Anyone familiar with the filed of psychiatry is also familiar with the notion that psychotic patients are detached from reality. Yet, anyone who worked with psychotic patients knows that they have their own realities, which is not totally chaotic or loosely put together; their realities are strongly convincing to them. It just isolates them from other realities behind the thick line of psychosis, a line that does not allow crossing it from both directions preventing exchanging ideas.
We (none psychotics) have our own personal realities too. It separates us from other realities with a thin line of subjectivity. It is thin because it could be crossed both ways: we allow others to cross it to test our reality and we cross it to test theirs. It goes without saying that all that happens in relative degrees of easiness. Despite the ease of that exchange we still maintain our own reality behind that thin line of subjectivity.
I have three reasons to mention this simplistic conception of the clashes of realities: The last mass murder in Las Vagus, Trumps speech in the UN a couple of weeks ago, and a subtle but important clinical matter.
It seems that the guy who did the shooting in Vegus did not show any signs of psychosis or history of serious cognitive pathology. He did not cross from his side of the line to our realities. However, his act of shooting has all the signs of psychosis of the schizophrenic (thought disorder). An act of that nature suggests a moment or a short period of psychotic breakdown. Could that what has happened? We are accustomed to measure the severity of mental disorder by the severity of the acts that result from them, not by the severity of the psychical condition itself, which could lay dormant and naturally out the patient’s own judgment. Dormant sever psychoses is seldom explored now a day, because of many positive developments in psychiatric care and many negative changes in our social life. This “crazy” man was going through a breakdown of his line of reality for only few months before he acted upon it. It showed before his overt breakdown in the spree of buying guns and ammunitions beyond any reasonable proportions to just committing his heinous crime. The personal reality of this man jumped the line and came to our world with a bang. His reality replaced other realities by jumping over the psychotic barrier. .
Trumps speech in the UN was another example of crossing a thick line between his reality and the ‘world’s’ reality. The reality of the situation was a gathering of presidents, prime ministers and rulers of nations, to give homage to the organization that represents the whole world…..not the place or the time to declare or initiate any national policy. This REALITY did not penetrate the thick line of Trump’s reality, which is confidence in succeeding to manipulate any crowd as he does in Alabama and Tennessee. The barrier that kept the reality of the situation from reaching him is “narcissism”. We all know that there is a gap between I and Me and that there is a difference between saying I am so and so and being that so and so. In Trump’s case there is no gap between the two pronouns and possibly he has no sense of I-ness to build that gap. Thus, reality to him is not an issue to fret about because it is what he says what it is.
Clinically, we work to introduce the patient to that thin line between his subjective reality and other realities. In a way we suggest crossing that barrier. The neurotic’s psychical difficulty is in that regard is what we call phantasy (his reality is phantasmic). The patient’s phantasy is his identity; it is his Me. It is the identity which was gradually he built from his caregiver’s definition of him during growing up. Its phanatasmic quality stems from unconsciously assimilating what the caregivers thought of him and maybe what he should be. It is not phantasy because there was no realty to compare with in his early childhood. Keeping that in mind should make us carful in crossing the line of the patient’s reality and trying to bring it more closely to another- so called- more or better reality. It could be more harmful to lose this phantasmic reality in the process of analysing it as a phantasy. because all what we could achieve by doing so is suggesting leaving something cardinal in one’s identity without having something to replace it.
I remember three cases that baffled me at the time of working with them and I was able to understand few years after my work with them ended. Two of them left the analysis by their request (one very angry and disappointed) when I became more active in bringing their unconscious reality into focus. The third patient was showing signs of regression when I tried to do that and I had to terminate her analysis before I could have considered it properly terminated.
Final statement in that regard: the most difficult and important in psychoanalysis is dealing with material stemming from parental input especially of that input was accompanied by its verbal equivalent. This explains to me the Americans resistance to eliminating the second amendment which was to serve a temporary purpose when it was adopted, As with patients, doubting or giving up a recommendation by parental authority (the forefathers) creates the anxiety of loosing the nation’s identity, without that amendment the US will not be the same. In a previous mass killing in 2015 there was a TV encounter with a young mother surrounded by her three children who just bought a gun saying she has to protect herself and her kids. That was her reality that neglected that she lives in a country of great police forces and an equally great judicial system. What the forefathers said becomes the ultimate and the name of the one and only reality.
Question: could we psychoanalysts insist on Eitingon’s model of training for the same reason.