La fabrique de l’intériorité ou comment faire exister la psychose

Abstract

ObjectivesThe technical developments in psychiatry are strengthening the materialistic model of mental illness. Alongside, a model of interiority is developing. The author explores the effects of this model in the clinical encounter with psychosis, and the meaning of the expression “it's in your brain”. MethodFirst we will see how, in our modern ontology, the appearance of the interiority-brain model has occupied a place left vacant in psychiatry: the referent of the symptom. Next, in the light of anthropology and the sociology of science, we will see how reality and truth of existence can be confirmed by an image, and in particular, brain imagery. Finally, considering the ontological upheavals in the area of psychosis, we will explore the clinical effects of this reference which fixes the issue of being and life experience with the premise “your psychosis is in your brain”. ResultsThe image of interiority thus produced amalgamates interiority, brain and the Ego. Brain imagery serves as evidence for its existence and the mark of interiority. This model of interiority only works in certain configurations of subjectivity, which may occur at certain specific moments in psychosis. DiscussionDisagreement between the model of the psychotic subject and the medical model of the illness is not a lack of insight, but should be seen rather as an attempt to “metaphorise” an experience of alteration of the Self. ConclusionsThe “brain disease” model of psychosis is constructed alongside an interiority model in accordance with a modern, naturalistic ontology. The experience of psychosis can overturn this model. The therapist can move away from his usual ontology to follow and support the attempt at metaphorisation of the psychotic experience.