Notes on Early Psychotic States1

In the histories of psychotic children we often meet with the following types of episode: massive transfusions, resuscitation, toxicosis, as well as non-cerebral diseases such as recurrent otitis, skin conditions, surgical operations, immobilization, etc. Some of these children present with mental deficiency, others with developmental dysharmony; others again have psychotic structures without impairment of maturation.

We find that we cannot discriminate between the psychotic structures of the mentally deficient group and the non-mentally deficient group; there seems to be no connection between physical or psychic trauma and the pathological organization. None of the clinical findings—difficulties in relating, whether of physical or psychic origin—could serve as a basis on which to determine the pathogenesis. Our experience also shows that it is important methodologically to keep separate the lines of approach to this problem according to whether they are directed towards the maturational aspect, the learning difficulties, or the libidinal organization.

On which of these lines can the psychoanalyst place himself? He can study the effects of the trauma, specifically the cerebral trauma, on the whole psychobiological development and thus bring into question the existence of a psychoanalytical area of study in early central nervous system diseases. He can accept the trauma as being at the origin of disturbances in relationship, upsetting the first libidinal ties—thus bringing up the question of the reaction character of psychotic symtomatology. He can, finally, study the effects on libidinal development of physical trauma insofar as it is experienced as a psychic trauma, or, rather, question whether there is such a relationship—which leads to a discussion of the genesis of these conditions in psychoanalytical terms. It is on the level of the gap between the traumatic event and the fantasy process (the psychosis) that the psychoanalyst will have to centre his delib