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'Sister, I am going crazy, help me': psychodynamic-oriented care in psychotic patients in inpatient treatment.

A common German expression for 'crazy' means literally 'not sealed'. In psychoses, the boundaries of the ego are brittle and dissolved, the pores are open. Fragmentations occur, fusions of undefined self and object represenations are impending. The self is projected and introjected, always struggling for a sealed-up, though sufficiently permeable, space. These psychodynamics form a characteristic feature of professional psychiatric care. Providing a sealing up and cohesive relation as a basis for the return into the non-psychotic world is one of the essential tasks of psychiatric nursing. The nursing relationship forms a sort of virtual membrane which is a point of intensive and accelerated exchange. Clinical vignettes will be used to demonstrate that the creation of reliable, encouraging contact can be successful when psychotic functional patterns are understood in terms of object relations theory.