Psychose froide, relation fétichiste : réflexions à propos d’un cas

Using certain fragments in the case study of a young patient hospitalized on several occasions at our institution and who was diagnosed as suffering from a “cold” psychosis, we have studied the pertinence of this concept in the institutional management of young non-delirious psychotic patients and smokers of hashish. E. and J. Kestemberg introduced the concept of “cold psychosis”. At the clinical level, this refers to that category of patients with identity disorders and a tendency towards substance abuse. Recourse to a fetish is one of the main elements in their intrapsychic functioning. The fetishistic relation is based on Freudian concepts of fetishism, but extends beyond the field of sexual perversion and leads to a particular type of object-relation, the predominant defence mechanisms being the split at the level of the self and denial. The use of a “fetish” by these patients is a means of providing a focus to bypass delirious expression in their transactions with reality, and the fetishistic relation also has a protective role in warding off innate aggressivity which could otherwise be expressed in an uncontrolled manner. This type of relation is established very early on in the infant’s development, even before he exists as a subject in relation to his mother. Later on, the adolescent or young adult is unable to identify with the oedipean triangle, as recourse to fetishism at an intrapsychic level is reflected by a split within the self, which blocks the way to bisexuality. In these patients who are prone to vacillating narcissism, and whose capacities for identification and sense of personal identity are a vast wasteland in which all relation with another individual represents a menace of annihilation unless they have at their disposal the possibility of dealing with the delirious situation and restructuring their attitude to life, the diversity of professional care-givers and mental healthcare centers that provide the institutional framework are the triggering factor for the therapeutic process which can guide these subjects towards a possible investment in the world outside, and in the individuals who live there.