On Freud’s “Neurosis and Psychosis” and “The Loss of Reality in Neurosis and Psychosis”: 100 Years Later. Edited by Gabriela Legorreta and Catalina Bronstein. New York/London:  Routledge, 2024.  160 pp

This book starts from Freud’s two important contributions on psychosis (both written in ) and has two purposes, the first to deepen Freud’s indications on psychotic functioning, the second to identify a line of development of analytical thought on the theme of psychotic illness in the last hundred years. It is a book that sets itself an important goal on a theme that risks confronting psychoanalysis with its own limits. Psychotic patients, in fact, are traditionally difficult to treat because psychosis, unlike other disorders, is a progressive illness that tends to devastate the entire personality.

As analysts, it is difficult to understand psychotic functioning because we usually work with neurotic patients who function, as Freud taught us, using the dynamic unconscious—that is, with processes such as repression, symbolization, conflict, oedipal issues, and other dynamics that are not present in these kinds of patients. Furthermore, in psychotic patients, unconscious intuitive functions, which can represent psychic reality, have come to a standstill or have been unable to develop. For this reason, it frequently happened that symbolic interpretations during therapy created psychotic transference, which led the patient to abandon the treatment.

It was not psychoanalysis itself that was iatrogenic but a certain technique useful for neurosis that turned out to be contraindicated for psychosis. For this reason, Rosenfeld1 stated that it would be necessary for psychoanalysts, even those who are experienced and well-trained, to learn

from scratch how to work with psychotic patients. In the analytical therapy of psychosis, a broader setting needs to be set up: the analyst must refer to the family that supports the patient (both financially and during the crisis) and must keep