Thoughts catalyzed by Ferro's paper

Lisa was 24 when her mind broke apart. Dr Ferro captures her state with his metaphors of Russian doll and puzzles. She was in pieces. She must have had a life situation that allowed for such falling to pieces. Perhaps, also, a wish to be held together by other mind functions, alongside the anxiety-driven push toward breakdown, to bring about the moment of no-more-functioning-in-the-social-world.

More and more, I find that a prescribing psychiatrist also serves as a back-up for the psychoanalyst, sometimes the medication and the psychiatrist serving as a sort of substitute for what hospitals did, when they were more available in the USA.

I like the way Ferro writes about the demand for the patient ‘to accept a setting with sufficiently established rules’. The famous and infamous rules … you must come four or five times a week; you must lie on the couch; we will have a pretty rigid schedule. I thought about how I have come to explain these dimensions of our strange work. I talk about the conditions under which I best can do the work I do. (I don't try to persuade the patient that it's simply for their own good, although I do use analogies such as ‘You want your mind to work in a new way and to have stronger emotion-containing muscles, so you have to get to the psychological gym regularly’.) Occasionally, I have treated someone refusing to consider coming more than once a week as an acceptable way to start, assuming I'd get to what would make them consult me and then reject what I suggested (as if they didn't trust my professional judgment) and yet still want to work with me. Often that has worked well, but a couple of times I could have usefully interpreted the hostility in their immediately refusing to undertake the type of treatment they know I do, and not interpreting it made the treatment skid along on thin ice or fall through it.

I read a transition between two of the paragraphs as being related to these rules. In the third paragraph, the topic is the rules. In the