Jungs views on causes and treatments of schizophrenia in ...ubhc.rutgers.edu/dsr/papers/documents/SilversteinJung2JAP.pdf · Jung’s views on causes and treatments of schizophrenia

Jung’s views on causes and treatmentsof schizophrenia in light of currenttrends in cognitive neuroscience and

psychotherapy researchII: Psychological research

and treatment

Steven M. Silverstein, Rutgers, The State University of New Jersey, USA

Abstract: Jung was the first to emphasize the importance of psychological factors in theaetiology and treatment of schizophrenia. Despite this, and other seminal contributions, hiswork on schizophrenia is almost completely ignored or forgotten today. This paper, afollow-up to one on Jung’s theories of aetiology and symptom formation in schizophrenia(Journal of Analytical Psychology, 59, 1) reviews Jung’s views on psychological approachesto research on, and treatment of, the disorder. Five themes are covered: 1) experimentalpsychopathology; 2) attentional disturbance; 3) psychological treatment; 4) the relationshipbetween the environment (including the psychiatric hospital) and symptom expression; and5) heterogeneity and the schizophrenia spectrum. Review of these areas reveal that Jung’s ideasabout the kind of research that can elucidate psychological mechanisms in schizophrenia, andthe importance of psychotherapy for people with this condition, are very much in line withcontemporary paradigms. Moreover, further exploration of several points of convergencecould lead to advances in both of these fields, as well as within analytical psychology.

Key words: attention, environment, heterogeneity, psychotherapy, schizophrenia, symptoms

A personality, a life history, a pattern of hopes and desires lie behind the psychosis.The fault is ours if we do not understand them.

(Jung 1961/1989, p. 127)

Introduction

In Jung’s 1907 book, The Psychology of Dementia Praecox, he noted, throughclinical and research data, what the symptoms of schizophrenia can revealabout unconscious and symbolic processes (Taylor 1998). In addition, he

0021-8774/2014/5902/263 © 2014, The Society of Analytical PsychologyPublished by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.DOI: 10.1111/1468-5922.12073

Journal of Analytical Psychology, 2014, 59, 263–283

commented how, as a guide to treatment, ‘the patient describes for us, in her symptoms,the hopes and disappointments of her life’ (Jung, 1907/1960, para. 298). This book hastherefore been viewed as the first psychodynamic conceptualization of schizophrenia1

(Rodriguez 2003). Jung’s positions were radical for their time, a period in psychiatrywhen psychotic symptoms were generally seen as meaningless phenomena. Thepurpose of this paper is to review Jung’s views on psychological approaches tostudying and treating schizophrenia, and to assess the validity of his ideas, and theusefulness of his approaches, in the light of current knowledge and paradigms inpsychopathology and psychotherapy research. The review is divided into 5 sections:1) experimental psychopathology; 2) attentional disturbance; 3) psychologicaltreatment; 4) the relationship between the environment (including the psychiatrichospital) and symptom expression; and 5) heterogeneity and the schizophreniaspectrum. A review of the above areas reveals that Jung anticipated many aspectsof the contemporary (re-)discovery of psychotherapy for schizophrenia, andprovided a seminal example of how a deep understanding of schizophrenia-relatedmental processes can be elucidated via experimental psychological research.

Jung’s views on psychological approaches to schizophrenia

Experimental psychopathology

Although experimental studies of schizophrenia are commonplace today, theywere rare in the first decade of the 20th century. Jung can thus be seen as apioneer in this approach. His studies of word association and reaction time(RT), published starting in 1904 (see CW volume 2), were recognized in theGerman literature as significant for their demonstration of the meaningfulnessof psychotic speech. So much so in fact that in 1905 Adolf Meyer reported onthese findings in the American journal Psychological Bulletin, where he notedthat this work was the best single contribution to the study of psychopathologyduring the past year2 (Taylor 1998). Jung’s work was held in high regard largelybecause, in contrast to the RT work of others, hefocused not only on theamount of time it took patients with schizophrenia to respond, but also on

