Psychosis and Regression1

The panel I organized and chaired had been the occasion of a vivid and even passionate exchange between the presenter of a very rich clinical case, Riccardo Lombardi (a training member of the Italian Psychoanalytic Society) and two discussants, Anne Silver (member of the American Psychoanalytic Society) and David Rosenfeld (a training analyst of the Psychoanalytic Society of Buenos Aires), all deeply experienced in psychosis, yet with very different theoretical as well as practical approaches.

Through the presentation of a very difficult case, Riccardo Lombardi aimed to show how Rose, a patient who suffered from several heavy psychotic crises and suicide attempts, was able to develop an ability to contain her emotional storms and realize important achievements in her life. Her analysis had the frequency of four sessions a week for its entire duration of, in all, 12 years. The analytic work was never interrupted even in periods of acute psychotic relapse which, with the help and support of both a pharmacologist and a consultant for the family, could be managed each time without needing further hospitalization. In the course of this analysis R. Lombardi presented four periods, lasting several months at a time, of psychotic destabilization, during which there emerged important elements of working through, that were consolidated in subsequent sessions during non-turbulent phases. During the first five years the patient achieved a first important contact with reality and resolved the profound dissociation which had caused her to deny the existence of the psychotic periods and not to recognize as her own the psychic elements that emerged during these crises. The growth she had consequently brought about of the non-psychotic part of her personality could make possible a further confrontation with the deepest aspects of her psychosis. The clinical presentation explored especially the clinical material of the fourth psychotic crisis in analysis, which involved the delusion of