Herbert Rosenfeld

Herbert Alexander Rosenfeld was born on 2 July 1910 in Nuremberg, into a Jewish family. He studied medicine at several German universities, became drawn to psychiatry at Munich, and graduated there in 1934. The anti-Jewish laws of the Nazi regime, which barred him from treating non-Jewish patients, drove him to Britain in 1935. He retook his medical examinations in Glasgow and worked in several hospitals, where he became interested in treating severely psychotic patients by psychotherapy rather than with drugs.

In 1942 he began a training analysis with Melanie Klein at the British Psycho-Analytical Society. He became an associate member of the Society in 1945, a full member in 1948 and a training analyst in 1949. His first training case became the subject of his first paper, Analysis of a Schizophrenic State with Depersonalization³ (1947). He was elected a Fellow of the Royal College of Psychiatrists in 1972, and he died in London in 1986.

Rosenfeld practised in London for the rest of his life and taught at the Institute of Psycho-Analysis and abroad, concentrating on psychotic and severely disturbed patients. Together with Segal and Bion, whose work on psychosis ran alongside his own, he extended Klein's teaching and became an authority on the psychoanalysis of psychosis.

As a training analyst he analysed Martha Harris during her psychoanalytic training, and he was one of the supervisors of Donald Meltzer's adult cases. He was also the first training supervisor of John Steiner, who later edited a volume on his work. Between 1978 and 1985 he was one of several British analysts invited by members of the Italian Psychoanalytic Society to give seminars and supervisions; transcripts of these were edited by Franco De Masi and published as Herbert Rosenfeld at Work: The Italian Seminars (2001).

He gathered his papers from 1946 to 1964 in Psychotic States: A Psycho-Analytical Approach¹ (1965). His last book, Impasse and Interpretation, appeared in 1987, the year after his death, as the first volume of the New Library of Psychoanalysis.

The 1947 paper reported what Riccardo Steiner, in his entry on Rosenfeld in the International Dictionary of Psychoanalysis, calls the first adult psychotic case treated successfully by "a purely interpretative psychoanalytic method". It drew on Klein's newly published Notes on Some Schizoid Mechanisms⁴ and was the first clinical paper to use her concept of projective identification. Rosenfeld argued that the fragmentation of his patient's ego and the feelings of depersonalization arose from excessive splitting and from the projection of parts of the self into objects (Analysis of a Schizophrenic State with Depersonalization³).

Against the view that psychotic patients withdraw from objects and form no transference, Rosenfeld held that schizophrenic patients form an intense transference in which the analyst is treated as the bearer of the patient's projected parts. He called it the transference psychosis and set it apart from the transference neurosis: it is marked by the massive projection of unconscious phantasies onto the analyst and by primitive object relations. Its interpretation became the core of his technique (Psychotic States¹).

In Notes on the Psychopathology of Confusional States in Chronic Schizophrenias⁵ (1950) he described states in which the normal, structuring split between good and bad objects, and between the loving and hating parts of the self, fails. Love and hatred become mixed, and the patient fears that the destructive impulses will destroy the good self and the good object. Where envy predominates, the good object itself is attacked, and good and bad can no longer be told apart. Rosenfeld treated confusion as poised between splitting and integration: it may be a step towards integration or a retreat from it. Klein took up his account of confusional states in Envy and Gratitude⁶ (1957).

Psychotic States collects papers in which Rosenfeld applied the theories and techniques Klein had developed with infants and young children to acute and chronic schizophrenia, severe hypochondriasis, drug addiction, severe depression and manic-depressive states. His aim was to test their therapeutic value and to see what they might show about the causes of psychosis. Besides the papers on depersonalization, confusion and narcissism, the book includes papers on male homosexuality and paranoia (1949), on the superego conflict and on transference phenomena in acute schizophrenic patients (1952), on drug addiction (1960), on the superego and the ego ideal (1962), on hypochondriasis (1964) and on acting out (1964). The Melanie Klein Trust describes the book as a strong case for the intelligibility of psychotic symptoms and for the benefit of treating them psychoanalytically.

A further paper of 1971, on the importance of projective identification in the ego structure and object relations of the psychotic patient, published in the collection Problems of Psychosis, sets out the different types and motives of projective identification; the Melanie Klein Trust calls it a standard reference. Rosenfeld came to distinguish projections that communicate a state of mind, which the analyst can contain, from projections that evacuate unwanted parts of the self or aim to control the object and deny separateness and dependence. Four chapters of Impasse and Interpretation² take up the containment of projective identification in borderline and schizophrenic patients and the countertransference difficulties it creates.

