Toward a psychoanalytical elaboration of perceptual organization impairments in psychosis

Objective.-The essay investigates the question of perceptual organization from a psychodynamic viewpoint and focuses on the impairments of perceptual organization in psychosis. It aims at renewing the therapeutic approach to these impairments in a research context, dominated by neuroscientific works that tend to consider them as deficits. Method.-The essay studies the Freudian theoretical works on perception and shows how they suggest an interpretation of perceptual organization in terms of psychogenesis. The authors then develop a theoretical reflection that relies on the psychodynamic analysis of three clinical cases of impairments of perceptual organization in psychosis. Results.-The authors show that from a psychodynamic viewpoint these impairments originate in the impossibility to elaborate the trauma in terms of 'loss'. The thesis defended by the authors is that the psychic constitution of a 'loss' is indeed what makes the perceptual organization possible. Therefore, the impairments of perceptual organization appear when the subject is confronted with the re-actualisation of a loss, which reactivates an experience that has not been elaborated by the subject. Discussion.-The psychodynamic approach developed in the essay differentiates from the neuroscientific approach on two main points. The subject's capacity to elaborate the trauma in the Freudian sense becomes essential in the perceptual organization. Therefore, the impairments of perceptual organization in psychosis can be explained psychogenetically and they rely both on conscious and unconscious processes. Conclusion.-In the clinical work with psychotic patients, the elaboration of the 'loss' that the subject has been unable to talk about, or even to conceive of, can constitute an essential psychotherapeutic modality. (C) 2014 Elsevier Masson SAS. All rights reserved.