Saturday, December 20, 2014

paranoia and dissociation (depression)

Before I turn to Klein I would first like to say that social ontology illustrates that every level of development seems to have a corresponding type of paranoia. The phallic level of having one’s reputation ruined can be contrasted to the auto-erotic level and the father imago of Space in which the ‘end of the world’ (and indirectly the paranoiac along with it) is also a very easily recognized form which Freud (914b) mentions in ‘On Narcissism’ (p. 76). At the anal stage there is the reference to secret groups that have more power than the officialized institutions of civilization (i.e. CIA, the Illuminati, etc.). I expect variations of these to exist and that they might follow the proto and deutero distinctions, but I believe that this will suffice to show the levels of Perfection that are in play. The last level, the narcissistic, is the one that Klein and others make the most of. Instead of a reference to social hierarchy the narcissistic stage involves figures that aren’t referenced by their social power. So while there are those that can influence one’s reputation at the phallic, or those that belong to powerful, secret groups that will end one’s life at the anal, at the narcissistic stage one’s “killer” or slanderer can be anyone. Although, this “anyone” will be given the coloring of being magical, monstrous, or other-than- human since the narcissistic stage references humanity in general (Economics, p. ?). Additionally, as always, there might be some confluence at work with other levels of Being. This means that someone at the top of social hierarchy as a celebrity or powerful figure may be selected with both his or her magical/monstrous aspects and position of power or influence is referenced too.  

Although the specific content of the phantasy involved in paranoia can reference the different levels of social ontology, Klein’s analysis directs us to a stage specific etiology. However, this stage changes. In one of her last accounts it is the auto-erotic stage which seems primary. She writes:

I have formerly also expounded my contention that paranoia is based on the distrust and hate of the internalized penis of the father (see in this connection my comments about the ‘Wolf man’, Psycho-Analysis of Children, Chapter IX). Further work has led me to link that distrust and hate of the internalized penis of the father with the relation to the mother's breast, for hate and distrust of the breast are transferred to the penis of the father. All these factors seem to me of importance in the understanding of paranoia (Klein, 1961, p. 279).

Here she references the importance of the part-objects of the auto-erotic stage and the transcription of power from the (part) mother imago to the (part) father imago. As mentioned in Economics, Klein holds that anxiety situations appear not just in triangular situations with father-substitutes but also in the defence of projective identification in which one assumes the place of the parental imago in order to project one’s triangular (including primal scene) anxiety into another person. In this way paranoia enshrines the triangular relation so that even when one assumes the position of the father-substitute and identifies with someone of a lower generation/class/or person of less prestige, in whom he causes anxiety, there is still the fear that this person wants to usurp one and may actually be successful. Thus, in the myth of the Greek gods, the basic state of paranoia is in the oracle foreseeing that a god’s son will overthrow him and this is seen in Cronos, for example, swallowing up all his children to avoid this[1]. In part-object language Klein writes that paranoia:   

is an instance of projective identification which is quickly followed by, and possibly simultaneous with, internalization. The fear of the object attacked by hostile projective identification (such as bad faeces put into it) in turn increases the feeling that the object will intrude into the subject. It is important to distinguish in analysis between this fear of being intruded into by the object with whom projective identification has occurred and the process of introjecting the hostile object. In the former case the ego is the victim of the intruding object, while in introjection it is the ego which sets the process in motion, even though it is bound to lead to persecutory anxiety (279-280)

As investigated in the last chapter, Klein appears to be differentiating projective identification from what was compared to a vertical repression in which the need for punishment makes one get off on bringing about castration anxiety from a father-substitute. So, Klein is saying that non-verbal arrogant and vain behavior that induces a subject egoist’s father-substitutes to attack his image and bring about his “castration” (anxiety) is one thing, but that paranoia from the assumption of the place of the father-imago is another thing[2]. Fairbairn (1952) also seems to agree that paranoia consists of something more than just  “the projection of repressed impulses, as is commonly supposed, but in the projection of repressed objects in the form of persecutors” (p. 75). He uses “techniques” to describe the paranoid defense, along with the others, and this implies that some operation involving the ego and the repressed drive-object relation is in order, as opposed to just a regression to a specific stage.

