ABSTRACT
Psychosis is the reiteration of human alienation at a number of systems levels. It begins with the alienation of mother from infant. It moves to the alienation of unintegrated aspects of the psychotic person’s mind from one another, and the alienation of the person from others perceived in an undifferentiated way as threatening aspects of self. The final iterations include alienation of others from the psychotic person believed to be less than human, and the centuries-old belief codified in social, psychiatric, and psychoanalytic attitudes that psychotic persons are constitutionally defective.
The basic themes of the book are recapitulated. These include the limitations of both the psychiatric and psychoanalytic models of psychosis based on the explicit or implicit assumption that the ailment results from a bio-genetic defect, limitations based on the idea that all mental illness lies on a single developmental continuum leading to a normal/neurotic personality, and limitations based on failure to recognize the critical formative role of the mother–infant relationship. Freud’s success organizing a movement with religious overtones to perpetuate his thinking has made it difficult for subsequent generations to address his ideas in a discriminating thoughtful way and is responsible for the perpetuation of his false and limiting beliefs about psychosis. Extrapolating from Freud’s discovery of the primary process, a model of two conscious mental processes and the role of the attachment–separation phase in determining their developmental vicissitudes and personality outcome is proposed. The manifestations of psychosis vary on a scale related to the severity of impairment of attachment and resultant separation–individuation and the consequent stage of in the life cycle in which the florid elements of the illness become apparent.
Problems related to treatment are reviewed, including, in addition to the severity of the illness, the pathogenic role of society in unwittingly fostering chronicity by stigmatizing and dehumanizing the condition and promoting treatments that are aimed at minimizing the social disturbance and promoting superficial compliance at the expense of reinforcing the underlying psychotic process and its chronicity. It is hoped that the revised model of psychosis and its treatment will help to foster a more humane understanding of the illness and point the way to treatment designed to promote individual personality growth.
