You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
22nd January 1953.
Dear Dr. Segal:
I am writing assuming you would welcome a further discussion of the point you made at the meeting last night. You seemed to say that of course every analyst knows that the patient has management needs. You mentioned the fact that no-one would analyse somebody who had not had food for five days. Presumably they would give food. You went on to imply that there is no essential difference between the management needs of a psychotic and a neurotic patient. If you really mean this, heaven help your psychotic patients, and until you recover from this point of view I am afraid you will not make a very interesting contribution to the theory of psychosis.
If you really believe, as many of us do, that the psychotic patient is in an infantile state in the transference situation, then what you are really saying is that there is no essential difference between the management needs of an infant and those of a grownup. Yet in conversation I am sure that you would admit that whereas a mature person can take part in his own management a child can only take part to some extent and an infant at the beginning is absolutely dependent on an environment which can either choose to adapt to the infant's needs or to fail to adapt and to ignore those needs.
I would say that the management problems are essentially different according to the level of development. If this is so, then management problems must be different in the analysis of psychotics and neurotics. As you know, I am one of those who go a little bit further and who say that in the analysis of psychotics we must actually study what we do when we take part, as we always must do, in management. It is not necessary for you to agree with this but your extreme view that you expressed last night seems to me to be one that you might easily wish to correct on another occasion.
One day when we meet we will be able to discuss this. Meanwhile, every good wish,
Yours sincerely,
D. W. Winnicott.