Understanding Schizophrenia: Toward a Unified Biological and Psychodynamic Approach

Abstract

Despite the advent of the neuroleptic drugs in the 1950s, schizophrenia continues to cause widespread economic burden and disability. Various psychoanalytic scholars have offered theories of schizophrenia as a mental illness, and research has consistently demonstrated psychotherapy’s effectiveness as a component of schizophrenia treatment. The contributions of the late Italian-American psychiatrist Silvano Arieti are reviewed here as an example of a unified biological and psychodynamic approach to schizophrenia. Clinical techniques for working analytically with schizophrenia patients are reviewed. Implications of an integrated approach to the disorder are discussed within the current climate of mental health.

Keywords:

• schizophrenia
• psychosis
• Silvano Arieti

Notes

1 One notable exception is Scandinavia, and in particular Finland, where patients with schizophrenia are routinely offered intensive psychotherapy as standard treatment.

2 Many modern analysts reject the concept of the schizophrenogenic mother due, in part, to the theory’s undue emphasis on maternal influence rather than a more general focus on problems in psychological integration.

3 Arieti’s advice in this regard must be considered within the current climate of psychotherapy. Nowadays, very few patients with schizophrenia have any experience in analytically informed treatment.

4 I consider McWilliams’ 2004 textbook Psychoanalytic Psychotherapy: A Practitioner’s Guide a must-read for beginning therapists and psychiatrists. I recommend it frequently to the psychiatry residents I teach.