Psychotic functioning in adolescence: The perverse solution to survive

Abstract

A psychotic breakdown in adolescence marks the emergence of a manifest aspect of a more complex process that has its origins in the patient's family pre‐history and in the patient's childhood story. This period of life is characterized by a sensorial explosion and adolescents will react differently according to the different resources they have at their disposal. Adolescents will attempt to create defensive solutions in order to face this decompensation on their own. In particular, polymorphously perverse behaviours can be utilized because of their specific characteristics in order to create a potent defence used to arrest a still more severe regression and at the same time providing the time necessary to safely navigate through a difficult and dangerous developmental phase. These solutions can be transitory or transform themselves into lasting defensive adaptations. These defensive modalities are very complex and articulated and can become fossilized in time, as, for example, in the case of a use of perverse defences against a breakdown. An analyst finding him/herself in these situations will find it difficult to differentiate in the diagnosis between a condition that is due to a perverse functioning used as a defence against decompensation, and a truly perverse structure that is beginning to emerge after puberty.

Translations of summary

Psychotisches Funktionieren in der Adoleszenz: die perverse Lösung, um zu überleben

Ein psychotischer Zusammenbruch in der Adoleszenz gibt das Auftauchen eines manifesten Aspekts eines komplexeren Prozesses zu erkennen, der in der familiären Vorgeschichte des Patienten und in seiner Kindheit gründet. Charakteristisch für diese Lebensphase ist eine Explosion der Sinne, auf die Jugendliche unterschiedlich reagieren – je nach den Ressourcen, die ihnen zur Verfügung stehen. Adoleszente versuchen, Abwehrlösungen zu finden, um diese Dekompensation eigenständig zu meistern. Polymorph‐perverse Verhaltensweisen sind aufgrund ihrer spezifischen Merkmale in besonderem Maß geeignet, eine starke Abwehr aufzubauen, die eine noch tiefere Regression verhindert und es Jugendlichen ermöglicht, sich durch eine schwierige und gefährliche Entwicklungsphase hindurch zu navigieren. Diese Lösung können vorübergehender Natur sein; sie können sich aber auch in dauerhafte defensive Anpassungen verwandeln. Diese Abwehrmodalitäten sind hochkomplexer und differenzierter Natur. Sie können sich im Laufe der Zeit verhärten, wie es beispielsweise im Fall perverser, gegen einen Zusammenbruch gerichteter Abwehrmechanismen geschieht. In einer solchen Situation ist es für die Analytikerin schwierig, diagnostisch zwischen einem Zustand, dem perverses, zur Abwehr einer Dekompensation eingesetztes Funktionieren zugrunde liegt, und einer genuin perversen Struktur zu unterscheiden, die nach der Pubertät aufzutauchen beginnt.

El funcionamiento psicótico en la adolescencia. La solución perversa para sobrevivir

Un brote psicótico durante la adolescencia marca el surgimiento de un aspecto manifiesto de un proceso más complejo, que tiene su origen en la pre‐historia familiar del paciente y en su infancia. Este período de la vida se caracteriza por una explosión sensorial, y los adolescentes reaccionarán de manera diferente según los recursos que tengan a su disposición. Intentarán crear soluciones defensivas para enfrentar la descompensación por sí mismos. En particular, pueden utilizar conductas polimorfamente perversas, debido a sus características específicas, para crear una defensa poderosa con el fin de frenar una regresión aún más severa y, a la vez, obtener el tiempo necesario para tramitar de manera segura una fase evolutiva difícil y peligrosa. Estas soluciones pueden ser transitorias o transformarse en adaptaciones defensivas persistentes. Dichas modalidades defensivas son muy complejas y articuladas, y pueden fosilizarse con el correr del tiempo, como, por ejemplo, en el caso del uso de defensas perversas contra un brote. Un/a analista que se encuentra frente a situaciones de este tipo comprobará que es difícil realizar un diagnóstico diferencial entre una condición en la cual el funcionamiento perverso se utiliza como defensa contra la descompensación, y una estructura verdaderamente perversa que empieza a emerger después de la pubertad.

