M.A. in Psychotherapy and Counselling

Year One Term Two

? 1996

In 1911 Freud published his 'Psychoanalytic Notes on an Autobiographical account of a case of Paranoia' at a time when psychoanalysis was a new and insecure science. Daniel Paul Schreber was a distinguished Judge who suffered a severe mental illness diagnosed as dementia paranoides, was confined in an asylum for several years but recovered sufficiently to publish his memoirs in 1903. Having devoted some thought to the issue of paranoia in 1909 and 1910 (Gay, 1989), Freud used evidence from Schreber's writings to illustrate and confirm his conclusions. I intend in this essay to re-examine some of this evidence from the perspective of the later psychoanalytic development, Object Relations theory. I shall be using principally ideas expounded by Harry Guntrip from the work of W.R.D. Fairbairn. Freud supported his analysis with a bare minimum of information external to the memoirs. I shall follow his lead for the major part of this re-assessment and use only the information that Freud includes in his case-study. Also like Freud I shall make occasional use of comparisons with other patients.

By 1911 Freud had developed his first instinct theory, founded on his assertion that the human psyche is fundamentally pleasure-seeking (Freud, 1916-17). In contradiction, Fairbairn eventually came to see the human being as essentially, from birth, object-seeking (Guntrip, 1961). Freud believed that instincts were biological givens. They arose from the body as libidinal impulses felt by the mind which then acted to reduce the resulting tension. This reduction in tension Freud defined as pleasure (Freud, 1916-17). The behaviour that would produce the desired pleasure required an object, but for Freud this was secondary, a means to an end. In Fairbairn's view the object was all important and pleasure was the means, or pointer to, or substitute for, that end (Guntrip, 1961). He therefore developed a theory of relationships.

Although acknowledging the self-preservative instincts, Freud had principally investigated the sexual component instincts, charting infantile development in terms of the oral, anal and genital erotogenic zones, and the progress from auto-erotism, through narcissism and homosexual impulses to heterosexual object choice (Freud, 1916-17). An infant could fail to negotiate this complex path successfully and become fixated at any stage, becoming liable to regress to that point under pressure in later life. The human psyche was for Freud a place of conflict between repressed sexual component instincts and the self-preservative or ego instincts which, in a civilised context, enforce the repression. Fairbairn rejected Freud's separation of energy (libido) and structure and drew heavily on Klein's theory of internal objects (Guntrip, 1961). He conceived the infant psyche as a dynamic unitary self or ego in a non-ambiguous relation with its first object the mother in a state of primary dependence. Frustration and deprivation of satisfaction inevitably occur and to defend against these real experiences the infant internalises and splits the object into good, accepted, and bad, rejected object. The bad object is further split in two, reflecting the exciting but frustrating aspect of mother, and the hostile rejecting aspect. In repressing these bad objects the ego must also split. A part of it, which Fairbairn called the libidinal ego, attached to the exciting object in a relationship of unsatisfied longing, is repressed with its object. Similarly the rejected object is repressed in a hostile relationship with an anti-libidinal ego. The good object, named by Fairbairn the ideal object, is projected back onto the real mother and to this relates the remaining portion of the ego, the central ego. The repressed part egos and bad objects exist as dynamic structures within the psyche and this ongoing structural conflict weakens the ego and is projected onto and played out in subsequent experiences. The more seriously inappropriate the real relationship of mother to infant, the more will the infant ego withdraw from it into what can only be an equally terrifying internal world. Guntrip in his studies of this schizoid condition added to Fairbairn's formulation a final defence. The libidinal ego, persecuted by the anti-libidinal ego as well as the exciting bad object splits again and, leaving a depleted portion of itself still struggling for survival retreats as the regressed ego into a phantasy recreation of the womb in the deep unconscious to await the possibility of re-birth.

Freud developed his method of free association in his work on analysing dreams which he saw as concealing in subtle ways the still active, though repressed, infantile sexual wishes (Freud, 1916-17). Fairbairn saw the dynamic structures he postulated clearly revealed in the dreams of his patients (Guntrip, 1961). I shall illustrate Freud's application of his method to Schreber's delusions and in turn apply Fairbairn's vision to the evidence.

