Imprisoned royalty: defensive failure and reconstitution on an inpatient unit

Treatment of schizophrenic patients in an inpatient setting has become ever-more challenging over time. Patients move in and out of hospital systems quickly, and the severity of patients' illnesses during their hospital stay makes the experience chaotic and intense. This paper offers a model for understanding psychotic patients' experiences on an inpatient unit, and for effectively working with them in this setting. I have drawn on a parallel in film, that of "The Madness of King George," to help illustrate the concept of the hospitalized schizophrenic patient as imprisoned royalty. Through this metaphor, I explore the process of defensive breakdown and repair in psychosis, as it occurs in the hospital setting. I examine the relationships between patients, clinicians, and aspects of the hospital, and review some of the common dilemmas in this type of treatment.