The Psychotic Wavelength The Psychotic Wavelength provides a psychoanalytical framework for clinicians to use in everyday general psychiatric practice and discusses how psychoanalytic ideas can be of great value when used in the treat- ment of seriously disturbed and disturbing psychiatric patients with psychoses, including both schizophrenia and the affective disorders. In this book Richard Lucas suggests that when clinicians are faced with psychotic patients, the primary concern should be to make sense of what is happening during their breakdown. He refers to this as tuning into the psychotic wavelength, a process that allows clinicians to distinguish between, and appropriately address, the psychotic and non-psychotic parts of the personality. He argues that if clinicians can find and identify the psychotic wavelength, they can more effectively help the patient to come to terms with the realities of living with a psychotic disorder. Divided into five parts and illustrated throughout with illuminat- ing clinical vignettes, case examples and theoretical and clinical discussions, this book covers: • the case for a psychoanalytical perspective on psychosis • a historical overview of psychoanalytical theories for psychosis • clinical evidence supporting the concept of a psychotic wavelength • the psychotic wavelength in affective disorders • implications for management and education. The Psychotic Wavelength is an essential resource for anyone working with disturbed psychiatric patients. It will be of particular interest to junior psychiatrists and nursing staff and will be invaluable in helping to maintain treatment aims and staff morale. It will also be useful for more experienced psychiatrists and psychoanalysts. Richard Lucas was a consultant psychiatrist at St Ann’s Hospital, London. He was also a fellow at the Royal College of Psychiatrists and a member of the British Psychoanalytical Society. In 2003 he received an OBE for his services. This is his only book. THE NEW LIBRARY OF PSYCHOANALYSIS General Editor Dana Birksted-Breen The New Library of Psychoanalysis was launched in 1987 in associ- ation with the Institute of Psychoanalysis, London. It took over from the International Psychoanalytical Library which published many of the early translations of the works of Freud and the writings of most of the leading British and Continental psychoanalysts. The purpose of the New Library of Psychoanalysis is to facilitate a greater and more widespread appreciation of psychoanalysis and to provide a forum for increasing mutual understanding between psy- choanalysts and those working in other disciplines such as the social sciences, medicine, philosophy, history, linguistics, literature and the arts. It aims to represent different trends both in British psychoanalysis and in psychoanalysis generally. The New Library of Psychoanalysis is well placed to make available to the English-speaking world psycho- analytic writings from other European countries and to increase the interchange of ideas between British and American psychoanalysts. The Institute, together with the British Psychoanalytical Society, runs a low-fee psychoanalytic clinic, organises lectures and scientific events concerned with psychoanalysis and publishes the International Journal of Psychoanalysis. It also runs the only UK training course in psychoanalysis which leads to membership of the International Psy- choanalytical Association – the body which preserves internationally agreed standards of training, of professional entry, and of professional ethics and practice for psychoanalysis as initiated and developed by Sigmund Freud. Distinguished members of the Institute have included Michael Balint, Wilfred Bion, Ronald Fairbairn, Anna Freud, Ernest Jones, Melanie Klein, John Rickman and Donald Winnicott. Previous General Editors include David Tuckett, Elizabeth Spillius and Susan Budd. Previous and current Members of the Advisory Board include Christopher Bollas, Ronald Britton, Catalina Bron- stein, Donald Campbell, Sara Flanders, Stephen Grosz, John Keene, Eglé Laufer, Juliet Mitchell, Michael Parsons, Rosine Jozef Perelberg, David Taylor and Mary Target, Richard Rusbridger, and Alessandra Lemma, who is Assistant Editor. ALSO IN THIS SERIES Impasse and Interpretation Herbert Rosenfeld Psychoanalysis and Discourse Patrick Mahony The Suppressed Madness of Sane Men Marion Milner The Riddle of Freud Estelle Roith Thinking, Feeling, and Being Ignacio Matte-Blanco The Theatre of the Dream Salomon Resnik Melanie Klein Today: Volume 1, Mainly Theory Edited by Elizabeth Bott Spillius Melanie Klein Today: Volume 2, Mainly Practice Edited by Elizabeth Bott Spillius Psychic Equilibrium and Psychic Change: Selected Papers of Betty Joseph Edited by Michael Feldman and Elizabeth Bott Spillius About Children and Children-No-Longer: Collected Papers 1942–80 Paula Heimann. Edited by Margret Tonnesmann The Freud–Klein Controversies 1941–45 Edited by Pearl King and Riccardo Steiner Dream, Phantasy and Art Hanna Segal Psychic Experience and Problems of Technique Harold Stewart Clinical Lectures on Klein and Bion Edited by Robin Anderson From Fetus to Child Alessandra Piontelli A Psychoanalytic Theory of Infantile Experience: Conceptual and Clinical Reflections E. Gaddini. Edited by Adam Limentani The Dream Discourse Today Edited and introduced by Sara Flanders The Gender Conundrum: Contemporary Psychoanalytic Perspectives on Feminitity and Masculinity Edited and introduced by Dana Breen Psychic Retreats John Steiner The Taming of Solitude: Separation Anxiety in Psychoanalysis Jean-Michel