THE THEORY OF THE GLIDING SPECTRUM OF PSYCHIC DISTURBANCES - THE CASUISTIC OF A SCHIZOPHRENICALLY STRUCTURED PERSONALITY

The author takes up an early statement by Freud, who said about a schi zophrenic patient, that his healing process started by re-establishing the Oedipus-Complex - a first hint at the possibility of treating psy chosis through psychotherapy. Freud thus regarded psychotic symptoms a s shifting and so began free himself from the narrowing categories of classical psychiatry. Based on the concept of the shift of symptoms Gu nter Ammons Dynamic Psychiatry regards the genesis, structure and dyna mics of neurosis, borderline-syndrome, psychosomatic diseases, drugadd iction, destructive sexuality and psychosis as placed on a gliding spe ctrum. Provided the patient is treated adequately there will be a freq uent change of symptoms and a development towards more health, which r equires a new diagnosis. In german-speaking countries psychiatrists ha ve been trying for about hundred years to find new ways in diagnosing, but in spite of more and more detailed systematics they haven't been successful yet. Today we know that it is necessary for the treatment o f psychotic patient to offer a therapeutic field like the Dynamic Psyc hiatric Hospital Menterschwaige in Munich consisting of a network of s ingle-, group- and milieutherapy as well as music-, dance-, theatre-, painting- and horseriding-therapy (Ammon, Burbiel 1992; Schmidts 1990) . The importance of this groupdynamic and integrative therapeutic conc ept can be illustrated by the therapy of a 47 year old patient, who ha d lived isolated with the diagnosis >>paranoid-halluzinatory psychosis <<. When she came to us she reported to have been telepathically extor ted, threatened and subdued for years by a strange power. She thought all her actions were examined, and psychosomatic symptoms occurred, es pecially when she tried to find a job. Diagnostic tests show formal re asoning problems and blocades, paranoic fantasies, reduced language co mpetence, strong ambivalence, autistic regression, disturbances of att ention and concentration and most of all anxiety. As for her family dy namics is concerned, there is significantly high symbiotic contact wit h her mother she shared the sleeping-room with, while her father was e xiled into the kitchen. She was the substitute for her mother's partne r, but at the same time felt rivalry and jealousy towards her elder an d more successful sister - being the scapegoat our patient thus held t he family together. At the age of 14 she suffered from erythrophobia a nd regression, later from psychosomatic reactions and skincancer, then she was labeled with the diagnosis >>psychiatric desintegration<< and at least she tried to get help from no less than 37 different medical and psychological institutions - both ambulant and in-patient. The pr ognoses were mostly bad, but the patient didnt give up. At the beginni ng of the analytic treatment in our hospital, the importance of the sy mbiosis-conflict that's behind the symptoms becomes evident - it's nev er been possible for the patient to get out of the symbiosis with her mother without feeling guilty - this dynamic became apparent in the si ngletherapy situation, when she showed a strong wish melting into one another with the therapist. While the female therapist tried to streng then all the contructive parts of the patient, the patient more and mo re tested her, if she could place confidence in the therapist, control led her and tried to make her part of her halluzinations. During this phase the nonverbal therapies became important, especially in the danc ing therapy she could experience her still repressed creative potentia l; the pictures made in the drawingtherapy became relevant as non-verb al expressions, the growing transference-relation showed strong symbio tic jealousy towards other patients in order to defend her fear of bei ng left alone. The counter-transference of the therapist helped to und erstand the unconscious dynamic of the patient. Despite of different m echanisms of defense (idealization, projection etc.) the patient could take first steps towards an own identity, she could free herself from deficient ego-demarcation and the hallucination of being influenced f rom outside; she had dreams instead, was elected project-leader in the milieutherapy, moved more freely in the dancing-therapy and played a part in the theatre-therapy that represented her own groupdynamic. The dreams discuessed in the single-therapy gave decisive clues and helpe d her to get away from the destructive dynamics of the past. Eroticism , sexuality and oedipal problems finally became in the therapeutic pro cess, the patient tried a cautions loverelation with another patient a nd her menstruation came back again after six years break. She took fi rst steps in building up a career in the social field and increasingly dealt with the world outside. She prepared herself for an ambulant th erapy with a male psychotherapist and showed none of her previous symp toms any more. Apart from occasional sleeping pills the patient has ne ver used any psychopharmacological medication. Even now, more than one year after leaving the hospital the patient feels good, she has no sy mptoms, she has moved away from her parents and works in a project for the integration of foreign children. She herself has described her wa y as from >>telepathy to empathy<<.