In paranoid-schizoid patients, how does projective identification present?

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Karyth Cara | College Teacher | (Level 1) Senior Educator

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Paranoid-Schizoid Patient

In Marilyn Klein's psychoanalytical theory, a paranoid-schizoid patient is one who has moved into adulthood without successfully reconciling the conflicts of the infantile developmental paranoid-schizoid and depressive stages. The paranoid-schizoid developmental stage, according to Klein, occurs in the very young infant who has an ego though a fragile and not fully integrated one. In this stage, good and bad are schizoid concepts, and bad creates reactions of paranoia of persecution.

In essence, an infant has a schizoid view of their own good/bad reactionary emotions and has a schizoid view of the caregiver's good/bad care. When a "bad" infant reacts with paranoid, persecutorial, violent emotions against an absent/delayed "bad" caregiver, the phantasies enacted in the infant's psyche destroy the "bad" caregiver. When the "good" caregiver rescues and cares for the "good" infant, the schizoid split of good from bad results in the "good" infant fully embracing the "good" caregiver; the split off "bad" infant and "bad" caregiver were destroyed in the paranoid phantasy.

In the depressive developmental stage, this good/bad schizoid-paranoia resolves itself in the psychological ability of the infant to integrate both polar qualities, good/bad, into the perception of a whole individual with good and bad attributes. A paranoid-schizoid patient continues in the inability to form integrated perceptions of unified personalities that contain both good and bad attributes; this is due to a failure of successful integration during the depressive stage.

Projection-Identification

According to Klein, projection identification is a primal mechanism that occurs in the paranoid-schizoid developmental stage in which the split characteristics of good and bad are projected--perceived as emanating from and originating from--the infant's cathected object. During infantile projection identification, the good is embraced and the bad is destroyed in infantile phantasies. During the depressive stage, the object's characteristics come to be integrated and the the object comes to be seen as a whole individual with independent attributes of both good and bad.

Projection Identification in the Paranoid-Schizoid Patient

The adult paranoid-schizoid patient, whose psychological operations were disrupted and unsuccessfully completed during development stages either as a result of poor parenting or of such things as trauma, continues projection identification by projecting--viewing as emanating from and originating from--"bad" attributes to the therapists. These "bad" attributes are usually the bad feelings, such as guilt, rage, humiliation, that are embodied within the patient's own ego-psyche and that produce reactionary feelings of persecutorial paranoia leading to more bad feelings, further projection identification and further persecutorial paranoia.

Background on the Development of the Concept of Projection Identification

Klein and colleagues were providing psychoanalytic treatments for schizoid and schizophrenic patients when their observations led to the origination of the concept of projection identification (the Melanie Klein Trust points out that "projection" and "projection identification" are understood as interchangeable terms for a single process). First added by Klein as a footnote in 1952 to a paper on schizoid mechanisms, Klein defined the concept in later works, a definition which has changed over time as the understanding of projection identification had developed and broadened over time (signifying this is a dynamic and relevant psychological concept).

Klein noted that states of vagueness, apathy, blankness and futility correlated with the perception that parts of the brain were missing. She associated these perceptions with the infant death wish and viewed them as the annihilation of the self. It was found that certain of these annihilated characteristics were still perceived by the patient as being present in other objects; sometimes the object was the analyst. Klein theorized that these parts of the self were lost in phantasies that destroyed and expelled bad objects in which parts of the self were caught up and also expelled. Since the expelled bad object and object-self have a unique referential relation to each other and are not successfully distinguished from each other, the result is an psychological perception that the expelled bad object is an integral segment of self and that self is therefore engaged in attacking self. Klein defined projection identification as the process by which the infant death wish, unresolved in early developmental stages, is split or fragmented and projected into cathected love-objects in the external world. Investigation expanding upon Klein's work has focused in particular on the role of projection identification in interpersonal aspects of communication and relations and in the occurrence of the process in a mild form in everyday life (as opposed to how it occurs in schizoid personalities).

Interpersonal Dimension in Therapy

It was found that in therapy, in context of transference and counter-transference, the expelled portion of the person's self can be projected into the analyst who, through interjection, is psychologically manipulated into taking on the projected characteristics. The intra-psychic worlds interact and the therapist becomes entangled in the patient's projection identification, the "core feature of the paranoid-schizoid method of defense" and essential in "primitive stages of development" (Hinshelwood). It was also found that non-violent projection identification produced by an individual with a stable ego attached to a good internal love-object is the cornerstone of communicating personal experience to the therapist; those without this non-violent form are perceived as affectively flat and personally tedious. It has been further found that empathy is built upon the mildest form of projection identification through which an individual is able to see from another person's perspective and able to put themselves in the other's shoes; empathy is the ability to gain insight into another's situation by perceptually "walking a mile in their shoes."

There is thus a spectrum of different "uses" of projective identification: expulsion, non-symbolic communication, and empathy (Hinshelwood, 1994).

Characteristics of Presentation

Some characteristics of how paranoid-schizoid projection identification may present in therapy are:

  • omnipotence: knowledge that is all inclusive
  • rejection of disagreement and difference of opinion
  • manic ego defense and maintenance of superiority
  • fragile, idealized ego-object
  • paranoia about secrets being kept from them
  • rejection of separate and different ego-selves for therapist and patient
  • feelings of inferiority and humiliation
  • obsessional and paranoid demands
  • fragility of ego-integrity and power
  • manipulative, agitated, demanding
  • personal life organized within the infantile depressive position (Waska)

Sources:

Robert D. Hinshelwood. "Projective Identification." International Dictionary of Psychoanalysis. Ed. Alain de Mijolla. Vol. 2. Gale Cengage, 2005.

"Paranoid-schizoid position: Definition." Melanie Klein Trust.

"Projective identification: Definition." Melanie Klein Trust.

Robert T. Waska, M.S., MFCC. "Projective Identification, Self-Disclosure, and the Patient's View of the Object: The Need for Flexibility." Journal of Psychotherapy and Research. 1999.

Kevin O'Leary and Julie Cradock O'Leary. "What is Projective Identification?" Drs-Oleary.com.

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M.P. Ossa | College Teacher | (Level 1) Distinguished Educator

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According to Kleinian theory, the external and internal relations between the self and the love-objects, like caregivers, are defended against from the very earliest age of infancy. The defense is splitting of characteristics into goo and bad, both for the self and for others. A paranoid-schizoid patient is one who did not successfully mature out of the good-bad split and come to see individuals, including self and others, as integrated personalities with both good and bad characteristics.

In the 1946 publication Notes on some schizoid mechanisms, Melanie Klein Trust explains the process of projective identification as a process by which the patient sees in someone else the bad characteristics expelled from themselves and attributed to an object in the external world.

However, projective identification may have an acquisitive characteristic where the individual might want to acquire the traits of another individual in aims of getting rid of their own.

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