1 Freud (1896) briefly described psychoanalytic conceptualizations of paranoia and hallucinationswithin the context of a case study of a patient who appears to meet modern diagnostic criteria forschizophrenia. However, with a few exceptions Freud did not pursue this line of thought, presumablyowing to his admitted lack of access to psychotic patients.2 However, Meyer rejected Jung’s toxin theory of schizophrenia [see Silverstein (2014) for anevaluation of it in terms of current evidence)]. In 1909, at the Clark University meeting at which Freudand Jung were in attendance, Meyer spoke against seeking the aetiology of schizophrenia in ‘artificialexplanations by specially invented poisons‘ (Leif 1948, p. 249),and rejected the existence of ‘toxins‘as causal in the disorder, while at the same time praising the psychodynamic views of Jung and Freudregarding the disorders they were writing about (Meyer 1910; Leif 1948). After an earlier (1908) visitwith Meyer, Jung wrote to Freud that Meyer is ‘entirely on our side in spite of the toxin problem indementia praecox’ (McGuire 1974, p. 170).

264 Steven M. Silverstein

the personal meaning of their responses and whether they could recall them onlater trials (Moskowitz 2006). This is consistent with the influence of Freud onJung, and therefore, Jung can be seen as perhaps the first to conduct empiricalinvestigations into Freud’s theories, an endeavour that did not become commonuntil the 1980s.Importantly, Jung recognized that long RT is not characteristicof all patients with schizophrenia (Peterson & Jung 1907/1981, para. 1176).This appreciation of individual differences foreshadowed the current focus onheterogeneity and subtypes within schizophrenia, including the recognition thatno impairment can be found in all patients, as currently diagnosed (Heinrichs2001; also the final section of this paper).The methods Jung employed in his research were both sophisticated and novel

(in terms of their application to schizophrenia), and the manner in which heincorporated technology into his studies foreshadowed the development of variousdisciplines within psychology. For example, Jung’s use of the ‘psychograph‘ orpsycho-galvanometer (to measure what we today call electrodermal activity) wasa clear precedent for today’s field of cognitive psychophysiology, where combiningelectrophysiological and behavioral measurement is routine. In particular, his workanticipated recent studies that use functional magnetic resonance imaging (fMRI)and event-related potential methods to probe the brain mechanisms involved informal thought disorder (e. g., Hokama et al. 2003; Kuperberg et al. 2006; Raglandet al. 2005; Spitzer 1993). In general, Jung’s work on word association inschizophrenia can be seen as anticipating modern day semantic network studiesof schizophrenia (e.g., Kreher et al. 2009; Kuperberg et al. 2006), in the sense thatthis new field assumes that the often odd verbal associations of schizophreniapatients can be understood psychologically.Perhaps the most important contribution of Jung’s experimental studies was

his demonstration that through the use of psychological methods, one candevelop insights into the personal issues around which complexes are formed,and which are the basis for psychotic and other psychiatric symptoms. Ingeneral, he believed that the factor that accounted for disturbances inassociation in schizophrenia was the complex—both by generating affectiveresponses to specific words and ideas (typically leading to longer RTs), and byinvoluntarily drawing attention to itself, which leads to reduced semanticprocessing of words, and therefore to an increase in superficial, concrete, andout-of-context associations. This view has received support from later researchdemonstrating that: 1) formal thought disorder during proverb interpretation isrelated to perceived level of psychological threat (Carson 1962); 2) abnormalproverb interpretation in peoplewith schizophrenia often involves inclusionmaterialfrom patients’ past or current experience (Harrow and Prosen, 1978, 1979);3) proverb interpretations are more concrete in schizophrenia when instructionsstress personalized involvement compared to when they do not, whereas thiseffect was not found in other psychiatric or neurologic patients (Nahor andVannicelli, 1976); and 4) intense stress leads to increased stimulation ofdopamine receptors in the prefrontal cortex and subsequent disconnection in

Jung, schizophrenia and neuroscience 265

prefrontal networks, and this has been proposed to be a mechanism involved inthought disorder in schizophrenia (Hains and Arnsten, 2008).

