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The aim of psychoanalysis

a
Dr John Steiner
a
The Tavistock Clinic , 120 Belsize Lane, London,
NW3 5BA
Published online: 11 Aug 2006.

To cite this article: Dr John Steiner (1989) The aim of psychoanalysis,

Psychoanalytic Psychotherapy, 4:2, 109-120, DOI: 10.1080/02668738900700111

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 PsychoanalyticPsychotherapy (1989) Vol 4 No 2, 109-120

THE AIM OF PSYCHOANALYSIS*

JOHN STEINER

SUMMARY
The changing aims of psychoanalysis are discussed with reference
to Money-Kyrle' s paper on the subject. The theory of dammed-up
libido, the theory of moral conflict and the theory of
misrepresentations and perversion of reality which he described, all
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imply different aims. It is argued that, in addition, the theory of

projective identification leads to a radical change in the aim of
treatment which can now be formulated in terms of helping the
patient regain lost parts of the self.

Psychoanalysis can have many different applications in social, scientific, and

cultural spheres; but it developed as a clinical treatment, and in m y view the central
aim for the analyst must remain the understanding and alleviation o f mental illness
and suffering and the p r o m o t i o n o f g r o w t h and development in the individual
patient. This view is reinforced if we recognise that in our contract with a patient we
accept a fee or an N H S salary on the implicit understanding that the treatment is
going to be o f help. W e m a y not be able to promise specific results, but we have to
believe that what we offer is the treatment o f choice; otherwise we would be b o u n d
to direct the patient elsewhere.
If the general aim o f psychoanalysis is the alleviation of mental illness and distress
then the specific aim will depend on our view o f the nature o f mental illness. I have
based these thoughts on t w o important papers by the English psychoanalyst R o g e r
M o n e y - K y r l e (1968, 1971), in which he describes h o w in his lifetime, which
incidentally corresponded very nearly to the history o f psychoanalysis, a variety
o f models o f mental illness were held by psychoanalysts. Although each new
model supplemented rather than replaced previous ones, the aim o f psychoanalysis
has changed in important ways as the model on which treatment is based has
changed.
I will briefly describe the three models which M o n e y - K y r l e proposed, and
interpolate a fourth, which I think he takes for granted but which in m y view
deserves special recognition. Before doing so, however, I will briefly discuss some
clinical material in order to see if the different models and their associated aims can
be usefully applied.

*Presented as a Freud Memorial Lecture at University College London, October 1987.

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 JOHN STE1NER

CLINICAL ILLUSTRATION: MRS A

W h e n she began analysis, Mrs A was a divorced w o m a n in her early 40s. She
w o r k e d as senior secretary in a large solicitor's office which she considered to be a
futile place, with no prospects and no future. She saw herself as plagued by bad
luck and had suffered a series o f misfortunes and betrayals, the most important o f
which was the infidelity o f her husband with her best friend, which led to the break-
up o f her marriage in her early 20s. Since that time, she had no relations with men
and lived a lonely and miserable life w i t h only her dogs and her w o r k to relieve her
solitude.
She was chronically unhappy, and m a n y o f her sessions were filled with detailed
descriptions o f a variety o f somatic complaints and long accounts of her misfortunes.
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The resentments mostly had to do with her childlessness and her relative poverty,
and involved the painful comparison with her husband w h o had gone on to re-
m a r r y and have children, and whose successful business she heard about periodically
from friends.
In fact, similar resentments had been present all her life: she was bitter towards her
sister and father, and envious o f her mother w h o she felt had an easy life because she
did not have to work. The parents slept in separate rooms and she shared her
mother's bed until she was given her own r o o m when she was 8-years-old. Her
feeling o f being special was shattered b y this expulsion, and she seems never to have
felt really loved. In her o w n r o o m she had some awareness o f her misery and o f her
rivalry with her sister and father, but she could never accept this and seemed always
to strive to recreate the special relationship.
Her father was a rather rigid schoolmaster who introduced a strict and arbitrary
morality into the home, which her mother and sister accepted without protest. She
was for a while, at least inwardly, rebellious and, unlike her sister, she did well at
school, going on to university where in her first year she surprised everyone with
her talent in science. It was soon after this that she had a b r e a k d o w n and was sent
h o m e in an acute anxiety state w i t h depersonalisation and some persecutory
thoughts. I came to think that as she began to use her intelligence in her adolescence
she began to ask what to her were dangerous questions, such as what her father's
strict morality was hiding; w h y her mother, w h o was highly intelligent, did not go
to work; and w h y the parents did not share a bedroom. She gradually i m p r o v e d but
could not return to college, and after two years off"she began a secretarial course, as
her sister had done.
I got the impression that a move towards independence had been abandoned b y
her and that instead she withdrew her interest from the real world to a rich fantasy
world f r o m which she got comfort. She spent much o f her analysis in this kind of
dream state which seemed to me to be an attempt to recreate the special kind o f
w a r m t h and closeness she felt she had in her mother's bed and thus to escape from
what she saw as a harsh reality. The fantasy world was strikingly reenacted both in
her everyday relationships and in the transference. She adopted a little-girl quality in
her manner which was highly erotised but with a kind of nalvet6 and apparent

