{"id":67216,"date":"2017-06-23T22:57:55","date_gmt":"2017-06-24T04:57:55","guid":{"rendered":"http:\/\/www.lankaweb.com\/news\/items\/?p=67216"},"modified":"2017-06-23T15:19:01","modified_gmt":"2017-06-23T22:19:01","slug":"sigmund-freud-on-schizophrenia","status":"publish","type":"post","link":"https:\/\/www.lankaweb.com\/news\/items\/2017\/06\/23\/sigmund-freud-on-schizophrenia\/","title":{"rendered":"Sigmund Freud on Schizophrenia"},"content":{"rendered":"

Ruwan M Jayatunge M.D.<\/em><\/strong><\/span><\/h2>\n

Schizophrenia is a mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour (WHO) and it is one of the most complex and disabling diseases (Weinberger & Harrison, 2011). Processing of social and emotional information has been shown to be disturbed in\u00a0Schizophrenia(McCormick et al., 2012).\u00a0\u00a0Schizophrenia has a multifactorial etiology\u00a0(Siever & Davis, 2004) and it is\u00a0affecting up to 1% of the population Searles , Makarewicz & Dumas ,2017).<\/p>\n

Schizophrenia was originally called the senility of youth by the Psychiatrist E. Kraepelin in 1911. Kraepelin(1856-1926)\u00a0originally called schizophrenia Dementia Praecox. He believed that the typical symptoms were due to a form of mental deterioration which began in adolescence.\u00a0\u00a0Patients’ cognitive dysfunction led\u00a0Kraepelin\u00a0to the assumption that\u00a0schizophrenia\u00a0is a form of juvenile dementia caused by a degenerative process of the human brain (Falkai\u00a0et al., 2015).<\/p>\n

In 1911 Eugene Beuler first used the term schizophrenia elucidating the major symptomatology such as blunted emotions, disordered thoughts, and loss of awareness.\u00a0Bleuler believed that schizophrenia patients experienced essential (fundamental) and accessory features. The essential features alone identified the patient Dementia praecox to schizophrenia\u00a0(Adityanjee et al., 1999).\u00a0\u00a0Bleuler deepened psychopathology, which depicted schizophrenic symptoms and their relation, and the importance of psychoanalysis for psychiatry (T\u00f6lle, 2008). Furthermore Bleuler criticized the term \u2018dementia praecox\u2019 because schizophrenia did not always first appear in adolescence and did not invariably end in deterioration (Adityanjee et al., 1999).<\/p>\n

Sigmund Freud (1856-1936)\u00a0maintained\u00a0an interest in the evolutionary origins of the human mind and its neurotic and\u00a0psychotic disorders\u00a0(Young, 2006).\u00a0 Freud argued that the ego\u2019s alienation from reality could cause psychosis. In 1924 Freud wrote that in psychosis the ego is dragged away from reality. Furthermore\u00a0Freud\u00a0predicted that paranoid\u00a0delusions\u00a0are motivated by unconscious homosexual impulses (Lester, 1975).<\/p>\n

Freud\u00a0was interested in Schizophrenia (which he called Dementia Praecox).\u00a0\u00a0<\/strong>Freud\u2019s interest in psychosis can be noticed since the very beginning of his theoretical work, as, motivated by his investigations regarding neurosis\u2019 etiology, he compared characteristics of neurosis to classic psychotic pictures, such as melancholy and paranoia\u00a0 (de Oliveira Moreira & Drawin 2015). Moreover Freud used to examine the blood of psychotic patients for the presence of infectious agents such as spirochete. Freud\u2019s early consideration of schizophrenia as a non-psychotic continuation of mental disorders, he later concluded that some of its aspects could be comprehended from a psychological point of view.<\/p>\n

Freud accepted Kraepelin\u2019s nosology, therefore, but he didn\u2019t share Kraepelin\u2019s views on causes (Dalzell, 2009). Freud thought that Schizophrenia was a form of attachment disorder and stated that schizophrenia develops when a child did not successfully develop an attachment\u201d with the parent of the opposite sex. Freud considered that infantis born into a state of mutual adaptation with the mother (Cohen, 2007).\u00a0As described by Freud\u00a0disordered family patterns (schizophrenogenic mothers) are the cause of\u00a0Schizophrenia. From the late 1940s to the early 1970s, the concept of the “Schizophrenogenic mother” was popular in the psychiatric literature. Research later confirmed that the mother who could cause schizophrenia in her offspring did not exist (Neill, 1990).<\/p>\n

Eugene Bleuler and Harry Stack Sullivan were\u00a0influenced by Sigmund Freud.\u00a0In\u00a0 1911, Eugene\u00a0 Bleuler\u00a0 highlighted particular\u00a0 characteristics\u00a0 in\u00a0 the\u00a0 family of\u00a0 schizophrenic patients,\u00a0 such\u00a0 as\u00a0 extreme inflexibility, incapability\u00a0 of\u00a0 communication,\u00a0 and\u00a0 mutual hostility \u00a0(Avramaki & E Tsekeris\u00a0 2011).<\/p>\n