Freud approached the memoirs with the hypothesis that paranoia arises from an ego's need to defend itself against an irruption of a passive homosexual libidinal impulse and that projection is the mechanism of defence employed. This he formulated as follows. A wishful fantasy 'I (a man) love him)', is contradicted as 'I do not love him, I hate him' and then projected to become 'he hates me' (200) so that the repressed desire is experienced as persecution by the illicitly desired object.

From this perspective the diagnostic element that stands out from the memoirs is the patient's conviction that he was to be emasculated, transformed into a woman and subjected to sexual use, initially abusively by a man but in the final, and to the patient acceptable, form of the delusion, redemptively by God. Schreber does not name the 'certain person' (178) to whom his body is to be surrendered for sexual abuse but Freud considered it indisputable from the internal evidence that this person was Flechsig. Professor Flechsig was the physician under whose care Schreber had made a complete recovery from an earlier bout of mental illness in 1884 and towards whom, as a result, he had felt a warm gratitude. He returned to the professor's clinic in Leibsig in 1893 at the start of his second illness but in the memoirs Flechsig appears as the original persecutor. Schreber records that he was notified of his appointment as president of a higher court in June 1893 and in the interim before taking up his new duties in October he experienced dreams of a return of his nervous illness and once had the thought while half awake that 'after all it must be nice to be a woman submitting to the act of copulation' (176). Freud interpreted these dreams as concealing a wish to be with Flechsig again and the associated thought as demonstrating an erotic desire aimed at his former doctor. The conclusion Freud presented was that the exciting cause of the second illness was a powerful impulse of homosexual libido directed towards Flechsig and the consequent defences against allowing the wish into consciousness.

Freud was of the opinion that the timing of the dreams disproved the patient's attribution of 'mental overstrain' (141) in the new post as the cause. However, from my chosen theoretical standpoint, the loss of effective functioning in real life confirms the patient's opinion. I see that the judge's central ego broke down under external pressures to reveal the underlying chronic ego-weakness. Fairbairn defined paranoia as one of the four alternative defensive techniques that can be adopted in the attempt to master internal bad objects and prevent a relapse into a schizoid (or depressive) state (Guntrip, 1968). The diagnosis of the first illness as severe hypochondria seems to show at that time the hysterical defensive mode (Fairbairn, 1941) in operation, with the patient suffering from an internalised rejected object and projecting an externalised accepted object onto Flechsig.

Of course Freud recognised that a mental collapse of such magnitude as Schreber's must have had its origins in a relationship of greater significance than that of doctor and patient and he invoked his discovery, transference, in explanation. He suggested that feelings of longing for his father or brother were displaced onto Flechsig. The memoirs revealed that both had died before the onset of the second illness. Freud could only suggest Schreber's age, 51, as a possible factor in the outbreak of homosexual libido at that time, since everyone he believed moves between homo- and hetero-sexual feelings influenced by external relationships (Freud, 1916-17) about which he knew nothing.

I, on the other hand, can point to Schreber's changed relationship with higher authorities who were affirmatively demanding of him increased responsibilities. This probably ambivalently desired promotion could  BOOKMARK  have resonated with the structurally embedded struggles of the transitional stage of quasi-independence (Fairbairn, 1941) of his infancy. The dreams and thought quoted above can be viewed as the surfacing from his unconscious of the 'passivity trends' (Guntrip, 1961, 394) which previously undermined him. If I imagine the dreams to have contained images of a sick Schreber this can be interpreted as the depleted libidinal ego. The thought about being a woman might indicate not only a wish to escape the burdensome active role in life but also possibly that Schreber experienced some difficulty in performing the sexual act. This could be linked to the childlessness of the Schreber marriage. The judge reveals explicitly that he was morally rule-bound and sexually abstemious, a recognisable schizoid character trait (Guntrip, 1968).

