Disturbances in Object Relations
in a Chronic Schizophrenic P a t k t
by Grace A. Fochtman
OBJECT relations
are initiated with the first extra-uterine contacts
and acts of mothering, which not only meet the
infant’s physiological needs, but which also com-
municate warmth and love. Bellak and Loeb
( 1969) define object relations as the capacity of
the organism to relate to all others, and especially
to significant others.
Initially, the infant is totally dependent. Since
he has no ego boundaries, he is unaware that his
needs are being met by an external source. As
a result, he feels omnipotent. Between one and
five months old, he differentiates between him-
self and his mother. Once he recognizes her as
the source of relief of his needs, she becomes the
all powerful one. The infant then tries to regain
his omnipotence by introjecting the mother. His
need for omnipotence decreases, however, as he
gains skills through mastery of his environment
at a later stage.
During the oral stage, the infant begins to
associate positive libidinal pleasure with the
mother. As the mother gives love, feelings are
awakened in the infant that develop into trust
and love. Because he is so dependent on his
mother, the relationship between mother and
infant takes on an intensity seldom if ever
equaled throughout life. For this reason, the rela-
tionship is most significant in determining the
personality patterns that evolve in a person, and
gives credence to the theories of object relations
that will be subsequently discussed - theories
that place the cause of schizophrenia in the con-
text of this early mother-infant relationship.
Antecedents t o Psychopathology
Theorists view schizophrenia in totally differ-
ent ways. Some view it as a psychiatric illness
syndrome, some as a faulty interaction pattern,
and some as a hereditary defect. The psycho-
analytic ego psychologists view it as a disturbance
in the ego function patterns. There is consensus
among them that the origins of schizophrenia lie
in the oral stage. They arrived at this belief from
observing adult schizophrenic behavior, which
suggests deficiencies in the ego, deficits that
would normally have been at least partially re-
solved by the end of the oral stage. However,
there is no agreement as to the specific process in
the mother-child relationship that results in the
malfunctioning ego of the child later in life.
Reichard and Tillman ( 1950), who studied
patterns of parent-child relationships of schizo-
phrenics, developed the concept of the schizo-
phrenogenic parent. They observed that parents
of schizophrenic patients fall into three, clear-cut
categories; the most common pattern being the
covertly rejecting mother who uses reaction for-
mation against her hostility. Over-protective, she
demonstrates “smother love” in an effort to keep
her child dependent. Her behavior leads to the
continuance of a primitive symbiotic relationship
between the two. The child’s ego remains fused
with the mother’s; consequently, the boundaries
between them never become clear. The mother
projects her dependency needs onto the child and
maintains him in this relationship. (pp. 247-
257)
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 Psychiatric Care
The author, a nurse therapist, chose to study
patient, over a period of four
months, using the theoretical framework of
a!
psychology because it afforded
a way of looking at and understanding the pa-
tient’s ego needs and ego development.
PATIENTDATA
Elaine, twenty-eight, had been in psychiatric
treatment for seven years and was by now
labelled chronic, undifferentiated schizophrenia.
When first seen by the author she manifested
impaired ego development, having difficulties
with incorporation, differentiation, integration,
over-dependency, and separation. Her mother,
diagnosed as a paranoid schizophrenic and alco-
holic, had been receiving psychotherapy for
fifteen years.
Diff erentiatiolz
Because of the pathologic relationship during
the phase when the child normally develops ego
boundaries, he is not able to see himself as a
separate entity. He cannot differentiate between
himself and others in his environment. He re-
mains an indistinguishable part of the whole. The
mother, because of her pathology, does not see
him as separate either. The mother and child
continue to use the incorporative mode of relat-
ing. They each feel to be at one with the other
and are unaware of any sense of separateness
between one personality and the other. Elaine
consistently referred to her mother and herself
as a unit. She never said, “I looked for a job.”
but rather, “ W e got a paper and looked for a
job.”
Incorporation
Incorporation becomes the person’s method of
establishing relationships. He uses this method
because he has never learned to view himself as
a separate entity, nor to function as a separate
entity. It is difficult for him to move away
from incorporation because he fears the other
14
person might retaliate and withhold love or
punish him. Therefore, he remains incorporated
with the other person, and any attempt by the
other person to assert his own individuality is
threatening and viewed as rejection. This is basic
to the all-or-none principle in symbiotic relation-
ships. He feels he must have all of the other
person at all times. If he is forced to share the
other person with someone else or if the relation-
ship ends, he experiences total rejection. He can-
not accept the reality that no one has another
human being totally to himself forever.*
When Elaine recounted past experiences with
other therapists, her use of incorporation was
evident. She wanted quickly to become a part of
the profession to which the therapist belonged.
She had wanted to be a social worker, psychol-
ogist, and a nun, depending on whom she was
seeing at the time. She also formed a rapid
transference with her therapists.
Integration
Integration goes hand-in-hand with differen-
tiation. The person, as he experiences objects as
separate, must be able to integrate these, see how
they fit together; otherwise he experiences life as
a series of unrelated fragments. Elaine had diffi-
culty integrating the positive aspects of relation-
ships; instead, she focused on the long series of
terminations she had experienced. She initially
was unable to see that she had gained something
from these relationships, although they caused
her pain when they ended. Nor could she inte-
grate the past experiences she had had with her
mother, which was evident when she was tempt-
ed to go to her mother for advice and assistance
to plan for her future and make a decision about
+Symbiosis can be seen o n a continuum, ranging from total
fusion where there is no differentiation between the self and
the other ( t h e other being perceived as the self) to the
kind o f relationship where there is differentiation but the
other is perceived only in the service of self. However, the
state of total fusion is sometimes described as fire-symbiotic,
or in iMahler’s terms, a state of “primary autism.”
- SHEILAROUSLIN,Clinical Editor.
 d
where to live after discharge from the hospital. live and take care of me, and I wouldn’t have to
Intellectually, she recognized that her mother have all that responsibility.” Overdependency, or -x
was ill, but emotionally she could not accept this
knowledge. As a result, she frequently exper-
object clinging, has several limitations as an
attempted solution. It never resolves the develop-
52
ienced rejection.
Ouer-dependency
Interference with differentiation results in a
lack of separateness and an inability to be self-
regulating. Lack of integration prevents inde-
pendent functioning. These ego deficits result
in a need for external regulation and control, but
the person has a fear of regulation and control
because these imply being fused with another.
Because the mother, the original object, was
associated with fusion, subsequent object rela-
tions are distorted by the susceptibility to incorpo-
ration and the fear of annihilation of any
separateness that has developed.
Burnham, et al. (1969) refer to the depen-
dency of the schizophrenic as one resolution of
the need-fear dilemma. The person can attempt
to resolve the dilemma by abandoning any inde-
pendence he may have developed, and fusing
inseparably with others. When this occurs he is
labeled over-dependent or narcissistic. He makes
spoken and unspoken excessive demands on the
object with no sensitivity to the object and no
desire to give anything in return. He may expect
the object to magically know, anticipate, and
fulfill his needs as if they were the object’s own.
More than simply wanting emotional nurturing,
he wishes to fuse with the object to achieve a self
through the object’s ego.
Elaine’s over-dependency was reflected in her
description of others. She described different
people as, “She was very nice, she would have
done anything for me.” When describing the
nun with whom she had previously resided, she
said, “She stopped whatever she was doing when
I needed her. She would hold my hand and let
me put my head on her shoulder.”
Elaine’s struggle with dependency was reflect-
ed in her desire to go into the convent, “If I went
into the convent, they would give me a place to

