The Ego Structure and the Self-Identity of the Schizophrenic Human and the Task of Psychoanalysis
(1998)
Therapeutic transformation of the otherwise splitting symbiosis, transformation of the self-object into the transitional subject and progressive psychopathology as a preliminary stage to dualisation, communication and rehabilitation are described against the background of the author's 50 years of experience of working with schizophrenic patients. In addition to good social and existential healing, the author stresses the value of the individual sessions for both therapist and patient. The author clarifies the difference between >projective identification< and >partial identification with the suffering of the patient<, the latter demonstrating the strong side of the therapist, who exerts a positive influence, converting schizophrenic symbiosis into therapeutic symbiosis.
The term psychotic crisis should be understood not only as an acute psychopathological syndrome occurring in the whole spectrum of psychoses, but also as a crisis that may occur in a healed patient facing difficulties in everyday life, or as a sudden change in a long and monotonous psychotherapy. The therapeutical duty often consists in >teaching<the patient to forget the urgency of the situation, as a condition for a serious work on himself. >Urgent intervention<by the therapist should be differentiated from >direct intervention<. The former requires abandoning of the classical setting of verbal encounter, whereas >direct interventions< even if urgent and different from the usual psychoanalytic interventions, do not imply a change in the setting. I use this method only with psychotic patients in a situation of crisis. It implies >progressive overturnings< i.e. changing the situation of the patient in a positive direction by images arising from our therapeutic unconscious as a >projection< of the therapeutical imago. Usually they are verbal, but here I will show graphic and what I call >transforming< images. The >overturnings< are here summarized as 1. The overturning of autism into a one-to-one relationship 2. the overturning of repression into integration 3. the overturning of the destructive splitting into individuation.
The profound psychic differences between the two human sexes are also reflected in their diverse psychopathology, even though the basic clinical forms remain common for both. In this study the problem of the psychoanalytic difference between the two sexes is discussed within the framework of psychotic situations; in intrapsychic relationships with the mother and the father, and between the patient and the therapist and with his sex. The problem of masculine and feminine psychosexuality is furthermore seen in a different light, in accordance with its pre- or postoedipal configuration.