‘ “Poor girl”: a case of active psychosis’: clinical commentary.

This commentary discusses an account of the psychoanalytic treatment of a manic depressive (bipolar) patient from a Lacanian perspective which raises many questions about the possibilities of treating psychotic patients psycho- analytically. It introduces Kleinian and Bionian perspectives on such treatment and the theory underpinning it. I have tried to indicate how a Lacanian and a Kleinian approach to this case can complement each other. The Lacanian account provides insights into how language functions to bind the delusional system, enabling the patient to deal more adequately with a precarious reality. The analyst shows the value of recognizing and accepting the patient’s reality as it is. By contrast, the Kleinian tradition stresses the active nature of unconscious phantasy and the transference and may shed more light on why the delusional system and the symptomatology take the forms that they do. It concludes that an open question must remain as to whether more active interpretation of the transference within the immediacy of the therapeutic relationship would ultimately enable this particular patient to develop a more containing object.