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IJP 26:179-180 (1945)

'The Psychoanalysis of Psychoses.': Paul Federn. Psychiatric Quarterly, 1943, Vol. VII, Nos. 1, 2 and 3, pp. 3–19; 246–257; 470–487.

Author: E. Grotijahn

Abstract

This paper is a résumé of the author's many years of experience with psychotic patients, interwoven with discussions of psycho-analytic, metapsychological and biological considerations, advice about technical procedures and quotations of remarks made by Sigmund Freud.

1Errors and their Avoidance. In psychotic or post-psychotic schizophrenic patients, an anamnesis should not be taken. When post-psychotic patients are forced to remember psychotic episodes, they often relapse. No psycho-analysis of psychotic patients can be carried through without the skilful assistance of someone who is ready to love the patient no matter how demanding he is. A mother, sister, brother, or nurse are acceptable; father or even a wife are less good. One condition of the treatment of psychotics is an aid in settling the sexual problem. The method of free association encourages a manic flight of thoughts and may easily lead to depressions by making feelings of guilt conscious. An immediate interruption of free association is recommended as the best strategy during slight psychotic periods, which seem to be unavoidable at times. From his observation of the terminal states of severe hysterias, the author was able to distinguish three different outcomes: sublimation, narcissistic organic disease, a severe climacteric or senile melancholia with final recovery leading to the 'post-psychotic evening of life'. The author is convinced that the success of shock therapy is due to the mental impression made by the treatment (or maltreatment) and to the amnesia established.
2Transference. In the treatment of the transference neuroses and psychoses the economic, topographical and dynamic conceptions are the same—the difference lies in the handling of the resistance and transference. To put it as an antithesis: 'In neuroses, we want to lift repression; in psychoses, to create re-repression.' Freud once said to the author: 'Psychotics are a nuisance to psycho-analysis'—his argument being tha

IJP 26:179-180 (1945)

'The Psychoanalysis of Psychoses.': Paul Federn. Psychiatric Quarterly, 1943, Vol. VII, Nos. 1, 2 and 3, pp. 3–19; 246–257; 470–487.

Author: E. Grotijahn

Abstract

1Errors and their Avoidance. In psychotic or post-psychotic schizophrenic patients, an anamnesis should not be taken. When post-psychotic patients are forced to remember psychotic episodes, they often relapse. No psycho-analysis of psychotic patients can be carried through without the skilful assistance of someone who is ready to love the patient no matter how demanding he is. A mother, sister, brother, or nurse are acceptable; father or even a wife are less good. One condition of the treatment of psychotics is an aid in settling the sexual problem. The method of free association encourages a manic flight of thoughts and may easily lead to depressions by making feelings of guilt conscious. An immediate interruption of free association is recommended as the best strategy during slight psychotic periods, which seem to be unavoidable at times. From his observation of the terminal states of severe hysterias, the author was able to distinguish three different outcomes: sublimation, narcissistic organic disease, a severe climacteric or senile melancholia with final recovery leading to the 'post-psychotic evening of life'. The author is convinced that the success of shock therapy is due to the mental impression made by the treatment (or maltreatment) and to the amnesia established.
2Transference. In the treatment of the transference neuroses and psychoses the economic, topographical and dynamic conceptions are the same—the difference lies in the handling of the resistance and transference. To put it as an antithesis: 'In neuroses, we want to lift repression; in psychoses, to create re-repression.' Freud once said to the author: 'Psychotics are a nuisance to psycho-analysis'—his argument being tha