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Salzman, L. (1966). The Psychoanalytic Approach to the Psychoses. Am. J. Psychoanal., 26(1):69-72.

(1966). American Journal of Psychoanalysis, 26(1):69-72

The Psychoanalytic Approach to the Psychoses Related Papers

Leon Salzman, M.D.

The role of psychoanalysis in the handling of the psychoses will be in the main determined by the readiness of future practitioners in the field of mental health to avail themselves of the insights that a psychodynamic theory of mental illness can offer to the prevention and therapy of these disorders. Since psychoanalytic theory presents a holistic view of man, it has the potentialities, if it does not get bogged down in more trivial concerns and organizational discords, of ultimately developing a holistic theory of psychotic development.

Rather than limit myself simply to the contributions such a holistic theory can make towards the therapy of the psychoses, I want also to demonstrate that such a theory can provide insights which could be utilized in community planning for the care and prevention of these disorders. In the long run our major efforts toward the control of schizophrenia will come from epidemeological studies which will provide clues to the kind of threats that precipitate and initiate the schizophrenic process. In particular, it may provide essential information about the process which in the course of time shifts from a thwart or deficiency into a psychosis requiring major medical and community efforts for its management.

With this view in mind I wish to examine one aspect of the problem by inquiring into the relationship of obsessional states to schizophrenia. It has been observed by many clinicians since Freud, and particularly by H. S. Sullivan, that the obsessional state frequently preceeds schizophrenia and may be a component part of the disease. The obsessional defense structure attempts to exert maximal control over oneself and the environment in order to guarantee absolute security and safety. It does this by attempting to know all that is to be known (perfectionism, omniscience) in order to foresee and forestall all eventualities. In addition, it avoids the knowledge of one's deficiencies and limitations by never acknowledging error or weakness.

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