Attention

Jung emphasized reductions of attention in schizophrenia, and this is consistentwith an enormous amount of empirical research (Reichenberg 2010). As didMasselon (1902), Jung noted that poor attention has a number of clinicallysignificant consequences. These include reductions in: the quality of perceptionof external objects; awareness of one’s personality; judgment; and feelings ofrapport, belief, and certainty regarding people and objects in the world. He alsobelieved that attentional impairment was related to the affective andmotivational disturbances found in people with schizophrenia. For example,Jung stated that ‘objects do not excite in the diseased brain the affective reactionwhich alone permits the adequate selection of intellectual associations’(Peterson & Jung 1907/1981, para. 1067). Here, Jung was clearly influencedby his hospital chief Bleuler, who had earlier written that ‘attention is nothingmore than a special form of affectivity’ (Bleuler 1906, p. 31). Theseobservations are consistent with recent research on the link between motivation,effort, and attention in people with schizophrenia (Gorissen et al. 2005;Granholm et al. 2007; Silverstein, 2010). The reader may note here that thereduction in consciously available attentional resources that Jung discussesresembles the abaissement duniveaumentale discussed throughout the Psychologyof Dementia Praecox. In a late paper, Jung clarified that he believed these to berelated: ‘the abaissement, whatever its cause, begins with a relaxation ofconcentration or attention’ (Jung 1957/1960, para. 544).An important contribution by Jung regarding the cause of reduced attention

involved his theoretical construct of the complex. In Jung’s view, the ego isnormally the strongest complex, and has the strongest attention-tone. However,in schizophrenia, a new complex or new complexes emerge and attract moreattention than the ego complex, as noted above. When the ego complexbecomes just one of several background complexes, its ability to excite orinhibit associations (seen as general functions of attention), or to direct thecontents of consciousness, is significantly reduced. He noted, however, thatthese alterations in attention only occur when the new complex is activated3.Specifically: ‘When the complex is hit, conscious association is disturbed andbecomes superficial, owing to the flowing off of attention to the underlyingcomplex (“inhibition of attention”)’ (Jung 1907/1960, para. 135). Furthermore,‘What disturbs the patients’ concentration is the autonomous complex, whichparalyses all other psychic activities’ (ibid., para. 162). Jung then added:‘curiously enough, this fact escaped Janet’ (ibid.).

3 Jung claimed, however, that interference from complexes is continual in schizophrenia, ‘which isseldom seen in normal people or even in hysterics’ (1907/1960, para. 208).


Jung hypothesized that the reduced attentional resources available to the egocomplex could account for some aspects of psychosis. For example, in his RTstudies, he observed that, in healthy people, when attention is distracted there isan increase in superficial associations (e.g., clang associations) and perseverations,and a decrease in meaningful combinations. This suggests that these phenomena,when they occur in psychotic patients, are due to an intrinsic factor (the complex)that is draining attentional resources from the ego. Elsewhere, he noted that ‘[t]hestate of reduced attention expresses itself in the decreased clarity of ideas. Whenideas are unclear, their differences are unclear too’ (ibid., para. 134). Jung alsodescribed how the emotionally excited state can prevent a person from payingattention to his/her own associations, which can lead to further thoughtdisturbances. The hypothesis that formal thought disorder in schizophrenia isrelated to attentional disturbance is supported by current research (Docherty,2012), and attentional impairment has also been found to be a factor in the sourcemonitoring failures of schizophrenia, which have been hypothesized to be asetting condition for hallucinations (e.g., Shakeel & Docherty 2012). Jung alsoseems to have anticipated recent cognitive psychological work on attention ingeneral, which posits that its function is to facilitate deeper (e.g., semantic)processing of attended-to perceptions and mental representations, and to inhibitprocessing of other stimuli (Fuster 2003; Pratte et al. 2013, in press).

Psychological treatment of schizophrenia

Jung was among the first psychiatrists to use psychotherapy as a treatmentfor schizophrenia (Jaffé 1972; McGuire 1960). Although Jung sometimesdoubted whether psychotherapy could be of more than limited benefit forsome patients with schizophrenia (1957/1960, para. 549), throughout hiscareer he maintained that in most cases, ‘schizophrenic disturbances couldbe treated and cured by psychological means’ (1958a/1960, para. 559).Jung’s position that people with schizophrenia could be helped, or evencured, with psychotherapy ran counter to the attitude that prevailed inpsychiatry throughout the 20th centuryand that is still prominent todayamong many leading psychiatrists (e.g., Fuller Torry, 2006), despite severalnotable contributions from psychoanalytic pioneers during the 20th century(Bachmann et al. 2003).Recently though, there has been a resurgence of effort dedicated towards

