Psychotic Elements in the Neurotic Disorders of Children1

During the past twenty five years I have practised individual psychotherapy with a wide variety of both psychotic and neurotic children. The usual distinction between psychosis and neurosis is that in psychosis awareness of commonly agreed reality is massively blocked or distorted, and in neurosis it is less so. However, in working with neurotic children I have invariably come upon a “pocket” of functioning in which awareness of reality was so blocked and distorted that it justified the term “psychotic”. What I learned from the psychotic children about the processes which blocked and distorted awareness of reality has helped me to work with these psychotic elements in neurotic children. This has seemed to increase the effectiveness of my work with such children.

I shall avoid the use of technical terms as, in so far as I can, I want to present the material from the child's point of view. I also want to make my meaning clear to those whose technical language is different from my own.

Of course, psychosis in children has many causes. It can be due to gross and detectible brain damage or to traumatic disturbances so early in life that it is difficult to distinguish their effects from inborn defects. These latter children may have brain damage which cannot be detected by the methods at present available, but I have found that some of them can be helped to achieve relatively normal functioning. It is from these children that the material for this paper has been drawn.

The tragedy in childhood psychosis is that due to certain pathological processes which will be discussed later, mother and child grow further and further apart in terms of a normal on-going relationship, although there is a morbid underground entanglement between them. To understand why this occurs we have to go back to the early mother-infant situation. In this early situation the nursing couple are such a unity that it is impossible to say whether the mother cuts herself off from her child