Psychopathology III: Psychotic States

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


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.

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 to occur of lived but un-thought memories/experiences

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

[33 pages]

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

[43 pages]

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

[42 pages]

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.

Optional Reading

Fabozzi, Paolo (2013) “Pervasive” Countertransference: Clinical Manifestations of the Patient’s form of Being. “The Italian Psychoanalytic Annual 7:9-26.

October 1, 2021 — Body and Adolescence

[42 pages]

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

[30 pages]

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

[34 pages]

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

[37 pages]

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

[39 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.

Grossmark, R. (2016) On Companioning. Psychoanalytic Dialogues, 26:698–712.

November 5, 2021 — Working with unrepressed unconscious

[44 pages]

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

Bromberg, P.M. (2008). Shrinking the Tsunami: Affect Regulation, Dissociation, and the Shadow of the Flood. Contemp. Psychoanal., 44(3):329-350.

November 12, 2021 — Perversion

[40 pages]

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 19, 2021 — Conclusions

[29 pages]

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