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“There’s no such thing as a patient”: Reflections on the Significance of the Work of D. W. Winnicott for Modern Inpatient Psychiatric Treatment

Casher, Michael Ira MD

doi: 10.1097/HRP.0b013e31828ea604

The writings of D. W. Winnicott, British pediatrician and psychoanalyst, focus on the details of the early dyadic mother-child relationship and how impingements on the smooth unfolding of the developmental process can lead to psychopathology. Several of his concepts, such as holding environment and transitional object, have permeated into psychiatric theory and practice. The scope of his creative theoretical and clinical thinking goes far beyond these well-known terms and has particular relevance to the acute inpatient psychiatric setting. This article outlines the significance of Winnicott’s major ideas and how they can be used to better understand the mutative factors of inpatient treatment, to illuminate complex clinical interactions, and to assist in guiding care of psychiatric inpatients.

From the Department of Psychiatry, University of Michigan; Adult Psychiatry–Inpatient Program, University Hospital, Ann Arbor, MI.

Original article received 2 September 2012; revised manuscript received 23 December 2012, accepted for publication 21 February 2013.

Correspondence: Michael Ira Casher, MD, University Hospital, 1500 East Medical Center Drive, UH 9C 9150, Ann Arbor, MI 48109-5120. Email:

© 2013 President and Fellows of Harvard College
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