Introduction

The term “neurosis” was coined by William Cullen to denote a nervous system disease, about a quarter century before Freud’s groundbreaking work. Freud co-opted the term and gave it psychological meaning as the cornerstone around which he constructed psychoanalysis. His theory has been modified in particulars by his successors over the past century, but its essential elements of infantile intrapsychic conflict, repression, unconscious mind, and re-emergence of the repressed in disguise remain as the psychoanalytic model of mind and its pathological aberration. The purpose of this chapter is to introduce psychoanalysis to psychosis in a way that is internal to psychoanalysis and at the same time independent of the neurosis model and the biases that attend upon it. The basic assumption of the brain defect model has permeated psychoanalytic efforts to understand psychosis, as well. As a consequence, the concept of psychosis has a place in mental health analogous to that of leprosy in medicine.