Institutional Transference: Theoretical and Practical Considerations in Psychoses

Institutionalization has been one of the earliest methods of dealing with the mentally ill. The removal of the psychiatric patient may not necessarily have been a therapeutic measure, although remissions often took place while he was away from family and community; more often than not it was a social measure, palliative in nature, that put distance between the well and the ill and helped the former to forget their helplessness in dealing with the latter. What was not known was that institutionalization brought with it additional problems to an already difficult and most complex situation.

Despite the fact that these people most of the time were held against their wills and the conditions under which they lived were less than desirable, a peculiar attachment to the institution developed. After a certain time some patients refused to leave when the authorities judged them ready to be released. When pressure was exerted and the patients did leave, they invariably found ways—most often because of a worsening in their condition—to be readmitted. Once back in the familiar and protected surroundings, they settled down again to their grim routine of living within the confines of the institution. Each mental hospital had “life” patients, not unlike certain prisons which have life prisoners. Many of these patients were useful to the institution and held fairly responsible jobs in the power plant, laundry, canteen, or the hospital farm. With the advent of the psychoanalytic era the term “institutional transference” was coined for this phenomenon of attachment, although there has been some misgiving about the use of this appellation, since, in the strict psychoanalytic sense, it may be inaccurate to speak of transference when it concerns an inanimate object such as an institution.