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Wexler, M. (1951). The Structural Problem in Schizophrenia: Therapeutic Implications. Int. J. Psycho-Anal., 32:157-166.

(1951). International Journal of Psycho-Analysis, 32:157-166

The Structural Problem in Schizophrenia: Therapeutic Implications

Milton Wexler, Ph.D.

Love in all its myriad forms still stands as the principal prescription for the treatment of schizophrenia. Affection and sympathy, tenderness and approval; these are the medicines of choice. Dosage, of course, depends only on the capacity of the therapist to give, and he is the best therapist who has the greatest libidinal resources. To all of which one might ask: How can it be that such a commodity so lavishly expended can be so potent? Or, how can it be that so potent a commodity is so lavishly and incautiously prescribed?

I believe that Eissler (3) is right when he indicates that the love and patience we would shower upon the psychotic is connected developmentally with earlier phases of contempt and enmity. Few things are so calculated to terrorize at least some schizophrenics as untimely affection, however real and unambivalent. Indeed, the same is true of some skittish children who can be won only by disinterest. If the veriest show of encouragement can be translated by a neurotic in the analytic situation as a seduction, its counterpart with the schizophrenic may be perceived as a rape. Love is no doubt an effective medicine but, as Freud indicated, many effective medicines are poisonous in nature. We must have caution how we use it.

I have a special interest in this problem, for I have been through two years of hell-fire and heaven with a schizophrenic patient who could, on occasion, speak the violent language of a jungle tigress. One gets introspective in the face of such assaults (afterwards of course) and begins to think about the attitudes which call them forth.

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