WHEN MORE IS BETTER THAN LESS;

THREE THEORIES OF PSYCHOSIS-

PROJECTION, DOUBLE BIND, AND
POSSESSION
Gerald H. Zuk
Carmen V. Zuk

ABSTRACT: Three psychological theories of psychosis are described,

each of which has standing in psychiatry. Defined by the terms pro-
jection, double bind, and possession, they initially appear to have
little or nothing in common to explain psychosis, but converge at
four points: (1) A high degree of anxiety precipitated by a dilemma
or conflict perceived to be unsolvable by the person; (2) the anxiety
triggers a shift from one thought or motive in the direction of its
opposite, because the original was believed too antagonistic to the
wishes of significant others; (3) the opposite, in order to remain op-
posite, requires that the original thought or motive be forgotten, (4)
a singular means to produce and reinforce forgetting is the inter-
position of psychiatric symptoms. In psychiatry today treatment
would fit more consistently with the three theories taken as a whole
rather than any one, and a rationale for this viewpoint is elabo-
rated.
KEY WORDS: theories of psychosis; projection; double bind; possession; Freud's
Schreber case.

Gerald H. Zuk, PhD, is in private practice at 25316 Pacy Street, Santa Clarita, CA
91321-3343. Carmen V. Zuk, MD, is a child psychiatrist-partner with Kaiser-Perma-
nente at its psychiatric clinic in Santa Clarita. CA. Reprint requests should be sent to
the first author.
This paper was the basis for an invited address by the first author under the same
title at the 3rd International Congress on Integrative and Eclectic Psychotherapy. Au-
gust 1, 1996, in Huatulco, Mexico.
Contemporary Family Therapy, 20(1), March 1998
© 1998 Human Sciences Press, Inc. 3
4

CONTEMPORARY FAMILY THERAPY

The biochemical achievements relevant to psychiatry have ob-

scured the psychological, particularly during the past two to three
decades, but psychological explanation is far from dead. It is not pos-
sible to describe psychosis through a microscope; and the success of
biochemical theories of psychosis has not matched the success of
drugs to contain symptoms.
In the writers' view, there are three psychological theories of psy-
chosis developed in the 20th Century that accord with clinical experi-
ence and have persuasive logic: These are Freud's theory of projection
(1911); the double bind theory (Bateson, Jackson, Haley, & Weakland,
1956); and the writers' "learning to be possessed" theory (Zuk, 1989;
Zuk & Zuk, 1992), each of which will be briefly reviewed. The conten-
tion is that the three provide a more comprehensive picture of psy-
chosis than any one alone; and that each provides a perspective that
supplements rather than discards the others. There is a consistency
among them in their explanation of psychosis; there is also a consis-
tency in the fact that each seems to play a role in normal socializa-
tion. Each brings a different perspective to the point at which a per-
son goes "haywire," where socialization takes a deviant turn, moving
the individual in the direction of psychosis. In using the generic term
psychosis, it is presumed that the reader is aware of its meaning
through experience with psychotics, and more particularly the de-
scription in the various editions of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV), published by the American
Psychiatric Association (the 4th edition, 1994).

PSYCHOSIS THEORIES
Projection
Meissner (1980) constructed a classification of Freud's defense
mechanisms in which projection is cited as both a narcissistic and
immature defense. As narcissistic, projection is a reaction to unac-
ceptable inner impulses as if they were outside the self. This might
take the form of delusions, especially persecutory delusions: ". . . ho-
mosexual libidinal impulses are transformed into hatred and then
projected onto the object of the unacceptable homosexual impulse"
(Meissner, 1980, p. 980). As an immature defense that is neurotic,
projection is an attribution of one's feelings that cannot be acknowl-
edged, and is shunted off toward outsiders in prejudice, suspicious-
ness, and increased vigilance.
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GERALD H. ZUK AND CARMEN V. ZUK

