Schizophrenia: When inhabiting become impossible. Considerations on clinical proximity

Abstract

Aims: By way of a reflection on what it means to "inhabit the world", we attempt here to capture what it is that prevents Paul, a schizophrenic patient, from sharing a common horizon with others. Method: The analysis of the case of Paul is in particular based on psychiatric phenomenology, on psychopathology of the psychoanalytic type, and on what it means to "inhabit" a concrete clinical dimension. Results: Paul has a clinical profile characterised by loss. The threat we experience when in contact with Paul's dissociation becomes easier to apprehend as we realise that we are also inhabited by him. Discussion: It is essential to metabolise this unsettling experience, first so as to accompany Paul in the care process without being caught up in the dynamic of his loss, and secondly to avoid fuelling his delirious excitement. Paul's mode of inhabiting becomes clearer as we realise what it means to be inhabited by him. Conclusion: Clinical proximity with schizophrenic patients, the analysis of our counter-transference experiences of the patient's inhabiting of our own psyche and of his home (we conduct home visits) and the concrete, subjective implication of caregivers all enable better understanding of the psychopathological processes and better therapeutic accompaniment. This does however entail a cost for the therapists in terms of implication and fatigue.