Fairbairn's theory of hostile unequal and therefore unstable intrapsychic relationships (Guntrip, 1961) predicates the inconstancy, multiplicity and reversibility of transference that is experienced clinically. The return of his illness and a perceived failure by Flechsig to provide immediate relief would have been more than enough to switch the transference to a negative one. Freud cites in support of his case 'a noteworthy detail' (180). An early significant factor in Schreber's decline after hospitalisation was a nervous collapse following a four day absence by his wife during which he experienced an excess of night emissions and after which he rejected her company. Freud interpreted this as showing her presence had a protective effect against her husband's homosexual impulses. I see it as demonstrating the supportive effect of an external 'good mother' figure and the emissions as indicating desire for the return of the good object. This abandonment might well have helped to precipitate a switch from the hysterical to its opposite the paranoid mode of defence in which the bad object is externalised. The patient's descent into the total schizoid withdrawal from the external world, or 'hallucinatory stupor' (143), described in the medical report on the case, I assume to have been part of the 'decisive effect' (180) of this episode.

In order to trace the patient's symptoms to their roots in infancy, Freud had first to account for the replacement of Flechsig as chief persecutor by God. He could link the two by means of one phantasied statement by Flechsig that he was 'God Flechsig' and also by the similar decomposition or splitting that overtook them both. The soul Flechsig fragmented into many souls, some of which formed into the upper and middle Flechsig while God became divided as the upper and lower God. However, Freud considered the first split to have been of the persecutor into God and Flechsig, showing that, as persecutor, Flechsig had represented a condensation of two similar figures. This made it clear to Freud that the doctor stood for the patient's brother and God for the more significant and loved father.

Schreber accused Flechsig of attempting to commit 'soul-murder' in relation to himself and indicated the meaning he gave to this term by reference to literary works such as Faust and Manfred. The latter, which received a second, explicit, reference, is a play in which sibling (heterosexual) incest is a major theme. From this Freud found confirmatory evidence for his hypothesis. His view was that as the unconscious struggle against the incestuous homosexual impulse transferred onto Flechsig intensified, Schreber's original infantile libidinal cathexis of his father came to the fore.

Freud had no doubt that such a father as the judge had had, a famous and publicly benevolent physician, could well have been transformed into a god in the imagination of a loving son, and his theory immediately clarified many details of the subject's phantasies. For Schreber's god was a strange deity whose trivial miracles and peculiar limitations could easily be understood as absurd reversals of the true attributes and activities of a fine doctor like Schreber senior. The judge's attitude towards his god was one of 'reverend submission' mixed with 'mutinous insubordination' (187) exactly that to be expected of a small boy towards his father.

Through his analysis of the manifest content of the delusions Freud had revealed the latent content of an infantile conflict with the father who would have so often prevented the small boy from achieving the pleasure his instinctual impulses sought. Freud could point to one clear reference to the auto-erotic activity that for him was the hub of the conflict. Schreber's voices told him that a neighbour, von W., had accused him of masturbation. The asylum's chief attendant was identified with this neighbour by Schreber and internalised as the von W. soul, becoming another persecutor and suffering the same divisions and multiplications as the Flechsig soul with whom it was both allied and in conflict. Freud reinforced the one explicit reference by linking it with the patient's account of the 'enforced thinking' that he felt bound to maintain because the moment he stopped God would have assumed that He had achieved His aim of rendering Schreber an idiot and would withdraw. The notion that masturbation would damage mental faculties was a commonplace.

Freud had successfully traced all the indications of a father-complex in the memoirs. I have given only a partial summary of his arguments but I will mention his concluding comments on the external life situation which might have provoked Schreber's unacceptable 'wishful fantasy' of becoming a woman. The judge makes clear in his writing his disappointment that he remained childless. Freud was of the opinion that a son might have provided him with a sufficient focus for the homosexual love that was left without an acceptable outlet by the deaths of father and brother, as well as satisfying the dynastic pride also evident in Schreber. The frustration of his childlessness might have induced a phantasy that if he were a woman he could better achieve what his wife could not and this in turn could have evoked the infantile attitude of passive love for his father. Freud made a connection between this line of thought and Schreber's redeemer self-identification which took the unusual form of a belief that a new race of men would be born from him once his transformation into a woman was complete and he was impregnated by God. This belief Schreber took with him into his resumed life on his release from the Asylum.

