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The Psychoanalytic Review,78(1), Spring 1991

Psychosis and Malice

Joseph H. Berke

Psychosis is an altered state of mind characterized by a predominence of primitive mental processes such as splitting, denial and projection. More profoundly, it involves a retreat from frightening, hated inner and outer realities into a dreamy, phantasmagoric often childlike state of being. This psychotic state is not necessarily a misfortune. Many observers have pointed out that it can be a creative experience, an attempt at emotional and social reconstitution after a period of great stress. Thus, the pediatrician and psychoanalyst, Donald Winnicott, saw both psychosis and regression ( they may occur separately or simultaneously) as the means by which some individuals seem to shed their false fronts in order to reach a new and vital relationship with themselves and the world. We can call this type of experience a benign psychosis.

However, more often than not, malicious intentions predominate. The affected person longs to annihilate hated feelings or relationships (and symbols) as well as anyone or anything associated with it. This, more common event, is best termed a malignant psychosis, for it is an invasive, life-destructive phenomena.

Sigmund Freud referred to the strength of such elements which attack ego growth and therapeutic change (traceable to "the original death instinct of living matter") in his paper "Analysis Terminable and Interminable". Similarly, the Kleinian analyst, Herbert Rosenfeld, documented many of the psychotic processes that contributed to the "negative therapeutic reaction" in a variety of papers and books.

The aggressive forces that underlie the destructive, psychotic aspects of the self include envy, greed and jealousy. They are attracted to and invariably attack the essential representatives of life -- the breast (the vital source), the womb (female potency) and the penis ( male potency) in all their real and symbolic forms. In this paper I intend to show how these persecutory forces operate and how their destructive consequences may be opposed and often overcome by their life-affirming counterparts -- gratitude, generosity and compassion.

 

An infant's early relationship with breast-reality determines his world-view, which, in turn, determines his relationship to life. A sense that "life is good" or "the world's O.K." reflects a positive world-view. The opposite sense that "life is bad" or "the whole world's horrible" reflects a negative model. These attitudes are not static. Many internal or external events tilt the balance one way or the other. There are occasions when reality is so intolerable that it becomes and literally feels like a bad breast. Then people deflect their hatred to consciousness itself, or space, or time, or, more prosaically, the weather. They want to flee from these things or fight them. Concurrently they will also try to establish new realities by flying to the sunshine during winter or by revelling in comforting day-dreams.

The re-evaluation and annihilation of reality is very clear during a psychotic or quasi psychotic episode. Then the very fabric of existence is at stake. Anything indicative of feeding or caring, and any links with food or care, may become the focus of savage attack. The links are crucial because they are reminders of the pain and suffering which mother and father, under the guise of 'life' has inflicted and still seems to be inflicting, on a hapless soul.

Typical links include perception and the perceptual apparatus, representing the desire and capacity to take things in (the symbolic equivalent of the mouth). They also include communication, words, thoughts and emotions, representing the intermediary between child and parents (the symbolic equivalent of the nipple or teat). Finally the links encompass states of mind and understanding, representing the parental container full of digested or undigested experiences (the symbolic equivalent of the bosom and its contents). Collectively these elements equal the mouth-nipple-breast connection which the contented person cherishes in contrast to the distraught person who solely wants to deny, subvert or smash them to smithereens.

 

* I have taken many aspects of this paper from my forthcoming book, The Tyranny of Malice: The influence of envy, greed and jealousy on character and culture, which will be published by Summit Books (U.S.A.) in the fall of 1988.

In a seminal paper entitled, "Attacks on Linking", the British psychoanalyst, Wilfred Bion, illustrated how these attacks may be reactivated, especially during psychoanalysis. The patient may feel compelled to repeat a hurtful relationship with an unresponsive, non-containing mother, or a very envied one. Bion comments:

"Attacks on the link, therefore, are synonymous with attacks on the analyst's, and originally the mother's, peace of mind. The capacity to introject is transformed by the patient's envy and hate into greed devouring the patient's psyche; similarly, peace of mind becomes hostile indifference."

