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Today the Psychoanalyst is being obliged to turn his attention to the psychoses more than ever before. There are many elements contributing to this trend. One is the increasing demand from a large segment of the population hitherto seriously neglected, for more intensive, more adequate therapy, including psychoanalytic therapy. This is now being expressed under the impact of community psychiatry. This group includes many cases of ambulatory psychosis. This situation is demanding a re-evaluation of analytic principles, techniques and conditions of practice so that they can be applied most beneficially to this larger group of patients and pathological conditions, where previously it might have been considered inapplicable or contraindicated.
Another factor is the change in prevailing psychopathology as seen in psychoanalytic practice. The “typical” neurotic patient is less frequently encountered and has been replaced by the character neurotic, the schizoid, the borderline or masked psychotic, or the adjusted, functioning chronic psychotic. It is to be anticipated that this trend will increase as more patients are being treated and maintained in the community rather than being hospitalized.
A third factor is the growing awareness among many analysts, that analytic methods can be effectively applied to many psychotic conditions. Until recently, most analysts were reluctant to treat the psychotic analytically. Classical psychoanalysis was, in fact, contra-indicated for the schizophrenias in that it might bring up too threatening, unconscious conflictual (libidinal) material against which the patients’ defenses might be inadequate. However, even within the orthodox framework, increasing emphasis on ego psychology has permitted modification of this viewpoint. But even more significant has been the emergence of newer psychoanalytic theories which have stressed the importance of cultural and attitudinal factors in producing the psychosis; the distortions of the total personali