Working with psychosis: Part 3 – ‘Struggling to contain madness – losing and recovering a capacity to think’

Abstract

This is the penultimate paper in a series about working with a patient suffering from a psychotic disorder. The paper describes the third year of the work in which ‘John’ had four breakdowns in a period of six months. Much of the time I was unable to think. I was sitting on the edge of my chair either worrying that John was breaking down again or trying to help him recover from a breakdown. My small office became a cramped prison cell in which I felt myself a witness to a disturbing dance into and out of madness. A turning point seemed to happen as I developed a way of thinking about John's breakdowns. I seemed then to become a less persecutory figure in John's mind and more someone to whom John could turn for help. We found a way of thinking and talking about an infant in John. John responded by finding a way of being in my office as though he was reclining in a hammock. His breakdowns ceased. He was able to share in common humanity's concerns following September 11. Finally, I discuss thoughts about containment particularly about the paternal role in containment, drawing on Robert Caper's elaboration of Bion's ideas about containing psychotic aspects of experience.