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Arieti, S. (1966). Emphasis on the Healthy Aspects of the Patient in Psychoanalysis. Am. J. Psychoanal., 26(2):198-200.

(1966). American Journal of Psychoanalysis, 26(2):198-200

Emphasis on the Healthy Aspects of the Patient in Psychoanalysis Related Papers

Silvano Arieti, M.D.

First of all I wish to thank Dr. Boigon and Dr. Weiss for inviting me to participate in this Round Table. Up to now I have considered myself a friend of your association, but I have by now been invited to participate so many times in your programs that I consider myself—presumptuously indeed—no longer a friend but almost an adopted son.

I shall limit my discussion to psychotic patients. It may seem strange that even in these patients who are generally considered the most serious and so difficult to treat, we could find some healthy aspects. These healthy aspects do exist, although they differ from the ones usually found in patients belonging to other categories.

If we exclude the chronic and the most recalcitrant cases, we can state that the psychotic patient is a person who has a propensity to move in every possible direction. Let us compare him, for instance, to the obsessive-compulsive who perennially broods over his obsessions and compulsions; the phobic patient who reduces the complexities of his life to the constriction of a specific and concrete fear; the borderline patient who does not move an inch from the border, either in the direction of normality or of the psychosis; the schizoid person protected by his character armor; the psychopath who ineluctably repeats the antisocial pattern; the homosexual fixated in his deviation; or to the pseudo well-adjusted character neurotic in whom we have repeatedly to sow the seed of discontentment. Through this comparison we see how incomparably freer are the movements of the schizophrenic: he is the traveler, along unusual paths, he is the one who demolishes and reconstructs. He is the one who dares, who dares to dare.

Of course, what I consider a healthy aspect of the patient is at the same time one of the most unhealthy aspects because the patient may not return from his journey into the psychosis. In his demolition he may demolish himself as a human being and, at times, what he reconstructs is so egocentric as to imprison him, as in a cage, apart from the rest of humanity. Nevertheless, I think that we must take advantage of this restlessness and mobility of the early schizophrenic to share with him a return to reality, a deeper insight, or a different outlook. Contrary to what was believed until approximately two decades ago, the schizophrenic does not like his exile and he wants to return, provided what

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