Daniel Marcelli: Adolescent Psychosis

The notion of schizophrenia often features in current psychiatric publications. What does this resurgence mean? Diagnosing an illness when the first symptoms are noticed, or even before, is an approach that is all the more justified because there is an effective treatment for it. But can the issue of adolescent psychosis simply be reduced to an illness that disturbs the normal functioning of the cerebral neuro-synaptic system, without taking into account the subject, his/her history, and the changes of his/her pubertal transformation? Effectively, every adolescent’s feeling of existential continuity is threatened by a risk of breakdown or rupture representing a real psychotic threat, which can be called “pubertal psychosis.” These are expressions describing a negative potential for disorganization that the contemporary person must surmount in order to fulfill the requirements of a subjectivation imposed on each as a mark of singularity. However, this work of subjectivation, which is never totally attained or completed, cannot start or continue if the narcissistic foundations of early childhood did not provide the subject with a sufficient basis of security. In the absence of this foundation, the gendered transformation of the body and pubertal fantasy become traumatic: in such a highly uncertain context, nosographic designation usually takes the form of a stigmatization for which the adolescent is at risk, especially given that one of the strategies for standing out consists of self-destructive activities. This justifies the importance of psychotherapeutic assistance to create with the adolescent a relational history that can serve as a prototype of a familiar foothold in the absence of the possibility of a return to self.