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Van Dusen, W. (1959). A Central Dynamism in Chronic Schizophrenia. Psychoanal. Rev., 46D(4):85-91.

(1959). Psychoanalytic Review, 46D(4):85-91

A Central Dynamism in Chronic Schizophrenia

Wilson Van Dusen, Ph.D.

Something of what is meant by the phenomenological approach needs to be described since there are actually several kinds of phenomenology. 1 European clinical phenomenology has been described by Van Den Berg 4 and is exemplified in the cases reported by Sechehaye 3 and Minkowski. 2 In it one bends every effort to discover every aspect of the world of the patient just as it is. The conceptual frame-of-reference is that of the patient. One wishes to discover and understand his every concern. But more than this one would want to discover and understand every gesture, the style of movements, the quality of the voice and its changes, and the very rhythms of the patient's existence.

As a brief example, with one chronic schizophrenic it was found that in any meeting with another person he expected to be grasped with questions. He was never the questioner. The questioning situation was life's supreme test. To match up to it he collected pockets-full of information gathered from hospital garbage cans. This information was committed to memory. He tried to anticipate the line of questioning and work out answers beforehand. He had the routine psychiatric examination down pat. His answers were stiff and stereo-typed and if one listened to the voice quality one sensed they were rehearsed. It was the unanticipated question from a dominant male that shattered him. Simply the gaze of such a male knocked him almost out of existence. He touched the top of his head to reassure himself of his existence or he rubbed his nose vigorously so he could feel himself. Always he turned away to collect himself so that he could match up to the questioner. All this had to be done in a hurry so that it might not be noticed. The epitome of wisdom and skill for this patient was the man who could anticipate and deal with every question.

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