In On the Psychopathology of Narcissism: A Clinical Approach⁷ (1964) Rosenfeld recast narcissism in Kleinian terms. Where Freud had described narcissism as libido withdrawn from objects onto the ego, Rosenfeld described an omnipotent relation to objects. Through omnipotent introjection the self claims the good qualities of the object as its own; through omnipotent projection it lodges its unwanted parts in the object, which is then kept devalued. The result is a grandiose idealization of the self. Because self and object are not told apart, the separateness of the good object is never acknowledged, and with it the dependence, envy and destructive impulses that separateness would arouse, and the anxieties of confusion and disintegration that follow from them.

His paper A Clinical Approach to the Psychoanalytic Theory of the Life and Death Instincts⁸ (1971), an invited contribution to the 27th International Psycho-Analytical Congress in Vienna, set a destructive aspect of narcissism beside the libidinal one he had described in 1964. In destructive narcissism it is the omnipotent, destructive parts of the self that are idealized. They are felt as a source of superior strength and, often represented in the patient's material as a mafia gang, are organized against the dependent self and its sane relations with good objects. Such organizations split the self and keep its sane part stunted in its development. Rosenfeld presented this as a clinical approach to Freud's theory of the fusion and defusion of the life and death instincts: the idealized destructive organization was, in his account, where the death instinct shows itself in the clinic. He returned to the theme in the chapter on destructive narcissism and the death instinct in Impasse and Interpretation.

In his last years Rosenfeld turned to breakdowns of communication between patient and analyst, and to the analyst's own part in producing an impasse. Impasse and Interpretation² is arranged in parts on the analyst's contribution to successful and unsuccessful treatment, on the influence of narcissism on the analyst's task, and on the influence of projective identification on that task. Among its chapters are studies of a narcissistic omnipotent character structure in chronic hypochondriasis and of narcissistic patients with negative therapeutic reactions. Rather than treating such dead ends as insurmountable, Rosenfeld held that they could be worked through, and that an impasse might let a patient re-enact with the analyst the impasses of their own development.

The book gave more weight than his earlier work to trauma and environmental failure in the formation of narcissistic organizations. Rosenfeld warned that patients who had been deprived or traumatized in childhood could be traumatized again in analysis if the analyst laid too much stress on innate destructiveness. In the closing chapter, an afterthought on changing theories and techniques, he distinguished thick-skinned narcissistic patients, who seem impervious and need firm and persistent interpretation if an impasse is to be avoided, from thin-skinned ones, who are hypersensitive and easily hurt, and for whom premature interpretation of their destructiveness can repeat an early trauma (thick-skinned and thin-skinned narcissism).

Rosenfeld's later views were contested. The Melanie Klein Trust records that his emphasis on trauma and on the analyst's errors caused controversy between groups at the Institute of Psychoanalysis, while the book is still valued for urging analysts to attend closely to how patients respond to their interventions, so that mistakes can be recognized. A review in the British Journal of Medical Psychology judged it "as valuable to the author's critics as it is to the many people who have followed his approach".

His theory of narcissism reached beyond the Kleinian group. In Contrasting Viewpoints Regarding the Nature and Psychoanalytic Treatment of Narcissistic Personalities⁹ (1974), Otto Kernberg aligned his own position with Rosenfeld's, among others, against that of Heinz Kohut, and said that he had taken many aspects of Rosenfeld's Kleinian technique while differing on details. Rosenfeld's omnipotent narcissistic object relations are commonly read as one source of Kernberg's pathological grandiose self, and André Green is also named among those who developed his account of destructive narcissism.

Within the Kleinian tradition, John Steiner built his account of the pathological organizations of borderline patients, and of the psychic retreats they provide, partly on Rosenfeld's concept of pathological narcissism. Later writers, among them Anthony Bateman and Ronald Britton, argued that thick-skinned and thin-skinned states can alternate within one person. In 2008 Steiner edited Rosenfeld in Retrospect: Essays on His Clinical Influence, which gathered conference papers by Britton, Michael Feldman, Edna O'Shaughnessy, Hanna Segal and Riccardo Steiner, a chapter by John Steiner that critically surveys the more controversial developments of Rosenfeld's later work, and four of Rosenfeld's own papers chosen by his colleagues as his most significant.

Rosenfeld's principal papers appeared in the International Journal of Psycho-Analysis: Analysis of a Schizophrenic State with Depersonalization³ (1947), Notes on the Psychopathology of Confusional States in Chronic Schizophrenias⁵ (1950), On the Psychopathology of Narcissism: A Clinical Approach⁷ (1964) and A Clinical Approach to the Psychoanalytic Theory of the Life and Death Instincts: An Investigation into the Aggressive Aspects of Narcissism⁸ (1971). The last was reprinted in the first volume of Melanie Klein Today (1988), edited by Elizabeth Bott Spillius.

His books are Psychotic States: A Psycho-Analytical Approach¹ (London: Hogarth Press, 1965) and Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psycho-Analytic Treatment of Psychotic, Borderline, and Neurotic Patients² (London: Tavistock, 1987). His seminars in Italy were published as Herbert Rosenfeld at Work: The Italian Seminars (2001), edited by Franco De Masi.