The Uncanny and Psychosis

As I was presenting my doctoral work at the International Society for Psychological and Social Approaches to Psychosis in Chicago a couple of weeks ago, we had an interesting discussion during the Q&A. In my paper, I shared my work of a two-year case study with a patient who was occasionally psychotic and I described a couple of uncanny experiences I had with the patient. My first experience occurred during one session when I was daydreaming about eating eggs once the session was completed. Instantly, the patient shifted the discussion to describe a new diet he was planning to begin. He reported that this new diet would require him to eat many eggs. Shaken from my reverie, I was baffled to hear the patient discuss eating the exact food that I had just been fantasizing about. The patient rarely described food and had never before mentioned eggs (this was around our 80th session together). Another instance happened when he was describing his religious beliefs and principles. During the conversation, he disclosed to me that he believes that I have an extensive religious background and that I know a lot about religion. I asked if he meant that I had some sort of pastoral background and he replied that I had simply studied religion on my own. His intuition was completely spot on although I had no idea how he discerned this about me. I never spoke about my religious background nor did I ever encourage him to talk about religious matters (except when he wanted to). During the Q&A, my professor described another uncanny experience when he was working at an inpatient hospital where both he and his wife used to work. One day a patient verbally attacked him and told him to go home and ‘fuck his wife already’. Unbeknownst to my professor, at that exact moment his wife was buying a pregnancy test, and it turned out that was she actually pregnant. My professor described that certain psychotic individuals have a ‘radar’ for understanding such matters.

Well how do we understand these experiences psychoanalytically? Psychosis is an experience that is related to the unconscious. Freud described the unconscious as operating with primary process thinking, which is the same logic that underlies psychotic processes. Moreover, in psychosis the repression barrier between id and ego is much more porous. Neurotics are notoriously defensive and they spend their entire life trying to avoid the terror of the unknown unconscious whereas psychotic individuals are often much more intimately acquainted with it. Perhaps this porous internal boundary (what Federn called the inner-ego boundary) allows these individuals to unconsciously detect the repressed and dissociated elements of the other person’s mind. Searles often spoke about the ways in which the therapist’s unconscious processes can drastically impact the psychotic individual. Searles reported that these individuals are much more susceptible to the other person’s unconscious and can in fact internalize those feelings and fantasies and express these through the creation of new symptoms. In analytic theory, we tend to think of psychotic individuals as constantly projecting internal impulses, wishes and fantasies into the outside world (e.g. paranoia) but Searles realized that they also are vulnerable to introject the unconscious processes of others. I also heard at the conference a quote that in almost every case of suicide one can find in that individual’s history a person who harbored deep and intense murderous fantasies towards that individual.

I don’t know if others have had similar experiences but I’ve found in my clinical work that working with psychotic individuals is the greatest proof of psychoanalytic theory.

4 thoughts on “The Uncanny and Psychosis

  1. This really is a stunning proof of Lacan’s theory of psychosis — including the fact that they’re stuck in the imaginary, right? Given that they can mirror and report back your unconscious process?

  2. Not only are the problems in the imaginary due to this mirroring process but also because of the profound bodily disturbances and image confusion often observed when individuals are experiencing psychosis (particularly the outer-ego boundary problems, a compromised capacity to determine where the self ends and the other begins). A realy great text that lays out and expands Lacan’s theory of psychosis by is Vanheule and Ver Eecke’s Phenomenology and Lacan on Schizophrenia after the Decade of the Brain (

    One could also argue that the impressive research on childhood abuse (particularly childhood sexual abuse) and psychosis indicates that the inability to assimilate real traumatic experiences in the symbolic leaves a hole in the symoblic. Lacan spoke about how delusions are attempts to patch over this rupture in the symbolic.

  3. Is nothing “coincidental” in psychoanalysis? I realize that a good analyst pays as complete attention to the manifold dynamics of the situation as possible, and communication is broadly complex. But all diagnosis without a treatment plan is sophomoric, no? How did the events relate to the client’s treatment plan?

  4. Is nothing coincidental? Psychoanalytic theory is committed to psychic determinism, the belief in the meaningful connection between psychological events in an individual’s mind. Obviously, coincidences do happen and not every thought or association of the patient is about the analyst nor is every fantasy and association of the analyst created by the patient. However, there are many connections between the two and these experiences and mergers seem to happen more often when working with individuals who have psychotic experiences (likely because of their porous outer-ego and inner-ego boundaries).

    Are treatment plans necessary? It probably depends on what you mean by treatment plans. Psychoanalysis has generally focused on promoting insight and making the unconscious conscious which is obviously fairly broad and does not require an obsessive treatment plan/structure.

    I don’t really understand your last question. These events happened in the course of treatment. I did not comment on either of these events because they weren’t particularly relevant to the patient’s symptoms however they were instructive and fascinating.

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