ABSTRACT

With a psychotic disorder, the precarious psychic coherence can be maintained only by sacrificing a sense of reality and vital affects. The ultimate defence against the escalation of psychic trauma is then resorting to a delusion which is no longer framed by primary identification but refers to autoerotic excitation and bizarre bodily sensations, forming a surrogate frame of reference for the individual’s psychic survival.

Correspondingly, the therapeutic setting should, in the first place, represent the same human frame of reference that the parents originally brought to the child’s id-perception, which the psychotic patient has fatefully lost by falling ill. This task is possible if the analyst is in genuine touch with the particular vulnerability of psychotic individuals. Perhaps the greatest value of the metapsychological models lies in providing the means for a definitive understanding of an individual’s helplessness in this delicate territory of human vulnerability.