Psykose - En livbøye i et stormullt sinn

Studenteropgave: Kandidatspeciale og HD afgangsprojekt

  • Liv Inger Bergland
4. semester, Psykologi, Kandidat (Kandidatuddannelse)
This dissertation answer a question of how the a psychological deficit can have effect on the risk of developing a functional psychosis. The understanding of pschysos is here made by it`s main features wich are delusions in combination with a sense of lack of reality. A function of the perceived detachment from reality has been pro-posed by four psychoanalytical theories, as well as the original attachment theory. The psychodynamic union which these theories form combines the methodological paradigm of humanism with natural science. While the psychoanalytical theories are derived from clinical practice and as such are able to offer phenomenological insight, the attachment theory is based upon a systematic gathering of its data, making it eas-ier to generalise the theory. With the attitude that no methods are eather good or bad, but rather adequate or not, relevant to the topic and phenomena at hand, litteature from both paradigmes are used. The four psychoanalytical theorists, who each focus on specific concepts of the prob-lem, relevant to psychosis and deficit, consist of Melanie Klein, John Steiner, Donald W. Winnicott, and Michale Balint. Klein offers an understanding of the paranoid-schizoid position, which gives rise to defence from psychotic anxiety that uses mechanisms such as splitting and projection. In using this defence, the unbearable drifts, emotions and fantasies, of the individual are projected outwards, changing the world into a nightmare of percutory anxiety, uniquely constitued by the individual’s fantasy. The resoulution of this position through development will, in the case of unresolved issues or conflicts, create fixation points from which the person may later relapse into a paranoid-schizoid position and re-experience the splitting and projec-tion. This may ultimately result in a fragmentet ego, wich is to be consideres the worst case scenario should the projected and identified parts succed in the destruc-tion from the projected part. This is especially likely should the good part-object, be projected and lost, leaving the person unprotected against identified persecutory and threatening forces. Klein’s theory is supplemented by Steiners third position, the experience of which resembles being a refugee from the outside, real world. This third position is under-stood as a psychic retreat to a psychotic organisation of the personality, through a process which is called “turning a blind eye”, or through omniopotent alliances, which make the retreat attractive both as a flight and as a perceived alliance with powerful and protective characters. While the theory, which is building on Kleins theory, does not give a greater understanding of the development of risk it does of-fers further insight into the phenomenological experience. Winnicott’s theory, on the other hand, focuses on the development of the reality sense and is a major a contribu-tion to our understanding of how a person can come to be detached through the not-good-enough or to-good-mothering phenomena. This is because the good-enough-mother provides the child with a feeling of being able to find ones objects in reality, called a potential space, is necessary for being able to play and through this learn the cultural meaning. Any parts of the culture that are not understood will make dealing with the objective reality more difficult. The combination of an individual not being able to find her or his object in the potential space while lacking an internal model of it, and the not-understood themes, will constitute a risk as it may lead the individual to redraw from the potential space into a subjective reality with subjective meaning. Winncott is in agreement with Balint, whose theory focuses on the mother’s ability to form a unity with an infant, and providing it a feeling of itself as ‘fitting in’ with the world. An individual who lacks a sense of fitting will grow up with a basic fault, a feeling so unbearable it is either defended against by a desperate clinging to her or his objects, or by investing her or his libido in non-living materials convinced that is all which is needed. Balint’s theory is in many respects similar to Bowlbys theory of attachment. This latter theory, however, adds a third category of attachment which together with Balint’s two suggestions constitute cognitive models of relating to oth-ers, and which are both governed by biological-cognitive systems that need to be in homeostasis. A secure base in these theories is a familiar one, meaning that when one is in need of the attachment figure it is when one does not have a repetoir of effective behavior that the anxiety rises, and can lead to a disorganised and unsertain base. In the case of a highly stressful event, especially impossible ones like the death of an important person, the two former categories may become disorganised as well, and thereby increase the risk of psychosis. One of the most important aspects of attach-ment theory is the understanding of each individual’s biological need for warmth and comfort from an attachment figure to buffer against stressful life events. Three major discrepancies between the theories make a unified conclusion more dif-ficult. These are the methodological issues; the controversy of the drifts in relations to the biological attachment need; and whether the deficit is made from, or triggered, by fantasy or real life experience. These are discussed, and investigated through ex-ternal research, followed by a choice of position. The meeting point between these is also of importance, resulting in a general focus on the impact of human relations on the development of a deficit, its relevance to the risk of triggering of the psychosis. A crucial point is the pain associated with relational threat, in a combination with the pain relief which may be offered by an attachment person. An individual who does not have such an emotional available other available, will run greater risk of develop-ing a psychosis because of her or his inadequate affect-regulation in relational isola-tion. Together, these theories suggest that the function of psychosis is to offer an ability to escape from an even worse reality of great discomfort, and the detachment from reality and disillusions as alternative ways of affect-regulation when effective attachment figures are not present. Triggers of psychosis are therefore likely to affect an individual by inducing a developmental deficit in handling and regulating affect, which ultimately makes an individual more vulnerable for risk factors relating to unbearable emotions.
Antal sider93
Udgivende institutionAalborg Universitet
ID: 17632256