ABSTRACT
In 1950, Hanna Segal wrote a paper in which she describes the treatment of a schizophrenic patient using a strictly psychoanalytic approach with only minimal modifications to the setting. Called “Some aspects of the analysis of a schizophrenic”, that paper is of considerable historical value since it is the first-ever account of the treatment of a confirmed schizophrenic, suffering from a delusion and hallucinations, by the psychoanalytic method. Segal began by seeing him five times a week in a hospital setting and then at home; after some six months, she succeeded in establishing a true psychoanalytic situation similar to that of neurotic patients – the patient lying on the couch with the analyst seated behind him. Before Segal, other psychoanalysts had undertaken the psychoanalytic treatment of psychotic patients – but only after making significant modifications to the setting. Segal’s approach was made easier thanks to Melanie Klein’s work on the nature of the psychotic mechanisms she had discovered in early infancy. Here, I am thinking in particular of Klein’s concepts of the paranoid-schizoid position and projective identification about which she had written in her 1946 paper, “Notes on some schizoid mechanisms”. At that time also, two other pupils of Klein had begun analysing psychotic or borderline patients – first Herbert Rosenfeld and then, shortly afterwards, Wilfred R. Bion. In the 1950s, Segal, Rosenfeld and Bion collaborated closely and created an atmosphere of research that was particularly favourable for the development of innovative ideas in a field of psychoanalysis that had for so long remained unexplored.
