FREUD'S ORY OF PARANOID

D E L U S I O N BASED ON THE
S C H R E B E R CASE C O N T R A S T E D WITH
RELATED THEORIES
Gerald H. Zuk
Carmen V. Zuk

ABSTRACT:. The historic importance of Freud's analysis of the Schre-

ber case is acknowledged, even though the theory it expounds is
largely disavowed. The theory ascribes the cause of paranoid delusion
to homosexual impulses unresolved in infancy or early childhood.
This paper summarizes Freud's monograph on Schreber and con-
trasts his theory with the views of various revisionists. The writers
focus on the Freudian concept of projection, which is intended to ex-
plain how much meaning can become reversed under the impetus of
stress, and the reversal lead to delusional tb~nl~ug. Based on their
work in family therapy, where they observed one form of pathogenic
relating termed learning to be possessed, the writers concluded that
this form w a s also based on a type of projection which could culmi-
nate in delusional ideation. A relationship between learning to be
possessed and H. S. Sullivan's theory of paranoid transformation is
described. A learning factor is present in several of the psychological
theories advanced to explain delusion, and the factor is Rl~irlto if not
identical with Freud's concept of projection.
K E Y W O R D S : paranoid delusion; theories of psychopathology; defense mechanisms;
cognitive versus psychodynamic theory.

Gerald Zuk, PhD, is in private practice at 25316 Pacy Street,Santa Clarita,Cali.

fornia 91321-3343. Carmen Zuk, MD, is a child psychiatrist-partneraffiliatedwith the
Southern California Permanente Medical Group at its psychiatric clinicin Van Nuys,
California.Both may be reached by telephone at (805) 252-7702.
Contemporary Family T~rapy, 17(2), June 1995
c 1995 Human S~enc,~, ~ . . , Inc. 209
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C O N T E M P O R A R Y FAMILY THERAPY

Freud's (1911) assertion in his monograph on Daniel Paul Schre-

her, a G e r m a n jurist (born, 1842) who experienced several psychotic
episodes described in his book (Schreber, 1903), that Schreber suffered
from paranoid delusion because of unresolved homosexual impulses
based in the narcissism of early childhood or infancy, is largely ig-
nored by the mental health community, even by those who are psy-
choanalytically-trained, although the monograph is stillconsidered
important reading and of substantial historicalsignificancein the lit-
erature on psychopathology. The paradox m a y be understood if
Meissner's (1980) superb review of Freudian psychology is recalled.
Schreber was Freud's firstmajor pronouncement on the cause of psy-
chosis in which he sought to establish a linkage between psychosis
and his psychology of neurosis.
Freud's viewpoint in Schreber was joined by such colleagues as
Abraham (1908), Jung (1915) and Ferenczi (1911), and continues to
receive support to this day (e.g.,see Katan, 1950, 1953). But his the-
ory has also been seriously challenged by disciples. Melanie Klein
(1946), for instance, turned it upside down: She suggested that homo-
sexuality was not the cause but the effectof paranoid ideation based
in the mother-infant relationship. Niederland (1974) suggested that
Schreber's illness was caused by the severe and punitive regime es-
tablished by his father, a physician and physical culture expert.
Schatzman (1973) contended that Schreber's problem was the effect
of a dysfunctional family. Lathane (1992) has taken the novel view
that Freud did not comprehend the German society of his time and
Schreber's, especially the judicial system, and therefore failed to un-
derstand that much of what might have seemed delusional in his
thinking was really not but rather a kind of code employed by Schre-
ber. Lathane also concluded that Schreber was really the victim of an
affective illness rather than paranoid delusion. Harry Stack Sullivan
(1953) had a theory of paranoid delusion unrelated to Schreber which
will be discussed later in this paper because of its connection to a
theory proposed by the writers.
There are several objectives to this paper:

1. Because of its historicalsignificancein the psychology of psy-

chopathology, to review the case in summary, and present
with brevity the viewpoints of key revisionists;
2. because it is crucial to his argument with regard to the origin
of paranoia delusion in Schreber, to focus on Freud's definition
and usage of projection;
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GERALD H. ZUK AND CARMEN V. ZUK

3. to cite the role of a variant of projection in the writers' concept

of learning to be possessed, a form of pathogenic relating they
derived from observations in family therapy, and believed by
them as a causal source of delusion, paranoid delusion in par-
ticular;
4. to compare the writers' concept of learning to be possessed
with Harry Stack Sullivan's concept of paranoid transforma-
tion, because it is believed there are striking similarities be-
tween the two.