developing effective psychotherapies for schizophrenia (Hamm et al. 2013; Lysakeret al. 2010; Lysaker and Silverstein, 2009; Silverstein and Lysaker, 2009), and thishas taken several forms. One involves continued modification of psychoanalytictreatments for people with the disorder (Havens, 2000; Silver et al. 2003; Silversteinet al. 2006a, 2006b), including development of psychodynamically orientedsupportive psychotherapy (Kates and Rockland, 1994). Perhaps the largest body ofwork has been on forms of cognitive behavioral therapy (CBT) that target delusions


and hallucinations, as well as the core beliefs associated with the anxiety anddepression that often trigger the emergence of psychotic symptoms. Much evidencenow indicates the effectiveness of CBT for reducing the frequency and severity ofpsychotic symptoms and improving quality of life (Rector & Beck, 2012;Tarrier, 2010). Moreover, traditional CBT approaches are being modified tofocus on more traditional psychodynamic issues such as the self (Chadwick,2006), and the integration of analytic (including Jungian) perspectives andtechniques (e.g., archetypal amplification) has been demonstrated tocomplement CBT approaches (e.g., Silverstein, 2007). In addition, CBT forpsychosis has recently been modified for use with patients with poor insightinto their condition (Perivoliotis et al. 2009), or with intense social anxiety(Smith & Yanos, 2009). Other studies have demonstrated that CBT can beeffective with patients whose symptoms are refractory to medication(Barretto et al. 2009; Turkington et al. 2008). Beyond psychotherapy, dataindicate that first episode psychosis can be treated successfully using a teamapproach involving intensive individual and family therapy delivered in thehome (Lehtinen et al. 2000), often with minimal medication use. There is alsoa huge amount of evidence indicating that a variety of group and familytreatments designed to improve social and other living skills can be effective(reviewed in Silverstein et al. 2006a, 2006b).Earlier, it was noted that Jung claimed ‘the patient describes for us, in her symptoms,

the hopes and disappointments of her life’ (Jung 1907/1960, para. 298). This positionhas been borne out by recent research demonstrating that the nature and content ofpsychotic symptoms such as hallucinations and delusions can be accounted for by apathway involving adverse experiences (e.g., trauma) and the attributional biasesthat develop in their aftermath (Bentall & Fernyhough, 2009; see also Greek,2010 for a first-hand account of the personal meaning of hallucinations). However,Jung believed that understanding the origin of psychotic symptomswas only the firsthalf of the therapist’s task. In his view, the second half involves their constructivecomprehension; in other words ‘What is the goal the patient tried to reachthrough his creation?’ (Jung 1915, p. 393). As it was in Jung’s lifetime, thisprospective approach is still largely un-used in psychotherapy with schizophreniapatients today.Although Jung believed that schizophrenia could be treated with psychotherapy,

he also recognized that under certain conditions, forms of psychotherapy could leadto symptom exacerbation—a warning that continues to ring true (Drake &Sederer, 1986; Silverstein et al. 2006a, 2006b). For example, he noted that whendealingwith patients with ‘isolation symptoms’ (e.g., dreams of cosmic catastrophesor the end of the world, perceptions of walls bending and bulging, beliefs thatrelatives are dead, etc., which he viewed as manifestations of the disintegration ofpsychic structures), this calls for ‘immediate precautions, such as discontinuationof treatment, careful re-establishment of personal rapport, change of milieu, choiceof another therapist, strict avoidance of any concern with the contents of theunconscious and especiallywith dreamanalysis, and so on’ (1958a/1960, para. 560).


One of the most interesting aspects of Jung’s writings on schizophreniatreatment is the extent to which his views on the continuity of normal, neuroticand psychotic experience are similar to those currently being espoused by groupsdeveloping CBT for psychosis (e.g., Bentall, 1999; Chadwick et al. 1999). Jung’sview that psychotic symptoms could be seen on a continuumwith normal ideationstood in sharp contrast to the influential view of Jaspers (1913/1997) who saw, forexample, delusions, as unrelated to normal thought processes and of indiscernibleorigin. In cognitive models upon which CBT for psychosis is based, aphenomenon like hallucinations can be seen as an extreme example of imagery,and a delusion can be seen as a thought that is ascribed to without question, muchin the same way that people rigidly hold to religious and political views. In CBTwith people with schizophrenia, symptoms are ‘normalized’ or de-pathologizedby explaining to the patient how they can be understood as extremes of normalfunctioning (caused by stress or various endogenous factors), and this providesa non-threatening rationale for therapeutic interventions to reduce the intensityof the symptom. For example, a delusional idea might be explained as an exampleof a non-questioning attitude being applied to the symptomatic idea, and thissets the stage for cognitive exercises and behavioral experiments to test thevalidity of the idea, and ultimately to replace it with ideas grounded in newexperiences of reality.Jung described many ways in which psychotic symptoms can be seen as

