Notes on the Psychopathology of Confusional States in Chronic Schizophrenias

A short paper on chronic schizophrenia in which Rosenfeld describes confusional states as the outcome of a failure of the normal, structuring split between good and bad objects, and between the loving and hating parts of the self. When that split breaks down, love and hatred become mixed, and the patient fears that the destructive impulses will overwhelm the loving ones and destroy the good self and the good object. Where envy predominates, the good object itself is attacked, so that good and bad can no longer be told apart and the confusion becomes unbearable. Rosenfeld places confusion between splitting and integration, and finds such difficulties in separating good from bad, to a lesser degree, in less disturbed patients too. Klein took up the idea in Envy and Gratitude (1957); the paper was reprinted in Psychotic States (1965).