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You cannot face it steadily, but this thing is sure,That time is no healer: the patient is no longer here.When the train starts, and the passengers are settledTo fruit, periodicals and business letters(And those who saw them off have left the platform)Their faces relax from grief into relief,To the sleepy rhythm of a hundred hours.
The chronically psychotic individual, whose primitive and brittle defenses are coupled with chronic anxiety, including prolonged spans of terror, calls into question our abilities and goals as analysts. We attempt to help the patient build a more secure defensive structure, while modifying the brutal attacks of the primitive superego. We hope that the patient will gain increasing self-awareness and that the process of self-exploration will become an autonomous and self-sustaining function. However, in reviewing our work with any patient, we often see that only a modification and not a transformation has occurred. The customary defenses remain a life-long part of the patient's reactive pattern, still available in times of severe stress. Freud (1937) said, “Of late years …, a relatively small number of severe cases of illness remained with me for continuous treatment, interrupted, however, by longer or shorter intervals. With them, the therapeutic aim was no longer the same. There was no question of shortening the treatment. …”