The terrifying confusion of good and bad - a possible factor in panic states

Published on 4 February 2023 at 17:55


I have recently become more aware of a particular form of anxiety, with early childhood roots, that may frequently contribute to both states of panic and psychosomatic disorders.

This insight arose initially when a client mentioned she had experienced a state of extreme panic, triggered in the following way. She had been reading about a particular form of vegetable that, when eaten raw, was exceptionally nutritious, and she had been enthusiastically consuming large quantities of what she perceived as a wonderful superfood. Then she had heard that if this vegetable was not washed and prepared very carefully it could give rise to very severe food poisoning. This sudden shift in perspective, from idealising the vegetable to seeing it as potentially lethal, had created a state of confusion and panic.

We looked for childhood precursors of this state of confusion and panic and saw that there were various ways and times that she had not felt she knew whether her mother was good or bad, nurturing or poisonous, sane or mad. In exploring this, it became clear that this state of confusion and panic was utterly intolerable – a state of anguish that a child could not articulate, even to herself, and could not possibly process through the mind. It therefore became channelled into the body for expression as somatic states of stress. Mast Cell Activation Disorder (see one of my previous posts) was then the vehicle for the resulting somatic illnesses – a bodily state of continual readiness for danger.

In Melanie Klein’s (1946) theorising about the mental states of troubled infants, she postulated first that a normal phase of splitting the world into good and bad takes place (following the cliched paradigm of the good and bad breast). This functions as a way of sorting and ordering emotional experience. It is a stage of development also associated with projection – trying to locate all the bad outside and all the good inside. Thus, she termed it the paranoid-schizoid position. In optimum healthy development, this would gradually give way to a more integrated and reality-oriented state of mind, where love and hate can be recognised as often co-existing and directed toward the same person – a state she called the depressive position. However, she considered that sometimes a terrifying state of confusion could occur, where the infant could not successfully split the emotional world into good and bad, nor reach a more integrated state. It seems likely that certain environmental conditions, particularly relating to the mother (but could involve other caregivers), such as psychosis or dissociative states or perversion of the mothering instinct, could exacerbate this tendency for confusion of good and bad. This can leave a child feeling terrifyingly alone, completely unable to communicate what is troubling and feeling she or he has to cope and make sense of a profoundly perplexing world without any help. The terrified state of confusion cannot be put into words by the one who is experiencing it – although a therapist may later be able to do so.

When these areas begin to be addressed in psychotherapy, there can be phases when the therapist is perceived with this same terrifying confusion – an intense and primitive paranoia. Once this is identified, and its developmental context correctly located, there can be much relief (for both client and therapist).

Energy psychology methods can be very helpful with these anxieties, but it may be imperative to understand the nature and source of the anxiety.

Phil Mollon


Reference: Klein, M. (1975) 1. Notes on Some Schizoid Mechanisms (1946). Envy and Gratitude and Other Works 1946–1963 104:1-24