XII. On Being Unable to Cure Psychosis

The practice cares for a number of ambulatory psychotic patients who are relatively unreachable by psychiatry, psychotherapy or even communal care. There is, nevertheless, rewarding work to be done by the general practitioner, painful though it may be to understand that there is a sane part of their personality imprisoned in the psychotic process. Amongst them are those young men and women, maintained at home by their parents, who rarely go out, are found at home looking baffled or, on a visit to other members of their family, are glimpsed as they scuttle off out of sight, scared, defiant, dishevelled.

Decades pass without change, until the exhaustion or death of their parents. The parents' pain, as their youngster drifts mentally away from them into the shadows, the nowhere of their psychotic world, is extreme. Compare the hope of young parents and their pride in the child's development, with the misery as items of schizophrenia become apparent: withdrawal, perverse behaviour, unemployability, delusion.

In this ruined inner world a psychotic part of the personality holds sway against the parents and their aspirations. The manifestations of the illness are complicated and obscured by the splitting of the self, so that the healthy part of the patient experiences himself as a prisoner of sinister forces — a gang, seeking to intrude and control his mind. The patient lives at a degraded level of vitality in identification with the victims of the persecution, but it is the inner family whose life is shattered by the phantasies of intrusive sexuality and violence.

A man of fifty-six, John, who has suffered from chronic schizophrenia since the age of fifteen, has been observed in the practice since the onset of his illness. He has an elder sister who is happily married with two adult children; his elder brother was killed in the war. Numerous attempts to help him have failed. He passes his days, heavily sedated at home, attended with devotion by his widowed mother. The lapse