“Madness” in the Countertransference: Evocative Encounters in Hospital Treatment

Every now and then a clinical situation arises that begs the question of who is more mad, the patient or the staff. One day a young hospital doctor walked onto a ward to find a female patient standing rigidly in the middle of the corridor. She was well-kempt and appropriately attired but stood with her head tilted backward to face the ceiling. When the doctor asked how she was doing, she replied, “Fine,” then told him not to worry about her. Over the next few minutes, she explained that she had been a bad person much of her life. She was now simply praying to God for forgiveness for her sins. She explained coherently that she needed to pray this way over the next several days. She would eat her meals in the dining room, tend to her personal hygiene, and sleep in her bed at night. However, she would spend the remainder of her day praying in the hallway so that others could witness her act of penance. To do penance in her room or in a less-conspicuous place would not be reverent enough.

The patient remained motionless for hours on end, much like a human mannequin posing in a department store. Her stony-faced behavior caused quite a stir on the unit, more so among the staff members than the other patients. The nursing supervisor quickly called the doctor aside to inform him that the patient was psychotic. Her behavior was quite troubled and therefore unacceptable. Proper nursing intervention mandated that the patient not be allowed to stand in the hallway. If she would not move on her own accord, she should be carried to her room.