Reading list: Pathological organisations

Klein herself did not specifically write about pathological organisations, but her understanding of the anxiety and defences of both the paranoid schizoid and depressive positions are used to understand this clinical phenomenon.

Main Kleinian papers

Riviere, J. (1936) ‘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.

Rosenfeld, H. (1964) ‘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.

Meltzer, D. (1968) ‘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.

Rosenfeld, H. (1971) ‘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.

Segal, H. (1972) ‘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.

Joseph, B. (1975) ‘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.

O’Shaughnessy, E. (1981) ‘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.

Riesenberg-Malcolm, R. (1981) ‘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.

Steiner, J. (1982) ‘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.

Joseph, B. (1982) ‘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.

Brenman, E. (1985) ‘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.

Steiner, J. (1985) ‘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.

Rosenfeld, H. (1987) 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.

Steiner, J. (1987) ‘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.

Spillius, E. (1988) ‘Pathological organisations: Introduction‘. Melanie Klein Today, Vol. 1. Routledge. Summary of major contributors and trends in concept of pathological organisations.

Steiner, J. (1990a) ‘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.

O’Shaughnessy, E. (1992) ‘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.

Steiner, J. (1992) ‘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.

Steiner, J. (1993) 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.