Orphans of the 'Real': I. Some modern and postmodern perspectives on the neurobiological and psychosocial dimensions of psychosis and other primitive mental disorders.

Abstract

To understand and treat patients suffering from psychoses (especially schizophrenia) and from other primitive mental disorders, it has become increasingly important to integrate the "soft science" of psychoanalysis, including its derivate, psychotherapy, with the "hard science" findings of neurobiology, infant development research, and newly emerging trauma research. The author presents such an integrated perspective, and also discusses a paradigmatic change within psychoanalysis itself, one that can be described as a transformation from the one-person ("modern") model to the intersubjective ("postmodern") model. This change is also characterized by a shift from drive theory to that of semiotic meaning and hermeneutics. In light of this transformative change and integration, the author formulates the concept of a generic type of patient, "orphans of the 'Real,'" whose illness can be described as the result of a premature awakening from the protective blanket of innocence because of hypersensitivity and/or traumatic abruption. These patients experience the "Real" without the protective blanket of imagination or symbolization.