Psychopathology III: Psychotic States

Fourth Year Adult Psychoanalytic Training (APT)
2021-22, 1st Trimester — Fridays, 3:30-5:00pm
Maureen Pendras, MSW
Sue Neell Carlson, MA


Introduction

Welcome to Psychopathology III.

In this course, we will explore psychosis and the unrepressed unconscious, 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.

September 10, 2021 — Psychotic States, Psychic Reality & Psychic (Non)Communication

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

Knafo, D. and Selzer, M. (2015). “Don’t Step on Tony!” The Importance of Symptoms When Working with Psychosis. Psychoanal. Psychol., 32(1):159-172

September 17, 2021 — Further Introduction

Our underlying fears of being close and in contact with psychosis, Knafo gives detailed clinical example.

Karon, B.P. (1992). The Fear of Understanding Schizophrenia. Psychoanal. Psychol, 9(2):191-211

Knafo, D. (2016). Going Blind to See. American Journal of Psychotherapy, 70(1):79-100.

September 24, 2021 — Ways of working with psychosis: psychotic transference and countertransference

Rosenfeld, H. (1987). Projective Identification and the Psychotic Transference in Schizophrenia. Impasse and Interpretation, New Library of Psychoanalysis, Chapter 11, 220-240.

Rosenfeld, H. (1987). Projective Identification and Countertransference Difficulties in the Course of an Analysis with a Schizophrenic Patient. Impasse and Interpretation, New Library of Psychoanalysis, Chapter 12, 241-261.

October 1, 2021 — Body and Adolescence

Bronstein, C. (2020). Psychosis and psychotic functioning in adolescence. Int. J. Psycho-Anal., 101(1):136-151.

Lombardi, R. and Pola (2010) The Body, Adolescence and Psychosis. Int. J. Psycho-Anal., 91(6):1419-1444.

October 8, 2021 — Somatic developments

Essentially we are a body ego, says Freud. In this week look at the origins of body-ego.

Anzieu-Premmereur, C. (2015). The Skin-Ego: Dyadic Sensuality, Trauma in Infancy, and Adult Narcissistic Issues. Psychoanal. Rev., 102(5):659-681

Winnicott, D.W. (1945). Primitive Emotional Development. Int. J. Psycho-Anal., 26:137-143

October 15, 2021 — Trauma and Its Implicit Level Re-enactment

Amir gives us a framework for understand ability to survive and heal from trauma, which rests on ability to differentiate inside from outside, this relates to the essential body-ego.

Amir, D. (2012). The Inner Witness. Int. J. Psycho-Anal., 93(4):879-896

Bergstein, A. (2020). Violent emotions and the violence of life. Int. J. Psycho-Anal., 101(5):863-878.

October 22, 2021 — Trauma

These articles discuss what cannot be born, witnessed, experienced the person and sometimes within the larger family system or culture at large. We consider this in terms of racism, sexism, sexual abuse, terrors, family traumas, etc.

Durban, J. (2011). Shadows, Ghosts and Chimaeras: On Some Early Modes of Handling Psycho-Genetic Heritage. Int. J. Psycho-Anal., 92(4):903-924

Wallerstein, H. (2020). Hunting the Real: Psychosis and Race in the American Hospital. Psychoanalytic Perspectives, 17(3):257-271

October 29, 2021 — Breakdown

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.

November 5, 2021 — Perversion

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

Stein, R. (2005). Why perversion? ‘False love’ and the perverse pact. Int. J. Psycho-Anal., 86(3):775-799.

November 12, 2021 — Working with unrepressed unconscious in psychosis

Lombardi, R. (2005) On the Psychoanalytic Treatment of a Psychotic Breakdown, International Journal of Psycho-Analysis, 86(5):1463-1476.

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.

November 19, 2021 — Conclusions

Lombardi, R. (2018). Entering One’s Own Life as an Aim of Clinical Psychoanalysis. JAPA 66(5):883-911.