ABSTRACT
Christian goes on frequent walks. As he walks, he thinks about ‘his healing’. He explains to his therapist: ‘Because, uh, you can consider me normal, but you can also think me completely crazy. It comes to the same thing.’ Therapist: ‘But how do you see yourself? You say: “You can think me crazy and you can think me normal.” But how do you see yourself, then?’ Christian: ‘I see myself as utterly crazy!’ This puzzles the therapist, since nobody admits to being crazy, let alone utterly so. ‘But what am I supposed to understand by this? Utterly crazy?’ ‘Well, it’s obvious’. Christian has thought about his self-description. He thinks of things that are ‘not done’: ‘I uh, told you that I am bothered by images, images of people. They should not be in my thoughts at all. I think of something quite different’ The therapist cannot solve Christian’s riddle, so Christian has to do so himself. Keeping within the bounds of what is permitted by convention is important to him, and he thinks constantly of things that are allowed and things that are not. Patients have to accept that ‘images’ and other ‘unreal’ things belong to the illness, and should not intrude. But when a patient freely admits to being ‘crazy’, therapists may feel alarmed because of the strong moral connotations attached to this term. To accept it would mean that the therapist and the patient would have to discuss it, and craziness concerns the whole being of a person. This could undermine the hospital’s accepted delineation between the ‘sick’ and ‘healthy’ parts of a person. However, in her discussion of ‘I am’ and ‘I have’ illnesses, Estroff suggests that schizophrenia and psychosis ‘are so closely associated with notions of the self that there may be extraordinary susceptibility to such engulfment of the person’ (1993:257). Such ambivalence creates a double bind on both therapists and patients.
