Sociopathic adaptations in psychotic patients

Many chronic psychotic patients make pathological adaptations to the environments imposed on them as a result of their illnesses, and those adaptations often distort the clinical picture and make it difficult for the psychiatrist to make a satisfying diagnosis and treatment plan. An example is the hospitalized patient who makes a dramatic recovery from his psychosis on the day his public assistance check is scheduled to arrive in the mail. The patient has developed the capacity to bend the course of his psychosis to his will, forcing it to serve his practical needs. The author presents several examples of patients who shift the focus of their activity from the manipulation and distortion of internal reality to the idiosyncratic manipulation of their external environments.