In Sigmund Freud's (1911) formula in the third section of his

monograph on Judge Schreber, based on the judge's autobiography
(Schreber, 1903), projection is composed of the following steps: (1) One
is sexually attracted to another of the same sex; (2) there is fear that
the attraction will be rejected; (3) there is a search for signs of rejec-
tion; (4) signs are found, and the individual believes he or she is the
subject of persecution by the loved one; (5) the love is turned to hate;
(6) persecutory delusions, in certain cases, reinforce the motivational
turnabout.
Freud's formula may well be the first psychological theory of how
psychosis develops in a person; but in one of those odd tricks of fate
his Schreber monograph, although of historical significance in his life
work has been relegated to a secondary role because of his espousal of
a homosexual theme in relation to paranoid psychosis. This emphasis
distracted attention from what in the writers' view is its major out-
standing contribution, and that is its definition of projection (not ho-
mosexuality) as a primary process causing psychosis.
The distraction was primarily due to Freud himself—his in-
sistence on the pathogenicity of psychosexual trauma, but was en-
couraged by colleagues such as Abraham (1953), Jung (1915), and
Ferenczi (1922). Further reinforcement even came from those who
challenged Freud, namely Klein (1946), who turned his theory upside
down. She said that it was paranoid psychosis that caused homosex-
uality, rather than the reverse, and that the disturbance originated in
a disturbed mother-infant relationship. Niederland (1974) believed
Schreber's psychosis had its origin in an unduly harsh parental fig-
ure, namely his father. Schatzman (1973) thought the problem was a
dysfunctional family. Lathane (1992), perhaps the most recent com-
mentator, thought Freud erred in his diagnosis and was not suffi-
ciently alert to the social system that existed in his time. Lathane
argues that Schreber really had a major affective disorder (not para-
noid) and that he was communicating in a kind of code about the
injustice of the system that had committed him to a mental institu-
tion.
Despite the distractions, in the writers' view Freud's Schreber
monograph was a great contribution to understanding psychosis be-
cause of his formula for projection. Leaving aside his insistence on
a homosexual motive, his formula clearly elaborated the steps by
which, under conditions of stress, the motive(s) of a person can be
turned upside down (the polarization of motives), and that psychosis
is an adaptation to maintain the turnabout. Schreber, it should be
6
CONTEMPORARY FAMILY THERAPY

recalled from his autobiography, suggested at several points that his

psychotic episodes were triggered by the stress of assuming the re-
sponsibilities of a more demanding post.
It seems clear that Freud intended Schreber to be an extension of
his theory of neurosis to the area of severe psychopathology, such as
psychosis; and he had already established the linkage between neu-
rosis and normal behavior (as in dreams, slips of the tongue, humor).
Projection played a role in each of these states, from the normal to the
psychotic, and Schreber was the best case for the extension of pro-
jection into psychosis.

Double Bind
One of the most powerful psychological theories of the mid-20th
Century directed specifically to explain schizophrenia, a mental dis-
turbance consistent with psychosis, the double bind was, interestingly
enough, the product of individuals, several of whom were not mental
health specialists (Bateson, Jackson, Haley, & Weakland, 1956). The
"logic" of the double bind takes the following form: (1) A mother, per-
haps because of persistent and overwhelming demands for nurtur-
ance by the newborn, develops anger toward the newborn which she
must disguise; (2) the disguise takes the form of assuming a respon-
siveness opposite to animosity, namely an overweaning display of af-
fection; (3) with maturation the newborn becomes aware of mother's
ambivalence, but dares not reveal it to her or others; (4) mother's
communication with the child is correctly perceived as ambivalent,
but the child cannot expose the ambivalent communication because of
his or her dependence; (5) the child is in a double bind situation be-
cause of all that has gone before, and continuing inconsistencies ema-
nating from mother, (6) caught in such a trap, the child in adolescence
or later develops psychotic symptoms.
Bateson and his colleagues credited the outstanding English logi-
cian-mathematician Bertrand Russell (Whitehead & Russell, 1910-
1913) for providing a theory of "logical types" upon which the double
bind was founded, but there were other reasons also that were re-
sponsible in part for the intense scrutiny the theory received from the
mental health community. For one thing, it arrived at a moment in
history when psychoanalysis was beginning to come under fire from
adversaries, particularly in biological psychiatry, but was greeted by
psychoanalysts as consistent with Freudian theory. Psychoanalysts
such as Sullivan (1953), Fromm-Reichmann (1948), Rosen (1953), and
 7

