ABSTRACT
In obsessional patients, the madness will be expressed only in their compulsive thoughts; the confinement might help to keep them sane, for the madness is limited to one area, keeping the rest of their personality fairly safe. Like S. Freud many years earlier, he challenged clinicians to listen to patients, even to those who appeared hopelessly mad. The psychotic refers to something unknowable, elusive to any kind of certainty. The analyst treating psychotic patients might glimpse this through an act of intuition, a gut reaction that results in “bursting out” with an inexplicable clinical intervention. Even if psychotic subjects do not know what to do with their knowledge, they may often have a disconcerting, accurate insight into their madness. If the clinical presentation of patients included hallucinations and delusions, a loss of capacity to relate to others, if they appeared to be detached, unresponsive, and negativistic, a diagnosis of schizophrenia was likely to be made.
