Fragmentation,persecution and primitive guilt

The clinical and theoretical approaches of Melanie Klein and her followers provide valuable direction in the psychoanalytic treatment of psychotic patients. This paper looks at Klein's work as well as the goals of psychoanalytic work. The clinical issues of primitive guilt and paranoia are discussed with regard to more primitive patients who experience internal fragmentation and psychic chaos. Finally, a case is explored in which a psychotic patient struggled with experiences of primitive guilt and intense persecutory phantasies.