The Infanticidal Attachment in Schizophrenia and

Dissociative Identity Disorder

Brett Kahr

W
hy do some individuals become schizophrenic? Why do others
develop depression? Why do others, still, become anorexic or bulimic?
How do certain people become alcoholic or drug-addicted? And why
do some commit arson, rape, paedophilia, murder, and other violent crimes?
Although biopsychiatrically-inclined colleagues have attempted to identify
a genetic basis for all of the aforementioned clinical manifestations, they have
not yet succeeded in doing so. But, do those of us with a more psychogenic
persuasion have a better answer?
Few psychological workers have devoted as much thought and care to the
question of the choice of symptom or the choice of neurosis than Professor
Sigmund Freud. Throughout his long and productive career as a psycho-
analytical researcher and clinical writer, Freud strove constantly to understand
what he could about the origins of the neurotic and psychotic illnesses with
which his patients presented in his consulting room. His early letters to the
Berlin otorhinolaryngoloist Dr Wilhelm Fliess attempt to establish different
aetiological–developmental pathways for a whole host of traditional psychi-
atric conditions ranging from the anxiety neuroses to paranoia (e.g., Freud,
1896b). During the course of Freud’s medical career, he would, from time to
time, link the onset of a particular symptom cluster to sexual trauma (e.g.,
Freud, 1895, 1896a), or, he might postulate that specific symptoms result from
transformations of instinctual urges, or from excitations of erotogenic bodily
zones. For instance, in his landmark essay on ‘Charakter und Analerotik’,
better known in English as ‘Character and anal erotism’, Freud (1908b, p. 175)
concluded his essay thus:

We ought in general to consider whether other character-complexes, too, do not

exhibit a connection with the excitations of particular erotogenic zones. At present
I only know of the intense ‘burning’ ambition of people who earlier suffered from

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enuresis. We can at any rate lay down a formula for the way in which character in
its final shape is formed out of the constituent instincts: the permanent character-
traits are either unchanged prolongations of the original instincts, or sublimations
of those instincts, or reaction-formations against them.

Freud elaborated his theories of aetiological causation in his famous clinical

studies, most especially in the analysis of the case of Dr Daniel Paul Schreber
(Freud, 1911c), and then, one year later, in his landmark article on ‘Über neuro-
tische Erkkrankungstypen’ (‘Types of onset of neurosis’), in which Freud
(1912c) delineated a variety of categories of disposition to neurosis, exploring,
inter alia, the impact of frustration as a principal aetiological component in the
development of illness, as well as the role of internal forces, and the impor-
tance of inhibitions (cf. Freud, 1913i).
By 1917, he had developed a very clear position about both the choice of
symptom and the development of psychopathology in his famous Lecture
XXIII on ‘The paths to the formation of symptoms’, which appeared in the
‘Allgemeine Neurosenlehre’ (‘General theory of the neuroses’), Part III of his
Vorlesungen zur Einführung in die Psychoanalyse (Introductory Lectures on
Psycho-Analysis). In this communication, delivered originally to students at
the University of Vienna, Freud delineated more fully one of the very first
multi-factorial models of psychopathogenesis, arguing that neurotic symptoms,
in particular, might result from a combination of causal roots, including,
‘sexual constitution’ or ‘prehistoric experience’, ‘infantile experience’, ‘acciden-
tal’ experience, ‘traumatic’ experience, and ‘fixation of libido’, all of which
conspire collectively to produce a welter of symptoms and symptom clusters.
By 1931, Freud had written a short, but helpful, essay, ‘Über libidinöse
Typen’ (‘Libidinal Types’), arguably his clearest and most concise exposition of
the links between what we might now refer to as a ‘character style’ and the
subsequent unfolding of a neurotic or psychotic illness. Freud noted that much
of human behaviour could be subdivided into three basic libidinal types: the
erotic, the obsessional, and the narcissistic. Although these typologies could
exist in a reasonably pure form, many individuals, by contrast, display features
of more than one libidinal type; therefore, one could readily speak of the erotic-
obsessional, the erotic-narcissistic, and the narcissistic-obsessional, and even of
an ‘erotic-obsessional-narcissistic type’ (Freud, 1931a, p. 219), which would
contain elements of all three basic characterological groupings. Freud theorized
that each of these basic positions or personality styles serves as the foundation
stone for more severe forms of psychological struggle, so that when the erotic
type, for instance, becomes ill, he or she will develop hysteria, whereas when
the obsessional type becomes subject to the vicissitudes of trauma, frustration,
excitation, and so forth, he or she will develop an obsessional neurosis. The
narcissistic type, by contrast, under stress and strain, may well become psychotic.

