The Psychodynamic Perspective

Freud believed, from his very earliest studies, that projection (the assignment of one's own undesirable traits or emotions onto others) was a central mechanism of paranoid thinking. In one of his most famous analyses, Freud considered the case of Schreber. Formerly an eminent physician and presiding judge in the highest court in Saxony, Schreber wrote detailed memoirs of his paranoid psychotic experiences. He believed, for example, that he was a victim of soul murder perpetrated by his doctor and that his body was slowly being transformed by God.

Apparently, Freud never saw Schreber personally, and his analysis appears to be based solely on the memoirs (Bowlby, 1973). With a sample size of only one, Freud arrived at a startling conclusion: Paranoia was a defense against unconscious homosexual urges! In a series of circuitous transformations, the original impulse ("I love him"), considered too repugnant for conscious awareness, is denied, then reversed by reaction formation ("I do not love him, I hate him"), resulting in aggressive feelings and overwhelming guilt, which must be projected outward ("I do not hate him, he hates me!"). Finally, the sequence ends with rationalization ("I hate him because of his hatred for me"). Paranoid delusions were explained as developing as a consequence of a withdrawal of libido from the homosexual object, followed by regression to a narcissistic stage of libidinal development. Here, primary process thinking dominates, with the result that the energy can be reconstructed and returned to the outside world through projection (Bak, 1946). Although ingenious, Freud's account seems fantastic by contemporary standards.

Whatever the merits of his contribution, Freud analyzed only paranoia, a singular symptom, and not the more contextual character type of paranoid personality consisting of an entire constellation of traits. After the psychosexual theory of character development fell into place, the concept of a paranoid character developed, rooted in anal-sadism (Ferenczi, 1919). The idea of an anal character is strongly associated with the compulsive personality, individuals who responded to caretaker control by developing ambivalence between guilty obedience and an angry defiance (Rado, 1959), but who eventually conformed vehemently to parental demands for perfection through reaction formation.

In contrast, paranoids react strongly against attempts to control their defecation. As caretakers become more and more frustrated, the child, who might defecate at any point, begins to develop suspicion about their motives whenever they are found hovering nearby (Menninger, 1940). Thus, preservation of autonomy becomes the major theme associated with toilet training, and the future paranoid learns that authority functions to undermine self-determination and free will. Coercion results in resentment, enduring grudges, and increased resistance. We certainly see this in Ron, who is extremely resistant to being controlled by the courts through the inevitability of making child support payments.

As psychoanalysis matured, instinct psychology was rethought in terms of ego psychology and object-relations theory. It became apparent that sexual and aggressive instincts, as conceptualized by Freud, were always experienced in context with the "representations" of persons formed in the mind of the developing infant, called objects. Actual people come and go, but the representations of early caretakers remain as a template for all future relationships. Object-representations are thus empowered to influence behavior across the life span. As a result, psychoanalysis simultaneously became both more interpersonal and cognitive.

According to object-relations theory, early stages of development are characterized by splitting. The primitive ego is not yet able to comprehend that aspects of self and others are composed of integrated, multilayered positive and negative aspects woven into a single, complex image. The normal adult mind, on the other hand, generally easily recognizes that most everything is possessed of these multiple aspects. Some are good and some are bad, to different degrees and in different ways. Maturity thus means coming to grips with ambivalence and the ability to tolerate and accept ambiguity and conflicting information. In contrast, the primitive ego, as yet unable to fuse disparate components, knows only all-good and all-bad representations of itself and others. The "good mother" and the "bad mother," for example, are very much separate entities, just like the "good self" and the "bad self." Splitting thus resembles dichotomous thinking, in that the objects that are split are completely polarized into what is experienced as good and pleasurable versus what is experienced as bad and unpleasurable.

Object-relations theorists maintain that the paranoid personality operates at a borderline level of personality organization (Kernberg, 1979), which is, by definition, dominated by splitting. Representations of self and others are highly polarized in all good and all bad, so that persons functioning at the borderline level often shift suddenly in their emotions. At one moment, they seem totally loving, trusting, and idealizing; frustrate them, however, and they shift suddenly to total hatred, condemnation, and rage. In the paranoid, the all-good images remain inside the self, and the all-bad images are projected outward. The external world thus becomes the source of all unplea-surable feelings, and the source of everything that is desirable and good remains inside the self, protected from contamination. Projection is thus doubly reinforcing; first, the bad aspects of yourself and others are neutralized and controlled by being disowned; second, the good or desirable parts that are left behind now become that much better, more pristine, virtuous, and innocent—important traits of the paranoid's self-image.

