A man like Kappler might become angriest, most detached, even sickest at those times his psychiatrist edges closest to the truths about his life. The rage and even the psychosis has to be seen for what it is: the flamethrower of a fortress under siege. Pleasantries, humor, and easy exchanges might be clues that no real work is being done.

There can be no retreat on the psychiatrist's part. One patient with a psychotic illness has written: "the doctor has to feel sure he has the right to break into the illness, just as a parent knows he has the right to walk into a baby's room, no matter what the baby feels about it. The doctor has to know he's doing the right thing...some people go through life with vomit on their lips. You can feel their terrible hunger but they defy you to feed them.

Autore: Keith Ablow