Visually controlled space orientation in endogenous psychoses

The visual controlled behaviour in space is measured in 30 psychotic patients. In a room with a row of 8 equal chairs we measured the right-left-choice and the choice of distance. The neglect of the left chairs in patient with "distrust" and "delusion" let us suppose a right hemispherical dysfunction. There is no correlation between psychosis and choice of distance, but a good correlation between disturbed parental home and near distance.     

The Hands of Egon Schiele

Through an exploration of Egon Schiele's life and enigmatic ?mannerisms?, which recall those of autistic children and schizophrenic patients, the author explores the impact his outstanding and disturbing paintings can have. The approach is biographical, revealing Schiele the artist as an already gifted though disturbed child. Some material refers to Schiele's way of expressing painful yet creative fantasies, in which different parts of his body (in particular his hands), projected into his paintings, form part of an intimate, creative, disturbed language. From childhood to his early death, Schiele used a coherent figurative language which was both realistic and oneiric; the author develops some ideas on art and psychoanalysis, particularly as to the creative process within a complex and disturbed personality. Working as he did between the psychotic and non-psychotic elements of his personality (Bion), Schiele is an appropriate artist for our time. His drama, his feelings of disintegration and ?dismemberment? are nourished by the creative, sane parts of his personality. The true psychotic artist is not entirely psychotic, for creation requires aesthetic taste and harmony.     

The Utilization of Cotherapists and of Group Therapy Techniques in a Family-Oriented Approach to a Disturbed Child

This paper presents theory and technique developed over a thirteen-year period with a group of chronically disturbed psychotic patients. When psychotic patients enter a group, the potential dynamics that develop within the group process mobilize psychotic resistances which become the dominant group feature. Resistances can retard group development, destroy cohesion, and result in repetitive role behaviors. Therapist interventions, especially those that join with the resistance, can promote the movement and integrity of the group while discovering aspects of primitive individual identity for the group members. Case material is included, illustrating both group resistance and group leader intervention strategies.     

On the psychoanalytic treatment of a psychotic breakdown

The author discusses the four-session-a-week psychoanalysis of a patient in psychotic breakdown with outbursts of violence. The analyst's first appearance in the transference was as a "rattle" (the noise made by his shifting in his chair), which constituted undeniable evidence of corporality--first the analyst's and then the patient's--leading eventually to the awareness of there being two separate persons in the psychoanalytic relationship. This case highlights the analyst's need to function in a particular way, and to allow him- or herself to be used in a particular way, in working with very disturbed patients, where issues of the body-mind relationship and of separation from the other are often central to the analytic work.     

On understanding projective identification in the treatment of psychotic states of mind: The publishing cohort of H. Rosenfeld, H. Segal and W. Bion (1946–1957)

A publishing cohort of Kleinian analysts – Rosenfeld, Segal and Bion – implemented Klein's (1946) notions of projective identification and the 'paranoid ' and 'schizoid ' positions in the understanding of a group of psychotic disorders. The author differentiates Klein's (1946) Notes on some schizoid mechanisms paper from its revised version of 1952, maintaining that it was Rosenfeld's clinical work during this period that helped to centralize Klein's redefinition of projective identification. The stage was set for Segal 's contribution in terms of 'symbolic equations,' where the psychotic's attack on the breast left him incarcerated in internal torment and persecution, where things-in-themselves were confused with what they symbolically represented. Segal in turn linked psychotic to normal, paranoid–schizoid to depressive positions, where by means of projective identification and symbolic imagination, the patient could arouse feelings in the analyst related to sadness, guilt and loss. Bion assumed that psychotic pathology reflected disordered thinking, when the severely disturbed used language as a mode of action. The psychotic was profoundly confused between the use of thought and action in the natural world – where thought was required, he preferred action and vice versa. Bion also drew upon projective identification in a new, broader way, so that analysis could now become more of an intersubjective, bi-directional field of projective and communicational influence between patient and analyst. The paper concludes with the impact of the work of Rosenfeld, Segal and Bion and variations on the technique of analyzing psychotic states in terms of the patient's early history, transference and countertransference.     

