Academic journal article International Journal of Psychoanalysis

Psychotic Withdrawal and the Overthrow of Psychic Reality1

Academic journal article International Journal of Psychoanalysis

Psychotic Withdrawal and the Overthrow of Psychic Reality1

Article excerpt

The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to 'dream') from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self-sufficiency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or 'dreamed' in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and 'deconstructed' in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re-emerge into a psychic reality.

Keywords: psychotic withdrawal, dissociation from psychic reality, psychopathological structure, delusional consciousness, fantasying, psychic retreat, hallucinatory reality, identity transformation, projective identification

Delusional production positions itself in a space that is neither the inner space of the psyche, nor external space, nor intermediate or transitional space ... . Does this mean that delusional people are the inventors of a fourth space? It is important to recognize that delusion cannot be limited to its manifest or latent meanings. Delusion has its own way of placing itself in space; that is, of secreting its own space. (Racamier, 2000, pp. 823-4)

'Once Chuang Chou dreamed that he was a butterfly. He fluttered about happily, quite pleased with the state he was in, and knew nothing about Chuang Chou. Presently he awoke and found that he was very much Chuang Chou again. Now, did Chou dream he was a butterfly or was the butterfly now dreaming that he was Chou?' (Chuang-tzu, quoted in Blechner, 2001, p. 239)2

This Chinese tale introduces a number of considerations on the nature of delusion, the central core around which the therapy of psychosis revolves. When I am awake, how can I know whether I am perceiving something real or whether, instead, creating an object with my imagination? What elements help me to differentiate reality from fantastic creations?

A brief clinical vignette taken from the initial interview with a 25 year-old patient, who presented problems of alcoholism and used soft drugs, is useful to illustrate the clinical problem I would like to discuss.

After having interrupted his university studies and broken off with a girlfriend, this patient withdrew into his home. He had always been a solitary child, perhaps overprotected by a depressed mother, also rather withdrawn from the outside world. He remembers that, as a child and then as an adolescent, he cultivated a fantasy world, his 'secret garden'. But the habit of day-dreaming has now become too invasive, leaving little room for contact with the world. He lies on his bed for hours on end dreaming of passing his exams, getting his degree, having success with women, being rich and travelling the world, up to becoming a hugely successful television personality.

He realizes that his day-dreaming is increasingly altering his mind, even without alcohol, and that the lie he is victim of presents itself to him as 'another world', a powerfully attractive force that distances him from a life of relationships. …

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