The first type of therapy is often based on some kind of developmental theory for the cause of schizophrenia. Sigmund Freud’s ideas about schizophrenia form the basis for many developmental theories. Freud based many of his ideas about schizophrenia on an analysis of a distinguished jurist named Daniel Paul Schreber who developed a psychosis in mid-life.[56] Schreber’s psychosis involved paranoid delusions of persecution, which Freud interpreted as manifestations of latent homosexual attraction to his father.
Freud theorised that because the homosexual attraction was too unbearable for Schreber to acknowledge it had instead been transformed into hatred for his father. Hatred for his father, in turn, caused Schreber to see him as a persecutor. This simple rationale became the basis for a general explanation of the paranoia which is commonly associated with schizophrenia. Similarly, the equally common phenomena of hallucinations was explained conversely as ‘wish fulfilment of unbearable ideas rejected by the ego’.[57]
Freud observed that problems with interpersonal relationships were associated with schizophrenia, and he applied his libido theory to find an explanation. He speculated that a schizophrenic’s inability to properly relate to other people is caused by the withdrawal of libido into the self. This withdrawal of libido is a regression to the infantilism of primary process thinking, and the ensuing focus on self gives rise to delusions and hallucinations as compensation for the deficit in interpersonal relations.
Freud believed that schizophrenics could not be treated by psychoanalytical means because their inability to form interpersonal relationships meant they were unable to engage in transference, which is essential to the process of psychoanalysis. This declaration of untreatability led to the marginalisation of Freud’s theories on schizophrenia and to a quest by successive theorists for a developmental hypothesis that would support some form of therapeutic intervention.
Harry Stack Sullivan’s theories extended Freud’s considerably. Although Freud and Sullivan had similar approaches to schizophrenia they came from very different cultural backgrounds that led them to different conclusions. Freud came from a Jewish, middle-class, sophisticated Viennese background, which gave him a detached, scholarly perspective, with an observer’s status that was not so much a personal attribute as one he had inherited with his ethnic identity. Sullivan, on the other hand, had grown up as a lonely outsider in a rural area of the United States.[58]
Sullivan’s personal struggle through childhood and adolescence, with a cold, rejecting mother and a shy, distant father, gave him a certain empathy with the schizophrenics he encountered in his adult career as a psychiatrist in the 1920s to 1940s. Although he began his career accepting many of Freud’s beliefs, his technique of closely observing and empathising with his patients led to many revisions.[59]
Sullivan came to believe that many psychiatric problems were due to the fraud and hypocrisy which he thought were endemic to society. He believed that the Oedipal complex, for instance, on which Freud’s theory of schizophrenia was based, ‘must be recognised as a distortion, not a biological development, in the normal male child. It is a fraudulent symbol situation commonly the result of multiple vicious features of our domestic culture’.[60]
Sullivan’s version of the developmental theory conceived by Freud was that schizophrenia is the outcome of interpersonal problems. To Sullivan personality development is dependent on a person monitoring the appraisal of significant people. When significant people are perceived to have a negative opinion, or when there are no significant people in a person’s life, then there is a risk of developing a personality deficit or schizophrenia. Sullivan’s theory contributed to a change in the focus of the developmental theories so that schizophrenia was no longer seen as an intrapsychic problem but instead became a problem associated with a person’s family or social environment.
Next: Family Environment
[56] Sigmund Freud, ‘Psycho-analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)’, The Standard Edition of the Complete Psychological Works of Sigmund Freud, pp. 3–82.
[57] Black et al., op.cit., p. 380.
[58] Jane Pearce, ‘Harry Stack Sullivan: Theory and practice’, pp. 159–66.
[59] Harry Stack Sullivan, Schizophrenia as a Human Process.
[60] Harry Stack Sullivan, ‘Erogenous Maturation’, pp. 1–15.