Programmed relaxation and reciprocal inhibition with psychotic children

This exploratory project illustrates, in contrast to earlier opinions, that psychotic children can be taught muscular relaxation through carefully structured training in physical relaxation. The learned relaxation behavior was apparently antagonistic to and effected a significant decrement in the generalized response of high anxiety which had previously led to aggressive outbursts. As a result of the exploratory project it was hypothesized that although systematic desensitization may be necessary for modifying specific patterns such as phobias, the generalized excitement response of psychotic and other severely disturbed children may be effectively and parsimoniously modified simply through general training in muscular relaxation.     

A group-centered object relations approach to group psychotherapy with severely disturbed patients

This paper discusses how the application of object relations theory to clinical intervention has extended the application of psychoanalytic group psychotherapy to more severely disturbed patients. The author suggests how to structure the group based on individual and group needs. Clinical issues are presented, including the group as a container, communication peculiarities, and psychotic response to separation, sexuality, and interpretation.     

Differentiation of Psychotic From Nonpsychotic Psychiatric Inpatients: The Rorschach Perceptual Thinking Index

The aim of the study was to investigate the validity of the Rorschach Perceptual Thinking Index (PTI) to detect psychotic perceptual and thought disturbance in a sample of Slovene psychiatric inpatients. Using a sample of 275 adult psychiatric inpatients of both sexes, we examined the differences between patients with psychosis (PP) and patients with no psychotic features (NP) from various diagnostic groups on the global PTI and its subcomponent variables. PPs obtained significantly higher PTI scores, indicating more disturbed perception and more thinking disturbance, than NPs. No differences were found for diagnostic differences within the PP and NP groups. Results are in accordance with previous studies of the PTI as a valid cross-cultural index of perceptual and thinking disturbance.     

Rediscovering trust: Towards an alternative psychotherapy

The collapse of significant human relationships is a primary cause of psychosis. When basic trust is extinguished, a person can feel that his or her actual existence is threatened by genuine relationships. Yet, every human being has a powerful innate need for relationships. Such is the tragic paradox of psychosis: the person is, at the same time, in terror over the possibility of a relationship and in despair over the impossibility of a relationship. An alternative psychotherapy must emerge that allows the psychotherapist and the disturbed person to build a bond of mutual care. Each person unconditionally accepts and confirms the other for what he is, and for what he may become. The psychotherapist must enter the bizarre psychotic world as a partner in a journey to recover the lost wholeness of the psychotic person. This relationship can serve as a bridge which allows the psychotic person to creatively discover a way to rejoin the normal world.     

Schreber, Perceval, and Van Gogh: Three Eminent Cases Considered from the Perspective of Four Characteristics of Psychosis

The psychotic dispositions of Schreber, Perceval, and Van Gogh are considered. Four characteristics appear to run through their psychoses, and these are identified and illustrated: (1) Negation, (2) persecutory belief, (3) obedience to a transcendental command, and (4) evangelism/martyrdom. Three of the elements have been identified previously, but evangelism/martyrdom is identified here for the first time. The characteristics tend to move in a linear direction, each reinforcing the psychotic state. Therapy requires a disruption of the path, whether through biochemical or psychosocial means or both.     

Narcissism,psychic recognition,and affective validation: A homage to the “later Rosenfeld”

Abstract

Recalling his own participation in a daily group seminar with Rosenfeld and taking this experience as his starting point, the Author describes and discusses the later Rosenfeld’s approach to working with severely disturbed narcissistic patients. Through a detailed analysis of a supervision of a session with a psychotic patient, this paper essentially highlights how important it is to construct a (cognitive and affective) basic common ground in order to subsequently proceed to interpretations of transference. In particular, the paper brings to light those elements allowing the creation of that basic cognitive-affective ground that is necessary to profitably (in a manner useful to the patient) connect the relational events narrated and acted by the patient with the hic et nunc of analytic interaction.     

