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St. John, R. (1968). Smiling in Schizophrenia. Psychoanal Q., 37:103-113.

(1968). Psychoanalytic Quarterly, 37:103-113

Smiling in Schizophrenia

Robert St. John, M.D.

In this paper I attempt to define a particular type of smiling observed in my work with chronic schizophrenic women and to demonstrate that it demarcates a division between two levels of regression. In addition, this smiling will be related to the 'smiling response' described by Spitz (15) in his observations of infants. Nevertheless, I must emphasize that the smiling response that I describe is seen as being analogous to but not identical with the smiling response of infants.

The material for the paper was obtained from observations made on a ward for 'chronic' schizophrenic women in a state hospital. The patients were seen daily and a log was kept which included: 1, descriptions of patients' verbal productions and behavior; 2, descriptions of my interactions with the patients; 3, comments about the patients by the nurses and attendants; and 4, my own feelings and thoughts about the patients, the ward, and my work. Anna Freud (2) discusses the relevance of observations of infants and children in regard to psychoanalytic theory; I feel her discussion holds true in regard to observations made on adult patients.


Doris, a fifty-seven-year-old obese, white woman was first admitted to the state hospital in 1940. The admission note states that she was brought to the hospital because she became 'violent at home' and had threatened to kill her parents. At this time she was described as being withdrawn, 'depressed', and tearful; the diagnosis was 'dementia praecox, catatonic type'.

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