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The arduous journey back from psychosis begins with the first contact between patient and analyst. In acute psychosis, the patient is disorganized, at loose ends, sometimes even incoherent. In one of its most dramatic forms, linguistically, the clinician is faced with complete word salad. More often, one is dealing with neologisms, derailments, auditory hallucinations, or bizarre behavior. The grandfather of Dementia Praecox or the Group of Schizophrenias, Eugene Bleuler focused on the patient's “lack of integrating capacities” in schizophrenia. Yet we are not faced with an absent capacity; rather, we are confronted with the parts and parcels of the patient's psyche. This is fragmentation.
Some will argue that “no, indeed, the patient is absent an integrating or synthesizing process.” But closer inspection reveals that synthetic activity is ever present in psychosis. In the amazing quality that humans have for self-healing, the process of refitting is never absent. With an ear to Dan Stern's (1985) work with infants, we as clinicians address this “emergent self” in our acutely psychotic patients. In The Interpersonal World of the Infant, Stern (1985) introduced the concept of “vitality affects,” which, in conjunction with conventional categorical affects, will help us and our patients in this recovery process.