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Psychosis and the concept of internal cohabitation

Abstract This paper was first presented at a conference with the title, ‘Where is the madness? Exploring aspects of the psychotic in ourselves and our clients’. The author explores the idea that ‘madness’ exists in us all in the form of an internal other mind that frequently operates as an inner voice or adviser. The paper elaborates the concept of internal cohabitation that conceptualizes two minds or egos – a psychotic and a non-psychotic – co-existing or cohabiting in the one body from birth. The nature of psychosis is discussed and clinical details are given involving two patients with, and one without, an obvious psychosis. Although the experience is writ large for the first two patients, on close examination, all three experience similar internal advice, warnings and threats, causing distress and an undermining of their autonomy. The paper illustrates the importance of therapists conducting a dual track analysis of both selves and remembering that they, too, can receive poor advice from their internal cohabitant. The paper ends by exploring the devastating problems that can occur when a patient with an obvious psychosis is not helped during the course of his therapy to differentiate his perceptions from those of the paranoid internal other and when the latter's terror of being annihilated by the analytic process is not recognized.