The Adoration of the Patient and its Disillusionment

All textbooks on psychoanalysis and psychotherapy assume that once the analyst learns to attain positive regard toward the patient, he maintains it over a lifetime of practice. Of course, there are certain categories of patients which involve extreme difficulty in positive regard, e.g., the chronic alcoholic, the character disordered, the drug addict; for most of us, positive feelings for them are not there to begin with. But, by and large, such patients are not the stuff of psychotherapy, and all but the minimally successful or specially motivated bar them from the consulting room. The patients we are discussing are the intelligent, subjective verbalizers who symbolize and internalize their pain and who are dependent on parent-surrogate models for amelioration. At any rate, the outcome of formalized psychoanalytic/psychotherapeutic training, and the training analysis which accompanies it, is a psychotherapist (hereafter called healer) who can regard his patient comfortably and lovingly, and in such a milieu apply the necessary corrective experiences which lead to cure. My longitudinal observations of the healers of schizophrenia, i.e., psychotherapists of schizophrenia, reveal that, to the contrary of this almost universal belief, there may be a “burning out” or disillusioning process with therapeutic maturation and aging which seriously diminishes positive regard and often reduces it to zero.

Healers of schizophrenia are the most heuristic exemplars of disillusionment1 possibly because of the dramatic and intense nature of their work. Treating schizophrenia is not so much an objective process, or even an artistic one, as an interpersonal one of great emotional moment. Objectivity or artistry could never provide the motor for the long years of intensive preoccupation required. The healers serve here as the raw data of the wider concept of the motivational curve of all people who undertake to heal, and the application of healing energy to others. Healing schizophreni