»Since reaching puberty, Aurélie has been invaded by paedophilic and sadistic fantasies ; after having contained them in her imagination for years, she has just acted upon them. As a parallel to this, everything that she presents during the session and elsewhere has an inflexibly labile character. Her psychopathological characteristics bear witness to a recurrent danger of psychotic disorganisation and are situated in the register of pubertaire psychosis. This clinical vignette offers an opportunity to discuss the link between perversion « and psychosis in puberty.»
The outcome of psychotic disorders during puberty depends on how the adolescent and his therapeutic environment make use of the adolescent’s hallucinatory world. When used and worked on within the analytical relationship, the narcissistic part of primary identifications is preserved, and it is no longer necessary to disinvest the Unconscious, as Freud postulates in the case of President Schreber and in schizophrenia. The hallucinatory then becomes a precious tool for saving and expressing desires; putting it into words will help to lighten the economy of the adolescent’s psychological functioning. This is illustrated using two clinical cases.