home first back 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 forward

unemployment and the stigma of mental illness caused to the family limited chances of
recovery. He believed that very few people recovered from the illness.

Bleuer was stimulated by the psychoanalytic work done with schizophrenic patients by his
assistant Dr Carl Jung, a student of Sigmund Freud. For Bleuer, the identifying characteristic of
the illness was not a poor outcome but a specific psychological picture:

A lack of continuity in the association between the patient's thoughts and a restrictive
expression of emotion [1994 pp 10-11].

Warner writes:

From the fragmentation of thinking and feeling, Bleuer derived the term 'schizophrenia',
'split minds'. Bleuer's treatment showed a higher rate of recovery from first episode
schizophrenia because his treatment of patients was more humane. He moved away from
institutional care [1994 ibid.].

Warner quotes Bleuer:

It is preferable to treat these people under their usual conditions and within their habitual
surroundings. The patient should not be admitted to hospital just because he suffers from
schizophrenia but only when there is a definite indication for hospitalisation.

As an established rule, earlier release produces better results. If the patient cannot return
to his own family, the "care" he may receive from a strange family often serves as an
adequate substitute [1994 ibid.].

Bleuer believed:

Idleness facilitates the predominance by the complexes over the personality. Regular work
maintains the activity of normal thinking...Low level work should not be expected to be
perfect...The quality of home environment is important to recovery. Stresses can cause a
relapse, such as too much responsibility at work or at home [1994 ibid.].

Bleuer believed that within institutions, close attention should be given to the patient's
environment. Good surroundings are beneficial, not noisy unpleasant ones. The use of
mechanical restraints should be limited. The patient's self-reliance was encouraged and
occupational therapy was considered essential.

Warner states (p 10) that 60 per cent of Bleuer's patients recovered from first episode
schizophrenia, as opposed to 12 per cent of Kraepelin's.

Moving away from the psychiatric models, the development of psychoanalysis is also important
in our understanding of schizophrenia. I am going to look at Klein's theory of the
paranoid/schizoid position and how it relates to the development of schizophrenia.

For Klein, the great fear behind the development of self is the fear of annihilation from within.
This prompts the early ego to develop defence structures. The first issue the child has to deal
with is separation from the mother, therefore it quickly develops a part-object relationship with
the mother's breast. Through the use of unconscious phantasy, the child splits the breast into
two opposites. There is the good satisfying breast which nourishes the child and which the child
phantasises about when hungry. Then there is the bad breast which frustrates the child when the
child is hungry and it's not there, or when it is there and the child has had to wait too long for a
feed. (See Hanna Segal [1973] ch 2, pp 11–23.)