Psychic reality and the nature of consciousness

In this paper we make the case for a psychoanalytically informed reconsideration of the phenomena of consciousness. Classically, following Freud, who viewed consciousness as merely a reflection or perception of unconscious mental activity, psychoanalysts have tended to regard a focus on conscious experience as potentially reductionistic and at risk of overlooking the mind's deeper structures. We describe the case of Mr K, a patient who experienced disturbances of consciousness that forced us to consider the possibility that the capacity to experience ourselves as conscious, intentional agents in a coherent world of objects is not merely a modality of perception but rather a maturational and developmental achievement that to some degree depends on adequate experiences of caregiving and is vital in ensuring the possibility of human communication. As such, it is a capacity that is vulnerable to experiences of neglect and maltreatment. We suggest that as well as compromising the capacity to think about one's own and other people's feelings, such experiences may have the further adverse consequence of leading the individual to experience and risk becoming conscious of certain dangerously maladaptive, destructive states of mind which in normal development remain inaccessible to conscious experience. Phenomenologically, such states of mind are experienced as fragmentation and disturbances of consciousness. We discuss the clinical implications of these reflections and the limitations they place on psychoanalytic work in the context of their impact on the work with Mr K.