Further Thoughts on `That Which Patients Bring to Analysis' J. H.

Rey
ABSTRACT. The concept of the internal objects and internal and external spaces has been further developed in this paper. These objects are an important part of patients seeking treatment for themselves for they are also looking unconsciously for 'treatment' of these objects. The objects are ' damaged' and the patient does not know how to repair them. He keeps them alive in the hope that help will come. The methods used to keep them alive, even when dying, have been described. The stages at which these objects have been, or are thought to have been, damaged is vital. For example, they can range from the sensori-motor level to higher levels of maturation, to produce psychosis, borderline or hypochondria. The concrete level is stressed for it leads to concrete repair as opposed to psychic reparation.

Introduction The internal object concept as developed by Melanie Klein and subsequent Kleinians has increased in importance in the past 60 years. The internal world and internal space, the stratified levels of activity of part and whole objects within the internal space, their incorporation, interiorisation, introjection, assimilation and nonassimilation, their projection and projective identification, their fate in the external world space and many other aspects have now become everyday problems of psychoanalysis. The subject is admirably discussed in the Dictionary of Kleinian Thought by R. D. Hinshelwood (1991). One of the thoughts that fascinated Dr Rey was the concreteness of internal objects and their life in a person's internal space or when projected into an external object's internal space. During the treatment of psychotic and borderline patients and of children this became even more evident. He gradually began to think that the most important task for a patient was to try and deal adequately with his damaged, badly treated, depressed and desperately unfortunate internal objects. This was specially true at the most concrete level of primitive and sensorimotor schemas. It becomes still more complex at higher levels of representation, symbols and metaphors and so on. Dr Rey started writing more specifically about the subject when dealing with the problem of repair and reparation of those objects without which a satisfactory life for the patient was not possible. Reparation is one of Melanie Klein's greatest contributions to psychoanalysis. Then there followed Dr Rey's introduction to the paper on 'Reparation' entitled ' Additional notes to the paper on reparation'. After this a paper by Clifford Scott on ' Repairing broken links between the unconscious, sleep and instinct and the conscious, waking and instinct' incited Dr Rey to follow the possible fate of internal

Dr Henri Rey, psychoanalyst and member of the British Institute of Psychoanalysis, has been well known for his own integration of Freudian-Kleinian object relations theory with Piagetian, psycholinguistic and biophysical conceptual frameworks. He worked for many years as a consultant psychotherapist at the Maudsley Hospital where he developed his theoretical models for the treatment of borderline and psychotic patients. Address for correspondence: L'eau coulee, Boute de la filatte, 17880 Les portes en re, France. British Journal of Psychotherapy, Vol 11(2), 1994 The author

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objects as well as id, ego and superego structures, and what happens to them in the passage from conscious to unconscious and vice-versa. This is the paper entitled `Awake, going to sleep, asleep, dreaming and awaking' which has just been published in his book Universals of Psychoanalysis (Rey 1994). Subsequently, it felt necessary to try to bring more precision to the state of these internal objects needing repair and reparation. This was attempted in the paper on `That which patients bring to analysis' (Rey 1994). The present paper, `Further thoughts on that which patients bring to analysis', was written as an introduction at the time Dr Rey originally presented the paper at a scientific meeting of psychoanalysts (Rey 1988). Jeanne Magagna Consultant Child Psychotherapist Great Ormond Street Hospital

Part One The main point of this paper is about trying to detect and understand what human beings do unconsciously with important psychic objects that have been damaged, that they are unable to put right, help or maintain with care. It is suggested that these inner objects are preserved by special methods in special places. As they are often considered to be dying, they have to be kept alive by manoeuvres described in the paper. There is some kind of hope or wish or expectation that someone will come who will be able to achieve what the patients could not. It is those objects I have called `that which patients bring to analysis'. In a previous paper on reparation (Rey 1986), using the Kleinian model, I described efforts made at reparation during the schizoid-paranoid position pointing out, though reparation proper belongs to the depressive position, that attempts at repair were made before that phase. Because of the lack of sufficient representation and symbolisation and because of the space-centred nature of thought at that time, reparation fails. Those attempts should have another name which I suggested could be `repair' because of their concrete nature as opposed to psychic reparation. Then certain manoeuvres are employed to deal with the objects of the failed repair: where to put them, how to preserve them, how to keep them alive and when possible bring them to treatment. All this is of course unconscious and patients do not come to analysis with this conscious purpose. However, it is a very different state of affairs to come and seek treatment for oneself consciously as compared to unconsciously seeking treatment for others, not as a resistance but as a necessity. It was necessary therefore to give examples of failed attempts at repair or reparation, of the places to keep those important objects, how to keep them alive when damaged or dying, and how to bring them to treatment. Because of the hierarchical organisation of the psyche in depth, it was natural and necessary to give examples belonging to all levels of psychic activity. So I gave examples for psychotic patients, borderline, psychosomatic, hypochondriacal, depressed and neurotic ones. One illustration was Miss R, the older unmarried woman in the group, who seemed to be nearer to a psychotic state. She had been diagnosed as a manic-depressive and, at times, as a schizophrenic or a borderline, as well as a chronic neurotic. She started the first group by saying: `I want to kill my mother'. In fact her mother had died some time earlier. The material that emerged in the course of the

