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Becoming Conscious and Schizophrenia

a

Donald Charles Grant FRANZCP. MRCPsych.

a

1021 Malvern Road, Toorak. Victoria, Australia 3142 E-mail:

Published online: 09 Jan 2014.

To cite this article: Donald Charles Grant FRANZCP. MRCPsych. (2002) Becoming Conscious and Schizophrenia,
Neuropsychoanalysis: An Interdisciplinary Journal for Psychoanalysis and the Neurosciences, 4:2, 195-203, DOI:
10.1080/15294145.2002.10773397
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195

Becoming Conscious and Schizophrenia

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Donald Charles Grant* (Melbourne)

Freud's thoughts on consciousness lie scattered

throughout his Complete Works. Nevertheless they
constitute a substantial theory of consciousness,
summarized here. Based on clinical material I am
suggesting the following modification of Freud's
theory of consciousness: the indirect route that a
specific internal emotional experience takes to
enter consciousness is not by association with a
``substitutive idea'' (Freud, 1915) but by the
subject's interaction with a material object of the
senses. Based on further clinical material I am
suggesting that the following sequence may occur
once self and object consciousness is established:
the conscious memory of the object is able to reevoke the conscious subjective state previously
experienced in relation to it. Having entered
consciousness by association with an object or its
memory, subjective states can then be represented
by words that are objects more suitable for use in
conscious secondary process thinking. Conscious
secondary process thinking can facilitate understanding of defenses and foster more realistic
conscious contents. Based on clinical material from
another patient I am also suggesting that schizophrenia is understandable as an illness in which
there has been a breakdown in the neuropsychological process of becoming conscious of the
subjective self while retaining object consciousness.

Introduction
Freud's (1895) rst theory of consciousness in his
``Project for a Scientic Psychology'' was a
biological theory concerned with excitation of
what he called ``omega'' neurons. He abandoned
this biological model for lack of sucient
neuroscientic knowledge to justify it but he did
not abandon the principle that mental phenom* Don Grant is a psychiatrist and psychoanalyst in private
practice.
Acknowledgment. I wish to express my gratitude to Drs. John
Cocks, Norman Doidge, Ed Harari and Reg Hook for their helpful
comments about earlier drafts of this paper.

ena have neurobiological correlates (Freud,

1914). In ``The Interpretation Of Dreams'' Freud
(1900) replaced his abandoned neurobiological
hypotheses with hypotheses about the structure
and functioning of the mind (rather than the
brain) and metapsychology was born as an
alternative to biological theorizing which could
not be tested at that time. His original position
about the status of his metapsychological theories
was modest. He (Freud, 1900) said, ``We are
justied, in my view, in giving free reign to our
speculations so long as we retain the coolness of
our judgement and do not mistake the scaolding
for the building . . . since at our rst approach to
something unknown all that we need is the
assistance of provisional ideas'' (p. 536). Later
in the same work he (Freud, 1900) added, ``we
must always be prepared to drop our conceptual
scaolding if we feel that we are in a position to
replace it by something that approximates more
closely to the unknown reality'' (p. 610).
This implies a readiness to continually revise
and rene our metapsychological concepts and
hypotheses about the structure and functioning of
the mind as we make more observations about
mental processes. Many psychoanalysts (e.g.,
Klein, 1946; Hartman, 1956; Bion, 1962; Lacan,
1966; Kohut, 1971) too numerous to list comprehensively have made contributions to this important work. Until recently the metapsychology
of consciousness has been somewhat neglected
but in recent years there has been renewed
interest, among a number of psychoanalysts, in
the nature of consciousness as a mental phenomenon and its relationship to biology.
This has been driven more by recent developments in neurobiology than psychoanalysis.
There has been a subtle but fundamental paradigm shift in neurobiology from the idea of a
brain which is genetically determined and static to
a brain which is developmental, experience driven
and dynamic within very broad genetically determined limits. This has provided psychoanalysis
and neurobiology with a common paradigm and

