Blank/Nondelusional Psychoses

BLANK/NONDELUSIONAL PSYCHOSES

Blank psychosis is defined as a psychosis with no readily identifiable clinical manifestation, where analysis alone affords access to a psychotic care: a nuclear structure that is the source of possible psychotic development without necessarily producing actual symptoms.

Jean-Luc Donnet and André Green (1973) introduced the notion of blank psychosis, based on a psychoanalytic session with a patient, "Z," conducted in a general psychiatry department.

As early as 1911, Eugen Bleuler had distinguished "simple schizophrenia" and "latent schizophrenia," and his notions of "schizoid" and "schizothymia" had already raised the issue of the boundaries of psychosis.

Psychoanalysis first considered the internal boundaries of psychosis in order to fathom its outer limits. Helene Deutsch described the "as if" personality in 1934, and as early as 1939 Maurits Katan studied "prepsychosis" in his work, "A Contribution to the Understanding of Schizophrenic Speech." Since Otto Kernberg's 1967 book Borderline Conditions and Pathological Narcissism, the study of prepsychosis has often been combined with that of borderline states.

Rather than a syndrome, blank psychosis evokes a structure that is not manifest. It can be mistaken for a depressive state with a configuration that is difficult to pinpoint, for a borderline state, or it can refer to psychotic development without obvious signs. Consistently nuclear, it corresponds to three parameters according to the "princes" description: a) oedipal organization remains triangular, but the two parent figures are identified according to their good or bad character rather than the masculine/feminine opposition; b) object relations bring internal objects into play; c) the subject is torn between good objects and bad objects, and between the good ego and the bad one, on account of the objects being driven back into the ego.

Unlike psychosis, the role of the external objects in blank psychosis shows that the subject continues to cathect reality, which is doubly inscribed, even as projection considerably modifies the subject's apprehension of it. However, there are strictly speaking no delusions, in the sense of either persecution by the bad object or protection by the good object.

"Empty" or "paralyzed" mental functioning of thought results from an active decathexis that is attributed to "the destructive drives' attack on the binding processes in so far as they are a function of consciousness's awakening to reality" (Kernberg, 1975).

The description of blank psychosis has had an effect comparable to the impact, in the 1970s, of the "borderline" category, linked to the expansion of a North American clinical tradition. The extension of psychoanalytic practice to the treatment of psychosis, and the surprises generated by this work, have motivated further interest. During the 1960s, Kernberg participated in a long-term study of forty-four difficult cases treated by psychoanalysts at the Menninger Clinic. When psychosis was triggered after several years in the same analytic situation, Kernberg considered such cases to involve "borderline patients" whose "ego is better integrated than in psychotics except where close human relations are concerned" (1975). With regard to both the triggering and the stabilization of psychosis, he focused less on biological continuity than on the structural continuity of the ego's defensive reactions, from a perspective informed by the work of Anna Freud. He sought to understand the negative factor that undermines the ego's consistency to a point of critical instability: "All defensive mechanisms also contain the germ of the ego's destruction" (Kernberg, 1975). Numerous studies of borderline states have similarly focused less on symptoms than on prepsychotic "personalities," their degree of consistency—albeit paradoxical—or their narcissism.

Meanwhile, Jacques Lacan, faithful to the "formal envelope of the symptom," demonstrated the importance of "elementary phenomena" (Lacan, 1993, p. 14) in the prepsychotic phase: intuitions, echoes, words, forced gestures, and the like, all of these intermittent and erratic. In the course of the interview, "eclipses" or "blanks" (or even memorization) in the patient's speech mark an impasse or confusion with regard to the signifier. Lacan unfailingly examined the sudden appearance of any neologism or surface manifestation of the "kernel of dialectical inertia"(p. 22). His criticism of Maurits Katan focused on the reconstruction of the "prepsychotic" phase, and the confusion of levels—imaginary, symbolic, and real—and also on the confusion between "understanding" and "imagining" in Katan's account. In Lacan's view, Katan's and innumerable other conceptions of "borderline states" had made naïve use of Freud's notions regarding the ego (the second topography) and his text "The Loss of Reality on Neurosis and Psychosis" (1924).

The "sinthomatic" structure described by Lacan in The Seminar of Jacques Lacan: Book III, The Psychoses (1955-1956) opened new perspectives on the psychotic kernel, as did Piera Aulagnier's work on "psychotic potentiality."

Michel Demangeat

See also: Anality; Borderline conditions; Dead mother complex; Intergenerational.

Bibliography

Freud, Sigmund. (1924). The loss of reality in neurosis and psychosis. SE, 19: 180-187.

Kernberg, Otto. (1975). Borderline conditions and pathological narcissism. New York: Aronson.

Lacan, Jacques. (1966).Écrits. Paris: Seuil.

——. (1993). The seminar of Jacques Lacan: Book III, the psychoses (1955-1956). (Jacques-Alain Miller, Ed. and Russell Grigg, Trans.). New York: W. W. Norton.

Mijolla-Mellor, Sophie de. (1998). Penser la psychose. Une lecture de l 'oeuvre de Piera Aulagnier. Paris: Dunod.