The Psychotic Crisis

In Greek Hippocratic medicine the term ‘crisis’ was used to indicate the ‘climax of the illness’, a critical point determining the subsequent course of the disease process towards a favourable outcome or a worsening condition. The Greek word KRINEIN from which the word ‘crisis’ derives carries with it the idea of separation, of a tear which will lead to a decisive transformation. That is why, in the individual or social history of man, it has always implied a radical change, marked by what we call a ‘moment of truth’.

In the course of long experience with psychotic and non-psychotic patients, I have been able to confirm the hypothesis that a crisis is always, for good or evil, a moment of clarity. Rudolf Otto (1969) described the religious crisis as a ‘luminous’ experience taking the space and name of the divinity - ‘I am the light’, ‘I am God’.

Kant (1781) used the concept of ‘the critical point’ to indicate the process by which reason looks into itself. Thus criticism is an experience of reason questioning itself. Later Husserl (1954) treated the topic of crisis from a phenomenological and social point of view. For Hegel, criticism is connected to knowledge and to the fact that all attempts at knowledge imply a risk. Marx, influenced by Hegel, described alienation as a ‘crisis of regulation’. In his writing on alienation Marx (1867) traced the degradation of work to the effect of reducing man himself to a commodity. The reification of work, making it into a thing, leads to the reification of man himself (Lukacs 1922). The relationship between man and the objects in the world becomes a common focus of interest for political sociology and for psychoanalysis. The feeling of impoverishment of the ego in the psychotic patient approximates to the sense of alienation that men feel in their work, when they excessively project their energy and creativity into the good they produce only to find they disappear with, as it were, their own psychic capital. Hinshelwood (1983) has