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Dear Editor
I thought that Cleo Van Velsen's comments on Michael Sinason's paper, in her review [last issue of Psychoanalytic Psychotherapy, vol. 14, No. 2, 189-191] of the book Psychosis (Madness], misrepresent his views and the analytic work reported in the paper. This chapter, entitled ‘How can you keep your hair on?’, reports on analytic work with a patient who had a compulsion to violently pull her hair out, but who afterwards recovered her ‘usual self’ and was then horrified by the damage done in theses attacks. Van Velsen claims that Sinason's concept of ‘Internal Cohabitation’ will be ‘allowing someone to evade ownership of “madness” by locating it in the “mad” self that can be seen as foreign.’ Sinason describes the analytic work that led the patient to be able to mitigate these attacks on her body and protect herself against them. This was achieved by analytic exploration of ‘who was doing what to whom’ in the internal world. Knowledge of this enabled the patient to gradually be emancipated from the tyranny of the abuse. Sinason's chapter illustrates how responsibility for madness requires detailed analysis of the workings of the internal world and is not achieved by premature demands for taking ‘ownership’ of madness.
Yours truly