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196
the potential to once more be complementary
elds of study. Coupled with the fact that imaging
of brain functioning as well as structure is now
possible, the time may indeed be right as Schore
(1997) has suggested to recommence Freud's
(1895) Project and seek the biological correlates
of our metapsychology. This possibility brings
into focus the need for psychoanalysis to formulate specic but tentative metapsychological
hypotheses, as Freud originally intended. It is in
this modest spirit that I want to put forward
some ``provisional ideas'' about consciousness.
My aim is to propose some metapsychological
conceptual ``scaolding'' whose strengths and
weaknesses will then be available for researchers
in psychoanalysis and neurobiology to assess and
perhaps test through clinical observation and
experimentation.
It is not my aim in this paper to try to
address big questions about the essential nature
of mental activity and its relationship to biology.
Despite the interesting nature of such questions
and the promising nature of new research
methods in neurobiology as a possible means of
investigating some of them, I want to turn aside
from them here and discuss a smaller question
about mental phenomena. The psychic mechanism by which we become conscious of our
subjective selves is a relatively small question
and this is what I propose to discuss in this paper.
Freud's Metapsychological Theory of
Consciousness
Freud had more to say about the experience of
consciousness than we sometimes think. Even
though I shall disagree with one aspect of it I shall
start by outlining Freud's theory of consciousness
because we often lose sight of it in the presence
of his more explicit theory of the dynamic
unconscious.
Freud (1915) himself referred to his metapsychological paper entitled ``The Conscious'' in
``The Unconscious'' but Strachey (Freud, 1915)
tells us in several footnotes that the paper was
never written or has been lost. We must therefore
glean Freud's thoughts on the nature of consciousness from a number of his papers on other
matters.
In ``Formulations on the Two Principles of
Mental Functioning'' Freud (1911b) wrote, ``The
increased signicance of external reality heightened the importance . . . of the sense-organs . . .
and the consciousness attached to them. Consciousness now learned to comprehend sensory
qualities in addition to the qualities of pleasure

Donald Charles Grant

and unpleasure which hitherto had alone been of
interest to it'' (p. 220).
Freud then saw consciousness as being
attached to two things. Firstly, in what he saw
as the earlier state, it was attached to the level of
internal excitation but only in a somewhat gross
way. It was aware of the general level of
subjective pleasure or unpleasure. Secondly, consciousness became attached to the sense organs
and learned to comprehend the sensory qualities
of objects, as opposed to the internal state of the
subject in the earlier type of consciousness.
Freud (1915) elaborated his views on the
earlier form of consciousness (consciousness of
one's own subjective state) in his metapsychological paper, ``The Unconscious''. He wrote, ``It
is possible for the development of aect to
proceed directly from the system Ucs.; in that
case the aect always has the character of
anxiety'' (p. 179).
Here he takes his theory of consciousness a
step further by proposing that if an internal state
of unpleasure proceeds directly into consciousness
it is always experienced by the subject as anxiety.
He continued his discussion and oered a
theoretical explanation for the variety of conscious aective states we all experience in addition
to anxiety. He said, ``Often, however, the
instinctual impulse has to wait until it has found
a substitutive idea in the system Cs. The development of aect can then proceed from this
conscious substitute, and the nature of that
substitute determines the qualitative character of
the aect'' (p. 179).
What Freud was proposing here was that for
an aect, which is an internally generated mental
state, to become conscious as anything other than
anxiety it must be brought into relationship to
something else. Freud proposed a ``substitutive
idea'' as this something else.
Freud (1911b) distinguished this rst type of
consciousness of the subjective self from a second
type of consciousness of objects. He saw consciousness of objects as a simpler, more direct
process than becoming conscious of states of the
subjective self. His view (1911b) was that external
consciousness was directly attached to the perceptual apparatus, and in ``The Ego and The Id''
he (Freud, 1923) stated that ``All perceptions . . .
are Cs. from the start'' (p. 19).
Indeed Freud (1938) said that to make an
unwanted sensory perception unconscious requires psychic work involving the operation of
the Ego defense of disavowal. Even then the
perception does not become entirely unconscious
but is simultaneously both known and not
known.

