Delusion and bi‐ocular vision

Abstract

The delusional experience is the result of a grave disjunction in the psyche whose outcome is not readily predictable. Examination of the specific mode of disjunction may help us understand the nature and radical character of delusion. I will present the therapy of a psychotic patient who after many years of analysis and progresses in his life continues to show delusional episodes although limited and contained. In his case, the two visions, one delusional and the other real, remain distinct and differentiated from each other because they both possess the same perceptual character, that of reality. He has a bi-ocular vision of reality and not a binocular one because his vision lacks integration, as would necessarily be the case if the two visions could be compared with each other. The principle of non-contradiction ceases to apply in delusion. A corollary of the failure of the principle of non-contradiction is that, if a statement and its negation are both true, then any statement is true. Logicians call this consequence the principle of explosion. For this reason, the distinction between truth, reality, improbability, probability, possibility and impossibility is lost in the delusional system, thus triggering an omnipotent, explosive mechanism with a potentially infinite progression. The paper presents some thoughts for a possible analytic transformation of the delusional experience.

Bi‐ocularity, the functioning mind of the psychoanalyst

“…In this case, the two visions, one delusional and the other real, remain distinct and differentiated from each other because they both possess the same perceptual character, that of reality. (De Masi, 2015) I had not read this paper when I first wrote mine and was struck by the similar use of bi-ocular to describe the unintegration of the two visions. This unintegration, I am suggesting, is part of the necessary gap which needs to be fostered as part of the analytic attitude.…”

The Feared Therapist: On Being Part of the Psychotic Patient's Paranoid Delusion

“…Where imagination can be used to repair the mind, delusion does the opposite, further solidifying and increasing the disturbing affects that it attempts to explain (Oppenheim, 2013). Delusion is a closed reality that is incapable of generating symbols (De Masi, 2015). Thus it does not invite the psychotherapist to reflect on its meaning or offer a contribution to its structure, which can, when the psychotherapist is implicated in the delusion, present the therapist with an anxiety‐provoking claustrophobic experience that leaves them with little to no room to react in a generative manner (De Masi, 2015).…”

“…In this sense patients suffering from psychosis can be said to operate via a private idiosyncratic code (Brazil, 1988). Because delusions (as code) are usually characterized by rigid structures and symbolic poverty, the patient is often unable to reflect on or be creative with what their mind has produced (De Masi, 2015). The delusional construction is not to be used to help them make sense of themselves and of their experiences, and thus further distorts their sense of their own subjectivity (De Masi, 2015).…”

“…Thus, the patient needs the delusion; often they can feel that their safety fundamentally depends on it (Knafo & Selzer, 2015). This does not, however, imply that the patient's experience of a paranoid delusion is any less traumatic (De Masi, 2015).…”

“…Not all forms of psychosis are necessarily rooted in early developmental failures and traumas (Schafer, 2011). There are many factors that contribute to fractures in subjectivity, and the development of psychosis is a complex process made up of many parts (De Masi, 2015; Bollas, 2015; Jakes, 2018; Kohut, 1977; Schafer, 2011). I use this specific collection of theoretical understandings of psychosis as an example of an approach that aids the psychotherapist in establishing an awareness and understanding of the psychotic patient's subjectivity (Stephenson, 2018).…”