Experiences in the Psychoanalytic Treatment of Psychotics

Patients suffering from frank or borderline psychoses show much greater intensity of affect under analytic treatment than do those crippled by neurosis. One would naturally expect this since the forces leading to psychosis are more powerful than those emotions which produce neurosis. So it follows that the relationship between patient and physician during treatment is more tempestuous than that ordinarily experienced in the analysis of the psychoneurotic. In place of the usual rather placid and overtly facile transference phenomena observed in the neurotic, there are on the contrary with the psychotic, profound swings of transference which are in essence similar to those of the neurotic, but so intense and so carefully concealed by a mask of indifference or a hostile suspiciousness that most nonanalytically trained psychiatrists, and many psychiatrists who have had analytic training, believe analysis of psychotic patients is impossible.

Textbooks have emphasized apathy and loss of affect as characteristic of schizophrenia. This is no loss but a mask. The early occurrence in the illness of hostile reactions followed by withdrawal, indifference or suspiciousness lends itself to the superficial appearance of inaccessibility. Much of the evidence that the psychotics are inaccessible comes from therapists who have not recognized that they themselves have engendered hostility with a consequent train of reactions ending in withdrawal and so called negativism. That these patients are not inaccessible has been repeatedly demonstrated by workers who have had the patience and perseverance to follow through and work day after day, week after week and month after month