(1973).

Journal of the American Academy of Psychoanalysis 1: 243-251

The Irrational in the Psychotherapy of Psychosis*

Gaetano Benedetti
It is surprising to nobody today to find the Irrational as the main theme of a psychotherapeutic congress. The times are past in
which Freud (1900) could state that the psychic life is as fully and strongly determined as the physical world. Of course, we must
distinguish between rationality and causality. The idea of causality can be questioned by means of rationality. But the philosophy
of positivism, in which we have grown up, has so linked both concepts, that one usually understand the Irrational as that area
where causality cannot be grasped.
Since the pioneer work of Gdell, scientists, particularly mathematicians, have, in this century, pointed out the limits of
logical determination. We now know that a logical system can contain no algorithms, which define its whole structure. In order to
be free of contradictions, every logical system must contain one or more areas of nondeterminability, that is, words which cannot
be derived from preceding axioms by means of the algorithms of the system. Within every undeterminable area, the number of
possible words is endless, so that discrimination is impossible. Today one must take it that free structures appear in every causal
context. Mathematicians modestly speak of an insight into the limited power of knowledge within logic itself, and therewith, for
the first time, suggest, in science itself, a concept of freedom related to the same structure of logics.
Certainly, one must be most careful in applying the insights

* Presented at the Fourth International Forum of Psychoanalysis, New York, October 1, 1972.
- 243 -

gained in the fields of mathematicians or of the natural sciences in other conceptual situations, such as in psychiatry. But now
mathematicians (C. Benedetti) also state that the theory of logical relativity is of a basic nature, it applies also to nonmathematical
structures and may also concern the realm of the psyche. I refer here to the work of ciberneticians such as McKay (1966), who,
moving from other theoretical considerations, also came to speak of a concept of logical relativity applying to the psychic
structures. For a long time now, psychiatry has been collecting a number of experiences which cannot be explained from a causal
point of view. Logical relativity does not mean the same for psychiatry as the indetermination theory of Heisenberg means for the
physical sciences, i.e., a new approach from the ground up, but rather, it is a rediscovering of its sourcethe release from the
Procustes-bed of the positivistic ideology of the last century.
In psychiatry we are in an area where nondeterminability appears at every step. It is important, therefore, to distinguish
between the time when this is due to insufficient research, and when it is due to the logical structure of knowledge itself. We lack
the strict criteria to make such differences. The boundary line eludes us. There are, however, psychiatric or psychotherapeutic
experiences which appear to be so far away from the rational side of the boundary line that one can seriously doubt whether a
fully causal and rational comprehension of them will ever occur. The genesis of schizophrenia is already interesting in this
context. About half a century of research on the psychogenesis of schizophrenia has not been able to seriously shake the heredity
theory. However, the genetic evidence is not sufficient enough to put aside our feelings that the first stages of psychosis occur
within the structure of family and society.
Now, we may ask if the latent psychopathology of the parents is an interpersonal source of the psychopathology of the
schizophrenic patients, or if it is transmitted to them by way of biological inheritance. But we can reverse the chain and ask if the
parents psychopathology is the cause of, or the reaction to, the impact of the child's psychopathology.
There are authors who claim that the latent psychopathology of the parents is an expression of the same constitution which
then manifests itself as a psychosis in the patientwhich may, in part, be true. Other authors, however, point out that the human
constitution can articulate itself only within the frame of a life history, which also impinges upon biological disposition (Bleuler
1968).
- 244 -

These authors, therefore, emphasize the significance of life experience in the pathogenesis of psychosis. Their observations also
do not fail to impress us. But, on the other hand, we face criticism if we do not account for the fact that much parental
ambivalence and hostility is also a reaction to the disharmonic psychological equipment of the future patient, and then to the
impact of his mental illness.
We can, in fact, surmise that psychic life is structured only along causal dimensions. Surely, it has been attempted to clearly
order the interacting groups of causal factors by means of experimental investigation (Rosenthal 1968). One has come to

