SUCCESSFUL DRUG-FREE PSYCHOTHERAPY FOR SCHIZOPHRENIA Successful Drug-Free Psychotherapy for Schizophrenia offers a close examination of how to treat schizophrenic patients using psychotherapy rather than drugs, applying derivatives of psychodynamic principles in treating patients. The author provides real examples throughout of how therapists can resolve patients’ emotional conflicts with better outcomes than by resorting to drugs. She presents methods that allow patients to avoid the neurological damage and obesity that can often result from the use of anti-psychotic drugs. The practical techniques and advice in this book enable therapists to resolve the chaos of schizophrenia using psychotherapy alone. Theoretically, this book can also be useful for work with depressives. Revella Levin, Ph.D., is a psychotherapist based in New York. SUCCESSFUL DRUG-FREE PSYCHOTHERAPY FOR SCHIZOPHRENIA Revella Levin First published 2018 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2018 Taylor & Francis The right of Revella Levin to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data Names: Levin, Revella, author. Title: Successful drug-free psychotherapy for schizophrenia / Revella Levin. Description: New York, NY : Routledge, 2018. | Includes bibliographical references and index. Identifiers: LCCN 2017048627 | ISBN 9780815376255 (hbk : alk. paper) | ISBN 9780815376262 (pbk : alk. paper) | ISBN 9781351122313 (ebk) Subjects: LCSH: Schizophrenia—Treatment. | Psychotherapy. Classification: LCC RC514 .L397 2018 | DDC 616.89/8—dc23 LC record available at https://lccn.loc.gov/2017048627 ISBN: 978-0-8153-7625-5 (hbk) ISBN: 978-0-8153-7626-2 (pbk) ISBN: 978-1-351-12231-3 (ebk) Typeset in Bembo by Apex CoVantage, LLC This book is dedicated not to a person but to a concept. That concept is separating the wheat from the chaff. Sigmund Freud, John Rosen, and Wilhelm Reich have made important contributions to the field of mental health, but have not only been roundly criticized, but all too often dismissed because some of their ideas have been condemned and some of their important contributions have been neglected. At the present time, Freud’s ideas are the most obvious example in the general culture. His most important contribution, the importance of the unconscious, is rarely spoken of today in a discussion of mental health. This book is not a paean to any of these gentlemen. Indeed, one of the jokes I tell about myself is “I read Freud and keep telling him where he has made a mistake, but he ignores me and keeps making the same mistake. I get so tired of his not listening to me, that I just slam the book shut.” I also have differences with Rosen and Reich. But I insist we are not so inundated with good ideas of how to help the mentally ill that we can afford to waste them if they can be helpful to patients, especially when what we most frequently have to offer them are drugs (at least in the United States) that are at best cosmetic and, at worst, dangerous and so frequently rejected by patients. To me, that is pure spend-thriftiness (to borrow a joke from Stephen Colbert). There are far too many people suffering the agonies of schizophrenia that we can afford to throw away theories with genuine contributions to make, even if flawed. So, this is a plea to extract the valuable ideas from the useless or dangerous ones from the same contributors. Let us, for example, be more patient with Freud. Yes, in many places he despaired of helping schizophrenics but in “Constructions in Analysis,” he offered a brilliant architectural framework of how to help them without naming them. Further, I have never heard anyone express sympathy for the fact that the poor man had no one to analyze him. Certainly, this is a great handicap for the founder of psychoanalysis. The importance of having someone besides the patient analyze the transference and resistance is far too essential to be omitted. Indeed, I (who was more fortunate) would ask the reader to offer me that grace throughout the present contribution, though I do not put myself in the class of the above-mentioned theoreticians. Before dismissing my work out of hand (or swallowing it whole), please separate what you think of as my wheat from my chaff. With thanks