Psychosis and Near Psychosis: Ego Function, Symbol Structure, Treatment, 3rd Edition

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The goal of psychotherapy as formulated in this revision of a classic text is to improve ego function of severely disturbed patients who are often hospitalized. This book shows why and how. It describes the psychotherapeutic techniques that aid patients to understand the meaning of the psychotic symbols so that they can experience reality and their emotions as separate entities. Medication effects and the neurobiology of psychotic and near psychotic patients are explained and evaluated in terms of specific ego dysfunction so that psychopharmacology may be targeted. With the first edition originally a recipient of the prestigious Heinz Hartmann Award, this valuable resource is a go-to guide for clinicians who treat patients suffering from crippling mental disorders.

Darian Leader on Psychosis

Lambeth and Southwark Mind's 2016 annual lecture. Darian Leader, a leading thinker and psychoanalyst, talks about the importance of thinking about psychosis and our responses to it. We can see the psychotic individual as attempting forms of self-cure, and the role of the analyst maybe to act as "secretary", to help this process. This modest role is in fact crucial in holding the patient together. This is one of many ideas formulated in this wide ranging lecture.

Books by Darian Leader:

• Hands: What We Do with Them - and Why

• On the Marketing of Depression

• What is Madness?

• The New Black: Mourning, Melancholia and Depression

• Why do women write more letters than they post?

• Why Do People Get Ill?: Exploring the Mind-body Connection

• Strictly Bipolar

• Introducing Lacan: A Graphic Guide

The Seed of Madness: Constitution, Environment, and Fantasy in the Organization of the Psychotic Core

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More and more individuals with ego defects, severe object relations conflicts, affective turbulence, and unassimilated contradictions are seeking help from psychoanalysts and psychotherapists. Contributors to this book explore hereditary and constitutional factors, environmental influences and unconscious fantasies in the development of the psychotic core in such patients and provide guidance for psychoanalysts and psychotherapists to hear and therapeutically respond to these patients' uncanny ways of describing their internal worlds.

This volume includes contributions by experienced clinicians from Europe and the United States, as well as case histories illustrating the transformation of the psychotic core and how these patients can develop healthier internal structures. The editors' introductory and closing summaries integrate knowledge dealing with especially difficult patients. By reading this book, psychoanalysts and therapists will be prepared to gain insights as newer neurobiological and psychological research findings become available and, hopefully, enthusiasm about working with individuals with 'the seed of madness'.

Incandescent Alphabets: Psychosis and the Enigma of Language

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Psychosis, an invasion of mind and body from without, creates an enigma about what is happening and thrusts the individual into radical isolation. What are the subjective details of such experiences? This book explores psychosis as knowledge cut off from history, truth that cannot be articulated in any other form.

Delusion is a new language made of 'incandescent alphabets' that the psychotic adopts from imposed voices. The psychotic uses language in a singular way to found and explain a strange experience that he or she cannot exit. Through the exegesis of language in psychosis based on first person accounts, the book orients readers to an enigmatic Other, pervasive and inescapable, that will come to inhabit every aspect of the psychotic's being, thought and bodily experience. The book deploys a poetics as a form of inquiry to give a nuanced picture of delusion as a repair of language itself, following Freud and Lacan - in historic and contemporary forms of psychotic art, writing and speech. Drawing on the author's own experience of psychosis and psychoanalysis, as well as conversations with analyst colleagues, Dr Rogers offers ways to listen to language in delusion, and argues for the promise of a modified psychoanalytic treatment with psychosis.

Fighting Melancholia: Don Quixote's Teaching

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Françoise Davoine has been investigating psychotic phenomena and trauma for over thirty years, in collaboration with Jean-Max Gaudillière. In this book, she draws on her literary background to take the reader on a fascinating voyage with an unexpected but most helpful guide: Don Quixote.

