Cognitive and affective features in childhood psychosis.

Abstract

This paper has explored the relationship between affect and cognition in normal, borderline, and psychotic child cases. In contrast to the normal child, an orderly unfolding of cognitive structures appears to be absent, or present only in part for the more severely disturbed child population. The aberrant delays presented by these children reveal a structure of cognition in which heterogeneous levels of thought coexist without reorganization into any known structure of totality. We hypothesize that an interactive relationship exists between these cognitive deficits, and the children's failure to achieve an integrated and differentiated self. We further speculate as a point of dysjunction the failure to coordinate the secondary schemata. This cognitive integration is coincident with the affective shift from passive to active, and a significant moment in the child's emerging individuation. In this latter process, active imitations of the mother play an extremely important role. As the beginning coordination of states and their transformations seemingly do not occur, active limitations do not function in usually expected ways, nor do they prepare the way for the later transition to partial identifications. It is these later internalizations which enable the child to sustain both more separate functioning and a sense of his own identity. The psychotic child appears to be enmeshed at the level of whole, merging identifications; that is, imitation of the other persists, and with it the fantasy of either being the other or not being.