title: Psychotic withdrawal and the overthrow of psychic reality.
abstract: The author attempts to distinguish between the world of fantasy and the imagination (which fuels our capacity to 'dream') from a withdrawal into fantasy. In this withdrawal, the foundations of which are laid in childhood, a dissociation from psychic reality starts and from it the delusional world arises and constitutes the adult illness. During therapies of adult patients who have experienced a psychotic state, it is often possible to reconstruct the state of infantile withdrawal and understand how their dissociation from reality was ignored or unknowingly encouraged by their parents. Children destined to develop psychosis enter into the dissociated world not just as a defence against anguish or loneliness, but also for the pleasure of experiencing a delusional self-sufficiency and a gratifying omnipotence in which anything is possible. Mental workings that take place in the withdrawal do not follow the rules governing normal psychic functioning. Those fantasies cannot be either repressed or 'dreamed' in order to be transformed into thoughts. These psychopathological structures, which develop early and autonomously, have to be understood during analytical therapy in their origins and 'deconstructed' in order to help the patient to escape from their dominion. By means of clinical examples, the author tries to shed light on the possible ways of reaching patients in their psychotic shelters, thereby helping them to re-emerge into a psychic reality.
authors.affiliation: franco.demasi@fastwebnet.it
authors.forename: Franco
authors.initials: F
authors.lastname: De Masi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003674:Defense Mechanisms; D003702:Delusions / Q000523:psychology* / Q000628:therapy; D004213:Dissociative Disorders / Q000523:psychology / Q000628:therapy; D005201:Fantasy; D005260:Female; D006801:Humans; D007063:Identity Crisis; D007092:Imagination; D008297:Male; D011573:Psychoanalytic Interpretation; D011575:Psychoanalytic Therapy; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D011936:Reality Testing; D012934:Social Isolation