On the Psychoanalytic Treatment of a Psychotic Breakdown

Falling, primitive separation and encapsulated body engrams - working through a bodily encoded unconscious syndrome

Besides the symbolic unconscious, psychoanalysis today investigates unconscious structures that are dissociated from mental functioning (Lombardi 2017) and encoded in bodily inscriptions. These bodily configurations often stay outside of the psychoanalytical attention and technique of treatment. Two concepts - encapsulated body engrams and somatic narration - provide a theoretical and technical proposition for the bodily encoded unconscious. Within this frame, the paper focuses on new aspects. It is outlined that the encapsulated body engrams result from a traumatic disorganization of the primal relation to the caregiver leading to an impossibility of a separation from the mother's body. Separation is now feared as a deadly fall into an endless abyss. However, this element is no longer viewed as an unconscious phantasy that can be interpreted but as the perception of a disorganized bodily syndrome that must be worked through with a considerable reverberation-time (Birksted-Breen 2009) in a body-to-body dialogue. Somatic narration encourages the patient to describe his painful bodily perception and invites the body-self to show up during the analytical encounter. Working this way allows the patients disorganized body-self to slowly develop into a container to harbor, organize and symbolize emotions. Four clinical examples illustrate this manner of working.

Entering One's Own Life as an Aim of Clinical Psychoanalysis

The historical development of psychoanalysis has demonstrated that the aim of clinical work can change as the patient population changes. One of the main tasks of psychoanalytic working through today is to help difficult patients trapped in imitative dynamics and "never-to-be-born selves" enter a life of their own. Particular emphasis is given to activating a body-mind relationship, catalyzing emergence from the unrepressed unconscious, and constructing space-time parameters in relation to the most primitive and undifferentiated emotional experiences. Two clinical cases are presented, in the first of which the analyst found himself invested with an intense devitalization that tested his capacity to be present. In the second case the analyst was confronted by the necessity of stimulating the birth of basic functions of mental notation in relation to blind and dangerous acting out. The confrontation in the analytic relationship mobilized the patient's internal resources of self-observation and self-containment, from which the capacity to exist and be present to the self could emerge.

Hallucinations in the psychotic state: Psychoanalysis and the neurosciences compared

In this contribution, which takes account of important findings in neuroscientific as well as psychoanalytic research, the authors explore the meaning of the deep-going distortions of psychic functioning occurring in hallucinatory phenomena. Neuroscientific studies have established that hallucinations distort the sense of reality owing to a complex alteration in the balance between top-down and bottom-up brain circuits. The present authors postulate that hallucinatory phenomena represent the outcome of a psychotic's distorted use of the mind over an extended period of time. In the hallucinatory state the psychotic part of the personality uses the mind to generate auto-induced sensations and to achieve a particular sort of regressive pleasure. In these cases, therefore, the mind is not used as an organ of knowledge or as an instrument for fostering relationships with others. The hallucinating psychotic decathects psychic (relational) reality and withdraws into a personal, bodily, and sensory space of his own. The opposing realities are not only external and internal but also psychic and sensory. Visual hallucinations could thus be said to originate from seeing with the 'eyes' of the mind, and auditory hallucinations from hearing with the mind's 'ears'. In these conditions, mental functioning is restricted, cutting out the more mature functions, which are thus no longer able to assign real meaning to the surrounding world and to the subject's psychic experience. The findings of the neurosciences facilitate understanding of how, in the psychotic hallucinatory process, the mind can modify the working of a somatic organ such as the brain.

Death, time, and psychosis

Working through the awareness of death and the consciousness of time, it is hypothesized, plays a decisive role in the analytic process and in the mental growth of psychotic analysands, as well as in the integration of the psychotic areas in healthier patients. Clinical material is presented from a psychotic woman treated analytically, four sessions a week, for twelve years. The patient suffered several acute relapses, during which the analytic work was not interrupted. Her fourth psychotic episode in the course of analysis, which involved a delusion about gray men and the theft of time, is explored in particular depth. This phase fostered the patient's recognition of the value of time, together with the acquisition of her own center of psychosensory integration, the basis of an ability to learn from experience.

The body, adolescence, and psychosis

This article explores aspects of the clinical development of a male 17 year-old patient who had four weekly sessions of psychoanalysis during an acute psychotic crisis. In the context of arrested adolescent development, a psychotic crisis can present an opportunity to set the process of maturation in motion again. Adolescent psychosis is examined in the light of Bion's theories of catastrophic change - in which the container/contained relationship becomes explosive and overwhelming - as well as of Ferrari's and Matte Blanco's hypotheses on the mind-body relationship. The authors emphasize the role of denial of the body and its changes in the genesis of adolescent psychotic conflict, and show how the analytic relationship can offer crucial reverie conditions for promoting recognition of the body, bodily sensations and affects, as a prerequisite for the activation of an autonomous mental system. This clinical approach entails recognizing the urgent need to make room for the elaboration of intrasubjective relationships and for mind-body dialogue, transference interpretations being postponed. Clinical material and fragments of analytic dialogue illustrate the authors' hypotheses and demonstrate the patient's development towards recognition of his body and an incipient capacity to think associated with the perception of the limits set by time and reality.

The body emerging from the "neverland" of nothingness

The author considers sensory perceptions arising from the body to be the first expressions of self-consciousness and mental existence in patients who are overwhelmed by a dimensionless abyss of nothingness. This perspective can help the analyst in catalyzing the patient's integration with his deepest levels of mental functioning. Clinical material from the four-session-per-week analysis of a psychotic patient is discussed. To this analysis and, finding the body meant finding "the land that never was," a "land" that could begin to exist in analysis thanks to a relational working through within the analytic couple.

Through the eye of the needle: the unfolding of the unconscious body

The body is the starting point of experience and the original source of psychic life. In the course of analysis "the camel" must "go through the eye of the needle," in the sense that the body must become the specific object of mental working through, although no link between the corporeal and the mental can be taken for granted. The body-mind relationship is explored in the light of Matte Blanco's hypothesis that symmetric and asymmetric relationships are always present in the mind in differing proportions, and that the realm of symmetry is the deep unconscious. In primitive mental states the body may be completely unperceived: just as H. G. Wells's invisible man could be seen only when dressed, so the body appears on the mind's horizon only when asymmetric thought is directed at it. Three clinical vignettes show the contribution of the body-mind relationship to the overcoming of serious impasses in analysis.