Fonctionnement psychotique à l'adolescence: une solution perverse de survie

Une dépression psychotique à l'adolescence marque l’émergence d'un aspect manifeste d'un processus plus complexe qui a son origine dans la pré‐histoire familiale du patient ainsi que dans l'histoire de son enfance. Cette période de la vie étant caractérisée par une explosion sensorielle, les adolescents réagiront différemment en fonction des diverses ressources dont ils disposent. Les adolescents tenteront de trouver des solutions défensives afin de faire face seuls à cette décompensation. En raison de leurs caractères spécifiques, les comportements pervers polymorphes peuvent notamment être utilisés pour créer un mode de défense puissant, servant à endiguer une régression plus sévère encore en même temps qu’à fournir le temps nécessaire à la traversée plus sécurisée d'une phase du développement difficile et périlleuse. Ces solutions peuvent être transitoires ou bien se voir transformer en des adaptations défensives à caractère durable. Ces modalités défensives, qui sont très complexes et articulées, peuvent se fossiliser avec le temps, comme par exemple dans le cas de l'utilisation de défenses perverses contre une dépression. L'analyste qui aura à faire face à de telles situations aura du mal à établir un diagnostic différentiel entre un état lié à un fonctionnement pervers utilisé comme défense contre une décompensation et l’émergence après la puberté d'une structure véritablement perverse.

Funzionamento psicotico in adolescenza: la soluzione perversa per poter sopravvivere

Il crollo psicotico in adolescenza segnala l'emergere di un aspetto manifesto di un processo più complesso che ha origine nella preistoria famigliare e nella storia dell'infanzia del paziente. Questo periodo della vita è caratterizzato da un'esplosione sensoriale e gli adolescenti vi reagiscono in modi diversi, a seconda delle risorse di cui dispongono. Gli adolescenti cercano di crearsi delle soluzioni difensive per affrontare da soli questo scompenso. In particolare possono far ricorso a comportamenti polimorfi perversi per le loro specifiche caratteristiche, atte a creare una potente difesa utilizzata per arrestare una regressione ancora più grave e, contestualmente, capace di fornire il tempo necessario per attraversare con sicurezza una fase evolutiva ardua e pericolosa. Queste soluzioni possono essere transitorie o trasformarsi in adattamenti difensivi duraturi. Queste modalità difensive sono molto complesse e articolate e possono fossilizzarsi col passare del tempo, come per esempio nel caso di un uso di difese perverse contro il crollo. Un analista che si trovi in queste situazioni, incontrerà delle difficoltà nel fare una diagnosi, a differenziare una condizione dovuta a un funzionamento perverso utilizzato a difesa contro lo scompenso, da una struttura realmente perversa che comincia a emergere dopo la pubertà.

Key words:

• Adolescence
• Psychotic states
• Perversion
• Identity
• Body
• Sexuality
• Sensoriality
• Decompensation
• Defensive solutions
• Breakdown

Notes

1. Meltzer (1973) calls these phenomena ‘zonal confusion’ (mouth–vagina–anus and nipple–tongue–faeces combinations appear). The infant has already learnt to distinguish these elements, but during puberty they can be re‐experienced, sometimes accompanied by an idealization of confusion.

2. Freud writes: “Two psychical attitudes have been formed instead of a single one – one, the normal one, which takes account of reality, and another which under the influence of the instincts detaches the ego from reality. The two exist alongside of each other. The issue depends on their relative strength. If the second is or becomes the stronger, the necessary precondition for a psychosis is present” (1940[1938], p. 201).

3. A group of French authors (Cahn, Chabert, Kaës and Richard amongst others) have coined the term ‘subjectivization’ (Richard and Wainrib, 2006) for this process, first introduced by Raymond Cahn in his 1991 work, Du sujet (1991a). What is meant by this is a continuous transformational process that has its roots in the body and develops in the thoughts, depending always upon the fundamental link with the ‘subjectualizing object’. According to Cahn, this implies the Ego and its functions “but also the self, the phenomenological unity of the person, the Eriksonian identity and Aulagnier's Ego” (Cahn, 2006[2008], p. 17). Adolescence is the most significant time for this.

4. I do not believe that in this specific point the patient was made use of by an all too classical interpretation. It is rather that he needed a change of climate and the well‐meant joke was what at the moment I deemed useful for dampening his sense of persecutory guilt that after the span of all these years had still remained in a much lighter measure within him. But of course it is not easy to dissect in detail what it is that pushes an analyst in a given moment to make one kind of intervention rather than another. But I can without a doubt confirm that the interpretation is not just by itself sufficient for this kind of patient, who is characterized by very primitive mental functionings. I believe that, beyond the interpretation, the patient has a need for an experience that must have to do with “sharing, living in a new emotional climate, feeling understood and lifted up, something that has to do with the primitive mental levels of the analyst in an analytic couple with the patient”.

5. Italian saying.