Ann-Louise S. Silver, MD 

While Freud said that personally, he did not like working with people struggling with psychosis, many who did work with them found Freud’s concepts extremely helpful. Ernst Simmel launched the first psychoanalytically oriented hospital, at Tegelsee. I. H. Schultz at Weisse Hirsch introduced his young assistant, Frieda Fromm-Reichmann to Freud’s writings. As soon as she discovered his works on transference she knew this was central. She had sensed there was something strange and important in the way patients idealized their doctors, and Freud made clear what was happening.

Meanwhile, doctors at hospitals in the United States were discovering Freud. Adolf Meyer, who had trained at the Burgholzli in Zurich, was the preeminent psychiatrist in the U.S. at the time that Freud, Jung and Ferenczi came to the Clark University 20^th anniversary conference in 1909. Freud was amazed to find how much his ideas had already influenced those in attendance and those presenting. They had come to meet the man whose writings had so influenced their work. William Alanson White and Smith Ely Jelliffe and their wives made trips to Europe each summer starting the following year. They met with the European pioneers in psychoanalysis and brought back their papers which they all translated on the boat. They summarized the German journals, all this published in America’s first psychoanalytic journal, Psychoanalytic Review, which began in 1913. Unfortunately, its first issue included CG Jung’s long paper in which he officially split from Freud.

White was the superintendent of the federal mental hospital, St. Elizabeths, in Washington. His staff contributed significantly to his journal, which thus has a heavy and fascinating emphasis on psychosis and psychoanalytic approaches. Harry Stack Sullivan joined the staff there in 1921.

I want to read Sullivan’s one genus postulate, which one can trace directly to White, and from White to people who heard Freud speak at Clark University.

“I now want to present what I used to call the one-genus hypothesis, or postulate. This hypothesis I word as follows: We shall assume that everyone is much more simply human than otherwise, and that anomalous interpersonal situations, insofar as they do not arise from differences in language or custom, are a function of differences in relative maturity of the persons concerned. ...I have become occupied with the science, not of individual differences, but of human identities, or parallels...I try to study the degrees and patterns of things which I assume to be ubiquitously human” [so much for mouse models of schizophrenia!] (Sullivan, 1953, The Interpersonal Theory of Psychiatry, pp.32-33).

We need to remember this now, in our current biological medicalized era in which people with schizophrenia are thought to suffer from some incurable and relentless brain disease requiring medications. These agents block dopamine pathways, impeding limbic system connections with the cortex. They thus have a powerful dampening effect on salience, defined by Kapur as “a process whereby events and thoughts come to grab attention, drive action, and influence goal-directed behavior…” (p. 14) This loss of verve, sense of wonder at a natural scene, or pleasure in a new insight or interpersonal connection, is intolerable for at least 75% of patients, who discontinue their meds within two years. (Psychiatry24x7.com which is sponsored by Janssen)

Frieda Fromm-Reichmann arrived in the US in 1935, working at the now closed Chestnut Lodge in Rockville. She formed an immediate affinity for Sullivan and they worked closely together. Her book, Principles of Intensive Psychotherapy is a classic, in continuous print since 1950. She stressed methods by which therapists could enhance and develop their empathic potential, building upon their respect for the patient. She echoed Sullivan in saying, “Such respect can be valid only if the psychiatrist realizes that his patient’s difficulties in living are not too different from his own.” (Fromm-Reichmann, 1950, p. xi) “Where there is lack of security, there is anxiety; where there is anxiety, there is fear of the anxieties in others. The insecure psychiatrist is, therefore, liable to be afraid of his patients’ anxiety.” (Fromm-Reichmann, 1950, p. 24) In a Lodge seminar on intuition, she said to a therapist, "To your problem of feel(ing) guilty if one doesn't understand, I had recently an idea about that - that the not being able to understand, that is, somebody communicating with us and we not understanding, in general connotes loneliness. If we don't understand, that touches on our own possibilities of loneliness, and rather than accepting there is this barrier of loneliness between the psychotic and us, we evade that and feel guilty. I think that the guilt feeling is an evasion of accepting the tragic facts of human loneliness." (p. 998 – seminar on intuition in treating schizophrenia)

Today, almost all the psychodynamic hospitals in the U.S. have been forced to close, and the few remaining rely heavily on medication regimens as well as psychotherapy. Therapists around the country are suffering their own loneliness, isolation, and now, with the murder of Wayne Fenton, anxiety as well. We have formed a non-profit organization, growing out of the triennial International Symposia on the Psychotherapy of Schizophrenia, launched in 1956 by Gaetanno Benedetti and Christian Müller, both of whom trained at the Burgholzli. ISPS-US welcomes everyone who is interested in this topic, whether they actually treat patients suffering from psychosis or not. Please visit our website (www.isps-us.org)-. We value our members who have recovered from psychosis among whom is our board member, Joanne Greenberg, author of I Never Promised You a Rose Garden.

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