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It seems important to establish at the outset my professional background. I am a psychiatrist and psychoanalyst working in a general hospital psychiatric department and also in private practice. I treat people with severe personality disorders through Transference Focused Psychotherapy. I also treat psychotic patients very often and many of them receive a combined psychopharmacological and psychotherapeutic treatment. In most cases, that psychotherapeutic work is supportive, the aim of helping the patient to reach his or her maximum functional level in all areas: work and leisure activity, affective relationships, sexuality etc. I know psychotic patients who, thanks to this combination, develop meaningful lives and have few relapses or hospitalizations. I do not believe in differentiating between pathologies depending on whether they are caused by biological or psychological problems. It is not the brain or the internalized object representations that are ill, but the person as a whole. Insisting today on Cartesian dualism only leads us to very reductionist and partial visions. Years ago, Engel (1977) published a legendary article advocating the consideration of the psychological, biological and social aspects of any health problem. I think this is an excellent recommendation for those of us who work in mental health, both inside and outside psychoanalysis.
Many psychotic patients, however, remain for long periods of their lives in and out of crises that entail enormous suffering for them and their families and involve very serious breaks in their interpersonal bonds and a reduction in their capacities. Others never stop coming out of psychosis and try to live with their delusions, their hallucinations and their constant terror of the reality around them and the fantasies that haunt them. Certainly, despite the research that has been carried out at all levels (biological, psychological and social) for the last hundred years, we are still unable to respond to all the