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.
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