You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Cahn considers what he terms the two quandaries of psychosis: the impossibility of transference and the loss of reality testing. If there is no such thing as transference in psychotic patients, then either the therapist is ensnared in a pseudotransference which can only lead to a pseudoevolution of the treatment, or else there is such a thing as psychotic transference, but it is redically different economically and structurally from that of the neurotic patient. Today the Freudian claim for an objectless stage of development is not tenable, except perhaps in a limited number of clinical conditions. There is something essentially different with respect to the object in psychosis. Something has been lacking from the start, a major perturbation has been operative, and this has rendered the subsequent psychical organization deficient. In the dyadic relationship, the decisive factor may have been a massive disruption of stimulus barriers preventing the unconscious from becoming organized. The results are the basic faults of the psychosis and its primitive defenses, splitting, denial, and the loss of subject-object differentiation, or identification with the aggressor. How does one help a psychotic patient to emerge from all these confusions of self and other which prevent a personal identity? All therapists with psychotic patients have tried to diminish this fundamental alienation. Each therapist has found appropriate measures, and, according to Bion, "it works." But just as often it does not work, Cahn argues. Is, then, all therapy with psychotics based on illusion? Cahn notes that most therapists consider decisive the invasive presence of the mother. This suggests that research should focus on the return from the conflict with the exterior object to the transferential relationship. The fundamental role of the external primary human environment in the development of the individual seems to be the most important theme to study. This means that a primary r