Based on my work with many mental health professionals I have come to see that almost without exception the therapist views the patient he is working with as the “bad object” and views the people in the patient’s environment as the “good object.”

In my view the good object is depicted as benign and rational, devoid of libidinal and aggressive impulses.  The bad object is depicted as the sole repository of libidinal and aggressive impulses — and therefore as also extremely fearful, a reversal of aggressive impulses.  The bad object’s thinking is depicted as irrational.

We can see this dynamic, I believe, in regard to a matter involving one of my past psychiatrists, Stanley R. Palombo, M.D.  I stated to Dr. Palombo that I was having difficulties with my coworkers.  I explained that they had spread a rumor that I was homosexual.  In Dr. Palombo’s view I had brought this situation upon myself because I had taken the decision to work in a law firm as a paralegal despite the fact that I was a licensed attorney.  Dr. Palombo depicted my coworkers as benign and rational — their rumors were triggered by my bad behavior and did evidence aggression against me.  I might not be a homosexual, but their opinions were simply that: benign opinions that were not the result of aggressive impulses.  In effect, I was the bad object and my coworkers were the good object: benign and rational.

But let’s reverse the situation.  Let’s say that I had said to Dr. Palombo the following:

I am working at a law firm, Dr. Palombo.  There’s a fellow I work with who has two law degrees, is licensed to practice law — but he works as a paralegal! Can you believe that?  I think he must be a homosexual.

In the above instance I would be the bad object (the patient in therapy) while my coworkers would be the good object — the people in my environment.

Dr. Palombo would have come up with a radically different opinion.  First, he would ask, “What does your colleague’s employment status have to do with you?  Does it affect you in any way?  Does it cause some problems for you that he’s an underemployed attorney?”  He would definitely not say, “Your colleague’s employment status has nothing to do with you, but it makes perfect sense that you are concerned about it.  Your thinking is perfectly rational since most people who are underemployed are in fact homosexuals.  Your thinking makes complete sense.  You are a rational person.”  No, he would not say that.

But there is more.  Dr. Palombo would begin to think clinically about my statements.  He would wonder, “Is this patient paranoid?  Is this patient narcissistically disturbed?  Is this patient in competition with his colleague — does that explain why this patient has a need to devalue a colleague?  Did this patient actually spread a rumor in the workplace that his colleague was homosexual indicating that he was interpersonally exploitive?”

The question is — when I complained that coworkers had spread rumors about me that I was homosexual, why didn’t he say, “Your colleagues are paranoid and narcisstically-disturbed.  There may be someone in your workplace who feels he is in competition with you, who feels threatened by you, and has a need to devalue you.  Perhaps you are the victim of a disturbed group process.”

The answer to this conflict of interpretations seems clear. The patient will always be the bad object and the people in the patient’s environment will always be the good object.  That is to say, in the clinical setting there will always be a struggle about the therapist’s paranoid schizoid anxiety and the therapist’s need to view the patient’s social system as the idealized group.

Consider the following case study in the DSM-IV Casebook published by The American Psychiatric Association:

False Rumors

Bob, age 21, comes to the psychiatrist’s office, accompanied by his parents, on the advice of his college counselor. He begins the interview by announcing that he has no problems. His parents are always overly concerned about him, and it is only to get them “off my back” that he has agreed to the evaluation. “I am dependent on them financially, but not emotionally.”

The psychiatrist is able to obtain the following story from Bob and his parents. Bob had apparently spread malicious and false rumors about several of the teachers who had given him poor grades, implying that they were having homosexual affairs with students. This, as well as increasingly erratic attendance at his classes over the past term, following the loss of a girlfriend, prompted the school counselor to suggest to Bob and his parents that help was urgently needed. Bob claimed that his academic problems were exaggerated, his success in theatrical productions was being overlooked, and he was in full control of the situation. He did not deny that he spread the false rumors, but he showed no remorse or apprehension about possible repercussions for himself.

Bob is a tall, stylishly dressed young man with a dramatic wave in his hair. His manner is distant, but charming, and he obviously enjoys talking about a variety of intellectual subjects or current affairs. However, he assumes a condescending, cynical, and bemused manner toward the psychiatrist and the evaluation process. He conveys a sense of superiority and control over the evaluation.

Accounts of Bob’s development are complicated by his bland dismissal of its importance and by the conflicting accounts about it by his parents. His mother was an extremely anxious, immaculately dressed, outspoken woman. She described Bob as having been a beautiful, joyful baby, who was gifted and brilliant. She recalled that after a miscarriage, when Bob was age 1, she and her husband had become even more devoted to his care, giving him “the love for two.” The father was a rugged-looking, soft-spoken, successful man. He recalled a period in Bob’s early life when they had been very close, and he had even confided in Bob about very personal matters and expressed deep feelings. He also noted that Bob had become progressively more resentful with the births of his two siblings. The father laughingly commented that Bob “would have liked to have been the only child.” He recalled a series of conflicts between Bob and authority figures over rules and noted that Bob had expressed disdain for his peers at school and for his siblings.

In his early school years, Bob seemed to play and interact less with other children than most others do. In fifth grade, after a change in teachers, he became arrogant and withdrawn and refused to participate in class. Nevertheless, he maintained excellent grades. In high school he had been involved in an episode similar to the one that led to the current evaluation. At that time he had spread false rumors about a classmate whom he was competing against for a role in the school play.

In general, it became clear that Bob had never been “one of the boys.” He liked dramatics and movies, but had never shown an interest in athletics. He always appeared to be a loner, though he did not complain of loneliness. When asked, he professed to take pride in “being different” from his peers. He also distanced himself from his parents and often responded with silence to their overtures for more communication. His parents felt that behind his guarded demeanor was a sad, alienated, lonely young man. Though he was well known to classmates, the relationships he had with them were generally under circumstances in which he was looked up to for his intellectual or dramatic talents.

Bob conceded that others viewed him as cold or insensitive. He readily acknowledged these qualities, and that he had no close friends, but he dismissed this as unimportant. This represented strength to him. He went on to note that when others complained about these qualities in him, it was largely because of their own weakness. In his view, they envied him and longed to have him care about them. He believed they sought to gain by having an association with him.

Bob had occasional dates, but no steady girlfriends. Although the exact history remains unclear, he acknowledged that the girl whose loss seemed to have led to his escalating school problems had been someone whom he cared about. She was the first person with whom he had had a sexual relationship. The relationship had apparently dissolved after she had expressed an increasing desire to spend more time with her girlfriends and to go to school social events.

DSM-IV-TR Casebook Diagnosis of “False Rumors”

This case was supplied as an example of Narcissistic Personality Disorder (see DSM-IV-TR), and the reader will certainly be struck by Bob’s grandiosity and insensitivity to others (lack of empathy). In addition, he is extremely jealous of his siblings, he spreads rumors about a student with whom he was competing, and he believes others envy him. In identifying behavior that justifies two additional criteria required for the disorder, we make some inference from the limited case material that is presented. For example, we assume that the reason Bob has had trouble with authorities about conforming to school rules is that he does not believe the rules should apply to him, and this behavior is an indication of entitlement. We interpret his spreading rumors about teachers and peers as evidence that he is interpersonally exploitative. His need for constant attention and admiration is suggested by his dramatic presentation.