FREUD'S DEFINITION OF PROJECTION

For Freud, projection was a defense mechanism against anxiety

by which a person's wish or motive with respect to another was con-
verted to an opposite wish or motive, a n d psychiatric illness like delu-
sion was a secondary means of m a i n t a i n i n g the conversion of mean-
ing. A positive attraction is converted to a negative under stress and/
or because the positive is deemed dangerous. Thus love for another
who is of the same sex is reacted to with anxiety and fear. These
"emotional" reactions trigger projection, which is the process of con-
verting thoughts to their opposite. Projection accomplishes this in
part by altering perception of the loved one. The loved one is deemed
unworthy, rejecting, and persecutory, and thus there is no merit to
what is felt toward him or her. There are competing thoughts with
respect to the loved one, and confusion occurs. Finally the negative
thoughts win out by a "solution~ which reduces the anxiety experi-
enced, but the "solution~ consists of thoughts which an objective ob-
server would deem delusional.
The following is a brief summary of the Schreber monograph
which is intended to refresh the reader's memory of the historic docu-
ment, particularly with regard to the critical role of projection.
1. The Case History. Daniel Paul Schreber was born in Leipzig,
Germany in 1842. His father was a physician and educator. There is
surprisingly little material regarding other family members, which is
to an extent compensated for by later revisionists. Freud's analysis is
based almost solely on Schreber's 1903 autobiography in which he
details his psychoses. Schreber attributed the episodes to the stress
associated with his appointment to posts of increasing responsibility.
2. Attempts at Interpretation. In this middle section, Freud pre-
sents his formula that Schreber's psychoses, which took the form of
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C O N T E M P O R A R Y FAMILY THERAPY

paranoid delusion, were caused by unresolved homosexuality, where

one of his psychiatrists was the immediate cause of attraction, but
where the psychiatristwas a ~transferential"representative of Schre-
ber's father and possibly brother. Schreber's fantasies included the
idea of himself as a w o m a n sought by m a n for sexual pleasure. He
also believed he had a special relationship to God.
3. The Mechanism of Paranoia. In this final section, Freud pre-
sents his ~ogic~ for Schreber's paranoid delusion, illuminating the
key role of projection. Step I of the logic is where Schreber has the
belief that he loves another man. Step 2 is the reaction against the
belief because it is socially unacceptable. Step 3 is the conflict be-
tween conflictingthought, and the effortto resolve the conflict.Step 4
is the emergence of a delusion when the conflictis resolved in favor of
the thought that is the precise opposite of the original.

PROJECTION AS A FACTOR IN LEARNING

T O BE P O S S E S S E D

We have defined projection as we believe Freud intended it in

Schreber as concisely as possible. Based on our experience in family
therapy (Zuk, 1984, 1989; Zuk & Zuk, 1992), we agree that projection,
if defined as an inversion of meaning, is a critical factor in delusional
ideation, provided that there is a broadening of the orthodox Freud-
ian definition.
In several publications we have described the concept of learning
to be possessed as a form of pathogenic relating observed in families
where an individual member behaves in a manner unacceptable to
the family, is disciplined by the family but also excused from accoun-
tability by the judgment of a key f~rn~ly member that the individual
was not acting normally, was not himself or herself, was under the
influence of indeterminate forces, perhaps under the influence of the
devil. The member learns that punishment, perhaps severe punish-
ment, may be avoided by acknowledging that one did not know what
one was doing, was not in control of oneself but was rather under the
control of an extraneous force, and therefore should not be held per-
sonally accountable. Delusional thinking is a consequence of the indi-
vidual's being freed from personal responsibility for odd, unusual or
bizarre thought or acts, especially as the individual may not be aware
of the motive to be freed from personal responsibility. We believe this
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G E R A L D H. Z U K A N D C A R M E N V. Z U K

