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Review
. Spring 2003;31(1):89-118.
doi: 10.1521/jaap.31.1.89.21931.

The Tragedy of Schizophrenia Without Psychotherapy

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Review

The Tragedy of Schizophrenia Without Psychotherapy

Bertram P Karon. J Am Acad Psychoanal Dyn Psychiatry. .

Abstract

No one who read Frieda Fromm-Reichmann's "Transference Problems in Schizophrenia" could reasonably think about persons with schizophrenia in the same way as before. Her writings made clear that schizophrenia is a human experience with meaning, meaning that is hard to uncover, but it only takes patience, kindness, a tolerance for not understanding as well as for the patient's desperate defenses, and a willingness to understand the human condition at its most painful and to take psychoanalytic ideas seriously when patients talk about them. Understanding persons with schizophrenia means facing facts about ourselves, our families, and our society that we do not want to know, or to know again (in the case of repressed feelings and experiences). Families and professionals are settling for treatments that aim at making the patient a lifelong cripple who is not too disturbing. Psychoeducational programs, which potentially could be helpful, usually give false information which makes worse the burdens of both patients and their families. The ultimate genetic experiment, the Nazi sterilization and annihilation of patients, led to no decrease in schizophrenia in the next generation. Long-term follow-up studies show one third of schizophrenics fully recover within 25 years and another third have social recoveries with or without treatment--and psychological treatments before the neuroleptic era, from "moral treatment" to psychoanalytic therapies, produced superior results, but we are not using them. The central role of terror in producing symptoms and the genesis and psychotherapeutic handling of symptoms, including delusions and hallucinations, will be described.

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