You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Frieda Fromm-Reichmann used to tell the story of a hospitalized schizophrenic patient who told her at their initial contact: “I will be a good patient and I will do what you want me to do and talk about whatever I am supposed to talk about. There is only one condition: you must promise me that you will not take away my hallucinations and delusions.” The patient made it clear that she considered her “psychotic core” to be her identity. She greatly feared being deprived of it. Her pledge to be a good patient and to be cooperative was based on her plea not to be coerced in the direction of accepting the outside world's concept of reality.
The definition of freedom differs according to the situational context and the position of the observer. Freedom usually means the ability to make choices. Under certain conditions the choices are very limited. For a person who is in jail, the one and only freedom is to get out of jail. For all practical purposes, this is a one-way street. The situation is a great deal more complicated once the person is no longer in jail. Once one is outside, freedom compels a person to avail himself of a number of options. The schizophrenic person may fear the need to make decisions and feels more secure “in jail,” that is, in a world of highly curtailed personal freedom.
Schizophrenic disorders have been traditionally looked upon as narcissistic manifestations. Freud distinguished between a transference and a narcissistic form of neurosis. The former is characterized by the capacity to form a constructive relationship, while the latter indicates a degree of ego weakness which precludes the development of a durable therapeutic alliance. In Freud's theoretical scheme, the schizophrenic patient is imprisoned within the primary process while his transferential potential is crippled.
It was Sullivan who recognized first that overt phenomena were misleading in that respect. He demonstrated convincingly that the schizophrenic patient has an excessive transfe