Find a therapist to treat psychosis

Most people organized at the psychotic level are not overtly psychotic.

The psychotic level of personality organization is characterized by fears of annihilation and engulfment.

The self-identity is too porous - the boundaries between the self and the universe are too blurred.

See below for more on this series of posts.

The three levels of personality organization in patient populations are neurotic, borderline, and psychotic.

Not everyone who is organized at the psychotic level is psychotic; in fact, most are not. Many people might appear fairly typical to others, but struggle with confusion about what is real or imaginary, or how separate or connected they are to the universe (4). All those who experience psychosis have at least for that period of time either regressed into the psychotic level or are typically organized at the psychotic level. In other words, to be overtly psychotic is to also be organized at the psychotic level of personality organization (necessary), but to be psychotically organized is not necessarily to be psychotic (not sufficient) (1, 4).

Clinical Features of the Psychotic Level of Organization

Please see this piece for the origins of the psychotic level of organization. The greatest fear of individuals organized at the psychotic level is dissolution; the disintegration of their already poorly bounded self into the universe. Analysts call it “annihilation anxiety”, and it is the anxiety that psychotic symptoms are designed to defend most vigorously against (5). From this perspective, these symptoms are not evidence of a mind in random disarray but organized primitive defenses against an unbearable anxiety. The fear is so visceral and existential that people have been known to faint or fully dissociate in the face of it. As Winnicott says in his paper Fear of Breakdown, on the nature of psychotic anxiety:

“I contend that clinical fear of breakdown is the fear of a breakdown that has already been experienced. It is a fear of the original agony which caused the defense organization which the patient displays as an illness syndrome” (6).

This feared fragmentation or dissolution is analogous to their experience of maternal engulfment, part of the origins of the psychotic organization. A mother who cannot allow for separation tends to unconsciously try to pull the child back into herself, like an amoeba surrounds its food source and envelops it for nourishment. Relatedly, the individual’s greatest wish is to be a fully separate, boundaried self, no longer at risk for splintering off into the universe or being swallowed whole by the........

© Psychology Today