Dissociation and confusion; evolution of the dissociative mechanism and emergence of confusional states at the time of reintrojection

Abstract

The splitting mechanism may be used in some cases as a kind of defense against confusion. This was clearly the case of a 23-year-old female patient. At the beginning of her analysis she established a clear cut separation between temperament and thought, between body and mind. She placed in the latter ah that was bad or forbidden and projected it ah on to her mother, who thought for both. The patient was the executing body.
Splitting was not completely successful, as it may well be guessed, for she could not avoid thinking. When she became aware of this, the patient resorted to another kind of defense, i. e. the denial of thought through non-verbalization of the same.
Furthermore the patient would prevent her parents from having sexual intercourse by sleeping in their bedroom, so as to maintain the existing family symbiosis which she used to locate her split parts. During a phase of her treatment she became aware that what she wished (i. e. union of fantasy and reality, thought and action, body and mind) could be realized.
This caused much anxiety to the patient but helped her to admit the union with her analyst. Then she underwent a phalhic homosexual phase which, through analysis, made the patient to regress to an oral relation At this very moment, when she had to admit her union with her analyst, the patient collapsed in a confusional state. She did not know what, or who she was. By
admitting the analyst’s interpretations she allowed the analyst enter herself, which made the patient collapse into the confusional state. Regression to a foetal situation was a defense reaction. Confusion was due to greed and envy of the good object.
A new phase of the treatment is described, during which the patient began to include the masculine figure (the father) as autonomus and independent from the rest of the family, thus establishing a clear oedipic situation. She defended herself
against this situation by attempting to realize the union with her mother. Furthermore she felt that she could not resolve the Oedipus complex because there again existed a confusion concerning the rôles, feminine and masculine, as a consequence of phantasies of infantile masturbation, which were revealed by then. She established again another oral relation, succeeding thus in overcoming confusion. Iii conclusion, and in accordance with Melanie Klein’s theoretical viewpoints, is described how splitting was a defense against confusion, caused ultimately by an increase of envy and persecution