Schizophrenia and Other Psychoses

  • Peter HartwichEmail author
  • Georg Northoff


Schizophrenia is a complex disorder that shows various symptoms which, as emphasized in older and recent psychopathological approaches, can be traced to a basic disturbance of the self with “self-fragmentation” (Kohut) of its spatiotemporal structure. Our neuropsychodynamic perspective focuses on the basic disturbance of self and its underlying neuropsychodynamic mechanisms—the latter are considered spatiotemporal at their very core as they focus on the spatiotemporal relation or alignment of the brain’s spontaneous activity to the respective environmental context the world.

We will explain how findings of neurobiological research of abnormalities in the brain open a new understanding of the etiopathogenesis and psychodynamic of psychotic diseases.

An abnormal resting state activity and imbalance between anterior and posterior midline regions (hyperconnectivity) correspond with disturbances of the self. The disbalance between default mode network and central executive network, lateral regions of the prefrontal and parietal cortex on the neural level, seems to mirror the confusion of external and internal mental content, which is on the neuropsychodynamic level a “self-environment blurring.” Such “self-environment blurring” leads to what psychodynamically has been described as loss of ego boundary (Federn, Freud) with “abnormal cathexis.” We consecutively describe examples of the investment energy “cathexis” in different psychotic qualities: hypocathexis, oscillating cathexis, decathexis, anticathexis, paracathexis, and hypercathexis.

How is such abnormal cathexis related to the different symptoms? On the clinical neuropsychodynamic level, we see the psychotic patient’s counter-regulation to restore the spatiotemporal structure of the self as a paraconstruction. Many symptoms are the result of different qualities of paraconstruction, which we describe in examples for particular cases, e.g., delusion of pregnancy, delusion of love, Othello syndrome, catatonic and coenesthetic syndrome, etc.

These compensatory mechanisms in psychosis do not reach the structural level of defense mechanisms as it was described in neuroses; therefore, it is necessary to create the concept of neuropsychodynamic paraconstruction which is to be understood in an unfolding matrix which is biological and psychodynamic as well.

One of the results is a paradigm shift of the therapist, who understands paraconstruction as a necessary protection for the self, which is in danger to fragment, and who should use treatment methods which are helpful beyond the symptoms in order to strengthen the spatiotemporal structure of the self.


Fragmentation of the spatiotemporal structure of the self Abnormal neuronal findings in schizophrenia Investment energy “cathexis” and cathexis variants Concept of paraconstruction: counter-regulation to restore the spatiotemporal structure of the self Approaches to neuropsychodynamic treatment 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry, Psychotherapy, PsychosomaticsGeneral Hospital of Frankfurt am Main, Teaching Hospital University FrankfurtFrankfurtGermany
  2. 2.Mind, Brain Imaging, and NeuroethicsInstitute of Mental Health Research, University of OttawaOttawaCanada

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