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treatment is as follows. Her mother was psychotic, said to be a chronic schizophrenic, highly obsessional and repetitive, talking endlessly and full of reproach towards the children and making them feel very guilty. The patient had led a most miserable life, unable to cope with her mother and yet unable to separate from her. What she meant when she said `I want to kill my mother' was not how much she wanted to kill her mother to be freed of her, but that death had not freed the patient because she had not killed the mother (inner mother) who was still persecuting her. Perhaps it meant, although dead my mother is not really dead. Gradually as the treatment proceeded it became evident that she had intensely identified with most aspects of her mother, had taken on her mother's illness, had given up working (she was a trained librarian) and had led a kind of psychotic life like her mother, chronically attending various hospitals. One day she came to the group and said: `Here we are, I have hallucinated. I have heard voices'. She explained this was the voice of her mother but the voice was not saying anything specific. A complicated process gradually unfolded. She had felt very guilty and very unhappy to have been unable to help her mother. Her identification with her mother had a complex origin. The important point was that it was not a straightforward identification through guilt. She had identified with her very ill mother in order to keep her alive, mother and daughter being one; she being alive, mother is alive. The patient then sought treatment. Having failed to help mother herself, she wished that others might be able to do so. Her hallucination was a psychotic proof of sharing the same identity with mother. The regret of not having killed mother was connected with her impotence at reparation, of making mother well but, of course, never doing the killing because of the great drive to keep mother alive and find those who would be able to cure mother for her. A fundamental motivation to repair mother was the immense desire to have a good mother, to know what it was to love a mother and be loved by her. Freeing mother by killing her would deprive her of a good mother forever. In due course I was able to interpret this material and it was a moment of deep emotion for the group (and for me) when the patient said in a most touching way `I want my mummy'. Throughout a whole lifetime this patient, unable to repair her mother, had kept her alive by lending her her own `being alive' and going from therapist to therapist to have this internal mother cured. The discovery by the patient of his/her fundamental aims about those inner objects is a dramatic event leading to dramatic changes in his/her treatment. This transformation of the aim has to become conscious to the patient and to the therapist to allow work to proceed with success. I summarise: there are manoeuvres to reassure oneself that the object is alive, others to keep them alive, and others to bring them to be repaired.

Part Two The writing of `That which patients bring to analysis' has had a long unconscious and then partially conscious gestation. I can remember perhaps some twenty-five years ago, when listening to a presenter of a case at the Maudsley Hospital, suddenly spontaneously exclaiming `but it is an ambulant cemetery you are bringing to the seminar!' The woman patient was on purpose walking past a cemetery to go to work with thoughts and feelings and body sensations all connected with dead people in her life. I was also influenced by my contact with psychotic patients describing people in all

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sorts of states inside them, specially an early one, a girl who took catatonic postures not to hurt her dying father inside her and to keep him alive. But I did not see that she could have wanted him brought to treatment, though she came with him inside her. As time went on examples of all kinds accumulated in my clinical experience. But though fascinated I did not make the link and was not sure what it meant. As I became more aware of the value of the concept of the inner object in all sorts of states and relations, the meaning of it all was also entering more clearly in my thinking. Later I began discovering how psychotic patients, especially schizophrenics, treated parts of their body as objects, often in a dormant state, waiting for something to happen that I did not understand. After years, this latest observation culminated in my actually writing the following in 1981, as the conclusion of the Clara Geroe lecture (unpublished) in Melbourne. I quote (Rey 1981):
For my part I know of no greater experience with the possibility of the new knowledge, to detect and come into contact with dying, but not dead, parts of the schizophrenic patient. To witness his incommensurable and hopeless efforts to protect those parts still precariously alive inside him, identified with, and located in, various parts of his body. Everything is concrete, he must not move or even think or wish, except to deny, project, and hallucinate pseudo-repaired objects. Failing to properly do reparation, he thus despairs. And I know of no deeper experience or no greater achievement than to help such a patient to bring the dying parts to life, diminish his fear of damaging his loved objects and help him to create less concrete inner objects, more symbols, and experience more compassion, more humanity.