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innocence. She dressed seductively and encouraged men to make advances in a way
which seemed to put them in the wrong. For example, she held hands under the
table with one of the partners at an office party but was shocked when he tried to see
her home.
It was almost impossible to speak about her behaviour or her fantasies, however.
If I did so she would become indignant, complaining that it was quite i m p r o p e r to
suggest such an awful thing and that the interpretation was nothing but a reflection
o f m y dirty mind. It seemed to me that she went into a kind o f dream-state in which
she felt close to me in a vaguely erotised way, but that i f this was mentioned the spell
was broken and she felt expelled from this intimacy, as she had been from her
mother's bed.
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THE FIRST MODEL: THE THEORY OF DAMMED-UP LIBIDO

Dating from Freud's early period, the first model is briefly discussed by M o n e y -
Kyrle, but despite its occasional revival it is chiefly o f historical interest. The
dominant assumption is that 'mental illness arose as a result o f sexual inhibitions', and it
w o u l d not be difficult to apply it to m y patient, who was certainly very inhibited
and frustrated in her longing to find someone to love and be loved by.
The aim o f psychoanalysis, according to this model, is to free the patient from
such inhibitions to enable a satisfactory discharge of libido to take place. In some
circumstances this can be very important, but M o n e y - K y r l e is surely right when he
suggests that, when naively understood, this model leads to a superficial analysis
and
... can encourage a patient to adhere to the unconscious belief that, instead
o f giving up his Oedipus complex he can realise it with the analyst's help
and so be master o f the world.

THE SECOND MODEL: THE THEORY OF MORAL CONFLICT

M o n e y - K y r l e ' s second m o d e l is really the central theory o f classical Freudian
psychoanalysis, and unlike the first model is the basic theory guiding many
psychoanalysts to this day. Here, the dominant assumption was that mental illness is
the result o f unconscious moral conflict and it rests on Freud's various theories o f
conflict, whether between unconscious impulses and the demands o f reality or in his
later structural theory between forces from the id in conflict with the superego.
Freud saw the ego being pulled by the demands o f these two agencies o f the mind:
the id representing primitive wishes, especially sexual and aggressive ones; and the
superego representing the prohibitions o f society, in the form o f internalised
parental figures. The patient's problem is to negotiate the conflicts; when unable to
do so he m a y develop symptoms as a compromise and use maladaptive mental
mechanisms to defend himself and his objects. Often these mechanisms become
installed as permanent features o f the personality.
The conflict model was enriched b y the recognition that while the superego is
based on an intemalisation o f parental figures it is also affected b y the patient's o w n

