A Gestalt Therapy Theoretical View of Psychosis

Hans Peter BILEK
Psychiatrist and Gestalt Therapist (Integrative Gestalt Therapy) in Vienna/Austria

Abstract of the lecture at the 10th Scientific Convention of the
Society for Gestalt Theory and its Applications (GTA)
Vienna/Austria, March 1997

In this lecture a new view of psychosis is presented. Based on Gestalt therapeutical considerations and on new findings in bio-semiotics, psychosis is interpreted as a functional process.

Three main aspects are fundamental for this thesis. First, that psychosis is a functional circumstance which gives an individual vital protection in a life-threatening situation. Thus, the process of psychosis is given a broader meaning and is taken out of the actual field of psychiatrics in the sense that it is not only a psychiatric disease. This is based on the fact

A) that psychosis also occurs in connection with organic brain disturbances as the reduced function of this important organ means an impasse situation for the individual, and

B) that psychosis also develops in healthy persons who are subjected to severe deprivation (thirst, prison etc.).

The second point is taken from an earlier paper of ours, in which we postulated that psychosis is - in the sense of Gestalt therapy - a Gestalt-collapse. Being able to perceive the environment as a 'Gestalt' is an unconditional prerequisite for person's health. It is very likely that the process of perceiving, i.e. differentiating the flood of impressions coming from the environment into 'nourishing' and 'non-nourishing' material, is only possible by perceiving 'Gestalts'. Perception of Gestalt is the actual form of orientation, and loosing this ability means loosing one's orientation.

This view is supported by new findings in bio-semiotics. For example, Thure v. UEXKÜLL postulates in a paper that every individual 'creates' his own environment with his psychic apparatus in his first phase of life. In bio-semiotics we speak of 'signs' which give us the necessary orientation in the same sense as in Gestalt. Of course, bio-semiotics and Gestalt are not the same scientific branches and do not have the same meaning (in this lecture an exact differentiation will be made), but we can use them identically in this special context.

The organization of the psychic apparatus in the first phase of life - nearly identical with the phase of symbiosis - is seen as the basis for a functioning perception in later life. If the individual is seriously hurt in this phase, his psyche will also be damaged, which can lead to a loss of orientation later on.

The concept of drive and drive-satisfaction was described by FREUD as early as 1915. The question as to how we choose an object out of the flood of perceptions has often been the subject of investigations in both Gestalt therapy and bio-semiotics. Fundamentally, this choosing is a search for nourishment in the sense of drive satisfaction. As this is not always tangible matter, the concept of the '4th quality of nourishment' is introduced. In this sense, the 'search for nourishment' is expanded immensely since all human relationships are included. As we know, e.g. from the findings of R. SPITZ, a lack of human contact is deadly. In this manner the 4th quality of nourishment is added to the three already established in natural science: oxygen, water and solid material.

In the following parts two major aspects of the psychotherapeutic research in psychosis are integrated:

First, the studies on the family-therapeutical aspects are mentioned. They show that persons who later on in life become psychotic often come from families which exhibit a lifestyle, which is not apt to provide nourishment in terms of personal relationship (the 'double bind' configuration is reflected upon as well).

Second, psychoanalytical studies are included, which show that such disruptions in parent-child-relation in early childhood (e.g. the broken-home situation) can lead to psychotic development in adults.

It is postulated that such disruptions negatively affect the psychic apparatus during its development, which leads to a weakness of organ such as is seen in physical medicine. This means that the individual will suffer from weakness in orientation and it is possible that he will decompensate at the point of a life-crisis (impasse situation). Puberty, the time when sexual drive impact comes up against super ego demands - very often the real beginning of a psychotic course of life - is used as an example of a typical impasse-situation.

By taking such aspects into account, psychosis is described as a 'decompensation of orientation'. In this context delusion and hallucination are newly interpreted. Both are regarded as outputs of the psychic apparatus, which projects an inner reality, a 'Gestalt' outside, in the sense of replacing the environment with one's own wishes. KAFFKAs 'The Castle' and GOETHEs 'Erlkönig' are cited to support this thesis.

How can this new hypothesis be linked to previously gained knowledge? It will be especially important to investigate what kind of connection exists between the so-called 'primary process' and the psychic apparatus and its role in orientation. The lecture concludes by asking what this new view of psychosis could mean for the therapist and for therapeutical outcomes. It is stated that we can understand the phenomenon of delusion, by regarding it as an effect of decompensating orientation and fruitless searching for nourishment. Adequate orientation of the therapist will assist him in developing therapeutical strategies which in turn will have a marked influence on the course of disease, especially schizophrenic afflictions or a schizophrenic defect.

Note: The views put forward in this lecture were discussed in detail in one of the workshops at the convention. Gestalt theoretically oriented psychotherapists pointed out that from their view they saw substantial differences both in approach and in theoretical foundation but that the lecture contained some interesting ideas worth a more thorough investigation and in psychotherapeutical practice there seemed to be more ideas and approaches which could be shared than in the theoretical explanation. Have a look at Questions and Answers for more sources on Gestalt theory and psychosis.

This is a provisional abstract of the lecture, please apologize the somehow clumsy wording in this provisional translation.

And now the new book on this topic in German:

Gerhard Stemberger (Hrsg.):

Psychische Störungen im Ich-Welt-Verhältnis

Gestalttheorie und psychotherapeutische Krankheitslehre

Click here for further information (in German)

Wien 2002: Verlag Wolfgang Krammer
184 Seiten, Preis € 21,80 zuzügl. Versandkosten

Dieser Sammelband enthält einige frühe gestaltpsychologische Arbeiten zur Psychopathologie (Schulte/Wertheimer zur Paranoia 1924, Erwin Levy zur Manie 1936 und zur Schizophrenie 1943), z.T. erstmals in deutscher Übersetzung, und neue Diskussions- und Übersichtsbeiträge deutscher, österreichischer und amerikanischer PsychotherapeutInnen und Psychiater zur Aktualität dieser Ansätze für eine psychotherapeutische Krankheitslehre.

Nähere Informationen zu diesem Buch

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Back to conference program 1997 in English.
Zum Tagungsprogramm 1997 in Deutsch.

Click here for a list of on-line abstracts of lectures at the Scientific Conventions of the GTA since 1997

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Most recent revision: 19.8.2000