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Psychoanalysis, although it has contributed a more fundamental approach to the neuroses, owing to various factors, has remained relatively unfruitful in the psychoses. There are at least two main reasons for this: one, inherent in the psychoanalytic theory, is the concept of narcissistic neuroses, and transference neuroses; the other, mentioned by Freud, was the unavailability of psychotic material to the earlier analysts. It was with some notable exceptions almost impossible for psychoanalysts to work in institutions. The division into the transference and the narcissistic neuroses, theoretically valid, seems to me, owing to the malignant connotation of the term, "narcissistic", to have hampered research in the psychoses.
Freud, 1 from the beginning, has emphasized the obstacles of work with psychotics: "The human being is therefore, on the whole, only accessible to influence, even on the intellectual side, insofar as he is capable of investing objects with libido, and we have good cause to recognize and to fear in the measure of his narcissism, a barrier to his susceptibility to influence, even by the best technique… Experience shows that persons suffering from narcissistic neuroses have not the capacity for transference or only insufficient remnants of it. They produce no transference, and are therefore inaccessible to our efforts, and are not cured by us." These observations seem to have acted as a red flag to many analysts, and have had the effect of delaying or even obstructing therapeutic attempts with psychotic patients.
As early as 1904 Freud 2 maintained "that psychoses, states