The term 'pathological organisations of the personality' refers to a family of extremely unyielding and tightly knit defences. Their function is to enable patients to avoid overwhelmingly persecutory and depressive anxieties by avoiding emotional contact with others and with internal and external reality.
There are two main and complementary strands in the concept of pathological organisation. The first strand refers to the dominance of narcissistic and omnipotent 'mad' and 'bad' parts of the self over the rest of the personality. Many authors stress that this tyranny has a tenacious hold because of its perverse, addictive and sado-masochistic character. The second strand concerns 'psychic equilibrium'. Pathological organisations provide patients with a precarious psychic equilibrium that is achieved through the pathological impairment of a potentially more responsive emotional self. Such organisations attempt to provide the patient with a new position, which is conceptualised as lying at a remove from the normal activities and anxieties of both the paranoid-schizoid position (Ps) and those of the depressive position (D). As a result, the more normal fluctuations and equilibrium between Ps and D are drastically curtailed. Their origins are thought to lie in the early emergence of unmanageable destructive tendencies, linked to envy and environmental failure, which undermine the structuring activities of normal schizoid functioning and occasion extreme and overwhelming paranoid anxieties.
Pathological organisations are highly resistant to change and pose considerable technical challenges in analysis. Contributors on pathological organisations provide a specifically Kleinian perspective on major questions raised by Freud, such as those of the negative therapeutic reaction and interminability.
For full references for Melanie Klein's works visit the 'Melanie Klein's publications' section.
1936 Riviere, J. 'A contribution to the analysis of the negative therapeutic reaction', International Journal of Psychoanalysis. 17: 304-320. First Kleinian formulation of a defensive organisation of the personality.
1964 Rosenfeld, H. 'On the psychopathology of narcissism: a clinical approach', International Journal of Psychoanalysis. 45: 332-337; republished in Psychotic States. Hogarth Press (1965). Fundamental definition of 'libidinal' narcissistic organisation or omnipotent 'mad' self.
1968 Meltzer, D. 'Terror, persecution, dread', International Journal of Psychoanalysis. 49: 396-400; republished in Sexual States of Mind. Strath Tay: Clunie Press (1973); and in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988). Formulates the notion of destructive narcissistic organisation and its tyranny over personality.
1971 Rosenfeld, H. 'A clinical approach to the psychoanalytic theory of the life and death instincts: An investigation into the aggressive aspects of narcissism', International Journal of Psychoanalysis. 52: 169-178; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988). Definitive formulation of a 'destructive' narcissistic organisation.
1972 Segal, H. 'A delusional system as a defence against the re-emergence of a catastrophic situation', International Journal of Psychoanalysis. 53: 393-403. Description of a psychotic patient's delusional, omnipotent world providing an unstable equilibrium against an early catastrophic situation.
1975 Joseph, B. 'The patient who is difficult to reach'. P. Giovacchini (ed.) Tactics and Techniques in Psycho-Analytic Therapy, Vol. 2. New York: Jason Aronson; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 2. Routledge (1988); and in B. Joseph (ed.) Psychic Equilibrium and Psychic Change. Routledge (1989). Close scrutiny of how pathological organisations function in the analytic relationship.
1981 O'Shaughnessy, E. 'A clinical study of a defensive organisation', International Journal of Psychoanalysis. 62: 359-369; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988). Detailed clinical description of a defensive organisation as a pathological formation on the border between Ps and D.
1981 Riesenberg-Malcolm, R. 'Expiation as a defence', International Journal of Psychoanalysis and Psychotherapy. 8: 549-570. Illustration of perverse, pathological use of masochistic expiation to avoid persecutory guilt.
1982 Steiner, J. 'Perverse relationships between parts of self: A clinical illustration', International Journal of Psychoanalysis. 63: 241-252. First use of the term 'pathological organisation'. Beginning of comprehensive theory incorporating both pathological narcissism and equilibrium between the pathological organisation and the paranoid-schizoid and depressive positions.
1982 Joseph, B. 'On addiction to near death', International Journal of Psychoanalysis. 63: 449-456; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988); and in Psychic Equilibrium and Psychic Change. Routledge (1989). A malignant self-destructive organisation is erotised and manifests as an addiction to near death.
1985 Brenman, E. 'Cruelty and narrow-mindedness', International Journal of Psychoanalysis. 66: 273-281; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988). Narrow-mindedness in the service of narcissistic omnipotence and cruelty as a defence against helplessness.
1985 Steiner, J. 'Turning a blind eye: the cover-up for Oedipus', International Review of Psychoanalysis. 12: 161-172. Defines perverse use of turning a blind eye to maintain pathological relation between split parts of the ego.
1987 Rosenfeld, H. Impasse and Interpretation Tavistock. (Chapters 6 and 13). Reiterates the distinction between libidinal and destructive narcissism, and implications for analytic treatment. Introduces a distinction between 'thin-skinned' and 'thick-skinned' narcissist.
1987 Steiner, J. 'The interplay between pathological organisations and the paranoid-schizoid and depressive positions', International Journal of Psychoanalysis. 68: 69-80; republished in E. Spillius (ed.) Melanie Klein Today, Vol. 1. Routledge (1988). More elaborate definition of the points of threatening transitions in Ps and D likely to promote reliance on pathological organisations.
1988 Spillius, E. 'Pathological organisations: Introduction' Melanie Klein Today, Vol. 1. Routledge. Summary of major contributors and trends in concept of pathological organisations.
1990a Steiner, J. 'Pathological organisations as obstacles to mourning: The role of unbearable guilt', International Journal of Psychoanalysis. 71: 87-94. The role of unbearable guilt in entrenching a patient's reliance on a pathological organisation.
1992 O'Shaughnessy, E. 'Enclaves and excursions', International Journal of Psychoanalysis. 73: 606-611. Description of how patients induce analysts to enter into idealised enclaves with them or into excursions away from areas of great anxiety. Both are forms of psychic retreat.
1992 Steiner, J. 'The equilibrium between the paranoid-schizoid and depressive positions', New Library of Psychoanalysis. 14: 46-58. Concise statement of subdivisions in Ps and D and equilibrium between them.
1993 Steiner, J. Psychic Retreats: Pathological organisations in psychotic, neurotic and borderline patients. Routledge. New term 'Retreat' describes out of reach or stuck states of mind in spatial terms. They arise from the operation of pathological organisations.