The Psychotic Core

Michael Eigen

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429921971
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book examines the key ordering—disordering processes of the psychotic self. It draws on Sigmund Freud, Jung, object relation and selfpsychologies, and, particularly, the work of Winnicott, Bion, and Elkin.

Chapter One
The Core of Psychosis

IF IT IS DEBATABLE whether or not there is a psychotic kernel in every person, it can at least be said that psychosis is one of the phenomena of human life that take us to the edge of what it is possible to experience. It both challenges and freezes the presuppositions that make personality possible. In psychosis, what we ordinarily take as material may be treated as if it were immaterial, and vice versa. Space and time become bizarre and poisonous playthings, or vacuous. An ecstatic spasm of color may shoot across a dangerous wasteland and for the moment save and uplift the subject's sense of self and other. In another moment, self and other fragment, collapse, spill into, menace, and deplete each other, and possibly vanish altogether.

It is in the psychoses that one encounters the most extreme rigidities and fluctuations of symptoms. In a short period of sometimes moments, an individual may seem to run through the whole gamut of clinical possibilities. It is as if his psyche has become a speeded-up movie, racing madly through a sequence of mental deformities, unable to choose and settle on the one that best suits it. Perhaps if he tries them all, he will finally find some combination he can live in, or, more likely, be able to breathe forever the freedom of limitlessness.

Yet the psychotic individual also experiences himself as desperately trapped. His fixity and fluidity mimic the continuity and change that characterize personal identity. The dualities that make up human experience are separated and exaggerated in psychosis. At times, it seems that the psychotic person dissolves his mind in order to rebuild himself from its elements. Or he may seem to need to search grimly through its debris, leaving nothing out, as if he were looking for something essential, but still unknown. He cannot rest until he sees everything. Yet everything dissolves and starts over without any sense of experience building on itself. The individual stares at himself through a kaleidoscope, but does not evolve. The flux itself becomes fixed and imprisons him.

It is often a relief when the individual drifts into a stable state, even if it turns out to be one from which he may never return. Things at last slow down, or one becomes used to the turns of the revolving door. To an observer, and sometimes to the individual himself, this may seem like the burn-out of a great volcano. But even when a person is chronically somnambulistic, deep rumblings are heard periodically, and one may momentarily glimpse fire and water. Thus we may also ask, if psychosis is a way of organizing experience, what happens when this last way breaks down?

In psychosis, as in creativity, ordering and disordering processes are interwoven. Rigidity and chaos alternate, and boundaries are distorted or dissolve. No wonder that it took so long to discover that a basic order informs psychosis.

A Basic Order

Whatever the drawback of classifications, they have made it possible to begin to think systematically about clusters of symptoms and behavior that seem to go together. Investigators may disagree as to which schematic grouping works best, but what is important is that the serious student of the subject can recognize the patterns another talks about. A common ground often makes possible meaningful disagreements.

At the end of the last century, an orderly classification of the various types of psychoses was made. Kraepelin¹ grouped several mental conditions under the heading of dementia praecox, but in 1911, Bleuler² reworked Kraepelin's subdivisions in terms of primary symptoms and splitting processes. In light of the severe splitting processes, he changed the name of this grouping to schizophrenia (literally, split or cut mind), a name in the mental sphere as dreaded as cancer in the physical. Classifications have perhaps become more sophisticated, but these early attempts to organize mental illness into discernible and useable networks can easily be read today.³

Many of the dangers of such classifications are now obvious. They establish stereotypical sets that persevere for decades (or longer) and may delay the investigation of the subtle processes that underlie genuine similarities and differences. Certain schizophrenic defenses mask a depressive illness and vice versa. A neurosis may mask a hidden psychosis. An initially mild symptom pattern may give way to an intractable, malignant one, whereas a seemingly florid madness will respond to careful therapeutic work. If one aims to cure a psychosis, one must be ready to run the gamut of all possible psychoses as therapy unfolds. In the consultation room, as in life, no a priori picture is invulnerable.

