Letters to the Editor

From Dr Richard Lucas

I read Michael Sinason's and Joscelyn Richards's papers on the ‘internal cohabitee’ (Psychoanalytic Psychotherapy, 7 No.3, 207-239) with great interest, but found myself questioning their recommended approach and particularly the appropriateness of its universal application to widely different clinical situations.

Bion referred to a psychotic part of the personality developing differently and so dominating in major psychotic disorders such as schizophrenia, that the non-psychotic part, for which it exists in negative juxtaposition, is obscured.

In other words, it is not a question here of identifying an ‘internal cohabitee’, but a sane part that is being dominated and murderously attacked. Bion's insights have direct clinical applicability. At times, one has to stand up to murderous states and appreciate them as masquerading as normality, and then get the patient into hospital for the protection of himself and others. The aim of Bion's grid was to help one to think more carefully about these issues. In the situation described above, Michael Sinason's point about a neglect of concern for the experience of the psychotic personality would not seem to be the pressing one.

Joscelyn Richards reports a problem in using the term psychotic, with its implication of madness for a disturbed patient, so she prefers the term ‘cohabitee’ or ‘other-self’. In contrast, Bion, in his paper ‘On Hallucination’, had no difficulty in referring to his patient behaving in a mad way, and the patient also referred to his own madness.

While we can all be intimidated by psychotic patients, when it is possible to identify where the murderousness lies and take issue with its approach, I have found that this can be a great comfort to the sane part of the patient that is being dominated. The patient then feels that he has an understanding person to whom he can turn at the time of future crises. With less severely ill patients, I think that a different approach to understanding is n