Harry Stack Sullivan promulgated the importance of the child\u2019s earliest interaction with the parents and its major distorting influence as etiologic in the pathology of schizophrenia (Neill, 1990). In the later years\u00a0Harry Stack Sullivan echoed that\u00a0mental illnesses are related to interpersonal relationships.\u00a0Sullivan\u2019s version of the developmental theory conceived by Freud was that schizophrenia is the outcome of interpersonal problems.Sullivan (1892-1949), well-known for his interpersonal theory of mental illness, is believed to have accomplished a high recovery rate in his treatment of schizophrenia during the 1920s (Wake, 2008).<\/p>\n

Bateson and colleagues (1956) believed that if a child receives contradictory messages from their parents they are unable to construct an internally coherent perception of reality and it could lead to develop schizophrenic symptoms.<\/p>\n

Evidence suggests that attachment styles may influence subclinical psychosis phenotypes (schizotypy) and affective disorders and may play a part in the association between psychosis and childhood adversity (Russo et al, 2017).\u00a0Social\u00a0attachment\u00a0is a biological and affective need (Tr\u00e9meau et al., 2016). In the later years Pinto, Ashworth and Jones (2008) hypothesized that the risk of developing schizophrenia can increase particular types of deprived childhood environments. Although schizophrenia is primarily genetic the social environment cannot be ignored. Studies show that the social environment can increase the 1% schizophrenia average by a factor of ten (Pinto et al., 2008). In addition Rajkumar (2014) indicates that disturbed\u00a0childhood attachment leads to core psychological and neurochemical abnormalities which are implicated in the genesis of schizophrenia and also affect its outcome.<\/p>\n

Although Freud was unacquainted with\u00a0neurochemical abnormalities he\u00a0based his theory of schizophrenia on a pre-structural libido model (Goldstein, 1978). As Freud described the libido is part of the id and is the driving force of all behavior. Libido is a motivational energy of the life instincts.<\/p>\n

According to the psycho-dynamic approach Schizophrenia is the result of the disintegration of the ego (Clarke, 2012). The Ego operates according to the reality principle. Fundamentally, the Ego has a set of psychic functions able to distinguish between fantasy and reality. It organizes thoughts and makes sense of the world. The Ego represents reason and common sense (Siegfried, 2014). Freud regarded Ego as a coherent organization of mental processes. Ego death represents a complete loss of subjective self-identity.<\/p>\n

Freud stated that hysteria, obsessional neurosis and hallucinatory confusion are three forms of defense (Freud, 1894). For Freud psychotic delusion was a defensive psychical reaction with a narcissistic dimension. As described by Freud delusional thinking arises as a result of the reaction-formation and projection of threatening unconscious homosexual wishes (Chalus, 1977). Furthermore he considered paranoia is a form of psychoneuroses (Freud, 1892).\u00a0 Freud concluded that psychosis is triggered by a disturbance in the relationship between the ego and the external world (Freud, 1924a).\u00a0\u00a0<\/strong>Feldmann (1989) indicated that in\u00a0schizophrenic delusion, there is some ‘effort after meaning’ manifest, compensating for psychotic disintegration.<\/p>\n

Freud’s 1911 hypothesis explains the basic disorder in schizophrenia consists in the patient’s inability to maintain the object relations. The Object Relations theories emphasize the first years of life, \u2018the pre oedipal period\u2019 in which nature of early human relationships determine the healthy physical and psychological development of the person, which are supposed to be developed through experiences with significant persons and situations. The individuals with schizophrenia lack basic trust; have poor ego boundaries, and a vulnerability to psychosis, which may follow reality testing disturbances (Khanum & Ahmad, 2012).<\/p>\n

In 1911 Freud argued that there is a unidirectional relationship between a delusional belief and consensually validatable reality: the delusion structures reality in accordance with the delusion’s demand (Hole, Rush& Beck, 1979).<\/p>\n

Klein (1948) concluded that object relation is a theoretical-derived concept comprising aspects of interpersonal functioning. Object-relations theory explains human behavior in terms of a person’s inner experiences of others, which are called objects. Internalization of relationships, projective identification, and containment are concepts within object-relations theory that help to explain the confusing and frustrating behavior of acutely psychotic patients (Connick Jamison & Kane, 1996).<\/p>\n

According to Khanum and Ahmad (2012) Object relation deficits are well studied in patients of schizophrenia. The disturbed object relation may take the form of either physical or emotional withdrawal (Weiner, 1966).<\/p>\n

