Incestuous Failure—Studies of Transference Phenomena with Young Psychotic Patients and their Mothers

Laforgue (1936) reported an attempt to treat a schizophrenic woman psychoanalytically. He found that the analysis required the coincidental treatment of the patient's older sister—a mother substitute—to whom there was a homosexual attachment. I do not know if analysts today, treating psychotic patients, would regard this as an unnecessary departure made irrelevant by subsequent advances of theory and technique; but to an analysed psychiatrist working in a mental hospital, who exposes himself to patient–nurse–doctor and family–nurse–doctor relationships, Laforgue's response makes good sense. It is from our dilemma about the psychotic patient, as an individual to be treated and as a part of a social unit, that two apparently divergent tendencies have evolved. On the one hand therapeutic optimism is based in helping the patient to become master of himself and captain of his fate, dependent upon an enrichment, a modification and a realignment within his inner world. The alternative tendency is to regard the patient as but part of a whole family, of whose sickness he is the final expression (or signal). Modification, not to say treatment, of this unit is surely no less formidable a proposition than the individual analysis of the psychotic patient. Yet, from the therapeutic will—I do not say zeal—of both schools, we derive that accumulated knowledge without which we would not even define the problem before us.

Working in a state mental hospital (Shenley Hospital, Shenley, Radlett, Herts.) with the most disorganized psychotic patients, I found myself in considerable doubt about attempting any variant of classical psychoanalysis in a setting for which I had clinical responsibility, i.e. a ward known as Villa 21 —accommodating 20 schizophrenic lads and their nurses (Conran, 1970). It seemed appropriate that I should immerse myself in the life of this social unit in order first to observe—in a psychoanalytic way—as much of what was going on as was available to me to kn