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As a resident in a state hospital, I worked for a time on a chronic ward housing patients who had been there more than 6 years, and some more than 20. Medication had quieted them, but did little to help them return to the world. Their days were spent in a large dayroom holding perhaps 200 patients, all sitting on hard chairs set in rows, one group facing a TV set on the wall, the other facing the first. There was no conversation, no communication of any sort, no interest in the programs on the television, and no spontaneous movement anywhere in the room.
I wondered, naively, if rearranging the chairs into small circles might stimulate some interaction, some conversation. So one lunchtime the aides and I scattered the chairs about, breaking up the rows and creating small groupings. We then sat back and waited while they shuffled back in from lunch. There was a pause at the door, silence, and then, for about 10 minutes, without a word being said, a constant scraping sound enveloped us as the chairs were replaced in their rows, all facing as they had before and—though I can't prove it—each one next to its original neighbor. Each person sat in the same place she had always sat and once more, all was right with the world.
During the Watergate hearings, Senator Sam Irvin said that the law assumes that each man intends the consequences of his actions. Similarly, a psychoanalytically existential view of man, such as Horney's formulation of character neurosis, attends to how the individual is actively responsible for the creation, perpetuation, and reinforcement of who he is, as well as how that experience of self serves as the organizing principle that gives meaning and direction to his life.
When the chronic, regressed schizophrenic patient maintains his detachment from the world with such consistency and energy, can this simply be the consequence of some genetic or developmental deficit, a lack of psychic resources with which to act in the world? Or is there also revealed a