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 JOHN STEINER

attitudes. Freud himself was aware o f this, but it was stressed by Melanie Klein, who
saw in her analysis o f even very y o u n g children that the harshness o f the superego
did not simply arise from a harsh upbringing. If we add to this model the discoveries
Freud made on transference and recognise that the conflicts are reexperienced in the
relationship with the analyst, a very sophisticated theory emerges and the conflict
can be w o r k e d through in the analysis and new compromises and solutions
discovered and established.
It is not difficult to apply this model to m y patient's situation, since it is clear that
she was in constant conflict between her wish to gratify her sexual and intellectual
interests, and prohibitions, which she felt prevented her from achieving her goals. A
very severe superego seemed to accuse her o f having unnatural or inappropriate
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desires, and she had to suppress these to avoid guilt and punishment. Indeed, such
guilt seemed to be so unacceptable to her that the w r o n g d o i n g was projected and
she felt herself to be a victim.
This m o d e l has led to treatment goals which aim to help the patient resolve the
conflict in more healthy ways. Perhaps most important has been the emphasis Freud
placed on insight as a therapeutic aim. If the patient has some understanding o f his
unconscious processes the conflict becomes less distorted b y primitive fantasy and
hence m o r e manageable. The adage ' W h e r e id was there ego shall be' in addition
suggests that control over the impulses through self-knowledge was part o f this aim.
The aim includes helping the patient construct a m o r e realistic internal world, in
which his objects are less distorted b y projections.
This model, and the aims o f treatment which go with it, remain central to
psychoanalysis, but carry with them important technical problems since the
understanding o f conflict involves moral choices which are often very difficult to
resolve. It is easy for the patient to d r a w the analyst into the conflict and treat him as
an adviser or coach w h o should help by suggesting what the correct choices should
be. Even i f one tries to avoid this type o f superego-ish analysis, it is impossible to
avoid communicating to the patient in one form or another which choice is morally
approved o f and which is not.
W h e n e v e r I tried to explore m y patient's fantasy life, for example, she seemed to
hear me j u d g i n g her unfavourably and implying she was doing something
improper, and this was one o f the factors which led her vehemently to deny her
fantasies. Indeed she managed to identify with the righteous j u d g i n g figure and
accuse m e o f having improper thoughts. Because o f these factors, it seemed
impossible for her to use her analysis to help her gain insight into her situation and
to use that insight to find a less disabling resolution o f her conflict.

THE THIRD MODEL: THE THEORY OF PROJECTIVE IDENTIFICATION

Melanie Klein's (1946) discovery o f schizoid mechanisms, in particular projective
identification, radically affects our model o f mental disorder and fundamentally
alters the aims o f psychoanalysis. She described projective identification as a
primitive mechanism in which part o f the self is split-off and projected into the

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object. The aim is sometimes to get rid o f unwanted attributes, and sometimes to
attack and control the object. But sometimes it also serves as a primitive means o f
communication with the object. A n important consequence of this mechanism is
that a lack o f separateness between self and object results, and it becomes unclear
which attributes belong to self and which to the object.
Projective identification, like other mechanisms o f defence, involves an uncon-
scious phantasy but one which has profound effects not only on the patient and his
perception o f the world but also on others. These others m a y be people, or parts o f
people, or even things such as animals or furniture; and, because Freud's early
theories spoke o f the object o f a drive they are loosely referred to as objects. W e
n o w recognise that projective identification has a powerful effect on the object used
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to project into, so that it is clearly more than just a phantasy on the part of the
patient. H o w these effects are produced often remains poorly understood, and the
patient m a y make us depressed, angry, excited or sleepy b y subtly engaging with
those aspects o f our personality which are prone to those feelings.
The patient often projects and disowns what he considers to be bad parts o f the
self, such as those which produce aggression, or guilt, or envy, but he may project
good parts such as a capacity to love, or to feel concern and regret. Splitting off and
projecting intellectual functions, such as the capacity to think, m a y be particularly
damaging. Such projections clearly affect the way the object is perceived, but they
also have a profound effect on the patient's mental resources which become depleted
as a result o f excessive projective identification.
One o f the most striking aspects o f m y patient's behaviour on the couch was what
I came to call her pseudo-imbecility. She w o u l d adopt a kind o f thoughtless
whining w a y o f speaking which made me feel it was impossible for her to think
intelligently. For example she w o u l d moan, ' W h y don't y o u tell me what to do?'
and having read in a b o o k on psychoanalysis that patients were supposed to free-
associate, she complained 'You didn't tell me I should free-associate. I have been
coming all these years and I never k n e w what I was supposed to do.'
It was difficult to believe that this same person could have excelled in science at
the University, and it was only as I got glimpses o f a quite superior intelligence, for
example when she mastered complex and subtle problems at work, that I began to
realise that she had done something with her capacity to think. In part, she seemed
to split it off and project it into m e so that she came to depend on me for the most
elementary thought; and one o f the factors behind this projection seemed to be the
conviction that thinking was dangerous.
I sometimes tried to explore her reluctance to use her intelligence, and I will
illustrate this kind o f w o r k by presenting part o f a session in which this theme came
up.
She began the session five minutes late, explaining that she had been struggling to
get away from a friend w h o wanted to talk and this had delayed her. She then
described a dream in which she was descending to the Underground and at the foot of the
stepsfound herself having to make a choice between the left-hand passage leading to town and