As I was writing those lines, somewhere my mind was linking them with seeing, more than thirty years before, a schizophrenic painting showing an animal having incorporated all sorts of objects placed precisely in different parts of its body, even one, a bottle, half inside, half outside its mouth. It made me think of some clinical material I had collected myself which I then discussed with Dr Clifford Scott and this helped me to imprint the experience in my mind. Another experience I would like to relate is from the therapy of a group of patients. Some eighteen years ago I was conducting a group of borderline patients. As they progressed they became more able to talk, to express themselves and to get excited when they shared experiences. On one such occasion this is how I described what I experienced. I quote (Rey 1975):
I, as therapist, had an extraordinary experience that we were not six people in the room, but a whole crowd of people of all ages, sexes and statuses, speaking and acting in all sorts of ways. It was a real encounter with a very concrete projection of the autonomous primitive groups (of inner objects) into a tower of Babel, a crowd made up of an assembly of sub-groups of unrelated partobjects.

Now I may add: all were very much in need of repair. Why were they brought in? Those objects belonged to the past and to the present, they were alive or dying or damaged. For what were they being brought to the therapist? I started then asking myself `How many internal objects can one cope with, with love, maintenance and care?' At that time I did not realise that there was a second most important question `How many "damaged" internal objects can one carry within oneself to attempt repair and try to keep alive for others to repair if one cannot do it?' It may not have been a cemetery that the patient mentioned earlier was carrying within herself; it may have been a hospital! At the time I made very superficial enquiry about psychotherapy groups. I asked my friends what happened in their groups. I had the help of some colleagues ( especially Dr John Wilson). A great proportion of groups

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that started with the usual eight patients ended with five (or less) on the condition that those leaving were not replaced. I also think that it depends how deeply the therapy is conducted and at what levels reparation is attempted or has to be done. The deeper the reparation, the fewer the number with which one can cope. In French Quebec, in the days when families of fifteen children or more frequently existed, I was told by colleagues that some girls were considered to be suffering from a very specific syndrome. I forget the name. After the mother had given birth to four or five children and was pregnant again, one of the girls, perhaps 8, 9 or 10 years old or less sometimes, had to take over the mother role and look after her siblings. Marriage was at a very early age and thus the girl passed from a first motherhood by proxy to a second one by marriage without knowing a maiden life. Once more how many important, highly cathected objects can one care for and what happens if they are damaged? More amazing still, I have just come across the case of a woman of 55 who is the oldest of about 10 children and who from the age of 8 started helping an old Hindu midwife with the task of bringing her mother's babies into the world. She describes how she had to hold them and cope with them when delivered. Later she became more and more frightened that the old midwife was no good and the babies were in danger - and she consulted a doctor. It is in a gradual evolution that the concept of a nucleus of highly cathected memories, then images, gave rise to the concept of internal objects in moments of great psychoanalytical creativity. The concept has proved to be one of the most helpful, useful and thought provoking. There is still a great deal of work to be done in that field, for instance, the precise way external and internal objects are constructed and their relations to not only external and inner spaces, but also to local spaces. There is also the relationship of those local spaces to each other and to global space. Self and objects have to be constructed; they are not just given at each new stage of development, from the most primitive to the most sophisticated layers of the mind. Psychic constructions surely must be one of our fundamental interests especially with regard to treatment. In spite of the detailed contribution of object relation theory to this field, I was greatly helped for the cognitive aspects of construction by the Piagetian contribution. I have so often paid tribute to Piaget's cognitive contribution that I may safely leave him alone now as he is not specially cherished by the main body of psychoanalysts who think he is only `cognitive'. Thus it is not only aggressive damage done to objects or parts of self that need reparation but also faulty constructions during growth. It therefore seems to me necessary to try to understand in the very minutest details how objects are constructed and cathected. We must try to know and apprehend the precise mechanisms and processes of thought that were at work, then the problem of faulty constructions and ensuing need for reparation follow. The same remarks apply to space and time constructs in relation to inner objects, which I shall return to later. It is wrong to confuse what is rational with rationalisation. And to understand rationalisation one must know about the developmental genesis of rational structures. Melanie Klein (1946, p. 21) must have understood this problem when she made the following statement in `Notes on some schizoid mechanisms':
I have also found that interpretations of schizoid states make particular demands on our capacity to put the interpretations in an intellectually clear form in which the links between the conscious, preconscious and unconscious are established. This is of course one of our

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aims, but it is of special importance at times when the patient's emotions are not available and we seem to address ourselves only to his intellect, however much broken up.

