Original article

Korean Journal of Schizophrenia Research 2010;13(1):9-14.

A Condensed Outline of the Psychotic Mind and Its Treatment

Gustav Schulman, MD

Abstract

The fundamental goal is to strengthen the mind so that it will become more able to bear the painful and/or unbearable perceptions, affects, and feelings. This makes development of the sense of reality possible. The enforcing occurs by repeated experiences of being contained in the here and now by the analyst, who has repeatedly to demonstrate his capacity to bear and understand what is intolerable for the patient. The patient will be able to internalize this function piecemeal. However, this process is frightening and fiercely resisted by the psychotic, because he will experience the return of the dissociated traumatized experiences and motivations as a traumatizing attack on his psychotic identity. The fundamental changes take place on the pre-symbolic level of affect tolerance, impulse control, and judgment. Integration of the dissociated parts of the self occurs by internalizing and assimilating the containing object with its containing capacities. The internalized resilient object will diminish the need to use massive splitting and pathological projective identification and make dismantling of the psychotic defenses and objects possible. The analyst will inevitably face massive aggression by the psychotic self as it fights for its existence against the analyst, who stands for reality - the very thing it cannot bear. The patient may be convinced that the analyst is annihilating him, when the dissociated parts return. When properly contained, these moments are, however, breakthroughs into reality and not break downs, as the patient fears. (Korean J Schizophr Res 2010;13:9-14

Key Words: Treatment of psychosis,Schizophrenia,Splitting.