 

Time was the essential issue for a middle aged teacher who consulted me after a suicide attempt. During the first months of treatment she was diligent and punctual. Rarely coming a moment too early, or tarrying a moment too late, her depression lifted and she went back to work. But the picture was too good to be true, as the summer holiday break dramatically proved.

A changed woman resumed sessions, someone who had cast aside her fastidious facades and was no longer able to prevent her underlying, psychotic preoccupations from gaining full expression. I soon became enmeshed with someone for whom time had become chaotic. She began to appear for her appointments minutes, sometimes hours early. Later on in the therapy, she would act like a thief and seize any excuse, a sudden memory, a last minute dream, a broken shoe to stay on and on. Occasionally she apologized. Yet the very next time she would beg and whine to stay longer, or refuse to leave. I felt as if I had to push her out of the room, whereupon she would dawdle on the stairs and hang around the street in front of my office.

In addition, he dressed differently. Previously the lady was prim and proper. Now she wore tight sweaters and short skirts, and doused herself in such heavy perfume that I felt faint from the fumes. Alternatively she would arrive bruised and scratched, with a torn shirt and dirty tights, screaming about suicide. Then she wouldn't turn up for a week, leaving me shattered about what happened to her.

I thought: "She wants to give me a good time, but if she can't, she'll give me a hard time, a very hard time". My intuition was right. She associated seductiveness with lust, and lust with being "a good time girl". She really was trying to show me what she wanted from me -- a good time, lots of time, all my time. And if she couldn't have it, then she would corrupt and disrupt my time and timing.

She hated the idea that I might have time for someone else, or keep time for myself. As the Christmas break approached, she became more disruptive, more seductive, more difficult. She intended to fill me with desire, or fear, or rage, so I could have no time in my mind for anyone else. This was her jealous revenge for my 'two-timing her' during the holiday.

Time, the time of sessions, my mental time were the links between her and me. The more she wanted me, the more she subjected these links to an unceasing barrage of greedy, envious and jealous attacks. Her mouth was insatiable for time. It never got enough. Almost in passing she recalled that her parents were farmers. They got up early and went to bed early. They never seemed to have any time for her, or if they did, they preferred to spend it with her two sisters. As a child she felt that outings were 'stolen time'.

The therapy sessions and the flow of time were my nipples and the milk that flowed through them. Her aims were ruthless control and abject contempt. Sometimes she talked so much that the sessions were deluged with ideas. On other occasions she maintained a sullen silence so that time soured and our work wasted.

Then there were different silences, akin to a calm, deathly quietness, with slow breathing and little movement for hours on end. It seemed she remained suspended in time, as if she had returned to an intrauterine state when there was no intermediary between her and me, and time was endless.

That's what she wanted, endless time, and me. I was the breast, a cornucopia of time, the source of everything her parents had denied her. Towards the end of the treatment, she apologized for all the upheavals and hassles. She knew she was difficult. Long ago she had sworn to herself that some day someone would give her all the time she had never had as a child. But if the person reneged, or if it didn't work out, then she was determined to destroy time once and for all.

 

Children at play demonstrate these fears and the wishes that lay behind them. The psychoanalyst, Hanna Segal, has described one little girl who was "preoccupied with pregnancies". During one session she started to smear glue on the floor. This turned out to be her 'sick' or vomit by which she hoped to spoil Segal's insides and prevent her from having new babies. Later she was frightened to come back because the same might happen to her.

In the same vein Melanie Klein narrated the story of 'Erna', a six year old who was obsessed by brutal fantasies of cutting, tearing and burning. These led to an extraordinary inhibition of learning whereby "arithmetic and writing symbolized violent sadistic attacks on her mother's body and her father's penis," as well as the babies contained therein.