113
 .JOHN STE1NER

the right-hand one leading home. She stood there unable to choose,feeling terribly heavy, and
found that she had a gardening sickle in her hand. Her indecision made her late and she was
relieved since this meant she did not have time to go to town and could go home and do the
work she needed to do in the garden, which was terribly overgrown and untidy. She recalled
h o w often when she felt she had too much w o r k to do at home she w o u l d go to
town and wander round the shops, sometimes buying impulsively. The sickle had
been loaned to her by a neighbour some two years previously and she discovered it a
few days before while clearing out her garden-shed. She felt guilty, not only that she
had not returned it but that she had never used it. She described it as a horrible sharp
thing and w o n d e r e d w h y the neighbour had not asked for it back. Perhaps he had
forgotten that he had lent it to her.
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I interpreted that the choice in the U n d e r g r o u n d in her dream represented the

conflict she was in between doing the painful analytic w o r k and fleeing from it, and
that the heaviness she felt seemed to have been connected with the strain o f the
conflict. I w o n d e r e d if a similar difficulty m a y have occurred on her w a y to the
session when she had to drag herself away from chatting with .her friend. W h e n I
suggested that there may have been some relief that she managed to get to the
session, she said that she felt heavy now, and complained that m y interpretations
were not clear and that they persecuted her since they made her feel there was a lot
o f w o r k to be done and hence that she must still be very ill.
I interpreted that part o f her despair at the idea o f w o r k was connected with her
fear us using her intelligence which she k n e w could be sharp and hurtful, tike the
gardening sickle, but which was also necessary for useful work. I thought she was
afraid to use her intelligence because she was afraid too that it could be used to attack
me more effectively than the kind o f blunt instrument her whining and complaining
represented. But I thought she was also afraid to think scientifically and to reach
conclusions on the basis o f evidence. If she did, she w o u l d have to evaluate what sort
o f analyst I was and she was afraid that she w o u l d be disappointed in what she
found. This w o u l d inevitably be a disappointment in comparison with the romantic
image she created o f me. N o doubt she w o u l d also ultimately have to come to terms
with what she was like, as well as w h a t sort o f man her husband was and what sort o f
parents and family she had. To recognise both positive and negative aspects o f her
objects she w o u l d have to clear away much confusion, which was usually dealt with
b y romantic idealisation and which was perhaps represented by the o v e r g r o w t h in
her garden. To do this she w o u l d need her intelligence, which seemed to be lost and
forgotten like the sickle in the garden-shed, and she was afraid that I too w o u l d
forget that she had it.
At first she responded indignantly, suggesting that it was a terrible thing to imply
that a patient could attack the analyst, but gradually she did begin to think about the
issue, and later even wondered if her sharp tongue had not been responsible for
sending her husband away. Moreover, she gradually came to recognise that she was
actually more intelligent than he was and that her cutting remarks had been based
on her capacity to see through him, which she felt he could not tolerate.

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I think it is possible to see that the conflict theory takes us only part of the way to
understanding this kind o f material and that the recognition o f projective identifi-
cation expands the possibilities enormously. The aim o f psychoanalysis according to
this model is to help the patient find an integration and re-acquire parts o f herself
which were previously lost through projective identification. The radical difference
between this model and the conflict model has not in m y view been sufficiently
appreciated. In practice, the conflict model retains its central place in our everyday
work, but the understanding o f projective identification profoundly affects our
technique. W e are less likely to become caught up in the conflict since the aim is to
help the patient re-acquire the means to w o r k through the conflict for himself.
Moreover, it allows the analyst to recognise h o w often he is working under the
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sway o f powerful projections and helps him to gain insight into his own defences
and consequently to be less likely to act out rather than to understand and interpret.
Although Freud did describe splitting, and spoke o f 'deformations' of the ego, he
mostly considered the individual to have an intact ego which was under pressure
from instinctual forces on one side and superego on the other. If the ego was
fragmented or damaged, as in psychosis, he thought the narcissistic withdrawal
which resulted interfered with object relations and hence made psychoanalysis
impossible. It was largely under the influence o f Melanie Klein that several British
psychoanalysts began to study and treat psychotic and borderline patients, and in
c o m m o n with others throughout the world found that they did indeed develop
relationships with objects which were very intense and disturbing to both parmcrs.
W i t h the discovery o f projective identification, it became possible to understand the
primitive mental processes involved in such psychotic transferences and then to
recognise that similar mechanisms were observable in all patients.
These discoveries led to a wave o f therapeutic optimism and confidence as it
began to seem possible to treat even very ill patients and to gain insight into the
deeper workings o f the mind. Some o f this confidence was certainly well founded
and continues to be felt, but it was not long before serious obstacles to progress were
recognised similar to those which Freud encountered and described as resistance. It
became clear that it was often not easy for the patient to face the psychic reality
which emerged i f he began to take back into himself previously split-off parts.
Often the crisis seems to centre on the recognition o f destructive forces, in particular
those linked by Freud to the death instinct and by Klein to primitive envy.