In her work, Davoine approaches madness not as a symptom, but rather as a place, the place where the symbolic order and the social link have ruptured. She sees the psychotic as a seeker, engaged in a form of exploration into the nature and history of this place. This brings us to the seeker Don Quixote. Davoine takes the reader into the world of the knight-errant, to describe his adventures in a fascinating new light.

Cervantes, the survivor of war trauma, captivity, and all manner of misfortunes, created this hero, first and foremost, so that the tale be told. Moreover, he created a necessary dyad: Don Quixote and Sancho Panza. Davoine sees the latter as a 'therapon', a second in combat and ritual double, Don Quixote's therapist. Like Sancho, the therapist is a comrade-in-arms, confronting trauma with the patient. Through transference, a significant relational bond develops. In Fighting Melancholia: Don Quixote's Teaching, Françoise Davoine offers a reading of Cervantes' novel from this perspective. Scene after scene, battle after battle, the epic tale is retold as a story of healing.

We live in times of world-wide violence, disruption, and disaster. Trauma is unavoidable. But Davoine points to a way out, through the healing power of symbolic exchange within a human relationship. Aside from being of great interest to all therapists working with psychosis and trauma, this book constitutes a brilliant reminder that all human beings, like knights-errant, aspire to 'become valiant, generous, magnanimous, courteous, dauntless, gentle, patient', as Cervantes says.

Making Room for Madness in Mental Health: The Psychoanalytic Understanding of Psychotic Communication

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In this book, Marcus Evans argues that in addition to providing a helpful treatment for patients who suffer from serious psychological difficulties, psychoanalytic thinking can also help mental health staff develop a better understanding of their patients and complement other ways of thinking about mental disturbance. Mental health professionals need to be receptive to their patients’ projections and communications, but these powerful projections can become overwhelming, especially for clinicians who are in direct contact with their patients for long periods of time. A psychoanalytic model which puts the understanding of the relationship between the clinician and patient at the centre of its preoccupations can also give mental health professionals a language for describing their experiences of, and interactions with, their patients. This model is developmental and provides a dynamic picture of the ways in which different parts of the patient’s self wrestle for control of the patient’s mind over time. Evans argues that this framework for understanding can help in the day-to-day management of these changes and fluctuations.

Evans believes that the diagnosis and active interventions employed by psychiatry need to be accompanied by a receptive approach to treatment and care. Mental health professionals need to be interested in the meaning of their patient’s symptoms and verbal and physical communications. These may convey important information about the patient’s internal world and underlying conflicts. This receptive approach requires mental health professionals to make a switch from the active state of mind demanded by active interventions, to the receptive state of mind required by the need to take in the patient’s emotional state and underlying personality structure.

Making Room for Madness in Mental Health draws on the author’s extensive experience of working psychoanalytically with people with severe and enduring mental illness, as well as providing psychoanalytic supervision and consultation in a range of mental health settings to show how psychoanalytic ways of thinking may complement other approaches to mental disturbance by highlighting the communication and meaning of such disturbance. This is illuminated by lively clinical vignettes, supported by accessible accounts of key psychoanalytic theory.

Working with people with mental illness can be rewarding and enlightening. It can also be disturbing, frightening, boring, frustrating, anxiety provoking and stupefying. Evans argues that we need to provide room and space for mental health professionals to reflect upon and think about their experiences on a day-to-day basis, and to train clinicians to senior levels in order that they can offer clinical supervision to front-line staff, which can help them develop ideas about the meaning of their patients’ symptoms and behaviours. Psychoanalysis offers a model for thinking about and providing meaning for, the anxieties that drive us ‘out of our minds’, and this can reduce the risk of thoughtless action. To some extent this involves putting the madness back into mental health.

The Logics of Madness: On Infantile and Delusional Transference

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In this book, Salomon Resnik describes his psychoanalytic work with psychotic patients and the logic that underlies their often-delusional constructions. He explores how the concept of psychosis has evolved over time and shows how the delusional world, with its proto-symbolic equations, may amount to a philosophy of life. Clinical examples taken from his own clinical work, both in individual psychoanalysis and in group therapy with schizophrenic patients, illustrate his theses.

