Mourning and psychosis: a psychoanalytic perspective

The author attempts to develop some of the basic models and concepts relating to mourning processes in psychotic patients on the assumption that situations of loss and mourning are key moments for psychoanalysis, psychotherapy, and therapeutic approaches in general. Secondly, he reminds us that 'mourning processes in psychotics' are not always 'psychotic mourning processes', that is to say, that they do not necessarily occur within, or give rise to, a psychotic clinical picture. These ideas are illustrated by a number of sessions and vignettes concerning two psychotic patients in psychotherapeutic and psychoanalytic treatment. In theoretical terms, it seems vitally important in this context to combine a relationship-based approach within a framework of special psychoanalytic psychopathology with an updated view of processes of mourning and affective loss. A fundamental requirement at clinical level is to determine the role to be played by psychoanalytically based treatments in combined, integrated or global therapies when working with psychotic patients. For this purpose, the paper ends by outlining a set of principles and objectives for such treatments.