Note on the Psychopathology of Confusional States in Chronic Schizophernias1

During the last ten years I have been treating by psycho-analysis a number of schizophrenics, some of very long standing. My aim was not only to achieve a therapeutic result, but to find out more about the psychopathology of this disease group. To achieve this aim I adhered to the regular analytic situation and deviated as little as possible from the established technique employed in treating neurotics, because I felt, and still feel, that only thus may it be possible to increase our knowledge of the psychopathology of schizophrenia.

This paper deals with the psychopathology of confusional states which I was able to investigate during the analyses of chronic schizophrenic patients. Feelings of confusion are part of normal development2 and they are a common feature in many pathological conditions. But in the schizophrenic process severe states of confusion seem to play an important part; I also noticed that following the confusional state there was either an improvement or a deterioration in the condition of my patients.

I shall use material from one chronic paranoid schizophrenic patient to illustrate my points. He is a painter, forty years of age (in 1948), and a manifest homosexual.3 From 1933, he gradually developed delusions of reference and persecution. In 1946 he started psycho-analytical treatment with a male colleague, and soon felt much better. After three months sudden changes took place in his condition. He stopped treatment, and soon afterwards began to act as if he were a young homosexual prostitute. Sometimes he made himself and others believe that he was a landworker. He tried to eliminate the fact that he was a painter completely from his memory and personality. When he later started to hear voices, they discussed among other things his age and his different selves, particularly whether he was a prostitute or a painter. His voices and his confusion between reality and phantasy became so bad that in summer 1947 he had to go