Treatment Failures and “Untreatable” Patients

In the total PRP population of 42, 11 of the cases (just over 25%) were adjudged overall to be failed cases—6 of the 22 who started in psychoanalysis and 5 of the 20 who started in psychotherapy; 7 of the 21 men and 4 of the 21 women. As

has been emphasized throughout this book, this finding must be viewed within the context of the “sicker than usual” patients taken into intensive psychotherapy and psychoanalysis at The Menninger Foundation, and of the “heroic indications” for such treatments, for which the psychoanalytic sanatorium has seemed to provide the logical locus of trial and of application. These 11 failed cases therefore included 8 of the 15 severely alcoholic PRP patients, 4 of the 8 severely drugaddicted patients, and 8 of the 14 significantly paranoid patients. This group of alcoholic, drug-addicted, and/or paranoid patients, as might be expected, clustered together among those who developed psychotic transference reactions; the 11 failed cases included 7 of the 12 who developed this psychotically regressive transference response (in 9 instances within psychoanalysis and in 3 instances within psychotherapy). In addition to the 7 whose treatment failures took place within the context of a psychotic transference unfolding, 3 others were in the group of 4 adjudged to be essentially untreatable within any available or known psychotherapeutic approach.1 The 11th failure, who neither developed an unfolding transference psychosis nor was considered inherently untreatable, was the extraordinarily difficult Sociopath whose whole treatment plan (which he successfully manipulated) was totally inadequate to his treatment needs. Perhaps he should have been declared among the “untreatables.”

Deaths from Mental-Illness-Related Causes

General Comments

Among these 11 treatment failures, it has been repeatedly mentioned that six (one-seventh of the entire sample of 42) died of mental-illness-related causes either while still in treatmen