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Freud also addressed the question of how

conscious thinking develops. He saw words as
playing a crucial role. He (Freud, 1923) said, ``But
what about those internal processes which we
mayroughly and inexactlysum up under the
name of thought processes? . . . only something
which has once been a conscious perception can
become conscious . . . The part played by word
presentation now becomes perfectly clear. By
their interposition thought processes are made
into perceptions'' (1923, pp. 19, 20, 23).
Later in ``An Outline of Psychoanalysis''
Freud (1938) addressed the same issue in a little
more detail saying,
The process of something becoming conscious is
above all linked with the perceptions which our
sense organs receive from the external world . . .
such may in fact be the state which prevails in
animals. But in men there is an added complication through which internal processes in the ego
may also acquire the quality of consciousness.
This is the work of the function of speech, which
brings material in the ego into a rm connection
with mnemic residues of visual, but more
particularly of auditory, perception [1938, pp.
161162].

Here he considered internal processes in the

Ego were able to be represented by words and
that words, being auditory or visual objects of the
senses, brought these processes within the domain
of the consciousness attached to the perceptual
apparatus.
A Modification of Freud's Theory of
Consciousness
I now want to describe some clinical experiences
that I had with a patient whom I shall call H.
These experiences led me to question Freud's
(1915) view that internal excitations become
conscious as qualitatively dierent aects by
becoming associated with a ``substitutive idea''.
Patient H
H was very dependent on hospitals and health
professionals due to a combination of a chronic
and severe physical illness, an eating disorder and
depression. These illnesses were dicult to contain and her prognosis was not good, but her
physician asked me if I could do anything at all to
help. I thought that an attempt to provide a
regular and reliable, emotionally containing
experience might help her to become more self

197
contained, and I agreed to see her. H soon
focussed her life around coming to see me twice a
week. During the sessions she lay on the couch,
not because I considered her treatment to be
formal analysis but because she said with some
factual basis that she was too physically ill to sit
upright without becoming dizzy. On the couch
she would writhe and sob and moan ceaselessly.
Clearly she was having a powerful conscious
emotional experience in the transference in her
sessions. I am using the term ``transference'' in
Joseph's (1985) sense to mean ``the total situation'' of the session. My presence in the setting of
therapy seemed to be the trigger that released her
internal emotional experiences into consciousness. There seemed to be nothing useful I could
say to her at that time. On the occasions when I
tried, the writhing, sobbing and moaning continued as if I had not spoken.
Gradually this activity decreased in the
sessions and the patient recommenced some
activity within her profession outside of the
sessions. Something had happened within her,
causing these changes, but the experiences she had
had with me were not in a form readily available
for thinking and neither of us was really sure what
it was that had made her dierent. We knew that
she had had powerful emotional experiences in
relation to me but at that time, while they were
still what she later came to call ``raw'', we could
hardly begin to think about them. In that ``raw''
stage her feelings were direct and overwhelming
and required my presence for their full intensity.
Becoming conscious of these internal emotional
experiences preceded her ability to name them or
to think about them. She was only able to
experience them while in the sessions with me.
Although I had no way of knowing it at the time,
these internal emotional experiences were not just
varying levels of unpleasure. Later H was able to
tell me that these experiences were of starting to
feel alive, sometimes hating herself, and at other
times feeling that she had some value. She did not
and could not tell me this at the time it was
happening. She was not able to think this herself
at the time it was happening. It was a conscious
emotional experience she had in relation to a
material presence and it preceded ideation about
its nature.
H's direct aective self consciousness is the
issue that led me to think about a modication of
Freud's (1915) view of the process of becoming
conscious of one's own internal emotional experience. While Freud acknowledged direct consciousness of subjectivity as a level of anxiety
along the pleasure-unpleasure series, he viewed
that type of consciousness as having quantity