Projection, then, according to the psychodynamic paradigm, cleanses the self of whatever is undesirable but does so at a tremendous cost: The genuine negative feelings that exist inside the self are experienced as coming from outside the self. Because whatever is bad or undesirable originates internally, it seems to follow the subject around. In a sense, paranoids just cannot get away from themselves, and persecution seems ubiquitous. As such, paranoids are vulnerable to self-referential constructions of reality, namely, ideas of reference and overgeneralized conspiracies. In effect, they are haunted and confronted by their own projected contents, eerie specters that shadow and persecute an innocent, all-good victim. They can run, but they can't hide. Whenever and wherever the paranoid feels vulnerable, for example, it is because others are somehow acting to make him or her feel that way. What others see, however, is someone who is perpetually irascible, perhaps even explosive, without adequate cause, perhaps without any apparent reason. Naturally, others react with irritation themselves, providing substantive support for what before were irrational fears. Eventually, projection may thus acquire a basis in reality.

We certainly see this in Ron. When the therapist asks for information, Ron becomes incensed and interprets the request as a display of skepticism. Thereafter, he projects his own aggression onto the therapist, who now belongs to the ranks of those who would attack and conspire against him. In this way, Ron turns his own phantom fears into reality. Almost anyone would be irritated with him. His coworkers probably feel the same way, only more so because they are chronically exposed to him. If they whisper among themselves about his strange reactions, they have good reason. From Ron's perspective, their whispers are not reality-based complaints about his behavior but instead covert machinations designed to bring him down.

Secondary defense mechanisms also arise in response to the vicious circles that paranoids create. As noted by Stone (1993), paranoids put psychological and geographical distance between themselves and others. Isolation serves as a means of resisting both invasion and external influence. Moreover, retreat from social life quells somewhat the agony of self-referential ideas, which are amplified when others are physically present. Paranoids also make use of fantasy and righteous indignation. Through revenge fantasies, they exact vengeance on their persecutors and reestablish their autonomy. Whereas before, the weak paranoid was at the mercy of the world, now the world is at his or her mercy. The paranoid swells with righteous indignation, glorified by the moral authority of a suddenly empowered, long-suffering victim, as Ron paints himself. Omnipotence and indignation further serve as means of cohering a self-representation perilously close to diffusion, much like the function of the grandiose self in the narcissistic personality (Stone, 1993). Keeping the self coherent forestalls or prevents psychotic disintegration. The internal and external worlds are distorted, but at least the self is preserved. Finally, rationalization and displacement are also commonly observed.

Many writers have noted the megalomania, that is, extreme overvaluation of the self, that exists among paranoids and its associated omnipotence. Both of these phenomena are related to pathologically low self-esteem. Grandiosity compensates for deep feelings of inferiority, and omnipotence compensates for the sense that the individual is completely ineffective or has no power in the world. According to McWilliams (1994), the relationship between the paranoid personality and the omnipotence of primitive narcissism betrays immense concerns with shame, guilt, and envy. All three call the perfection of the narcissistic self into question, and all three are projected onto others. Shame, for example, derives from feeling that the individual is somehow defective, inferior, or ugly in the sight of others and that these others are acutely aware of such shortcomings.

In fact, the hazy fear that their shameful acts have been exposed underlies the development of many ideas of reference. If you take a moment to think about your own shameful secrets, the worst-case scenario is easily envisioned: Not only have you been found out but others are secretly discussing you, eagerly gossiping about your shameful acts but without letting you know that they know. To rid themselves of such intolerable notions, paranoids project shame and then naturally conclude that it is others who are actively trying to shame or humiliate them. Perhaps Ron, for example, feels that he should be much further along in his career, or perhaps he simply feels ashamed that the family is having money problems and thus needs to construct a scenario in which his coworkers are conspiring to exploit him. His suspicions distort reality, but they at least salvage what little self-esteem he has. The experiences of guilt and envy are essentially dealt with the same way. Where paranoids might feel guilty, it is others who have wronged them. Where others have characteristics that paranoids envy, it is others who envy them.

