ABSTRACT
Obsessive-compulsive neurosis provides an illustration of the frequent differences between the psychiatric and psychoanalytic approach to understanding severe mental illness, and of the fact that psychotic features may be found in non-psychotic individuals. Ada had been in psychiatric treatment for over twenty years for an illness, diagnosed as obsessive-compulsive neurosis, which involved severe anxiety, ritualistic symptoms, and inhibitions characteristic of this illness. When the psychotherapy began, the characteristics of her thinking, the details of her complaints, and her personal history became clearer. As the psychotherapy proceeded, Ada gradually experienced some reduction in the level of her background anxiety, and found relief in expressing some of her aggressive feelings towards her mother. The psychodynamic formulations helped the therapist to begin to think more effectively about possible meanings of his patient’s bizarre behaviour and of the thinking that produced it.
