Psychosis as a sacrifice of sovereignty

ABSTRACT

In this work, I explore psychosis as an intersubjective state. Positing the importance of an early traumatic loss of a significant figure, I describe a situation in which a caregiver is not able to achieve separateness and unconsciously relates to their child as a replacement for the beloved lost object. The child unconsciously interprets this complicated state as a plea to abandon separateness and exist as a part of the caregiver’s inner world. This act of surrender is unconsciously phantasised by the child as a means of preserving the aliveness of the caregiver’s central internal object, which holds the caregiver’s subjectivity together. In unconsciously fulfilling the role of protector of his caregiver’s sanity, the child becomes bound by the psychotic anxiety that demonstrating autonomy will destroy this state of merger causing the caregiver’s mind to disintegrate. The child thus feels that he cannot develop himself without risking the caregiver’s collapse and must therefore become ‘nobody’ or ‘no-thing’, often psychotic and sometimes suicidal. I describe a continuum of pathology dependent on the caregiver’s ability to differentiate their child from their forsaken object. I present a clinical example of psychoanalytic psychotherapy with a five-year-old boy who suffered from psychotic anxiety about bodily fragmentation, and the accompanying work with his mother, who was neglected in her childhood. I discuss the essential elements of playing, which were crucial in reaching this boy in his psychotic, near-death state. The implications of this theoretical view illustrate the repercussions of self-sacrifice on a child’s ability to accept help.

KEYWORDS:

• Childhood psychosis
• psychotic states
• relational trauma
• symbiosis
• Winnicott

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Due to the patient’s age, his parents were approached for consent to publish the clinical material included in this paper. They read the paper, and gave permission on their own, and their child’s behalf. All identifying features have been changed.

Additional information

Notes on contributors

Yaakov Roitman

Yaakov Roitman, Ph.D., clinical psychologist and supervisor, in private practice, Mazkeret Batya, Israel, [email protected]. His area of interest comprises Bion, Winnicott, childhood trauma, autistic spectrum disorders, and childhood psychosis.