From optimism to pessimism. A case study of a psychiatric patient

• This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. • The focus of this study is a 50-year-old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. • Data collection using five methods occurred during a 21-month period. Results of the content analysis processes identified four distinct but non-discrete phases of the patient's complex condition. • Medical and nursing care was categorized in three approaches: optimistic, strategic and resigned. • The results raise the question of whether there is action that is without any meaning as an expression of the patient's wishes, thoughts and feelings. • It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his ‘real’ self. His experience was that of a splintered world.