[Is Chestnut Lodge salt in the wound of psychoanalytic contributions to the treatment of schizophrenia?].

In a catamnestic follow-up study of 226 patients treated psychotherapeutically in Chestnut Lodge on an inpatient basis, two-thirds of the schizophrenics and one-third of the patients with affective disorder presented with an unfavourable course. Since the schizophrenics had a chronic type of schizophrenia, this result agrees largely with the general course of schizophrenia. Although it is a disappointing result, it does away with both myths and distorted stories told about Chestnut Lodge. Social considerations as well as those based on institution analysis and on family therapy led to the thesis that the external reality of life of the schizophrenic patient is involved in deciding his possibilities of development even if the therapeutic approach is based on intrapsychic factors. The institutional nature of Chestnut Lodge, involving care and exclusion, was an obstacle to fulfilling Chestnut Lodge's claim that the conditions for an experimental trial in psychotherapy of schizophrenia (which aims at uncovering and understanding the patient's disturbed subjectiveness) are fulfilled only by a type of social psychiatry that allows the patient to solve the task of mastering his life in an adequate manner.