Now consider the case of Stephen, the child genius (see Case 13.2). Stephen is obviously highly intelligent, having obtained his doctorate in physics at the age of 23. We can imagine how proud his parents must have been, as both lacked a formal college education. We can also speculate that Stephen must have felt enormous pressure to stand out just as much among his colleagues as he did among his fellow students. Unfortunately, his own megalomania keeps getting in the way of his progress, creating conflicts with supervisors who feel that he spends too much time on his own "secret schemes" and not enough on company projects.

Despite his objective intellectual gifts, it appears that Stephen has a fragile self to defend. Evidence of a crushingly low self-esteem is found not only in his grandiosity, but also in his condescending reaction to constructive criticism and in his need to conceal his own projects. To defend himself, Stephen has chosen a path already trod by his own father, probably because he knows it to be an excuse to which his parents will resonate: Not only was the father too brilliant for those around him, but the son is, as well. Accordingly, Stephen is convinced that his coworkers and supervisors are trying to undo him by stealing his ideas, by not paying him what he is worth, and by appraising his work as "absurd schemes." Such misread signals and unwillingness to consider the evidence are part of the paranoid pattern. Stephen's solution is to counterattack by spending even more time on a scheme that would not only "revolutionize the industry" but also vindicate and avenge him against his critics. Unfortunately, the reverse proves true. Stephen's plan is rejected for overlooking certain simple facts of logic and efficiency. Faced with objective evidence of failure not easily denied, Stephen withdraws to his home and begins drinking to excess. After a series of similar rejections, he is finally faced with two choices: either crumble under self-condemnation or retreat into a world of complete fantasy. Stephen chose the latter.

Akhtar (1992, pp. 167-168) describes overt and covert aspects of the paranoid personality, closely paraphrased here. In the area of self-concept, paranoids overtly seem arrogant, self-righteous, and easily enraged. Covertly, however, they feel timid and inferior and are plagued by doubt and guilt. In the area of interpersonal relations, they overtly seem mistrustful, humorless, accusing, and cold. Covertly, however, they are exquisitely sensitive, naive, frightened of power and authority, vengeful, and grudge holding. Overtly and covertly, Stephen fits this profile. He is definitely arrogant and self-righteous, as evidenced through his reaction to constructive criticism of his pet projects, also evidence of his sensitivity and self-doubt. Had Stephen been blessed with a greater sense of self-worth, he would have been able to make use of such criticism in the spirit in which it was intended and perhaps even get his associates excited about his ideas, which he instead safeguards jealously as his own private property. Moreover, as the child genius prematurely pushed forward by the momentum of his own intellect, Stephen is easily seen as being frightened of power and authority.

The shy only child of Informally educated parents, Stephen was considered a "child genius" in his early school years. Having always been pushed by his parents to succeed, he received his doctorate in physics at 23 and was a celebrated student in his department. Subsequently, however, things turned sour. He held several middle-level positions as a research physicist in a number of industrial firms, going from one to another following a series of disputes, claiming that others were trying to steal his ideas.1

Stephen's father also had considerable difficulty in his career. Although uneducated in a formal sense, he understood a great deal of technical information, consulting with several companies who sought someone with his detailed knowledge and inventive mind. But these positions did not long endure. In less than a year, two at most, Stephen's father would alienate almost all of his colleagues, accusing them of trying to steal his ideas and of not paying him what he was worth. Stephen recalled quite vividly the dinner table conversations when his father would be furious because he was being "fired again" because he was "too smart for the fools around him."

In a similar pattern, Stephen's own arrogance and egocentricity were now creating conflicts with his supervisors, who felt Stephen spent too much time on his own "secret schemes" and not enough on company work. Anyone who commented on his projects, even in a constructive manner, was subsequently greeted with condescension. Eventually, Stephen was assigned less important jobs that made him feel that both his supervisors and subordinates were "making fun of him" by not taking him seriously.

Almost as revenge, Stephen began to work on a scheme that would "revolutionize the industry," a new thermodynamic principle that, when applied to his company's major product, would prove extremely efficient and economical. He worked in private as long as possible, refusing to share any of his ideas with his "turncoat colleagues." After several months of what was conceded by others as "brilliant thinking," he presented his plans to the company president. Brilliant though it was, the plan overlooked certain obvious simple facts of logic and economy.

Upon learning that his plan had been rejected, Stephen withdrew to his home and established a habit of drinking to excess. Thereafter, he became obsessed with "new ideas," proposing them in intricate schematics and formulas to a number of government officials and industrialists. New rebuffs followed, which led to further efforts at self-inflation. Not long thereafter, he lost all semblance of reality and control. For a brief period, he convinced himself that he was Niels Bohr, a famous quantum physicist. Whether such grandiose delusions could be attributed to his drinking problem and personality problems, or were better conceived as an outgrowth of his paranoid personality pattern alone, was a major question for clinical assessment.

