Chapter 8. The Role of the Claustrum in the Onset of Schizophrenia*

My clinical experience over the years, of analytic work with adults and children, normal, borderline and psychotic, and a wide supervision component of my work, has resulted in the building of a model of the mind, based chiefly on the work of Freud, Abraham, Klein and Bion, in which the geographic dimension of structure is very central. The “worlds” in which human mental experience takes place are various, at least four in number, fundamentally: outside, inside and the interior of internal and external objects. To this must be added, in the case of schizophrenic phenomena, a fifth world which is essentially “nowhere”, that is, having no dynamic or structural links with the other four. This I see as the world of the delusional system while the other four are dimensions of psychic reality.

Given that the human personality is never unified but variously unintegrated and riven by splitting processes, the theoretical problems encountered in the clinical approach to the schizophrenias may be seen, grossly speaking, as three in number: how does the delusional system form? how does a part or parts of the personality come to live in this “nowhere” world? and what are the factors which determine the access to consciousness of the mental state of such deluded part or parts? Here I wish to focus attention on the second of these questions, but to give it substantial texture it is necessary to indicate very briefly my approach to the other two.

The delusional system is similar to “Man's Picture of His World”, in the sense of Money-Kyrle, something that is built bit by bit by “learning from experience” in Bion's sense. The delusional system is constructed bit by bit in parallel with the building of the worlds of psychic reality. But just as they are constructed through successful symbol-formation and by introjection of received symbols, the delusional system is built up from failed symbol-formation — what Bion has called the