Psychoanalytic concepts of the etiology of severe mental illness.

In this paper I challenge some prevalent psychoanalytic concepts of the etiology and pathogenesis of severe mental illness which I believe to be in need of revision. There is insufficient evidence to conclude that the etiology of the two major adult psychoses, schizophrenia and manic-depressive illness, can be attributed to failures in development or fixations during the earliest years of life. Furthermore, I believe it incorrect to ascribe these failures of development to deficiencies in the early maternal environment. I base my disagreements on three main considerations: the misinterpretation of the etiological significance of regression, the relevance of new biological data, and erroneous conclusions drawn from lack of diagnostic distinctions. I also challenge the generally held concept of etiologic phase specificity which proposes that failures during various early phases of development can be correlated with different kinds of adult psychopathology. In calling this concept into question, I argue that current psychoanalytic concepts of the etiology of the borderline group of disorders also need to be reevaluated.