Psychoanalysis of a Case of Paranoia

“Every beginner in analysis experiences some anxiety at first in anticipation of the difficulties he will encounter in the interpretation of his patients' associations, and in the task of uncovering repressed material. He will soon learn, however, to minimize these difficulties, and exchange for it the alternate conviction that the only really serious difficulties are those met with in the handling of the transference.” —Freud.1

With the appearance of his article, “Psychoanalytische Bemerkungen ueber einen autobiographish beschriebenen Fall von Paranoia,”2 Freud had made the paranoid syndrome accessible to analytic investigation. Following this, other analysts contributed a number of important studies on the same topic. Since it became apparent that the analysis of an acute psychosis was technically impossible, an attempt was made to circumvent this difficulty, either by substituting a series of analytic observations in place of an actual analysis, or to attempt a real analysis in cases, where patients showed some insight into their illness, or where they had already recovered from their acute psychotic episode.

I had occasion to analyse a patient who some years previously had suffered a severe attack of paranoia, for which he had been hospitalized for several months. Although the patient had entered analysis for other reasons, it soon became apparent that basic paranoid