GERALD H. ZUK AND CARMEN V. ZUK

others, were treating psychotic patients at this time, and there was
hope that psychoanalytic psychotherapy could cure psychosis alone. It
became clear during the late 1950s and early 1960s that psycho-
analysis was not a cure, although it helped define the limits of the
problem presented by a psychosis such as schizophrenia.
The double bind survived because it became clear to clinicians
that, despite its limit as a universal cause of psychosis, it had sub-
stantial practical value in diagnosis and treating various mental dis-
orders and was particularly useful in family therapy which became
legitimized as a new mental health approach in the early 1960s. Its
usefulness has not declined, and has even entered the broad English
lexicon, further evidence of its flexibility. It is not uncommon to hear
references to someone "caught in a double bind," although it has lost
its particular meaning when so used today. Bodin's (1981) chapter is
excellent for its history and definition of the double bind, and the
contribution of the theory to other concepts purporting to explain
what constitutes change in family therapy and the means to effect
that change, such as developed before, during, and after the death of
the founder of the Mental Research Institute in Palo Alto, California,
Don D. Jackson (1965). Bodin recognizes the universality of the dou-
ble bind, its critical role in normal socialization of the child as well as
in psychopathology.
Possession as a cause of mental disturbance is not new in human
history, as Mora (1980) has reported in substantial detail. Belief in
possession of the individual by malevolent outside sources predates
the major western religions, although these religions continue to uti-
lize possession by malevolent outside sources, such as the Devil be-
cause the belief seems to have served a useful purpose. To this day,
possession by the Devil has not been discarded by the major religions
as a cause of mental disturbance, although there is increased sophis-
tication in methods of exorcism, that is, treatment of possession by
religious practitioners.
The writers took cognizance of the fact that possession has been
"taught" in families for centuries—transmitted from generation to
generation—and that all or almost all children learn from parents
and others about the existence and reality of the Devil, and that the
Devil can cause behavior that is disapproved by parents and others.
Because the initial teaching is by parents, the mother in particular, it
cannot be ignored, but with maturation the child can interpret it dif-
ferently, and also turn it to advantage when occasion demands. In
place of the term possession, the writers used the broader term
8

CONTEMPORARY FAMILY THERAPY

"learning to be possessed," signifying thereby that possession was not

a product of unseen malevolent forces, but that it was an interperso-
nal process—to use Sullivan's (1953) language—calculated to mold
the behavior of one party vis-a-vis another.
In several papers on the subject (Zuk, 1984; Zuk & Zuk, 1992;
Zuk & Zuk 1995), "learning to be possessed" was based on the follow-
ing steps: (1) A child engages in a behavior disapproved by a parent;
(2) by the attitude (gestures, tone of voice) of the parent, the child is
aware of disapproval; (3) the child expects punishment of a predict-
able kind—spanking, shouting, blunt threat; (4) instead, the child re-
ceives a warning that his or her behavior is "foreign," strange, incon-
sistent with the past, as if it were not the product of the child's will
but of someone else's; (5) the child's behavior may be excused as the
product of intervention by an outside force, such as the Devil, the
object of the parent being to place the blame elsewhere so that the
child will experience a discipline that consists of loss of personal re-
sponsibility; (6) the child experiences injury to his or her selfhood or
capacity to function as a responsible person and resents the parent's
judgment; (7) but the child learns there is a bright side to the parent's
judgment: He or she, the child, learns how to escape being personally
accountable for behavior deemed unacceptable by parent; (8) since
psychotic behavior is behavior in which society, through its experts,
deems the individual to be personally unaccountable for his or her
bizarre symptoms, the child is tempted to use psychosis as an escape
from personal responsibility for behavior deemed unacceptable.
It is common for the family therapist to hear comments directed
by parents toward their erring children such as, "He is not himself,"
"something's come over her," "I don't know what's possessed him,"
"what the devil has gotten into her?" These seem harmless enough
comments made by desperate parents about children proving hard to
handle, but one can speculate that their cumulative effect on a child
over time might have consequences perhaps unintended by the par-
ents. Presuming normal intelligence in the children, they might well
form the conclusion (i.e., learn) that at some critical point or points in
development forces outside themselves determine their behavior, and
the intent of these forces is usually evil. There are times when it is
convenient to have parents and other adults convey such belief, be-
cause it can mean that the child may escape the worst consequences
for behavior deemed unacceptable.
"Learning to be possessed" has been proposed as a theory of psy-
chosis, paranoid delusion in particular, and the writers' are indebted
 9
GERALD H. ZUK AND CARMEN V. ZUK