From my standpoint as an inheritor of the later clinical researches of Fairbairn and Guntrip, the diagnostic feature of the case is the multiple splitting and mutual hostility of the figures from his environment internalised by the patient. However, Freud's ideas are not refuted or contradicted, rather the material is analysed further to earlier origins. As Guntrip asserts: 'It is often possible to discover the angry rejective mother behind the angry rejective father in ....... dreams' and 'Oedipus and inverted Oedipus complexes, and homosexual relationships and dreams, are all susceptible of reduction to (the) basic pattern of a three fold splitting of the object relationship life' (Guntrip, 1961, 326).

Fortunately Freud quotes at length a passage from the memoirs which shows this precisely. I will transcribe it with suggested clarifying substitutions.

This passage demonstrates both the original threefold splitting and the oedipal situation that came to overlie it. With the simple substitutions suggested, the small boy defending mother against the (sexual?) impositions of father is revealed. Schreber believed that Flechsig had managed to get to heaven without dying or undergoing the usual purifications and thereafter exerted a malign influence on God. This suggests the little boy's understanding that father had privileged access to mother, and indeed dominated her. I shall examine the structure of God and heaven in detail in due course.

In the passage from the memoirs quoted above I interpret God as Fairbairn's ideal object. With the failure previously described of Schreber's external supportive figures the only recipient available for a projection of the ideal object was the God in whom, in adult health, the patient did not believe, a measure perhaps of the underlying infantile despair in the face of maternal abandonment. God was a weak ally because in effect the ideal object remained internalised and so vulnerable to attack from the bad or rejected object, Flechsig. Schreber's wording reflects the defensive need to split off and repress the bad object and preserve at all costs some possibility of a good relationship with the protected ideal object. The sacrifice of himself is precisely what happened as the rejected object was split  BOOKMARK  into the exciting, but unsatisfying, object, Flechsig, and the rejecting object, the soul of Flechsig. The infantile ego had to split as well. The soul of Schreber, which was to be 'delivered up' (149) to murder I recognise as the anti-libidinal ego. Since the only possible form of relationship with the rejecting object is one based on identification (Guntrip, 1961), I relate soul to soul. Schreber's body, which I equate with his libidinal ego, split from his soul, was to be transformed into a woman's body and surrendered to sexual abuse. I see the reversals and projections that Freud saw as the mechanism of paranoia, but in terms of Fairbairn's endopsychic structures locked in reversible relationships. So to escape from experiencing himself as the needy infant ego, angrily desiring the sexually exciting but frustrating breast/mother/Flechsig, Schreber projected all these feelings so that Flechsig became the hostile sexual abuser. Instead of desiring, Schreber's body became the desired woman/mother. It was being 'drawn back ever more deeply into the revival of original primary identification with the mother' (Guntrip, 1961, 329). I must add at this point that my own experience of working with a male client who was sexually abused as an infant by his mother, and who has described feeling like a woman helpless before me waiting for me to take him, suggests to me that Schreber's delusions might well have had some factual basis. If so the exciting object would have been experienced carrying a double load of unsatisfied need, the mother's and the infant's.

So in this passage, viewed as if it described a dream, it is possible to distinguish the ideal object, God, defended by the central ego, the 'I' of the writer; the exciting object, Flechsig, engulfing the resisting libidinal ego, Schreber's body; and the rejecting object, Flechsig's soul with which the anti-libidinal ego, Schreber's soul, is so identified as to have ceased to exist separately, a form of murder.

