Minauf M
Fortschr Neurol Psychiatr. 2005 Nov;73 Suppl 1:S78-83. doi: 10.1055/s-2005-871001.
The author -- specialized in Psychiatry and Neurology as well as a Psychoanalyst -- reports her experience during some decades of treating patients with schizophrenia in greatly different hospitals and institutions. Many examples demonstrate that psychoanalytical knowledge and recognizing psychodynamic connections can essentially contribute to understanding and treating psychotic patients. From the multitude of psychoanalytic theories on the etiology of schizophrenia some aspects are demonstrated, mainly those regarding their use in practical work. Some of them are: ego-disturbance, the psychotic symptom as a defence mechanism and the problem of countertransference. Regarding the ego-disturbance some examples show that usually not all ego-functions are impaired. Thus, cognitive functions may not only frequently be preserved, but may be working even better than usual. Out of numerous mechanisms of defense in schizophrenia projection, identification, projective identification, splitting, denial and regression are especially important. Moreover, psychotic patients frequently show certain symptoms that are related to very personal experiences. They can often be recognized quite easily as defence mechanisms. Countertransference is of great importance when treating such patients. Three of these numerous phenomenous are mentioned especially: anxiety, compassion, which may lead to identification, and the incapacity to accept the limit of therapeutic measures. The author is convinced that the so-called "psychodynamic" and "biological" psychiatry are not in opposition. Splitting them is not justified because according to the different stages of illness treatment with drugs as well as with different psychotherapeutic methods, even with psychoanalytical ones and social rehabilitation, are necessary. The etiology of schizophrenic psychosis cannot be explained with psychoanalysis either. Yet, the knowledge of psychodynamic processes can contribute essentially to understanding the illness and treating the patient. The compliance accomplished thereby can improve the quality of life of the patient and possibly for the therapist too.
作者——专门从事精神病学和神经病学研究，同时也是一名精神分析学家——报告了她在几十年间于不同医院和机构治疗精神分裂症患者的经历。许多例子表明，精神分析知识以及识别心理动力学联系对于理解和治疗精神病患者至关重要。从众多关于精神分裂症病因的精神分析理论中，展示了一些方面，主要是那些在实际工作中的应用。其中一些包括：自我紊乱、作为防御机制的精神病症状以及反移情问题。关于自我紊乱，一些例子表明通常并非所有自我功能都会受损。因此，认知功能不仅可能经常得以保留，甚至可能比平时运作得更好。在精神分裂症众多的防御机制中，投射、认同、投射性认同、分裂、否认和退行尤为重要。此外，精神病患者经常表现出与非常个人化经历相关的某些症状。它们通常很容易被识别为防御机制。在治疗此类患者时，反移情非常重要。特别提到了这些众多现象中的三种：焦虑、可能导致认同的同情以及无法接受治疗措施的局限性。作者坚信，所谓的“心理动力学”精神病学和“生物学”精神病学并非相互对立。将它们分开是不合理的，因为根据疾病的不同阶段，药物治疗以及不同的心理治疗方法，甚至是精神分析方法和社会康复都是必要的。精神分裂症性精神病的病因也无法仅用精神分析来解释。然而，心理动力学过程的知识对于理解疾病和治疗患者至关重要。由此达成的依从性可以提高患者的生活质量，对治疗师来说可能也是如此。
