A psychoanalytic look at repetitive outbreaks of brief psychosis

This article aims to take a psychoanalytic look at brief psychoses at risk of repetition. By this we are referring to very florid psychotic symptomatology that first appears in adults with no significant history of psychopathology. This is almost completely reversed with pharmacological treatment; however, the threat of repetition persists. We illustrate the difference from schizophrenia and borderline pathology. We present two cases in detail to demonstrate, first of all, that psychoanalytic therapy drastically improves the prognosis. Furthermore, both case studies, in patients with comparative richness of mental functioning outside of their psychotic episodes, afford us direct access to the essence of psychotic functioning. We will demonstrate how the external triggers are specific to each case and how these relate to unsymbolised material in each patient. These are themes that are heavily loaded with traumatic weight in the patients' histories, concerning elements which previous generations had not worked through, and which remain in a kind of non-symbolic register outside of word-presentations, associatively disconnected from the rest of the mental functioning until sparked by the particular external trigger which activates all of their pathogenic potential. We intend to analyse the improvement of these patients and we make considerations about technique.