The Mechanisms of Isolation in Neurosis and their Relation to Schizophrenia1

We know that the term schizophrenia is used to include a whole array of clinical cases, often differing widely from one another, whose pathogenesis remains obscure in spite of the many theories which have already been put forward on the subject. We know, further, that all these morbid states are characterized by a greater or lesser dissociation of the subject's psychic activity, accompanied by auditory, visual or sensory hallucinations or by incoherence in speech [ Wortsalat ] or symptoms of mental automatism. There is no need for me to give a detailed clinical description of schizophrenia: we are familiar with it through the writings of Bleuler and his school. My intention in this paper is rather to put before you the various psycho-analytical notions which may at any rate throw more light on certain aspects of these pathological states and suggest new aims and methods for a therapeutic technique in such cases. But before turning to the real subject of this paper we must bear in mind that psycho-analysis cannot attempt to deal with anything but psychogenic symptoms. This fact narrows the field of our investigation considerably, for we have every reason to suppose that certain schizophrenic conditions are connected with the problems of heredity and possibly even of infective diseases. All these questions, unfortunately, we must leave on one side; we cannot enter on a discussion either of heredity2 or infective disease and of their influence in the development of schizophrenia. We must content ourselves with attacking such problems as come within the scope of our knowledge and, in particular, of our psycho-analytical knowledge.

We are all familiar with Freud's work on the case of Schreber (published in 1911). In it Freud touches on all the important questions which confront the investigator who endeavours by means of psycho-analytical theory to discover the source of schizophrenia. Freud's aim is to shew how Schreber's dissociation may have been conditioned