to the schema of the development of logic in normal children devel-

oped by Jean Piaget (1963, 1970; Piaget & Weil, 1951). Delusion can
be defined as a false belief of certain duration highly resistant to com-
monsense and reason, often associated with extraordinary stress oc-
curring in an adolescent or adult which can evoke a flight-or-fight
reaction in the victim. The writers have speculated and offered anec-
dotal evidence based on their own professional experience, and based
also on certain experiments conducted by Piaget with normal children
in the six to eight year old range. When the child's logic appears in an
adult, it is possible to conclude by experts the existence of a paranoid
delusion.

DISCUSSION
Three theories of psychosis are summarized, and at first glance it
appears that they have nothing in common, but in this section com-
mon elements among the three will be proposed. Each of the theories
appears to be a distinct perception of psychosis; each was proposed in
a different decade of this century; each was derived from a different
logical "system." It cannot be emphasized too strongly that none of
the theories has been subjected to so called "hard" scientific scrutiny,
but each of them has accorded with clinical experience, common
sense, logical integrity, and historical precedent.
The theories have been presented in the first section, and the
differences should be obvious to the reader, but the common elements
may not be; therefore, the common elements will be enunciated in
this section. The common elements are proposed as follows:
1. Projection, double bind, and possession ("learning to be pos-
sessed"), when they occur in an individual, create a high level of anxi-
ety. In the case of projection, the anxiety is a consequence of social
unacceptability. In the case of double bind, the anxiety is created by
an inability to resolve inconsistent "messages" which cannot be ig-
nored. In the case of possession, the anxiety is created by uncertainty
that an act deemed unacceptable by another was done willfully by the
perpetrator, or was rather the intervention of malevolent bodies out-
side the control of the perpetrator, and, therefore, that the perpetra-
tor was guiltless.
2. Projection, double bind, and possession, when they occur in an
individual, create a belief tending in an opposite direction. In the case
of projection, perfectly described by Freud in the case of Schreber, the
10
CONTEMPORARY FAMILY THERAPY

belief was turned from one of sexual love to hatred. In the case of the
double bind, the original intention of the so-called "victim" was nulli-
fied by contradictory instruction emanating from a source that the
"victim" could not ignore. In the case of possession, the "victim's" be-
lief is reversed by being told that he or she was not personally respon-
sible for an act, but that the act was atypical, probably the interven-
tion of a malevolent source which subjugated the "victim's" will, and
therefore was an act resulting from a subversion of personality (i.e.
the person was "not himself).
3. Projection, double bind, and possession, because they create a
high level of anxiety regarding an unacceptable thought or motive
relating to self tend to invoke forgetting, a clouding of consciousness,
or outright amnesia. Convincing data following the experience of
trauma (e.g. as exemplified in the diagnosis of post-traumatic stress
syndrome, fugue states, and other dissociative psychiatric disorders),
confirm the existence of forgetting following incidents in which an
individual feels for whatever reason a "victim," or helpless in the face
of uncontrollable events, or helpless in the face of demands that are
known but where there is uncertainty about the ability to deal with
them.
4. Projection, double bind, and possession, are not passive but
dynamic human processes that require a constant source of "energy"
for sustenance; therefore, the forgetting, clouding of consciousness, or
amnesia that characterize the states when they are generated require
a constant energy reinforcement. Depending on the depth of the con-
flict that generated the states, and/or the height of anxiety generated
by the conflict, a source of reinforcement may consist of symptoms of
mental illness ranging from neurosis to psychosis. (There must be
also a significant factor in the capacity of the individual to tolerate
stress, which must be factored into the equation that determines the
degree of dysfunctional response.)
The theories presented here, which appear to be quite divergent,
are not divergent in several essential elements which have been set
forth in this section. They represent different perspectives of psy-
chosis—perspectives that are equally as important in their sim-
ilarities as in their differences.