In Psychoanalysis of Children Klein (1932) locates the etiology of paranoia in the “earlier anal stage” but in an earlier work she clarifies that this is synonymous with Freud’s narcissistic stage (p. 207 fn). “My conclusions are in agreement with Freud's hypotheses,” she writes, “according to which the fixation-points of dementia præcox [schizophrenia] and paranoia are to be sought in the narcissistic stage, that of dementia præcox preceding that of paranoia (Klein, Importance of Symbol, p. 38). In this view, Klein seems to regard auto-erotic absolute narcissism with narcissistic stage primary narcissism as closely related but recognizes a difference between them in regard to etiology. This gives us an important distinction between paranoid schizophrenia and paranoia in other forms that don’t have the delusional certainty but have the same feelings that are also mixed with borderline or neurotic doubt.      

In ‘A Contribution to the Psychogenesis of Manic-Depressive States’, as in many other places, the reference to feces and part-object castration anxiety in many stages is referenced. Thus, despite her desire to reference a certain stage as the stage of paranoia she continues to recognize the confluence of many stages. Additionally, she notes that the “whole object” of the anal stage exists in the paranoiac but that defenses from more primitive or earlier stages will have a more profound influence on the incapacity for later ego and object drives.  She writes

The paranoiac, I should say, has also introjected a whole and real object, but has not been able to achieve a full identification with it, or, if he has got as far as this, he has not been able to maintain it. To mention a few of the reasons which are responsible for this failure: the persecution-anxiety is too great; suspicions and anxieties of a phantastic nature stand in the way of a full and stable introjection of a good object and a real one. In so far as it has been introjected, there is little capacity to maintain it as a good object, since doubts and suspicions of all kinds will soon turn the loved object again into a persecutor. Thus his relationship to whole objects and to the real world is still influenced by his early relation to internalized part-objects and fæces as persecutors and may again give way to the latter. It seems to me characteristic of the paranoiac that, though, on account of his persecution-anxiety and his suspicions, he develops a very strong and acute power of observation of the external world and of real objects, this observation and his sense of reality are nevertheless distorted, since his persecution-anxiety makes him look at people mainly from the point of view of whether they are persecutors or not. Where the persecution-anxiety for the ego is in the ascendant, a full and stable identification with another object, in the sense of looking at it and understanding it as it really is, and a full capacity for love, are not possible (p. 155, emphasis mine).

Three things are important in this passage. The first is that Klein references that a ‘full identification’ or what I’ve pointed to as the father complex or trito stage hasn’t been achieved at the narcissistic stage. The second is that there are also part-object relations from the auto-erotic stage that may occur simultaneously with the paranoia. Generally, we can say that the earlier the defusion the more global and powerful the problems with relating to others is[3]. The third is that at the narcissistic level of Being expressed here both the fear of engaging with humans in general and in the specific ego functions of the “acute power of observation” go together. In the narcissistic stage there is a reference to an external object but, as I expressed in Economics, it is “incomplete” and the drives to relate to it are expressed in omnipotent wishes when defusion exists such as psychic powers, magic, “the secret”, or “evil eye”. Despite this, however, the ego capacity of this stage still deals with perceptions of the external world as opposed to the preoccupation with one’s inner world of phantasy in the auto-erotic.

In Shapiro’s famous ‘Neurotic Styles’ the rigidity of the paranoiac’s perception to investigate his environment, is the objective basis for how the subject phantasy elements adhere to reality[4]. He also recognizes  the assumption of the father imago in the subject egoist as a form but also recognizes paranoia in “furtive, constricted, apprehensively suspicious individuals” along with the “rigidly arrogant, and more aggressively suspicious, megalomanic ones” (p.54). However, the examples of rigid suspicious perception that he gives also seem to range across social ontology. He mentions a patient who quickly scanned his library and noticed a certain book (p. 58). A psychotic paranoid person I worked with would read the paper and find references to himself by tangential associations to the material. Thus, in contrast to social ontology, specific ego functions may be more important in some forms of paranoia and the illusions/delusions of social ontology may not be front and center.

