ABSTRACT
In 1954 Edith Jacobson discussed the identifications of the delusional schizophrenic patient who may eventually consciously believe himself to be another person. She rdates this to early infantile identification mechanisms of a magic nature which lead to 'partial or total blending of the magic self and object images, founded o n phantasies or even the temporary belief of being one with or of becoming the object, regardless of reality'. In 1967 she describes these processes in more detail. She discusses 'the psychotic's regression to a narcissistic level , where the weakness of the boundaries between self and object images gives rise to phantasies, or experiences of fusion between these images . These primitive introjective or projective identifICations arc based on infantile phantasies of inco rporation, devouring, invading (forcing oneself into), or being devoured by the object'. She also says 'We can assume that such phantasies, which pre-suppose at least the beginning distinction between self and object, are characteristic of early narcissistic stages of development and that the child' s relation to the mother normally begins with the introjective and projective processes'; and that the 'introjective and projective identifICations (of the adult patient) depend on the patient's fixation to early narcissistic stages and upon the depth of the narcissistic regression'. In discussing clinical material of the Patient A she described this fear that :my affectionate physical contact might bring about experiences of merging, which in turn might lead to a manifest psychotic state. Her views that the introjective and projective identifications observed in the adult patient depend on the fixation to early narcissisti c phases where these identifications originate, seem identical with my own views and there is nothing in her clinical and theoretical observations which I have quoted above with which I would disagree. She stresses, however, that she differs from Melanie Klein and my own opinion in so far as she does not believe that the projective identifications of the adult patient observable in the transference or acted out by the patient with objects in his environment are in fact a repetition of the earl y infantile projective and introjective processes, but are to be understood as a later defensive process, as in her view early processes cannot be observed in the transference. She also disagrees with my analytic technique of verbally interpreting the processes of projective identification when they appear in the transference, which I regard as of central importance in working through psychotic processes in the transference situation. ]
communication. Many psychotic patients use projective processes for communication with other people. These projective mechanism:; of the psychotic seem to be a distortion or intensification of the normal infantile relationship, which is based on non-verbal communication between infant and mother, in which impulses, parts of the self and anxieties too difficult for the infant to bear are projected into the mother and where the mother is able instinctively to respond by containing the infant's anxiety and alleviating it by her behaviour. This relationship has been stressed particularly by Bion. The psychotic patient who uses this process in the transference may do so consciously but more often unconsciously. He then projects impulses and parts of himself into the analyst in order that the analyst will feel and understand his experiences and will be able to contain them so that they lose their frightening or unbearable quality and become meaningful by the analyst being able to put them into words through interpretations. This situation seems to be of fundamental importance for the development ofintrojective processes and the development of the ego: it makes it possible for the patient to learn to tolerate his own impulses and the analyst's interpretations make his infantile responses and feelings accessible to the more sane self, which can begin to think about the experiences which were previously meaningless and frightening to him. The psychotic patient who projects predominantly for communication is obviously receptive to the analyst's understanding of him, so it is essential that this type of communication should be recognized and interpreted accordingly.
