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The value of psychoanalysis in the treatment of the psycho-neuroses has been definitely established. Its rôle in the therapy of the psychoses, however, is still questionable. Some claim that it can be used in every psychiatric condition without fear. Others believe that it might be harmful in certain types of cases. Freud stated that the narcissistic neuroses were not responsive to psychoanalysis. Kirby1 thought that it might be detrimental to some patients of the narcissistic group. Hinsie2 observed that the literature gave the impression that psychoanalysis had a poor influence in the management of schizophrenic patients. However, he found only two case reports dealing with this matter. Kessel and Hyman3,4 in a general review of the value of psychoanalysis found it to be ineffectual in the major psychoses. However, Coriat, Brill and Alexander considered it to be suitable for some psychotics. Brill5 affirmed, “It is absurd to say that anything done by a psychoanalyst can do harm.” Alexander6 stated, “Psychotic reactions to the analytic approach are not an unfavorable sign because they show that the course of the psychosis can be influenced by psychologic influences.”
In the following case, after extensive psychoanalysis, the symptoms of the patient not only failed to subside but became markedly aggravated as evidenced by the patient's committing homicide and later developing a psychosis. The anamnesis of the patient was obtained by both thorough social service investigation and interviews with the patient before, during and after his psychosis. The patient had a superior intelligence, was markedly cooperative and did not attempt to gain any personal advantage thereby. His data is therefore considered to be trustworthy.