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Articles

Beyond Symbiosis

The Role of Primal Exclusions in Schizophrenic Psychosis

Pages 8-30
Published online: 28 Dec 2017
 
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This article is based on years of clinical experience with adult psychotic patients, including both those who are chronic and those experiencing their first episode of schizophrenia. These patients live in the London borough of Lambeth in South East London, which is recognized as having one of the highest rates of psychosis in the United Kingdom and probably in Europe (Kirkbride et al., 2006). The author first describes Berne’s (1957/1969) views on splitting and his later theory of Parent exclusions (Berne, 1961/1975) in creating active psychosis and then suggests that schizophrenia is a relational trauma disorder rather than the result soley of symbiosis (Schiff, 1975) or the product of intrapsychic conflicts (Novellino, 1991, 1998, 2004; Novellino & Moiso, 1990) and complex contaminations (Goulding & Goulding, 1979). The author proposes that schizophrenia involves profound multiple structural exclusions that are responsible for early Parent lacunae within the Child ego state (P0 and P1), ultimately resulting in ego/self-fragmentation.

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Author information

Zefiro Mellacqua

Author Biography
Zefiro Mellacqua, MD, is a psychiatrist (general adult psychiatry) working with a highly professional and exceptionally enthusiastic home treatment team based at Lambeth Hospital, South London, and Maudsley National Health Service Foundation Trust, in the London borough of Lambeth, United Kingdom (UK). He is an honorary research fellow with the First Psychosis Studies team at the Institute of Psychiatry, King’s College London. He trained as a psychotherapist at the Auximon Institute in Rome, Italy, and is a Certified Transactional Analyst (psychotherapy) trainee with the European Association for Transactional Analysis (EATA). Dr. Mellacqua is also a specialist associate of the Royal College of Psychiatrists (UK) and works as a psychiatrist and transactional analysis practitioner in private practice. Dr. Mellacqua may be reached at the Institute of Psychiatry, 6 De Crespigny Park, 5th floor, First Psychosis Studies, London SE5 8AF, United Kingdom; email: . The material on which this article is based was presented as a workshop entitled “Beyond Symbiosis: Encountering the So-Called Schizophrenics” on 5 July 2013 during the EATA Conference in Oslo, Norway.