Ifilft WEATHERING THE STORMS PSYCHOTHERAPY FOR PSYCHOSIS RRAY SON WEATHERING THE STORMS WEATHERING THE STORMS Psychotherapy for Psychosis Murray Jackson Foreword by Preface by James S. Grotstein Paul Williams K A R N AC LONDON NEW YORK First published in 2001 by H. Karnac (Books) Ltd, 118 Finchley Road, London NW3 5HT A subsidiary of Other Press LLC, New York Reprinted 2002 Copyright ©2001 Murray Jackson Preface copyright © 2001 Paul Williams Foreword copyright © 2001 James S. Grotstein The rights of Murray Jackson to be identified as the author of this work have been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. British Library Cataloguing in Publication Data A CLP. for this book is available from the British Library ISBN 978 1 85575 267 2 10 9 8 7 6 5 4 32 Edited, designed, and produced by Communication Crafts www.karnacbooks. com This book is dedicated to the Scandinavian psychotherapists who made it possible and who, for reasons of confidentiality, remain anonymous "I have gathered a posie of other men's flowers, and nothing but the thread that binds them is my own." Montaigne CONTENTS ACKNOWLEDGEMENTS ix ABOUT THE AUTHOR xi PREFACE by Paul Williams xiii FOREWORD by James S. Grotstein xv Introduction 1 1 Psychotic features in obsessive-compulsive neurosis: "Ada" 11 2 Obsessional symptoms following adolescent psychosis: "Brenda" 26 3 Obsessions in schizophrenia: "Alec" 40 4 Paranoid schizophrenia— command hallucinations: "Brian" 61 5 Hysterical psychosis: "Claudia" 76 6 Anorexia, psychosis, and the question of sexual abuse: "Dorothy" 95 7 Paranoid schizophrenia— space-time factors: "Conrad" 120 8 Chronic paranoid schizophrenia— schizoid thinking: "Ellen" 141 vii Viii CONTENTS 9 Paranoid violence: "Duncan" 150 10 Schizophrenia—psychotherapy, termination, reparation: "Florence" 162 11 Paranoid psychosis— delusional body image: "Elmer" 176 12 Paranoid delusions— sealing-over and working through a psychotic transference: "Frank" 191 13 Phobia, hysteria, psychosis: "Grace" 208 14 Chronic schizophrenia— catatonic and spatial features: "George" 219 15 Manic-depressive psychosis: "Harry" 235 16 Vignettes 255 17 Mostly theory 273 18 Mostly practice 294 19 Conclusions 303 APPENDIX A: Characteristics of schizoid thinking 313 APPENDIX B: Infant research and the "right mind" 317 APPENDIX c: Thefuture—winds ofchange 319 GLOSSARY 321 REFERENCES AND BIBLIOGRAPHY 343 INDEX 360 ACKNOWLEDGEMENTS My indebtedness to my old friend and mentor, the late Henri Rey, is incalculable. I am particularly grateful to Jeanne Magagna, who, having col­ lected and edited Rey's work, helped me very much with my own. As a teacher of trainee psychiatrists and child psychotherapists, she scrutinized the manuscript in its several draft forms and made many invaluable contributions and helpful suggestions. Michael Sinason also gave a great deal of his time in studying the text, and his exper­ tise was particularly helpful. Since this work is the fruit of many years of teaching about psy­ chotic illness and its treatment in collaboration with a large number of Scandinavian psychiatrists and psychologists, I can only name some to whom I am especially indebted. In Norway, I owe a great debt of gratitude to Anna Leira, to the late Thoralv Nadland, and to the late Endre Ugelstad; in Finland, to Yrjo Alanen and Viljo Rakkolainen; in Sweden, to G»ran Andre, Ulla Arnell, Johan Cullberg, Magnus Elfstadius, Kina Meurle Hallberg, Rolf Holmqvist, and Tiit Saarman; in Denmark, to Ulla Bartells, Eliza­ beth Blum, Jens Bolvig Hansen, Anne Viskinge Jensen, Margit Jorgensen, Ulla Just, Ebbe Linnemann, Gert Rasmussen, and Bent Rosenbaum. They opened doors to teaching /learning opportunities and offered warm and generous hospitality. Pearl King told me long ago that I should write about my psy­ choanalytic work in hospital and academic psychiatry, and I was extremely fortunate in having the opportunity of learning from psy­ choanalysts who knew a great deal about psychosis, in particular Henri Rey, Hanna Segal, Betty Joseph, Herbert Rosenfeld, and Leslie Sohn. Jeremy Holmes, Michael Sinason, and Cesare Sacerdoti encour­ aged me to write about psychosis, and Paul Williams conceived the ix