This chapter addresses a subtle irony in the treatment of mental disorders: after antipsychotic medication has helped psychotic patients to gain control over some of their cognitive functions, they recognize and understand that they have been and to an extent remain psychologically impaired. Some psychotic patients may then withdraw even further from social commerce. An improvement in one area of functioning seems to bring on, or at least is accompanied by, a worsening in another area. This observation with respect to severe psychological illnesses is not a new one. Sigmund Freud, in his study of depression, noted a similar paradox.
In his paper Mourning and Melancholia (1917), Freud wrote that severely depressed people experience a profound impoverishment of their self-respect. Such people reproach themselves for all manner of sins and evil deeds, and they are perplexed about why their friends and family bother with them since they are so debased. Their selfcriticism seems to know no bounds. Freud then commented,
It would be … fruitless … to contradict a patient who brings these accusations against [himself]. He surely must be right in some way and be describing something that is as it seems to him to be. Indeed, we must at once confirm some of his statements without reservation … it is merely that he has a keener eye for the truth than other people who are not melancholic. […]