In his exploration of the psychotic ego and multi-dimensionality, he shows how his work is a continuation of the ideas initially put forward by psychoanalysts such as D. W. Winnicott, Melanie Klein and Hanna Segal, as well as how much it owes to his own analysis with Herbert Rosenfeld and supervision with Wilfred Bion. For Resnik, working with psychotic patients amounts to an “archaeology of the present”. He discusses in detail such concepts as narcissistic depression, the atmosphere of the psychoanalytic encounter, the role and impact of dreams in psychosis, and the dimensionality of the psychotic universe. His development of the idea of maternal (holding function) and paternal reverie, with its organizing and structuring function, is ground-breaking, and his comments on Fairbairn's description of the early splitting of the ego throw a new light on hysterical phenomena in the psychoses.

Treating People with Psychosis in Institutions: A Psychoanalytic Perspective

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This book brings together the histories of a number of psychoanalytically-informed hospitals, and provides a synthesis of the theoretical underpinnings in the institutional practice of each. Of particular interest is how psychoanalysts and psychoanalytically-trained staff working in institutions apply their theoretical understanding, and in what ways the psychoanalytic technique has been modified or adapted to the treatment of individual patients with psychosis and to the workings of an institution in general.

Here the institution is the subject of the case study. Institutions that are theoretically orientated to psychoanalysis were chosen and examined, taking into account their various approaches to the treatment. A number of institutional models that are informed by psychoanalysis offer a guide to the treatment and present a version of institutional practice that is different from the prevailing models in psychiatry. This has implications for health services in the current climate of mental health reform.

Psychoanalysis has its greatest efficacy in long-term treatments and has shown its suitability for patients diagnosed with psychosis when the method is adapted to the uniqueness of each person and is conducted by an experienced clinician. The treatment of psychosis cannot usually be conceived without considering some form of institutional care, although this does depend on the level of the individual’s psychopathology. This is because the majority of people with a psychotic illness, especially those with schizophrenia, will be exposed to inpatient, community or outpatient treatment, in one form or other, during the course of their lives.

CONFERENCE: Psychosis and Psychoanalysis - 20 March 2016, Freud Museum London

History - Politics - Theory - Technique

Giotto di Bondone, detail from The Last Judgement, 1304-05

Organised in collaboration with the Psychosis Therapy Project, a therapy service for people experiencing psychosis.

The relation between psychosis and psychoanalysis is a paradoxical one. Psychosis is a core term in the theory of psychoanalysis, a site of clinical challenges and radical questioning. Yet it has no place in classic psychoanalytic technique.

Is there a place for psychosis in psychoanalysis? Is there a place for psychoanalysis in psychosis?

This one-day conference brings together eminent practitioners of psychoanalysis from a variety of theoretical perspectives to discuss these complex and topical questions. Drawing on their important contributions to the area of psychosis, the speakers will reflect on the political, theoretical and technical implications of their work.

More info here. 

SPEAKERS AND TITLES

Haya Oakley: Life in the “Anti-Psychiatry” Fast Lane

Brian Martindale: Family and Psychosis (Past & Present)

Jay Watts: Navigating Language Games around Psychosis

Barry Watt: The Politics of Kleinian Technique in Post-war UK (TBC)

Kate Brown: Attachment Theory and Psychosis

Stijn Vanheule: Conceptualising and Treating Psychosis: A Lacanian Perspective

Clinical Rountable moderated by Gwion Jones:
Dorothée Bonnigal-Katz (Presenter)
Christos Tombras and Tomasz Fortuna (Respondents)


SPEAKERS' BIOGRAPHIES:

Dorothée Bonnigal-Katz is a psychoanalyst and a translator. She is a member of the SITE for Contemporary Psychoanalysis and one of the editors of Sitegeist: A Journal of Psychoanalysis and Philosophy. She is the founder of the Psychosis Therapy Project. She has translated a number of psychoanalytic works including Dominique Scarfone’s Laplanche: An Introduction (2015) and she translates for the International Journal of Psychoanalysis on a regular basis.

