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Hoffmann, K. (2002). The Development of Clinical Psychoanalytic Practice with Psychotic Patients. Psychoanal. Hist., 4(1):21-30.

(2002). Psychoanalysis and History, 4(1):21-30

The Development of Clinical Psychoanalytic Practice with Psychotic Patients

Klaus Hoffmann

Psychoanalytic therapy of psychoses in the German-speaking world, indeed in the world in general, began at the Psychiatric University Hospital in Zurich. Actively supported by Eugen Bleuler, its then director, Karl Abraham, Carl Gustav Jung and Ludwig Binswanger worked with psychotic patients using Freud's method of free association and attention to the expressions of the unconscious. Freud favoured this as, inter alia, the following postcard message to Bleuler dated 30 January 1906 shows: ‘Honoured colleague, after Jung's splendid study of dementia praecox, now your so comprehensive essay—I'm confident that we'll soon conquer psychiatry’ (Bleuler 1979, p. 21). In the foreword to his monograph Dementia Praecox or the Group of Schizophrenias Bleuler himself wrote in 1911:

The whole idea of dementia praecox stems from Kraepelin; moreover, the grouping of and emphasis on the individual symptoms is almost entirely his achievement…. An important part of the attempt to extend the pathology is nothing other than the application of Freud's ideas to dementia praecox. (p. 15)

Abraham described sexual traumatizations as causes of psychotic illness, both in the schizophrenic and manic-depressive forms. For this reason he considered psychoanalytic treatment to be highly effective. He limited himself here—always with clear methodical restrictions—to individual cases observed and treated by himself, and consistently made it clear that, in his opinion, serious psychic illness arose from a combination of constitutional and experience factors, but that psychoanalytic treatment frequently led to ego-strengthening and hence to significant improvement.

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