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May 9, 2001. Martin Willick's “Psychoanalysis and Schizophrenia: A Cautionary Tale” ( J. Amer. Psychoanal. Assn. 49/1) typifies what I consider a very dangerous trend in current psychoanalytic thinking. Willick rejects all psychoanalytic theories of schizophrenia and all psychoanalytic evidence about the etiology of schizophrenia because, he claims, “The neurobiological research of the past twenty-five years offers compelling evidence that the etiology of schizophrenia is, to put it succinctly, biological rather than psychogenic” (p. 29). He then suggests that the same may prove to be true for borderline personality disorder as well. I disagree. There is no scientific or psychoanalytic evidence whatsoever to support this kind of either/or dichotomizing—considering some symptoms psychogenic and others biological.
I first became aware that analysts had begun to think this way approximately ten years ago, when I attended a discussion group on “analytic process in patients treated with antidepressant medication” at a Fall Meeting of the American. I was astonished at how many colleagues there—young and old alike—were accepting without question that major depression is a brain disease having nothing to do with inner conflict and impervious to psychoanalytic treatment. In fact, out of fifty or so analysts in the group, I was the only one who clearly and coherently objected to this view. I argued that even the most profoundly “biological” depression must necessarily happen within a psychological context and must be understood, like any other symptom, in terms of inner conflict. Before that meeting I had assumed that all psychoanalysts shared this view. Since then I have come to realize that our psychoanalytic understanding of human nature is being severely eroded by the materialistic prejudice of biological psychiatry. As Willick's article vividly illustrates, we are so impressed and/or intimidated by the claims of Big Science that we are ready to abandon the hard-won insight