The psychotic character

A warp in the childhood emotional pattern may involve the ego and superego enough to cause psychotic elements or coloring, which may evolve into the psychotic character or into the potential for it or for psychosis. A brief review of relevant literature and a series of clinical vignettes are presented from the perspective of Alexander's model of the neurotic character. The psychotic is seen as showing: the dynamics of the neuroses acted out as in the neurotic character; narcissistic egocentricity and a failure of emphathetic, sympathetic identification and loving object relations; id impulses rationalized by a distortion of reality (manifested not in specific delusions, but rather, more diffusely throughout the ego); minimal or no insight into illness, as in criminality; and a failure of defenses against id impulse although the ego organization is intact. The clinical material reveals that these elements are encountered in all combinations and gradations; several types of psychotic character are discussed.