WARNING! This text is printed for the personal use of the owner of the PEP Archive CD and is copyright to the Journal in
which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.
meaningful observations, which are, however, not able to dispel many uncertainties. Others have tried to bridge what cannot be
defined with a convincing not-only-but also. This is, however, no help to us in the discrimination of the factors involved. At
this point the question arises, whether knowledge in this field does exist which is independent from the position of the observer.
Is not the distance which we have from the sick also a factor in our knowing him? It is possible at the same time to be close to a
patient, that is, to introduce ourselves fully into the inner structure of his suffering, and at the same time, from a distance, state
that his experience is nonreal?
Our positivist attitude is even more strongly shaken where we are confronted with the experiences of the psychotherapy of
psychosis. Many of their reportsperhaps mostare so formulated as to fit into our traditional categories. Others, however, go
along different paths, and this is all the more so when they come from the personal depths of the individual psychotherapist.
There is a natural reserve among psychotherapists to speak about some very deep involvement with the existence of their patients.
It is not only my observation, but also that of the greatest psychotherapists of psychosis I know, that to remain fully effective,
some psychotherapeutic experiences should not be spoken about.
I believe that the irrational components of the psychotherapeutic process are just not suited for a systematic
conceptualization. This is because of the uniqueness of their nature and because of the linkage between their effectiveness and
their intimacity. So one must often be satisfied with a few indications.
Let us consider, for a moment, the central psychotic experience of ego splitting, psychic dissolution, and existential
nothingness in schizophrenia. This is the central experience the psychotherapist has to deal with. The crumbling of the egoic
world is often
- 245 -

described by the patient in a shattering way which cannot be rendered by our words and conceptual categories.
Sometimes it is as if he would suffer this dissolution in a physical dimension; pieces of his body are ripped from him, his
burning skin is pulled off him, his limbs are broken. It may be also happen that the disintegration affects the speech of the patient.
The same splitting manifests itself in dreams where fire, destruction, and explosions, appear; also, in waking lucid experiences,
where every thought transforms itself into the opposite; where everything is possible at the same time, things real and things
unreal; where the ego of the patient cannot take positions, because it dissolves or is completely missing; where words and object
relationships fade; or else, after the crumbling of the relationships, combine in a new and abstract manner. Sometimes the patient
is utterly unable to express what he senses. His experiences are not communicable and transformable into speech, because they do
not arise from that linguistic approach to the world which is correlated to an ontologically preserved ego structure. In the same
way as the ego-structure dissolves, so from its very core is the interior experience no longer structured along a dimension of
communicability.
Syntactic order means a relation of objects which are no longer correlated to each other when the primary ego-thou relations
dissolves. The attempt at expressing and communicating is then no longer a source of pleasure, but appears to the subject as a
senseless task. Thus psychotic experience becomes irrational to some degree as it loses the organization of communication.
How can our explanations help the patient? In his condition of crumbling, insights, when at all possible, already disintegrate
at the moment of formation. They cannot strenghthen the ego, because they only increase the amount of work to be done by it.
When a true psychotherapeutic participation in such a condition comes about, which, by the way, cannot be planned or foreseen,
it will at first be experienced by the psychotherapist as a feeling of helplessness. He no longer stands apart from a whirlpool, but
feels himself sucked into it. I know cases where even hallucinations and feelings of depersonalization and derealization
characterize the condition of the therapist. It can, for example, occur during a course of a psychodrama, where the therapist
changes his role with the patient, that he suddenly feels depersonalized; reality escapes him, everything appears nonsense, objects
no longer stand in relation to each other, and words are no longer sufficient to express such
- 246 -

experiences. It can also happen that the therapist experiences in his dreams such conditions of depersonalization that were
previously described to him by his patient.
In such cases it is possible to speak of a psychic infection. Folie a deux is a well-known concept of psychiatry. But the
psychotherapeutic folie a deux is less well known. It cannot be fully studied, because a precondition of its therapeutic
effectiveness is that it should not be objectified. This psychic infection is something which is never foreseen, planned, or wished
by the psychotherapist. Of course, it works only if the therapist is thoroughly healthy and not a latent psychotic or schizophrenic.
He is, however, powerfully attracted to the unconscious of the other. It appears to me that the relationship cannot be fully
explained in terms of transfer. Theories are possible, but the situation itself must be experienced in a nonrational way in order to
be effective.
A consequence of this situation is that the helpless patient, with his disappearing ego, now experiences a certain segment of
the world, that is, the relationship with his therapist, as an enclave where he is mighty. He is powerful because he makes the other

