History of Psychoanalytic Perspectives on Schizophrenia

spiritual_emergency · 02:51 AM

An article I came across that I thought was quite informative. It offers a number of viewpoints from various clinicians in the field of psychology -- not psychiatry. As a result there is more emphasis on environmental factors that may produce psychosis.

My own thoughts are that psychosis is produced as a result of damage to the egoic structure which cracks, fragments or shatters, typically as a result of environmental pressures. Of the many "schizophrenics" I've spoken with over the past several years there has nearly always been a signicant event prior to the psychotic episode that seriously challenged their sense of self-identity to the extent it produced ego collapse. Trauma also seems to play a significant role in the lives of those who have experienced psychosis.

Quote:

Brief Review of the History of Psychoanalytic Perspectives on Schizophrenia

Freud believed that the illness he named as one of the narcissistic neuroses, schizophrenia, is triggered by a withdrawal of emotional investment in external or internal objects secondary to what we would today call a narcissistic injury. In his view, positive symptoms such as hallucinations and delusions were restitutional, i.e., attempts at self-cure.

Freud saw the core problem as a decathexis of objects (a ‘silent lesion’ if you will, perhaps the psychoanalytic analogue of the ‘silent genetic or prenatal lesion’ identified in current neurodevelopmental theories which interact with later normal brain development to bring about the clinical picture of psychosis) and a hypercathexis of the ego (which is how he explained such phenomena as grandiosity and hypochondriasis).

Freud’s famous comment that a delusion is like a patch applied over the tear between the ego and external world reflects on his viewpoint of symptoms as restitutional, i.e., an attempt to reforge object ties. Freud saw the central conflict as one between the id and the external world in which the latter becomes remodeled to fit the needs of the beleaguered patient.

Federn understood schizophrenia to be a problem of too little narcissistic investment in one’s ego boundaries. Edith Jacobson emphasized the lack of differentiation between self and other. Jung emphasized the importance of the feeling-toned pathogenic complexes and the role of trauma in schizophrenia.

Sullivan understood schizophrenia to be the result of severe and dissociative warping of the personality and self-esteem. Sullivan, as did Melanie Klein, emphasized the role of severe anxiety (what Marvin Hurvich would refer to as annihilation anxiety) and loneliness.

Frieda Fromm-Reichmann stressed the strong conflicts between dependency and hostility.

Melanie Klein emphasized the role of projective identification, schizoid anxiety (a feeling of falling into bits - unintegrated) and the predominance of paranoid-schizoid narcissistic functioning over more integrated depressive anxieties and guilt.

Bion emphasized that we all have psychotic and non-psychotic parts of our personalities. He saw the psychotic person to be under the sway of terror: a fear of being eaten up not just by the therapist or hospital, but by her or himself as well. Bion speculated that the patient is painfully aware of being dependent upon someone outside the self and being all alone at the same time.

Hanna Segal (personal communication) believed that her most significant contribution to psychoanalysis was her concept of the symbolic equation, in which symbol and symbolized become equivalent in the psychotic patient’s mind.

Herbert Rosenfeld emphasized that the psychotic person projects so much of her or himself into the other that there is a paranoid reaction of being colonized and invaded because of pathological projective identification.

Winnicott noted that what we see clinically in psychosis is a defense structure developed around unthinkable, primitive agonies. (Winnicott thought that anxiety was too mild a word for this state).

Elvin Semrad and David Garfield, saw schizophrenia to be the result of ego breakdown triggered by unbearable anxiety and other affects.

Harold Searles emphasized both conflict and deficit and the importance of one’s countertransference in helping the patient to reconstitute a firmer sense of self and identity.

Ping-Nie Pao, as did Margaret Mahler, understood schizophrenia to be reflective of a derailment in separation-individuation with symbiotic deficits. Pao thought that as a result of conflict over separation, sex and aggression, the person experiences organismic panic and a paralysis of integrative ego function, with a pathological reorganization of self which is evident in grandiose and persecutory delusions.

Kohut emphasized building an empathic bridge to shore up a noncohesive and fragmented self. (Parenthetically, towards the end of his life, Kohut reversed his position that psychoanalysis could not be used with persons with schizophrenia and he reported treating patients with paranoid delusions. He saw the latter as a psychologically meaningful way of expressing emotional states).

Lacan viewed schizophrenia as a foreclosure of the key signifier “name-of-the-father.” The latter helps the developing child move beyond imaginary and symbiotic entanglements with the primary caregiver.

Bert Karon underscores the sense of terror in psychosis and

Ann-Louise Silver and Stefanie Glennon emphasize authentic interpersonal engagement.

Gaetano Benedetti and Maurizio Peciccia understand the danger in schizophrenia to always be one of self-loss and that this can occur at the poles of autonomy or relatedness. They see the structural problem in schizophrenia to be a de-integration of the separate and symbiotic selves.

These are a few of the contributions psychoanalysts have made to the field of psychosis psychotherapy. I have, regretfully, left out many of the contributions, friends and colleagues of mine in ISPS (www.isps.org and www.isps-us.org) have made.

Source: Brief Review of the History of Psychoanalytic Perspectives on Schizophrenia

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