19 th International Congress of the ISPS, New York 2015 - Defence mechanisms in psychosis: from “scotomization” to “annulment”

Abstract

In his handbook Psychodynamic psychiatry in clinical practice, G. O. Gabbard distinguishes between primitive defence mechanisms, involved in psychosis, and the neurotic defence, such as repression. It is well known that repression is a central concept in Freud’s works. The paper discusses René Laforgue’s ideas on “scotomization”, the neurological, physiological phenomenon in which someone does not see an object in front of his/her eyes. When scotomization becomes psychic dynamic it could lead, during weaning, to the narcissistic isolation of psychotic patients. Years later Laforgue’s idea seems to have influenced Lacan’s concept of “foreclosure”. Independent from the French debate, in 1970 Massimo Fagioli proposed the concept of “annulment drive” (pulsione di annullamento), a psychical black -out of the individual when confronted with an element of reality experienced as too problematic, referring to the psychic capability of “not seeing”, i.e. to make  mentally disappear a human reality. Currently, a stable and growing number of Italian psychiatrists consider the concept of the annulment drive to be an essential tool in the treatment of psychotic patients.