In Economics I referenced Freud’s notion of jealousy at the proto phallic or mother-complex stage in which the individual notices that the love object’s attention or attraction to another man is a cause for jealousy even though it may be unconscious for her. In classic characterology, Reich holds that the phallic stage is the main cause of paranoia. Reich writes that “almost all forms of active and female homosexuality, most cases of so-called moral insanity, paranoia, and the related forms of schizophrenia… belong to the phallic-narcissistic character type”  (p.219). However, Reich’s phenomenological descriptions don’t separate the grandiose or megalomanic type involve in projective identification and the “suspicious” individuals.

Following the centrality of the phallic nuclear complexes we can surmise that the phallic stage is the starting point for the paranoid defense. Then, secondarily, the anal, narcissistic, or auto-erotic stages can provide coordinates for the social ontology of paranoia (reputation, secret groups, end of the world) or the importance of the ego cognition involved in the suspicion.  

If we follow Klein then there should be a schizophrenic stage (auto-erotic), a paranoid stage (narcissistic), and then a depressive stage (anal) and she often regards the first two as similar (i.e. paranoid-schizoid) but not identical. However, we also find in her work the idea of persecutory and depressive anxiety that may not represent the vertical axis but rather the horizontal axis of psychic bisexuality. This isn’t necessarily a contradiction because she also recognizes that intermingling of the active and passive poles and therefore, the anal stage may represent the capacity for the egoistic pole to have depressive features due to this intermingling. I must reserve judgment here until more clinical experience allows me confidence in this matter. 

Because of this intermingling, it should also be salient that a parallel form of persecutory anxiety can arise in the altruistic pole at the anal stage. I’ve had little clinical experience with the grandiose type of subject egoistic paranoia, but enough to have a phenomenological sense for it. However, I’ve had a lot of experience with the altruistic form of paranoia. In this form individuals often don’t have elaborated delusions but simply maintain that they are being hunted by the CIA, police, FBI, etc. and often fear, or are on the look out for, helicopters, suspicious buildings or vehicles, or the appearance of law enforcement leads to intense fear and anxiety. The centrality of law enforcement is a solid link to the anal stage social anxiety of the institution of law enforcement that relates to the individual’s interaction with civilization. In contrast to the grandiose SE paranoia which has anxiety related to projective identification this form references parental substitutes that are seen as above one[5].

I think we should save paranoia as the designation for the subject egoistic defense that is coupled with megalomanic or grandiose features and for the altruistic variety in which reference to law enforcement and the police is highly prevalent. The latter types seem to be an instance of the projection of self-criticism onto the object. In social ontology the object at the anal stage is civilization and the fear of the police means that they don’t have to live with their conscience continually attacking them. In this way both Klein’s formulation and Freud’s formulation have valid insights and can be differentiated clearly in phenomenology and reference to the relations to imagos. It is still important to acknowledge that a person may actually function in another libidinal position but have suffered defusion and enacted the paranoid projective identification defense in the subject egoistic part of their personality. One patient who functioned altruistically was a member of the masons and was interested in secret knowledge and was paranoid of the CIA who seemed to be after him because he grandiosely thought he had important secrets. However, his demeanor wasn’t competitive and concerned with power but was deferential and supportive of others and idealized others. Grandiosity could be inferred from having the CIA watching him but it wasn’t manifested in how he acted with others. In individuals with the subject egoistic position being dominant they are often criminals and there is strong manifest aggression and superiority.       

Conceptual clarity is important in these matters and being able to judge that individuals are “suspicious” of others at the narcissistic stage because of “magical thinking” shouldn’t be described as paranoid. For example, in Tausk’s example of the influencing machine there are phantasies of someone having their mind taken over, having their thoughts “drained off,” feelings the loss of potency or power, being watched, and having certain sensations or thoughts being caused[6]. I can understand how someone might call these suspicions “paranoid” but all these examples cite a lack of separation from the social or sexual object that illustrates a magical/supernatural connection that is a cause of anxiety. Grandiose projective identification or people who often can’t say no to others and are caring or warm to others but fear law enforcement for something wrong they’ve done (anal) or loss of reputation (phallic) is salient. The latter corresponds to those that fear being discovered as homosexuals in my experience but I haven’t had a large enough experience to say this is exclusive to altruism.    

