Chapter 11 Psychosis: Not Thinking in a Bizarre World

Bion often mentioned his indebtedness to Freud and Klein for the foundations of psychoanalytic thinking on psychosis. As an introduction to the exposition of Bion, I shall give the briefest of sketches of them both. Central to Freud’s view of how psychosis differs from neurosis, and how neurosis in its turn differs from more normal states, is the ego’s relation to reality. In its normal condition the ego is largely governed by what Freud called the ‘reality principle’, reality, ‘internal and external, being made known to the ego by the senses, by consciousness and by thinking’. In Freud’s words:

one of the features which differentiate a neurosis from a psychosis [is] the fact that in a neurosis the ego, in its dependence on reality, suppresses a piece of the id (of instinctual life), whereas in a psychosis, this same ego, in the service of the id, withdraws from a piece of reality.

That is, in neurosis the relation to reality is retained at the cost of instinctual repression, while in psychosis the relation to reality is lost. The psychotic ego has a need to find some substitute for the reality it has lost – for example, in a delusion – which Freud sees as an attempt at cure. Moreover, as a result of his researches, Freud also became convinced of a proclivity for psychosis in us all. He writes:

From the very beginning, when life takes us under its strict discipline, a resistance stirs within us against the relentlessness

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and monotony of the laws of thought and against the demands of reality-testing. Reason becomes the enemy which withholds from us so many possibilities of pleasure.

The loss of reality, delusional attempts at cure, and intrinsic hatred of thought and reality are Freud’s main ideas.

Klein approaches psychosis via anxiety. It is her view that our earliest anxieties are psychotic in content. The normal development of infants, she writes, ‘can be regarded as a combination of processes by which anxieties of a psychotic n