The necessity to put right faulty constructions at all levels of the hierarchy of development of object and object relations and of pathology, maintained by all kinds of impulses and anxieties in the ever-present here and now, necessarily implies trying to develop as much understanding as possible of the mechanisms of reparation. I mentioned at the beginning that, because of the wish to repair and its failure, manoeuvres and mechanisms to keep the object alive are elaborated in the hope that one day reparation will become possible. The whole paper is about this view and above all about the manoeuvres to keep the object alive. If this is right, the consequences can be very important for treatment. Let me start with Freud's `Mourning and melancholia' (Freud 1917). In my paper I pointed out that I said little about the many reasons to preserve and keep alive these inner objects, such as feelings of guilt about which a great deal has been written, fear of internal persecution, fear of losing good objects and difficulties in protecting objects. I instead chose to emphasise the mechanisms used to keep the objects alive, especially the damaged and dying ones, in order to do reparation and restore them as good objects, without which life cannot be normal, satisfying and worth living. In `Mourning and melancholia', Freud made the great discovery that the shadow of the object fell upon the ego and that the self-recriminations were a continuation of the attacks on the object, thus making it difficult to mourn the object. Included in the many reasons for this identification is lending one's life to the damaged or dying object by projective identification, for instance, and keeping the object alive in the hope that reparation may become available one day. The substitution of oneself, or part of oneself for the object would not only be due to guilt, punishment or continued destructive impulses but also, in some cases at least, to wait and find an opportunity for reparation. It was perhaps too daring to choose one of Freud's most important, famous and most loved papers as a first example. So here are some examples of common everyday happenings. For instance, there is the example of the well-known schizoid mechanism of identifying the object with a hard object as did my patient who identified father and mother with steel-plated battleships. Of course it is obvious that they were thus prevented or protected from deadly damage. But there was something else I did not see at the time, which was that the patient should want to preserve his parents to bring them to reparation. The battleships even in the worst naval encounters could never be sunk, they were damaged, perhaps, but not sunk. They were kept floating. If they stood for the parents in aggressive sexual intercourse, the parents were kept alive. That is all the steel armour could do. Is it possible that the fighting was a proof they were not dead, the sensation of pain and mental suffering demands being alive. In sadomasochism there is a pleasure in causing pain and experiencing pain. Could it be a double process, that is, the pleasure and satisfaction can also be to prove to oneself that the object is alive and present and not absent or dead? Maybe the object is waiting for repair and reparation. I will refer later to the problem of sado-masochism in this context. However I must point out that this patient I attempted to treat some forty years ago, a young 18-year-old schizophrenic, has taught me so many things that I must count him as one of my great teachers. From him I learnt a lot about how the body ego is constructed inside and outside, how important the inside of the mother is, how all

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objects are structured with an inside, how the psychotic thinks that objects that cannot be repaired should be wiped off. He also taught me how dreams when drawn and painted reveal the state of the body symbolised by the earth, mountain and streams and later by religious symbols, and a great deal more about formation of symbols, about the use of identification with hard material to preserve soft objects from damage and destruction. He taught me that a positive transference can be achieved with schizophrenics, how they can become sad when separating. He brought about lasting good memories when he wrote to me years later. Paradoxically he has been a good psycho-analytical inner-object to me. And now after so many years I can use his material to develop, if possible, ideas that in the course of time have emerged from other patients' phantasies. I have come across some material, in Melanie Klein, that possibly links together the `keeping alive' and sadomasochism, that is pain as a sign of being alive. In the 'Psychogenesis of manicdepressive states' (Klein 1935) she writes: `The phantasy of keeping the kidney and the penis alive while they were being tortured expressed both the destructive tendencies against the father and the babies, and to a certain degree, the wish to preserve them' (my italics). Since I am reviewing some of the factors and experiences that influenced my thinking, there is another important area I want to mention. It is the evolution and maturation of the concepts of space and time. They are not given notions, they are constructs, and each stage of the construction is the result of highly emotional love and hate impulses cathecting and giving meaning to each cognitive stage of the evolution of space and time constructs (see Rey 1994). Referring to the present paper under discussion it must be that inner objects cannot exist except in phantasised spaces and times. For some years now space has become an important preoccupation of psychoanalysts and a more systematic approach has been adopted. I want to mention specifically the kind of space where objects are kept alive, damaged and dying, for the sole purpose of being repaired, as if hope dies hard in the human heart. Obviously there must be a classification of spaces according to the developmental stages of specific space constructs where the object had to be stored and kept into suspended animation (as is practised for human embryos nowadays and organs preserved for grafting purposes). At the most primitive levels of development they are felt to be real live objects as described in some of my examples. They are either located inside the subject itself or in one or more of its objects. But many places are used either symbolically, metaphorically or otherwise. A glance at the cases quoted in my paper ( Rey, 1988) illustrates this point. The woman with asthma whose father died in hospital sought treatment in hospital; another in a mortuary; another in a cemetery; another inside a fur coat; another in a little blue house and there are many others. It would be important to work out in details the anxieties and phantasies determining the choice of spaces. How are we to move our patients' inner objects to the right space for reparation? Presumably one of the best places is in the consulting room. But just think of my patient who, because he could not distinguish between couch and mother, would not lie on the couch because he would sink in and become a prisoner inside it. Actually he had phantasies, quite conscious, of getting inside his mother to see what was inside whilst she was asleep so that she would not know what he was doing. Then he became afraid she would wake up and be very angry, and his father as well. He then thought it would be better if she were dead to explore her inside, and when this was done she could come back to life. And so when he came to the room for treatment with me he

