You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
A psychoanalytic approach to the theory and treatment of psychosis has been discussed in the literature since Freud's early writings. In “Further Remarks on the Neuro-Psychosis of Defence” (1896) Freud reported a case of chronic paranoia. At that time, before the development of an instinct theory, he described paranoia as proceeding from the repression of distressing memories, and the symptoms were determined in their form by the content of what had been repressed. These ideas were later modified by Freud especially with the introduction of instinct theory.
Freud was basically pessimistic about the treatment of psychosis. He wrote in 1905: “Psychosis, states of confusion and deeply rooted depression therefore are not suited for psychoanalysis; at least not for the method as it has been practiced up to the present” (p. 264).
In 1916-17, he also advised against treatment of the psychosis. “The narcissistic neuroses can scarcely be attacked with a technique that has served us with the transference neurosis…. What always happens with them is that, after proceeding for a short distance, we come up against a wall which brings us to a stop…. In the narcissistic neuroses the resistance is unconquerable” (p. 423).
Later (1933, 1937, 1940), Freud continued to advise against psychoanalytic treatment in the narcissistic neuroses. He believed that with