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Vamik Volkan welcomed everyone with a brief overview of the beleaguered state of analytic treatment of schizophrenia. The panelists presented their findings and their experiences to the contrary.
Jorge Tizón presented his paper ‘Psychoanalytical therapies of the schizophrenic patients: Is it necessary to reconsider today their objectives and theory?’ He emphasized the need for a unified psychoanalytic theory of schizophrenia, taking biological, psychological and social factors into consideration. Dr Tizón contended that a relational point is necessary and, in this context, the ‘negative symptoms’ such as autism are more significant than the ‘positive symptoms’, e.g. hallucinations. A particular type of object relatedness, the ‘symbiotic-adhesive relationship’, is characteristic and has important implications for treatment goals.
In Tizón's ‘special psychopathology’, psychotic defenses against catastrophic anxiety are the ego's desperate attempt to stabilize an utterly chaotic inner world. An inability to overcome symbiosis may manifest itself in a fluctuation between pseudo-independence and pseudo-dependency as well as a host of prodromal conditions, such as negativism, impulse disorders, hyperactivity, severe phobias, obsessive disorders etc. The experience of the ‘body self’ is profoundly disturbed; somatic and hypochondrical delusions as well as bizarre polymorphous sexuality may be quite prevalent. There is a predominance of projection over introjection with routine regression to the paranoid-schizoid position associated with waves of persecutory anxieties. In order to avert ensuing mental confusion and disintegration, splitting and projective identification are employed to provide some semblance of differentiation of the self.
Dr Tizón considers the importance of early micro-injuries or neurodevelopmental alterations in, for example, the PDL (pre-frontal dorso-lateral) cortex, the cortex-thalamic connections, the limbic system and the cortex-cerebellum connections