The Analysis of Psychotics1

When dealing with the endogenic psychoses, it is quite unjustifiable for us to confine our efforts to diagnosis and prognosis; nor is it enough, simply because the disease is conditioned by endogenic factors, to see to it that the patient is placed under care and remedies suggested by the symptoms are applied, thereafter letting the morbid process take its course while we observe it with psychological and clinical interest. Appropriate treatment on both physical and psychic lines may have a favourable influence upon the case, both in respect of the severity of the particular attack and the course it follows and of the onset and duration of completely or relatively normal periods and the patient's attitude towards reality at such times. It is probable that such treatment may even affect the degree in which he approaches to normality.

A number of psychiatrists, notably Aschner, have revived the methods of an earlier date in medicine; but, as Aschner himself observes, such success as can be achieved thereby is possible only when the attitude and behaviour towards the patient of those with whom he is in contact are psychologically sound.

With psychotics as with children the result of a psycho-analysis depends so largely upon the helpfulness of their environment that, if the rest of his family dislike a psychotic patient, the treatment is as much hampered by this exogenic factor as it may be on the endogenic side by the severity of the disease. In no single case have I succeeded without the steady co-operation of his family or of someone in their place. When we remember, however, that others besides psycho-analysts aim at achieving proper care for such patients within their family circle, it is clear that our duty is to perfect our technique for the analysis of the psychoses, so that it may always be available where the environment is suitable. An important desideratum is the psycho-analytical training of nurses and attendants.2