Attacks on the pregnant body extend to caves, houses and any life-filled interior structure up to and including the mind. The psychotic teacher I just described also sought to interfere with my mental life. She loathed my thoughts (to her, mental babies as well as psychic food) and the mind womb which carried them. So she repeatedly refused me the time and space to develop my ideas by engaging in a variety of anxiety provoking activities designed to abort my creative processes. Consequently I noticed that my interpretations rarely grew to term. Either I would blurt them out prematurely (suffer a psychic miscarriage) or remain unheeded (be a bearer of stillborn messages). Her onslaughts illustrate another dimension of 'the negative therapeutic reaction'.

This woman, and other patients of mine, took oral issues onto a sexual battlefield which included both the womb and, of course, the penis. Preoccupations with the penis extend from the anatomical organ to far reaching concerns about strength, power, authority, virility, ambition, energy and enterprise, which account for Carl Jung's trenchant remark, "the penis is only a phallic symbol".

 

The longing for male qualities, functions and status, the phallus, features in many cultures, but in this century Freud drew special attention to phallic wishes during the course of describing the development of female sexuality. He called the sudden shocking awareness of absent maleness and the wish to overcome it, penis envy. Related to the castration complex or the masculine complex, this term (and attendant assumptions) has achieved a prominent place in the psychological literature and popular parlance. * But I believe it is a misnomer, and asgenerally used, perpetuates several misconceptions.

The classical concept of penis envy has little to do with envy. On the contrary it conveys intense admiration, emulation and identification for all things masculine. It is a wish, first for a penis, then for a penis in intercourse, and finally for a penis substitute, such as, a baby.

An admixture of resentful, raging, spiteful, spoiling, begrudging, belittling attitudes and actions towards men, maleness and male organs certainly does exist. This is appropriately called penis envy and can be expressed by the penis as well as towards it.

The penis, or better, the phallus, calls onto itself intense hatred for many reasons, not the least because the phallus represents maleness, with everything connected with male generative powers, with the male contribution to the continuity of life. However for people whose inner tensions reflect intense pre-oedipal conflicts, the penis attracts hatred not only because of its maleness, its phallic qualities, but especially because of its femaleness, the fact that the male organ is the heir to the breast.

Much of the passionate love and hate originally directed to Mother and her body becomes redirected to Father and his organ. In their minds' eyes both boys and girls tend to transform the penis into a richer source of food, pleasure and stimulation. They imbue it with the power.

 

* In classical psychoanalytic theory it is the girl or female who suffers from penis envy, that is, the resentful awareness of an organ absence which she tries to deny or remedy. In contrast the boy or male suffers from the castration complex, that is, a complex array of feelings centering around castration anxiety, the fear he will lose what he has. In the popular genre, penis envy and the castration complex are often used synonymously. In fact, they may be suffered by members of either sex to satisfy all desires and turn to it with devastating voraciousness whenever they feel hungry and deprived, or are deprived such as during weaning, separation and illness. **

I am not just describing a phantasy. In actuality, fathers and husbands are often considered superior providers. Women may prepare food, but men grow, trap or rear it, and gain the glory for culinary expertise. Traditionally the most famous cooks in Europe and other gastronomic centers have been men. The male product has also been likened to superior milk -- a rich, condensed cream. High caste Hindus aver that a single drop of semen takes forty days and forty drops of blood to make, although a careful attention to diet speeds things up. There is a reservoir in the head with a capacity of just under seven ounces. A good store of quality semen/cream guarantees health and well being.

It follows that many people prefer fellatio to any other genital activity. This practice gives undisguised expression to the ideal of the feeding phallus and subsumes the wish to suck, chew, bite, swallow and retain the penis or its products in the mouth, or other parts.

