Collected Papers on Schizophrenia and related Subjects

views updated

COLLECTED PAPERS ON SCHIZOPHRENIA AND RELATED SUBJECTS

By the time this book was published, Harold F. Searles, M.D., was 47 years old and was already widely regarded as the world's leading authority on the intensive psychotherapy of patients with chronic schizophrenia.

His writings on schizophrenia reveal his unparalleled skill in making contact with severely ill patients, and learning from them not only about schizophrenia, but about the human condition in general. ("Research in schizophrenia has its greatest potential value in the fact that the schizophrenic shows us in a sharply etched form that which is so obscured, by years of progressive adaptation to adult interpersonal living, in human beings in general.") He consistently avoids the temptation to view the patient as the sole repository of psychopathology within the patient-analyst dyad. Thus, he continually focuses not only on the patient's transference to the analyst, but equally on the analyst's countertransference to the patient.

His many original contributions to the topic of countertransference are among his most significant and widely recognized accomplishments—for example, in discussing dependency conflicts over his regressive dependency needs and omnipotent fantasies, and the role of these countertransference feelings in both motivating the analyst to treat schizophrenic patients, and also in interfering in the psychotherapeutic work.

Searles's papers are unusual for the candor with which he presents his own thoughts and feelings to the reader. For example, in exploring the role of defenses against grief and separation anxiety in the patient's manifest vindictiveness, he writes of a woman who fled her therapy with him to avoid facing her grief over an early loss. Searles adds, "My belief now is that I, too, contributed to the dissolution of the therapy, on the basis of my own anxiety about grief from my early life—an area which, at the time, I had not yet explored at all thoroughly in my analysis."

Another quality which pervades Searles's contributions is his deep and abiding interest in unconscious processes, including those in patient and analyst. He thus remains more faithful to Freud's work than many analysts in the United States.

Searles believes that conflicts over love rather than conflicts over hatred and rejection are more basic in the development of schizophrenia. He contends that the schizophrenic illness represents the patient's "loving sacrifice of his very individuality for the welfare of a mother who is loved genuinely, altruistically, and with...wholehearted adoration." He further maintains that this genuine love, which is mutual, can be difficult to recognize because the patient and mother are unconsciously afraid of their love for each other. He traces this conflict back to the mother's own childhood experiences, which have led her to believe that her love is destructive.

Searles emphasizes the role of symbiotic relatedness between analyst and schizophrenic patient. He believes the treatment of these patients is so prolonged partly because both patient and analyst fear and resist this symbiotic stage of the transference and countertransference. Because of the fluctuating role reversals in this phase of treatment, the analyst must be relatively accepting not only of omnipotent feelings that accompany being in the role of an infant's mother, but also accepting of the infantile dependency feelings that result from being in the converse role of the infant. Anticipating Kohut, Searles wrote as early as 1958 of the analyst's difficulty in tolerating the patient's adoration: "It requires a sounder sense of self-esteem to be exposed to the patient's genuine admiration, of this degree of intensity, than to face his contempt towards oneself.

"Driving the other person crazy" includes reciprocal efforts to do so between parent and child, as well as between analyst and patient. Lack of integration in one person tends to have an emotionally disintegrating impact on the other person. Motives for driving another person crazy, which are largely unconscious, can include a wish to destroy that person psychologically; a wish to externalize one's own craziness in the other person; a child's wish that the parent's covert craziness would become obvious enough that others would validate the child's perceptions and share the burden of caring for this parent; a wish to individuate or help the other person individuate, which may be experienced by both parent and child as a wish to drive the other person crazy; and finally, Searles especially emphasizes the wish to attain a deeply gratifying symbiotic mode of relatedness with the other person. He notes that an important unconscious motive in the analyst's choice of profession may be the presence of reaction formations to unconscious wishes to drive other people crazy. He speculates that the irrational "schizophrenogenic mother" concept appeals to analysts who are striving to deny their own regressive urges toward symbiotic relatedness.

Searles's influence on psychoanalysis and psychotherapy worldwide has been immense. His genius at discerning and describing unconscious processes in patient and analyst has profoundly enriched our understanding of a wide range of psychopathology, and has made invaluable contributions to the understanding and use of countertransference.

Richard M. Waugaman

See also: Counter-transference; Mutual analysis; Negative therapeutic reaction; Schizophrenia.