The “Black Hole” as the Basic Psychotic Experience: Some Newer Psychoanalytic and Neuroscience Perspectives on Psychosis

The psychoanalytic treatment of psychotic disorders has had a long and complicated history because of the historic preference of psychoanalysis for neurotics. Nevertheless, it has survived the prejudice of psychoanalysts and empirical psychiatrists and now enters an interdisciplinary phase in which psychotic psychopathology is understood as primarily an emotional disorder, but one that must also be considered from the point of view of neurobiology and neuropsychology as well as sociology. In this contribution, I offer the idea that perhaps the most important subtext in the psyche of the psychotic is what has been called the black hole. This massive deficit is ultimately attributable to a precocious abruption of the mother's physical and psychical presence from the infant, a phenomenon that has hereditary, congenital, perinatal, and continuing developmental reinterpretive elaborations. The psychoanalytic treatment of the psychotic consists of reversing the direction of his or her cataclysmic descent into the black hole and, at the same time, empathically loosening the control that the protective psychotic alterego has on the surviving self. Further, the psychoanalytic treatment of schizophrenia, in particular (as well as many of the other primitive mental disorders), now frequently involves both an interdisciplinary orientation and perspective and choices of interdisciplinary modalities extending across the whole biopsychosocial spectrum.