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Pious, W.L. (1950). Obsessive-Compulsive Symptoms in an Incipient Schizophrenic. Psychoanal Q., 19:327-351.

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(1950). Psychoanalytic Quarterly, 19:327-351

Obsessive-Compulsive Symptoms in an Incipient Schizophrenic

William L. Pious, M.D.

That in some cases psychoneurotic symptoms mask an underlying psychosis and may even serve somehow to prevent the outbreak of a psychosis has been repeatedly described in the psychoanalytic literature. In 1913 Freud (7) recommended that the first few weeks of psychoanalytic treatment be 'designed as an experiment'. 'Often enough', he said, 'when one sees a case of neurosis with hysterical or obsessional symptoms … a doubt which must not be overlooked arises whether the case may not be one of incipient dementia præcox …'.

Federn (3) gives repeated similar warnings. For example he reports an early experience with the psychoanalytic treatment of an apparently obsessional girl: 'Psychoanalysis proceeded with "too little" resistance. The girl lost most of her compulsions too quickly. I had to leave Vienna in 1914 for New York and left her able to continue her studies. When I came home four months later, she received me with pride and shyness in her eyes and confided to me that she was loved by a great actor and that Friedrich Nietzsche's voice had spoken to her.' He goes on to point out that early recognition of a latent psychosis is important as a guide to changing the therapeutic aims and methods. In discussing the early recognition of hidden schizophrenia, he refers to the relation of the neurotic symptoms to the underlying psychosis. He says that 'hidden schizophrenia is indicated during analysis by quick and even sudden disappearance of severe neurotic symptoms; yet, fortunately, as mentioned before, some schizophrenic cases resist dissolution of the superficial neurosis'. Such a relationship is further indicated when he points out that 'in the three cases with bad results, psychoanalysis of the neuroses was the leading goal'. He also refers to a communication from Freud (concerning a patient whom he had referred to Freud) which

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