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I shall confine myself to expressing some ideas about what I think is effective in the treatment of schizophrenics. Of course, any therapeutic approach is based more or less on a theoretical framework, and even in a brief presentation such as this one, we cannot help but refer to theories.
According to the original conceptions of the orthodox Freudian school, the effectiveness of the treatment lies in the fact that: 1) what was previously unconscious was made conscious by the treatment and therefore is not so disturbing any longer, 2) the repressing forces and the defenses of the ego need no longer be used in warding off instincts, and the invested energy may be liberated and used for constructive purposes, 3) the methodology consists of showing to the patient sooner or later how the past is effective in the present.
Now although some of these ideas or their derivatives may be retained in understanding the treatment of neurotics, this formulation must be considered inadequate in explaining the effectiveness of treatment of schizophrenics.
With the exception of the well-systematized paranoid, what is generally unconscious in the normal or in the neurotic is quite often conscious in the schizophrenic. Although some areas are dissociated or unconscious in the schizophrenic too, the main disturbance derives from the state of psychic disequilibrium, disintegration and fragmentation, rather than from the state of unconsciousness of conflicts. As a matter of fact, at times we would prefer that certain conflicts would be unconscious, at least as long as we cannot use the awareness of them in the effort toward reintegration.
Again with the exception of the well-systematized paranoid, there is no energy wasted in repressing or in useless defenses. As a matter of fact, one gets the impression
that quite often the patient is not able to build up defenses. It is true that the phenomena of regression may be considered defenses, but they involve withdrawal and retreat rather than rep