Brett Kahr
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1 Thus we observe in Freud the prototype of more contemporary theories of

2 psychoanalytical characterology (e.g., Shapiro, 1965, 1981; McWilliams, 1994),
3 wherein a predisposing style becomes the launching point for a more severe
4 breakdown state.
5 Both Dr John Bowlby and Dr Donald Winnicott – each in his own particular
6 accent – elaborated greatly upon Freud’s research, and made an enormous
7 contribution to the study of human psychology by noting that early deprivation
8 serves as an aetiological factor in the development of subsequent delinquency.
9 In Bowlby’s (1973) work with his cohort of juvenile thieves and other deprived
10 persons, and in Winnicott’s (1956) studies of the antisocial tendency, we have
1 strong clinical evidence for the role of early loss as a primary aetiological
2 component of delinquency, and, also, of depression.
3 In this tradition of investigation, using the theories of clinical psychoanalysis,
4 developmental psychopathology, and attachment research, I have postulated that
5 unconscious parental death wishes may well serve as an aetiological component
6 that contributes to the development of a schizophrenic psychosis in later life
7 (Kahr, 1993, 2007). I have referred to this phenomenon as the ‘infanticidal intro-
8 ject’, which in turn contributes to the development of an ‘infanticidal attach-
9 ment’ style between child and parent.
20 In view of the biopathological hegemony in contemporary psychology and
1 psychiatry, I presented my findings on schizophrenia – all derived from day-
2 to-day psychotherapy sessions with long-term chronically psychotic men and
3 women – with a certain amount of trepidation. Can a death wish really con-
4 tribute to the development of a putative brain disease such as schizophrenia,
5 especially in view of the ubiquity of death wishes in daily life? Fortunately, an
6 increasingly large number of colleagues have begun to share comparable case
7 material with me, describing instances in which patients had become psychotic
8 in the wake of a particularly insidious death wish, as opposed to the more
9 ‘ordinary’ death wishes that Donald Winnicott (1949) had described in his land-
30 mark essay ‘Hate in the counter-transference’.
1 We owe a great debt to Adah Sachs for her thoughtful and ground-breaking
2 response to my article ‘The infanticidal attachment’. Drawing upon her extensive
3 work with both psychotic men and women from her tenure working in a
4 variety of psychiatric hospitals, and from her more recent work at the Clinic for
5 Dissociative Studies in London, Sachs has made an important contribution to
6 our understanding of both attachment theory and developmental psycho-
7 pathology by attempting to differentiate between the type of infanticidal intro-
8 ject or infanticidal attachment (IA) which might contribute to the development
9 of schizophrenia on the one hand, and to the development of dissociative
40 identity disorder on the other. I must confess that I have grappled with this
1 question for some time, and to my great relief, Sachs – a compassionate and
2 experienced clinician – has provided a vital, hitherto missing clue.
3

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1 Sticking close to her clinical data, Adah Sachs has subdivided my concept of
2 ‘infanticidal attachment’ into two further varieties: ‘symbolic infanticidal
3 attachment’ and ‘concrete infanticidal attachment’. In the former condition –
4 the symbolic infanticidal attachment – parents will convey death wishes to
5 their offspring in symbolic, disguised form (as in the case of ‘Vita’ [Kahr, 2007],
6 in which her mother ripped open the child’s teddy bear with a large, carving
7 knife). In the latter condition – the concrete infanticidal attachment – parents
8 will transmit death wishes to their children in a much more immediately
9 sinister manner, even killing a pet or a baby in front of the child’s eyes as part
10 of a multi-perpetrator ritual sacrifice, which psychoanalyst Dr Valerie Sinason
1 (1994, 2002) and others have written about so compellingly.
2 Sachs’s differentiation between the two sub-types of IA corresponds quite
3 well with my own clinical experience with these two diagnostic categories
4 (reasonably extensive with schizophrenic individuals, and somewhat less exten-
5 sive, though still longstanding, with those individuals diagnosed as struggling
6 with dissociative identity disorder). In this respect, her bisection of IA into the
7 two categories of ‘symbolic’ and ‘concrete’ deserves further consideration and
8 further elaboration from colleagues as a most welcome and carefully constructed
9 contribution to the ancient Freudian problem of symptom choice. In other words,
20 why would one set of infanticidal introjects contribute to the likelihood of a later
1 diagnosis of schizophrenia while another set of such introjects would increase
2 the likelihood of a subsequent diagnosis of dissociative identity disorder?
3 In reading and re-reading Adah Sachs’s exegesis about the IA and its vicis-
4 situdes, I found myself wondering whether, in addition to discriminating
5 between a symbolic IA and a concrete IA, one might also consider a further
6 sub-division between ‘unconscious infanticidal attachment’ and ‘conscious
7 infanticidal attachment’. I have certainly worked with schizophrenic patients
8 whose parents harboured conscious desires to kill their children, but, in the
9 vast majority of cases, these infanticidal wishes and introjects would often
30 occur outside of consciousness, usually in a split-off manner. One cannot help
1 but wonder whether those who suffer from an unconscious form of IA may be
2 more likely to develop schizophrenia, whereas those who suffer from the
3 conscious form of IA may become more prone to receive an ultimate diagnosis
4 of dissociative identity disorder.
5 The work on the infanticidal attachment, though rooted in over seventy years
6 of psychoanalytical theorizing, remains still quite fledgling, especially in rela-
7 tionship to questions of aetiology. I commend Adah Sachs for her creative
8 contribution to this vital matter, and I trust that other colleagues will share
9 their clinical findings in a generous way, so that together, as a psychothera-
40 peutic community, we can contribute our extensive knowledge of the histories
1 of our patients and clients in an effort to better understand both the origins and
2 the treatment of severely shattered states of mind.

Brett Kahr
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The Infanticidal Attachment in Schizophrenia and Dissociative Identity Disorder