1 51. The theme of this paper is that the differentiation of the psychotic from the non-psychotic personalities depends on a minute splitting of all that part of the personality that is concerned with awareness of internal and external reality, and the expulsion of these fragments so that they enter into or engulf their objects. I shall describe this process in some detail and shall then discuss its consequences and how they affect treatment. The conclusions were arrived at in analytic contact with schizophrenic patients and have been tested by me in practice. I ask your attention for them because they have led to developments in my patients which are analytically significant and not to be confused, either with the remissions familiar to psychiatrists, or with that class of improvement that it is impossible to relate to the interpretations given or to any coherent body of psycho-analytic theory. I believe that the improvements I have seen deserve psycho-analytic investigation. 52. I owe my clarification of the obscurity that pervades the whole of a psychotic analysis mainly to three pieces of work. As they are crucial for understanding what follows I shall remind you of them. First: (2) Freud's description, referred to by me in my paper to the London Congress of x 953 (0, °f the mental apparatus called into activity by the demands of the reality principle and in particular of that part of it which is concerned with the consciousness attached to the sense-organs. Second: Melanie Klein's (5) descrip-tion of the phantasied sadistic attacks that the infant makes on the breast during the paranoid-schizoid phase, and third: her discovery of projective identification (7). By this mechanism the patient splits off a part of his personality and projects it into the object where it becomes installed, 43 44 Second Thoughts sometimes as a persecutor, leaving the psyche, from which it has been split off, correspondingly impoverished. 53. Lest it be supposed that I attribute the development of schizophrenia exclusively to certain mechanisms apart from die personality that employs them, I shall enumerate now what I think are the preconditions for the mechanisms on which I wish to focus your attention. There is the environ-ment, which I shall not discuss at this time, and the per-sonality, which must display four essential features. These are: a preponderance of destructive impulses so great that even the impulse to love is suffused by them and turned to sadism; a hatred of reality, internal and external, which is extended to all that makes for awareness of it; a dread of imminent annihilation (7) and, finally, a premature and precipitate formation of object relations, foremost amongst which is the transference, whose thinness is in marked con-trast with the tenacity with which they arc maintained. The prematurity, thinnncss and tenacity arc pathognomonic and have an important derivation, in the conflict, never decided in the schizophrenic, between the life and death instincts. 54. Before I consider the mechanisms that spring from these characteristics I must dispose briefly of a few points that concern the transference. The relationship with the analyst is premature, precipitate, and intensely dependent; when under pressure of his life and death instincts, the patient broadens the contact, two concurrent streams of phenomena become manifest. First, splitting of his personality and pro-jection of the fragments into the analyst (i.e. projective identification) becomes overactive, with consequent con-fusional states such as Rosenfeld (9) has described. Second, the mental and other activities by which the dominant impulse, be it of life or death instincts, strives to express itself, are at once subjected to mutilation by the temporarily subordinated impulse. Harassed by the mutilations and striving to escape the confusional states, the patient returns to the restricted relationship. Oscillation between the attempt to broaden the contact and the attempt to restrict continues throughout the analysis. 55. To return now to the characteristics I listed as intrinsic
Bion, W. R. (1957). Differentiation of the Psychotic from the Non-Psychotic Personalities. International Journal of Psycho-Analysis, 38, 266–275.