Discussion of Roberto Quartesan's Paper

In this evocative, sensitive report of work with Ms A in Perugia, Italy, Roberto Quartesan shows the effectiveness of psychological interventions in the treatment of a schizophrenic woman in conjunction with pharmacologic and rehabilitative strategies. This integration reflects a broadly psychoanalytic approach, one distinguished not by use of the couch, but instead by use of the therapist and his understanding of unconscious process, dynamic motivation, defensive and adaptive function, and the reciprocal influence of transference and countertransference. Moreover, in describing the changes in the transference position of Ms A, Dr Quartesan demonstrates that the centerpiece of an analytically informed treatment of a schizophrenic person is in fact the analytic work, not only the way it edifies the treatment team, or provides a theoretical basis for a multi-modal approach.

Dr Quartesan's method was based in large part on his careful study of the delivery of care at Chestnut Lodge Hospital in Rockville, Maryland. He visited the hospital frequently in the 1980s and 1990s, often staying for prolonged periods. David Feinsilver's (1986) model for comprehensive treatment, itself developed at Chestnut Lodge, was a particular inspiration to Dr Quartesan. The current report of Dr Quartesan comes at a time when the place of psychodynamic therapies in the treatment of schizophrenia is newly being debated. The debate, however, has suffered from a failure to recognize changes in analytic theory and technique, and misunderstanding about what it means to apply psychoanalytic principles in the treatment of severely disturbed patients. Even before more recent understanding of biological aspects of the illness, analytically trained colleagues questioned whether analysis alone could cure schizophrenia. Sigmund Freud said, in the case of Paul Schreber, that analysis would not succeed with paranoid patients because they did not cathect others, including of course therapists, and this inte