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would either stay by the door or by a window so that he could escape if necessary when his anxiety increased. This is part of the fundamental claustro-agora-phobia-philia position I have described in other papers as a basic structure in psychopathology. This leads us to another characteristic of those objects awaiting reparation - and to the most difficult problem of all in psychoanalysis. How is the sense of reality and of existence born, that reality that appears innate, certain, unquestionable, that cannot be doubted. What is the description of inner reality and for that matter of external reality? I do not wish to raise any philosophical questions here but only to look at some points of interest to the psychoanalyst when face to face with the ultra-stability and irreversibility of certain phantasies and specially about inner objects in need of reparation, which is the main goal of our present inquiry. For an attempted answer I will choose to go straight to dreams and dream-objects as they are also dealt with in my 1988 paper. To dream, as opposed to day-dreaming, physiological changes must occur in the brain during sleep. Those brain changes abolish nearly all contact with the external world as a source of perceptual information. However, bodily internal information may still reach the dreamer. Then dream-phantasies and dream-objects acquire that sense of reality so difficult to describe. In dreams what happens `is', an object, however peculiar, `is', action in dreams, although thought, `is', the dream-space `is' and so on. What has psychoanalysis to say? Something analogous to dreaming happens during awakeness in infancy before external reality has become fully established. The testing of external reality is not yet fully there, although as modern research has shown, it is present much more than was previously believed. External reality is being constructed and not yet fully available. Therefore early phantasies arising out of internal bodily information could have at times an unchallenged sense of reality. As Freud (1917) wrote: `We suppose that it (the id) is somewhere in direct contact with somatic processes and takes over from them instinctual needs and gives them mental expression'. Those somatic processes at first play an important role, replacing the perceptual information of the external world and giving phantasies the same sense of reality that perceptions give to external reality. Early inner objects then are part of this early psychic system. They have an unshakable sense of reality of ultra-stability and of resistance to reversibility, the latter belonging to later constructions in the developing meta-systems provided by upper layers of the psyche during maturation. Without a meta-system change cannot take place. W e can now proceed to consider some characteristics of those inner objects, specially the damaged ones that have to be kept alive for reparation by those others than the subject's ego as, for instance, what the mother or an adult can do that baby cannot do. I have quoted in the paper material showing that often those objects are neither really dead or really alive. I think since objects are constructed as described by projections with part of the live sensations of the subject, that part keeps them alive. I do not know if, when sensations are absent, this can contribute to some kind of an equivalent of external absence or non-existence, a precursor to a death concept. But then the object can be resuscitated when the sensations, good or bad, reappear as happens with external objects reappearing. In this way we can see in operation the mechanism of keeping the object alive by lending one's live sensations to the object and waiting for the craved object that will come to repair the damaged object, specially when it is seriously damaged. At that time, in view of the importance of the bodily sensation part of the inner objects, it means that putting right damaged objects implies also dealing with that concrete aspect that sensation had endowed to the object.

