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John, R.S. (2001). Transference and Countertransference Contributions Toward Understanding the Phenomenon of Institutionalization of Schizophrenic Patients. J. Amer. Acad. Psychoanal., 29(1):17-32.
  

(2001). Journal of American Academy of Psychoanalysis, 29(1):17-32

Transference and Countertransference Contributions Toward Understanding the Phenomenon of Institutionalization of Schizophrenic Patients

Robert St. John, M.D.

I am not mad: this hair I tear is mine; my name is Constance; I was Geffrey's wife: young Arthur is my son and he is lost: I am not mad: I would to heaven I were! For then, 'tis like I should forget my son or madly think a babe of clouts were he: I am not mad: too well: too well I feel the different plague of each calamity.”

Shakespeare, King John, Act III, Scene IV

This quotation is a succinct, poignant, albeit poetical description of the point I am trying to make about schizophrenia in this article. Constance is depressed. She is not schizophrenic because she has a firm grasp of her own identity; she understands the loss she has suffered and she accepts and experiences her own feelings of grief as an understandable, although painful reaction to that loss. Furthermore, she does not numb her feelings of grief behind a wall of autistic denial, nor does she try to replace her lost son with some phantasied object. She experiences her loss realistically, as well as the painful feelings that accompany it.

In this article I plan, by using a series of clinical vignettes, to illustrate how I learned from my clinical work with schizophrenic patients how they experience an autistic feelinglessness in place of profound feelings of grief and despair. It should be stressed that I am not making an argument against the current psychobiological theories of schizophrenia, nor am I making a contribution toward a particular etiological theory of this disorder.

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