Kate Brown is a Bowlby Centre trained UKCP registered attachment based psychoanalytic psychotherapist who started her career in therapeutic communities working with adults with a variety of mental health difficulties, and with adolescents individually and in groups. She has worked with young mothers and in mainstream community psychiatric services with patients’ families. She has also provided time limited therapy with former servicemen who had experienced complex trauma. She teaches at The Bowlby Centre and has also delivered freelance training. Kate completed an MSc in psychotherapeutic approaches in mental health in 2012. She is a member of the Attachment Journal editorial group, former chair of the clinical forum at The Bowlby Centre. Kate has recently begun a PhD in the psychoanalysis department at Middlesex University in the history of the therapeutic community movement and the treatment of trauma. Kate has recently moved to Bournemouth where she will be developing a private practice.

Dr Brian Martindale is a psychoanalyst and psychiatrist. He was founder (with colleagues) of the EFPP, the European Federation of Psychoanalytic Psychotherapy in the Public Sector, its first chairperson and is now Honorary President. He was chair of the ISPS, International Society for the Psychological and Social Approaches to Psychosis from 2010-2015 and past editor of the ISPS book series. He is now an Honorary Lifetime Member. He represented psychiatry for Western Europe to the World Psychiatric Association (WPA) for six years. After many years as a Consultant Psychiatrist in Psychotherapy, he worked in a NHS early intervention in psychosis service for 7 years before retiring in 2012 and now works in private practice outside Newcastle.

Haya Oakley has been practising psychoanalysis in London since 1968. After a brief spell at the David Cooper 'anti-university' group she joined the Philadelphia Association where she worked for many years with R.D. Laing and colleagues training psychotherapists and working in 'therapeutic households'. In 1997 she left the Philadelphia Association and set up, with others The Site for Contemporary Psychoanalysis. She has been a member of the Guild of Psychotherapists since 1982 and is a founder member of The College of Psychoanalysis UK. Honorary Fellow of UKCP. Haya’s interests include the politics of psychotherapeutic organisations, the issues surrounding State regulation of the 'impossible profession', the comparative study of psychoanalytic theories and the question of psychosis. Haya is involved in teaching, supervising and analysing and has contributed to a number of publications as well as TV and radio programmes.

Christos Tombras trained as a psychoanalyst with the Centre for Freudian Analysis and Research. He is a member of CFAR and of the College of Psychoanalysts - UK, and has his private practice in North West London. His research interests include the relationships between psychoanalysis and continental philosophy.

Stijn Vanheule is professor of psychoanalysis and chair of the Department of Psychoanalysis and Clinical Consulting at Ghent University (Belgium), and a psychoanalyst in private practice (member of the New Lacanian School for Psychoanalysis and World Association of Psychoanalyse). He is the author of The Subject of Psychosis – A Lacanian Perspective (Palgrave Macmillan, 2011) and Diagnosis and the DSM – A Critical Review (Palgrave Macmillan, 2014), and of multiple papers on Lacanian and Freudian psychoanalysis, psychoanalytic research into psychopathology, and clinical psychodiagnostics.

Barry Watt is a psychoanalyst in private practice and a member of the SITE for Contemporary Psychoanalysis. He is one of the senior practitioners at the Psychosis Therapy Project as well as a housing advocate and community activist.

