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Presenter: The psychiatrist who referred this patient to me diagnosed him as psychotic. He had been committed to hospital. I didn't have a vacancy but I interviewed him and we agreed to leave it until I had a vacancy. Later he left hospital and phoned me, but I still had no vacancy. I said I would phone him when I had a mutually convenient time.
Bion: Where does this idea come from – that the patient needs help? We can understand that the psychiatrist would think so, but the interesting thing is that apparently the patient thinks so too. In other words, he is not so mad that he doesn't know he needs help. There are plenty of people who are what we would call ‘insane’ but who wouldn't want any help from anybody; they could feel that they were quite all right. But this patient seems at any rate to be sufficiently well to know that he is ill.
P: When he first came he gave the impression that he expected a great deal of me. At the same time he couldn't articulate words to express himself in order to communicate with me. I experienced this problem of mutism with another patient, and based on this I had the impression that this patient would remain silent for a long time. I knew he was studying architecture, so I suggested that he might like to do some drawings for me if he was having difficulty in using words. He accepted the suggestion enthusiastically, and has drawn in every session since.
A kind of ritual has been established: he does the drawing; I ask what he has drawn; he gives it to me; I look at it and ask what he thinks about what he has drawn. Sometimes I ask, “How do you interpret the drawing?” Or, “What have you drawn?” In the last session I said, “Give the drawing a title.” He thought for a while
and then answered, “Bestiality Advancing”. I asked him, “Are you representing the advance of bestiality by a foot that is advancing?” He replied, “Bestiality is not a foot; it is something that has feet.” He spoke quite quickly and then drew a line round the picture