Some Paths Towards Psychotic Alienation


In this paper I use the term alienation to describe the mind’s detachment from psychic reality and its withdrawal into an alien world that leads to progressive dehumanization. In spite of this phenomenon having a psychodynamic nosography and descriptive models that effectively reveal it in detail, mental alienation is still mysterious and unsettling, especially when it manifests all of a sudden in clinical work. Alienating withdrawal into sensory fantasizing, which causes increasing loss of contact with human reality, is often preceded by a long period of time spent in a dissociated world that has gradually replaced psychic reality. However, prior to the human world being completely replaced by the alien world, both worlds coexisted for a considerable length of time in the patient’s mind. My hypothesis is that the dissociation from psychic reality that underlies the future state of psychotic alienation occurs in psychic withdrawal that begins in infancy. This mental state is particularly obvious in small children who constantly live in a fantasy world.

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Correspondence to Franco De Masi.

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Address correspondence to Franco De Masi, M.D., Via Ramazzini 7, 20129 Milan, Italy.

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De Masi, F. Some Paths Towards Psychotic Alienation. Am J Psychoanal 77, 347–358 (2017).

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  • alienation
  • delusion
  • hallucination
  • psychic reality
  • psychotic retreat
  • dissociated life