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The introduction of neuroleptic drugs gives new hope to psychotic patients. But as their symptoms improve, they move swiftly from the hospital to the community. The majority, however, live at the periphery of society, frequently returning to the psychiatric ward. Therapy tends to be brief, drug-oriented, and with emphasis on overt behavior control. With each new admission, there is a new therapist and a new treatment. The results are dismal. The history of “Sylvia Frumkin” as described by Susan Sheehan (1982) epitomizes this approach.
I believe better results can be achieved with some patients if, in addition to the usual drug and milieu therapy, they can form a consistent, long-lasting therapeutic relationship where they may reexperience early phases of development through the attachment to an empathic therapist leading to emotional object constancy and maturation.
This paper describes the recovery of Anna, a young woman who spent most of her twenties in psychiatric hospitals, a severely regressed psychotic with a diagnosis of schizophrenia. In spite of various modes of treatment, including large doses of neuroleptics, she was often wild, paranoid, catatonic, and delusional with evidence of serious thought disorder. Then, after years of psychosis, with the help of a therapist at a state hospital who devoted many hours to an intense reparenting relationship and later in therapy with me, she started on the long road to recovery.
Anna's development was arrested early and regressed further during her illness. As she recovered, she appeared to recapitulate Mahler's (1975) developmental phases, summarized below.