Intimidation at the helm: superego and hallucinations in the analytic treatment of a psychosis.

On the basis of the development in the course of analytic treatment of a young male patient in a state of hallucinatory terror, the author discusses in this paper the nature of the psychotic superego. He shows how the process of recomposition of the self after a psychotic breakdown involves the transition from a terrorising and destructuring type of superego to one more reminiscent of that seen in depressive illness. The author describes this process against the background of the variations in the auditory hallucinations that began during the analysis. In the first phase of the analysis the patient is helped to free himself from the intimidating power of the hallucinatory superego, while the second phase centres on the patient's own involvement in producing the hallucinations. The author shows how the analysis mitigated the destructive hate resulting from unbearable psychic pain and describes how insight and transformation gradually ensued in the hallucinatory state. The resulting restoration of an internal psychic space is stated to be essential to the reconstitution of a whole and separate self. After drawing an interesting parallel between the psychotic superego and the attitude of God in the Old Testament story of Job, the author places his thesis in the context of the ideas of Klein, Bion and Rosenfeld.