1 Numbers mark aspects of the case most consistent with DSM criteria, and do not necessarily indicate that the case "meets" diagnostic criteria in this respect.

Paranoid Personality Disorder DSM-IV Criteria

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

(2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

(3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

(4) reads hidden demeaning or threatening meanings into benign remarks or events

(5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

(6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

(7) has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder with Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g. "Paranoid Personality Disorder (Premorbid)."

Reproduced with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Copyright 1994 American Psychiatric Association.

In the area of social adaptation, Akhtar states that paranoids are industrious, driven, and successful when working on their own. Covertly, however, they have frequent interpersonal problems, carry personal issues into the workplace, work poorly as part of a team, and are oblivious to aesthetic appreciation. In the area of love and sexuality, they are overtly unromantic and averse to sexual humor and gossip. Covertly, however, they doubt their sexual ability and may have sadomasochistic tendencies. In the area of ethics and ideals, they overtly value the intellectual but seem moralistic and religiously fundamental. Covertly, however, they are morally idiosyncratic, sometimes with socio-pathic tendencies. Of these, Stephen is definitely not a team player. The remaining descriptors seem to apply more to Ron, who is certainly moralistic and obviously not much of a romantic.

Contemporary psychodynamic developmental accounts of the paranoid personality emphasize the importance of early abuse. Whereas normal persons learn a basic sense of trust during early development, the paranoid learns basic mistrust. Such concerns are often symbolically expressed as a fear of being eaten up or devoured, which might be referred to as boundary loss or a fear of engulfment. McWilliams (1994) stresses the presence of criticism and ridicule in the families of future paranoids and the possibility that the child may have been scapegoated for attributes that the family would like to disown. As noted by Blum (1980, 1981), Freud anticipated the modern view through his paper on the Wolf Man, which links paranoia and sadomasochism. Such elements appear in the case of Schreber, whose father invented and published methods of child-rearing that featured cruel exercises and harnesses, through which even the posture of a child could be controlled, ostensibly to prevent poor circulation and eventual paralysis. Apparently, the young Schreber had been a prime benefactor of his father's "wisdom" throughout his childhood. As a result of such evidence, Freud's original hypothesis has been generalized: Paranoids do not possess latent homosexual wishes but nevertheless long for comfort from the same-sex parent, their abuser, most often the father, which may be mistaken as a homosexual wish.

Other developmental facets of the paranoid personality often reflect variations on the theme of early sadistic abuse or readily follow as an understandable consequence of early abuse. Searles (1956) stresses the desire for revenge that is often found in paranoids. Cameron (1963) emphasizes that as a result of such treatment, children become supersensitive to subtle hints of hostility, contempt, criticism, and accusation. Hypervig-ilance provides a means of protection against deception and sudden attack. Because paranoids do not discriminate in their projections, their entire world becomes a "pseudocommunity" populated by persecutory others. Grandiosity may be seen as a compensation for abuse as well as a means of reinforcing the boundaries of the self against dissolution (Bursten, 1973; Kernberg, 1982). Auchincloss and Weiss (1994) regard the paranoid character as needing a magical connection to caretakers, an intolerance of indifference. Better to suffer and be connected than to be ignored.

In the case of Stephen, none of these developmental hypotheses are easily sustained based on the evidence presented, because abuse does not appear in the case write-up. Nevertheless, certain facts stand out. For one, Stephen has many aspects of the narcissistic personality and thus somewhat resembles the description of the fanatical paranoid, described previously. We note further that Stephen's parents pushed him forward, certainly not as a means of gratifying his own needs, but as a means of gratifying theirs, a compensation for poor family status. We can imagine Stephen as the perfect little genius, celebrated by his parents but also carrying a great responsibility. The implicit message was: "We, your parents, wanted to be so much more than we are. Now, you must succeed where we have not. Otherwise, the verdict of the world on your family becomes reality. Save us. If you are brilliant, you are loved." Accordingly, Stephen's grandiosity defends not only his own self-worth but also the worth of the family. Given such high expectations, shortcomings were probably inevitable. Because these are intolerable to his narcissistic need for perfection, they must be externalized. The ultimate result is a paranoid personality that decompensates into a paranoid psychosis.

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