ABSTRACT
This chapter provides a look at a 20-year clinical engagement with a psychotic woman. For years, the patient limited the therapist’s vocabulary to five words: yes, no, I don’t know. The case raises questions about how emotional growth can take place in the absence of effective repression or stable identifications. The author sees the patient’s sadomasochistic control of the interaction as enabling a conscious effort toward self-cure. The case demonstrates the syntax of psychotic mentation, especially the concreteness of thought and the intrusive conscious presence of unmodified sexual and aggressive wishes requiring spoken disavowal.
