A summary of the progression of of schizophrenia from the first through fourth stages.

In this part of the book we shall examine the mechanisms with which the patient attempts to envision life in a less frightening manner.

A psychodynamic understanding of any human being and, in our particular case, of a person who will eventually suffer from schizophrenia, requires that we study the following:

1. The world which the child meets.

2. The child’s way of experiencing that world, especially in its interpersonal aspects.

3. The way the child internalizes that world and the effects of such internalization.

4. The ways by which the sequence of later experiences weaken, reinforce, distort, neutralize, expand, or restrict the effects of the early experiences.

In many cases of schizophrenia the disorder does not manifest itself, at least in its initial stages, with obvious symptoms. Some cognitive alterations may appear to be within the normal range or not distinguishable from those occurring in neuroses and character disorders. Usual psychological tests may also fail to show evidence of cognitive impairment. However, people who knew the patient well can recognize the difference in him. His attitude toward life has changed.

Although primary process mechanisms continue to function in these children for a period of time longer than in normal circumstances, the primary process is eventually overcome and to a very large extent is replaced by secondary process mechanisms.

Because the early experiences have made the future patient awkward socially, clumsy in his activities, and somewhat inadequate in coping with life in general, his defects become more evident in adolescence and later, when he has to deal with a greater range of situations.

The fourth, psychotic, period of schizophrenia covers the whole psychosis, from its onset to termination.

The schizophrenic patient to be reported in detail in this chapter was never seen by the author, nor discussed in supervision with other colleagues. This chapter illustrates how much, in some instances, we can learn about the psychodynamics of schizophrenia from the special perspective of a close member of the family.

The psychodynamic study of these cases is hindered by several difficulties. The first is the rarity of these cases. Whereas in the past catatonic patients were quite numerous, now they have drastically diminished in number. The second difficulty lies in the manifest symptomatology, which lends itself to a psychodynamic study much less than do other types of schizophrenia.