I shall now interpret the complex structures and behaviours of Schreber's God. In the theology of the memoirs God, having created the human race from His own substance, withdrew to a great distance and rather than having any understanding of the living was only involved with corpses. After death and obligatory purification human souls were eventually reunited with God in a state of bliss as 'fore-courts of heaven'. The state of bliss was one of sexual voluptuousness unending. The image that this description evokes for me is of a baby sated at the breast, but only after a period of deprivation of maternal comfort so extended that ego loss (death) has occurred. Having been, perhaps, washed and changed, the baby, at last restored to mother, has to 'start again, permanently deprived of its own root' as Winnicott put it (Guntrip, 1968, 420/1).

Freud himself elucidates some of the evidence that links the fore-courts of heaven with womanhood. Schreber felt himself assailed by 'miracled birds', (168) former fore-courts of heaven whose senseless gabble Freud chauvinistically likened to that of young girls. The judge, who indeed noted that the 'inquisitiveness and voluptuous bent' (170) of these birds resembled that of little girls, believed that their purpose was to transfer to him the ptomaine (corpse) poison they carried. It is difficult not to see this in terms of Klein's work on infantile phantasies of poisonous milk from the bad breast (Klein, 1975) and guess at younger sisters provoking intense jealousy in the little Daniel Paul.

Voluptuousness played a major part in Schreber's delusional system in relation to God. It was both demanded of him by God and a trap that bound God to him. For Schreber believed that his body when in a state of excitement held an irresistible attraction for God so that He could not disengage His 'nerves'. This threatened His very existence. Trapped in Schreber's body the 'nerves' lost their state of heavenly bliss and the persecutions resulted from God's desperate attempts to get free. At the heart of this mutual struggle for survival can be discerned the baby's orally incorporative hungry love (Guntrip, 1968) with its associated fear of devouring destructively or being devoured that results from severe early disruption of the maternal bond. Schreber knew he would suffer worse if God withdrew and the enforced thinking to prevent this, linked by Freud to masturbation, is a typical Schizoid defence against the depersonalisation that loss of relatedness brings (Guntrip, 1968).

The 'fore-courts of heaven' or anterior realms of God supplanted the man Flechsig as the exciting object and the soul Flechsig was similarly demoted. For there were also the posterior realms of God, divided as previously stated into the upper and lower God. The upper God was connected in some mysterious way to 'a fair race (the Aryans)' (155) while the lower God was linked to the dark semitic race. These divisions of God contended against each other in their efforts to survive. If I make explicit the historical reality of the dominant controlling race versus the hated and victimised other, I can use Freud's method of association to support my interpretation of the lower God as Schreber's anti-libidinal ego, in a hostile rivalrous identification with the rejected object or upper God.

The trivial silly miracles that Freud used to support a father-complex are to my eyes the clearest indication of the underlying maternal derivation. For God was deeply involved in the motherly task of controlling Schreber's excretory functions. He it was who miracled up the judge's need to defecate, at the same time ensuring that the lavatory was occupied, and then mocked him for being too stupid to shit. Schreber foiled this perfidy, the aim of which was to destroy his reason, by using a bucket. Since God could not learn from experience this sequence was repeated ad nauseam until the sufferer came to see God as 'ridiculous or childish' and scoffed at him aloud in self-defence (159). This account immediately brings to mind Klein's six year old patient Erna (Klein, 1975) whose games included many variants on the theme of a baby defecating and being violently scolded by a mother or governess with Erna enacting each role in turn. Just so Schreber acted out a representation of his potty training with a pail and played both victim and persecutor.

Although at times Schreber personally reviled God, he maintained that for the rest of humanity God remained an object of veneration. This suggests the attempt by a re-emerging central ego to preserve God as an ideal object. It is possible to see a move towards the infant's developmental advance to perception of mother as a whole person in this re-unification of three part objects in the one God. But such a healing was beyond attainment. In its wrestling with its exciting object, Schreber's libidinal ego drew more and more of the 'nerves' of God into itself, so becoming increasingly identified with the ideal object as well as with the exciting object. In Freud's terminology regression to the fixation point of narcissistic libidinal cathexis of the ego took place. Megalomania was the result.

