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Donald Meltzer’s work with Bion’s theories led him to propose a classification of the pathology of projective identification , according to whether the disorders are primarily in the field of projection or mainly in that of identification (Meltzer, 1986) . Pathology of projection has to do with the way the inner world of the object is fantasized; here we are in the field of phobias, especially agoraphobia and claustrophobia. Fantasies about the nature and quality of the atmosphere that could prevail within the object are also found in some psychotic states of confusion, especially those observed during adolescence. Meltzer also mentions the syndrome of distorted perception, which he calls the “delusion of clarity of insight”, namely, the conviction of knowing exactly what another person is thinking. The most common pathology of identification consists in an immediate appropriation of the object’s qualities. Hysterical conversion is the classic example of it is, but it is also present in manic-depressive psychosis, in hypochondria and in states of pseudo-maturity, where the subject may be stuck in his projective identification with an idealized object, without proceeding further to a work of mourning of the latter in order to build, first, an intermediate state of heterogeneous hyper maturity, then, to then reach a balanced ideal of the Ego. Some years later, Meltzer (1992) explores the unconscious choice of the part-object into which projective identification is accomplished. He notes that it involves different parts of the fantasized mother’s body – genital apparatus, anus, breast, head – and develops his clinical exploration into the different pathologies according to the choice of a particular container, respectively: sexualization/excitement, secret/robbery, and omnipotent generosity/idealization. The situation of “good” and “bad” objects will also vary depending on the pathology of projective identification. Melanie Klein had already noted that, in addition to keeping the good objects inside of the Ego and projecting the bad objects outside the Ego in order to protect it from them, the opposite and complementary situation is also very common: when the inside of one’s own mind or body are experienced as bad and dangerous – as for example, in melancholy – the patient projects his good objects and the good parts of his Ego into an external object in order to protect them against his own bad, attacking parts. Frances Tustin (1992) suggested the use of the term, “adhesive equation” to describe autistic children who are chronically “stuck” to their mothers in such a way that there can be no space between them. Tustin emphatically underscored the point that without an awareness of psychic space, no true object relationships can exist and that without relationship, the self building processes of identification cannot be set in motion. It might be said that adhesive equation or adhesive identity serves to establish a sensation of existence rather than a sense of self and object . It would seem that a “skin object” must be incorporated very early on in mental development in order to allow for a space within the self to develop so that the mechanism of projective identification, as the primary method of non-verbal communication between the mother and the baby in search of detoxification and meaning, can function without impediment. Indeed, the work of Mauro Mancia (1981) supports the notion of a potential for this early development of a psychic skin in utero.
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