Intrapsychic Structure, Object Relations, and Interpersonal Interaction: Treatment Process and Change in the Psychiatric Hospital

In 1933 Noel Coward described the three main characters in his play Design for Living. He said,

These glib, overarticulate, and amoral creatures force their lives into fantastic shapes and problems because they cannot help themselves. Impelled chiefly by the impact of their personalities each upon the other, they are like moths in a pool of light, unable to tolerate the lonely outer darkness, and equally unable to share the light without colliding constantly and bruising one another's wings. (p. xvi)

Although Coward was referring to the characters in his satirical and icy comedy, one may take his description as paradigmatic of the predicament of some very severely ill people. For example, here is an excerpt from a letter written by a former patient to a nurse about one year after leaving a long-term hospital treatment unit:

I always remember the truly incredible and loathsome burden I was during times of particular despair…. I see so clearly now how that affected — had to affect you all, for you are human. I didn't at all see it — or care to see it at the time. Now it's so hard and so sad to think that I did to the staff what I did.

This article addresses the processes involved in change and the construction of treatment programs for severely ill patients. These processes are seen to have much in common with human development, change wrought by life, and change brought about by psychoanalysis.