And yet the very fact that one can and will be wrong indicates that there is something to be wrong about. We make educated guesses from moment to moment. Investigators from different and even the same schools disagree. One disagrees with oneself. Yet there is a sense of basic order if one can only find it, and we each fight for the truths we believe we glimpse. Our maps do not simply capture or impose order; they also express aspects of our encounter with an order we help mediate.

For the most part, Freud used the classifications he found ready made and appreciated the heroic work of others who made his own work possible. A fundamental obsession of his throughout his life's work, especially at its outset, was how individuals choose the internal defenses that account for the external patterns of symptoms we observe. His emphasis was on the inside, the invisible depth dimension, but taxonomy was a stimulus and an anchor. Thus, he wrote about the psychic life of individuals one might "classify" as hysteric, depressive, paranoid, or schizophrenic. He did not try to change the hard-won nosologies that facilitated communication and exploration, but rather opened these "boxes" to see what made them what they were. To be sure, Freud's particular concept of obsessional neurosis changed the meaning of this syndrome, so much so that we would not be wrong to say that psychoanalysis invented (discovered) the way we see obsessional behavior today. He also tried to redesignate Kraepelin's dementia praecox and Bleuler's schizophrenia as paraphrenia,⁴ but his attempts failed. Generally, Freud worked with conventional psychopathological categories.

The ordering of certain psychopathologies stimulated much of Freud's thinking. He was particularly fascinated by the amount of fluidity between categories that could coexist with a basic descriptive stability. He attempted to do justice to the continuum he felt existed between the normal and the pathological and among the various types of psychopathologies. Such concepts as fixation and regression express his view of a fluid or mobile energy, which can take on different forms. It was a momentous breakthrough to link psychical energy with ontogenetic development. According to his concept, this energy assumes typical forms, according to the current phase of development. At the same time, congenital predisposition and environmental factors (e.g., extent and quality of trauma) influence which aspects of developmental phases become dominant or fail to appear.

According to Freud, all aspects of development contribute to how the individual organizes meaning and is affected by meaning. In the end, Freud is less concerned with the exactitude of developmental ordering than with how a variety of developmental factors are typically organized. Given a life history, there is no a priori schema to understand adequately the ways in which an individual makes use of the developmental spectrum. This explains Freud's flexibility in his use of the developmental sequences he helped discover (the oral, anal, phallic, and genital phases and their subphases). Freud used his developmental schema as a kind of musical scale, a resource that changes in value according to context. It is always an open question as to just what meaning or use individuals may make of their developmental possibilities.

The Centrality of Psychosis in Psychodynamics

Later in this chapter, I will outline my approach to the vast chasms and subtleties of psychotic experience. And throughout this book we will study, in detail, the key ordering–disordering processes of the psychotic self. Before reaching that point, however, several preliminary issues must be discussed; the first is the centrality of psychosis in the depth psychologies and, by implication, in the makeup of humankind.

Psychosis has been the Cinderella of psychoanalysis. Freud spent most of his efforts formulating the structures and psychodynamics that distinguish the psychoneuroses, and insisted that psychoanalysis was not equipped to deal with the psychoses. Yet some of the most important psychoanalytic advances (e.g., the work with narcissism) were made in attempts to understand psychosis. Freud's theory would not be what it is, if it were not implicitly based on a phenomenology of psychosis. An awareness of psychotic experience played a significant role in the foundation and growth of psychoanalytic theory. Let us briefly review some aspects of Freud's thought in order to convey just how central a subject psychosis is to his understanding of psychic life. The importance of this centrality cannot be overemphasized.