A beam of "chimeric" darkness: presence, interconnectedness, and transformation in the psychoanalytic treatment of a patient convicted of sex offenses

The paper puts forward the dimension created by analytic presence and the ensuing patient-analyst interconnectedness in the process of psychoanalytic treatment and change, particularly with more disturbed patients. Working within this dimension, at a fundamental level of contact and impact, opens up new possibilities of extending the reach of psychoanalytic treatment. The analyst's "presencing" and interconnectedness with the patient forge a living therapeutic entity that is not a one-person or two-person psychology, but an emergent two-in-one new entity that goes beyond the confines of the separate subjectivities of patient and analyst and the simple summation of the two. The paper describes the kind of knowledge, experience, and powerful therapeutic potential that comes into being through analytic "presencing" and patient-analyst interconnectedness, and particularly focuses on the chimeric element, or quality, of this interconnectedness. The term "chimera/chimerism"-chosen here for its wealth of mythological, genetic, biological, biomedicinal (chimeric proteins), and psychoanalytical associations-is used in this paper to highlight the complex quality of patient-analyst interconnectedness, especially in difficult, psychotic, psychically foreclosed, dissociative and perverse states. The author offers an extensive clinical account of psychoanalytic treatment of a patient convicted of sex offenses in order to illustrate "presencing," interconnectedness, and the extent and intricate emotional meaning of the extreme chimerism that this kind of (difficult) treatment entailed.     

Alpha-rhythm asymmetry of schizophrenic patients before and after tryptophan administration

Before and one hour after tryptophan loading laterality differences in the alpha-waves were evaluated from the EEG data obtained from 16 right-handed patients with paranoid hallucinatory schizophrenia and 16 right-handed controls. The alpha wave asymmetry of the patients which was increased and shifted to the right before tryptophan loading may be due to a disturbed relationship between both hemispheres. Particularly in the patients, the pronounced changes in the laterality of alpha-waves after tryptophan loading demonstrate that like psychotic substances tryptophan and its metabolites may bring about changes in subcortical and cortical asymmetries.     

Psychosis: New Existential, Systemic, and Cognitive-Behavioral Developments

Until recently, perhaps the major avenues of working with severely disturbed patients have been based upon either organic-chemical or intrapsychic determinants and treatment components. One recent development is an emphasis upon interpsychic and interpersonal factors and determinants in both the understanding and the treatment of extreme psychotic disturbances. Existential, systemic, and cognitive-behavioral conceptualizations and therapies maintain substantial independence of one another. Yet these three share at least two significant commonalities. One is that they each emphasise the interpsychic and interpersonal. A second is this first commonality has led to some exciting new developments in the understanding and treatment of psychosis.     

THE USE OF THE ANALYST AND THE SENSE OF BEING REAL: THE CLINICAL MEANING OF WINNICOTT'S “THE USE OF AN OBJECT”

“The Use of an Object and Relating through Identifications” (1968) represents Donald Winnicott's theoretical and clinical legacy. The author develops this concept from a clinical point of view, through the analysis of a woman with psychotic functioning. He reflects upon the dramatic quality of risks inherent in the processes linked to the use of the object with seriously disturbed patients. He explores different meanings of the analyst's survival, linking it to the analyst's response. The processes of the use of the object—that is, the encounter between the patient's potential destructiveness and the analyst's capacity to respond through his own judicious subjectivity—let the patient experience the analyst's capacity to keep his own subjectivity, authenticity, and creativity alive. It is starting from the traces of this live object that patients gradually form their own personal sense of being real.     

‘The newspaper reader’: On the meaning of concrete objects in a psychoanalytic treatment1

The author investigates the meaning of concrete objects in the psychoanalytic treatment of a severely disturbed patient for the development of his inner world and the analytic process. She includes a survey of relevant theoretical concepts with an emphasis on Winnicott and Bion. It is shown that the objects served basic defensive functions both within the analytic relationship and for the precarious intrapsychic state of the patient. The author describes the technical dealing that led to a structural change. From the comparison of the initial dream and a later dream, Mr N's inner development from total inclusion in the object to triadic reality of separated, repaired objects becomes discernible. The author shows how this progress was facilitated by his use of concrete objects as links between his psychotic and non‐psychotic parts, as well as by the specifi c way the analyst handled the paradoxical transference‐ countertransference. She also illustrates the thesis that the developmental steps described are crucial for the capability to digest psychic pain by symbolization instead of discharging it in a destructive‐violent way.     

