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Observing that love is still the principal therapeutic prescription for schizophrenia, Wexler questions its incautious use and remarks that if the mildest reassurance is interpreted by the neurotic as seduction, in the schizophrenic it may be perceived as rape. An abstract of therapeutic sessions with a chronic, hebephrenically deteriorated schizophrenic woman of forty follows. The patient, continuously hospitalized for five years, had not proved amenable to shock treatment nor to psychotherapy. The first ten months of treatment were characterized by much loving attention, and on occasion by interpretations. The only responses were crude sexual overtures, or violent rages and attacks. However, the patient manifested growing interest and the therapist became the central figure in her delusions. Then, partly on the basis of theoretical considerations, Wexler began consistently to side with the patient's moralistic condemnation of sexuality and aggression; from this point on he took a very active part in forbidding sexual and aggressive acts and thoughts. When assaulted he would immobilize her and when the provocations were violent enough, force was met with force. Clinical improvement was striking and rarely did the patient fail to thank the therapist for restraining the overwhelming instinctual forces which had seized control. This patient, whose weird dress, bizarre manners, and assaultive behavior made her a serious management problem in the hospital, improved sufficiently to live in a foster home and travel alone to her appointments, do housework and become interested in a hobby.
Wexler expresses concern that what he has said might be interpreted as an endorsement of acting out by the therapist, and emphasizes, with Winnicott, the inevitable presence of countertransference hate in the treatment of psychotics and the need to convert it into an objective, conscious instrument. He then indicates that his observations are not new but often overlooked. He cit