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This report covers the panel on 24 July, when all presentations were given, and the panel on 25 July, when the discussion was held after an introductory summary by Jorge García Badaracco, chair.
The panels were characterised by the basic assumption that psychotic symptoms have an interactional meaning. There was a feeling that the discussion functioned as a large container with the participants sharing their experiences. The intensity of this clinical reality seemed to override theoretical differences.
The psychotic dilemma proved to be a strong concept and was the theme running through the two days. Although this concept is not really new (e.g. Bateson, 1956; Bion, 1957; Lidz & Lidz, 1949; García Badaracco, 1986), the presentation by Stavros Mentzos (Frankfurt), ‘The dilemma of the schizophrenic and the therapeutic relationship as an alternative experience’, made it fresh and fruitful. Mentzos put psychotic dilemmas and neurotic conflicts in opposition. In his model most psychotic symptoms are not the result of defective ego-functions but the expression of active defences against dilemmas producing unbearable intrapsychic tensions. The prominent dilemma in psychotic pathology is the dilemma between having no object and fusion with an object: in other words, ‘loss of object’ versus ‘loss of self’. This idea is supported by the fact that psychoses are often triggered by the distance of the object, experienced as too great, or the proximity of the object, experienced as too close. In fact, first psychotic episodes are often seen in relation to a separation from the family or in a first love: hence the capital importance of offering the patient a new experience of relationships in order for them to obtain a balance between proximity and distance, between self-orientation and object-orientation. This differs from the model of M. Klein, which is based on aggression against the object.
It was the view of Juan Tubert-Oklander (Mexico) in his presentation