Dr Jay Watts is a Clinical Psychologist and Psychotherapist working from Systemic and Lacanian orientations. She is Honorary Senior Research Fellow at Queen Mary, University of London, as well as being in full time private practice. Jay has held a number of senior academic and NHS posts, including leading Early Intervention in Psychosis and Integrative Psychotherapy Teams, heading research for a NHS trust, and developing teaching modules as Senior Lecturer in Counselling Psychology at City University. Jay continues to teach on a number of Clinical and Counselling Psychology trainings, and has published widely. She is Practice Editor for the European Journal for Counselling and Psychotherapy, and is Foreign Correspondent for ‘Mad in America’.

Creativity and Psychotic States in Exceptional People: The Work of Murray Jackson

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Creativity and Psychotic States in Exceptional People tells the story of the lives of four exceptionally gifted individuals: Vincent van Gogh, Vaslav Nijinsky, José Saramago and John Nash. Previously unpublished chapters by Murray Jackson are set in a contextual framework by Jeanne Magagna, revealing the wellspring of creativity in the subjects’ emotional experiences and delving into the nature of psychotic states which influence and impede the creative process.

Jackson and Magagna aim to illustrate how psychoanalytic thinking can be relevant to people suffering from psychotic states of mind and provide understanding of the personalities of four exceptionally talented creative individuals. Present in the text are themes of loving and losing, mourning and manic states, creating as a process of repairing a sense of internal damage and the use of creativity to understand or run away from oneself. The book concludes with a glossary of useful psychoanalytic concepts.

Creativity and Psychotic States in Exceptional People will be fascinating reading for psychiatrists, psychotherapists and psychoanalysts, other psychoanalytically informed professionals, students and anyone interested in the relationship between creativity and psychosis.

Working With Difficult Patients: From Neurosis to Psychosis

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In this book the author examines the series of connections that give rise to the intimate relationship between environment and individual in the construction of emotional suffering, emphasising both the undisputed pathogenic action of environmental stimuli and the active participation of whoever is obliged to suffer the negative situation. Franco De Masi shows that the way in which one tries to escape suffering is what often seriously jeopardises growth.

The aim of Working with Difficult Patients is to point out the intrinsic link between some forms of mental suffering and the distorted responses that the patient has received from his or her original environment. For this reason the author explores the concept of the emotional trauma in particular, since this trauma, which occurs in the primary relationship, often impels the child into relational withdrawal and towards constructing pathological structures that will accompany him or her for the rest of their life. The chapters are ordered according to a scale of increasing treatment difficulty, which is proportional to the potential pathogenicity of the underlying psychopathological structure. Consequently, the borderline state and the psychotic state are located at either end of an axis of progressive complexity and difficulty towards change.

The author endeavours to set out a panorama of the main psychopathological entities as he has encountered them and indeed still encounters them in his clinical activity, presenting the material according to a criterion that highlights the differences between the individual case histories. A number of chapters in the second part of the book attempt to clarify the various psychic processes that underlie some frequently encountered psychopathologies.

Sexual Ambiguities: Sexuation and Psychosis

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How does one become a man or a woman? Psychoanalysis shows that this is never an easy task and that each of us tackles it in our own, unique way. In this important and original study, Genevieve Morel focuses on what analytic work with psychotic subjects can teach us about the different solutions human beings can construct to the question of sexual identity.

Through a careful exposition of Lacanian theory, Morel argues that classical gender theory is misguided in its notion of 'gender identity' and that Lacan's concept of 'sexuation' is more precise. Clinical case studies illustrate how sexuation occurs and the ambiguities that may surround it. In psychosis, these ambiguities are often central, and Morel explores how they may or may not be resolved thanks to the individual's own constructions. This book is not only a major contribution to gender studies but also an invaluable aid to the clinician dealing with questions of sexual identity.

Childhood Psychosis: A Lacanian Perspective

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Childhood Psychosis is a well-structured and informative study that explores childhood psychosis and its different manifestations in depth, with special emphasis on the relation between psychosis and autism. Tendlarz uses clinical cases to illustrate different aspects of psychoanalytic theories and treatments.