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Fisher and Greenberg (1985) pointed out the scarcity of the clinical data Freud published to support his psychoanalytic conclusions. Freud's data on psychotic patients are especially sparse. A review of the entire corpus of his publications by Brody (1970), considering only patients actually treated by Freud, showed one case of paranoia among 12 “major” cases (those with at least several pages of description and a statement of the analysand's life circumstances) and 10 cases of psychosis (none after 1924) among the other 133 cases. Although the Schreber case (Freud, 1911) presented a development of Freud's theoretical concepts concerning the psychoses, it did not, of course, include any direct clinical involvement by Freud.
Freud did not advocate psychoanalytic treatment for psychotic patients. Each time he addressed this question in his technical writings, he recommended against taking these patients into analysis (1904a; 1904b; 1913; 1917a; 1933; 1940). None of these writings include any reference to any of Freud's own experiences in attempting analysis with psychotic patients.
In 1913 Freud wrote that the psychoanalyst “cannot fulfill his promise of cure if the patient is suffering, not from hysteria or obsessional neurosis, but from paraphrenia, and he therefore has particularly strong motives for avoiding mistakes in diagnosis” (pp. 124-125).
In theoretical terms, Freud speculated in his 1914 paper “On Narcissism: An Introduction” that the psychotic patient was untreatable by psychoanalysis because “He seems really to have withdrawn his libido from people and things in the external world, without replacing them by others in phantasy” (p. 74).
A review of the McLean Hospital case record, interviews with subsequent treating psychiatrists (Lynn, 1990a, 1990b), Freud's brief 1927 discussion and his published correspondence with