[Undated] [2]. Cogitations

I am reminded of the Millais Culpin case: the patient committed suicide after an interview when Culpin told him that analysis was not suitable for him. Culpin was blamed by the coroner and attacked in The Times, which suggested that an end should be put to psychoanalysis.1

With this patient it is essential never to forget that one is dealing with a schizophrenic. That is to say that one should never forget that the patient is both murderous and irresponsible, and that ‘common sense’, i.e. the common sense of the society, dictates a particular diagnosis and a particular attitude of individual members of the society to the patient. Resistance to this dictation carries the penalties which the group always threatens to exact from those who resist its dictates. The ‘common sense’ of the patient, however invisible and undetectable it may seem to be, tells him this, for he has common sense though he makes uncommon use of it.

Although the analyst must never cease to be a member of his group, and must be correspondingly sensitive to its dictates and the risks his ignoring of these dictates carries, neither must he ever permit the ‘socialism’ of his orientation to obscure the immediate vivid reality that confronts him in the consulting room. The patient knows this too; he is prepared to play his part in exacting a heavy penalty if the analyst does not behave with the perspicacity that is not only demanded by the work, but also by the patient's determination that the analyst should support, by his conduct in devoting his exclusive attention to the patient – no matter at what cost to himself – the patient's narcissism against his ‘socialism’ (and also be as socially ostracized).

The analyst is thus forced to experience the split which the patient himself suffers between his narcissism and his socialism. That this

split exists is made apparent by the patient's reaction to the analyst's ministrations to his narcissism. We have seen that the patien