A Brief Description of the Treatment of Schizophrenic Patients

Currently, there is a great difference in the way that professionals understand schizophrenia. In Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [1,2] we find even a contradictory statement. That statement reads as follows: “There is a strong contribution for genetic factors in determining risk for schizophrenia, although most individuals who have been diagnosed with schizophrenia have no family history of psychosis strong” [1,2].

DSM-5^TM states in this sentence a belief followed by the report of a fact. The belief stated is that “there is strong evidence for genetic factors in determining risk for schizophrenia” [1,2]. The fact reported is “that most individuals who have been diagnosed with schizophrenia have no family history of psychosis” [1,2]. But if there is no family history of psychosis then there is no proof of genetic origin of schizophrenia.

If there is no solid argument for a genetic cause of schizophrenia, then the rational method of research is to look for environmental causes for schizophrenia and psychosis. This is precisely what Lacan did in a Seminar he gave in 1955 - 1956. There he analyzed the case of Judge Schreber. He was a highly respected Judge in Germany at the time of Bismarck. However, his wife had had five or six miscarriages. Judge Schreber started to realize that he would have no children. Judge Schreber could not deal with this psychological loss. He started to hallucinate to deal with the unacceptable fact of not having children. He hallucinated that he was becoming a woman in order to marry God in order to create a new mankind. His narcissism went even a step further and he dreamt that he would become the patron saint for that new mankind.

Lacan gave a psychological interpretation of the mental illness of Judge Schreber. Lacan argues that originally all human beings relate to a mother or a mother figure. Without such a mother figure 20 to 30% die in the first three years. But when babies develop consciousness, they cannot accept such full dependency. They create two fantasies. They imagine that their mother is perfect and omnipotent, otherwise they would not feel safe. Next, they imagine that they are everything the mother could want. If children can have those two fantasies, they flourish. But if those children were to maintain their grandiose narcissistic view of themselves, they would not be good candidates for becoming a friend or a future partner. Hence Lacan argues that these childish fantasies must be corrected. According to Lacan this happens when the child sees that the mother has an interest in a third, normally the father. As the mother has an interest in a third, then the mother must have it all. But if she misses something and shows an interest in a third, it means that the child cannot provide for the lack in the mother.

Lacan’s idea is now that if the mother of a child does not show an interest in a third then the two childish fantasies continue. Judge Schreber could not deal with the lack of having no children. He then imagined an alternative world where his unmet desire for children was satisfied. In that alternative world, he satisfied his unfulfilled wish in a hallucinatory way. His imagination replaced reality.

The treatment of such patients consists in listening to their imaginary world and then finding a way to introduce them to reality. Bertram Karon and Palle Villemoes created a specialized talk therapy for such patients [3].

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision. Arlington (VA): American Psychiatric Association; 2000.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington (DC): American Psychiatric Association; 2013.
3. Ver Eecke W. Breaking through schizophrenia: Lacan and Hegel for talk therapy. Lanham (MD): Rowman & Littlefield; 2019. Available from: https://psycnet.apa.org/record/2019-35232-000