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In my opinion the analyst should be a model of understanding and flexibility in modes of treatment for other mental health disciplines. However, most analytical interventions are only weakly applicable to psychotic states. It is possible that there are basic assumptions in the way you, the analyst, practice which are limited to normal psychology and which do not apply to extreme states.If you find that your work does not apply to the psychotic states, you normally conclude that the people are unconscious and must wait for enlightenment. Secretly you believe that humankind will never change. You are hopeless. Alternately, you may believe that psychosis is due to social ills, God, the collective unconscious, an undiscovered toxin, early childhood experiences or fatefully weak egos.These beliefs indirectly help to sustain the steady number of psychotic episodes because you, who are best trained to work with these people, defer such work to others. Moreover, your hopelessness acts hypnotically on patients in extreme states by intensifying their own anger and sense of hopelessness. Please let us be aware of our beliefs about psychotic states.*140\227\8*

Many hospitals, both community hospitals and teaching hospitals, have established specialized units, informally called AIDS units or wards, for people hospitalized with HIV infection. AIDS units usually deal with all facets of care: they offer not only medical expertise but also social services, psychological support, advice on nutrition, addiction services, and access to AIDS-advocacy groups. In short, they offer the same services to someone in the hospital that comprehensive care programs (discussed previously in this chapter) offer to an outpatient. In many instances, the AIDS unit is part of a comprehensive care program.     The person on an AIDS unit will receive a level of expert medical care not generally available to a person with AIDS on, for example, a general medical ward. In addition, the people providing the care on an AIDS unit have specifically chosen to work with people with HIV infection. The principal disadvantage to being on an AIDS unit is that your diagnosis is obvious to visitors. Hospitals with AIDS units usually offer the person the option of care on this unit or care elsewhere in the hospital.*159\191\2*

In all chronic conditions there is a need to “be realistic” and a problem in defining “reality” and in accepting it. One of the most difficult realities of epilepsy is that no one can predict when and where (or even if) a next seizure will occur. This is “the uncertainty factor.” It is this uncertainty factor that differentiates epilepsy from most other chronic conditions. It is this uncertainty factor that is most disturbing to older children with epilepsy as well as to their parents. “Could I have a seizure while crossing the street?” “Is it all right for me to go to school today, or will I be embarrassed by another one of those things?” “Suppose he goes to the prom and has a seizure?” Uncertainty leads to anxiety and worry. Coping with anxiety is the principal task for a parent of a child with epilepsy. Worry must be contained. It cannot be allowed to permeate every waking moment of your life. It cannot be allowed to be the master, dictating overprotection of your child.But how can worry and anxiety be contained? It’s useless to be told not to worry. You need to be helped to see the reality of your child’s epilepsy. For some, that reality may be a few seizures, likely to be controlled, and epilepsy that eventually disappears. For other parents, the reality may be continuing seizures or retardation or other disabilities. No one can predict with absolute certainty what the future holds for a child with epilepsy, any more than we can predict with certainty what the future holds for a child without epilepsy.It is the lack of ability to influence the future that can be the most disturbing to people with epilepsy and to their loved ones.*188\208\8*