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Psychotic Organisation of the Personality

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Psychotic Organisation of the Personality CHAPTER TITLE I PSYCHOTIC ORGANISATION OF THE PERSONALITY PSYCHOANALYTIC IDEAS AND APPLICATIONS SERIES IPA Publications Committee Gennaro Saragnano (Rome), Chair and General Editor; Leticia Glocer Fiorini (Buenos Aires), Consultant; Samuel Arbiser (Buenos Aires); Paulo Cesar Sandler (São Paulo); Christian Seulin (Lyon); Mary Kay O’Neil (Montreal); Gail S. Reed (New York); Catalina Bronstein (London); Rhoda Bawdekar (London), Ex-officio as Publications Officer; Paul Crake (London): IPA Executive Director (ex-officio) Recent titles in the Series include Theory of Psychoanalytical Practice: A Relational Process Approach Juan Tubert-Oklander Art in Psychoanalysis: A Contemporary Approach to Creativity and Analytic Practice edited by Gabriela Goldstein The Female Body: Inside and Outside edited by Ingrid Moeslein-Teising and Frances Thomson-Salo Death and Identity: Being and the Psycho-Sexual Drama Michel de M’Uzan Unpresented States and the Construction of Meaning: Clinical and Theoretical Contributions edited by Howard B. Levine and Gail S. Reed The Ethical Seduction of the Analytic Situation: The Feminine–Maternal Origins of Responsibility for the Other Viviane Chetrit-Vatine Time for Change: Tracking Transformations in Psychoanalysis— The Three-Level Model edited by Marina Altmann de Litvan Hostile and Malignant Prejudice: Psychoanalytic Approaches edited by Cyril Levitt Freud and Culture Eric Smadja Play, Gender, Therapy: Selected Papers of Eleanor Galenson edited by Nellie L. Thompson Psychopathology of Work: Clinical Observations edited by Christophe Dejours Finding the Body in the Mind: Embodied Memories, Trauma, and Depression Marianne Leuzinger-Bohleber The Future of Psychoanalysis: The Debate about the Training Analyst System edited by Peter Zagermann The Analytical Process: Journeys and Pathways Thierry Bokanowski PSYCHOTIC ORGANISATION OF THE PERSONALITY Psychoanalytic Keys Antonio Pérez-Sánchez First published 2018 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2018 Antonio Pérez-Sánchez The right of Antonio Pérez-Sánchez to be identified as the author has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record has been requested for this book ISBN: 9781782205685 (pbk) Typeset in Palatino by The Studio Publishing Services Ltd email: [email protected] CONTENTS ACKNOWLEDGEMENTS vii ABOUT THE AUTHOR ix SERIES EDITOR’S FOREWORD xi PREFACE by Dr Ronald Britton xiii INTRODUCTION xvii PART I THEORETICAL (AND CLINICAL) ASPECTS CHAPTER ONE Psychic pain, the psychotic part of the personality, 3 and pathological organisation CHAPTER TWO Communication and the psychotic part of the personality 25 v vi CONTENTS CHAPTER THREE Psychotic organisation of the personality: 55 psychopathological dynamics and foundations CHAPTER FOUR Consequences of the dynamics of the psychotic 87 organisation of the personality CHAPTER FIVE Symbolisation in the psychotic organisation of 121 the personality CHAPTER SIX Delusional world, mental emptiness, and other 135 clinical manifestations CHAPTER SEVEN Technical aspects of psychoanalysis in patients with 159 psychotic organisation of the personality PART II CLINICAL (AND THEORY) CHAPTER EIGHT The psychoanalytic method in a schizophrenic patient: 183 indication and beginning of analytical process— psychic pain and transferential vertex CHAPTER NINE Emerging from psychotic organisation 217 CHAPTER TEN General discussion and conclusions 247 REFERENCES 261 INDEX 267 ACKNOWLEDGEMENTS First of all, I would like to express my gratitude to Ms B for allowing me to share the unusual experience of being in intimate contact with madness within the framework of a psychoanalytic treatment. I learnt a lot about psychotic functioning, not only for her, but also for our non-psychotic patients and even for ourselves. This gratitude is increased if we consider the enormous psychic pain, concomitant to this adventure in this analytic work, that Ms B had to endure. This experience, on which the book is based, would not have been possible without the help and support of many professionals who collaborated with me in a kind of “container therapeutic structure” (Pérez-Sánchez, 1996b), which included my psychoanalysis with Ms B. I refer to the psychiatrists and psychiatric hospital professionals present