[1] Instead of seeing the paranoiac indirectly fearing his own death in the end of the world phantasy this reading implies that he himself is the world.
[2] This becomes a strong reading of the oedipus myth in which Oedipus’ hubris regarding the search for his father’s killer(s) becomes an incentive for Tiresias to appear as someone who will tell him the truth. However, instead of being castrated there is a self-castration.
There is also an interesting difference in the Kleinian and Reichian/Fairbairnian position on the need for punishment being an ego defence vs. Klein’s claim that it is a hostile introject.  
[3] The paranoia of one patient got so bad he moved onto government land so he could be alone in the wilderness and not have to deal with people. This flight from otherness in general, as opposed to the fear of engaging with others is illustrated in this.
[4] This should be contrasted to the earlier auto-erotic level of perception in which perceptions don’t concern human objects but details in the environment. Shapiro similarly mentions the obsessive-compulsive character as having a rigidity concerning noticing objects in the external world. As mentioned in Economics, the trito or father complex stage in which the nuclear complexes are mastered through instinctual renunciation exists also in pre-phallic stages. Therefore, between auto-erotic phantasy and narcissistic stage wishes that still cognize a human object we should find an auto-erotic trito stage in which external reality (as opposed to phantasy) is established and a fixation on that external reality is possible. Thus, without the auto-erotic trito being reached, Klein notes that defences against the auto-erotic oedipal leads to a lack of interest in external reality (“outside world”) and repression of the most basic relations to others in the lack of affect and anxiety found in some people. Klein writes:

The ego's exaggerated and premature defence against sadism checks the establishing of a right relation to reality and the development of phantasy. The further sadistic appropriation and exploration of the mother's body and of the outside world (the mother's body in an extended sense) are brought to a standstill, and this causes the more or less complete suspension of the symbolic relation to the things and objects representing the contents of the mother's body and, hence, of the relation to the subject's environment and to reality. This withdrawal becomes the basis of the lack of affect and anxiety, which is one of the symptoms of dementia præcox. In this disease, therefore, the regression would go right back to the early phase of development in which the sadistic appropriation and destruction of the interior of the mother's body, as conceived of by the subject in phantasy, together with the establishing of the relation to reality, was prevented or checked owing to anxiety (p. 39). Klein, M. (1930). The Importance of Symbol-Formation in the Development of the Ego1. Int. J. Psycho-Anal., 11:24-39

Hypothetically, the “living machine” form of obsessionals with no emotions and no inner life would have defended against the auto-erotic nuclear complex while having made it to the auto-erotic trito. In Greek myth we find two opposed stories of the moon (Selene) and the dawn (Eos). The former loved Endymion and the latter loved Tithonus. Endymion’s body stayed youthful forever while remaining asleep while Tithonus chattered on endlessly while his body aged. Placing these gods as prior to the rule of Cronos (Time/the narcissistic stage) it seems probable that they relate to these early functions of affect block and the other autistic trait of chattering endlessly at people without noticing their disinterest or annoyance.  
[5] In parallel, the primitive depression in altruism also resembles projective identification in which the parental imago is usurped and the individual feels outside of his body, in a black hole, wants to disappear in sleep, or just “not present” or “out of synch” with others. These are early forms of Death in which the parental imago is not there or available and the child experiences abandonment or aloneness. There is some obvious overlap with dissociative disorders in this formulation that, again, makes the need for conceptual clarity very important. 
[6] There is still some confusion for me about the narcissistic stage as the encounter with otherness and the encounter with the transitional object. From the work of Tausk and others it is apparent that things (transitional objects) have a significance at the narcissistic stage and can be the cause of powerful psychotic delusions and culturally often magic is attributed to things (amulets, hats, wands, etc.). I’m not sure if the transitional object appears in either the masculine or feminine lines of development, or if it is split between the egoistic or altruistic poles, whether it is an object for both, or whether it may appear in the narcissistic trito stage when the two poles become more intermingled. In Economics I mentioned that the narcissistic stage referenced anxiety situations in terms of the big bad wolf “huffing and puffing” on the houses of the 3 little pigs and that I’ve worked with patients who had a triangular situation with houses. I would like to say that just as there is a move from the opposite sex parent in the phallic nuclear complex to a sibling in order to respect the difference between the generations, that it seems like there can be a move from the house to certain things/items in the house on the way to the narcissistic trito. So far, in my clinical experience the relation to the house and then items seems to appear in feminine patients (OE and SA).     

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