Psychotic Personality – What is Psychosis?

At the end of the psychotic spectrum, people are much more devastated and disorganized. Psychoanalysis of an agitated patient can vary from a pleasant conversation to the possibility to become a victim of the attack which has its purpose to murder. Before the antipsychotic drugs in the 1950s, few therapists had a natural talent of intuitive and emotional stamina, to have a significant therapeutic effect on people who are in psychotic state. One of the greatest achievements of psychoanalysis was a certain order in an apparent chaos of patients who were cast as mad and incomprehensible people.

Those patients who are in a state of psychosis are not hard to diagnose: they have hallucinations, delusions, ideas of reference and illogical thinking. However, around a lot of people who are on psychotic character level of the organization, but their inner turmoil is not visible if they are not under a sever stress. Knowing that in the course of psychotherapy, you, as therapist, deal with “compensated” schizophrenic or prone to suicidal depression patient, can mean the different between prevention and provoking someone’s death. In this section it will be explained to the reader the scheme of some human features with a fragile psyche.

First, it is important to understand the defense used by psychotic people. This is the escape to fantasy, denial, total control, primitive idealization and devaluation, primitive forms of projection, splitting and dissociation. These defenses are verbal and nonverbal; they protect the psychotic personality from the archaic fear is so overwhelming that even the frightening distortions created by the defenses seem to be less evil.

Secondly, people whose identity is organized on a psychotic level, have serious difficulties with the identification – they are not confident in their own existence, even more than that their life is satisfactory. They are confused about who they are. These patients usually resolve these basic issues of self-determination, as the concept of the body, age, gender and sexual orientation. Questions: “How do I know who I am?” or even “How do I know that I exist?” are not usual for people with psychotic constitution. They are given very seriously and it is an essential feature of their psychology. They also can not rely on the experience of others as to the experience of having their own continuity. When the analyst asks to describe themselves or other people, their descriptions are usually obscure, concrete or obviously distorted.

Often there is almost imperceptible, that a patient with a psychotic personality is not rooted in reality. Although most people have the remnants of magical ideas (God decided to send the rain, because I forgot my umbrella), careful study will show that such beliefs are not strange for their Ego. They are usually far from universally accepted representations of “reality” or completely entangled in them. While these people may be supernaturally responsive to stimuli, the underlying situation they often do not know how to interpret their meaning and give them a personalized sense.

People with a tendency to psychotic breakdowns are not able to step back from their psychological problems and treat them without passion. Perhaps, in terms of cognitive deficits that may be associated with difficulties of schizophrenia. Even those patients who are mastered in jargon to pretend that they are capable of introspection (“I know that I have a tendency to over-reaction” or “I do not always guide the time, space and identity”) show an attentive to reduce anxiety, they repeat what they had head about themselves.

Early psychoanalytic formulations concerning the difficulties faced by people with psychotic state, predict the consequences of their misconceptions about reality, emphasized the energy aspect of the dilemma, saying that they spend too much energy to fight the existential horror and to assess the reality does not remain forces. Models of ego psychology and psychotherapy highlight the lack of internal differentiation of psychotic personality ID, Ego and Super-ego, as well as differences between observed and experienced aspects of the Ego. Researchers of psychosis refer to the confusion of boundaries between inner and outer experiences and to the lack of basic trust which makes entry into the world of uncertainty, where the therapist abides too dangerous psychotic. Perhaps a full explanation of the lack of psychotics “observing ego” includes all these elements, as well as some constitutional, biochemical, situational and traumatic aspects. Those who want to help these people need to realize that potential or overt psychotics are very close to the fear and terrible chaos.

The nature of the basic conflict of depressive people is existential life or death, the existence of destruction of safety or fear. Their dreams are filled with chilling images of death and destruction. “To be or not to be” – is the repeating topic. The psychologist – psychotherapist Laing described these patients as suffering from “an ontological vulnerability”. A study of psychoanalysis, under the control of schizophrenic families in the 1950s and 1960s, showed the patterns of emotional communication where a psychotic child received hidden message which implied that he is not a separate person but a continuation of someone else.

Although the discovery of major tranquilizers distracted attention from the psychological studies of the processes associated with psychosis, no one has yet provided evidence which would refute the observation that the psychotic personality is skeptical of his right to exist as an individual, or perhaps not familiar with the feeling of existence.

Patients whose structure belongs to the psychotic level, the counter-transference of the analyst is often very positive. The nature of this good sense is different from that which characterizes the counter-transference reactions f the neurotic level with customers. Typically, in relation to the psychotic people there is more power of parental protection and deep emotional empathy than for neurotics. The expression “favorite schizophrenic” was popular as an expression of sympathy, which therapists often showed toward their ill patients. (A striking contrast is a group and in the future this will be discussed, the population of borderline patients). Psychotic patients are so desperately in need of basic human relationships and hoping that someone will be able to alleviate their misery and loneliness they will be grateful and responsive to each physician who will make something more than simply will classify and treat them.

People with psychotic tendencies are fond of the sincerity of the therapist. Cured of schizophrenia, a woman once told that she could even forget the serious shortcomings of her therapist, had considered them “honest mistakes”. Psychotic patients also appreciate the educational efforts of the therapist towards normalization or transformation of their prejudices. This tendency the therapist can experience his power and grace to the patient.

On the other side of a painful addiction of the patient to the therapist is responsible. In fact, the process of counter-transference is similar to the normal feelings experiences by the mother to the child under the age of fifteen years: the children are delight by their affection and are scared of their needs. They are not in opposition and not angry, but straining your resources to the limit. “I would not work with schizophrenic – said one analyst – if I was not ready to be eaten alive”.

This “consumer” feature is one of the reasons why many therapists prefer to work with schizophrenic people. Besides it, the access to the deep psychotic personality disturbing realities that others would prefer to ignore is often too great for us. The other reasons of their unpopularity are: lack of adequate training for therapists in the psychotherapy, the economic pressures that fuel streamline regarding the limited approached or “management” rather than psychotherapy, as well as personal inclination is not to work with relatively modest goals than those that could be achieved with the personalities with neurotic level. Working with psychotic clients may not be effective and bring professional satisfaction for therapist if you stick to a realistic view of the nature of psychological difficulties.