WARNING! This text is printed for the personal use of the owner of the PEP Archive CD and is copyright to the Journal in
which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.
similar to himself. The experience of utmost weakness is complemented by this experience of latent power; by contrast, the power
of the therapist will be coupled with a feeling of helplessness. As these two poles, power and weakness, tear apart the therapeutic
unity, they are at the same time held together; in this way the therapist becomes a model of integration for his patient. But he is
not a model to be simply imitated, as it can happen in the field of education, but he is a kind of matrix on which the ego structure
of the other is formed. With the word irrational here I mean an effect which does not lie in the transmission of words and
insights, but which makes these possible. Through this integration with his therapist the patient is brought into a dimension of
unity. In such cases the patient may even sense a feeling of sympathy for his therapist, and wish to help him. He requests him to
stay in one piece. The patient experiences that he is in the therapist. His helplessness has gone into the therapist, and has
become his helpless side. The patient's helplessness, which earlier was experienced by him as his total being, is now, through the
transfer into the other, and by means of the mirror of the patient, sensed as only a part of the whole. Because the therapist not
only defines the helplessness of the patient, but makes it a part of himself, the patient on his part can take the therapist into
himself. A
- 247 -

taking-in of the other occurs on both sides. That also means, that in the same manner as the helplessness of the patient is in the
therapist, and activates him, the therapist is also in the patient and will be sensed by him even physically. That is, that some
helping hallucinations can be the starting point in overcoming the basis of hallucination itself.
All of this can be explained in rational terms as a process of object relationship formation. However, the irrational point is
that such an object relationship can come about only if it is sensed and conceptualized by the therapist as a genuine being in the
other.
The therapist not only experiences the weakness of the patient, but also his pathogenic power, which makes the therapist
powerless. On his side, the patient not only senses the might of the therapist, which he fears in the outside world; he now also
senses the therapeutic helplessness which was his own, and which now has been given back to him, but has been assimilated and
overcome by the other. This is a kind of a returned helplessness, which has gone through, and been transformed by, the
therapeutic psychometabolism, so that the weak ego of the patient is now able to take it over, and to work it through, without
being overpowered by it. I know that I have been expressing myself in symbols which are far removed away from clear tidy
formulas; but in this way I can best stay with the theme of this lecture, that is, the Irrational. If I should go too far in my attempt
to rationalize the Irrational, then I would miss that core of the process, the way to which can only be indicated but not proven.
What I have been describing is a kind of involvement with the patient, which is, for others, not therapeutic, but
antitherapeutic. Laing (1959), e.g., writes in The Divided Self: The others love is therefore feared more than his hatred, or rather
all love is sensed as a version of hatred. I do not wish in any way to question the experiences of Laing, or of Fromm-Reichmann
(1950); but I should, however, also like to offer those of someone like Searls. Basically, they are all true, and here we have the
Irrational of the Psychotherapy of Psychosis. Surely, we can attempt to find out which special ingredients must be in the
personality of the patient or of the therapist, so that one or the other point of view is truer. But all our indications will be
hindsight, never foresight; they are never supported by a causal relation.
The irrational moment in the Psychotherapy of Psychosis can also be observed in those phenomena which appear to us as the
reversal of some psychopathological mechanisms in psychotic
- 248 -

families. Such experts in the field of schizophrenia as Wynne (1965), Stierlin, and others, have often described how parents of
psychotic patients may act out their own emotions through identification with their child. They are unable, for some
psychodynamic reasons, to live out their own emotions by themselves; for they put their own anxieties into the child, so that he
adopts them and carries out the parental emotions without being able to differentiate these from those of his own being. In such
transactions one can see the origin of a disturbed identity in psychosis. Now, I have observed that the same process can take place
in a reversed direction from patient to therapist. This reversal is then a precondition of the patient's being free from this
disturbance. The following example can illustrate this.
A psychotherapist observes an aggressivity (towards other objects rather than his patient) in his daily life which is foreign to
his character and his usual reactions. He is surprised at himself; he is not able to understand this phenomenon, which he has not
yet brought in connection to his patient or to his conscious countertransference. Later it becomes clear that the patient is coming
into a new phase of his development which is characterized by a release of that emotion, in this case aggression, which had
disturbed the therapist. The patient becomes more aggressive; he is less afraid to express his aggressivity and to integrate it, after
the therapist partially took his emotion into his own daily life.
Is there a connection between these two phenomena? As a controlling analyst I have always been astonished by the
coincidence of the two events. I had the impression, as did the controlled therapist himself, that he becomes by means of the
integration of a quantum of the patient's aggressivity into his own daily life, an unconscious model of integration for his patient.
The remarkable thing there is that we may not understand this becoming a model in a rational or causal way, because the patient

