvement that it is impossible to relate to the interpretations given or to any coherent body of psycho-analytic theory. I believe that the improvements I have seen deserve psycho-analytic investigation.
I owe my clarification of the obscurity that pervades the whole of a psychotic analysis mainly to three pieces of work. As they are crucial for understanding what follows I shall remind you of them. First: Freud's (2) description, referred to by me in my paper to the London Congress of 1953 (1), of the mental apparatus called into activity by the demands of the reality principle and in particular of that part of it which is concerned with the consciousness attached to the sense-organs. Second: Melanie Klein's (5) description of the phantasied sadistic attacks that the infant makes on the breast during the paranoid-schizoid phase, and third: her discovery of projective identification (7). By this mechanism the patient splits off a part of his personality and projects it into the object where it becomes installed, sometimes as a persecutor, leaving the psyche, from which it has been split off, correspondingly impoverished.
Lest it be supposed that I attribute the development of schizophrenia ex