 

'Colin' is a fifty year old businessman whose obsession, whose driving force, is "big pricks". He is constantly on the go and has become a connoisseur of haunts and hideaways all over Europe where he seeks out men who possess the largest organs. He aims to see and suck on them. But he has another and even more compelling obsession, jewellery shops. He can spend hours searching for gems, the right gems, especially diamonds and rubies. As with big 'pricks', he becomes mesmerized by the sight of large jewels. In fact he will make any excuse to look at and fondle them. This led to his entering therapy. He had begun to spend so much time and money in these shops, that his family and business were in jeopardy. During the course of the treatment he had a frightening but vivid vision of jewels embedded in the walls of the consulting room:

 

"I could hardly believe it, they looked so real. They were everywhere, bigs ones, little ones, and even as I thought of them they grow brighter, more magnificent. But what surprised me the most was their shape, their cut. I couldn't get out of my mind that they looked like tits and then like pricks, tits and pricks over and over, all ending in sparkling points of light."

These gems were brilliant teats, nipples, thumbs, concentrations of desire. Colin transformed cravings for an engorged nipple into passions for a huge penis. In his mind they looked alike and were alike, a conjunction noted by the Dutch analyst, August St"rcke, who asserted in 1921 that children are dependent on a penis-like organ of their mother and often experience weaning as a castration.

Interestingly, the penis and nipple do not only look alike, but share similar functions. They engorge when stimulated, yield life-giving fluids and link one person to another. A big penis, like a big nipple, means a big link. This is especially important for children and adults like Colin who feel uncertain about the extent of their parents' love or their own ability to retain it.

As we can see here, intense desire and hate do not only assail girls. They are just as prevalent among boys, who, after all, suffer similar conflicts. Penis envy is not sex restricted. Problems about alleged small penes, demonstrate that far into later life men can remain preoccupied with oral issues transferred from their mothers and wives onto their own organ. Alternatively, a phallic breast may inspire awe and terror. One person recalled that he had gradually reconciled himself to the fact that other boys and men had larger organs and could pee farther and higher. But even as an adult he remained tormented by the memory of a wet nurse who had inadvertently sprayed his face with a huge spurt of milk from her nipple. From that point on he felt that women had a powerful advantage over him and he hated himself for not being more like them.

 

Another 'borderline' patient counfounded me with her shrieks and general intransigence. She made me feel like the breast that couldn't feed, the womb that couldn't conceive and 'the prick' that couldn't penetrate. With a fixed stare that looked daggers and radiated resentment, she used to declaim:

"I'm so powerful, I can go anywhere, do anything, no-one can handle me........I think of being a rapist, forcing myself into every mind.......I want to expand and take over space......take over time.......take over people."

So many sessions were rapes, of me by her. She allowed me no voice or even thoughts, no way to touch her, nor hope to stop her. She was a woman bewitched by phallic forces who yearned to become the instrument for my destruction. With screams, yells and shit in the post she threatened to blow me up and cut me down. She was a self trying to embody teeth, turds and knives.

On the deepest level I was the hated phallus which had access to mothers and the hated mother who was impenetrable to her. During an insightful moment she casually remarked that the reason she got angry was that "men can enter women, but women can't". She wanted to get inside people like men, otherwise no one would get inside her. Anyway, she recalled, no-one could get through to her mom, she was unavailable, always putting on powder. "My mom was a beautiful brick wall."

This conflict with her mother was never resolved, maybe mitigated. The active hate conveyed her hurt and also pre-empted feared critical condemnations. She rarely acknowledged wrongdoing, but tended to treat me like the law which added another dimension to her rage. Otherwise many meetings were punctuated by withdrawal and derision. She didn't feel anything and I couldn't help her. Men were 'wankers', I was stupid, and there were lots of therapists who could do a much better job.

The unfeeling attitude reflected a state of emotional frigidity and sexual uncertainty. She aspired to keep me a weak and impotent. Then I couldn't challenge her masculine fronts or feminine daydreams. Infidelity was a stick to batter my ego, while promiscuity a promise of insatiable appetites replayed by a female 'Don Juan'. The dragon of jealousy lurked along with envy. She hated men who got through to Moms, but she feared Mom for her wanting a man. My weakness was proof that I wasn't worth having, and vindication that she, like her mom, was invincible.

