A Holistic (Horney) Approach to the Psychoses: The Schizophrenias: Part II the Psychodynamics of Clinical Symptoms

Statistically, the greatest incidence of the schizophrenias occurs during the third decade, although the peak of onset seems to be moving toward adolescence. Of course, it does occur and recur later than this period, although less often. The adult schizophrenias are, like the neuroses, the product of dynamic emotional forces acting along two axes: the longitudinal, involving maturational growth from infancy to senescence, and the horizontal, involving the interplay of emotional experiences in the immediate present. The clinical picture is analagous to a flowing pond, into which stones are thrown. The ripples from each stone will not overflow the banks provided the size and impact is not too great (the horizontal-emotional stress), and also provided the water level supplied by the inflowing and outflowing streams is not too high (the vertical-growth process). At this time, although maturational processes are continuing (body image, self-concept and identity formation), they are less rapid, intense and blatant since physical growth is slower and therefore there is less of a threat to the self in their change. The functional personality or actual self—the sum of personality traits, attitudes towards others and towards one's self, needs, standards, values, conflicts and main solutions—is relatively established and fairly consistent. Some of these traits are expressed, some repressed, some idealized, some despised, so as to give the greatest possible feeling of inner unity.

To explain such dynamic organization in the schizophrenias as compared to the neuroses, it is helpful to examine the basic common dynamic features of all these psychoses, regardless of their symptomatic type or form. These do not correspond to the standard psychiatric symptoms since they are not simply descriptive nor necessarily expressed as such in behavior. Rather, they underly and produce the classical symptoms. It is their variation in expression which accounts for the forms of