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198
only, unless it was associated with a ``substitutive
idea''. This did not seem to be the case with H.
For her the direct physical experience of particular objects of her senses (the setting of therapy
and the analyst) evoked qualitatively new conscious self-experiences (feeling ``alive'' in her selfhatred or in her sense of worth). The implication
of this seems to be that for H these objects of the
senses played a crucial role in evoking consciousness not only of themselves as objects of the
senses but also consciousness of the qualitative
state of herself in relation to them.
Freud hypothesized that a ``substitutive
idea'' was necessary to bring internal emotional
states of the self into consciousness with a
particular quality. My observations with H lead
me to suggest a dierent proposal. This is that it is
having an internal emotional experience in relation
to an object of the sense, that brings the specic
quality of the internal emotional experience into
consciousness, along with the consciousness of the
object. I am not talking here about the internal
objects of Object Relations Theory but about
interaction with material objects of the senses as
detected by the perceptual apparatus. This
suggestion may sound new but it is not. It has a
long history in philosophy from Hegel (1807)
through Heidegger (1927) to Merleau-Ponty
(1945) all of whom argued that the subject must
engage with the object to achieve self-denition.
This seemed to be the case with H, whose
consciousness seemed to be activated through
the perceptual apparatus as Freud described, but
it illuminated not only the qualities of the objects
(the analyst and the setting) but also the state of
herself (feeling ``alive'') in relation to them. This
occurred with H before words or ``substitutive
ideas'' were present.
Consciousness of states of the self that were
rst experienced by H in this way in relation to
the analyst and the setting were subsequently reexperienced in relation to the visual memory of
those objects. The visual images acquired the
property of being able to re-evoke the subjective
states of herself now associated with them. This
capacity to represent her internal emotional
experiences with visual images brought H to what
I shall loosely call the second phase of her
treatment. Now H no longer had to be in my
actual presence to feel alive. She only had to
remember me. Although this was a conscious
experience it was not yet in language nor in a
form particularly suitable for use in thinking,
which was dened by Freud (1911b) as understanding the relationships between objects (to
which one must add ``and the self''). In this
second phase H seemed contentedly stuck at the

Donald Charles Grant

point of idealization of the analyst, whose
presence in material reality or in visual memory
was a necessary condition for her to feel alive.
This preverbal thinking in images and experiences
had an inexible and concrete quality.
At rst this new ``alive'' experience in
therapy was as amazing to H as it was unexpected. Although she only felt it in relation to
the actual experience of the analyst in the setting
or its memory, that was enough to enable her to
recommence a little work in her profession. She
felt alive and at times at least worthy enough to
produce something. She was also continuing to
become more conscious of dierent states of
herself in relation to other objects that came to
include some of the products of her own work.
These evoked feelings of life and self worth in her.
At the same time she was also bringing
words into connection with these newly conscious
states of herself, creating a language that was
genuinely meaningful to her. I will loosely call the
development of language the third stage of her
treatment. In this stage she came to describe my
consulting room and its immediate environs as a
``cocoon''. We were increasingly able to speak
about this ``cocoon'' and the importance it had in
enabling her to feel safe enough to have a fuller
conscious self experience while in it with me. This
enabled us to think not only about the ``cocoon''
as a place which was an object of the senses but
also about the emotional state of feeling safely
``cocooned'' which she experienced in it. Gradually H became more able to articulate increasing
numbers of words and phrases describing and
representing her experiences in the ``cocoon'' with
me and out of the ``cocoon'' without me. She said
she ``couldn't breathe'' and was ``dead'' when out
of the ``cocoon'' and could only wander like a
``hungry ghost'', waiting for her next session.
These words representing her emotional experiences were able to mediate those emotions into
her consciousness.
H's self consciousness had initially required
my actual presence with her in the ``cocoon'' as an
immediate object of her senses. Next it had
required the visual memory of the analyst in the
setting. It could now be evoked by words that
represented those experiences. The words ``cocoon'' and ``Dr. Grant'' had become able to reevoke certain internal emotional experiences
related to feeling alive rather than dead and
became the means by which she was able to focus
her consciousness on to this new alive experience
of her self. It was only when we reached this third
stage in which her consciousness of her subjective
states and her objects was represented in words
that we could begin the process of thinking about

