Psychoanalysis in a closed ward: The psychoanalytic act in psychosis and case management in a “mental health” institution

Clinical work and diagnostic procedures in mental health institutions are mainly psychiatrically–biologically oriented and the basic requirements from clinicians include case management and support over various aspects of the patient’s daily life, his/her rehabilitation and relations with his family. The role of psychotherapeutic work in general, and in particular psychoanalytically oriented work, is not clear and is often neglected. This article represents a Lacanian Psychoanalytic approach for clinicians in mental health institutions and argues that it is applicable and beneficial for patients even when the institutional orientation is markedly different. It is based on the Lacanian emphasis on the differentiation between two main personality organizations, a neurotic and a psychotic, together with an emphasis on a non interpretative, non authoritative approach to treating patients with psychotic personality organization. The author argues that a position referred to as “the secretary” is beneficial in helping patients improve their life situations and adjust better to the hospitalization and other demands. It also helps the clinician’s practice in case management and rehabilitation procedures.