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IN THIS PAPER WE WILL discuss some concepts of psychosis, its clinical manifestations, and certain hypotheses as to its origin and evolution. Bion considers the concept of psychotic personality of fundamental importance to the understanding of phenomena associated with the psychotic process, regarding the psychotic personality as a mental state whose characteristics give rise to all those manifestations that are observable, in one form or another, in seriously disturbed patients.
The papers published by Bion on subjects related to psychosis come chronologically after his work on groups. Some of those papers are predominantly clinical and include case reports, while others are more theoretical and formulate hypotheses related, among other things, to language and thought in the schizophrenic. The papers written during this period (1950–1962) were later republished in his book Second Thoughts(1967), where they are rediscussed as a whole in the final commentary.
The patients, whose treatment has served as a basis for some of the hypotheses put forward in this chapter, were attended by Bion in a psychoanalytical setting no different from that normally used with neurotic patients, although in some cases the patients had a diagnosis of schizophrenia. The technique employed was always exclusively interpretive, both the positive and the negative transference being taken into account. In the interpretation of the material use was made of the Kleinian theories of part—object relationships, the paranoid—schizoid and depressive positions, the theory of envy, and the theory of early defence mechanisms, especially splitting and projective identification.