Psychoanalysis Meets Psychosis

Michael Robbins is former Professor of Clinical Psychiatry at Harvard Medical School, USA. He is a member of the American and International Psychoanalytic Associations. His previous books include Experiences of Schizophrenia (1993), Conceiving of Personality (1996), The Primordial Mind in Health and Illness: A Cross-Cultural Perspective (2011), and Consciousness, Language and Self: A Psychoanalytic, Linguistic and Anthropological Exploration of the Dual Nature of Mind (2018).

• Theorists of psychosis whose contributions are discussed in chapters 4, 5, 6, and 7IntroductionPART I: NOT FULLY HUMAN: THE UNWITTING COLLUSION BETWEEN MEDICINE AND PSYCHOANALYSIS1: Not fully human: Psychiatric and psychoanalytic understandings of psychosis2: The medicalization of madness: Evolution of the equation of psychosis with degeneracy PART II: PSYCHOANALYTIC MODELS OF PSYCHOSIS3: Freud’s attempt to treat psychosis as though it were neurosisObsessive-compulsive thoughts or delusional/hallucinatory enactments? Freud’s interpretive enactment of his theory of repressed unconscious and its results4: Freud’s three models and their offspring i: The inability to relate5: Freud’s three models and their offspring iia: The inability to integrate mind and become neurotic: The European Kleinian iteration6: Freud’s three models and their offspring iib: The inability to be neurotic: the American ego psychology iteration of the integration model and Kernberg’s transatlantic rapprochement7: Freud’s three models and their offspring iii: Thought disorder: the primary processPART III: A NEW BEGINNING: DISTINGUISHING PSYCHOSIS FROM NEUROSISClinical preface to chapters 8, 10, & 13JaneJacobLisabethCharles8: Two conscious mental processes: The role of primordial consciousness in psychosis and other human phenomenaMisconceptions of psychosis as an adult onset disorder of genetic originCharacteristics of reflective representational thoughtCharacteristics of primordial consciousness or first mindClinical illustrations of primordial consciousnessDreaming and primordial consciousnessAttachment and the commencement of psychic life 9: Return to the Rat Man: Psychosis as a manifestation of primordial consciousness10: Psychosis as a disorder of attachment and separation-individuation Psychosis and pathology of separation: The stages of separationRelationship between schizophrenia and psychotic personality disorder: The false self Clinical illustrations of false selfGood enough attachment and development of the two mental processes: Rank and BowlbyPathology of attachment, maladaptive persistence of primordial consciousness, failure to separate, and development of psychosis Clinical illustrations of pathological attachment and failure to separate PART IV: TREATMENT OF PSYCHOSIS11: The medical treatment of psychosis: Transforming psychosis from a socially disruptive to a socially adaptive disease12: Studies of the efficacy of psychological and psychoanalytic therapies of psychosis13: Psychoanalytic therapy of psychosis: Transforming primordial conscious mentation to reflective representational thoughtThe therapeutic processThe remembered and reconstructed pastThe process of therapyStages of therapy with schizophrenic persons and psychotic personalitiesCriteria of successful treatment and outcome 14: Qualities of a psychoanalytic therapist of psychosis15: Patients write about their therapy16: The 11 year therapy of a chronic paranoid schizophrenic womanBackgroundYear oneYear twoYear threeYear fourYear fiveYear sixYear sevenYear eightYear nineEpilogueDiscussion17: ConclusionReferencesIndex

"Robbins’ goal is to introduce psychoanalysis to psychosis in a way that is internal to psychoanalysis and at the same time independent of the neurosis model and the biases that attend it. He does so successfully in this carefully reasoned and clinically illustrated book, as he returns us to a theory of primitive mind and primary process that Freud himself intimated but never further developed. In so doing, Robbins joins the increasingly interesting minority of analysts who are trying to extend psychoanalytic theory to include the understanding and treatment of psychoses. For Robbins, psychosis is the consequence of a developmental pathway separate and independent from that of neurosis. It begins with problems of attachment and separation that produce early failures to separate self from object and integrate a cohesive sense of self. These failures leave one incapable of experiencing, sustaining and resolving intrapsychic conflict and lead "to inappropriate and maladaptive persistence of primordial conscious mentation in contexts where reflective representational thought would be appropriate and adaptive."-Howard B. Levine, MD, Editor-in-Chief, The Routledge Wilfred R. Bion Studies Book Series