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The application of psychoanalytic knowledge to the care of the patient in hospital is considered in relation to two patients, one an acute surgical admission, the other psychotic. The psychological parallel is examined and defined before proceeding to where they diverge. The psychotic patient's use of splitting and protective identification, in order to avoid psychic pain felt to be incompatible with survival, is described along with the hospital staff's unconscious and empirical collusion with it. The patient's need to be ill, which is his right to be ill in hospital, is considered in relation to the psychotic's denial of his need. The inseparability of the care of the patient's body and mind, in these circumstances, is also illustrated, and argued to be equally germane to psychoanalytic thinking in this setting. It is submitted that the application of psychoanalytic knowledge catalyses and sustains relationship with these patients. The use of interpretation is briefly noted.
The paper is an attempt to stimulate thought and other publications in this field, one of lasting relevance to psychoanalytic psychotherapists working in the National Health Service.