Concern: spurious or real

This paper is about a group of patients who appear to show excessive concern for their objects, reflecting a combination of a real wish for reparation alongside an attitude of hostility and superiority towards the object. Detailed clinical examples from two patients are used to illustrate a certain combination of characterological defences in these patients who have been severely deprived, and overcompensate for this experienced deprivation by the expression of excessive concern for an object that is simultaneously experienced as hostile and frustrating. Side by side with the partial achievement of the depressive position there is an early 'take over' of the breast, in which the infant 'becomes' the breast and shows behaviour which is in part a fake of a very concerned mother. The paper includes a discussion of some of the technical problems in dealing with such patients, and stresses the need for distinguishing between what is real and what is false; it suggests that what is required is a balanced or 'two handed' approach, in which there is firm handling of the manic or pretentious 'take over' together with a sympathetic understanding of the underlying vulnerability of these patients.