Discussion of Harold F. Searles, Jean M. Bisco, Gilles Coutu, and Richard C. Scibetta's Article, Violence in Schizophrenia

I have been struggling to put together some reasoned and coherent discussion of this prodigious paper, and have finally had to put aside the idea of anything but broadly “associating” to it.

Two contradictory strands seem to run through the paper: one, the intensity and totality of the undifferentiated state shown in the various patients described; and the other, Searles's insistence on the rigidity and vindictiveness of the superego in each case—a phenomenon which argues at least some degree of differentiation.

The paradox of this seems to me the crux of the matter. Tenderness is vitally necessary somewhere (whether in therapist, relative, or patient), yet it is simultaneously life-destroying, violence (murder) being the equally essential alternative, as vitally necessary in the therapist as it is in the patient himself.

This has to do with the problem of containing the violence. The strength of the container must be at least equal to that which is to be contained.

The patients described show this in quite markedly different degrees—Mr. Delaney's violence being to all intents and purposes uncontainable; Mrs. Glaser's being containable in the measure that it could be first repressed, or dissociated, then that the repression or dissociation could be undone. In my view, this is of both diagnostic and prognostic significance. I have come across a number of people, in treatment situations and elsewhere, where schizophrenia was masked by a defensive use of psychopathy: when the psychopath broke down under stress a schizophrenic appeared. I would regard Mr. Delaney as an example of this, whereas Mrs. Glaser could almost be considered a “major hysteric.”

Outside of psychiatry, a beautiful picture of this is shown in Ibsen's Peer Gynt. At the start of the play Peer is portrayed as

a psychopath, consistently hostile to his mother, Åase. When she dies and he is driven out from the community, what reality sense he had is lost, and throughout the rest of his life he alternates bet