South African Psychiatry - February 2019

FEATURE
Nevertheless, failure to initially refind the object
that was always present in reality implies that at
a fundamental level the person can essentially
continue to base judgements of the external world
on what feels good or bad regardless of whether
actual events concur with this illusory narrative or
not. Freud (1925) explains: “All images originate from
perceptions and are repetitions of them. So that
originally the mere existence of the image serves
as a guarantee of the reality of what is imagined...
The reproduction of a perception as an image is
not always a faithful one...The process for testing
the thing’s reality must then investigate the extent of
these distortions” (pp. 369-370). Failure to interrogate
these distortions means that the vagaries of thought
can be equated with external phenomena and the
tenacity of internal desire with magical fulfilment:
‘I wish it! Therefore it IS so!’ then dominates the
relationship with reality and decision making. This
elevates thinking to an idiosyncratic and concrete
belief in mind over matter. In the real world, of
course, things are not absolute and we all revert to
a problematic relationship with reality intermittently
and then, hopefully, ‘return to our senses”.
THIS PSYCHOLOGICAL FLUX IN TERMS OF
ONGOING ATTEMPTS TO RECOVER AS
MUCH REALITY AS POSSIBLE IS DIFFERENT
FROM FORECLOSURE OF THE REALITY
PRINCIPLE AT A SUBSTANTIVE LEVEL. THE
LATTER RESULTS IN A DISREGARD FOR
MEANINGFUL REALITY-TESTING EVEN IF
COGNITIVE AND INTELLECTUAL ABILITIES
ARE SUBSEQUENTLY WELL-DEVELOPED
PRECISELY BECAUSE ESSENTIALLY THE
PSYCHE IS NOW A CLOSED, REGRESSIVE
SYSTEM AT ITS CORE. THIS PROCESS
IS AN UNCONSCIOUS ONE AND SO
THE INDIVIDUAL AFFECTED HAS LITTLE
INSIGHT INTO IT.
This type of thinking is more common than we
imagine and can appear in many disguises. This
hallucinatory fulfilment of wishes (wunscherfüllung),
as noted by Freud (1900) takes place in dreams
and, unfortunately, in the waking state too. The earth
is flat and there is no global warming are obvious
examples. Others follow. Dr Hendrik Verwoerd, the
architect of Apartheid in South Africa, stated in 1961
that Apartheid had been much misunderstood and
that it could just as easily have been described
as a policy of ‘good neighbourliness’. In 1985 P. W.
Botha, the Prime Minister who declared the states of
emergency in South Africa, addressed the National
Party congress with these words: “I am not prepared
to lead South Africans and other minority groups
on a road to abdication and suicide.” After the
destruction of the twin towers in New York, the 2003
invasion of Iraq under the presidency of George
Bush, took place triumphantly in spite of insufficient
evidence that there were, in fact, weapons of mass
destruction in Iraq. Thabo Mbeki’s adamant denial
from 1999 to 2008 that HIV and AIDS were linked
denied individuals antiretroviral drugs and cost
nearly half a million South Africans their lives. Donald
Trump made numerous references to a wall during
his 2015 to 2016 USA presidential campaign: “I will
build a great wall - and nobody a builds wall better
than me, believe me...I will build a great, great wall
on our Southern border, and I will make Mexicans
pay for that wall. Mark my words.” Kallie Kriel from
Afriforum insisted in 2018 that Apartheid was not
a crime against humanity because the death toll
was too low and with one fell swoop negated the
atrocities of Apartheid and the Rome Statute of 1998.
THUS AN INDIVIDUAL’S LINK WITH
DECISIONS AND BEHAVIOUR MAY NOT
BE WELL GROUNDED IN REALITY BECAUSE
THE SECOND LEVEL OF JUDGEMENT WAS
NOT SIGNIFICANTLY ESTABLISHED AND
CONSOLIDATED IN THE FIRST PLACE.
Perceptions of reality persist but are eclipsed,
disavowed and denied. Andre Green (1999)
aptly expresses this: “The subject cannot believe
his eyes, but it is precisely because he can see
and not because he is blind” (p. 90). This creates
a basic internal core upon which the rest of the
psychic structure has to be put together. The more
observable layers of psychological scaffolding may
vary considerably but underneath an essentially
primitive constellation is used to negotiate living in
that the sense of self remains inflated, entitled and,
most importantly, wish laden and oblivious of reality
which cannot then be negotiated in a complex,
reasonable, fluid and empathic way. The ideas
in the mind are then beyond question and desire
becomes the law for acting rather than judgement
or emotional thoughtfulness. Moderation of the
archaic representation of the object through
learning from experience is inhibited and further
development of the primitive superego is thwarted.
THIS IS CLEARLY A FACTOR TO BE
CONSIDERED IN THE GMHMP WHICH
WAS SET IN MOTION ACCORDING TO
INTERNAL PRESSURES IN TERMS OF WHAT
FELT GOOD AND BAD REGARDLESS
OF HOW OMNIPOTENT, UNINFORMED
AND UNREASONABLE THE BASIS FOR
THE THINKING HAPPENED TO BE. THE
RATIONALE AND EXECUTION OF
THE MARATHON PROJECT WAS NOT
INTERROGATED BUT RATHER DRIVEN BY
WISHING, FANTASY AND COMPULSION.
This allowed realistic evidence-based concerns to
be strenuously negated resulting in a life-threatening
endeavour - a Decanting. The former MEC, Qedani
Mahlangu, was able to verbalise exactly this but
could not see the inherent problem in her thinking.
When she was asked in an interview (2017) with
Devi Sankaree Govender for Carte Blanche (MNet
SOUTH AFRICAN PSYCHIATRY ISSUE 18 2019 * 21