This weekend I read Franco De Masi’s text Vulnerability to Psychosis. It’s an interesting object relations account of psychosis. In chapter six he addresses the relationship between the psychotic individual’s auditory hallucinations and the superego. The psychotic superego is often punitive, persecutory and excessively critical. Many individuals who have psychotic experience have command hallucinations such as “You should hurt yourself because you’re pure evil.” Interestingly, command hallucinations are particularly common for individuals who experienced serious childhood abuse. In this chapter De Masi draws a fascinating parallel between the God of the Book of the Job and the psychotic superego.
De Masi writes: “Blind with wrath and haughtily insistent on His right to dispose of His creatures as He sees fit, God hurls Himself upon Job and yells at this mere worm crawling in the dirt who dares to ask for explanations of His behavior. Before such an arrogant and narcissistically touchy God, Job appears as a desperate and devout person; the violence of his words against God is dictated more by exasperation that by rebellion. Everything would be assuaged if he would only understand the link between sin and punishment. The story of Job can, in my view, also be understood as the description of a relationship between the ego and the psychotic superego during the course of a psychotic breakdown, in which the protagonist, like my patient, finds himself expelled from the state of well-being and flung on to a dung-heap, a prey to a destructive and accusing voice…The psychotic patient is more like Job: he has to confront a threatening world that is out to annihilate and terrify him rather than to make him feel guilty. The God of Job demands subjection without even allowing him to understand the reason for the wrath and the origin of the sin: the patient in this phase therefore has to face not so much guilt as terror” (P 120-121).
De Masi then connects this experience with Klein’s understanding of the infant in the paranoid-schizoid position who attempts to negotiate the terrifying and chaotic world. At this stage, Klein understood the infant as trying to survive the annihilation anxiety generated by the infant’s powerful death drive. Bertram Karon has also described schizophrenia as a “chronic terror syndrome” where the patient is contending with horrifying realities that threaten their very existence. Job’s experience with the arbitrary and vengeful attitude of God parallels the psychotic individual’s experience with their auditory hallucinations. Often the psychotic individual is taken by complete surprise by the unpredictable and inexplicable ridicule of the menacing voices.
Bonus points for readers who can find other Biblical stories that nicely illustrate psychoanalytic principles.