Complementary perspectives in subclinical psychosis: From clinical high-risk and personality organization to ordinary psychosis

Abstract

ABSTRACT In this paper, I try to bring the Lacanian psychoanalytic concept of ‘ordinary psychosis’ (OP) into dialogue with the prevailing paradigms in psychiatry and psychodynamic theory regarding subclinical psychosis: respectively, the model of clinical-high-risk for psychosis and that of personality organization/disorder. OP is a bottom-up clinical approach applicable to both atypical/subclinical psychoses and disordered personality that identifies both the main psychological difficulties encountered and the compensatory mechanisms employed by the individual. Its diagnosis relies on subtle indices or markers of a ‘disturbance of the sense of life’ and of a failure of knotting together the elements of the subjective structure. Many patients typically diagnosed with a personality disorder may be treated as cases of OP. This clinical concept is not limited to a descriptive approach and it offers insights into both subtle psychological deficits and mechanisms contributing to resilience. It avoids the risk of unjustified preventive treatments and stigmatization carried by a model of attenuated psychosis. It facilitates the direction of the psychotherapeutic treatment offering more than support to the individual’s adaptive attitudes. It offers insights into the communication between the medical and the psychodynamic models. OP is therefore a category of clinical utility, psychological validity, and ethical value.