The nature of the psychotic state.

Abstract

We have drawn on a number of sources in discussing the shared nature of various psychotic states, with a debt particularly to the psychoanalytic and cybernetic points of view. Clinical psychiatry does have some problems with its classifications of states of illness. At present there seems to be some disagreement between the point of view which sees all psychiatric illnesses in mutually exclusive syndromes, and the point of view which sees mental health and equilibrium as existing along a continuum. Psychotic states occupy one end of such a continuum or spectrum: they are far enough removed from normality that the two are mutually exclusive, and they differ quantitatively and qualitatively from neurotic states. The concept of psychosis appears to have operational value. We must however disentangle several kinds of definitions or we have semantic chaos. Socially, insanity is defined as behaviour beyond the social norm and carrying with it certain connotations of danger to the social fabric. Clinically, the diagnosis of psychosis implies a serious disorganization of mental health or adaptation with a guarded prognosis and requiring special drastic treatment methods. Psychopathologically how can the psychotic state be defined? We have devoted some space to the discussion of the concept of the cognitive and executive ego, since psychosis is seen primarily as a disordered ego state. The nature of this disorder appears to be that of a rupturing or disarticulating of certain fundamental organizations of memory, which have been welded together into the primordium of the ego. In architectural language we might call these foundations, in computer language programs, in cybernetic language guidance systems, and in everyday language, character. The nature of the bonds and energies which hold such collections of experience together as guidance systems is not understood. We must assume that it has a neurophysiological substrate. Both under conditions of extreme psychic stress and of bra:n-tissue disturbance these fundamental operating patterns are disrupted, resulting in certain characteristic symptoms of hallucinosis, extremely severe affective change, and disorders of thought and logic. This model his some implications for treatment, particularly for psychotherapeutic treatment, including the management of ‘organic’ psychoses. There are, further, certain interesting contradictions between the social, clinical and psychopathological frames of reference which we have touched on only briefly.