Psychosis Precipitated by Psychoanalysis

Although the occurrences of psychotic episodes during the course of psychoanalytic therapy are well known, they have received only scant attention in the literature. Among recent contributions are those of Romm (8), Little (6), and Reider (7). It is by no means evident that every episode occurring during psychoanalysis must be considered eo ipso a therapeutic failure. Such an interlude in some cases may prove to be not only unavoidable but even clinically desirable. Since a considerable wealth of clinical symptomatology is encountered in these cases, it is necessary to introduce some general principles which will serve as guideposts.

Without going so far as some of our Latin American colleagues who speak of a micropsychosis occurring during certain sessions in every patient (2), it is a fact that some patients show transient disturbances of seemingly more than a neurotic nature. For example, one may see moments of deep depression based mostly on reactions of mourning originating in the emerging material from the past as well as from the transference: these may represent not only the reactions of frustrated love but, most prominently, mourning after the loss of a love object destroyed in fantasy by the patient's hostility. Further, brief episodes of paranoid distortion may be observed wherein the analyst becomes the persecutor determined to destroy the patient's talent, creativity, love, and masculinity. These episodes include not only typical reactions such as paranoid ideation as a defense against the onrush of homosexual libido but