Delusional mood; a forgotten concept in a case of patricide
Karl Jaspers, philosopher and psychiatrist, claimed that the development of psychosis is a two-stage process. The first stage includes the concept of ‘delusional mood’. Delusional mood is a phenomenologically peculiar mental state characterized by its ununderstandability. Similarly, both Freud and Bion saw psychosis as a two-stage state or process: a dynamic coexistence, in which there is an initial psychic catastrophe or breakdown, possibly a “nameless dread” (in psychiatric nomenclature “delusional mood”), both characterized by a denial or disavowal of an unacceptable reality, followed by the creation of a substitute reality with delusions and hallucinations that ‘make good the damage done’ (Freud 1924 Neurosis & Psychosis, SE 19 149-53.). This psychoanalytic formula can distill psychosis into a notion of ‘psychic retreat’.
We will present detailed clinical material derived of a young man who was charged with patricide. The aim of clinical case is twofold: i) to outline a psychoanalytic explanation of delusional mood and its role in the patricide and ii) to offer a phenomenological account of what it means to have a delusional mood.
The psychoanalytic explanation will detail the urgency of a need for relief from apparently intolerable mental states involving intense but diffuse anxiety seems to be critical in the development of delusional mood. A phenomenological account of delusional mood attempts to drill down further and uncover the nature of psychosis. The central claim is that delusional mood is ununderstandable. We will conclude by identifying substantial points of disagreement between the two accounts with respect to the concept of delusional mood. Panning out more broadly, we believe the origin of their divergence is embedded within Jaspers’ general approach to exploring the mind that is distinct from – and often at odds with – the psychoanalytical approach. There are, historically, two distinct traditions here: psychoanalysis and existential psychotherapy.
Ronald Doctor is a Consultant Psychiatrist in Medical Psychotherapy and Forensic Psychotherapy, West London Mental Health NHS Trust, a Fellow of the British Psychoanalytical Society, member of the IPA committee on Psychoanalysis and Law, board member of the International Association for Forensic Psychotherapy, and Hon. Clinical Lecturer, Imperial College, London. He has edited two books: Dangerous Patients: A Psychodynamic Approach to Risk Assessment and Management (2003) and Murder; a Psychotherapeutic Investigation (2008) and published History, murder and the fear of death, International Journal of Applied Psychoanalytical Studies (2015) 12.2 152-160.
Michael Jewell is a British psychiatrist based in West London. He has presented at multiple international conferences, including International Congress 2019 and International Association of Forensic Mental Health Service 2019. He is currently studying an MA in ‘Philosophy and Mental Health’ at the University of Central Lancashire, UK.