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Becoming Conscious and Schizophrenia

the relationships between them and the distortions of those relationships (e.g., by projective
identication and idealization).
Now I was able to begin some interpretive
work in addition to the work of holding and
containing that had been going on before. We
started to be able to think and talk about what
was going on in the container of the sessions
rather than just experience it. Among the rst
useful interpretations I was able to make were
those about feeling ``cocooned'' by the holding
and containing setting. H was now able to tell me
about her conscious experiences of herself and me
in the ``cocoon''. Although these conscious
experiences were distorted by Ego defenses they
were mistaken for reality at that time. H's
defenses did not stop her from having conscious
experiences of herself in relation to me. What they
did was distort the experiences of which she
became conscious. Mostly she became conscious
of herself as dangerously bad and me as an
idealized being who contained all good.
This initial idealized experience of me could
perhaps be seen as a ``substitutive idea'' although
not in the sense that Freud (1915) intended. My
work with H leads me to suggest that a
``substitutive idea'' may be not so much the thing
that brings the state of the self into consciousness
as the result of defensive distortions operating on
new conscious experience. It was not until they
were represented in words that H's initial
distorted conscious experiences of herself and
me could be thought about and their defensive
aspects interpreted. The interpretation of these
defenses was not the means of bringing them into
consciousness in the rst and second stages of her
treatment. In fact it seemed in the work with H
that becoming conscious of certain internal
emotional experiences in relation to me in the
setting of therapy (i.e., in the transference) was a
necessary precondition for us to think and speak
about them and their defensive aspects.
It seemed equally necessary for me to reach a
similar point. Becoming conscious of my own
emotional experiences in the transferencecountertransference relationship seemed a necessary precondition for me too to name them. Only
then could I begin to think about the quality of
my countertransference and wonder what it
meant about H that I was having this particular
experience of her instead of some other. Only then
could I begin some interpretive work. I'll give an
example.
For a long time H reported her experience of
feeling alive only in the sessions and dead outside
them. I became conscious of a vague feeling of
disquiet in myself that she seemed to depend

199
utterly on my presence to experience what was
after all a part of herself. It was as if that good
creative part of her was part of me. H seemed
comfortable with that but I was not and I
recognized that was the source of my disquiet. I
interpreted that it was as if H left the good
creative part of herself with me instead of taking
it with her when she left at the end of each session.
This of course is part of what Klein (1946)
described as projective identication. However I
think my interpretation came not directly from
some theory in me but from my becoming
conscious of and then being able to think about
my disquiet when H not only garaged part of
herself in me but also seemed very comfortable
with that arrangement.
H was receptive to that interpretation. In
subsequent sessions she went on to speak about
her feeling that she was full of something really
bad. When she thought about the inside of her
body she envisaged it as full of some disgusting
poisonous slimy black substance that would kill
anything alive. That was why she could not eat. It
would only nourish and strengthen the badness in
her. She believed that the badness in her was too
strong for anything alive and creative to survive
there. She said it was like she was leaving the
good part of herself with me where it would be
safe. These further associations gave me the
opportunity to interpret her idealization of me,
saying that she seemed to believe that everything
bad and awed was in herself and that I was
awless and full of nothing but good, like some
sort of Godlike being.
The interpretation of these defenses of
projective identication and idealization enabled
H to be more than just conscious of their
actualization in the transference. It enabled her
to understand and think about herself and me in
new ways. She realized that her deadness resulted
from having projected the alive part of herself
into me for safekeeping. Her anorexia was in part
at least her attempt to punish the bad self inside
her and starve it to death. She recognized that the
bad self was linked with a feeling of rage inside
her. She also realized that I am not God.
With these new insights H's consciousness of
herself and me changed and developed into
something more realistic. She became more able
to re-own good creative parts of herself, to work
and to have better relationships that now made
more sense to her. She became able to question
her earlier rigidly held view that the analyst's
presence or memory was necessary for her to feel
alive and worthwhile. She began to feel worthwhile in relation to some of the products of her
own work. This led her to begin to think the

