The Persecuting God and the Crucified Self: The Case of Olav and the Transformation of His Pathological Self-Image

This case study describes the treatment of “Olav,” a divorced lawyer in his mid-30’s, who, at the time of treatment, had been continuously hospitalized in closed, short-term psychiatric wards for more than seven years with severe treatment-resistant depression, transient psychotic episodes, self-destructive behavior, suicide attempts, and Axis II diagnoses of Borderline and Paranoid Personality Disorders, with narcissistic traits. He was about to be admitted to a long-term ward for chronic schizophrenics. A great deal of his psychopathology revolved around his feeling tortured from condemning inner voices of what he called “The Committee,” which he believed were the sacred voices of God. Olav’s treatment took place in our institution’s “VITA” unit, a 12-week, group-based, residential day-treatment program that explicitly concentrates on existential and religious issues, and is based on principles drawn from existential, narrative, object relations, and affect theories. The VITA program includes diary-writing, affect consciousness exploration, individual therapy, and regular group sessions with such activities as mindfulness training; art therapy focusing on drawing or painting internal representations of self, father, mother, and God; reflection on existential issues; "here-and-now-oriented" psychodynamic group therapy; and physical exercise. An assessment battery of standardized, quantitative, clinical questionnaires documents Olavʹs dramatic improvement over the course of treatment and at one-year follow-up.