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Flescher, J. (1953). The “Primary Constellation” In The Structure and Treatment of Psychoses. Psychoanal. Rev., 40(3):197-217.

(1953). Psychoanalytic Review, 40(3):197-217

Original Articles

The “Primary Constellation” In The Structure and Treatment of Psychoses

Joachim Flescher, M.D.

What qualifies me to deal with the present topic is certainly not the great number of psychotics I have more or less successfully treated, nor a special interest in the treatment of psychoses. But a fortuitous circumstance has made me face, in a more immediate way than other analysts perhaps, the problem deriving from the fact that in recent decades psychiatry has succeeded in making a definite stride in the cure of psychoses, previously a source of great frustration. I refer to the shock treatment which first started with the application of pharmacological methods (insulin, cardiazol, acetylcholine and other drugs), and then depended largely on the use of the types of shock that are induced by electric current. As assistant to the originator of electro-shock therapy, Professor Cerletti, Director of the Neuropsy-chiatric Clinic of the University of Rome, I was assigned to investigate the psychological aspects of this new treatment. Starting with the study of amnesia (18), my findings led me to investigate the psychodynamics of electric shock. This research gave promise of answering a question in my mind at the time: How to correlate the success obtained through the physical treatment of psychoses with the fact that psychoanalysis too—I myself had already had encouraging results with at least two cases—succeeded in curing non-neurotic


* This paper is a condensation of one read before the Psychiatric Forum Group, meeting in New York, November 8, 1950.

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