15
.-c
(I)

.-g! her parents experienced marital discord and person, he has destructive thoughts and feelings.
c.
gP divorce was being discussed. After her second Instead of interpreting these thoughts and feel-
hospital admission, her parents divorced and ings as the result of the separation, he sees them
f
a her father remarried. She was admitted soon after as the cause of the separation.
Elaine’s history, in which each successive
hospitalization was linked to a stress precipitated
by separation, clearly suggested that the primary
goal of therapy should be to prepare her for a
successful emotional separation. By the time
therapy is terminated, its success will be mea-
sured in the degree to which Elaine perceives
others as separate entities rather than an exten-
sion of herself, and to the extent to which she
can maintain “object constancy” ( i.e., sustain
relationships over long periods of time and
tolerate both the physical absence of the object
and the frustration, anxiety, and hostility related
to it.) (Bellak and Loeb)

References
Bellak, L. and L. Loeb (ed.),The Schizophrenic Syn-
drome, New York: Grune & Stratton, 1969.
Burnham, D., A. Gladstone and R. Gibson, Schizo-
phrenia and the Need-Fear Dilemma, New York:
International Universities Press, 1969.
Reichard, S. and C. Tillman, “Patterns of Parent-Child
Relationships in Schizophrenia” Psychi&-y, 13:247-
257, 1950.

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