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For [[psychoanalysis]], as for medical research and the entire field of [[mental ]] health, schizophrenia is a [[complex]], baffling, and [[frustrating ]] disorder. It is not particularly rare, affecting [[about ]] 1 percent of the population; its distribution is worldwide. A century after Emil Kraepelin created the diagnosis of [[dementia ]] praecox and its extensive symptomology—renamed schizophrenia by Eugen Bleuler—it remains poorly [[understood]]. In spite of revolutionary advances in [[biology ]] and neuroscience, no [[treatment ]] or combination of therapies offers a reliable [[cure]].

Like all the [[psychotic ]] disorders, schizophrenia was [[thought ]] from the start to have an [[organic ]] basis, but Kraepelin was [[forced ]] describe it as a "functional disorder." Early age of onset and [[absence ]] of brain lesions such as might be found in epilepsy or tertiary syphilis, for example, encouraged early [[analysts ]] to attempt treatment, especially in light of the limitations of [[other ]] therapeutic modalities. It became plausible to [[suggest]], at least tentatively, that schizophrenia was a [[psychological ]] disorder that originated, like [[neurotic ]] conflicts, in infancy and early [[childhood]]. The fact that some small but significant percentage of [[patients ]] experienced [[full ]] or [[partial ]] recovery made it a target for therapies of all kinds, including psychoanalysis.

Although [[Freud ]] himself was skeptical about prospects for successfully treating schizophrenia, the disorder was central to the [[activity ]] of many early analysts, who often were associated with hospitals for the insane. Karl [[Abraham]]'s first letters to Freud concerned [[psychosis]]; like Carl [[Jung]], he worked at the Burgholzi Central Asylum and [[University ]] [[Clinic ]] in Zurich, which Bleuler directed. In the [[United States]], where [[psychiatry ]] only gradually became a primarily office [[practice ]] beginning about 1920, psychiatrists influenced by Freud also worked in asylums. Adolf Meyer and William Alanson White were both hospital-based psychiatrists, as was Harry Stack Sullivan, who reported impressive results with his analytically oriented treatment beginning in the 1920s. Particularly influential, Sullivan's [[work ]] led to the creation of a [[psychoanalytic ]] enclave at Chestnut Lodge in Rockville, Maryland, devoted to the treatment of patients with schizophrenia and related disorders.

The rapid growth of psychoanalysis as a medical specialty in the United States after [[World ]] War II affected the way that schizophrenia was perceived, understood, and treated. The broad [[theoretical ]] reach of psychoanalysis, with its ambitious aims to provide a general [[psychology]], extended to schizophrenia both as an explanatory tool and treatment modality. In retrospect it is clear that as a treatment it was not successful and that the early-childhood environmental deficit [[model ]] that analysts proposed could not be sustained. At the [[time]], however, without benefit of drugs or a significant [[knowledge ]] base in neurochemistry, and in the wake of a period during which [[biological ]] explanations of mental disease had favored eugenics, [[psychoanalysts ]] appeared to be modern and forward-[[looking ]] professionals who were making an earnest and humane effort to [[understand ]] severe [[psychopathology ]] in [[terms ]] of [[developmental ]] deficits.

Psychoanalysis was not seriously affected by the introduction of phenothiazine in the mid-1950s. But the narcoleptics and their successor drugs set the [[stage ]] for the de-institutionalization of the mentally ill that began a decade later and also opened the way for the dopamine hypothesis, the first of various neurochemical pathways to be implicated in schizophrenia. By the late 1960s the [[authority ]] of psychoanalysis was eroding, both as [[therapy ]] and [[theory]], and it had to compete with a diversified marketplace of competing treatments. As psychoanalysis in the United States entered a period of steep decline in the 1980s, its efforts on both a theoretical and [[clinical ]] level were often held to be of no account. However, one positive outcome of [[analytic ]] interest in the severe mental disorders, in fact, was a sophisticated and durable typology of what became known as the borderline and [[narcissistic ]] disorders (Kernberg 1975), which developed along [[separate ]] lines and found a respected [[place ]] in clinical psychiatry and mental health practice more generally.

The [[list ]] of analysts who studied and wrote about schizophrenia is long and includes interpersonalists, ego psychologists, Kleinians and their successors, together with any [[number ]] who might be described as individualistic or idiosyncratic. Key [[texts ]] included papers by [[Paul ]] Federn, Melanie [[Klein]], Harold Searles, and many [[others]]. Some analysts published books on schizophrenia that remained in print for decades, such as Frieda [[Fromm]]-Reichman's Principles of Intensive [[Psychotherapy ]] (1950) and Silvano Arieti's The [[Interpretation ]] of Schizophrenia (1955). Arieti served for years as editor of the voluminous American Handbook of Psychiatry.

Today, psychoanalysts view schizophrenia through a diversity of lenses. Many if not most would acknowledge the medical consensus that it is essentially a biological disorder and would not recommend the kind of intensive therapeutic efforts employed in the [[past]]. Analysts seeking an in [[media ]] res would hold that analytic therapy can be beneficial while giving up earlier etiological views. A minority of analysts, post-Kleinians and others, continue to view schizophrenia as amenable in a [[global ]] [[sense ]] to therapeutic [[intervention ]] and theoretical elaboration. Although the classic psychoanalytic model of the etiology of schizophrenia is definitively obsolete, all these currents can coexist and develop alongside the diathesis-stress model of the disorder, currently dominant in psychiatry and [[medicine]].

See also: [[Ambivalence]]; Anti-[[Oedipus]]: [[Capitalism ]] and Schizophrenia; As if [[personality]]; Basic Problems of Ethnopsychiatry; Blank/nondelusional [[psychoses]]; [[Character ]] [[Analysis]]; "Claims of [[Psycho]]-Analysis to [[Scientific ]] Interest"; Collected Papers on Schizophrenia and Related [[Subjects]]; Dementia; Disintegration, [[feelings ]] of, ([[anxieties]]); [[Ego Psychology ]] and Psychosis; [[Foreclosure]]; [[Infantile ]] schizophrenia; ; [[Language ]] and disturbances of language; "Metapsychological [[Supplement ]] to the Theory of [[Dreams]]"; [[Narcissism]], secondary; Numinous (analytical psychology); "On the Origin of the 'Influencing [[Machine]]' in Schizophrenia"; Organic psychoses; [[Paranoia]]; [[Paranoid ]] psychosis; Paranoid-schizoid [[position]]; [[Paraphrenia]]; [[Persecution]]; Psychological types (analytical psychology); Psychology of Dementia præcox; Psychology of the [[Unconscious]], The;[[Psychoses, chronic and delusional]]; Psychotic/neurotic; Psychotic [[transference]]; [[Splitting ]] of the ego; [[Symbolic ]] equation; Symbolic realization; Thought-[[thinking ]] [[apparatus]]; "Unconscious, The"; [[Violence ]] of Interpretation, The: From Pictogram to [[Statement]]; [[Word]]-presentation.