Shattered worlds/psychotic states: A post-Cartesian view of the experience of personal annihilation.

Abstract

Adopting a post-Cartesian, intersubjective viewpoint that focuses on the interplay of worlds of experience leads to an opening up of the most severe ranges of psychopathology-the so-called psychoses-to psychoanalytic understanding and treatment. A Cartesian theory, inevitably preoccupied with the individual mind and its contact with a stable external reality, cannot encompass experiences of extreme self-loss and of the disintegration of the world. A sketch is offered of varieties of the experience of personal annihilation within an intersubjective, phenomenological framework of understanding. Features of the intersubjective fields typically associated with delusional states, manic episodes, and extreme trauma are discussed.

I do this for Your Own Good: A Story of Shrieking, Disaster and Recovery

“…Crucial to my work with this patient were the ideas of Atwood, Orange, and Stolorow in their paper, " Shattered worlds / psychotic states " ( Atwood et al , 2002 ) and in the chapter " Contexts of nonbeing: Varieties of the experience of personal annihilation " (Orange et al , 1997) . These authors describe treatment as emphasizing understanding and validation of the patient ' s experience.…”

“…Centrally guiding my understanding of Teresa are words from Ferenczi (1929Ferenczi ( /1955Ferenczi ( , 1933Ferenczi ( /1955 ; Kohut (1971Kohut ( , 1977Kohut ( , 1981Kohut ( , 1984 ; and Atwood, Stolorow and Orange ( Atwood and Stolorow, 1980 ;Atwood et al , 2002 ;Orange et al , 1997 ;Stolorow and Atwood, 1992) . Ferenczi (1929Ferenczi ( /1955 in his paper, " The unwelcome child and his death instinct " , explained the dynamics that fi t Teresa as an unwanted child, especially her chronic suicidal ideation and self-mutilation: … children who are received in a harsh and unloving way die easily and willingly.…”

Delusional themes of penetration and loss of boundaries and their relation to early sexual trauma in psychotic disorder

“…While it may not be feasible to draw a linear parallel between the content of these delusions and specific childhood experiences, this paper will suggest that by closely examining the content of the psychotic experiences, it may be possible to understand their psychodynamic functions for the individual more fully and to use this knowledge in order to advance therapeutic progress. Similarly, Atwood, Orange and Stolorow (2002) have suggested that although concrete events in the person's history may contribute to psychotic experience, attempting to trace its roots to external environmental conditions such as victimization or to internal pathological conditions overlooks the complex interactions between the two. Thus, it seems to be more useful therapeutically to focus on the individual's psychotic experiences on their own terms.…”

“…In both sexual abuse and in psychosis, the individual's sense of self is deeply undermined (Atwood et al, 2002;Searles, 1986). In both instances, the person also lacks a sense of having a boundary which delineates I from not-I, self from object.…”

“…The current paper focuses on the psychotic experience of being violently penetrated by an object and its functions for the individual in attempting to cope with early traumatic experiences with primary figures. In exploring the case material presented here, a phenomenological viewpoint is adopted, which reflects both an object relations approach to treating psychotic disorder and a phenomenological approach to interpreting psychotic experience (Atwood et al, 2002). Thus, the objective reality of the sexual abuse as well is not questioned, but rather, the focus remains on its meanings for the patient (Atwood et al, 2002;Schwartz, 2000).…”