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This paper is mainly a contribution to the psychotherapeutic management of violent and murderous patients, and also illustrates Dr. Searles's interviewing technique, wherein he attempts in one consultation to assess the personality structure of the patient through his own countertransference reactions. In his summary Dr. Searles stresses that he has highlighted various concepts relating to the schizophrenic's superego and the poor differentiation between the human and non-human ingredients in the schizophrenic's world. These latter aspects, however important and interesting they may be, do not come through very convincingly in the interviews, but this is hardly surprising; the personality structure and confusions of the schizophrenic often need very detailed psychoanalytic investigation to be properly understood.
I myself have never treated anybody who actually committed a murder. However, several of my acutely schizophrenic patients were violent and some of them suffered from delusions of having committed murder. I also treated a young married woman doctor, more than 20 years ago, who suffered from a severe syphilophobia which at times was clearly delusional. She had violent murderous impulses against her infant, particularly for the first three months of the baby's life, and she came for treatment soon after her confinement because she was convinced that without treatment her child's life was
in real danger. While the severe syphilophobia related to an act of unfaithfulness to her husband several years previously, the illness as a whole had to be regarded as a post-partum psychosis, and was related to an intense projective identification of herself with the newborn infant, whom she mis-identified as her sick paranoid baby self which she had never been able to accept and which she regarded as not human. Her murderous hatred against this self was also projected into the analyst, representing the mother; she constantly feared that the analyst could not stand her and