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The ego is primarily a body egoÓ, Sigmund Freud.
Some material has been assembled in the 60s, notably by Wilhelm Reich, Alexander Lowen and followers for the relation between psychosis and body aspects [Reich, Wilhelm, Character Analysis, 3d ed.][Lowen, Alexander, Physical dynamics of Character Structure, or The Language of the Body, Grune and Straton, 1958.]. Under the title of Schizoid or Schizophrenic Character, they describe the main features of the reflection of psychosis in the body. Such as:
In structural psychology, we do not follow the common use of lists of symptoms to describe pathologies, since to our point of view, a given psychic structure manifests `symptoms' in function of its environment, and especially of its transferential environment: symptoms are not specific of the individual (or of its `character'), but are function of its psychic structure and of its environment, and especially of the unconscious of the persons present.
In so far as the body is the support of the psychic structure, the defects in the psychic structure project themselves in the body, or even more, are the defects of the body itself. There is a profound identity between body and structure, and this is the reason for a body approach in the treatment of severe psychic disorders. The other reason is that severe disorders, autism, psychosis, and their derivatives, anorexia-bulimia and addictions in general, are defects of the originary register, a functioning where there is only body life, and body recording of the events.
We have seen in Psychosis Theory and Structural Perspective on the Psychoses that these classes of disorders stem from aberrant or absent root imprints before birth or at birth. In the lesser cases one has the impression that the problems arose from the feeding and separation period but usually, we are here already in the realm of the consequences of wrong imprinting at birth.
Autistic structuring comes from the absence of the triggering of the agressive drive during birth, the strive for expulsion which in normal neonates initiates the vitality program for life. Typically, the autistic individual is an unborn child and lacks the expulsion impulse imprint and its initialisation of the body vitality. The subsequent features are the lack of demand and interest for the world and of the agressive drive which produces the encounters and confrontations necessary for learning.
Psychotic structuring comes from the absence of maternal bond at birth, followed by maternal rejection and unconscious impulses of destruction of the neonate. This fact usually entrains the absence of the necessary symbiotic life or the creation of an aberrant symbiosis. Typically, the psychotic individual is an uncarried child having had no original bond and who has not lived the absolute safety and automatic feeding and care everyone has to have. It has also been shown that psychotic types have an absence or a grossly distorted original father imprint. In the absence of the symbiotic bond, no father imprint can ever reach the neonate, since the `father' is naturally born by the mother. Furthermore, if the rejection of the child at birth comes from a disorder of the mother and not from disastrous birth practices, the father imprint (i.e. the sexual component of life) has long been eliminated from her life and goes hand in hand with the rejection of the child. As a consequence, the psychotic child has had no father as well.
The main events these children live are:
They thus record an absolute terror, a breakdown of the functioning, the impossible recollection of self, the subsequent despair, a dying and a separation of soul from self.
To preserve biological life, this child enters a separation of self from body, a psychic death, and loses the possibility of an integrated psyche. Major functions such as perception, apperception, feeling, are hastily inhibited, and links between functions such as mental and sentiment, body and sentiment, planning and sentiment, etc. are cut to try preserve the core of the psyche. The body is then voided of its life and vitality in order not to sense nor perceive, nor to react to the forever menacing world, if it has not been already extracted from the womb void of life, before its vitality sets on.
Of course, there are as many adventures of the onset of psychosis as there are individuals, depending on the compensations possibilities of the environment, the degree of guilt of the mother or father which may produce a vicarian care in the place of the regular symbiosis. And there are as many adventures of living with a broken or uncomplete structure.
Here the general characteristic is the effort to adapt, i.e. to try behave as `normal'. The psychotic is basically an individual where all effort is directed towards appearing normal. Most psychotic individuals do not show abnormal symptoms in ordinary situations.
The tensions in the psychotic individual are opposite to that of the neurotic individual: they are an effort to appear normal, an effort to produce behaviour, instead of an effort to refrain unwanted behaviour.
A consequence of this effort is a body where tensions are opposite to those of the neurotic. A mixed type is often encountered where a layer of `neurotic tensions' due to the refrain of unwanted crisis lay upon a layer of psychotic tensions. These tensions are deeper since they built up earlier.
A psychotic individual is always in a delicate balance and prone to crisis ranging from the utmost violence to sheer despair which both express the originary drama and a tentative to get out of it. The effort to maintain this balance produces a specific type of tensions. Holding the incipient crisis also takes tensions which may look like the neurotic tensions of repression but are in fact at variance with them.
There may be no tensions in the body, since separation from body life, or absence of vitality, is a sufficient preservation scheme from the emergence of undesirable behaviour.
