Treating People with Psychosis in Institutions: A Psychoanalytic Perspective

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This book brings together the histories of a number of psychoanalytically-informed hospitals, and provides a synthesis of the theoretical underpinnings in the institutional practice of each. Of particular interest is how psychoanalysts and psychoanalytically-trained staff working in institutions apply their theoretical understanding, and in what ways the psychoanalytic technique has been modified or adapted to the treatment of individual patients with psychosis and to the workings of an institution in general.

Here the institution is the subject of the case study. Institutions that are theoretically orientated to psychoanalysis were chosen and examined, taking into account their various approaches to the treatment. A number of institutional models that are informed by psychoanalysis offer a guide to the treatment and present a version of institutional practice that is different from the prevailing models in psychiatry. This has implications for health services in the current climate of mental health reform.

Psychoanalysis has its greatest efficacy in long-term treatments and has shown its suitability for patients diagnosed with psychosis when the method is adapted to the uniqueness of each person and is conducted by an experienced clinician. The treatment of psychosis cannot usually be conceived without considering some form of institutional care, although this does depend on the level of the individual’s psychopathology. This is because the majority of people with a psychotic illness, especially those with schizophrenia, will be exposed to inpatient, community or outpatient treatment, in one form or other, during the course of their lives.