The Body Image in Hysterical Psychosis

It is not usual at a scientific congress to start with images, but I wish only to use them as metaphors to introduce and make clear my position of research in relation to psychosis. (1) I shall try to conceptualize psychosis authentically, in statu nascendi, through the patient's own language, and (2) I shall try to explain the data of psychosis, avoiding extrapolations from the structure of neurosis, and therefore going from 'the inside' to 'the outside' and not remaining in 'the underwood border' of an impenetrable, formerly burnt and deforestated virgin forest which can sometimes block all access to 'the inside'. The metaphor of the virgin forest is intended to show the specific character of this terra incognita which in German is called Fremdheit: that which is forever foreign and cannot be grasped by mere extrapolation from ordinary life; one must have the courage to recognize the gap which separates us from psychosis.

The attempts to understand psychosis without bridging this gap have resulted in the massive nosography inherited from classical psychiatry. But 'the inside' method is that of personal involvement, of daring to take the patient 'by the hand' and accompany him in his 'descent into hell'.

Without the knowledge of the structures of the unconscious which Freud developed as an instrument for the treatment of neurosis, the analytical approach to psychosis would not have been possible. There is indeed only one unconscious. Several years ago, I suggested the following formula: 'Neurosis and psychosis differ from each other in that the fundamental structures which find symbolic representation in language and which contain the precipitates of the earliest body experiences are destroyed in psychosis and distorted in neurosis' (Pankow, 1960, p. 274).

For some 20 years, I have based my analytical approach to the treatment of psychosis and certain psychosomatic disorders on the body image, and have been able to demons