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“It remains for the future to decide whether there is more delusion in my theory than I should like to admit, or whether there is more truth in Schreber’s delusion than other people are as yet prepared to believe.”–Sigmund Freud, 1911
Burgeoning research into the phenomenological psychopathology of schizophrenia including first-person and narrative accounts (Fusar-Poli et al., 2022; Ritunnano et al., 2022) has put us in a better position than ever to understand madness on its own terms. There is an increasing consensus that cardinal symptoms of madness, such as delusions and hallucinations, are best understood not as a regression to primitive psychological functions (as classical psychoanalysis contends) nor as mere neurological epiphenomena (as biomedicine would have it), but as manifestations of a fundamental disruption in what phenomenologists term the “basic” or “minimal self.” This notion, familiar to us from the prescient work of Laing (1960), raises a number of questions for mental health clinicians of every stripe: What are we treating when we treat madness? Are certain forms of psychosis categorically different than the madness of everyday life? Or do all of us, schizophrenics and neurotics alike, contain, in Michael Eigen’s (1986) term, a “psychotic core.” Is there a coherence to psychotic experience akin to what proponents of neurodiversity (Kapp, 2013) contend is present in autism? Is schizophrenia, however disabling, also an identity, a different way of being-in-the-world (Sass, 2007)?
In recent decades psychoanalysis has increasingly embraced the embodied, implicit, enactive, and intersubjective dimensions of developmental and therapeutic process (Posner, 2024). A veritable “ontological” (Ogden, 2019) turn has been unfolding across schools, one that foregrounds the manner by which meaning is co-created in psychotherapy – the “something more” than insight and interpretation – and asks new questions about the meaning and purposes of p