to the late John Kerr, who brought my attention to that concept in his book “A Most Dangerous Profession” (Alfred Knopf, p. 183) and has so often inspired me. CONTENTS Acknowledgements ix 1 Introduction 1 2 Awakening the Schizophrenic Dreamer 10 3 The Difference Between Infantile Omnipotence and Grandiosity 27 4 Bathsheba: A 19-Year Recalcitrant Case of Schizophrenic Requiring 20 Months to Get to the Neurotic Level 44 5 “Black Hole” Phenomenon: Deficit or Defense? A Case Report 56 6 Addendum to “Black Hole” Phenomenon: Deficit or Defense? A Case Report 68 7 Faith, Paranoia, and Trust in the Psychoanalytic Relationship 72 8 John Rosen: Genius or Quack? Historical Reflections of a Former Student 90 9 Five Errors in Freud’s Structural Theory and Their Consequences 108 viii Contents 10 Communicating with the Schizophrenic Superego 119 11 Communicating with the Schizophrenic Superego Revisited: A New Technique 143 12 Identification with the Schizophrenic Superego 167 13 “Out, Damned Spot! Out, I Say”; or, Karl Abraham Revisited 174 14 Opposing Opinions as to Treatment of Wishes and Hopes Pathology: A Response to Salman Akhtar 189 15 The Excuses for “Supportive” Rather Than “Active” Psychotherapy 202 16 Toward a More Optimistic View of What Analysts Can Achieve 210 17 The Burned-Out Therapist 224 18 How to Decrease Your Chances of Getting Hurt or Killed When Working with a Schizophrenic Patient 229 19 Technique: Dos and Don’ts 241 20 Side Effects of Anti-Psychotic Drugs 249 21 Epilogue 251 Index 253 ACKNOWLEDGEMENTS This book was completely edited by Saideh Browne, for which I am most grateful. 1 INTRODUCTION When I was 14, I was one of those fortunate people who knew what I wanted to do when I grew up. The story is rather amusing. A couple who were both social workers happened to be visiting at our home. They asked me what I wanted to do when I grew up. I said shyly, as adolescents sometimes do (surprisingly, I can still hear the sound of my voice in my mind when I said it), “I don’t know.” They per- sisted with “Well, what do you like to do?” I replied, “I like to figure out people and I like to help them.” They replied, “That is social work.” I said, “That’s a job?” I was very surprised and said, “Do you mean they pay you for that?” They laughed. From an emotional point of view, it took me many years to get over my surprise that I could be paid for doing something I would enjoy so much. As the years went by, my interests gradually became more specific. But it was in my Master’s Rorschach class at City College of New York that I discovered exactly what I wanted to do. Again, I was fortunate because our professor was Ruth Monroe, the foremost expert in the city on Rorschach at that time. Near the end of the semester, she handed us the record of a hebephrenic, saying “I know you won’t be able to do the dynamics of this patient, but do the best you can.” I read it, and, almost immediately, I felt I understood it. I was completely taken by surprise. But an argument started in my mind, “Ruth Monroe said it couldn’t be done. How come I did it?” Her assistant graded the paper with a “C,” writing “fancy.” But I knew I had something. I consulted a senior analyst and she told me about John Rosen, saying “He is a Freudian but he likes his patients.” I read his book and came to the conclusion that it wasn’t the Freudian approach that cured his patients but the fact that he really liked them. (I had been studying the neo- Freudians at that time, i.e., Horney, Fromm, and Sullivan. And we students used to make jokes about Freud.) But I was fascinated and decided I wanted to work for Rosen as one of the assistants he used. I got an interview and, in a few months, I was called and driven 2 Introduction to a rented house in Bucks County, Pennsylvania, with a patient. The patient was so sick that she couldn’t even form a coherent delusion. Again, fortune smiled on me. The psychiatrist fellow who was supposed to be in charge of her train- ing with Rosen became ill, and I was put in charge of the patient. Rosen would come to visit three times a week to supervise my work. He was no feminist. I was expected to do four hours of housework and permitted to try to do therapy with my patient for another four hours.