Concern: Spurious Or Real

This paper is about a group of patients who appear to show excessive concern for their objects, reflecting a combination of a real wish for reparation alongside an attitude of hostility and superiority towards the object. Detailed clinical examples from two patients are used to illustrate a certain combination of characterological defences in these patients who have been severely deprived, and overcompensate for this experienced deprivation by the expression of excessive concern for an object that is simultaneously experienced as hostile and frustrating. Side by side with the partial achievement of the depressive position there is an early ‘take over’ of the breast, in which the infant ‘becomes’ the breast and shows behaviour which is in part a fake of a very concerned mother. The paper includes a discussion of some of the technical problems in dealing with such patients, and stresses the need for distinguishing between what is real and what is false; it suggests that what is required is a balanced or ‘two handed’ approach, in which there is firm handling of the manic or pretentious ‘take over’ together with a sympathetic understanding of the underlying vulnerability of these patients.

In this paper I want to focus on a group of patients who appear to show excessive concern for their objects. This concern, while partly related to a real wish for reparation, simultaneously shows itself to be a reaction formation against an attitude of hostility and superiority towards the object. This superiority is based on a manic ‘take over’ of the maternal function.

A capacity for concern is one of the characteristics which, according to Klein, develops in the course of the depressive position. However, in her paper on ‘Anxiety and guilt’ she makes this emendation:

There appear to be transitory states of integration even in very young infants … which give rise to depressive anxiety, guilt and the desire to make reparation … As an alternative method, very likely a simulta