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Despite impressive advances in neurobiology and associated neuro-developmental theory, schizophrenia and related severe mental illnesses continue to follow a chronic or remitting course in the majority of cases.
Psychoanalytic knowledge provides an essential perspective in the attempt to understand and help the severely mentally ill, and such knowledge should not be incompatible with modern findings of neurobiology. The severely ill person is best treated from the outset in a hospital facility where his individual needs and capacities can be fully assessed within an integrated perspective, one which is able to provide a continuing resource as long after discharge as is necessary. A consistent and integrated philosophy of the nature of psychotic illness and its treatment can improve the quality of care provided by psychiatric wards, some of which are both inefficient and anti-therapeutic.
For such a gradual transformation to come about, training of all professional staffln integrating neurobiological and psychoanalytical knowledge is necessary. This paper presents some reflections on the subject deriving from the author's experience in the British National Health Service and in several Scandinavian countries.