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If that sensation is felt as greatly endangered or lost in memory this may lead to the object being lost or lifeless for ever or whatever death is in the primitive unconscious. This is the part which must be restored. Some thirty years ago I treated a woman patient who had to cut herself frequently to provide the necessary information reassuring her that she was alive. She did this by using the sensation of pain, the warmth of the blood, the sight of it and the fear of death, meaning life was still there if death could come after. She cut deeper and deeper. I also treated a borderline little girl of 12 who was very jealous of a younger brother. At school she replaced him by a little boy called Peter. She then imagined Peter loved her. She wanted to prove that to the therapist who was a young woman. This would be done by trying to force the therapist to agree with the phantasy. But she needed a sensation part to the phantasy to make the therapist's statement she was seeking come alive. So she attacked the therapist with a sharp pencil to create pain so that the therapist's words would have a sensation part, thus creating a phantasy object as real as possible. The girl could be dangerous as well, as she had also carried a knife on occasions instead of a pencil. A widespread method is to use masturbation as a source of sensation to give reality to phantasies by projective identification. Whatever the many aspects of sadomasochism, one important aspect must surely be the creating of sensations that can be used and be displaced into the object that has to be kept alive, as well as for other reasons. This is a vast subject that demands a great deal of elaboration. I have already mentioned dreamobjects. You will remember that Freud first thought that what was symbolised and represented in dreams was the body, the body parts and functions, or they at least played a very important part in the oniric creations. Thus the dream can make alive and bring to the dreamer not only his objects but also himself at various ages as specific objects in the here and now of the dream. In this way reparation of parts of self presented as object can become possible for the subject. This last example, showing an attempt to make objects alive by creating the sensation of pain, also included action. Dead objects are motionless. Live objects are capable of action. One of the most extra-ordinary characteristics of dream-work is the creation during sleep of virtual action that is experienced by the dreamer as real action. Therefore dream-objects acquire thus an amazing sense of `perceptual' reality. So little if anything at all has been written about characteristics of virtual energy, virtual action and virtual images in psychoanalysis. Yet so much has been written about acting out. During awakeness in normal people this `virtual reality' is abolished. Then, in order to feel reality giving action, one must resort to action. Thus primitive memories of sensori-motor schemes can produce virtual dream action experienced as action during sleep, when external world perceptual information is abolished, or memories can be turned into real action in the external world when a person is awake. During psychoanalytical therapy there are many occasions when words and action, at the linguistic level, fail to satisfy the subject that he has conveyed, either to the therapist or to himself, the reality, at a sensori-motor level, of his phantasies, wishes, desires and object relations. He then wishes to or actually passes to action, within or outside the analytical space. There seems to be a necessity to revert to the actual time of the events having taken place in space and time and at the sensori-motor level of that specific phase of development, to be able to bring about dissolution-reconstruction, that is repair or reparation. Nothing else seems to be needed. The actual moment of the past has to be lived with sensation and action in the here and now. Sexual activity is a

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giver of sensation and life par excellence and for this reason it is extensively resorted to, to create reality. Unfortunately destructive action can also be used as mentioned, to prove the state of being alive. This is one aspect of sado-masochism. In psychosis it is possible to see this very process in the conscious phantasies of the patient, thus presenting very important possibilities for the treatment of psychotic manifestations, hallucinations and delusions. It may be that patients have to regress to very primitive levels of object formation and object relations in order to feel they are alive and real, an experience, that having succeeded in being psychotic, is unchallenged for them by the testing of external reality. I once treated a patient who, every time he had to solve some of his fundamental problems, went into a psychotic episode. In his first attack he talked about male objects with a religious flavour; it was a short attack. Then he said: `Where are the women?' He had a second episode, short lived, when female figures appeared with also a religious background. Then he wondered about real human beings and he had a third short psychotic episode with his family as the central theme. Every time the psychotic episodes became deeper. He then had to reconstruct the universe around him followed by an episode bordering on catatonia. He was concerned with the restructuring of the parts constituting his body and those of his parents, of his wife and her parents and his own daughter. Thus he thought that if he had sex with his wife he would also have sex with his father and mother-in-law as she, his wife, was made of them. Similarly for his parents and himself. His daughter was also involved as she was made of his wife and himself. Because of that incestuous situation he did not want to have another child with his wife. After working through all those phases he was able to enter into a more frankly depressive phase and greatly to increase his sense of `reality'. Here is then an illustration of the construction of the self and objects, with part objects and objects of the external world manipulated in phantasy. Those objects had kept their individuality, the state in which they were at the time of the original attempted constructions, so that the ego was an aggregate instead of a syntonic structure. Unless such objects when damaged undergo reparation, the self made of the aggregates cannot be a healthy structure. I have for a fairly long time now wondered how it was possible that some psychotics, at least, did not get better because nobody understood that they would stay in their psychotic state until the reason for being psychotic was understood by others. Damaged inner objects could only be sincerely thought of, by the patients, to be alive and concretely available for reparation if remaining in the necessary state of mind, that is psychotic and out of touch with external reality. Being brought back to so-called normality by therapists who had not understood the reason for the psychosis with the task of reparation, would be felt as a catastrophe by the patient. Working for a short time in a specialised institution with a group of psychotics who had committed criminal acts of an irreversible nature, including murder, I became very aware that when they were getting close to giving up their psychosis, they retreated. It was too difficult for them to face what we call external reality. There was a nice young man who during his psychosis had killed his brother and sister to save them from leading the kind of dissolute life that he thought he himself had lived. I became very aware of his problem; perhaps if I had known more then, I could have helped him. Later I saw another patient who had been in an institution for several years for gravely wounding a man who remained paralysed. He was a complete stranger to the patient in