Vitality may have not set on (autistic), or may have been annihilated (psychotic) to avoid suffering (early psychic death), or later to avoid impulsive behaviour for safety reasons (later defense).
A constant result of the early a- or de-structuration of the neonate is the withdrawal of the vitality from the body. It is both a consequence and a safety measure to prevent further crisis and unequal fight with the environment (parents and caretakers). In the autistic case, vitality has not been triggered at birth. This lack of vitality prevents the need for other type of defenses against the parents, mainly the mother, since it produces a lack of response when attacked. It also prevents the need for the buildup of autoprotection schemes since the traumatic events recorded at origin are not suficiently fed by the vitality to burst out loose. Withdrawal of vitality is in itself an `absolute' system of defense needing no other to complement and passes completely unaware since withdrawal of vitality suppress feelings. There is no way to feel or even make ourselves an idea of the absence of something we never had. Furthermore, one aspect of the disorder is precisely the impossibility to feel (at the apperception level). Here lies the meaning that only psychotic people have real unawareness of what they are, do or live.
The functional cut is sometimes so great that even elementary perceptions may have gone altogether: the person may be insensitive to a host of stimuli, may not see colors, and have only a faint notion of others and what is happening around her. However, in contrast, she may have an enhanced sensivity to the surrounding events and especially to the unconscious events in the interlocutor greater than normal since repression is absent and does not hinder the body perception mechanism.
One constant effort of the psychotic is to evade situations where vitality can be retrieved since its retrieval will feed the enkysted events and set them loose without the mechanism of repression to regulate their expression. This feature also passes completely unaware.
Crisis here may refer to a sudden release of energy, usually associated with the revelation of an enkysted event, either one of the original traumas or a later one. Generally, one finds in these crisis all possible instinctual survival reactions: violence, flight, shame, despair, feelings of dying and/or wish for dying, tentative to destroy, jealousy, and worst of all the experience of either falling apart, of splitting into pieces or of being cut in two, of falling and disappearing in the vacuum, of dissolving into annihilation or of blowing out and scatter into space.
The inner events of the psychotic are very severe traumas, the mishandling of the neonate having attacked the fundamental instinctual drives and needs. As all recorded events, they have a natural tendency to replay to try and release the associated fears and suffering. And as all recorded events, they have a drive for `repair' which means putting onto others the same violence one has put onto him at first. That violence may amount to impulses to destroy all around or to kill the original agressors, which with the shift in time and persons will be redirected towards other surroundings and other individuals. These crisis are functionally a necessary step towards healing, but their social inacceptability is a serious problem, especially since viewed from the psychotic, the attackers who need to be punished for their feat are the same who forbid this necessary retaliation, thus forbidding repair. This latter double bind reinforces the de-structuration he is already victim of and the rage he has to obtain justice for the initial deed.
The aspect of a crisis is twofold: it is first a decompensation, i.e. a breakdown of the frail stays of the broken psyche; second, a replay of the original breakdown in search of a better outcome. The body aspect which interest us here is the following.
In a crisis, a burst of violence or acts of despair reconstruct for a while the unity of the body and self, since this unity is needed to retrieve vitality and potency of action. If prevented by some mean, of the inner or of the outer, the liberated energy is impeded to flow in the body and express itself by motion, and floods the mental system to produce delirium and hallucinations.
Therefore one has to distinguish acts made under the drive of delirious process which may be very dangerous or detrimental to the person and nearbys, and acts of reconstruction which may be very violent but are on the contrary very beneficial to the person, however dangerous to the others. This is an important issue for the therapy of psychotic people and one of its difficulties.
A psychotic does not have a well defined idea of his contours, of his body and of his external appearance. He also does not have an idea of what is going inside of him. He usually has a grossly distorted image of his body, his face and his ego. This is due to the fixation at the womb state (autism), or at the (aberrant) symbiosis state (psychosis) which is anterior to the integration of the image of self which occurs normally it seems between 6 to 15 months.
Furthermore, he has probably, as we all do, recorded and made his the unconscious idea and sentiments the mother had of himself at that age (which we do through the maternal talk); but that unconscious image the mother has of her infant can be anything (in the mother of psychotics case) ranging from ugliness to fragmentation and monstruosity, and her unconscious wishes and sentiments which are completely perceptible to the infant can range from disgust to murder with all tones in between.
The image we have of self, if not dissolved at a later stage, is the unconscious image our mother has of us at birth and during the symbiosis stage. It seems to be introjected very early, and made our self image distinct from other's during the mirror stage (between 6 and 15 months say).
It is not surprising then that the psychotic has a strange image of himself, which can be:
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