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Grotijahn, E. (1945). 'The Psychoanalysis of Psychoses.': Paul Federn. Psychiatric Quarterly, 1943, Vol. VII, Nos. 1, 2 and 3, pp. 3–19; 246–257; 470–487.. Int. J. Psycho-Anal., 26:179-180.
Psychoanalytic Electronic Publishing: 'The Psychoanalysis of Psychoses.': Paul Federn. Psychiatric Quarterly, 1943, Vol. VII, Nos. 1, 2 and 3, pp. 3–19; 246–257; 470–487.

(1945). International Journal of Psycho-Analysis, 26:179-180

'The Psychoanalysis of Psychoses.': Paul Federn. Psychiatric Quarterly, 1943, Vol. VII, Nos. 1, 2 and 3, pp. 3–19; 246–257; 470–487.

E. Grotijahn

This paper is a résumé of the author's many years of experience with psychotic patients, interwoven with discussions of psycho-analytic, metapsychological and biological considerations, advice about technical procedures and quotations of remarks made by Sigmund Freud.

1. Errors and their Avoidance. In psychotic or post-psychotic schizophrenic patients, an anamnesis should not be taken. When post-psychotic patients are forced to remember psychotic episodes, they often relapse. No psycho-analysis of psychotic patients can be carried through without the skilful assistance of someone who is ready to love the patient no matter how demanding he is. A mother, sister, brother, or nurse are acceptable; father or even a wife are less good. One condition of the treatment of psychotics is an aid in settling the sexual problem. The method of free association encourages a manic flight of thoughts and may easily lead to depressions by making feelings of guilt conscious. An immediate interruption of free association is recommended as the best strategy during slight psychotic periods, which seem to be unavoidable at times. From his observation of the terminal states of severe hysterias, the author was able to distinguish three different outcomes: sublimation, narcissistic organic disease, a severe climacteric or senile melancholia with final recovery leading to the 'post-psychotic evening of life'. The author is convinced that the success of shock therapy is due to the mental impression made by the treatment (or maltreatment) and to the amnesia established.

2. Transference. In the treatment of the transference neuroses and psychoses the economic, topographical and dynamic conceptions are the same—the difference lies in the handling of the resistance and transference. To put it as an antithesis: 'In neuroses, we want to lift repression; in psychoses, to create re-repression.' Freud once said to the author: 'Psychotics are a nuisance to psycho-analysis'—his argument being that there is no transference and no healthy ego in psychotics. It is true that the psychotic transference is not reliable, because the psychotic does not separate psycho-analysis from life until his ego-structure is almost restored. A positive transference must

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never be dissolved. In contrast to the neurotic, analysis cannot be continued with the psychotic during periods of negative transference. Whenever the patient feels understood, 'he is yours'. The experience of the good transference is the chief normal reality for the psychotic.

In the psychotic state ambivalence is replaced by two or more ego-states. Neuroitcally, ambivalent feelings toward the same object result in reaction- and symptom-formation. Psychotically, the contrasting emotional tendencies tear the ego into parts. Schizophrenics crave for a true mother whose love they never felt. Motherhood is defined by Federn as 'the natural feeling that the fate of another person is more important than one's own'. There is no feeling of duty, no sensual joy, no feeling of sacrifice. It is an instinctual behaviour pattern. If the psychotic transfers his mother relationship to a male analyst, he easily confuses homo- and heterosexual feelings and becomes more perturbed. This is the main analytical reason for the help of a nurse in caring for psychotics. It demonstrates again and again that the psychotic is more dependent upon reality than the neurotic in the transference situation.

3. The Psycho-Analytic Process. The psychotic has little or no logical but much essential understanding of the connections between unconscious elements and their conscious representations. Interpretations are much less opposed by idresistance than in the analysis of neurotics. A sudden disappearance of obsessional or hysterical symptoms may indicate the onset of a psychosis. In such cases resistance must be established and the normal ego-cathexis must be returned to the deserted ego-boundaries by giving up the method of free association. There should be no further interpretation of the positive transference and no further analysis of resistance which maintains repression.

Federn distinguishes reality sensation and reality testing. Because the ego-boundaries lose their cathexis, ideas, thoughts and memories are experienced as real by reality sensation and cease to be mere thinking. As in the process of awakening one goes through mental processes as through reality, the schizophrenic is not able to awaken fully from his pathological realities. When we treat a schizophrenic patient we treat in him several children of different ages. The psycho-analysis of psychotics consists basically in the restoration step by step of the normal narcissistic cathexis to the ego; it reverses the losses of narcissistic cathexis which occur step by step through the schizophrenic process.

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Article Citation

Grotijahn, E. (1945). 'The Psychoanalysis of Psychoses.'. Int. J. Psycho-Anal., 26:179-180

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