The Denial of Character Pathology in Psychotic Patients and Their Doctors with Peter B, Dunn at NYPSI

Dropped on:February 28, 2014
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New York Psychoanalytic Society & Institute
“Works in Progress” Seminar Series

Peter B. Dunn, MD will present
The Denial of Character Pathology in Psychotic Patients and Their Doctors
Wednesday, March 5, 2014 at 8:00 p.m.
The Marianne & Nicholas Young Auditorium
247 E. 82nd Street, NYC

For information or to register, click HERE or visit

Denial of psychosis in psychotic patients is widely discussed as a cause of non-compliance and relapse. Less often discussed are patients who accept the reality of their psychosis but deny the broad scale character pathologies that commonly – though not universally – accompany psychotic disorders. Such character pathology includes varied cognitive deficits, intense passive yearnings often punctuated by impulsive actions, unreliability in affect modulation, intense narcissistic fragility, the relative inability to read the motives of others, and an intensity of aggression that fuels a self-destructiveness that may only be satisfied with a real or symbolic obliteration of their original identities.

It is a paradox that it requires a great deal of psychological health to accept that one is psychologically ill. If the illness is a chronic psychosis, acceptance requires the capacity to mourn the wished self. Unable to face the pain of mourning, the actively psychotic patient whose psychosis is triggered by the traumatic narcissistic injury brought on by their most recent failure is unable to mourn so he presents instead with melancholic despair or blames others in a paranoid delusional state, or asserts a manic sense of superiority. When the patient is no longer psychotic, manifestations of denial are subtler. The patient may come to accept that he has a psychotic disorder but believe that an Axis One Disorder such as Bipolar Mixed Type is akin to a diagnosis of a pulmonary abscess. That is the patient may find solace by thinking that their bipolarity is, like an abscess, an isolated area of pathology in an otherwise healthy person. The treating doctors may adopt the same technique.

This presentation will discuss the role that denial of character pathology played in the deterioration of a male patient with severe bipolar disorder. As a counterpoint, selections from a film about a fictional, severely ill bipolar patient will be shown to illustrate how the overcoming of such denial may lead such a patient to flourish.

Peter Dunn, M.D. is the Director of Clinical Services at NYPSI and serves on the editorial boards of the Psychoanalytic Quarterly and the International Journal of Psychoanalysis. He is the 2014 recipient of the Liebert Lectureship.

Students, academics and clinical professionals in the analytic community are encouraged to attend.

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