The mask of psychotic diagnoses

Chronic mental illness results in the patient becoming adhered to a DSM-IV diagnostic label. Over time, this diagnosis can expand and become a "mask" that invisibly covers over the true person of the patient. Most commonly, two things then occur. First, the outside world forgets that the patient is a person and family, friends, staff, and doctors begin to treat the patient according to the superficial aspects of what the mask of the diagnosis connotes, rather than connecting with the person struggling with the illness. Second and, perhaps, more insidious, is that the patient, who has been vulnerable and shattered by his or her experience and battle with the illness, adopts the mask as a kind of invisible protective shield. The task of making contact with the patient behind the mask of the diagnosis is therefore a formidable one for psychoanalysts and therapists and staff who work with seriously ill patients. Treatment must focus on the dual process of interfering with the patient's use of the diagnostic mask while, at the same time, making safe contact with the person of the patient behind the mask. A focus on affect can help achieve these dual goals. By utilizing Semrad's (Semrad and van Buskirk, 1969) method of noticing and asking about "feelings" as conveyed by hallucinations, delusions, or bodily sensations, a reliable relationship can evolve and the clinician can come to have an important "selfobject" (Kohut, 1971) meaning for the patient. By attuning to the patient's "vitality" affects (Stern, 1985), great stability and a new sense of "aliveness" is made possible to help the patient emerge from the deadening effects of the illness and the mask of the diagnosis.