is a powerful motive in humans, explaining erratic and even psychotic

behavior in individuals as well as groups. While it is not identical
with Freud's concept of projection, it is akin in that there is an inver-
sion of meaning: In learning to be possessed, the individual changes
meaning by accepting the advice of others that he or she did not m e a n
his or her behavior, and therefore is not responsible.
Learning to be possessed is a cognitive dysfunction of otherwise
normal mental development. The writers have referred to the work of
Piaget (1963), who described the transition at age six or seven in nor-
maI children from prelogical to logical forms of thought. At this criti-
cal age, the newly-found capacity of normal children to think "log-
icallf' is still very fragile, and mistakes are common. Sometimes
these mistakes may be taken as amusing, or they may be taken as
early harbingers of later disasters. Piaget and Weil (1951), while in
no way so intending, provided examples of errors in the problem-solv-
ing ability of normal young children that bore--insofar as the writers
are concerned--an extraordinary resemblance to the ideation of
adults w h o were delusional. The children escaped a psychiatric diag-
nosis because they were children; but if adults they would have met
most if not all of psychopathology that is required for the diagnosis of
numerous severe psychiatric disorders in addition to delusional disor-
ders.

A RELATION BETWEEN SULLIVAN'S PARANOID

TRANSFORMATION AND LEARNING
TO BE POSSESSED

Although he indicated in his writings that he did not have much

use for the concept of projection, Sullivan certainly implies a concept
closely akin to projection in the theory he named the paranoid trans-
formation (Sullivan, 1953, pp. 361-362). The intention of this section
is to show how Sullivan employed a variant of projection to explain
the origin, psychologically, of paranoid delusion; and another purpose
is showing kinship between Sullivan's theory and learning to be pos-
sessed. A quotation from Sullivan will assist in demonstrating the
two goals referred to in the preceding paragraph:

In these situations, it is now impossible to maintain reason-

able dissociation of previously dissociated tendencies in one's
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CONTEMPORARY FAMILY THERAPY

personality which are still, in terms of the personified self,

apart. As a result, that which was dissociated, and which
was in a certain meaningful sense related to the not-me, is
definitely personified as not-me--as others. And the others
carry the blame for that which previously had to be main-
tained in dissociation as an intolerable aspect of one's own
personality.
Now at the beginning of this transformation the only im-
pression one has is that of a person in the grip of horror, of
uncanny devastation which makes everything threatening
beyond b e l i e f . . . . Under these circumstances, needless to
say, he arrives at a state which is pretty hard to r e m e d y - - b y
categorical name, a paranoid state. (Sullivan, 1953, pp.
361-362)

Sullivan, especially when he wrote himself rather than when

edited by associates, was often difficult to follow because of the com-
plexity of his sentences and his penchant for words or phrases which
he wished to invest with meaning that was different from ordinary
usage. In the quotation shown above, there are three terms that are
not easy to comprehend: not-me, dissociate, and personify. By not-
me, Sullivan refers to that part of the self which is separated and
denied. Dissociation is the process whereby the separation and de-
nial occur. By personify, Sullivan refers to a process whereby mate-
rial from the not-me is attached to another, an outsider as a kind of
scapegoat.
All three of Sullivan's terms imply projection, meaning an inver-
sion or conversion of meaning, often polar in degree. The use of the
term paranoid transformation may be considered nothing more than
a confirmation that meaning has undergone a change by which the
self disbelieves what had previously been acknowledged, and safely
transferred to another source that now becomes the source of the un-
wanted belief and is now considered a persecutor. There is a close
correspondence between paranoid transformation and learning to be
possessed because in both cases the individual can disavow personal
responsibility for thoughts or behavior that are at odds with social
convention. But it would be improper to conclude that there are no
differences between the two, for there are. In paranoid transforma-
tion the individual determines what shall be assigned to the not-me,
to be set aside and forgotten; but in learning to be possessed, an out-
side force (such as a parent) determines what it is that an individual
will or will not be held personally accountable for.
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GERALD H. ZUK AND CARMEN V. ZUK

