The reviewed article is ‘A Case Managed at Home’ by Donald Winnicott. Winnicott describes in this case study a child who develops a neurosis followed by an acute psychotic episode. Winnicott describes how the case is managed by the family within the home environment supported by his weekly visits when the family recreate the paranoid position of the child by isolating themselves from outside services including the postman. He describes how the child feels safe initially only in the direct presence of the mother but that in a period of a year-and-a-half this space increases to that of the house and further afield. The psychotic features include withdrawal, paranoid delusions and suspected hallucinations. The case involved neither medication nor psychotherapy and the girl appeared to have remained in remission at the stated follow-up two years later. The onset of the psychosis is acute but there is no description of a medical work-up of the case. The psychosis follows the wedding of the aunt. Winnicott’s explanation involves a description of an identification with the male – in this case the bridegroom. Winnicott describes this as an example of a case that can be managed at home although it is interesting to consider the cultural factors which facilitate treatment at home. As this paper was written in 1955 it offers us a historical glimpse into Winnicott’s management of a case and it would be interesting to contrast this with contemporary practice which would depend on local service configurations including relevant protocols.
Donald Winnicott. A Case Managed At Home. p118-126. Chapter X in D.W.Winnicott. Through Paediatrics to Psycho-Analysis. With an introduction by M.Masud R.Khan. The International Psycho-Analytical Library. Edited by M.Masud.R.Khan. The Hogarth Press and The Institute of Psycho-analysis. 1978.
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