The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.

A syndrome of psychic blankness, or pseudo-depression, here labeled aphanisis, is seen commonly in chronic schizophrenic patients. it is frequently confused with and misidentified as a postpsychotic depression. Clinical observations deriving from a setting of intensive psychotherapy with three chronic schizophrenic patients are compared with recent information concerning the normal and pathological development of affects in children to identify the state of aphanisis as distinct from states of depression phenomenologically, developmentally, and psychodynamically. Careful scrutiny reveals aphanisis to be an actively maintained regressive or primitive psychological state of an autistic nature serving important defensive/adaptive aims. Discussion highlights the differential diagnosis between aphanisis, postpsychotic depression, and maturational grief and how this may help reduce heterogeneity in the sampling of various postpsychotic syndromes for treatment and research purposes.