Day-care Center, Operational Unit, and Social Network

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I do not believe that any reflection on rehabilitation is possible without keeping in mind the picture of the psychotic who cannot be cured, who is the principal user of day-care centers: a person who tends to transform the catastrophe of psychosis into a neatly stabilized way of life, a way of organizing survival, oras Racamier (1980) expressed it into a paradoxical way of existing without existing. We well know that, in confronting chronicity, one of the principal tasks of anyone working in mental health is to keep psychotics alive in their own minds, seeking with them to give some significance [to their lives] that will surmount the frustration, the pain, and the boredom of apparent repetition of the same thing, to maintain a capacity for imagination and, at the same time, for patience and waiting in the face of the continuous questions, never answered, that are raised whenever one peers into their psychotic worlds. The hard core of the problem confronting psychiatric services in attending to that dual reality of the world without and the world within a problem that makes psychiatric work an undertaking different from a purely psychotherapeutic or a purely social project is, in terms of both the feelings involved and the more practical question of how to organize such services, the chronicity of psychotic disorders. It is a problem from the past that lingers in the present. In the past, however, the asylum gave an answer or rather, the nonanswer with which we are familiar, ratifying the depersonalization that is an inherent part of mental illness. Whereas the incurable psychotic has been taken as the classic case for demonstrating the antitherapeutic nature of the asylum as an institution, the