Reading and Writing: Psychoanalytical Treatment in a Case of Paranoia

Difficulties encountered in clinical work with psychoses require psychoanalytical approaches different from those used for treating neurosis. The authors use a clinical case of a paranoiac patient to highlight the role played by writing, drawing, and painting in the psychoanalytical treatment of psychosis. They also discuss the role of the reader-analyst in this patient’s transferential process, which led to the emergence of a new subjectivity.     

Between a suffering body and a body in a state of need: Aulagnier’s theory of discourses on the body applied to primitive mental states

ABSTRACT

In her theory of discourses on the body, Aulagnier makes the comparison of the concept of ‘a suffering body’ and the concept of ‘a body in a state of need’. The last type is what she thinks is often found in addiction, anorexia and in borderline states, conditions marked by a radical negativity. On the other hand, ‘a suffering body’ is a concept that indicates a relation and two bodies, mother’s and child’s, that communicate. Suffering and infantile sexuality is a first attempt to accept separation by weaving a net of fantasy over the abyss of lack and separation. If pleasure and suffering are lacking as representations, the sensory reactions may exist physiologically but without psychical existence. The concepts of ‘a suffering body’ and 'a body in a state of need' will enable us to think about important structural differences between neurotic-, borderline- and psychotic conditions. As a foundation for her concepts lies a metapsychological elaborations of three kinds of processes for representation: the primal-, the primary- and the secondary process.     

Narrative Understanding in Acute Psychosis

Hermeneutical premises are adequate in understanding the psychotic patient. It is more important to hear and try to understand the patient's story told by the latter as an equal partner in conversation than understand events through stories in which the meanings are already determined. Understanding is dependent on the unique way in which the feelings, thoughts, and actions of the patient are connected with those of the ward staff, i.e., mutual knowledge. In this way understanding conforms to the preunderstanding of the interpreter as well as adequately captures the intentions of its originator. These are the preconditions for the integration of the need-adapted approach to the treatment of schizophrenia.     

Reliability of the Halstead-Reitan Battery in individuals displaying acutely psychotic behavior

The purpose of the present study is to examine the test-retest reliability of the Halstead-Reitan Battery (HRB) in an acutely psychotic population. Ten acutely psychotic patients, initially tested upon admission to an inpatient unit of the Austin State Hospital, were selected for retesting on the basis of showing the most complete remission of psychotic symptoms of all patients tested over the 14-month period from June 1978 to August 1979. Only patients showing good remission were selected in order to maximize the potential for changes in test performance to occur and, thus, provide a conservative estimate of test-retest reliability. The average retest interval was 10.4 weeks (SD=6.67), with retest being completed just prior to discharge. Reliability was examined for each HRB subtest across subjects, as well as for each subject across subtest. While the patients generally showed an improved performance at retest, the reliability of the HRB was relatively high.     

A Model to Transform Psychosis Milieu Treatment Using CBT-Informed Interventions

Although CBT for psychosis (CBTp) has been recommended as a best practice since 2002, CBTp’s availability is quite limited in the U.S. Integration of CBTp-informed interventions into the milieu of the treatment settings in which the majority of the 2.4 million Americans with psychosis receive treatment may greatly improve access to those services. This paper presents an evidence-based model for training line staff in CBTp principles, in order that more staff throughout the U.S. might better support the recovery of people with psychosis in this way. Examples are provided to illustrate effective strategies and approaches.     

Religion and Madness

The question I try to answer in this paper is: How should we distinguish mad from sane religious belief? After looking at the clear-cut but opposed answers of Freud and Jung, I then examine the modern psychiatric answer, particularly as presented in the DSM IV. After arguing that each of the three answers is unsatisfactory, I look at what I take to be the more promising approach of Con Drury, Wittgenstein’s friend and biographer, in an essay called “Madness and Religion,” where, drawing on the religious histories of Joan of Arc, George Fox and Tolstoy and three of his own psychiatric patients, Drury suggests that there is no objective yet ethical way to make the distinction. This leads to my own answer, which is that the best we can do is to distinguish mad from neurotic religious belief; and hence that the safest position, although not the most comfortable, is the neurotic one.