Psychosis and adolescence. The relation of intrapsychic structure formation and change to action and task

This article is an exploration of intrapsychic structure formation and change from the point of view of a psychoanalytic concept of action. It compares the normal development of intrapsychic structure with that involved in psychotic disorganization as individuals encounter adolescence and its developmental tasks and requirements for action. The flexible complexity of intrapsychic structure and available action in a normally developing adolescent and the contrasting fixed simplicity of intrapsychic structure and its repertory of action in psychotic patients are highlighted. Four different environmental life occasions, all of which are associated with intrapsychic change, are examined against this background. The first of these involves little initial action on the part of the ego, although lasting change does occur. The last three involve both inner and outer developmental actions that can be central to growth and may be the occasion of psychosis. The first environmental life occasion is "trauma," in which the person's action, potentialities, and intrapsychic structure are disrupted by the world's destructive action and are thereby changed. The second is "intimacy," in which newly evolved actions and interaction are sought, often with little regard for or knowledge of the accompanying necessities of intrapsychic change. In the third --"success"--new intrapsychic change and altered necessities of action can surprisingly affect both the sense of continuity within one's inner world and the nature of one's relationship to the action of the outer world. The fourth occasion is "analytic" therapy, in which the regularities of one's intrapsychic structure and its stereotypies of action are often disrupted by the very "therapeutic" processes that allow these to be observed and examined in the course of promoting progressive development. All of these exciting and dangerous occasions mark out a separate, autonomous, individual, chosen act. The attempt to explicate the role of action in intrapsychic structural change during analytic work with a psychotic patient defines the analyst's actions as interferences and disruptions of that inner structure. His actions are noted, felt, represented, and organized into a part of that reformed, newly organized inner structure. Those analytic actions are represented by the patient as "having an impact" upon the patient and do indeed affect the patient. In that regard it is asserted that for a full, psychoanalytic conception of the ego, what is required is not only a central "body ego," but the integration of action in the formation and function of that ego's intrapsychic structure--an "action ego." Clarification of the complex relationship of conceptions of "fantasy" and action are re-examined in this context.(ABSTRACT TRUNCATED AT 400 WORDS)