Psychotic decompensation, a breakdown of the psychic balance in an individual, is mainly characterized by the fact that this person “Out of the real” : it can then present what we have delusional puffs, very sudden delusional episodes. Faced with the “sick”, two attitudes exist: on the one hand, the caregivers who try to isolate, to categorize certain humans according to their symptoms, to make them apart. On the other, those who, like Freud, “Discover that behaviors, even seemingly the most insane, have a meaning”. Thus, an episode of psychotic decompensation would be “An attempt by human beings to find solutions – admittedly dysfunctional – to deeply human problems”.

There are several types of decompensation: metabolic (such as diabetes) or cardiac, or the decompensation of respiratory failure. And so, disturbances, usually compensated for, lead to deregulation. The failure of regulatory mechanisms can be caused by a malformation or by a disease. It then causes very serious disturbances in the body, the balance of which is upset. In psychiatry, psychotic decompensation is an episode during which the psychic balance of an individual is failing, and then, “The patient leaves reality”, in the words of the writer André Maurois.

This psychotic decompensation is characteristic of psychoses: mental illnesses affecting behavior, and of which the patient does not recognize the morbid nature – they are present, mainly, in people with bipolar disorder and schizophrenia. For Freud, these psychotic decompensations were characterized by “The fact for a subject to escape unacceptable or impossible to integrate contextual constraints, by creating a new reality that he is the only one to perceive and which protects him while locking him up”.

In his preface to Freud’s book, Neurosis and Psychosis, Robert Neuburger estimated: “Freud tries to account primarily for psychosis, which remains, after his discovery of the meaning of neurotic productions, the” dark continent “of psychiatry because of the irrational and enigmatic aspect of psychotic behavior and convictions”.

Freud’s contribution to psychiatry was, in particular, to show that neurosis and psychosis do not define abnormalities, but beings who have tried to find solutions – admittedly dysfunctional – to deeply human problems. Sandor Ferenczi, Hungarian psychoanalyst, comments on this other fundamental contribution of Freud: “Before Freud, psychiatry was not based on psychology, we tried to reduce pathological symptoms to alterations in the brain”.

And in fact, according to Freud, the symptom of a psychotic decompensation has a meaning and a function. What if, for example, was hiding behind such and such a patient, claiming to want to save the world, a real stake, an inappropriate and dysfunctional response to a problem that he feels strongly when he is not delusional, the urgency that there is? has to act to save the planet? The meaning of the symptom would then be to highlight a fear of a real dysfunction – such as climate change -, and its function would be to express this fear, which, once the patient has come back to reality, could become a problem. motor to act. To go further still, from the patient’s point of view, a certain logic would be at work in psychotic decompensation, and, while the basic concept is false and delusional, all the elements of delirium would in fact be coherent. , but based on this initial mistaken concept.

If, among psychiatrists and psychoanalysts, there are those who tend only to categorize these behaviors without seeing in them anything other than anomalies, others, like Freud, discover that “Behaviors, even seemingly the most insane, have a meaning”. 

When faced with an episode of psychotic decompensation, the best reflex is to go to an emergency department. Hospitalization in a psychiatric unit may be necessary for a certain time: that for the patient to find a mental balance, to recover what we could call “reason” …

Several forms of action are then open to different therapists: psychiatrists will set up a drug treatment, often based on antipsychotics (or neuroleptics), which, by reducing for example the excess of dopamine involved in the episode delusional, will allow the person to gradually return to reality. Alongside this, psychologists play an essential role, through speech, active listening to the patient.

Other forms of care exist: music, art, theater, or even horse riding or sports, aimed at helping the patient to regain his mental balance. The entourage, the family, also play an essential role in the accompaniment of a person affected by a psychotic decompensation. Psychiatrist Marion Leboyer believes that, even if the psychiatric care system is currently suffering a lot, it also conceals incredible human resources, initiatives and hopes. 

Very often, the first psychotic decompensations occur in adolescence, between the ages of 15 and 25 years. It will then take a few years, very often, to find a lasting balance, but this is now achievable, on the one hand thanks to regular psychotherapeutic monitoring, on the other hand with the taking of a long-term treatment. antipsychotics, which will sometimes be needed throughout life.

Psychically affected patients can now lead an almost “normal” life, however society is not always ready to welcome them: thus, people with a mental handicap are still all too often stigmatized and hardly manage to find a job. , although their mental capacities are not necessarily altered.

Armand, who frequents the Clubhouse in Paris, a non-stigmatizing social space geared towards returning to work, testifies: “Today, I am looking for a part-time job, otherwise I no longer have any private life: because of my illness, I need to sleep eleven hours a night. And then it takes time to organize the treatment and care. In a recruiting situation, I am not saying that I am schizophrenic. The solution I have found is to say that I am coming out of depression. Either the company is ready to accept this, and that’s good. If this is not the case, a fortiori she will not be ready to work with a schizophrenic. And I won’t want to work there either. In terms of management, I also know that an aggressive or too directive tone can weaken me«.

As Freud said, “Nothing is more human, closer to us than psychic suffering and its consequences” : comments corroborated by a figure, advanced by psychiatrist Marion Leboyer in her book Psychiatry, the state of emergency : 12 million French people are affected by multiple forms of mental illness.