Psychoanalysis of the Psychoses: Current Developments in Theory and Practice (The International Psychoanalytical Association Psychoanalytic Ideas and Applications Series)

Psychoanalysis of the Psychoses brings together a distinguished international set of contributors, offering a range of views and approaches, to explore the latest thinking in the psychoanalytic treatment of psychosis and related disorders. Drawing on findings from neuroscience, theory and clinical material from many schools of psychoanalytic thought, this book offers a comprehensive guide to understanding how psychosis is conceptualised from a psychoanalytic perspective. It looks at how to work with psychotic patients, typical problems in treating psychosis and the role of pharmacology. It demonstrates the relational dimension, capable of strengthening the patient's observing Ego and facilitating the integration of the different areas of the personality. This process can identify and work through the main psychological stress factors involved in psychotic disturbances, transforming chaotic thoughts into springboards for important insights, and offering patients the precious chance to construct for the first time a creative relationship with their own existence. Psychoanalysis of the Psychoses will be of great interest to psychoanalysts and psychoanalytic psychotherapists as well as psychiatrists wishing to draw upon psychoanalytic ideas in their work. Cover 1 Half Title 4 Series 5 Title 6 Copyright 7 Contents 8 List of contributors 14 Series editor’s foreword 18 Permission acknowledgements 20 Introduction to the psychoanalysis of psychoses: current developments in theory and practice 22 A note on the historical development of the psychoanalysis of psychoses 29 A brief outline of the book 36 Part I General perspectives on the psychoanalytic experience with psychosis 46 1 Child psychosis: an impairment in the work of representation 48 The origin of the concept of child psychosis 48 The question of aetiology 49 Psychoanalysis: an inescapable therapeutic reference 50 The containing function 52 Psychic bisexuality of the containing function 53 The principle of the treatment 54 2 Chestnut Lodge and the psychoanalytic approach to psychosis 64 Psychoanalysis and the treatment of psychosis 64 The early history of Chestnut Lodge and its move toward psychoanalytically informed treatment of psychosis 65 The development of therapeutic approaches to psychosis 68 A theory rooted in the Chestnut Lodge experience 75 The schizophrenic’s objects 75 Psychotic processes and contemporary psychoanalysis 80 Conclusion 81 3 A personal path to analytic therapy for psychosis 86 Failures 87 Dreams in the psychotic state 89 Infantile psychotic withdrawal 90 Psychotic transformation 92 Beyond the dynamic unconscious 94 Propaganda in the analytic relationship 96 Conclusion 100 4 Psychosis and body­mind dissociation: a personal perspective on the psychoanalysis of acute crises and of schizophrenia 104 “Curing” psychosis 104 Intervene as soon as possible 106 Going about it 107 The analytic dialogue 107 Internal world and external world 108 Fundamental intersubjectivity and working through focused on the patient 109 The profound levels 110 Schizophrenic logic and the “unfolding” of symmetry 110 Helping the patient’s use of language to evolve 111 Analysis of models and mental theories 111 Hate, destructiveness and negative transference 112 Transference onto the body and the body-mind dialogue 113 Time and psychosis 113 Psychosis and regression 114 Counter-transference, bodily counter-transference and the analyst’s working through 115 The limits of the counter-transference 116 A clinical experience 117 Conclusion 121 Part II Communication and empathy with the psychotic analysand 126 5 Aspects of clinical work with psychotic patients 128 Communication: emotional, musical, and verbal 128 Schizophrenia, paranoia, and stigma 132 The first psychotic break 135 Hallucinations and delusions become dreams 136 6 Psychoanalytic therapy of a chronic paranoid schizophrenic woman 142 Year two 146 Year three 149 Year four 152 Year five 153 Year six 155 Year seven 157 Year eight 158 Year nine 160 Epilogue 162 Discussion and conclusion 163 7 The psychoanalyst and psychosis: the bull in a China shop 166 Psychotic mental functioning 166 Narcissistic features in the session 173 Dependency as the search for the environment­mother and autoeroticism 175 Structural identifications arise from the work of mourning 176 Structuring the narcissistic base 178 8 Pain in search of psychical shelter 184 A short theoretical premise 184 Before the erection: smearing the canvas 195 The “viper”: a frightening shape 198 The search for a shape 200 Final considerations 202 Part III Particularities of thought 206 9 The reversal of thinking: Bion’s theory of psychosis 208 The earthquake 209 Transformations in hallucinosis 215 10 Dream, psychosis and separation anxieties 224 Starting from Freud 224 After Freud: a brief look at the literature 226 Inability to produce a good dream and psychotic potentiality 227 Dream life as a generative theatre of meaning 230 Dreams and images of the body 231 Giacomo’s dreams 233 Final considerations 241 11 Note on psychotic activity in pathological organizations 248 Pathological organizations 249 Clinical example 1 253 Clinical example 2 258 Conclusion 262 Part IV Flexible integration between psychoanalysis and pharmacology 266 12 The current state of psychodynamic treatment of psychosis 268 13 Psychoanalysis and prescription drugs in the treatment of psychotic disorders 280 A review of the literature 280 Questions of method: the drug between symptom as symbol and symptom as sign 283 Emotional, relational and transference transformations following the use of medication 288 Learning from experience (and from failure) 290 Returning to the method . . . 297 Index 302