The Psychotherapy of the Psychoses in Analytic Training

In Writing about the psychotherapeutic treatment of psychoses I am afraid I shall invite criticism from my colleagues for implying that the treatment of psychosis in Germany today does not bear comparison with, nor is it quite up to, international standards; though, admittedly, it is thanks to this comparison that we in Germany have been able to initiate discussion on general psychiatric care. Even so, those who study the conditions of the psychotically ill in Germany base their deliberations in this field largely on a comparison with the progress achieved in the U.S.A., England and the Scandinavian countries. It need hardly be said, therefore, that at all important meetings and congresses held in the Federal Republic, there is a demand for the programme to include papers dealing with the psychotherapeutic treatment of psychoses whenever possible.

To begin with I propose to make a short historical digression, since it is important to sketch in the development which has led to the situation on which our present-day practice is based.

As we now know, the forerunners, or earliest practitioners, of the dynamic approach to psychiatry were the shamans and medicine men of primitive peoples, who treated and cured illness by psychological methods. No branch of science has, however, subsequently undergone so many metamorphoses and been exposed to so many threats as the dynamic approach, especially within psychiatry itself. Always ambivalent, it has been treated at all times like an unloved child. Discoveries made in physics, chemistry and physiology have always gained easier success and recognition. Moreover, dynamic thinking in psychiatry tends to be especially neglected during those periods when the natural sciences are expanding. This can be easily illustrated if we take, by way of a contemporary example, the victorious progress and extended use of psycho-pharmacology, and compare it with the numerous attempts that have been made to win an assured place