September 19, 2017
"The Denial of Character Pathology in Psychotic Patients and Their Doctors" with Peter B. Dunn, MD
Denial of psychosis in psychotic patients is widely discussed as a cause of non-compliance and relapse. Less often discussed are patients who accept the reality of their psychosis but deny the broad scale character pathologies that commonly – though not universally – accompany psychotic disorders. Such character pathology includes varied cognitive deficits, intense passive yearnings often punctuated by impulsive actions, unreliability in affect modulation, intense narcissistic fragility, the relative inability to read the motives of others, and an intensity of aggression that fuels a self-destructiveness that may only be satisfied with a real or symbolic obliteration of their original identities.
It is a paradox that it requires a great deal of psychological health to accept that one is psychologically ill. If the illness is a chronic psychosis, acceptance requires the capacity to mourn the wished self. Unable to face the pain of mourning, the actively psychotic patient whose psychosis is triggered by the traumatic narcissistic injury brought on by their most recent failure is unable to mourn so he presents instead with melancholic despair or blames others in a paranoid delusional state, or asserts a manic sense of superiority. When the patient is no longer psychotic, manifestations of denial are subtler. The patient may come to accept that he has a psychotic disorder but believe that an Axis One Disorder such as Bipolar Mixed Type is akin to a diagnosis of a pulmonary abscess. That is the patient may find solace by thinking that their bipolarity is, like an abscess, an isolated area of pathology in an otherwise healthy person. The treating doctors may adopt the same technique.
This presentation will discuss the role that denial of character pathology played in the deterioration of a male patient with severe bipolar disorder. As a counterpoint, selections from a film about a fictional, severely ill bipolar patient will be shown to illustrate how the overcoming of such denial may lead such a patient to flourish.
New York Psychoanalytic Society & Institute
247 East 82nd Street (between 2nd and 3rd Avenues)
The Marianne & Nicholas Young Auditorium