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The history of psychiatry during the last two decades has shown a significant development in the widespread and almost general acceptance of physical methods in the treatment of psychoses. Only a comparatively small group of psychiatrists and psycho-analysts still believe that psychotherapy should be the method of choice, particularly with patients suffering from schizophrenia. At first glance the disagreement between these two schools of thought may appear to be less extensive than it really is, since many therapists recommend a combination of both methods. Particularly do those schools which pride themselves on their eclectic approach emphasize the necessity of psycho-therapy before, during, or after the application of physical treatment. I have always felt this advice to be somewhat indicative of the gulf which separates the two approaches.
Although the eclectics are specific in their teachings as to the choice and technique of physical treatment methods, they are unspecific and vague in regard to the psychotherapy that is to be combined with surgery, electricity or injections. In the literature of the eclectics psychotherapy appears either as a deus ex machina which will take care of whatever the physical treatment has not accomplished, or else as an adjunct to enhance the therapeutic efficiency of one of the physical treatment methods. Any deliberation as to what the physical side of the treatment can effect as compared with the added psychotherapy, how both methods work together, which technique of psychotherapy ought to be used under what circumstances and at what time, has escaped my attention when perusing eclectic literature.
This raises the suspicion that psychotherapy has often no precise place in the thinking of those who recommend it.
But when we turn to those who are sympathetic to the psychotherapy of schizophrenics, or who even believe it to be the only proper method of treatment, we may often feel disappointed at finding neither a precise statem