THE RE-AcQuISITION OF PROJECTED PARTS OF THE SELF

The theory describing h o w projected parts o f the self are re-acquired and
reintegrated into the self is still very incomplete, and I can only touch on it here. It
does seem to involve t w o stages: first, a stage in which an object is used as a
container to collect and integrate the disparate parts o f the self which he receives
through projective identification (Bion 1956). If the analyst can register and give
meaning to the projected fragments an integration takes place and the patient feels
less anxious as he feels understood. In this phase, however, he is dependent on the

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availability of the analyst to act as the container and bring the parts together through
giving them meaning. Bion who described this mechanism suggested that it is
through being understood in this way that the patient can take the projections back
into himself; but I believe he continues to need the object to act as a container and
that the projections are not truly withdrawn from the object until the second stage.
It is in this second stage, which represents a move towards independence, that the
object has to be relinquished, and I believe that it is at this point that the projections
are returned to the self. This stage involves facing the loss o f the object and
consequently means that mourning must be worked through.
The process seems to require the painful recognition of reality if it is to be
successfully negotiated. First, the reality of the dependence on the object in the first
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stage has to be acknowledged and then the reality o f the loss of the object has to be
faced, and both are often vehemently resisted. It is clear that projective identification
itself obscures the reality o f the separateness between self and object, and it is this
reality which is reestablished if the projections can be returned.
This is not, however, a static process and projective identification is going on all
the time in every interaction. It is responsible for our capacity to put ourselves in
someone else's shoes and adds depth to human relationships. Normally, however,
the process is relatively fluid so that we project and then take back projections in a
flexible way. Problems are produced when the projected fragments stay stuck in the
object and produce a rigid kind o f object relationship which is called narcissistic
because the subject is relating, not to a separate person, but to himself in the object.
In these narcissistic types of object relationship the separate existence o f the object is
denied and it is treated either as part of the self or as a possession of the self.
Even when relationships have been relatively normal, this type of rigid narcissistic
projective identification can be called into play in times o f stress. This is particularly
true when loss has to be faced and Freud himself described how, following a
bereavement, the loss of an object leads at first to an identification with the object
and a denial o f the loss. In Mourning and Melancholia Freud (1917) goes on to
emphasise the importance o f facing reality if mourning is to be worked through.
For example, he suggests that it is when
Reality-testing has shown that the loved object no longer exists, [that] it
proceeds to demand that all libido shall be withdrawn from its attachments
to that object.
Nowadays we think more in terms o f parts of the self than of libido, and it is only
a small step to suggest that it is in the process o f mourning, when reality-testing is
applied, that projections are returned to the ego and that it is this process which is so
painful and so violently resisted. If mourning can be worked through then the
object is perceived more realistically and the self is enriched, but as a consequence
the individual is more clearly aware o f a separateness of self and object, and
recognises more clearly what belongs to the self and what belongs to the object.
Separateness makes one aware o f both good and bad aspects o f the object and the

