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Rosenfeld, H. (1954). Considerations Regarding the Psycho-Analytic Approach to Acute and Chronic Schizophrenia. Int. J. Psycho-Anal., 35:135-140.

(1954). International Journal of Psycho-Analysis, 35:135-140

Considerations Regarding the Psycho-Analytic Approach to Acute and Chronic Schizophrenia

Herbert Rosenfeld

I propose to discuss the psycho-analytic approach to the treatment of schizophrenia, as it is being developed by a number of psycho-analysts in England, including myself. This work derives from Melanie Klein's researches into the early stages of infantile development and from the technique she uses, both in adult neurotic and borderline psychotic patients and in the analysis of children.

In our approach to schizophrenia we retain the essential features of psycho-analysis: namely, detailed interpretations of the positive and negative transference without the use of reassurance or educative measures; the recognition and interpretation of the patient's unconscious material; and, above all, the focusing of interpretations on the patient's manifest and latent anxieties. It has been found that the psychotic manifestations attach themselves to the transference in both acute and chronic conditions, so that what one may call a 'transference-psychosis' develops. The analyst's main task in both acute and chronic schizophrenias is the recognition of the relevant transference phenomena and its communication to the patient. Particularly in the analysis of acute schizophrenia, certain practical problems arise as to the management of the patient in the consulting-room; these will be described later.

THE MANAGEMENT AND TREATMENT OF ACUTE SCHIZOPHRENIC STATES

The first difficulty in managing an acute schizophrenic patient outside the analysis is the question whether he should be kept at home or in a mental hospital or nursing home.

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