WARNING! This text is printed for the personal use of the owner of the PEP Archive CD and is copyright to the Journal in
which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.
knows nothing of the therapist's experience. We are dealing with two symmetrical independent but correlated processes. Probably
some will feel tempted here to doubt the reliability of these observations. But, through this doubt one would postulate ipso facto
the primacy of rationality and causality in the chain of events. The question is however, whether this belief, on which the
philosophy and rationality of psychotherapy is usually based, may be open for some exceptions or areas of nondeterminability.
The question indeed belongs in the theme of this congress (Fourth International Forum of Psychoanalysis, N.Y. 1972), whose
main topic is the Irrational.
- 249 -

The psychic interaction between the ego of the psychotherapist and that of his patient is most intense where the ego of the
patient, because of its disappearing limits, is open to the world, and demands a similar openness on another level, on the side of
his partner.
We can understand, within this frame of conceptualization, the age old anxiety of society in the encounter with the insane.
This anxiety had an irrational unconscious source and the attempt at rationalizing it led to the exclusion of the sick from our lives.
One thought, for instance, that the insane was possessed by a demon. The psychotherapy of psychosis is an attempt to understand
the irrational of our minds within the categories which are proper to it, without distorting the phenomena through a too far
reaching rationalization. This side of the therapeutic relationship certainly does not exclude the other side, the analytical rational.
We could not succeed in bringing back the patient into the midst of our rationality, that means of our understanding, if we would
not also keep this main dimension in mind.
One could get the impression that we consider irrationality as a main aspect of psychotherapy with psychotics, but the
irrational is due to the theme of this congress. We are indeed more critical of our irrational experiences than it may appear from
this paper. But let us not forget that our readiness to commit ourselves to the irrationality of the psychotherapy of psychosis also
contributes to the disappearance of those irrational dimensions of the sickness, which psychiatrist V. Gebsattel (1954) once
described with the following words: In our meeting with the sick we are still fascinated by a last core of inaccessibility of his
being.
This sentence, which teaches us never to cease wondering about the insane and never to confuse the sick with the sickness, is
only half of the whole truth. The other half of the truth can be expressed with the insight that the more we are ready to commit
ourselves to our and the patient's irrationality, the more he becomes a brother to us and the other part of our own self.

References
Benedetti, C., Aree di Indecidibilit, strutture discontinue, e figure di indeterminazione, unpublished.
Benedetti, G. (1971), The psychodynamik approach to schizophrenia, Acta Psychiat. Scan., Suppl. 224.
- 250 -

Bleuler, M. (1968), A 23-year longitudinal study of 208 schizophrenics and impressions in regard to the nature of schizophrenia,
in The Transmission of Schizophrenia, (Rosenthal and Kety, Eds.). Pergamon, New York.
Freud, S. (1942), Die Traumdeutung, Gesammelte Werke. Imago Publishing.
Fromm-Reichmann, F. (1950), Principles of Intensive Psychotherapy. University of Chicago Press, Chicago.
Gebsattel, V. E. Von (1954), Prolegomena einer medizinischen Anthropologie. Springer, Berlin.
Gdell, cit. von Calogero Benedetti.
Laing, R. D. (1959), The Divided Self. Tavistock Publishing, London.
McKay, D. M. (1966), Conscious control of action, Brain and Conscious Experiences. Springer, Berlin.
Rosenthal, D. and S. S. Kety (1968), The Transmission of Schizophrenia. Pergamon Press, Ltd., London.
Wynne, L. C. (1965), Thought disorders and family relation of schizophrenics. IV. Results and implications, Arch. Gen. Psychiat.
12, 201-212.
- 251 -

Article Citation [Who Cited This?]

Benedetti, G. (1973). The Irrational in the Psychotherapy of Psychosis. Journal of the American Academy of Psychoanalysis 1:
243-251

WARNING! This text is printed for the personal use of the owner of the PEP Archive CD and is copyright to the Journal in
which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.
WARNING! This text is printed for the personal use of the owner of the PEP Archive CD and is copyright to the Journal in
which it originally appeared. It is illegal to copy, distribute or circulate it in any form whatsoever.