Abstract
This paper outlines a psychoanalytic contribution to a growing research field in psychiatry: that of psychotic vulnerability, and the related neurogenetic modeling of schizophrenia. We explore this contribution by focusing on recent studies concerning a neurodevelopmental disorder, the 22q11.2 microdeletion syndrome – which comprises DiGeorge syndrome in particular. It is one of the most common rare genetic syndromes, and the patients that it affects present a very high rate of psychotic symptoms (between 30 and 40%). For this reason, it has sparked an increasing number of clinical research projects which give it a paradigmatic status, as much for psychotic vulnerability as for potential neurobiological and genetic markers of schizophrenia. This syndrome illustrates one of the major stakes in contemporary psychopathology: the articulation of clinical, neurocognitive, and genetic approaches in a pluri-disciplinary manner. We seek to show that psychoanalysis, when it participates in this articulation, opens up specific hypotheses and research perspectives. In particular, based on the epidemiological observation of the role of anxiety as a predictor for psychosis, we underline the potential relevance of psychoanalytically oriented differential clinical practice and the psychodynamics of anxiety: they can contribute to studies and clinical follow-up on the 22q11.2 microdeletion syndrome and, more widely, to research on the detection and prevention of psychotic vulnerability.
Highlights
Contemporary psychopathology presents a growing number of psychiatric studies focused on risk factors for psychosis and its prevention
We believe that a psychoanalytic approach could contribute to this field by drawing on recent studies focusing on a neuro-developmental pathology: 22q11.2 microdeletion syndrome
Our perspective is that of complementarity between the psychoanalytical, neurodevelopmental, and psychiatric paradigms (Bazan, 2011; Milrod et al, 2014; cf. on necessary complementarity, Armando et al, 2017, 2018). Such complementarity is necessary to research on vulnerability to psychosis, and conditions the reopening of the dialogue between psychoanalysis and psychiatry – which, as Rudden et al (2003) have underlined, has almost ceased due to the gap between their respective paradigms
Summary
Contemporary psychopathology presents a growing number of psychiatric studies focused on risk factors for psychosis and its prevention (for a historical perspective and contemporary overview, see Lieberman et al, 2019). 22q11.2 microdeletion syndrome appears to highlight the interest of such a psychodynamic view, because of its complex clinical interactions between organic and mental disorders Anxiety in these children could be the psychological result from somatic, cognitive and relational disturbances experienced during their development (Beaton and Simon, 2011). This perspective leads to question potential vulnerability to psychosis from the perspective of these different types of anxiety, which do not necessarily assume the aspect of a symptom or an anxious disorder: castration anxiety, objectloss anxiety, anxiety of destruction or fragmentation, and so on While these different modalities of anxiety can coexist in a subject, mental functioning is most often organized around one dominant modality, a decisive element for differential clinical practice in psychoanalysis. This can in turn affect his interactions with his or her peers, and thereby reinforce narcissistic fragility (Potier et al, 2016): these difficulties in identification and the fragility of his self-confidence weakens his defenses against the anxiety emerging in those situations
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