OPEN DIALOGUE IN PSYCHOSIS I: AN INTRODUCTION AND CASE ILLUSTRATION

As a social construct, our approach to work with severely disturbed psychiatric patients in crisis, termed Open Dialogue (OD), begins treatment within 24 hours of referral and includes the family and social network of the patient in discussions of all issues throughout treatment. Treatment is adapted to the specific and varying needs of patients and takes place at home, if possible. Psychological continuity and trust are emphasized by constructing integrated teams that include both inpatient and outpatient staff who focus on generating dialogue with the family and patients instead rapid removal of psychotic symptoms. The main principles are described, and a case is analyzed to illustrate these.     

Coherent Themes: Individuals’ Relationships with God,Their Early Childhood Experiences,Their Bonds with Significant Others,and Their Relational Delusions During Psychotic Episodes All Have Similar Holistic,Existential, and Relational Themes

An adult seems to articulate surprisingly similar meaning themes and similar processes about relationships in several widely disparate domains of behavior, domains of both non-pathological and pathological types. Whether the person is consciously describing early relationships with parental figures, unconsciously acting them out in current relationships, experiencing relationships with God or the Transcendent, or acting on the basis of relational delusions during psychotic episodes, his or his experienced relational reality seems to be filtered through a single, coherent, personally unique spiritual, existential, and epistemological relational lens. Conflicts may involve other relational meanings, but may be conflicts because of the existence of that dominant lens. Two parts of that dominant lens system, specifically the part relating the person’s concept of God to the other parts of the system and the part relating the specifics of psychotic breaks and spiritual emergence to other parts of the system, are seldom discussed. Both understanding the person’s dominant relational lens and the implications of that person’s using the lens to see reality, and sharing that knowledge with the individual (if he or he has stabilized to some degree) can help the troubled or disoriented individual. That person can gradually give a more adaptive meaning to consistent distortions in the many areas of meaning and behavior attached to relationships, and even to very skewed behavior such as hallucinations and delusions during psychotic breaks. Distortions during experiences of spiritual emergence also can be made clearer to the disturbed client if the therapist has a better understanding of the person’s overall coherent relational meaning system and its implications, and can translate the language of that system into spiritually transformative terms. A case is summarized and discussed as an example of these ideas. Then, two theories are described. A useful theory of human-felt connection and a cognitive developmental theory of Postformal Complex Thought have been developed by the author and described in earlier publications. These two theories help make sense of the multiple but coherent themes, cognitive dimensions of theme genesis and change, and the nature of the relational lenses used. Suggestions about interventions in the person’s system of coherently distorted relational themes, suggestions based on the two theories, are discussed. The recommendation is made that all therapists become fluent in the languages of, and especially the connections among, all of the relational areas named in the title of this paper that are part of the coherent relational theme.     

Existential and psychopathological evaluation of group psychotherapy of neurotic and psychotic patients

General problems in researching group psychotherapy are reviewed, especially for those with similar theoretical and methodological approaches. The sample consisted of 100 subjects, 26 of whom were neurotic and 24 of whom were psychotic. They were treated in small groups, headed by the author (the experimental group). An equal number and the same categories of patient attended control psychiatric sessions (the control group). All subjects were tested twice. With three instruments: the semantic differential (with twelve existential categories, five general therapy, and three ego psychology categories), the Kotchen test, and MMPI (midiform). A discriminative analysis of tests and the repeated test data, statistically significant, revealed experiential changes in existential categories, such as "Freedom," "Sex," and "Love" amongst psychotics; and in the case of both psychotic and neurotic patients, treated in groups and compared with the controls, such categories as "Understanding among people." With the help of MMPI, a statistically significant reduction of hysteria in neurotic subjects was established, as well as the preventive effects of group psychotherapy regarding the emergence of psychopathy in psychotic patients. Correlation calculations indicated a greater discrimination in the perception of changes using existential categories in the experiencing of psychotic and depressive patients. Finally, the results obtained are discussed from the viewpoints of clinical experience, results obtained in similar research studies, and unanswered questions resulting from such research.