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denial o f separateness consequently serves as a protection against both frustration

and envy. It is understandable therefore that reality-testing m a y be resisted so
vehemently since it involves acknowledging things which p r o v o k e violent feelings
and threaten to shatter the patient's equilibrium. Moreover, it is clear that all those
lesser degrees o f loss, such as when we have to face rejections or interruptions in our
relationships, involve processes essentially similar to those we see in more gross form
following a bereavement.
If we were able to help the patient face the reality o f their dependence and then
the reality o f their loss as it is experienced in the transference, we could help them
take back projected parts o f the self and reintegrate them into the personality. It is
this which we can consider to be the aim o f psychoanalysis according to the third
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model, but again, when w e try to w o r k on this problem in practice, we find that
resistance is once more encountered and this most c o m m o n l y takes the form o f a
denial or misrepresentation of reality. If reality cannot be faced mourning cannot
proceed and the patient cannot regain the parts o f the self he has disowned.
The denial as we have seen depends on projective identification and a narcissistic
type o f object relationship, but it can take a variety o f forms. In psychosis for
example reality m a y be so intolerable that the patient resorts to an omnipotent
contradiction o f it through delusion-formation or alternatively he may violently
attack the mental apparatus which w o u l d normally register it (Bion 1956). Such
mechanisms involve a contempt for reality, but what I want to consider here is the
more common, and in some ways m o r e insidious, way in which reality can be
distorted and misrepresented.
This bring us to

T H E FOURTH MODEL: T i m THEORY OF MISREPRESENTATIONS AND

PERVERSIONS OF REALITY
O u r understanding o f these mechanisms has in part resulted from the study o f
perversion and was initiated by Freud's (1927) discussion o f fetishism. He suggested
that the fetish was a substitute for the woman's penis which the little b o y once
believed in, and that he does not want to give up this belief in the face of evidence.
Freud thought that the idea o f not having a penis is associated with castration and
that the b o y fears that if his mother can lose her penis he , l i g h t lose his.
Perversion is today seen as more complex than this, but w h a t is important for the
present discussion is the w a y Freud observed that children solve the problem b y
simultaneously holding t w o contradictory beliefs: that w o m e n do have a penis and
at the same time that they do not. If these threaten to clash, the patient reconciles
them with a variety o f arguments which Freud described as 'artful'. The b o y m a y
hold the belief that some w o m e n do not have a penis, but that his mother does have
one, or that if she does not have one n o w she once did, or that she has a hidden one
inside, or that she has lent it to his father, and so on.
Although this kind o f mechanism was first described in perversions and is
certainly very important in these conditions, it seems to be a much more general

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 JO~N STEINER

reaction to a piece of reality which is difficult to accept. In fact, in the original paper
on fetishism Freud mentions two patients w h o could not accept the reality o f their
father's death.
It was only in one current o f their mental life that they had not recognised
their father's death; there was another current which took full account o f
that fact. T h e attitude which fitted in with the wish and the attitude which
fitted in with reality existed side b y side.
If such a failure fully to recognise the reality o f loss persists it interferes with the
process o f m o u r n i n g and will consequently lead to obstacles in the return o f
projections.
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I believe that some patients adopt such an attitude to a whole area of reality which
they find unacceptable, and that they retreat to a kind o f borderline state (Steiner
1987) in which reality is not completely denied and is also not completely accepted.
Freud (1924) himself described something like this and he wrote, in his paper on
neurosis and psychosis, that
... in neurosis, too, there is no lack o f attempts to replace a disagreeable
reality by one which is more in keeping with the subject's wishes. This is
made possible by the existence o f a world of phantasy, o f a domain which
became separated from the real external w o r l d at the time o f the
introduction o f the reality principle. This domain has since been kept free
from the demands o f the exigencies o f life, like a kind o f 'reservation'; it is
not inaccessible to the ego, but is only loosely attached to it. It is from this
world o f phantasy that the neurosis draws the material for its new wishful
constructions, and it usually finds that material along the path o f regression
to a more satisfying real past.

I think we can recognise h o w in m y patient the withdrawal to a w o r l d o f

phantasy served to create such a reservation or borderline state into which she could
retreat, where she did not have access to her intelligence and did not need it because
she could see it as m y responsibility to look after her. The basis o f the fantasy world
was romance in which the patient w i t h d r e w to inhabit a child-like w o r l d o f magic
in which erotism was rife but overt sex was quite absent. In this world the reality o f
difference was obliterated and there were no distinctions between adult and child or
between rnale and female.
Most important o f all, it blurred the reality o f the passage o f time, since in the
dream-state the romance seemed to go on for ever. Even the whining and
complaining seemed to be an expression o f the same state, since it demanded that the
analyst take in these projections and soothe the patient by going along with the
illusion. M o n e y - K y r l e points out that these states are often a defence against the
reality o f ageing and death, and this was very important in m y patient, who
continued to think o f herself as an adolescent and lived in a kind o f never-never
world. It is interesting that Stoller (1976) has suggested that this kind o f perversion is