CONCLUSION

By focusing on Freud's use of the concept of projection to explain

how paranoid delusion results from unresolved conflict,by citing the
work of his revisionist disciples and how variants of projection can
account for other theories of paranoid delusion, such as the authors'
learning to be possessed, the authors call attention to what should be
obvious: That projection is a fundamental concept in the "logic" of a
major psychopathology despite its association with the irrationality
typically identified with psychopathology; therefore, that projection is
a function of learning or cognitive theory.
Freud's famous Schreber "formula~ is contrasted with two others
in this paper which also utilize the concept of projection. In Freud's
case, projection emerged as a means to resolve a conflict in adulthood
replacing gender identity that had its origin in childhood. In Sullivan's
case, a poor self-judgment was at first separated off from the self, then
later "projected" on another individual or group that was disliked. The
writers' concept of learning to be possessed took note of how often chil-
dren's behavior is judged by significant others, and approved or disap-
proved by them. When disapproved, the child is said sometimes not to
be behaving normally, as if under the control of a malevolent force, like
the devil. The child may become confused as to when his behavior is
real or unreal; that is, when he is accountable for it and when not.
Sullivan's paranoid transformation and the authors' learning to pos-
sessed are variants on Freud's concept of projection, all of which under
certain conditions can result in serious mental disorder.

REFERENCES

Abraham, K. (1908). The psycho-sexual differences between hysteria and dementia

praecox. In Selectedpapers of Karl Abraham, MD. London: Hogarth (1949).
Ferenczi, S. (1922). On the part played by homosexuality in the pathogenesis of para-
noia. In Contributions to psychoanalysis (trans. by E. Jones). Boston: Badger
(1916).
Freud, S. (1911). Psycho-analytic notes on an autobiographical account of a case
of paranoia (dementia paranoides). In Standard edition of the complete works of
Sigmund Freud, VoL 12 (trans. by J. Strachey, pp. 9-79). London: Hogarth
(1953-1966).
Jung, C. (1915). On psychological understanding. In C. Jung, The psychogenesis of men-
tal illness.Bollingen Series 20. N e w York: Pantheon (1960).
Katan, M. (1950). Schreber's hallucination about the ~litth men." International Jour.
nal of Psycho.analysis, 31, 32-35.
Katan, M. (1953). Schreber's prepsychotic phase. InternationalJournal of Psycho-anal-
ysis, 34, 43-51.
216

CONTEMPORARY FAMILY THERAPY

Klein, M. (1946). Note on some schizoid mechanisms. International Journal of Psycho-

analysis, 27, 99-110.
Lathane Z. (1992). In defense of Schreber: soul murder and psychiatry. Hillsdale, NJ:
Analytic Press.
Meissner, W. W. (1980). Theories of personality and psychopathology. In H. I. Caplan,
A~ M. Freedman, & B. J. Sadock (Eels.), Comprehensive textbook of psychiatry (Vol.
1, 3rd ed., pp. 631-728). Baltimore: Williams and Wilkins.
Niederland, J. G. (1974). The Schreber case: Psychoanalytic profile of a paranoid per-
sonality. Hillsdale, NJ: Quadrangle.
Piaget, J. (1963). The attainment of invariants and reversible operations in the devel-
opment of thinking. Social Research, 30, 283-299.
Piaget, J. & Weft, A. M. (1951). The development in children of the idea of homeland
and of relations with other countries. International Social Science Bulletin, 3,
561-578.
Schatzman, M. (1973). Soul murder: Persecution in the family. New York: American
Library.
Schreber, D. P. (1903). Denkwurdiqkeiten eines nervenkranken nebst nachtrage und
einem anhanq uber die frage: °Unter welchen voraussetzungen darf fur geistes-
krank erachtete person geqen ihren erklarten willen in eine heilanstalt festgehalten
werden?" Leipzig: Mutze.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry, Vol. 1 (H. S Perry & M. L.
Gawel, Eds.). New York: Norton.
Zuk, G. H. (1984). On the pathology of blaming. International Journal of Family Ther-
apy, 6, 143-155.
Zuk, G. H. (1989). Learning to be possessed as a form of pathogenic relating and a
cause of certain delusions. Contemporary Family Therapy, 11, 89-100.
Zuk, G. H., & Zuk, C. V. (1992). The logic of delusion. Contemporary Family Therapy,
14, 273-284.