Freud's depiction of primary process owes much to his fascination with psychotic thinking. For example, the fusion and dispersal of meaning characteristic of the associative spread, yet fixed preoccupation, of psychosis influenced the development of Freud's concepts of condensation and displacement. Similarly, his depiction of the unconscious as timeless, without contradiction and possessing an internal, not external, reality, is steeped in the phenomenology of psychosis. His later descriptions of the id draw on affectively cataclysmic aspects of psychosis (volcanic upheaval, the seething caldron). For Freud, libido itself had not only a plasticity and fluidity, but also a relentless drivenness that, if unchecked and rerouted, would amount to madness. Thus, Freud was able to describe an aspect of the infantile mind as out of contact with the outside world and given to hallucinatory, wish-fulfilling operations. A radical disregard for usual boundaries, which is so characteristic of psychosis, runs through Freud's descriptions of unconscious processes. It is as if Freud is saying that the human psyche is rooted in the same type of world the psychotic lives in, that, in some sense, psychotic experience has a certain primacy. From this vantage point, neurotic defenses arise, in part, to master or restructure a basic psychotic propensity. A basic madness thus informs human life, and sanity (including neurotic sanity) is a positive and, possibly, a heroic achievement.

Freud emphasized his position when he informally spoke of psychosis as an irruption of the unconscious and a weakening of the ego's ties with reality. For Freud, psychosis represents a more extreme, fundamental dominance of the pleasure principle, primary process thinking, and the id than neurosis represents. If repression (the cornerstone of psychoanalysis) has difficulty maintaining itself in neurosis, it is still more defective and more fragile in psychosis, to the point of seeming to disappear entirely.

To be sure, Freud, formally, in his explicit theoretical statements, saw neurosis as opposing perversion.⁵ In his official doctrine, neurotic defenses structured the psyche's polymorphous perverse disposition, and, especially, contrasexual tendencies. But his image of the deepest psychic events uses psychotic phenomena as its model. For example, he depicted dream life as a psychosis that occurs for every individual each night. To take only one of his references, virtually at random:

A dream, then, is a psychosis, with all the absurdities, delusions and illusions of a psychosis. A psychosis of short duration, no doubt, harmless, even entrusted with a useful function, introduced with the subject's consent and terminated by an act of his will. None the less it is a psychosis, and we learn from it that even so deep-going an alteration of mental life as this can be undone and can give place to normal function. Is it too bold, then, to hope that it must also be possible to submit the dreaded spontaneous illnesses of mental life to our influence and bring about their cure?⁶

This affirmation of hope came near the end of Freud's life. The dream remained, to the end, "the royal road to the unconscious," and his association of dreams with psychosis runs through his entire oeuvre. This strong association again suggests that the phenomenology of psychosis played a fundamental role in Freud's depiction of the unconscious.

As Freud developed his views on narcissism, he wrote that psychosis might be the key to the understanding of the human ego. "just as the transference neuroses have enabled us to trace the libidinal instinctual neuroses, so dementia praecox and paranoia will give us insight into the psychology of the ego."⁷ He developed his theory of narcissism, in part, as a response to the phenomena of psychosis as he understood them.

A pressing motive for occupying ourselves with the conception of a primary and normal narcissism arose when the attempt was made to subsume what we know of dementia praecox (Kraepeiin) or schizophrenia (Bleuler) under the hypothesis of libido theory. . . . Let me insist that I am not proposing here to explain or penetrate further into the problem of schizophrenia, but that I am merely putting together what has already been said elsewhere, in order to justify the introduction of the concept of narcissism.⁸

He postulated an "original libidinal cathexis of the ego" (a "primary narcissism," which unified earlier and diffuse autoerotic impulses) as a frame of reference in which to situate what he called the two principal characteristics of psychosis: megalomania and "the diversion of interest from the external world, from people and things." Psychosis makes markedly explicit a megalomanic dimension that runs through human life.

Thus we form the idea of there being an original libidinal cathexis of the ego, from which some is late...

Table of contents

• Cover
• Half Title
• Title
• Dedication
• Copyright
• Contents
• PREFACE
• ACKNOWLEDGMENTS
• CHAPTER ONE The Core of Psychosis
• CHAPTER TWO Hallucination
• CHAPTER THREE Mindlessness
• CHAPTER FOUR Boundaries
• CHAPTER FIVE Hate
• CHAPTER SIX Epistemology and Reversal
• CHAPTER SEVEN Schreber and Rena
• CHAPTER EIGHT The Psychotic Self
• EPILOGUE
• REFERENCES
• INDEX