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Analysts usually shy away from the idea of taking a psychotic patient into therapy because, unlike some other disorders, psychotic illness takes a progressive course and can devastate the entire personality. It is as if psychosis represents, in psychoanalysis, an unknown and unknowable territory. This is why we welcome with interest the appearance of From Breakdown to Breakthrough, written by Danielle Knafo and Michael Selzer, which deals with the theme of psychosis and its psychoanalytic treatment. The intent of my commentary is to explore what hypothesis the two authors advance as to the nature of psychotic disorders and if there are new elements that can help us better decipher the enigma of this mysterious illness.
In my view, one of the reasons why psychoanalysis encounters difficulties with patients with psychosis is that it is difficult to understand psychotic functioning because we usually work with neurotic patients who function, as Freud taught us, using the dynamic unconscious, with processes such as repression, symbolization, conflict, and oedipal issues. These dynamics, in my view, are not present in patients with psychosis. In psychosis, the dynamic unconscious is paralyzed and does not allow intuitive and symbolic functioning. A voice or an illumination unveils a new reality to the patient, who believes that this new perception undeniably bears the truth. In psychosis, the mind proceeds by sensorial functioning, by sensorial revelations and not by intuitions, disrupting the patient's ability to think and dream.