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200
unthinkable. If she could feel worthy in a
situation that was not directly dependent on the
``cocoon'' but was in relation to things which she
herself had produced then there must be something worthwhile in her. From this it seemed a
short step to think that perhaps colleagues would
nd something of value in her work and by
extension in her. She took steps to share and
discuss some of her work with one or two much
admired colleagues. Their conrmation of the
value of her work strengthened her ability to
value herself.
For the purposes of this paper there are two
main points that I want to draw from this
discussion of patient H. Firstly, for H consciousness of certain states of her subjective self, albeit
distorted by defenses, arose in relation to certain
material objects of the senses detected by the
perceptual apparatus and preceded their nonverbal or verbal representation and the capacity
to think about them. This is my point of
dierence from Freud's theory of consciousness.
He postulated that it was a ``substitutive idea''
(Freud, 1915) that brought an unconscious
internal state of the self into consciousness with
a specic quality. Secondly this new consciousness of her subjective self did not seem to promote
change and development in itself. It seemed more
like simply becoming conscious of her internal
state as it was, including its distortion by
defenses, without any capacity to separate distortion from reality. It was not until H and I
developed verbal representations facilitating
thinking and discourse about the relationships
between these states of herself and her objects
including her defenses in the transference-countertransference relationship that this separation
became more possible.
Schizophrenia Revisited:
Impaired Consciousness of the Subjective Self
The modication of Freud's theory of consciousness that I have just outlined enabled me to think
about another patient (whom I shall call E), in a
new way. I now want to describe this patient
who was not treated by me personallyand the
new way I came to think about him and the illness
of schizophrenia from which he suers.
Patient E
E has a diagnosis of chronic severe schizophrenia.
He believes that aliens control his world. They
send secret coded messages to him via the

Donald Charles Grant

television set. More coded messages are sent by
arranging the garden hose in certain congurations. They also speak to him directly; he hears
their voices. They inhabit the bodies of neighbors
and strangers to spy on him and inuence him.
They read his mind and control his thoughts.
They regularly capture his mother and brother
and torture them by feeding them into a giant
mincer and mincing them up. They then reconstruct them out of the mince and return these
creations home to E. His mother and brother
don't know that anything has happened to them
but E does.
E said that he had passed a butcher's shop
and had seen some mincemeat on an absorbent
pad (which are used in Australia nowadays to
absorb excess moisture from packaged meat). He
had the thought that it was like his mother
wearing a tampon. At this stage E still knew that
the mincemeat was just mincemeat and that it
evoked associations in his mind about mother and
menstruation. He knew that these associations
had their origin in his mind within himself. One
week later when he was next seen he said the
mincemeat was his mother sitting on a tampon
and that she had been minced by the aliens and
not yet put back together when he had seen her.
For him his experience was no longer his personal
subjective reaction to a piece of mincemeat but
had become the perception of his mother, minced
and bleeding. The capacity to see the mincemeat
as a representation of the menstruating mother
and his emotional reaction to her could not be
sustained. E no longer thought that the mincemeat reminded him of his mother or that the pad
reminded him of menstruation. To him they were
now the actual visual perception of these objective
things. His consciousness of his thoughts and
feelings as his subjective reactions to these things
had all but disappeared. In their place were
conscious thoughts and feelings about his mother
that were now experienced as arising from
perceptions of the objective mother who the
bleeding mincemeat now was.
In a second incident E heard noises coming
from an adjoining bedroom one night and said
they were caused by people there having illicit
sexual intercourse. He was asked,
``Do you think that there could be some
other explanation for the noises you heard?''
He immediately replied in a tone of utter
certainty,
``No.''
Here too there is no sense of a subjective self
who might hear the noises and think ``those
noises sounds like someone having sexual intercourse'' and who might experience all the

