In classical descriptive psychiatry the term 'paranoid' is often used ambiguously -- referring to a variety of clinical processes which should be more clearly differentiated. Specifically, in this paper, we have differentiated three distinct sets of clinical phenomena all usually lumped together as 'paranoid': 1. Paranoid from a Sense of Guilt, 2. Paranoid from a sense of Low Self-Esteem, and 3. Paranoid from a Sense of Persecution. These three processes are distinct descriptively, dynamically and genetically. Further, this differentiation is most significant pragmatically as the treatment is different for each type.
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I divide this paper into three parts. First, I discuss Freud's ideas about repression and the unconscious sense of guilt in order to compare them with Klein's view that we disown uncomfortable facts through a process of splitting and projection, leading to a paranoid defence against guilt. Second, I describe Klein's struggle to understand the origin and the severity of the primitive super-ego which was so prominent in her child patients.
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