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The Infanticidal Attachment in Schizophrenia and Dissociative Identity Disorder

Brett Kahr

hy do some individuals become schizophrenic? Why do others develop depression? Why do others, still, become anorexic or bulimic? How do certain people become alcoholic or drug-addicted? And why do some commit arson, rape, paedophilia, murder, and other violent crimes? Although biopsychiatrically-inclined colleagues have attempted to identify a genetic basis for all of the aforementioned clinical manifestations, they have not yet succeeded in doing so. But, do those of us with a more psychogenic persuasion have a better answer? Few psychological workers have devoted as much thought and care to the question of the choice of symptom or the choice of neurosis than Professor Sigmund Freud. Throughout his long and productive career as a psychoanalytical researcher and clinical writer, Freud strove constantly to understand what he could about the origins of the neurotic and psychotic illnesses with which his patients presented in his consulting room. His early letters to the Berlin otorhinolaryngoloist Dr Wilhelm Fliess attempt to establish different aetiological–developmental pathways for a whole host of traditional psychiatric conditions ranging from the anxiety neuroses to paranoia (e.g., Freud, 1896b). During the course of Freud’s medical career, he would, from time to time, link the onset of a particular symptom cluster to sexual trauma (e.g., Freud, 1895, 1896a), or, he might postulate that specific symptoms result from transformations of instinctual urges, or from excitations of erotogenic bodily zones. For instance, in his landmark essay on ‘Charakter und Analerotik’, better known in English as ‘Character and anal erotism’, Freud (1908b, p. 175) concluded his essay thus:
We ought in general to consider whether other character-complexes, too, do not exhibit a connection with the excitations of particular erotogenic zones. At present I only know of the intense ‘burning’ ambition of people who earlier suffered from

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ATTACHMENT: New Directions in Psychotherapy and Relational Psychoanalysis, Vol. 1, November 2007: pp. 305–309.

most especially in the analysis of the case of Dr Daniel Paul Schreber (Freud. Although these typologies could exist in a reasonably pure form. in which Freud (1912c) delineated a variety of categories of disposition to neurosis. By 1917. one could readily speak of the eroticobsessional. or sublimations of those instincts. ‘traumatic’ experience. ‘infantile experience’. arguing that neurotic symptoms. by contrast. or reaction-formations against them. for instance. Brett Kahr . 219). frustration. In this communication. p. which appeared in the ‘Allgemeine Neurosenlehre’ (‘General theory of the neuroses’). ‘Über libidinöse Typen’ (‘Libidinal Types’). becomes ill. By 1931. and the narcissistic-obsessional. he or she will develop an obsessional neurosis. and the narcissistic. Freud delineated more fully one of the very first multi-factorial models of psychopathogenesis. Freud elaborated his theories of aetiological causation in his famous clinical studies. and even of an ‘erotic-obsessional-narcissistic type’ (Freud. one year later. Part III of his Vorlesungen zur Einführung in die Psychoanalyse (Introductory Lectures on Psycho-Analysis). whereas when the obsessional type becomes subject to the vicissitudes of trauma. therefore. which would contain elements of all three basic characterological groupings. arguably his clearest and most concise exposition of the links between what we might now refer to as a ‘character style’ and the subsequent unfolding of a neurotic or psychotic illness. excitation. the erotic-narcissistic. display features of more than one libidinal type. 1931a. ‘sexual constitution’ or ‘prehistoric experience’. exploring. he or she will develop hysteria. but helpful. the obsessional. and so forth. all of which conspire collectively to produce a welter of symptoms and symptom clusters. and then. may well become psychotic. in particular. in his landmark article on ‘Über neurotische Erkkrankungstypen’ (‘Types of onset of neurosis’). essay. We can at any rate lay down a formula for the way in which character in its final shape is formed out of the constituent instincts: the permanent charactertraits are either unchanged prolongations of the original instincts. as well as the role of internal forces. Freud theorized that each of these basic positions or personality styles serves as the foundation stone for more severe forms of psychological struggle. by contrast. Freud noted that much of human behaviour could be subdivided into three basic libidinal types: the erotic. many individuals. Freud had written a short. under stress and strain. delivered originally to students at the University of Vienna. inter alia. and the importance of inhibitions (cf. he had developed a very clear position about both the choice of symptom and the development of psychopathology in his famous Lecture XXIII on ‘The paths to the formation of symptoms’. The narcissistic type. so that when the erotic type. and ‘fixation of libido’. 1913i). ‘accidental’ experience. the impact of frustration as a principal aetiological component in the development of illness. Freud.306 ATTACHMENT enuresis. 1911c). including. might result from a combination of causal roots.

