OPENINGS

What is psychosis?

While many mental health professionals consider “psychosis” to be a severe mental illness, we consider psychosis — and related experiences of crises or extreme states — to be a particular structure that describes an experience or a way of being in the world. For the person living with this structure, social rules and what is considered to be “normal” can feel arbitrary, and they might invest themselves in a mission or project to help ground their experience, to explain the world, and/or to solve a major social problem. This can produce a lot of suffering, and it can be very helpful to have a place to speak about these experiences — dreams, voices, hallucinations or visions, delusions or frameworks, projects, life histories — without fearing punishment or rejection. We offer a space for someone to say what they haven’t yet been able to.

To avoid the stigmatization involved with the label of psychosis, some groups use terms like “voice hearers”’ or “non-conventional structure.” Sometimes, people who are what we call psychotically structured might be diagnosed with a psychotic disorder according to the DSM. Other times, they might have another diagnosis, often one considered to be severe or chronic. Or, they might have no diagnosis at all. Similarly, they may see a psychiatrist to prescribe medication that can help to alleviate suffering or to quiet the voices, even if it leaves one’s experience unaddressed. Diagnoses extend only as far as the symptoms they describe. Rather than diagnoses, we work with what someone has to say about their experience, including their suffering.

What can psychoanalysis offer?

Rather than an approach that considers psychosis to be a lifelong illness only manageable with medications, psychoanalysis offers something else: an opportunity to speak about one’s experience in order to overcome the suffering it involves. We work according to what one has to say about their life, not a predetermined plan.

Psychosis can be successfully treated in an outpatient setting by inviting someone to be an agent and author in their own treatment program. Our milieu involves group activities, artistic and recreational projects, and support for attendees’ own endeavors. Attendees also work with an arts coordinator who assists in the development of artistic projects, as well as a “go-to” clinician who provides support through the experience of psychoanalysis, during crisis, and with day-to-day decisions. We can also work with the participant’s psychiatrist or recommend one, where applicable.

While this process can be difficult at times, it builds towards an opportunity for the individual to live meaningfully with others by creating connections between inner experience and the outer world. We offer a space where one’s experience is attended to in a way that is impossible in conventional treatment programs, and we welcome experiences that are often not tolerated by the society in which we live. By upholding a work of speech, we aim to support newly meaningful engagement with the world.