Between 1905 and 1911 a perspective slowly appeared in\u00a0Freud’s\u00a0works — a perspective which he considered “historical” and which he eventually named “history of the\u00a0libido’s development” (“Entwicklungsgeschichte der\u00a0Libido”) in 1911(\u00a0Cotti ,2004). The psychoanalytic sense of “libido,” which Freud describes as an energy that can be directed to human beings or, as in the case of the anchorite in the example, sublimated and directed toward non-human objects such as God or nature.\u00a0For Freud,\u00a0libido\u00a0was the major force in personality development, and he posited sexual conflicts as the heart of neuroses, sexual fixations as the essence of perversions\u00a0(Person, 2005).<\/p>\n

Freud believed that schizophrenia occurs when the ego becomes overwhelmed by demands of id or besieged by unbearable guilt from the superego. In schizophrenia disintegration of the ego occurs. The ego cannot cope so it uses defense mechanisms to protect itself which is regression. The schizophrenic\u2019s fantasies become confused with reality which gives rise to hallucinations and delusions. Freud is suggesting that the schizophrenic is dreaming and the hallucinations are not really happening, but they cannot tell the difference between dreams and reality.<\/p>\n

For Freud Schizophrenia\u00a0was an infantile state. He stated that symptoms such as delusions of grandeur reflect this\u00a0primitive state. He further thought that\u00a0auditory hallucinations reflect\u00a0the persons attempt to re- establish ego control.\u00a0Freud assumed that that patients with Schizophrenia regress to a state of primary narcissism.\u00a0The conception of narcissism according to Freud involves a number of different issues and hypotheses (Palmowski, 1989).<\/p>\n

Primary narcissism is the initial focus on the self with which all infants start and happens from around six month up to around six years. It is a defense mechanism that is used to protect the child from psychic damage during the formation of the individual self.\u00a0According to Freud \u00a0 new-born babies are characterized by primary narcissism, that he de\ufb01nes as the libidinal complement to the egoism of the instinct of self-preservation.\u201d In other words, primary narcissism, which would predominate until the development of the Ego, corresponds to an innate instinctual behavior which is mainly driven by the desire and energy of the newborn to survive, and by a capability of satisfying these instincts on itself (auto-ero-tism\u201d) (\u00a0Perogamvros,\u00a0 2012)<\/p>\n

In 1911 Freud analyzed the Daniel Paul Schreber ‘s\u00a0 memoirs. Schreber – a German judge was diagnosed with Dementia Praecox. Freud used his “libido” theory to analyze Schreber\u2019s illness. Freud considered this to be a consequence of two libidinal cathectic fixations (Silber, 2014).<\/p>\n

Based on his analysis Freud concluded that the disorder could not be treated psychoanalytically because of the disorder’s inherent deficits in the capacity for object relatedness, including the therapeutically necessary development of transference to the treating person (McGlashan, 2009). However Around 1907 to 1908, some of Freud\u2019s inner circle, Federn, Jung, and Abraham, began to express that psychoanalysis could be applied effectively to schizophrenia (Osborn, 2009).<\/p>\n

According to Freud\u2019s libido decathexis-restitution model of schizophrenia in 1914 he argued that these patients cannot develop transferences towards the analyst, and therefore, analysis cannot be effective. However in 1924 Freud attempted to widen the scope of psychoanalysis to include more severe psychiatric illness, including schizophrenia (Ridenour, 2016). Freud\u2019s approach coincide with Kohut (1984) who argued that psychoanalytic treatment begins with the understanding phase \u2013empathy and moves towards the explaining phase \u2013interpretation\u00a0 (Ridenour, 2016; Kohut,\u00a0 1984).<\/p>\n

Freud’s “Project for a Scientific Psychology” (1895) reflected his attempt to explain psychic phenomena in neurobiological terms. His basic hypothesis was that neurons were vehicles for the conduction of “currents” or “excitations,” and that they were connected to one another. Using this model, Freud attempted to describe a number of mental phenomena, including: consciousnesses, perception, affect self, cognition, dreaming, memory, and symptom formation. However, he was unable to complete his exploration of these mental processes because he lacked the information and technology that became available over the following century (Glucksman, 2016). If Freud had lived several more productive years he would have given a more rational explanation of Schizophrenia.<\/p>\n

\u00a0Acknowledgement<\/u><\/strong><\/p>\n

Dr. Tom Dalzell – St Vincent’s University Hospital, Dublin, Ireland<\/p>\n

References<\/u><\/strong><\/p>\n

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Ruwan M Jayatunge M.D. Schizophrenia is a mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour (WHO) and it is one of the most complex and disabling diseases (Weinberger & Harrison, 2011). Processing of social and emotional information has been shown to be disturbed in\u00a0Schizophrenia(McCormick et al., 2012).\u00a0\u00a0Schizophrenia has […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68],"tags":[],"class_list":["post-67216","post","type-post","status-publish","format-standard","hentry","category-dr-ruwan-m-jayatunge-m-d"],"_links":{"self":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/67216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/comments?post=67216"}],"version-history":[{"count":0,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/posts\/67216\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/media?parent=67216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/categories?post=67216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lankaweb.com\/news\/items\/wp-json\/wp\/v2\/tags?post=67216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}