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Catch-22 (Heller, 1962) is a black comedy novel about death, about what people do when faced with the daily likelihood of annihilation. For the most part what they do is try to survive in any way they can. The book begins, “The island of Pianosa lies in the Mediterranean Sea eight miles south of Elba.” That is the geographical location of the action. Much of the emotional plot of the book turns on the question of who's crazy, and I suggest that it is illuminating to look at its world in Kleinian terms. The location of the story in the inner world is the claustrum—a space inside the psychic anus, at the bottom of the psychic digestive tract, where everyone lives perpetually in projective identification, and the only value is survival. If one is expelled from the claustrum, there are only two places to go: death or psychotic breakdown (Meltzer, 1992). What people do in these circumstances is to erect individual and institutional defences against the psychotic anxieties engendered by unconscious phantasies of the threat of annihilation. These defences are extreme, utterly selfish and survivalist.
In certain institutional settings they are erected against death itself and correspond to what Joan Riviere called in her essay “On the Genesis of Psychical Conflict in Early Infancy” (1952), “the deepest source of anxiety in human beings” (p. 43). She suggests “that such helplessness against destructive forces within is ubiquitous and constitutes the greatest psychical danger-situation known to the human organism …” (ibid.). Isabel Menzies Lyth argues that these anxieties are reevoked in the work of nurses, where death is present