国际先进创新、思想和创意杂志

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How Does Psychoanalysis Work With Persons Afflicted By Schizophrenia

Wilfried Ver Eecke

I make use of Lacan to understand schizophrenia. I then
explain, from a Lacanian point of view, the success of
three therapists treating persons afflicted by
schizophrenia. I refer to the Finnish "Open Dialogue"
method where up to 85% of persons, afflicted by
schizophrenia, are successfully treated. In this paper I
will concentrate upon the question as to how
psychoanalysis, in modified form, works with patients
afflicted by schizophrenia and psychosis. I will start by
mentioning the “Open Dialogue” method used in
Finland. I will point to the success of the “Open
Dialogue” method to prove that schizophrenia can be
cured by using talking therapy. Next, I will present
Lacan’s theory of schizophrenia. From Lacan’s theory I
will extract the concepts of the imaginary and the
symbolic. I will then use Lacan’s theory to explain the
success of the methods to treat schizophrenia developed
by Bertram Karon, G. Prouty and Palle Villemoes. I
will argue that their success lies in the fact that these
three therapists start by accepting the imaginary aspects
of the patient. Only in a second step do they introduce
the logic of language in their therapy.
In the abstract of their article “The Comprehensive
Open-Dialogue Approach in Western Lapland” the
authors, Jaakko Seikkula, Birgitta Alakare & Jukka
Aaltonen, write: “In a two-year follow-up of two
consecutive periods during the 1990s (1992–3 and
1994–7) it was found that 81% of patients did not have
any residual psychotic symptoms […] 84% had
returned to full-time employment or studies. Only 33%
had used neuroleptic medication”. dialogue in the joint
therapy meetings, in order to create new words and a
new joint language for experiences that previously did
not have words”. Let us start with a couple of cases.
One schizophrenic patient told her therapist that she
had no hands. When the therapist asked the patient how
she knew, the patient said that her father had told her
so, that very morning. To the question by the therapist
as to what the father had said, the patient answered:
“My father told me that I was handicapped.” The
conversation was in Dutch where the words for
“handicapped” sounds like “handicut.”, the patient had
interpreted the sentence of the father literally. She
interpreted “handicapped” not metaphorically as being
disabled but literally as having one’s hands cut. The case
of this patient illustrates Lacan’s theory that
schizophrenic persons have a deficient relationship to
language. In the case of this first patient, language could
not be fully used in its metaphorical dimension. What is
worth noticing in the “Open Dialogue” method is the
unusual form of communication. The three mental health
professionals do not talk in a normal way to the mentally
ill person. Instead, the three mental health professionals
talk to each other. They talk in the presence of both the
mentally ill person and his or her family. Then they ask
the mentally ill person and his family what he or she
picked up from the conversation. Garry Prouty calls his
method “pre-therapy” He considers his therapy a
specification of the patient centered therapy developed
by Carl Rogers. Like Rogers, Prouty recommends two
attitudes for the therapist. These two attitudes try to
make the dual relationship of patient/therapist the sole
relevant relationship. These attitudes try to make
irrelevant the considerations of a third party. the parents,
might push the patient to respect the currently accepted
civilized behavior patterns.
Keywords: Prouty; Karon; Villemoes; Lacan