Trauma and psychosis: A review and framework for psychoanalytic understanding

Abstract

Empirical research substantiates Ferenczi's conception of the etiological importance of early neglect and abuse in the development of psychosis. Abuse can derail the development of language, identity, and social relationships that are intrinsic to schizophrenia, possibly through undermining secure attachment relationships. The Lacanian emphasis on language and early proto-dialogues with the Other can be useful in understanding this process. Some therapeutic implications for psychoanalytic approaches to the treatment of psychosis are proposed.

Key words:

• trauma
• psychosis
• symbolization
• attachment

Notes

¹Of course, psychoanalytic approaches to psychosis were pursued at places working in the interpersonal tradition, such as Chestnut Lodge Hospital, in Maryland, and in Kleinian centers. The results of this form of intensive treatment were disappointing. (McGlashan, 1988; Lucas, 2009). The International Society for Psychotherapy of Psychosis has represented analysts working in the area of psychosis for many years. Their contributions cannot be assessed in this article.

²See the rationale for exclusion in the 2003 PORT recommendations (Lehman et al., 2004).

³Karon's record of research is unusual in this respect, but it does not meet the criteria of groups like PORT for “evidence-based” treatment.

⁴Brentall (2003), a cognitive psychologist, has been a strong voice in questioning the categorical diagnosis of schizophrenia in favor of the effects of specific individual experiences.

Additional information

Lewis A. Kirshner, MD, is a training and supervising analyst at Boston Psychoanalytic Society. He is the author of Having a life: Self-pathology after Lacan (Analytic Press, 2003) and editor of Between Winnicott and Lacan: A clinical engagement (Routledge, 2011).