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Thomas Freeman, M.D., is a member of the British Psycho-Analytical Society and a foundation fellow of the Royal College of Psychiatrists. He was for many years a general psychiatrist in various mental institutions. He was also a practicing psychoanalyst. In a splendid book, Freeman has set forth the justification of the right of the psychoanalyst to treat the major psychiatric disorders. He traces the development of the classic psychoanalytic theories of the major psychoses, basing his argument heavily on Freud's work in this field but not overlooking the pioneering efforts of Abraham and Ferenczi.
Why has it become necessary to plead the clinical right of the classical psychoanalyst? In recent years many have become alarmed because the growth of psychopharmacology and biological psychiatry has overshadowed the psychoanalytic insights to psychiatric patients, especially those with the major disorders. This has occurred despite the way psychoanalytic conceptualization and therapeutic zeal have enlarged the clinical field.
It has long been recognized that individuals with a psychosis are unwilling or unable to share their innermost feelings and thoughts and that this resistance takes uncertain and delusional forms. Often patients attribute their other thoughts to the therapist, and the search for the unconscious roots is obstructed by an absence of a therapeutic alliance between the patient and the patient's own thoughts.
In the last two decades descriptive studies of the psychoses have been marred by the use of drugs, particularly in a long-lasting form. This is because drugs render it difficult to determine whether, for example, a catatonic sign or delusion has disappeared. This need not be so if the drug is employed under the supervision of an understanding analyst, nurse, or even family member. It has been apparent in studying the drug-treated psychotic patients that the so-called positive symptom has often been dispelled, but the drug has proven powerless against th