The Unconscious and Psychosis: Some Considerations on the Psychoanalytic Theory of Psychosis

The author contends that the various psychoanalytic theories and techniques employ different models of the unconscious, each relating to a different unconscious reality describable in terms of specific mental functions. He reviews in particular the Freudian dynamic unconscious, based on repression; the Kleinian unconscious, which adds the notions of unconscious fantasy and splitting of the object; Bion's conception of the unconscious as a mental function of which the subject is unaware but which can formulate thoughts and metabolise emotions; and the neuroscientific view of the unconscious as coinciding with that of which one is unaware and not with the Freudian repressed. The author thus distinguishes between the dynamic and the emotional unconscious and between ‘unconscious’ and ‘unaware’, and notes the role of distortion of the ‘unaware’ perceptions involved in the analytic relationship in the impasse situation. He is particularly concerned to show that, whereas neurosis involves the dynamic unconscious, psychosis alters the emotional unconscious, the entity underlying the sense of identity and the ‘unaware’ consciousness of existence. In psychosis the emotional unconscious is blinded, so that the patient is conscious but lacks awareness. The dynamic unconscious is also affected. After presenting two case histories, the author draws attention to the need for further clinical and theoretical research in this field.