Psychoanalysis of Schizophrenia: A Successful Outcome Presenter: Michael Robbins, M.D. January 20, 1994 Joyce Lerner, C.S.W.

Michael Robbins presented a detailed case study of a course of psychoanalytic psychotherapy with a schizophrenic patient. The report included a history of the patient from childhood, family dynamics, parental attributes and behaviors, and the difficulties that brought the patient under his care. She received therapy from Robbins, both in the hospital and as an outpatient, between the ages of nineteen and twenty-five. Adjunctive pharmacotherapy was incorporated into her treatment.

Robbins, author of Experiences of Schizophrenia (1993: Guilford, New York), prefaced his presentation by reminding the audience of the interpenetration of organic and environmental factors in the etiology of schizophrenia. He noted that identical twin studies cast doubt on the thesis that schizophrenia is solely organic. Experience can modify an organic disposition to develop the disorder. Furthermore, the fact that analytic therapy of a schizophrenic patient can be successful provides additional evidence that more than organic considerations deserve to be included in discussions of the etiology and history of schizophrenia. Nevertheless, Robbins emphasized, failures are also common in these treatments. Determinations of success and failure, he said, depend significantly on how the goals of treatment are described. A core vulnerability to schizophrenia in certain individuals seems evident, but this vulnerability is lessened or strengthened by environmental factors. In this connection, for example, parents may either exploit or compensate for their child's disorder. Varying degrees of denial by parents of a child's schizophrenia are commonplace.

In the discussion, ably moderated by Joyce Lerner, members of the audience said that the clinical presentation was unusual in its thoughtfulness, respect for the patient, and in the quality of rapport that this exceptional therapist demonstrated.