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In the first two Chapters I have traced the early phases of the analytic process, first the gathering of the transference processes into the treatment, and second the differentiation of self and object which is brought about by the systematic investigation of the operation of massive projective identification, as it is intensified in the transference in relation to separation. It seems clear that, since massive projective identification can function to counter any configuration producing psychic pain at infantile levels, no other problem can really be worked through until this mechanism has been to some considerable degree abandoned. In the neurotic patient this may be accomplished in a matter of months or a year of analysis, but in borderline and psychotic patients it is the major work, taking years—and its accomplishment represents an analytic achievement of the first order. In fact, as I have said it would probably be called the crucial step in establishing fundamental health and removing the danger of psychotic deterioration.
The relinquishment of this mechanism for escaping from the dilemma of infantile distress makes possible the establishment of a limited type of dependence. We have come to call this the “toilet-breast” relationship in order to designate the purely expulsive aim and part-object experience. It would appear that before the internal “toilet-breast” has been established the unavailability of an object in the outside world capable of containing such pain throws the ego back on massive projective identification with an internal object: if this fails to control the anxiety, states of schizophrenic withdrawal into delusion or autistic fragmentation, separately or in tandem, appear to be the only recourse.