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Every psychiatrist has had cases that seemed to be hopelessly involved in schizophrenic psychotic processes but which nevertheless, after some months or years, have set all his gloomy prognostications at naught, some even achieving on recovery a better social adjustment than had been possible before the illness. Sometimes these cases are dismissed as merely further evidence of the uncertainty of psychiatric diagnosis. Such cases, however, should challenge us to try to understand psychodynamically just what the process was by which the unexpected recovery took place or to answer if possible the paradoxical question of why it was necessary for these patients to develop a psychosis as a step in the process of achieving a better adaptation to life.
In this paper we wish to present two such cases who underwent no treatment other than the good physical care and sympathetic interest in the patient's communications which is offered in every good psychiatric hospital, but who nevertheless achieved unexpected recovery.
The points that we wish to illustrate are two: (1) that an acute psychosis may be a transitional episode in the process of emancipation from an old method of adjustment and 'learning' a new one, and (2) that during the acute psychosis the mechanism of recovery may be indicated in advance by the content of some of the delusions.
Our first patient is a young woman of twenty-four, a nurse, the youngest of eight children. The parents were Italians, originally Catholics who had been converted to the Protestant faith. The patient's father was somewhat of a rebel and left home early in life; he also left his church and became a converted Protestant. He graduated from a liberal university and