Possible causes of psychotic breakdown, meanings of withdrawal and structure design for the care of the psychotic crisis

Jung, in 1908, had stressed the fact that in the period preceding the psychotic onset, particularly significant facts of life had destabilized the psychic asset of the patients. In other words, to use the terminology... [ view full abstract ]

Jung, in 1908, had stressed the fact that in the period preceding the psychotic onset, particularly significant facts of life had destabilized the psychic asset of the patients. In other words, to use the terminology of Zubin and Spring, various kinds of stressors had intervened on a psycho-biologically structure particularly vulnerable ". (Fulvio Marchese – Caterina La Cascia - Alessandro Bruno – Daniele La Barbera 2015).

This was the case of a young patient of mine with an inconsistent self, which I reckon to be compared to the damaged self theorized by Heinz Kohut. After a series of very stressful emotional traumas causing him an adolescent breakdown, my young patient had a psychotic onset. The fall of the Self and its further fragmentation regressed him to the stage of archaic grandeur, expressed through a delirium of omnipotence, as hypothesized by H. Kohut.

The psychotic onset may then prove “ necessary” every time a person with an
inconsistent or damaged Self needs " a retreat" after a chain of emotional traumas no longer tolerable because of the subsequent dissociations and fragmentation of the Self.

Dissociation predisposes to "social withdrawal", threfore to a particular use of imagination and thought in order to escape the anguish and the catastrophic feelings no longer tolerable that can overwhelm the Self. The catastrophic and disorganizing feelings that precede the fall of the Self, as well as the massive cortical activity resulting, can cause a quite prolonged hypervigilance that leads to a psychotic onset.  The consequent emotional instability makes therefore necessary an "emotional rest" in an environment
whose warmth, empathy, sympathetic attitude, psychotherapy, physical and
sensory wellness are the pillars for the psychic restructuring, in order to bring back both mental and biophysical well-being. The "retreat" also performs various functions and prevents any further damage.