extremes of normal functioning. For example, regarding hallucinations, henoted that dementia praecox ‘merely sets in motion a preformed mechanismwhich normally functions in dreams’ (1907/1960, para. 180). Regarding formalthought disorder, Jung believed it could be accounted for by reductions inattention to one’s own thoughts, a view with obvious therapeutic implications,in terms of cognitive remediation. Many other examples of normalization existas well. For example, he noted that the effects of a complex (e.g., heightenedemotional reactivity to complex-related stimuli) can be found in normal people,and that, in his research, he found that blocking and amnesia, as found duringassociation tests in people with schizophrenia, are also found in normal people(1907/1960, para. 16). Similarly, what Jung called ‘fascination’—the behaviour,in schizophrenia, of drawing attention away from the stimulus word orenvironment when a complex is activated—is similar, in everyday life, tonormal people breaking off an unpleasant conversation by suddenly startingto speak about something else. He noted, therefore, that ‘fascination’ is ‘on alevel with normal mechanisms’ (1907/1960, para. 178). Jung also believed thatthe use of neologisms by people with schizophrenia was but an extremeexample of what could be observed in healthy people, and people with hysteria,where linguistically odd reactions, or use of foreign words occurs when complexesare activated. Related to this, he noted that in healthy people, ‘Quotation is afavourite way of expressing complexes’ (1907/1960, para. 244). Regardingdelusionsor statements of grandeur, Jung noted that the often bizarre statements ofpsychotic patients can be understood as efforts to preserve self-esteem. Specifically,


he saw such statements as ‘I am triple owner of theworld’ (1907/1960, para. 232),and ‘I am the finest professorship…I am Double Polytechnic irreplaceable’(1907/1960, para. 219), as examples of wish-fulfillment, compensating for adamaged sense of self. Jung compared comments such as these to ‘the pompous styleof officials or half-educated journalists’ (1907/1960, para. 269) who often also uselanguage as a manifestation of a striving for prestige. This hypothesis is consistentwith modern research and theory on an altered and damaged sense of self inschizophrenia (Lysaker and Lysaker, 2008; Moe & Docherty, 2013). Finally,regarding the idea that complexes can gain in strength and detract from egofunction, Jung noted that this is similar to what happens when one is in love.When this occurs, a person’s attention is attuned to anything having to do withthe beloved, items are collected, ideas not related to the person’s greatness areignored, affect is heightened, and most thought is directed to the relationship.Despite the many ways in which Jung’s views provide strategies for a normalizingrationale for multiple psychotic symptoms, use of these perspectives within apsychotherapy context has not been reported.The implications of many of Jung’s observations on the psychological basis of

psychotic symptoms are consistent with recent development in the treatment ofschizophrenia. For example, his observation that many of the bizarre andgrandiose statements of patients are wish-fulfillments that compensate for adamaged sense of self anticipated modern psychotherapeutic efforts to strengthenthe sense of self in schizophrenia (Chadwick, 2006) and to reduce internalizedstigma and enhance personal narratives (Yanos, et al. 2012). Jung also noted that‘[i]n a case where the symbolism is so richly developed, the sexual complex cannotbe lacking’ (1907/1960, para. 276)4, and he compared the grandiose delusionalstatements of a female patient to ‘unmistakable affectation such as is often foundin elderly spinsters who try to create a substitute for unsatisfied sexuality by thegreatest possible perfection of demeanour’ (1907/1960, para. 201). To be sure,in routine clinical practice, sexual issues are ignored in the treatment ofschizophrenia patients with the notable exception of the recent development ofthe 2-part UCLA Friendship and Intimacy Module, which is a manualizedtreatment focusing on dating skills, sexual behaviour, birth control methods andsexually transmitted diseases (see Kopelowicz et al. 2011). Jung also wouldrecommend books or essays for his patients to read (see 1958a/1960, paras. 561and 574 for two examples), a practice currently known as bibliotherapy, and thathas been applied to a wide range of psychiatric conditions, including schizophrenia(e.g., Elser 1982). He also frequently recommended art therapy for his patients(1958a/1960, para. 562), which is now widely practiced. In addition, Jung