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Becoming Conscious and Schizophrenia

attendant emotional reactions which that thought
might evoke. Instead E experienced what was to
him, beyond any shadow of doubt, an objective
sexual event detected by his perceptual apparatus
(auditory).
A third example concerned E's experience of
his therapist. E told him one day that he thought
there were two of him (the therapist). One was a
good and helpful person; the other was one of the
aliens or at least in league with them. Instead of
being able to recognize that he was having two
dierent subjective experiences with the therapist,
sometimes feeling secure and at other times
feeling anxious and suspicious, his subjective
experiences were mistaken for perceptions of
two dierent objects of his senses.
The experiences that E described in this
material will not be surprising to anyone who has
worked with patients suering from schizophrenia. Such bizarre and puzzling experiences
and ideas are common in patients suering from
this illness. However we can extract from this
clinical material a hypothesis that what a schizophrenic patient (at least one with the type of
schizophrenia that E has) cannot adequately do is
locate the origin of his subjective experiences
within himself; he mistakenly feels they arise from
perceptions of objects. The major symptoms of
schizophrenia become understandable if we adopt
this hypothesis.
Passivity is the name given to the subjective
experience of lack of personal mental agency. It
has been considered pathognomonic of schizophrenia. It would follow directly from the
hypothesis that a defect in developing consciousness of the internal origin of experiences of the
subjective self is the key psychopathology of
schizophrenia. In a state of passivity, experiences
are felt to have their origin in objects and to have
been received from outside the self. E's mistaking
his dierent subjective reactions to his therapist
for two dierent therapists points to such a state
of pathological consciousness.
The pathological aect in schizophrenia is
variously described as at, dull, inappropriate or
incongruous. In the case of E, at or dull seemed
to be the more accurate description of his
pathological aect. For most of the time E would
talk about the alarming things that he believed
were going on around him in a relatively matter
of fact sort of way. Once again it was as if he had
no subjective self reacting specically to these
horrors but was simply describing what were to
him a series of objective events. He did have a
certain level of anxiety but it did not seem to vary
appropriately with the subject matter he was
talking about. This anxiety was more like a

201
background state of excitation than a specic
subjective reaction to specic fears about specic
things. This lack of subjective emotional responses appropriate in quality and quantity to
dierent situations could also be understood as a
direct result of the failure of the process of
becoming conscious of the state of his subjective
self.
If this process of becoming conscious of the
subjective self were faulty, as seemed to be the
case with E, one might ask, ``what then happens
to internal excitations which cannot achieve
normal consciousness as aects''? Freud (1920)
in ``Beyond the Pleasure Principle'' pointed to a
possible answer. He wrote, ``. . . a particular way
is adopted in dealing with any internal excitations
which produce too great an increase in unpleasure: there is a tendency to treat them as though
they were acting, not from the inside, but from
the outside . . . This is the origin of projection''
(p. 29).
Freud (1920) was referring to the projection
of an idea but it is also possible to project parts of
the self into objects. This is what Klein (1946)
introduced the term projective identication to
convey, in distinction to projection (of an idea).
Bion (1967) considered that projective identication was a major psychopathological mechanism
in schizophrenia and was a means of attacking
hated reality. I wonder if in some patients at least
the pathological process is less purposeful than
that and might be secondary to the failure from a
variety of causes of the process of becoming self
conscious as I have tried to describe it. That
failure might in some cases be in the associated
biological processes rather than being primarily a
mental process of a defensive nature as suggested
by Bion (1967). In either case the result is likely to
be high levels of unconscious internal excitation.
This would be partly experienced in consciousness
as anxiety and partly dealt with by projecting
unconscious excited parts of the self into objects,
leaving the conscious self depleted and creating an
ever-increasing number of fantastic objects
crowding into consciousness. Clinical observations with E seemed to suggest this. His consciousness of his own aects was impoverished,
leading to a at relatively xed level of anxiety. At
the same time he consciously experience himself
as increasingly surrounded by a variety of
fantastic objects such as the mince meat mother
and the aliens to whom he attributed his
experiences.
Activation of projective identication in
response to high levels of internal excitation also
oers a possible explanation of E's auditory
hallucinations and delusions. If, through projective

