The psychodynamics of the recovery of a traumatised narcissistic patient with bipolar psychosis

The psycho-dynamic highlights of a psychotic patient with emotionally depriving childhood and multiple traumatic experiences will be presented. He developed a narcissistic grandiose personality.  He had to be hospitalized... [ view full abstract ]

The psycho-dynamic highlights of a psychotic patient with emotionally depriving childhood and multiple traumatic experiences will be presented. He developed a narcissistic grandiose personality.  He had to be hospitalized twice due to a depressive psychosis with serious suicidal attempts. The patient´s illustrative dreams are used to clarify the psycho-dynamics of his problems and the process of his recovery. His parents had a limited containment capacity and interest of helping the children to manage their feelings. He developed a narcissistic character organization,    used massive dissociation and denial which hindered him to digest his depressive affects, leaving him helpless when meeting disappointments and setbacks. His high intelligence helped him through the school years, until he moved to live on his own and started his engineering studies at the university. His delusional belief of his superiority collapsed and pushed him in deep unmanageable depression. He had never learned to cope with defeat, inferiority and envy. The depressive affects were persecuting (beta-elements) for him, which he had to dissociate.  This led to paranoid experiences which he could not distinguish from objective reality in his psychotic states.  He became addicted to alcohol because he needed regularly to numb his unbearable affects and feelings. He became seriously suicidal and acted out dangerously needing hospitalization. Recovery became gradually possible through regular experiences of good enough emotional containment in a stable analytic relationship of his dissociated parts. A trans-formative process got going and he became stronger.  Eventually he could permanently stop drinking. This enabled normal psychoanalysis to begin after three years of life threatening crisis during more of less permanent drunkenness with the psychotic narcissistic part often domineering the transference.