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To the Editors: I am grateful to Dr. Schrut for his letter. It has indicated that my presentation did not sufficiently clarify certain points and gives me the opportunity to rectify aspects of that deficiency.
Dr. Schrut makes four points: 1. The Forum's format enables readers to learn more from the author's paper and the ensuing discussion than he could from the former alone. 2. The use of the couch is not essential for the patient to gain insight, be he neurotic or psychotic. 3. Schizophrenic patients need to develop a symbiotic relationship with a therapist in order to help them undo the effects of early deprivation of meaningful interrelationships with a human being and they will benefit by modification of “the introject” whether they go beyond that point or not. 4. Most schizophrenic patients require a more human experience than is afforded by psychoanalysis including use of the couch.
The fact that Dr. Schrut's letter does not seem to validate his first point, insofar as its application to my presentation is concerned, indicates that I should have spelled out more clearly the reason for my study.
The purpose of the controlled observation was to test empirically Freud's dictum, first enunciated unequivocally perhaps in 1908, that psychoanalysis is contraindicated for the treatment of psychotics. In 1911, arguing from the position of the topographical theory, Freud stated that psychoanalysis could not be used because such patients are incapable of developing transference. That argument has long since been discredited and was by Freud. Yet, although he undertook the analysis of psychotics subsequent to 1908 and as recently as the late 20's or early 30's, he seems never to have retracted his 1908 position in writing. My report indicates that position to have been erroneous.
So far as I am aware, this issue was not at stake. Nevertheless, the position of analysts in general is that proper use of the couch enhances the development of deeper and more effective insight