A mild-mannered man developed paranoid psychosis following the onset of tinnitus. He subsequently killed a workmate whom he believed had poisoned him causing tinnitus. Post-homicide, the patient’s calm state was rapidly restored. We eventually came to understand that prior to the tinnitus the patient’s inner world was dominated by a phantasy of an idealised ever-available, ever-understanding internal maternal object unconsciously represented by the patient’s love of classical music which unfailingly assuaged his anxiety. Tinnitus, denying him this soothing input, was unconsciously experienced as a hated paternal object destroying the loving union of mother and infant. The homicide victim came to represent this paternal object, the source of projected oedipal murderousness. Retrospectively, the patient’s easy-going ‘chameleon-like’ pre-breakdown personality was understood as a pathological organisation based on acquisitive projective identification with a phantasised mother with ideal receptive capacity – an ‘identificate’ (Sohn 1985) – with (paternal) violence and destructiveness split off and inaccessible. Failure of separation, denial of loss and lack of acceptance of the Oedipus situation precluded the development of the ‘third position’ required for insight and symbolisation. Five years weekly psychotherapy in a secure unit provided some understanding of his inner world and the tragic course of events together with a significant degree of psychic development.

耳鸣发作后，一个礼貌的人出现偏执型精神病。随后，他杀死了一个据信使他中毒导致耳鸣的同事。凶杀后，患者的平静状态迅速恢复。我们最终了解到，在发生耳鸣之前，患者的内心世界被理想化的，永远可用，永远了解的内部母体的幻象所支配，而这种幻觉却无意识地由患者对古典音乐的热爱所代表，并始终如一地减轻了他的焦虑感。耳鸣否认他的这种安慰性输入，在不知不觉中被视为仇恨的父权对象，破坏了母亲和婴儿的爱心结合。凶杀受害者开始代表这一父系对象，即预期的俄狄浦斯谋杀之源。追溯地 患者的随和的“变色龙样”崩溃前性格被理解为一种病理组织，该组织基于对具有理想接受能力的幻化母亲的习性投射识别，即“身份”（Sohn 1985），并带有（父亲）暴力和破坏性分裂，无法进入。分离的失败，拒绝的损失以及对俄狄浦斯情境的缺乏接受，排除了发展具有洞察力和象征意义的“第三位置”的可能性。每周在一个安全的单位进行五年心理治疗，可以使他对自己的内心世界和悲惨的事件过程有所了解，并能在很大程度上发展心理。