Psychotic patients seen from Bion’s cornerstone

doi:10.15406/ijfcm.2025.09.00378

International Journal of

eISSN: 2577-8269

Family & Community Medicine

Mini Review Volume 9 Issue 2

Psychotic patients seen from Bion’s cornerstone

Alina MAPN da Silva,¹ Luiz Carlos de Paiva Nogueira da Silva,¹ Ana Paula Pantoja Margeotto,¹ André Luis Valera Gasparoto,² Tania Leme da Rocha Martinez¹

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¹Nephrology Department, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
²Intensive Care Unit, BP - A Beneficência Portuguesa de São Paulo, São Paulo, Brazil

Correspondence: Tania Leme da Rocha Martinez, Rua Comandante Ismael Guilherme, 358 - Jardim Lusitânia, 04031-120 - São Paulo – SP, Brazil, Tel 55 11 98323-9863, Fax 55 11 3842-3789

Received: March 21, 2025 | Published: April 15, 2025

Citation: Silva AM, Silva LCPN, Saldanha AL, et al. Psychotic patients seen from Bion’s cornerstone. Int J Fam Commun Med. 2025;9(2):36-37. DOI: 10.15406/ijfcm.2025.09.00378

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Abstract

The analytical technique in the psychotic part of the personality faces challenges in the interpretation-construction of the primitive material, requiring more sensorial approaches, such as metaphors and myths. Interpretation should consider analogy, symmetry and polyvalence, helping the patient to reconstruct his way of thinking. Bion explains that through sounds and associations, internal conflicts about rivalry and envy are revealed. The psychoanalytic technique does not refer only to psychotics, but also to neurotics who manifest metonymic language and symbolic codes. The analyst must balance empathy and objectivity, avoiding memories and preconceptions, allowing for more authentic interpretations. The analyst's role includes containing fragmentations of the self, decoding symbolic messages, and dealing with neurotic and psychotic defenses. Bion's concept of "not knowing" highlights the importance of renouncing partial vision in order to achieve deeper understanding, comparable to the mythical wisdom of Tiresias. Finally, the psychoanalyst must be attentive to unconscious thought, which operates in a symbolic and non-logical way. The psychoanalysis of psychoses requires humility, telepathy and understanding of primitive psychic functioning, allowing the patient to differentiate the self from the object and reconstruct his psychic identity.

Keywords: Bion, psychosis, neurosis, psychoanalysis, psychology, psychiatry

Introduction

In the analytic technique for the psychotic part of the personality, it is very difficult to use the interpretation-construction, applying it specifically to the primitive material, that is, to that derived from its psychotic part. This interpretation-construction is characterized by its analogical, symmetrical and polyvalent qualities. In order for the analogical quality (relationship and connection between two elements) of interpretation-construction and help to the patient (who does not have the capacity for abstraction and does not understand the abstractions formulated by the analyst) to work, we must use a model closer to the sensorial (model of myths and certain metaphors), such as mouths and chest to define sensations and bonds. Symmetry should be used without altering the values of its elements, such as omnipotence-helplessness and bifocal vision (eyes that meet or parallel lines that meet). The polyvalence in the interpretation-construction suggests a different possibility, both for the mind of the analysand and for that of the analyst, who must be without desire, without memory and with "rêverie". All three of these types of interpretation can lead to the reconstruction of the apparatus for thinking thoughts and putting into words images, myths, and fantasies.^1–6

In a practical way, Bion⁷ gives the example of a patient, a chemist, who was silent and began to make sounds, making it seem to the analyst that he wanted to evacuate. The answer was a babbling: "ah pro-ble-m in la-ah joh-nacio" and sounds like flatus. Bion said, "your mouth, throat and anus are competing to see which one wins." The patient babbled and finally exploded: "equivalent to as if they were trying to see who will be in charge, how to take the microphone and keep others away" and continued, talking about a collaborator who gave him doubt, he was going to work with him on an explosive and dangerous project; his colleague had lost an eye in the explosion. Bion was surprised by so much material, but he just said "hum" and fell silent. Bion then told the patient that he should feel distressed about coming to an analyst of limited intelligence compared to the other analyst he knew; Bion would represent a bottle, in front of a breast. The patient said, "the other way around." But Bion continued: "the bottle was at least efficient in the laboratory, compared to humans; the envy that the eyes saw, produced destruction-exploitation". The patient began to stutter again, but made no sound.

