The Evolution of Psychoanalytic Practice with Psychotic Patients

1917: Thus we discover that we must renounce the idea of trying our plan of cure upon psychotics—renounce it perhaps for ever or perhaps only for the time being, till we have found some other plan better adapted for them.

1938: They manifest no transference and for that reason are inaccessible to our efforts and cannot be cured by us.

From 1917 to 1938 Freud reconfirms that the classical handling used in psychoanalytic cure is not adapted to the treatment of psychotics. Since then, have we found a more satisfying handling method for psychotics?

There have been numerous attempts over the years to deal with this problem, so we can't pretend to cover this subject in just half an hour. The most fruitful attempts have come out of England, around the Tavistock Clinic: for example the anti-psychiatry work of R.D. Laing, Cooper and others. And then in France, after World War II we have institutional psychiatry, where many names can be quoted, such as Diatkine, Lebovici, Racamier, Oury, Tosquelles, etc.

Putting aside these attempts at creating new methods inspired by psychoanalysis, I will concentrate on a more specific subject. How has the actual care of psychotics within a psychoanalytic cure modified the psychoanalytic method itself?

Here I would like to make it clear that I am not talking about the evolution of the actual theory of psychoanalysis. In fact, since psychoanalytic reflection on psychoses is forever present, right from the beginning in the work of Freud himself, the actual psychotic dimension has had a continuous impact on the notions of theory (splitting, projection, etc.) and on meta-psychological concepts (second topography, death wish in particular).

I will concentrate rather on the actual method of the cure psychoanalysts have been using on psychotic patients, ignoring Freud's scepticism in this field.