Two Avenues of Approach to the Schizophrenic Patient1

While psychoanalysis was invoked very early in its history for the understanding of psychoses, its therapeutic application to these disorders was thought impracticable because of the psychotic's narcissistic incapacity for transference. However, since Abraham (1), who originally shared this attitude toward schizophrenia (1908), published his work on the manic-depressive psychosis (2), efforts to psychoanalyze psychotics, especially schizophrenics, have become increasingly frequent. A considerable group of writings on this subject deals with these efforts in relation to schizophrenics, or (more often) with less strictly defined psychotherapies in which psychoanalytic ideas play an important part. (See 13), (14), (4), (19) as examples of early and recent reviews.) It merits special statement that Abraham himself, in 1916 (3), mentioned the analysis of a case of schizophrenia simplex.

Thus the first obstacle to be overcome was the inhibiting pessimism regarding therapeutic contact with schizophrenics; soon thereafter came the published demonstration of actual and effective transference relationships with a certain number of schizophrenic patients. However, the apparent mastery of the "sine qua non" in certain cases left us with other no less formidable problems: Can such relationships be established with large numbers of severe cases, and if so, how? What are the essential nature, meaning, and remote effects of these relationships? Finally, do we have sufficient data with which to establish