The History of the Psychoanalytic Treatment of Schizophrenia

Psychoanalysis is now approximately 100 years old. In 1893 Breuer and Freud published their article on the application of the psychoanalytic method to patients with hysteria. At first, psychoanalysis, as a treatment method, limited itself to ambulatory patients. Freud and the pioneers of psychoanalysis considered their patients to be “psychoneurotic.” As we look back at the early case descriptions, we realize that not all of their patients would be capable of a “classical” psychoanalytical therapy—as we understand this treatment today. Breuer's patient, “Anna O.,” and many of Freud's famous cases, including Dora and the “Wolf Man,” would be considered “borderline” by Kernberg's criteria, set forth in 1967 in his article entitled “Borderline Personality Organization.” These borderline (and in any case, very fragile) patients would not be ideal choices for classical psychoanalysis (e.g., using the couch, meeting four or five times a week). But the pioneers of psychoanalysis had no way of knowing at first just which patients were treatable by the analytic method, and which ones would require special changes from the standard technic. I use the word “standard” here with the awareness that it took some years before a standard or orthodox technic could take shape and be accepted by the majority of practicing analysts. These special changes—departures from standard technic—would later on be called parameters. But at the turn of the century, Freud and his early followers were still “finding their way.” They were discovering through trial and error how best to treat the various types of patients that they worked with.

In the very early years of the 20th century, a few psychoanalysts attempted to apply the analytic method to patients who were psychotic. Most often these patients were diagnosed as cases of dementia praecox. This had be Kraepelin's term (borrowed from Benedict Morel's demence precoce of the 1860's) for the condition that would soon thereafter be called schizophr