‘Psychopathology and Primitive Mental States’ by Robert Caper

Caper's paper is a discussion of ‘primitive’ mental states and focuses on the question of whether or not psychological illness in an adult can be thought of as a regression or fixation to a ‘primitive’ mental state (representing an early stage of normal development). An intensive discussion of fundamental issues raised by this question followed, although it took place between a small number of discussants. The paper begins by reviewing observations by Freud and others on the subject. Freud described an early egg-like state of hallucinatory gratification based on the pleasure principle (Freud, 1911). This state of unreality is usually only partially successful, as physical needs supervene (e.g. hunger), which indicates that the lack of contact with reality is not total. Klein, Bick, Bower, Stern and Emde, amongst others, have confirmed the validity of Freud's view—Caper feels that Emde's work on the mutuality of attunement between mother and infant is particularly relevant (Emde, 1988a, b).

Caper argues that there must exist from birth awareness of separateness of an object which permits learning from experience. The child's outlook will be modified by experience, and whatever magical thinking that might occur will also be altered. He draws a parallel between what he sees as ‘unconscious magical thinking’ in infants and delusional thinking in adults. Lack of modification will result in the infant being seen as abnormal. Caper states that an ill adult is not an older version of a normal child; the illness is the outcome of a non-progression from an already abnormal state. Failure to learn from experience in order to modify infantile delusions (in Kleinian terms, omnipotent unconscious fantasies of splitting, projection and introjection) leads to an experience of self and object as idealised (positively and negatively). There occurs identification with a good self/object and dis-identification with (ejection of) a bad self/object. Paranoid-schizoid thinking