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The author investigates the reasons why, in serious pathologies, the pull toward self-destruction ceases to be a sign of alarm and becomes the pleasure of self-destruction. Beginning with the Freudian idea of death drive and its subsequent transformation by M. Klein, Winnicott, Rosenfeld, and H. Segal, De Masi considers Smirgel's (1986) position, linking the death instinct to pleasure, reversing the hypothesis Freud made in 1920.
In the following development of his work, the author makes a hypothesis about the link between narcissism and the death instinct and asks the following question: “What is it that attracts the patient so much to estrange him from this link?”
The analysis of the “foetus condition” toward which the patient moves is considered: on the one hand, as a mental status protecting from over-stimulation; on the other, for some other analysts, e.g., Segal (1993), it is a violent process, self-mutilating, involving the need to cut the sense organs. The clinical stories of two psychotic patients clarify the author's position. He considers the return to a foetus condition as dismantling the sense organs, as destruction of the psychic apparatus and emotional and relational reality, an operation of de-mentalization and decapitation. The effect is to close one-self in a pleasant sensorial prison whenever the drive for life arises again, a prison which it is not easy to get out of. The analyst has to take into account the pain these patients have to deal with and their means of facing it.