Comparable passions preoccupied a student I treated. He had had many breakdowns and had been diagnosed as paranoid schizophrenic. One day he reported a disturbing dream, that he was having anal intercourse with a stranger. After the man had entered him, his own anus turned to glass which shattered and cut the other's penis to shreds. His thoughts led to gay magazines and then to a play about Mary Barnes, a woman whom I had helped and with whom I had collaborated on a book. (11) I said that I thought that I was the stranger and the dream had to do with his penis greed and envy and jealousy. He craved my knowledge, the sharp edge of intellect which would make him invincible like Siegfried or Woton. Yet as soon as he heard me, he felt like an asshole and proceeded to soil my ideas and cut them to shreds. He had a glass ass because his feelings were fragile. His envy turned love to hate which shattered under pressure of hunger and rage. Then he was terrified I would return the rancor.

The man calmed and brought up Plato. Plato desired young boys. He was a young boy vis-vis me. I shook my head and said he was the Plato who wanted to screw me because he felt superior and wanted to take over my ties to other therapists and sources of knowledge. He calmed, but again blew up, screaming that the room was too light and accusing me of controlling the level of lighting. I pointed out that lighting had to do with enlightenment. He resented the degree of my enlightenment and bitterly resented the degree to which I was in charge of his. The moment before, I had given too much. That made him feel guilty. Usually, however, I gave too little. That meant I was selfish and stingy. A smile broke across his face: "You know, I can see me mum. She never fed me enough. I remember wanting to cut up her tits with a carving knife."

The smile signaled a hint of recognition that the roots of his phallic desires and shattering hostilities ran deep indeed, from virility to feeding, from the head to the heart. For him, as everyone, the penis held diverse, often divergent, degrees of meaning, signifying both femaleness as well as maleness. In this case, the paranoid anxieties were overdetermined, but the essential hatreds concerned feminine issues which had taken masculine forms.

 

I would like to summarize my discussion of the active, malicious sources of the psychotic aspects of the self by briefly reviewing an account of a happily married middle aged professional woman who entered treatment with Hanna Segal because of depression and work inhibition. The problems that emerged during the final phase of her analysis recapitulate many of the themes I have been describing.

Having worked through triangular rivalries with her brother and father, and penis grenvy, she seemed ready to conclude the treatment. But before this could happen, a frightful residue of unresolved craziness burst out. She became obsessed with ideas that her husband was unfaithful and her brother was interfering in her analysis, a delusional state of morbid or psychotic jealousy. Although these disturbing thoughts gradually receded, she was left feeling very fragile, and worried about a small wart that had appeared on the crown of her head. She associated it with "warts on the brain" and growing a penis.

One day she met a friend at a party, a spinster who suffered from alopecia nervosa, that is, anxious loss of hair. The party itself had been lots of fun, like a carnival, with dancing and balloons to bring home. But the patchy bald woman upset her. Afterwards she had a dream which featured a repulsive growth right next to her wart. In the dream she thought, "And the little wart as well!" She had not expected to suffer from both.

The puzzling Images slowly revealed their secrets. In the analysis the woman connected the growth with her friend's baldness, with cancer of the womb and breast, and with a spoilt balloon losing its air. Simultaneously she recalled a dead sister with beautiful hair whom she had envied, terribly. Having no husband, or children, or parents, her friend was like this sister who had lost her life at an early age.

All these connections helped, but her torments persisted until she came across a Spanish proverb about ringworm:

"If envy were ringworm, how many ringwormy people would there be in the world!"

Of course, she thought, ringworm is a growth which invades the skin. Then everything fell into place and she experienced enormous relief. The "wart on her brain" was envy which like ringworm or cancer, invaded all her relationships and activities. The dream thought, "And the little wart as well," equaled an earlier, unconscious realization that she had greed and envy on the brain. She wanted everything for herself, the breast, the womb, babies, all manner of feminine success, and the penis, phallic achievements as well, while also begrudging her sibs and parents the same.

