Psychopathology III: Psychotic States

Adult Psychoanalytic Training (APT)
2019-20, 1st Trimester — Fridays, 3:30-5:00pm
Sue Neell Carlson, MA


In this course, we will explore the unrepressed unconscious realm of primitive states of mind and psychotic areas of the personality, with a specific focus on the impact of early and/or severe traumatic experiences.  

The course and the readings may feel dysregulating.  Although an intellectual grasp of the material is important, the very nature of such realms of human experience require an emotional and intuitive grasp of the felt experience of “being with.”  Our intention and hope is to foster a containing environment during our class time in order to allow for the emergence of an emotional grasp of these often non-verbal, somatic, non-symbolized states of being. Feeling disturbed and disrupted will most likely be part and parcel of the learning experience, and the process of encountering these extreme states of that which has interrupted or shattered the growth of the self of an individual.  Ogden wrote:

We regularly create the soothing illusion for ourselves that we have nothing to lose from the experience of reading, and that we can only gain from it.  This rationalization is superficial salve for the wound that we are about to open in the process of our effort to learn.  In attempting to learn, we subject ourselves to the tension of dissolving the connections between ideas that we have thus far relied upon in a particular way: what we think we know helps us identify who we are (or more accurately, who we think we are).
—from Primitive Edge of Experience, p.3

We also want to consider that Ogden’s views regarding learning pertain to our approach to understanding the psychotic realm.  It is inherently disturbing.  We stand to lose something—perhaps, what we thought we knew, and to gain a new way of hearing, and a softening to the suffering of others.

Psychopathology I (Neurotic States) included the developmental achievement of triangular relationships and the clinical emphasis of working with the repressed unconscious, and Psychopathology II (Borderline States) focused on the dyadic realm, between self and other where splitting and projecting of concrete states of mind prevail.

Psychopathology III will delve into profound problems of and within the core self. Our focus will be around the question of what allows for healing and growth in the analytic endeavor with severe pathology, specifically with clinical interventions that are based on the analytic experience of “living with and through.”  Through our readings and class discussions, we hope to explore new ways of hearing and being with psychotic processes and the unrepressed unconscious where the primary therapeutic work is to bear the impact of coming to know what has been relegated to the body and orphaned in non-symbolized lacunae of thought.  This type of therapeutic labor allows for the possibility of raw and unbearable experience(s) to be born into the realm of symbolic thought; suffered and known.

Learning Objectives

At the end of this course Clinical Associates will be able to:

  1. formulate what is meant by the unrepressed unconscious and how this relates to psychotic states of mind.
  2. think about and identify their own countertransference in work with patients and employ their intuition and capacity to dream in the analytic endeavor 
  3. with this knowledge be better able to attune to one’s patient and distinguish between insight interpretations oriented toward intrapsychic conflict and the analytic endeavor of “living with and through” experience with the patient in order for mentalization of lived but un-thought memories/experiences to occur.

September 13, 2019 — Psychotic States, Psychic Reality & Psychic (Non)Communication

[26 pages]

Steiner, J. (1991) A Psychotic Organization of the Personality, International Journal of Psycho-Analysis, 72:201-207.

De Masi, F. (2006). Psychotic Withdrawal and the Overthrow of Psychic Reality. Int. J. Psycho-Anal., 87(3):789-807.

September 20, 2019 — Working with the Unrepressed Unconscious

[43 pages]

Bergstein, A. (2013). Transcending the Caesura: Reverie, Dreaming and Counter-Dreaming. Int. J. Psycho-Anal., 94(4):621-644.

Carvalho, R. (2002). Psychic Retreats Revisited: Binding Primitive Destructiveness, or Securing the Object? A Matter of Emphasis?. Brit. J. Psychother., 19(2):153-171.

September 27, 2019 — The Body-Mind Relationship

[43 pages]

Mitrani, J. (1996) Ch1, “Unitegration, Adhesive Identification, and the Psychic Skin: Variations on Some Themes by Esther Bick” in A Framework for the Imagery: Clinical Explorations in Primitive States of Being. pp1-26.

Fabozzi, P. (2012). Corpses, Gods, and Turbulence between Patient and Analyst: Reflections on Some Clinical Manifestations of the Non-Repressed Unconscious. Ital. Psychoanal. Annu., 6:35-51.

October 4, 2019 — States of Breakdown

[61 pages]

Eshel, O. (2013). Patient-Analyst “Withness”: On Analytic “Presencing,” Passion, and Compassion in States of Breakdown, Despair, and Deadness. Psychoanal Q., 82(4):925-963.

Bergstein, A. (2014). Beyond the Spectrum: Fear of Breakdown, Catastrophic Change and the Unrepressed Unconscious. Rivista Psicoanal., 60(4):847-868.

October 11, 2019 — Therapeutic Transformation of Psychic Trauma

[53 pages]

Gurevich, H. (2008). The Language of Absence. Int. J. Psycho-Anal., 89(3):561-578.

Eshel, O. (2016). The “Voice” of Breakdown: On Facing the Unbearable Traumatic Experience in Psychoanalytic Work. Contemp. Psychoanal., 52(1):76-110.

October 18, 2019 — Survival Mechanisms – Autistic and Dissociative

[39 pages]

Farber, S.K. (2008). Autistic and Dissociative Features in Eating Disorders and Self-Mutilation. Mod. Psychoanal., 33A(1):23-49.

Tarantelli, C.B. (2012). The Fear of Turning into Dust: Notes on a Group for Sexually Abused Women. Am. J. Psychoanal., 72(1):52-63.

October 25, 2019 — Specific Aspects of Trauma Considered

[49 pages]

Lombardi, R. (2005). On the Psychoanalytic Treatment of a Psychotic Breakdown. Psychoanal Q., 74(4):1069-1099.

Fabozzi, P. (2013). «Pervasive» Countertransference: Clinical Manifestations of the Patient’s form of Being. Ital. Psychoanal. Annu., 7:9-26.

November 1, 2019 — Shame, Somatic Violence  & Love

[37 pages]

Lombardi, R. (2007). Shame in Relation to the Body, Sex, and Death: A Clinical Exploration of the Psychotic Levels of Shame. Psychoanal. Dial., 17(3):385-399.

McDougall, J. (1997). Somatic Violence and the Therapeutic Relationship. Canadian J. Psychoanal., 5(1):51-72.

November 8, 2019 — Perversion

[42 pages]

Amir, D. (2013). The Chameleon Language of Perversion. Psychoanal. Dial., 23(4):393-407.

Eshel, O. (2005). Pentheus rather than Oedipus: On perversion, survival and analytic ‘presencing’. Int. J. Psycho-Anal., 86(4):1071-1097.

November 15, 2019 — States of Psychic Deadness

[35 pages]

Eshel, O. (1998). ‘Black Holes’, Deadness and Existing Analytically. Int. J. Psycho-Anal., 79:1115-1130.

Bergstein, A. (2009). On Boredom: A Close Encounter with Encapsulated Parts of the Psyche. Int. J. Psycho-Anal., 90(3):613-631.

November 22, 2019 — Suicide and The Psychoanalytic Approach

[26 pages]

Asch, S.S. (1980). Suicide, and the Hidden Executioner. Int. R. Psycho-Anal., 7:51-60.

Lombardi, R. (2010). Flexibility of the Psychoanalytic Approach in the Treatment of a Suicidal Patient: Stubborn Silences as “Playing Dead”. Psychoanal. Dial., 20(3):269-284.