Illness can push people into the paranoid-schizoid position

There are two different ways of responding to anxiety; the paranoid-schizoid  (p-s) and depressive positions.

In the paranod-schizoid position, anxieties are about life and death.   There may be underlying panic and massive fears.

• time stands still
• we see things as ‘you OR me’ , ‘your life OR mine’, not ‘you AND me’.
• selfishness may save our life
• consideration for others is cut off and out
• we split people and things into simple categories, depending on whether they will keep us alive or threaten us
• the capacity for reasoned thought is lost
• apology is impossible  – responsibility is so frightening it has to be disowned
• huge, life-threatening self-blame is covered up by blaming someone else
• people can be afraid they should pay for their sins with their lives – so in order to save their lives, they may deny their sins.
• forgiveness is not an option
• other people may be felt as dangerous, threatening, intrusive.
• other people may be used or manipulated or threatened, as a way of getting rid of terrible anxieties into them and out of the self
• other people may be seen as cartoon characters:  Perfect Angels or Monsters, Saviours or the Devil himself.

People aren’t always aware that this is how they feel, but it may be possible to deduce it from their behaviour and what they say.

In the paranoid-schizoid position, guilt and blame can become persecutory.

• too much guilt cannot be felt; it can only be pushed into or onto someone else
• blame (originally and secretly) directed at the self is redirected at other people
• other people are then felt to be blaming and accusing
• guilt increases, and is increasingly denied, pushed onto someone else

When someone is ill, their partner, their child or their parent may be terrified about what will happen to their own lives.

P-S mechanisms can then mean that the ill person is blamed for their own illness, and for ruining other people’s lives.

When things get better and their anxieties reduce, they can revert to ‘depressive position’ mechanisms.  In the depressive position:

• there is a sense of time; of present, past and future being distinct.
• a sense of concern for others returns
• other people are experienced as more real, more whole, more human-sized and less cartoon-like
• sorrow and apology become possible as guilt becomes more realistic and less frightening
• people can reach out in a caring way
• there can be hope for a more realistic outcome
• other people do not seem so ideal
• there is less idealisation of the self
• fear is less powerful and more realistic

People can move from one position to the other, as their anxiety levels are raised or lowered.

Panicking is exhausting and frightening.

These ideas are based on the work of Melanie Klein:  http://www.melanie-klein-trust.org.uk/   Julia Segal writes about Melanie Klein’s work in Phantasy in Everyday Life (Karnac books, Aronson or Penguins) and Melanie Klein (Sage)