In this world of invasive rivalry her friend represented both her sister and Mother. Hanna Segal, pointed out, for this woman penis greed and envy (separate and fused) and sibling rivalry were secondary to breast and womb greed and envy, intense desires and malice really directed at and concerned with her mother, and her mother's body, the spoilt balloons. As for her dead little sister, and anyone like her, she needed them, both to feed her vanity, and to use as a dustbin for her own shitty, sooty feelings. In this sense this story is a version of Cinderella, but with a different ending. Here the older girl ( that is, the step-sister) comes up trumps while Cinderella remains with the ashes.

In fact this person wanted everything and hated everybody. Segal comments:

"She envied men their penis and the love of the woman; she envied mothers their new babies; feeding mothers their breasts; married women their husbands; but she also envied the unmarried women their time, free of family or financial worries, and sometimes their greater professional success."

Because of these feelings, all she did or had, marriage, children, professional skills, joie de vivre, was spoilt by guilt which surfaced as depression and difficulties at work. And the successes she did manage, which weren't inconsiderable, added to her troubles. These only began to lift after she understood the dream and acknowledged the dark side of herself. As for the wart, it dried up and fell off of its own accord.

 

The key element in overcoming the noxious, psychotic-making effects of malicious impulses is the willingness to recognize them. This is all part of the process of perceiving and accepting internal reality. Of necessity this 'seeing into things' involves the recognition of basic positive forces, of gratitude, of generosity and of compassion. When this happens, as for example, during the depressive position, the child or adult is able to redress the emotional balance between omnipotent destructive wishes and life sustaining ones, and mitigate his or her psychotic states of mind.

An exchange between myself and a patient, an artist beset by paranoid anxieties and schizoid defences, illustrates the capacity to dissolve malice. This person had been enjoying a particularly good period of work. After being told that I would have to change the time of a session and miss another, he came to our next meeting in a very angry mood bitterly complaining that his creativity had left him. Moreover, a woman who reminded him of his former wife had begun to pursue him. From many previous discussions I knew that any such woman represented his own jealous, hysterical self. So I replied that he was being chased by his own furious feelings towards me for changing a session, stealing his creativity and leaving him adrift, excluded and unwanted. The man concurred and his mood lifted. He began to talk about his sister who had just written to him from far away. He realized how much he liked her. Again I related his thoughts to myself. It was clear that when I helped him to un!

derstand his bad temper, he realized how much he liked and valued me, both for myself and as a reminder of his own 'good parents'.

Then, he suddenly sat up and exclaimed:

"I see horrible little things, they seem to be melting, dissolving away in some warm medium, a pleasant warm medium. They are scrunched up little bits with little faces on them, evil little imps. They remind me of mosquito larva in a barrel of rain water.

As he was talking the combination of melting imps and mosquito larvae evoked Images in my mind of primitive blood sucking creatures turning friendly. I told him I thought the warm pleasant fluid represented the power of his warmth and affection to melt and transform his envious stings, greedy bites and jealous fears, everything that had been aroused by the sudden separation and attendant assumption that I was away enjoying myself at his expense. He smiled and replied:

"Yes, it's true. But you know they don't disappear. They just become smaller, and much less menacing. I shall try to put them into my work."

On the following day the man was unusually relaxed and confident. He said a great burst of energy had been released, and that he felt wonderful. Instead of holding back out of fear, he had been able to put the creatures' potential to good use. Once they had dissolved in the warm water, his negativity did likewise and he had been able to maintain a positive frame of mind and feel closer to me.

 

The whole cycle of love and hate which I have delineated in this paper strongly emerged in the person of a man whom I knew while he was a resident at the Arbours Centre in London. To conclude I shall recount a poignant exchange between him and myself. (13)

This man had been severely wounded during the course of prolonged conflicts with an ostensibly loving, but tyrannical family as well as his own inner demons. When his negativity predominated, he often affected a posture of psychotic withdrawal. As far as he was concerned the world was dead, and so was he, all of which terrified his parents. On the other hand, he could also be warmly playful and communicative, reparative efforts which were usually rebuffed by the very same people who were urging him to get better. Then the negativity would return with a vengeance.