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reality. This man, in the patient's delusion, was identified with a phantasied enemy and persecutor of his country. The patient was still psychotic. After dealing with those problems I have just mentioned the patient was able to be discharged and to survive outside. Whilst on the subject of psychosis it seems very relevant to give some consideration to the persecuting objects at the origin of persecutory and paranoid delusions. Kleinian theory has described in great detail the origins of bad persecuting objects and the various manoeuvres either to eradicate them, or displace them or render them unable to exercise their evil power, through a number of defences that are now well known. It is obvious that those manoeuvres and defences have failed in paranoid psychoses. It is suggested here that this state of affairs is typical of the failure of reparation proper and the survival in an operating way of the persecuting object. If, as suggested, inner objects do not really die or if they die they may resurrect at will, then the only possibility of success left is the capacity to do reparation, taking into account the difference between pseudo-repair and true psychic reparation. Melanie Klein (1935) writes in her paper on the 'Psychogenesis of manic-depressive illnesses':
In my experience the paranoic conception of a dead object within is one of a secret and uncanny persecutor. He is felt as not being fully dead and perhaps reappearing at any time in cunning and plotting ways, and seeming all the more dangerous and hostile because the subject tried to do away with him by killing him (the concept of a dangerous ghost).

In a subject still functioning, at least partly, on space-centred thought and within the schizoid-paranoid position, still conceiving only of concrete repair or omnipotent return to a pre-damaged phase of being, there is a necessity for that person to remain fixated at, or regress to that stage so that the object can be dealt with according to the level of existence at which it is experienced. One of the most urgent tasks of the therapist is to try and convey an understanding on his part to the patient of that state of affairs. The extent or degree to which the patient possesses at least some traces of the mechanisms evolved during the working through of the depressive position will be crucial in facilitating, firstly, the task of helping the patient to understand that the therapist understands and, secondly, to begin to pass from the concrete attempts of repair to psychic reparation. I believe that the great importance of interpreting and making conscious to the patient that he, the patient, has been waiting for somebody to give a sign of his understanding has been greatly ignored. I have given the example of the woman in the group who identified with her persecuting mother and, unable to kill or cure her, brought her as an inner object from hospital to hospital and from therapist to therapist until her quest was understood. The mother had to be presented concretely and she had to be her mother. In some ways it could be said that this woman had sacrificed herself to give a better life to her mother. Of course if she had succeeded she also would have benefited, but so also is the promise of a better life given to willing scape-goats and sacrificial volunteers. In my paper on `That which patients bring to analysis' (Rey 1988)1 have mentioned how the history of sacrifice throughout the ages illustrates the passing of life from one object, the sacrificial object to another chosen object for a certain aim. Since then I have come across a most remarkable book on sacrifice by Pierre Solie (Solie 1988), a Jungian analyst. This book covers in a most comprehensive and learned way the

