A Holistic (Horney) Approach to the Psychoses: The Schizophrenias

It has been said, and I believe justly, that whoever knows schizophrenia, knows all psychiatry. The great importance of this group of psychoses cannot be overestimated, and it is becoming even greater with changes in present social conditions, and in the resulting form of psychiatric and psychoanalytic practice. This significance has been reflected in the tremendous volume of papers on these psychoses and the infinite amount of effort and thought they represent. But in attempting to review this body of literature, one is left with a feeling of confusion about the number of factors and aspects to be considered, and about the often contradictory conclusions and opinions on each aspect. One cries out for some approach that will unify these differences, that will make sense out of this plethora. Yet, as Redlich¹ has emphasized in his overview of the concept of schizophrenia, one may well ask whether a common fundamental disturbance—the Grundstörung of German psychiatry—can or will be found, or whether any single psychodynamic approach will explain all the phenomena. Nevertheless, we are moving in this direction. This paper will attempt to point out how this holistic theory can be helpfully applied to the schizophrenias, and how it can thereby increase our understanding of them.

Until recently, the application of our holistic approach to these psychoses was limited, for a number of reasons. There was a relative lack of clinical psychoanalytic experience by analysts using this theory. The psychotic patient was less frequently referred to the holistic psychoanalyst than the neurotic, a lingering effect of the traditional analytic position. Some analysts were reluctant to accept such patients, even when they were referred, because the major therapeutic tools with which they were most familiair were thought to be applicable only to the neurosis; and they felt, therefore, that the consequent technical difficulties w