Quinodoz Unconscious Logic: An Introduction to Matte-Blanco’s Bi-logic and its Uses Eric Rayner Understanding Mental Objects Meir Perlow Life, Sex and Death: Selected Writings of William Gillespie Edited and introduced by Michael Sinason What Do Psychoanalysts Want?: The Problem of Aims in Psychoanalytic Therapy Joseph Sandler and Anna Ursula Dreher Michael Balint: Object Relations, Pure and Applied Harold Stewart Hope: A Shield in the Economy of Borderline States Anna Potamianou Psychoanalysis, Literature and War: Papers 1972–1995 Hanna Segal Emotional Vertigo: Between Anxiety and Pleasure Danielle Quinodoz Early Freud and Late Freud Ilse Grubrich-Simitis A History of Child Psychoanalysis Claudine and Pierre Geissmann Belief and Imagination: Explorations in Psychoanalysis Ronald Britton A Mind of One’s Own: A Kleinian View of Self and Object Robert A. Caper Psychoanalytic Understanding of Violence and Suicide Edited by Rosine Jozef Perelberg On Bearing Unbearable States of Mind Ruth Riesenberg-Malcolm Psychoanalysis on the Move: The Work of Joseph Sandler Edited by Peter Fonagy, Arnold M. Cooper and Robert S. Wallerstein The Dead Mother: The Work of André Green Edited by Gregorio Kohon The Fabric of Affect in the Psychoanalytic Discourse André Green The Bi-Personal Field: Experiences of Child Analysis Antonino Ferro The Dove that Returns, the Dove that Vanishes: Paradox and Creativity in Psychoanalysis Michael Parsons Ordinary People, Extra-ordinary Protections: A Post-Kleinian Approach to the Treatment of Primitive Mental States Judith Mitrani The Violence of Interpretation: From Pictogram to Statement Piera Aulagnier The Importance of Fathers: A Psychoanalytic Re-Evaluation Judith Trowell and Alicia Etchegoyen Dreams That Turn Over a Page: Paradoxical Dreams in Psychoanalysis Jean-Michel Quinodoz The Couch and the Silver Screen: Psychoanalytic Reflections on European Cinema Edited and introduced by Andrea Sabbadini In Pursuit of Psychic Change: The Betty Joseph Workshop Edited by Edith Hargreaves and Arturo Varchevker The Quiet Revolution in American Psychoanalysis: SelectedPapers of Arnold M. Cooper Arnold M. Cooper. Edited and introduced by Elizabeth L. Auchincloss Seeds of Illness and Seeds of Recovery: The Genesis of Suffering and the Role of Psychoanalysis Antonino Ferro The Work of Psychic Figurability: Mental States Without Representation César Botella and Sára Botella Key Ideas for a Contemporary Psychoanalysis: Misrecognition and Recognition of the Unconscious André Green The Telescoping of Generations: Listening to the Narcissistic Links Between Generations Haydée Faimberg Glacial Times: A Journey Through the World of Madness Salomon Resnik This Art of Psychoanalysis: Dreaming Undreamt Dreams and Interrupted Cries Thomas H. Ogden Psychoanalysis as Therapy and Storytelling Antonino Ferro Psychoanalysis and Religion in the 21st Century: Competitors or Collaborators? Edited by David M. Black Recovery of the Lost Good Object Eric Brenman The Many Voices of Psychoanalysis Roger Kennedy Feeling the Words: Neuropsychoanalytic Understanding of Memory and the Unconscious Mauro Mancia Projected Shadows: Psychoanalytic Reflections on the Representation of Loss in European Cinema Edited by Andrea Sabbadini Encounters with Melanie Klein: Selected Papers of Elizabeth Spillius Elizabeth Spillius. Edited by Priscilla Roth and Richard Rusbridger Constructions and the Analytic Field: History, Scenes and Destiny Domenico Chianese Yesterday, Today and Tomorrow Hanna Segal Psychoanalysis Comparable and Incomparable: The Evolution of a Method to Describe and Compare Psychoanalytic Approaches David Tuckett, Roberto Basile, Dana Birksted-Breen, Tomas Böhm, Paul Denis, Antonino Ferro, Helmut Hinz, Arne Jemstedt, Paola Mariotti and Johan Schubert Time, Space and Phantasy Rosine Jozef Perelberg Rediscovering Psychoanalysis: Thinking and Dreaming, Learning and Forgetting Thomas H. Ogden Mind Works: Technique and Creativity in Psychoanalysis Antonino Ferro Doubt, Conviction and the Analytic Process: Selected Papers of Michael Feldman Michael Feldman Melanie Klein in Berlin: Her First Psychoanalysis of Children Claudia Frank TITLES IN THE NEW LIBRARY OF PSYCHOANALYSIS TEACHING SERIES Reading Freud: A Chronological Exploration of Freud’s Writings Jean-Michel Quinodoz Listening to Hannah Segal: Her Contribution to Psychoanalysis Jean-Michel Quinodoz This page intentionally left blank THE NEW LIBRARY OF PSYCHOANALYSIS General Editor: Dana Birksted-Breen The Psychotic Wavelength A Psychoanalytic Perspective for Psychiatry Richard Lucas First published 2009 by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Simultaneously published in the USA and Canada by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an Informa business © 2009 Lynne Lucas Typeset in Bembo by RefineCatch Limited, Bungay, Suffolk Paperback cover design by Sandra Heath All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Lucas, Richard, 1943–2008. The psychotic wavelength : a psychoanalytic perspective for psychiatry / Richard Lucas. p. : cm. Includes bibliographical references and index. ISBN 978-0-415-48468-8 (hbk) – ISBN 978-0-415-48469-5 (pbk.) 1. Psychoses. 2. Psychoanalysis. I. Title. [DNLM: 1. Psychotic Disorders–diagnosis. 2. Psychotic Disorders–therapy. Affective Disorders, Psychotic–diagnosis. 4. Affective Disorders, Psychotic– 3. therapy. 5. Psychoanalytic Theory. WM 200 L933p 2009] RC512.L83 2009 616.89′17–dc22 2009003522 ISBN 978-0-415-48468-8 (hbk) ISBN 978-0-415-48469-5 (pbk) Dedicated to the memory of Richard Lucas, OBE 2nd April 1943 – 28th July 2008