You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In recent years there has been an increasing awareness among analysts that behind the neurotic aspects of the patient's personality there lies hidden a psychotic problem which needs to be dealt with to ensure real stability. This was particularly highlighted by Bion (1957) in his seminal paper on the differentiation of the psychotic from the non-psychotic part of the personality. However, I do not feel that this is still fully recognised. In the course of a periodic review of the progress of my analytic practice, and particularly of my patient's habitual modes of communication, I became aware that certain among them whom I thought of initially as being only mildly neurotic, some of whom were also analytic candidates, revealed during the course of treatment phenomena familiar in the treatment of autistic children.
These patients were highly intelligent, hard-working, successful and even prominent professionally and socially, usually pleasant and likeable, who came to analysis either ostensibly for professional reasons or because of a failure to maintain a satisfactory relationship with a husband or wife. It gradually became clear that in spite of the analysis apparently moving, the regular production of dreams and reports of progress, there was a part of the patient's personality with which I was not in touch. I had the impression that no real fundamental changes were taking place. There is an obvious parallel with what Winnicott (1960a) has called the false self and which Rosenfeld (1978) has termed ‘psychotic islands’ in the personality, but I do not think these terms quite do justice to what may be described as an almost impenetrable cystic encapsulation of part of the self which cuts the patient off both from the rest of his personality and the analyst. This encapsulation manifests itself by a thinness or flatness of feeling accompanied by a rather desperate and tenacious clinging to the analyst as the sole source of life, accompanied by an underlying pervasive fe