chapter  Three
17 Pages

Rigidity and stability in a psychotic patient: some thoughts about obstacles to facing reality in psychotherapy

WithMargaret Rustin

This chapter discusses a particular kind of rigidity in a post-autistic patient, Holly, who lives simultaneously in a psychotic private world. After a very long labour, Holly was delivered by forceps and was said to be at risk; the parents felt that this was due to oxygen deficiency, but the details are not clear. Holly cried less after breastfeeding was abandoned, and she found solace in playing on her own for hours at a time. When Holly was 2 years old, the family consulted a child psychiatrist because of her peculiar language development. The family was referred to a hospital for psychotic children quite some distance from their home. When Margaret Rustin first began to see Holly, she encountered a completely mad child. The setting for psychoanalytic therapy, with its emphasis on structured reliability, is a double-edged matter with such patients—the regular sessions can become part of the patient's organized evasion of life unless one is very attentive.