Book
Collected Papers on Schizophrenia and Related Subjects
Harold F. Searles's first book gathers some two dozen papers he wrote between 1951 and 1963, most of them during his years at Chestnut Lodge, on the intensive psychoanalytic psychotherapy of chronic schizophrenia and on related clinical questions. Published in 1965 by International Universities Press in New York and by the Hogarth Press in the International Psycho-Analytical Library in London, with a preface by Robert P. Knight, and later reissued in the Maresfield Library, the volume is arranged chronologically, so that it traces the gradual evolution of Searles's thinking. Its papers range from early studies of incorporation, perplexity and vengefulness, through the patient's vulnerability to the therapist's unconscious processes, oedipal love in the countertransference, the effort to drive the other person crazy, integration and differentiation, sexuality, anxiety about change and death, and schizophrenic communication, to later papers on the phases of patient–therapist interaction, concrete and metaphorical thinking, neutral therapist responses, transference psychosis and psychoanalytic supervision. Throughout, Searles treats the therapist's own feelings as a primary source of clinical information and the relationship between patient and therapist as the medium of change.
Main ideas
- The therapist's emotional responses, including feelings usually thought improper such as oedipal love for the patient, are a legitimate and indispensable source of information about the patient rather than mere obstacles to treatment.
- Psychotherapy with chronic schizophrenia passes through recognisable phases, which Searles names out-of-contact, ambivalent symbiosis, pre-ambivalent symbiosis, resolution of the symbiosis, and a late phase in which the patient's individuality consolidates.
- Efforts by one person, often unconscious, to undermine another's confidence in their own perceptions and feelings, the effort to drive the other person crazy, play a part both in the aetiology of schizophrenia and in the therapeutic relationship.
- The schizophrenic patient is acutely sensitive to the therapist's unconscious processes, and the patient's relationship with the mother contains positive feelings that the therapy must come to recognise.
- Recovery involves a struggle between integration and differentiation, and confronts the patient with anxiety about change, about their sense of personal identity and about the inevitability of death.
- The recovering patient gradually learns to distinguish concrete from metaphorical thinking, and the therapist's neutral responses and the emergence of a transference psychosis have their own place in the treatment.
- In supervision the supervisor's own emotional experiences carry information about the treatment being supervised, a theme Searles develops in his papers on psychoanalytic supervision.
What it shows
- 1959
Harold Searles introduced Effort to drive the other person crazy
Searles's 1959 paper in the British Journal of Medical Psychology, reprinted in his Collected Papers (1965). It treats the effort to undermine another person's trust in their own feelings and perceptions as an element both in the aetiology of schizophrenia and in its psychotherapy.