developmental psychopathology. In Bowlby’s (1973) work with his cohort of juvenile thieves and other deprived persons. and made an enormous contribution to the study of human psychology by noting that early deprivation serves as an aetiological factor in the development of subsequent delinquency. I have referred to this phenomenon as the ‘infanticidal introject’.. using the theories of clinical psychoanalysis. an increasingly large number of colleagues have begun to share comparable case material with me. and from her more recent work at the Clinic for Dissociative Studies in London. and. Sachs has made an important contribution to our understanding of both attachment theory and developmental psychopathology by attempting to differentiate between the type of infanticidal introject or infanticidal attachment (IA) which might contribute to the development of schizophrenia on the one hand. wherein a predisposing style becomes the launching point for a more severe breakdown state. of depression. I have postulated that unconscious parental death wishes may well serve as an aetiological component that contributes to the development of a schizophrenic psychosis in later life (Kahr. 1994). and to my great relief.g. I presented my findings on schizophrenia – all derived from dayto-day psychotherapy sessions with long-term chronically psychotic men and women – with a certain amount of trepidation. which in turn contributes to the development of an ‘infanticidal attachment’ style between child and parent.ATTACHMENT 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 20 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 7 8 9 40 1 2 3 Thus we observe in Freud the prototype of more contemporary theories of psychoanalytical characterology (e. especially in view of the ubiquity of death wishes in daily life? Fortunately. and attachment research. In view of the biopathological hegemony in contemporary psychology and psychiatry. we have strong clinical evidence for the role of early loss as a primary aetiological component of delinquency. McWilliams. Drawing upon her extensive work with both psychotic men and women from her tenure working in a variety of psychiatric hospitals. In this tradition of investigation. 1981. Shapiro. 2007). and to the development of dissociative identity disorder on the other. Sachs – a compassionate and experienced clinician – has provided a vital. I must confess that I have grappled with this question for some time. as opposed to the more ‘ordinary’ death wishes that Donald Winnicott (1949) had described in his landmark essay ‘Hate in the counter-transference’. 1965. 307 The Infanticidal Attachment in Schizophrenia and Dissociative Identity Disorder . 1993. Can a death wish really contribute to the development of a putative brain disease such as schizophrenia. hitherto missing clue. and in Winnicott’s (1956) studies of the antisocial tendency. describing instances in which patients had become psychotic in the wake of a particularly insidious death wish. We owe a great debt to Adah Sachs for her thoughtful and ground-breaking response to my article ‘The infanticidal attachment’. also. Both Dr John Bowlby and Dr Donald Winnicott – each in his own particular accent – elaborated greatly upon Freud’s research.

whereas those who suffer from the conscious form of IA may become more prone to receive an ultimate diagnosis of dissociative identity disorder. Sachs’s differentiation between the two sub-types of IA corresponds quite well with my own clinical experience with these two diagnostic categories (reasonably extensive with schizophrenic individuals. I found myself wondering whether.308 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 20 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 7 8 9 40 1 2 ATTACHMENT Sticking close to her clinical data. and I trust that other colleagues will share their clinical findings in a generous way. but. though rooted in over seventy years of psychoanalytical theorizing. 2002) and others have written about so compellingly. disguised form (as in the case of ‘Vita’ [Kahr. in addition to discriminating between a symbolic IA and a concrete IA. especially in relationship to questions of aetiology. In the former condition – the symbolic infanticidal attachment – parents will convey death wishes to their offspring in symbolic. 2007]. I commend Adah Sachs for her creative contribution to this vital matter. in the vast majority of cases. The work on the infanticidal attachment. which psychoanalyst Dr Valerie Sinason (1994. One cannot help but wonder whether those who suffer from an unconscious form of IA may be more likely to develop schizophrenia. and somewhat less extensive. In this respect. these infanticidal wishes and introjects would often occur outside of consciousness. as a psychotherapeutic community. we can contribute our extensive knowledge of the histories of our patients and clients in an effort to better understand both the origins and the treatment of severely shattered states of mind. one might also consider a further sub-division between ‘unconscious infanticidal attachment’ and ‘conscious infanticidal attachment’. Brett Kahr . In the latter condition – the concrete infanticidal attachment – parents will transmit death wishes to their children in a much more immediately sinister manner. Adah Sachs has subdivided my concept of ‘infanticidal attachment’ into two further varieties: ‘symbolic infanticidal attachment’ and ‘concrete infanticidal attachment’. her bisection of IA into the two categories of ‘symbolic’ and ‘concrete’ deserves further consideration and further elaboration from colleagues as a most welcome and carefully constructed contribution to the ancient Freudian problem of symptom choice. I have certainly worked with schizophrenic patients whose parents harboured conscious desires to kill their children. usually in a split-off manner. even killing a pet or a baby in front of the child’s eyes as part of a multi-perpetrator ritual sacrifice. so that together. with those individuals diagnosed as struggling with dissociative identity disorder). in which her mother ripped open the child’s teddy bear with a large. why would one set of infanticidal introjects contribute to the likelihood of a later diagnosis of schizophrenia while another set of such introjects would increase the likelihood of a subsequent diagnosis of dissociative identity disorder? In reading and re-reading Adah Sachs’s exegesis about the IA and its vicissitudes. In other words. though still longstanding. carving knife). remains still quite fledgling.

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