The interaction of the schizophrenic and the milieu in the acute psychiatric ward

SUMMARY

The interaction of the schizophrenic with the milieu of the acute ward is discussed from a psychoanalytic point of view. In the acute phases of the disease, the schizophrenic experiences internal chaos. While he is undergoing such internal stress, he will constantly be trying to adopt globally to the milieu, and he will seek relief by transposing (projectively) his chaotic feelings onto everyone on the ward. This will affect and stress members of staff. As they are affected by this stress, interactional patterns involving both staff and patients may emerge: chaos, splitting and persecutory patterns. Chaos is seen as the primary reaction, while splitting and persecutory patterns seem to arise from within the staff. If the members of staff are not attuned to the pathology of the patient, they may react in such a way as to aggravate the problem. It is unfortunate if the unconscious feelings of guilt in individual staff-members, for appearing to persecute the patient, lead to their ‘acting out’. During the initial stages of hospitalisation, the schizophrenic seems to need the help of a psychotherapeutic approach from the multi-disciplinary team to alleviate his inner chaos. However, during the later stages, he will be better helped by more limited contact with a responsible key-worker, or, even better, a psychotherapist in a regular psychotherapy programme adapted to his needs.