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This paper is an attempt to summarize some of the most important problems I have encountered in a 20-year-old psychotherapeutic experience with schizophrenic patients.
According to modern interpretation, schizophrenia is a disease resulting from the interplay of biological and psychodynamic factors. The former lays down those childhood reactions which form the inner world and determine social reactions. The latter consists of the ongoing psychogenic experience, based on information from outside, and which organises those underlying psychobiological structures which process them. This working hypothesis is the main basis of my presentation. Of course, I cannot unfold the complex problem of psychotherapy of schizophrenia in the tremendously wide range of modern psychiatry, which includes group therapy, family therapy, community therapy, therapy in a hospital setting, and rehabilitation. Within this paper I shall try to reach the roots of the problem by confining myself to one topic alone. This will be, according to my major personal experience, that of individual therapy. Do not think that individual therapy is an old-fashioned approach because it can help only a few patients. It is crucial in that it gives us insight into the structure of schizophrenia and enables us to conceive of a philosophy of treatment outside of individual psychotherapy. I shall begin with some basic considerations.
Today even biologically oriented colleagues no longer ignore the fact that it is hardly possible to reduce schizophrenic illness to the findings of elementary biology alone. A biologically oriented psychiatrist like Weitbrecht thinks, for instance, that schizophrenia cannot be explained by Huber's theory of energetic-potential loss because the psychotic disturbance takes place on a very high ego level, having to do with the most complex inner life of the patient. At best, only from a very differentiated point of view could psychobiology come into question, wherein it would concern its