Sometimes I was able to follow these emotional swings by his use of words. During up periods he would doodle incessantly, emphasizing, in particular, the word, EVIL. He liked to write and draw EVIL every which way. One day he cornered me in the kitchen and exclaimed:

"You know, Joe. EVIL spelled the other way is LIVE." I had never previously thought of the reverse spelling of the word. Upon reflection, I observed that by playing with words one could turn bad to good, evil to live, not unlike the ancient Gods who could transform Furies into Eumenides or 'kindly ones'. He nodded in agreement. Yes, he knew it was possible to turn bad to good, to transcend evil. That's why he doodled. It helped him to overcome terrible "urges". When EVIL returned, his rage gained the upper hand. But when LIVE appeared, his tension disappeared and the world became OK again.

"Joe, That's why I write. When I can't get away from EVIL, everything feels real bad inside. But when I change it 'round, to LIVE, then I feel good. I have to do this, Joe, turn EVIL to LIVE, and keep it there. For me, it's a matter of life and death."

NOTES

1. Many of the issues which I discuss in this paper are elaborated in greater detail in my (1988) book, The Tyranny of Malice: Exploring the Dark Side of Character and Culture.
2. It follows that many people prefer fellatio to any other genital activity. This practice gives undisguised expression to the ideal of the feeding phallus and subsumes the wish to suck, chew, bite, swallow and retain the penis or its products in the mouth or other parts.
3. "Grenvy" denotes the fusion of greed and envy, as well as the simultaneous expression of them. The term was suggested by Dr, Nina Coltart (Berke, 1988, pp. 26-27).
4. Segal (1975) comments: "She envied men their penis and the love of the woman; she envied mothers their new babies; feeding mothers their breasts; married women their husbands; but she also envied the unmarried women their time, free of family or financial worries, and sometimes their greater professional success."
5. The Arbours Crisis Centre is a facility of the Arbours Association which was established by myself and others in 1970 to provide personal, psychotherapeutic support, and places to live outside mental hospital, for people in severe emotional distress. In addition to the Crisis Centre, the Arbours sponsors three long-stay therapeutic communities, a consultation service and training program (Berke, 1979, 1981).

REFERENCES

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BERKE, J. H. (1979) I Haven't Had to Go Mad Here. London: Pelican.
_________ (1981) The Case of Susan and Peter: The Psychotherapeutic Treatment of an Acute Psychotic Episode at the Arbours Crisis Centre. J. Contemp. Psychother., 12:77-87.
_________ (1988) The Tyranny of Malice.. Exploring the Dark Side of Character and Culture. New York: Summit.

BOEHM, F. (1930) The Femininity Complex in Men. in H. Ruitenbek (ed.),
Psychoanalysis and Male Sexuality. New Haven, CT: College and University Press, 1966.

FREUD, S. (1937) Analysis Terminable and Interminable. Standard Edition, 23:216-253.
________ (1965) Psychotic States: A Psycho-Analytic Approach. London: Hogarth.

ROSENFELD, H. (1971) A Clinical Approach to the Psychoanalytic Theory of the Life and Death Instincts: An Investigation into the Aggressive Aspects of Narcissism. Int. J. Psychoanal., 52:169-178.
_______(1975) Negative Therapeutic Reaction. In Peter Giovacchini (ed.), Tactics and Techniques in Psychoanalytic Therapy (vol. 1l): Countertransference. New York: Aronson.

SEGAL, H. (1975) Introduction to the Work of Melanie Klein. London: Hogarth.

STARCKE, A. (1921) The Castration Complex. Int. J. Psychoanal., 2:179-201.

WINNICOTT, D. W. (1954) Metaphysical and Clinical Aspects of Regression within the Psycho-Analytical Set-up. In Collected Papers.. Through Pediatrics to PsychoAnalysis. London: Tavistock, 1958.

 

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The Psychoanalytic Review
Vol. 78, No. 1, Spring 1991