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D. W. Winnicott once stated that theory was his only companion while he was treating children; otherwise he was alone with them. Participation in a workshop forced me to examine who and what are my own internal companions when I work with schizophrenics. I discovered many inhabitants of my milieu interieur, some shareable publicly, others not. To my surprise, many of these special companions are questions.
First, who are “schizophrenics”? In one week, my mail contained a series of articles which indicated that the problem of diagnosis of schizophrenia is alive, pressing, and unresolved. Seymour Kety presented his group's research into the hereditary transmission of schizophrenic disorders in adoptive children, their natural and adoptive families, and controls, and concluded — in rebuttal to Thomas Szasz, who calls mental illness a “myth” — that if schizophrenia is a myth, it is a myth with a significant genetic component. A cross-cultural evaluation of Schneider's first-rank symptoms of schizophrenia and a review of Bleuler's major and minor criteria in schizophrenia revealed significant differences between these scales. An article cited problems in differentiating schizophrenia from manic-depressive psychosis when making a diagnosis and pointed out the therapeutic importance of distinguishing the two. A letter indicated that many adults diagnosed as schizophrenics are really adult hyperkinetics who respond better to Tofranil than to phenothiazines. Another letter noted the changes in subtype diagnosis of schizophrenia from 1920 to 1966 in a general psychiatric hospital: a decline of hebephrenic type, relative constancy of paranoid type, and great increase in chronic and undifferentiated types.
Certain concepts and definitions are of particular importance to me in regard to “schizophrenics”: H.S. Sullivan's statement that “we are all more simply human than otherwise”; L. B. Hill's comment that “money, power and the love of women are not the goals of the schizophrenic”