In this example, Bion makes use of the "analog" models (bottle and breast), "symmetry" (visual and auditory sensation, i.e., sounds, as well as countertransference) and "polyvalence" (referring to the patient's body, the transferential relationship and the external reality of the laboratory, along with feelings of rivalry and envy).^8–12

A case like this is interesting to show how the psychotic part of the personality described by Bion and similar to the schizoid personality, described by Fairbairn,¹³ is much more frequent than one thinks; it is not only found in schizophrenics, but also in neurotics, mainly in its manifestations in the form of metonymic language, code (Von Domarus' principle), bizarre objects or even by attacking the root of thought.

All the difficulties of the analytical technique on the psychoanalysis of psychoses should be applied to narcissistic treatment, especially focusing on its psychotic part.¹⁴

It is necessary, however, to emphasize the importance of interpretation-construction through clarification and preparatory explanation for the interpretation of the phases of analogy and patience, as well as the absence of memory and desire (not knowing to recognize) also using empathy, telepathy, humility, sincerity, loyalty, respect and "caritas". The analyst must be, as we have already said, on alert for the halt of development; he must not cease to focus on narcissistic defenses and must maintain for some time the identification of the analyst by the analysand with characters from childhood, in order to help him distinguish the self from the object, but he must offer, on the other hand, a model of synthesis and later accept the role of self-object in order to inspire confidence and be the continent of the fragmented parts of the glorious self.

The analyst must also show this state of entrenchment motivated by massive projective identification and play the role of mirror (not malignant mirror, but through understanding and empathy), to connect the patient's "gyroscope" and become an ego-prosthesis" and a good continent. In the same way, it is necessary to make the patient feel that the analyst is not his self-absorbed family, full of witchy messages, with a pathological predominance of the "paternal law". This attitude will help to remove him from the "vicious cycle of hopelessness". The analyst must decode his messages through the teleological understanding of metaphorical metonymic languages and paleosymbols and always be aware of perspective reversals and paranoid schizodefenses, hypertrophies of the mechanisms of denial of massive projective identification and regressions. On the other hand, it must address and remove the patient's false-ego and make up for the lack of the gratifying object.

It is also of great value to use the teachings of Bion; "To perceive the truth, at a certain moment [he refers to an interpretation during the psychoanalytic session], it is necessary not to use memory so as not to have a preconception" - or, in other language, "to have exempt eyes". This attitude is so that the real situation cannot be harmed. For this it is also necessary to have a deep interest in the possibility of some discovery, but without any preconceived utilitarian idea.

To benefit from the situation, Bion emphasizes, therefore, the importance of cultivating attitudes of not knowing: "I didn't know", but if you know, then admit it, to avoid the deluge of knowledge, because in the investigation of human knowledge, it is necessary to ignore in order to recognize. It would be the same as applying the principle of Tiresias: in the myth, Tiresias was punished by Juno who took away his sight for having committed a sexual transgression (because he had transformed himself into a woman to get to know her better). Made blind he would have better capacity for inner vision and clairvoyance of occult things (he would possess the third sight of occultists). It is therefore necessary to renounce the vision of a part of reality in order to be shrewd in something concrete. In a certain sense, restricting the extent of knowledge is what occurs in certain schizophrenic attitudes, or even in certain neurotic attitudes, due to the fact that patients use inhibition and mental dullness as a defense; nature itself uses this Bionian concept: the schizophrenic, in order to defend himself, uses the ability to think thought.

Unmissable to consider that emotions are also included in countertransference. It is very important to keep in mind that utilitarian thinking, in the absence of pain, could bias a psychoanalytic interpretation.

The psychoanalyst needs to have wisdom (experience, intuition, knowledge, technique, etc.) and must be enlightened about the unconscious thinking that develops in parallel with conscious thinking, because the psychotic part of the personality is not governed by logical ideas, that is, because it does not apprehend by the sensory elements, by the "thing in itself", but by the symbols (SYN = indeterminate and BALLO = to transmit, send), because the Mohammed of the "Verse of Light" (Muraro) already said: "It is expressed in symbols for men".