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expressed in the popular addiction to romantic books and magazines which he sees
as the female equivalent o f pornography.
In fact, however, over the years, m y patient did significantly broaden those areas
of her life where she could use her intelligence and she began to face some of her
reality. But it was always a struggle and she was always likely to be tempted back
into her dream-world if reality became too difficult to bear.
In the process o f creating these worlds where reality is simultaneously both
accepted and disavowed, the truth is not completely denied as it is perhaps in
psychosis, but instead is misrepresented and distorted. It is curious that the original
meaning o f 'perversion', namely a turning awayfiom what is good and true, is close to
the meaning which psychoanalysts are coming to emphasise. Although it is perhaps
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especially clear in the sexual perversions, these mechanisms where truth is twisted,
distorted and misrepresented can I think usefully be thought of more generally as
perversions of the truth.
Money-Kyrle came to regard these misrepresentations o f the truth as a central
obstacle to progress in analysis, and we can consider their recognition to represent a
fourth model o f psychoanalysis, namely one where mental disorder results from
such misrepresentations which consequently prevent real experience from getting
through to the patient. Development which requires the experience of mourning
and the relinquishing o f lost objects cannot therefore proceed and separateness
cannot be achieved.
The aim of psychoanalysis according to this model would be to help the patient
understand the process by which he maintains such distortions and to find ways o f
helping him understand both the denial of his dependence on the object and the
denial o f loss. This may involve long and patient analysis, in which much mental
undergrowth is cleared away until, through first acknowledging and then relin-
quishing the object, the patient regains access to his own resources.
The aims of psychoanalysis can be summarised by looking at the models in
reverse order o f their discovery. If we can understand the distortions,
misrepresentations and perversions of reality and the role they play in maintaining
the confusions between self and object which result from projective identification,
the patient can be helped to bring reality to bear on those situations of separation
and loss which he experiences in the process o f an analysis. If this reality is worked
through, a quantum of mourning takes place as the object is relinquished and a
quantum o f self is withdrawn from the object and returned to the ego. The ego is
thereby strengthened and the object is in a measure seen more realistically. This then
means that conflict is tackled with greater resources and there is a lessening of the
need to evade reality.
If we review this over-simplified survey of the aims of psychoanalysis, it is clear
that each of the successive models evolved when the theory could not help the
analyst through an impasse in his clinical work. Each has enlarged and deepened our
understanding of individual development, and each has a relevance to the under-
standing o f the patient and his situation.

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 JOI-IN STEINER

REFERENCES

BION, W.R. (1956). Development of schizophrenic thought. Int.J.Psycho-Anal., 37

344-46; and in Second Thoughts. London: Heinemann 1967.
FREUr), S. (1917). Mourning and melancholia. SE 14.
FREUD, S. (1924). The Economic problem of masochism. SE 19.
FREUD, S. (1927). Fetishism. SE 21.
MON~Y-KYRLE, Ik. (1968). Cognitive development. Int..J.Psycho-Anal., 49 691-98;
and in The Collected Papers of Roger Money-Kyrle. Perthshire: Clunie (1978).
MON~Y-KYRLE, tk. (1971). The Aim of psychoanalysis. Int._l.Psycho-Anal., 52
103 06; and in The Collected Papers of Roger Money-Kyrle. Perthshire: Clunie
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(1978).
K~EIN, M. (1946). Notes on some schizoid mechanisms. Int.J.Psycho-Anal., 27
99-110; and in The Writings of Melanie Klein. London: Hogarth (1975).
STEINER, J. (1987). The Interplay between pathological organisations and the
paranoid-schizoid and depressive positions, lnt.J.Psycho-Anal., 68 69-80; and in
Spillius, E. Bott Melanie Klein Today: 1: Mainly theory. London: lq,outledge
(1988).
STOLI.~R, R. (1976). Pornography and perversion. In: Perversion: the Erotic Form of
Hatred. New York: Harvester.

Dr John Steiner
The Tavistock Clinic
120 Belsize Lane
London N W 3 5BA

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