Transference and Defence in Manic States

The aim of this paper is to describe some of the special features and difficulties in the transference in the analysis of manic states. In view of the fact that manic defences occur in both neurotic and borderline cases, I hope that the extreme pathological features shown here will also be helpful in understanding transference phenomena in less disturbed patients. I intend to present some suggestions as to the underlying factors in the production of mania. My main point is that mania is a massive defence arising from failure of the containing processes which normally occur in the infant–mother relationship, and which results in a catastrophic fragmentation of the ego.

The patient whose material I use to illustrate my thesis was admitted to hospital at the age of 20 in a state of catatonic stupor. He gradually improved over a period of three years until it was felt he might benefit from analysis. The salient features of his history, as elicited from his parents, were that his mother had never wanted him, was disgusted by physical contact with him, and usually used to put him in a pram and leave him in the garden even as a very small baby. She could remember no details of his later behaviour or development, and seemed completely devoid of any emotional contact or insight into his difficulties. He has one brother, seven years younger, who was said to be normal. The boy went to a public school at the age of 13 and the parents were very surprised when they were asked to take him away when he had an acute psychotic breakdown three years later. Following this, he had several admissions to mental hospitals and had ECT drugs, etc., without improvement. Father was a bluff, hearty, extravert man, who seemed to be more sympathetic to his son's difficulties than his wife. However, I think he welcomed the analysis because it got rid of his own responsibility for the boy.

From the beginning of the analysis the patient refused to use the couch, and sat facing me in a chair