ABSTRACT
This chapter presents a case study named Brain who was brought to a large discussion group after he had had three years of weekly psychotherapy. Brian had been disabled for more than twenty years by an illness diagnosed as chronic paranoid schizophrenia, and he was maintained on a moderate dose of neuroleptic medication. These auditory command hallucinations, beginning at the age of 20, soon became a permanent feature of his mental life. The commands to abandon any attempt to struggle or to help him were auditory hallucinations, operative at a different level from the visual perceptions of the “monster”. The onset of Brian’s psychosis in late adolescence was most likely the expression of the failure of defences against forbidden sexual and aggressive wishes. Brian’s case illustrates both some of the complex factors that may be involved in such a situation and how a psychotherapeutic approach in the appropriate setting with the right psychotherapist can help the patient.