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202
identication, E's own capacity to think were
partially experienced as relocated outside himself
he would mistake some of his own thoughts for
perceptions received via his auditory apparatus
from objects outside himself. Clinical evidence for
this was not so clear in E's material but with
another patient, whom I shall call F, it was.
F also suered from schizophrenia but had
been in remission for some time. During her
regular visits while she was well she told her
therapist that if she was relapsing and becoming
ill again she usually noticed a change in her
subjective experience of herself. She was in the
habit of conducting debates with herself in her
mind. When she was well her experience of this
was that the thoughts on both sides of the debate
were clearly hers. If her schizophrenic illness were
starting to relapse, however, she would feel as if
she was losing control of one side of the debate
and it seemed to take on some sort of life
independently of her. If the relapse could not be
halted at that stage the experience would develop
further. One side of the debate would become
consciously experienced as if it were not only
independent and something foreign in her mind
but as if it were a perception of a voice from
outside of herself.
E's auditory hallucinations like those of F
could be understood as the result of the projection of some of his own thinking resulting in a
pathological state of consciousness in which the
boundary between self and other has moved to an
abnormal setting. Since there were no visual
stimuli corresponding to the pathological auditory experience thus created, E attributed the
voices to mysterious unseen aliens. Although E
could not see them he heard their voices so he
knew they were there. His belief that these heard
but not seen aliens were the source of the voices
was E's primary delusion. This delusion can be
seen as his attempt to explain and make some
sense of the pathological conscious experience
that resulted from projection of part of his own
thinking.
Formal thought disorder in schizophrenia
involves the fragmentation of the form or
structure of thinking as opposed to its content.
It is understandable in the pathological model I
am suggesting as a consequence of the projection
and objectication of parts of the Ego or Self
including the capacity to think. The remaining
fragments of subjectivity and capacity for thinking are expressed in the fragmentary thinking and
speech.
Fragmentation and weakening of one's self
experience as a result of projective identication
seems to be less in focus than the pathological

Donald Charles Grant

distortion of objects which results from it. This
seems to be so even though Melanie Klein (1946)
in ``Notes On Schizoid Mechanisms'', in which
she introduced the concept of projective identication, made a point of it. She says there is a
``weakening and impoverishing of the Ego'' (p. 9)
consequent upon the projection of large ``parts of
the self'' (p. 9).1 In a patient like E the weakening
and fragmentation of the Ego or Self including
the capacity for thinking is severe and is reected
in the symptom of formal thought disorder.
In summary, I am suggesting that in E's
schizophrenic illness the key psychopathology is
impairment of the capacity to become conscious
of the internal origin of subjective states of the
self while retaining the capacity for object
consciousness. This impairment of the capacity
to become conscious of the internal origin of
aspects of experience would lead directly to the
symptoms of passivity and attened aect. The
associated projection of unconscious excited parts
of the self into objects would result in the suerer
consciously mistaking his own internal states for
perceptions from objects. This state of pathologically distorted consciousness would give rise to
hallucinations. Delusions are the patients attempt
to make sense of the pathological consciousness
that results from the multiplication and distortion
of objects and the impoverishment of the Ego or
Self. The depleted and fragmented conscious self
that remains is reected clinically in the symptom
of formal thought disorder. This model accounts
for the major symptoms of schizophrenia.
I have suggested above that biological
factors might play an important etiological role
in schizophrenia but this is not to say that
schizophrenia should be thought of as a simple
genetically driven biological illness. Recent research has shown that biological brain development like psychological development is to a major
degree experience driven within a broad genetically determined framework and is dependent
on appropriate interactions with objects (Schore,
2000). We therefore need to keep an open mind
about the balance of genetic and experiential
factors that might be signicant in the development of schizophrenia. The work begun by Freud
(1895) in The Project, correlating psychological
and biological processes, is now being taken up
again by a number of researchers. (Schore, 1997)
When it has proceeded further, the answer to
questions about the balance between genetic and
environmental factors in the cause of schizophrenia
1
Melanie Klein seems to use the words ``Ego'' and ``self''
interchangeably in her paper.

Becoming Conscious and Schizophrenia

might become clearer than it is at present. What I
am suggesting in this paper is not a cause of
schizophrenia but a psychopathological mechanism for symptom formation in those suering
from this illness or at least from the type that E
had. This psychopathological mechanism may be
in the nature of a nal common pathway that
could be triggered by a number of dierent
causes.

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Donald C. Grant FRANZCP. MRCPsych.,

1021 Malvern Road,
Toorak. Victoria,
Australia 3142
E-mail: dcgrant@ausdoctors.net