Freudian Interpretations of Psychosis and Schizophrenia

   (1907 and after)

   Freud’s fellow psychoanalyst Karl Abraham (1877–1925), who was just finishing a term as assistant physician at Bleuler’s service in Zurich’s Burghölzli psychiatric clinic and about to establish himself as a privately practicing psychiatrist in Berlin, attempted in 1907 a psychoanalytic explanation of adolescent sex dreams in dementia praecox, published in the Zentralblatt für Nervenheilkunde und Psychiatrie (he wrote a second article in 1908 on the difference between hysteria and dementia praecox). Freud’s own views of psychosis (1911). In 1911, Freud set himself for the first time to the task of explaining psychotic illness in terms of libido theory. (See PARANOIA.) In analyzing the autobiography of the jurist and politician Daniel Paul Schreber (who in 1903 had written a book about his nervous illness), Freud determined that paranoia and dementia praecox (schizophrenia) had different unconscious mechanisms. (Freud believed, however, that Schreber had paranoia, not schizophrenia.) Freud accepted Emil Kraepelin’s construction of dementia praecox, as well as Eugen Bleuler’s emendation of it. Yet, Freud disliked the terms the two men had devised, and explained dementia praecox in terms of a retreat of the libido from the outside world. He preferred the term "paraphrenia" (Gesammelte Werke, VIII, p. 313). Freud’s paper "Psychoanalytic Remarks About an Autobiographically-Described Case of Paranoia (Dementia paranoides)" ("Psychoanalytische Bemerkungen über einen autobiographisch beschriebenen Fall von Paranoia [Dementia paranoides]"), appeared in the Yearbook of Psychoanalytic Research (Jahrbuch der psychoanalytischen Forschung) in 1911. Psychoanalytic interpretations of psychosis resumed with the writings of Vienna psychoanalyst Paul Federn (1871–1950), especially his "Analysis of Psychosis" in the International Journal of Psychoanalysis ("Psychosenanalyse," Internationale Zeitschrift der Psychoanalyse) in 1933; then in the New World, these analytic efforts to confront psychosis were continued by, among others, the neo-Freudian Harry Stack Sullivan. Psychoanalytic concept of "border-line" psychosis (1924). When he joined the Vienna Psychoanalytic Society in 1924, Robert Wälder (1900–1967), a Viennese lay-analyst, gave a paper entitled "Über den Mechanismen und Beeinflussungsmöglichkeiten der Psychosen." The paper was published in English in the Journal of Psycho-Analysis (1924) as "The Psychoses: Their Mechanisms and Accessibility to In-fluence." Wälder said he wanted to understand "the conditioning factors by which a psychosis comes about or is avoided in those ‘border-line’ characters in whom the phenomena of transition to a psychosis are so readily observed"* (p. 260). * Wälder’s "border-line" patients were not at all the same as the "border line" patients that New York psychoanalyst Adolph Stern (1879–1958) later described in a 1937 paper, published in 1938 in the Psychoanalytic Quarterly. (See Personality Disorders: borderline [1938].) By the term, Stern meant patients who were neither psychotic nor psychoneurotic but whose common characteristic was that they failed psychoanalysis. Stern suggested that these patients had 11 traits in common, including "narcissism" and "a state of deep organic insecurity or anxiety." (See also Borderline States.)