The nerves of God, once embedded in Schreber's body, became nerves of female voluptuousness. Even after his discharge from hospital the Judge would sometimes stand bare chested before a mirror decked in 'feminine finery' (165), perceiving himself to have female breasts, having achieved the perilous psychic security of complete merger with mother. Schreber believed he could keep God, his exciting object, contentedly bound to him if he compensated the nerves for their lost state of bliss by frequently enacting the part of a woman lying luxuriating in sexual gratification. Again, I am reminded of Erna (Klein, 1975) and her wish to be treated as a baby, and masturbated.

Schreber's mental collapse had been heralded by a 'torturing bout of sleeplessness' (142) a typical response of a terrified central ego to the developing danger of an incapacitating regression (Guntrip, 1968). In the course of the early and worst, phase of his illness, Schreber endured sufferings so horrific that he yearned for death. Many times he tried to drown himself in the bath. I recognise this as an acting out of the pull of the regressed ego back to its phantisised safety in the waters of the womb, which of course feels like death to the rest of the psyche and can lead to suicide (Guntrip, 1968). The persecuting horrors were the defensive struggle against total ego-loss, or 'soul-murder'. Fortunately again, Freud included just enough information to allow me to identify through Schreber's literary references the origin of this term in the double-bind inflicted on the infant by a controlling parent. Faust bartered his soul to get what he wanted. Manfred had his soul snatched away without his collusion. As my client, in emotional agony, once expressed it to me, representing his abusive mother, 'If I don't please you, you will abandon me. But to please you I have to abandon myself. Either way I am destroyed'. Like Freud, I think that having a son might have benefited Schreber because by projecting his regressed ego onto a baby he could have experienced re-birth vicariously. As it was, re-birth could only be attained through the delusional belief in the ultimate re-birth of mankind from his body.

To my modern eyes, the Schreber case presents as a record of appalling childhood abuse. Schreber at his lowest point believed that many of his internal organs had been destroyed, that he was infected with the plague, that he was 'dead and decomposing' and that 'his body was being handled in all kinds of revolting ways' (143). All this closely matches  BOOKMARK  accounts of their sensations that I have heard from clients who were sexually abused from infancy. It is now known that Schreber senior was an 'authoritarian monster' (Storr, 1989) subjected his sons to a variety of torments to break their will and promote his conception of health. One example Storr details explains much. The father administered enemas to prevent nocturnal emissions. I would characterise this as instrumental anal rape for the purpose of emasculation and, as in general with sexual abuse, it would probably have had an adverse affect on adult sexual life as I previously postulated. I do not consider that this information, which relates the father's reality so clearly to the son's phantasies, confutes my analysis. For under the aegis of such a husband any mother would most likely be seriously impeded, both by external restrictions and impositions, and by internal neediness, from engaging in a healthy nurturing relationship with her baby. That nevertheless she succeeded surprisingly well is attested by Schreber's public career and happy marriage.

Freud considered that the recovery which permitted Schreber to return to normal life came about through the delusioned resolution of the instinctual conflict. The fixed megalomania supported the ego and justified the feminine wishful fantasy. The homosexual impulse became acceptable to consciousness because it served both God and humanity.

My understanding is that, having re-lived, in phantasy, much of his childhood trauma and abreacted the split-off emotions, Schreber's central ego was able to re-constitute itself. This it did through a delusional resolution of the original unmet love needs which lie at the heart of all psychopathology (Guntrip, 1968). The essentially insane conundrum forced on the child - 'He loves me, he tortures me, I must love him' was resolved on the side of unreality as 'He loves me, this is not torture, I can love (serve) him' by the creation of an acceptable meaning for the experiences. There was no one who could affirm for Schreber the fundamental truth in his sufferings and so allow the reality based 'He does not love me. This is torture, I hate him' to emerge. When in 1907 his mother died and only months later his wife suffered a stroke, the judge could not survive the loss of both external good objects and collapsed into terminal insanity.