Schreber Revisited
We know from his autobiography how Judge Schreber was diag-
nosed and treated in the Germany of his day, that is, toward the end
 11
GERALD H. ZUK AND CARMEN V. ZUK

of the 19th Century. Essentially, the curative emphasis seems to have

been "rest," that is, hospitalization that removed him from the stress
of his ordinary daily life. Schreber seems to have benefited from the
rest cure—during which, to be sure, he ventilated to himself and
others the most fantastic of his thoughts of sexual violation of his
person by other men. The fantastic thoughts ran their course, he be-
came less preoccupied by them, his relationship to hospital personnel
normalized, and in one instance he was able to present to a court a
well-reasoned document asserting that as he was free from the fan-
tastic thoughts, he ought to be free from hospitalization, and the
court agreed.
Freud never treated Schreber because he had no opportunity to
do so, but one may reasonably conclude that he would have employed
psychoanalysis had he had the opportunity, and that quite likely the
homosexual fantasies of Schreber would have been given close atten-
tion through interpretation. The object of the interpretation would
have been "to make the unconscious conscious," that is, to persuade
the judge as to his homosexual orientation, and for him to come to
terms with that as regards his family life and work situation.
Today more than a century later, what would be accepted psychi-
atric practice with regard to a patient presenting as Judge Schreber?
If seen today at the time of his most florid paranoid psychosis, the
mental health practitioner would have almost certainly considered
the following steps: (1) Hospitalization; (2) the use of psychotropic
medication; and (3) only when the patient would have become amena-
ble to more or less normal verbal exchange, would psychotherapy
have been considered in one form or another to help deal with the
conflict that overwhelmed the person. In striking contrast to the
treatment of a century ago treatment today of a patient like Judge
Schreber would likely employ a mix of methods. The psychotherapies
made available to the judge would most likely be of the short-term
variety, because these are now well accepted.
Schreber himself noted the connection in time between his psy-
chotic episodes and his promotions to higher levels of judicial respon-
sibility. Generally accepted treatment today would make much more
of this connection than did Freud, who noted them in his commen-
tary, but considered them of minor or secondary significance as re-
gards the true and essential cause of the judge's psychosis. Today
there would be less attention paid than Freud suggested to develop-
mental psychosexual deviation, and more to the judge's dilemma of
how to handle increasing job responsibility—his sense of competency
12
CONTEMPORARY FAMILY THERAPY

or incompetency to do so. Certainly the support of his family, or fail-

ure thereof, would have been more fully explored, and family mem-
bers would have been more directly involved in treatment procedure.
It is a reasonable conclusion that a fair degree of "double-binding"
was affecting the judge, and the particulars of that process would
have been explored. Did he conclude from the admonitions of signifi-
cant others in childhood that his capacity for personal accountability
was flawed, yet found that he was under increasing demands for ac-
countability as he grew older and received the "reward" of the com-
munity as a righteous and upstanding person? Did he seek to evade
the conflict by resorting to paranoid psychosis when no other accept-
able alternative presented itself? Current psychiatric practice would—
or at least should—have explored this dilemma.
It is suggested that the theories described here, both as regards
their differences and elements in common, provide a better "fit" with
current psychiatric (in the generic sense) diagnosis and treatment
than any of the theories considered singly.

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