when she was briefly hospitalized during her breakdowns, as well as those who attended her for the psychopharmacological prescription and control. My appreciation to all of them. In a special way I must thank Dr Pere Bofill (Barcelona) and Dr Hanna Segal (London), for their help in understanding the clinical material and, above all, in avoiding my too often losing my analytical identity in dealing with such emotional turbulence. vii viii ACKNOWLEDGEMENTS Many other people accompanied me at different times during the preparation of the book. In the Spanish Psychoanalytical Society, I presented several papers on the subject that are now part of the book, and many colleagues contributed with their comments and sugges- tions. I also want to particularly thank Ester Palerm for having given me the opportunity to verbalise dark aspects of some passages of the manuscript, and participate in an enlightening dialogue. Seminars with students from the Institute of Barcelona have also been a stimulus. I am also grateful to the IPA Publication Committee for having accepted the proposal of this book for its publication in the Psycho- analytic Ideas and Applications series, and in particular to their chair, Genaro Saragnano. I am also in debt to the translators, Caroline Williamson and Mary García, with whom I worked intensely to trans- form the Spanish manuscript into English, and to my English teacher, Maggie Evans. Between the manuscript and the text that the reader has in his hands, there has been considerable improvement, thanks to the careful and excellent team work of Yvonne Doney, Anita Mason, Julie Collings, and Hilary Perry of The Studio Publishing Services. My thanks also to the Karnac team. I also offer my appreciation to Dr Ronald Britton who, kindly and generously, agreed to write the preface to the book, which is a creative contribution. I must also not forget Dr Claudio Eizirik and Dr David Rosenfeld, who read it and gave it their support. ABOUT THE AUTHOR Antonio Pérez-Sánchez is a psychiatrist and psychoanalyst. He is a training analyst and supervisor of the Spanish Psychoanalytical Society (SEP) (a component society of the International Psychoanalytic Association) and he teaches at the Barcelona Psychoanalytic Institute. He was the president of SEP (2008–2011). He has worked in psychi- atric hospitals and outpatients departments for many years and now works in private practice as psychoanalyst and psychotherapist. He is interested in the differentiation between psychoanalytic psychother- apy and psychoanalysis itself, and has written about this subject. He has also written on psychological phenomena from a psychoanalytic perspective, including envy, psychic truth, forgiveness, and time. He is the author of five books: Elementos de Psicoterapia Breve Psicoanalítica (Elements of Brief Psychoanalytic Psychotherapy) (1992), Prácticas Psicoterapéuticas. Psicoanálisis Aplicado a la Asistencia Pública (Psycho - therapeutic Practices: Applied Psychoanalysis in Public Mental Health Care) (1996), Análisis Terminable (Terminable Analysis: A Study in Ending the Psychoanalytic Process) (1997), Interview and Indicators in Psychoanalysis and Psychotherapy (2012, Karnac; also in Spanish, Promolibro, 2006, and Italian, Astrolabio, 2014), and Psicoterapia breve psicoanalítica (2014). ix x ABOUT THE AUTHOR He is now chair of the Sponsoring Committee of the International Psychoanalytical Association for the Study Group Nucleo Portuguese Psicoanalitico (Lisbon). He is a member of the European team of the Interregional Encyclopaedic Dictionary of the International Psycho - analytical Association. SERIES EDITOR’S FOREWORD The Publications Committee of the International Psychoanalytical Association continues, with this volume, the series “Psychoanalytic Ideas and Applications”. The aim of this series is to focus on the scientific production of significant authors whose works are outstanding contributions to the development of the psychoanalytic field and to set out relevant ideas and themes, generated during the history of psychoanalysis, that deserve to be known and discussed by present psychoanalysts. The relationship between psychoanalytic ideas and their applica- tions has to be put forward from the perspective of theory, clinical practice, technique, and research so as to maintain their validity for contemporary psychoanalysis. The Publication Committee’s objective
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