Autobiographical delusion and subjectivation: problems in diagnosis and treatment during adolescence

Adolescence is the time when methods and contents of autobiographical construction are acquired. Wordsworth’s “The Prelude” is an example of a project of creating an autobiographical self as opposed to uncertainty about one’s own capacities and difficulties in achieving an ideal. In the poem, it’s possible to discern the appearance of what Tulving defines as “the representational abuse”: a failure in the examination of reality and specifically in the discrimination between memories originated from the perceptive experience and those arising from self‐generated processes.The autobiographical function appears to be useful in coping with emotional challenges during adolescence. Patients diagnosed with schizophrenic disorders, however, often have particular difficulties in this domain. Once the autobiographical delusion appears, treatment becomes extremely complex: the observing self can be projected onto the therapist, who may observe the patient but not interact with the pathological narration nor modify the ‘representational abuse’. The paralysis of the therapist, and how to get out of it, become major challenges. The solution may be the choice of an integrated therapeutic approach, in which psychotherapy, psychopharmacology and rehabilitation are combined. This kind of intervention requires a consistent setting, enabling the therapist to apply a deep analysis of transference and countertransference. Adolescence is the time when methods and contents of autobiographical construction are acquired. Wordsworth’s “The Prelude” is an example of a project of creating an autobiographical self as opposed to uncertainty about one’s own capacities and difficulties in achieving an ideal. In the poem, it’s possible to discern the appearance of what Tulving defines as “the representational abuse”: a failure in the examination of reality and specifically in the discrimination between memories originated from the perceptive experience and those arising from self‐generated processes.The autobiographical function appears to be useful in coping with emotional challenges during adolescence. Patients diagnosed with schizophrenic disorders, however, often have particular difficulties in this domain. Once the autobiographical delusion appears, treatment becomes extremely complex: the observing self can be projected onto the therapist, who may observe the patient but not interact with the pathological narration nor modify the ‘representational abuse’. The paralysis of the therapist, and how to get out of it, become major challenges. The solution may be the choice of an integrated therapeutic approach, in which psychotherapy, psychopharmacology and rehabilitation are combined. This kind of intervention requires a consistent setting, enabling the therapist to apply a deep analysis of transference and countertransference.