Understanding psychotic disorder

Abstract

Understanding another person's mind is based on a shared frame of reference that derives from primary identification. In a psychotic disorder, this metaphorical configuration becomes damaged, leaving the ego in a state of extreme helplessness. To safeguard at least a minimum of psychic survival in this situation, the helpless ego resorts to a delusion that will form a surrogate frame of reference, which is no longer linked to primary identification, but to autoerotic excitations and self-induced affect states. The treatment of a psychotic patient should aim at the recovery of the original frame of reference based on primary identification and represented by the analyst in the analytic setting. The shared understanding of the patient's extreme helplessness paves the way for the unfolding of object directional needs and wishes in the therapeutic relationship and for their gradual internalisation into a more solid psychic structure.