Why bother with the struggle to forge a psychotherapeutic-psychoanalytic approach which might be mutative in the schizophrenias, if neuro-psychopharmacology is considered the “gold standard” and first line treatment approach? Goldstein (2003), writing in the New England Journal of Medicine (Goldstein DB: “Pharmacogenetics in the laboratory and the clinic” N Engl J Med 348:553-556, 2003) noted:
“One of the most striking features of modern medicines is how often they fail to work. Even when they do work, they are often associated with serious adverse reactions” (p. 553).
Sullivan et al (2006) noted that although many persons diagnosed with schizophrenia benefit from long-term pharmacotherapy:
“...the benefits of antipsychotic treatmnet are inconsistent, incomplete, and often countered by significant side effects-relatively rare, life-threatening conditions (e.g., agranulocytosis, sudden cardiac death), side effects associated with long-term morbidity (e.g., tardive dyskinesia, increased body mass, impaired glucose metabolism), and subjectively unpleasant states associated with nonadherence (e.g., akathesia). Although most individuals respond to treatment, poor or partial response is common, and many patients require trials of multiple medications” (p.50).
It is for these reasons and many others stemming from my own personal psychodynamics and history, that I have devoted a significant portion of my life to, and enjoyed furthering the development of psychoanalytic and psychotherapeutic approaches to persons diagnosed with severe mental illness.
Gaetano Benedetti (1993), Swiss psychiatrist-psychoanalyst and co-founder of ISPS (see www.isps.org and www.isps-us.org) in 1956, described the positive changes which take place in psychotic symptomatology when they are taken up in a long-term relationship devoted to understanding, containment and reliable and steady support. Benedetti noted:
“In this way, the psychotherapy becomes progressive; and the psychotherapist’s discovery of this ‘progressive psychopathology’ is the meaningful continuation of the regressive psychopathology’ studied by psychiatry during the first half of this century [the twentieth], with the research carried out by Bleuler, Schneider, and Kretschmer, in the ‘classic’ age of our discipline” (p.xxi).
Benedetti continues:
“All this has nothing to do with the etiology of schizophrenia [a biographical facet of the human being, not just a medical disorder], as the natural sciences conceive it. It is a world of its own which, precisely because it has no intention of interfering with other fields of knowledge and with the continuous progress of biological research, is able to stand up, in all its autonomy, against them. But autonomy is not its only quality. Revelations about the nature of existence are always fundamental--and we learn here about the structures of human psychoses, to return to the great studies carried out by Jung, Federn, Sullivan, Frieda Fromm-Reichmann, Gertrud Schwing and M.-A. Sechehaye. We also learn here about the psychopathology of our own society, so well stressed during the past decade by M. Siirala, which is revealed to us no less by mental illness than by poverty, exploitation, drug-taking or oppression. And it reveals us too, in the manifestations of the illness over the course of time. So, in the end, we learn something about our own identity as well” (pp.xxi-xxii).
The latter point reminds me of the one genus postulate of HS Sullivan (1953-The Interpersonal Theory of Psychiatry):
“We shall assume that everyone is much more simply human than otherwise...” (p.32).