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history of sacrifice from most ancient times, in most ancient cultures and in all the great religions of all time. It describes the aims and exact details of the aims, the rites and the methods most rigidly used. The role of sacrifice also as creator of civilisation and individuation is also explained. He considers the evolution of sacrifice during its collective evolution in the history of humanity, as well as its history in the individual recapitulation in ontogenesis. That implies the passage from exo-sacrifice to endo-sacrifice by the process of internalization, especially in the depressive position. Thus he writes in a note about this: ' "The schizoidparanoid position" is exo-sacrificial. The "depressive and maniacal position" tends towards endo-sacrifice and it succeeds in this in melancholic suicide.' In my papers, 'On reparation' and `That which patients being to analysis', I have been struggling to describe the difference between schizoid repair and depressive reparation. The internal object in the schizoid paranoid position is treated very much as the external object because of its concrete sensori-like characteristics. The internal object of the depressive position by comparison is much more a psychical object, a nucleus of highly specific and highly cathected memories, beginning a new evolution distinguishing it from the external object and the schizoid-paranoid one. Somewhere Pierre Solie uses the term ` renunciation'. Using it for my own purposes I think in the light of what I have written, one can say that in the depressive position there is a `renunciation' to schizoid-paranoid repair and recreating the object as it was predamage. This leads to a most complex series of progressive changes involving the use of newly emerging emotional capacities, mechanisms and manoeuvres so profoundly described by Klein and others. The important point here is the distinction to be made between aspects of the subject's ego resulting from object identifications and internal objects representations within the self. Confusion may and does arise both between ego and internal objects and between internal and external objects. Perhaps here I should explain the necessity I faced with the 1988 paper of giving examples of damaged inner objects at various levels of construction during development. I gave examples of neurotic, hypochondrial, psychosomatic, borderline or schizoid, and psychotic inner objects. The task of keeping those objects alive for repair and reparation is not the same for the different levels of structuration and psychic existence. Unfortunately the task of repairing those damaged objects varies enormously in difficulty, as for instance the hallucinations and delusions of schizophrenics. The beginning of an answer may be attempted in terms of structural changes. Considered as structures, inner objects evolve normally in the course of development. Early structures become part of more complex ones. A more advanced structure, thus developed, implies in the course of its construction the dissolution of the more primitive part structures allowing them to become an integral part of the new structure, which is then a meta-system to the more primitive one, the system. The system gives its dynamics or energy to the meta-system of which it has become part. If the system keeps an individuality within the meta-system then we have an aggregate, an a-syntonic system. So the problem then is to hope that sufficient reversibility exists in the primitive system, however small this is, to be able to alter the structure so as to allow its integration in new meta-systems. It may be also that the higher meta-system is inadequate to integrate the sub-system. Could that be an important aspect of dream-objects mentioned before? By displacement, and condensation and symbolisation dream objects are constructed.

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Thus they may vary from mere aggregates to more cohesive structures. Undoing condensation and repairing the parts will allow the possibility of more cohesive structures to be formed and become available for reconstruction and progress. There remains another consideration which I will call inner object potential! The thought really came to me first as `tablet potential' when considering that a little tablet, say for insomnia, is so small, and yet people expect it will develop into sleep with all its consequences, such as dreaming. No need to quote a multitude of other `tablet examples'. I asked myself: could one apply this idea to inner objects with regard to their unfolding capacities? This is similar to the ovum, for that extraordinary biological microscopic inner object has not only biological potential, but also can develop into the creation of a world of psychic phenomena after it has developed the brain. Psychoanalysts then deal with the psychic aspects of its potential. This is an analogy of course. I do not know if anybody has followed the unfolding career of those inner objects normal and pathological. How do they grow with age, how do they change, learn and inspire us. Our good functioning must depend a great deal on such processes, making it an urgent task to ensure they can grow and function normally and happily. The growth of our own ego, its good functioning, its growth by identification with the characteristics of its objects, its good relationships with inner and external objects, its creativity are all interconnected. Freud was the first to have opened up the royal road to the unconscious and to dreamobjects, to our dreams. I wonder what his inner objects were saying to him, how they inspired him? What were their potentials? I wonder how often he might have thought about Keats' poignant verse:
When I have thoughts that I may cease to be Before my pen has gleaned my teeming brain.

References
Freud, S. (1917) Mourning and melancholia. In Standard Edition, Vol. 14, pp. 242-260. Hinshelwood, R.D. (1991) Dictionary of Kleinian Thought. London: Free Association Books. Klein, M. (1935) A contribution to the psychogenesis of manic-depressive states. In Writings, I, p. 270. Klein, M. (1946) Notes on some schizoid mechanisms. In Writings, III, p. 17. Rey, J.H. (1975) Liberte et processus de pensees psychotiques. In La Vie Medicale au Canada Francais, Vol. 4. Rey, J.H. (1981) The Clara Geroe lecture in Melbourne (unpublished). Rey, J.H. (1986) On reparation. In Journal of the Melanie Klein Society, 4(1), pp. 5-36. Rey, J.H. (1988) That which patients bring to analysis. In International Journal of Psychoanalysis, 69, p. 457. Rey, J.H. (1994) Universals of Psychoanalysis (edited by J. Magagna). London: Free Association Books. Solie, P. (1988) Le sacrifice. Edition Albin Michel.

Note
Available for 10 is a tape of Dr John Steiner and Mrs Maria Rhode discussing the work of Henri Rey, along with Dr Rey discussing anorexia with SPP and Association of Child Psychotherapists members at a Scientific Meeting at the Tavistock Clinic in June 1994. Please send cheque to the Society for Psychoanalytic Psychotherapists, c/o Mrs Eileen Francis, Adult Department, Tavistock Clinic, 120 Belsize Lane, London NW3.