4 Jung’s discussions of sexuality in schizophrenia are rare, and do not occur after his earliest writingson the disorder. It is possible that they reflected his consideration of Freud’s desire for him to extendlibido theory to an understanding of schizophrenia (see Freud’s 1908 letter to Jung in McGuire 1974,p. 168; B. Silverstein 1985, 2003), although Jung was openly resistant to accepting this mission, evenas early as 1907 (see his Foreword to The Psychology of Dementia Praecox).


(1958a/1960) delivered what may be the first example of cognitive remediationfor schizophrenia (Silverstein, 2000). Specifically, a female patient told him thather hallucinated voice (which she interpreted as God’s) said she should tell Jungto read her a chapter of the Bible at each session, and then she would memorizeit at home. Jung followed these instructions, and reported that

the exercise notonlyhelped the patient’s speech and powers of expression but alsobrought about a noticeable improvement in the psychic rapport. The end result wasthat after about eight years the right side of her body was free of voices.(1958a/1960, para. 574)

Jung understood the therapeutic effects of this intervention as being due ‘to thefact that her attention and interest were kept alive’ (ibid.,para. 574). In additionto demonstrating the beneficial effects of targeting cognitive processes directlyfor treatment, a now well established method for schizophrenia with demonstratedeffectiveneness (Medalia andChoi, 2009), this clinical vignette has all the hallmarksof what is today called recovery-oriented treatment, in the sense that the task waspersonalized and therefore meaningful to the patient. These factors have beendemonstrated to be important to treatment success (Medalia et al. 2002), but arestill too rarely present in treatment today.Beyond the importance of specific interventions, Jung recognized that the

non-specific factors in therapy, primarily the personal relationship between patientand therapist, were the critical factor in treatment response. For example, he noted that

It would be a mistake to suppose that more or less suitable methods of treatmentexist… The thing that really matters is the personal commitment, the serious purpose,the devotion, indeed the self-sacrifice, of those who give the treatment. I have seenresults that were truly miraculous, as when sympathetic nurses and laymen were able,by their courage and steady devotion, to re-establish psychic rapport with theirpatients and so achieve quite astounding cures.(1958a/1960, para. 573)

This view is supported by data from several countries on the Soteria approachto treating young people with schizophrenia—where treatment is largelyprovided by laypeople in a non-stigmatizing, home-like, accepting environmentwhere the focus is on exploring the phenomenology of the patient, often withminimal or no use of medication (Bola & Mosher 2003; Calton et al. 2008). Itis also consistent with much psychotherapy research in general thatdemonstrates that the therapist’s qualities of warmth, empathy, and genuineness(i.e., ‘non-specific factors’) are more important than the theoretical orientation ofthe therapist (Patterson 1984), and that relationship building in the treatment ofpsychotic patients is critical (Jackson et al. 2008).Regarding the therapist, Jung commented that ‘one can bring about noticeable

improvements in severe schizophrenics, and even cure them, by psychological treatment,provided that “one’s own constitution holds out”’ (1907/1960, para. 573). The latter


point anticipated later research on therapist personality characteristics associated withsuccessful psychotherapy of people with schizophrenia (Cancro 1983; Frosch et al.1983; Whitehorn and Betz, 1960).In short, keeping in mind that whether schizophrenia can be cured by any means

remains a controversial issue, and that, given changes in diagnostic practice, a portionof the people diagnosed with schizophrenia that were treated (and possibly ‘cured’)by Jung would not meet modern criteria for the disorder, Jung’s position on theeffectiveness of treatment delivered by committed therapists and other staff membershas received empirical support from several sources.

The relationship between the environment (including psychiatric hospital wards),and the expression of symptoms

Jung was one of the first clinicians to recognize that the patient’s environmenthad a significant impact on symptom expression and overall functioning—aview that has been confirmed by numerous lines of research over the last century,including the large body of evidence on family therapy reducing relapse rates inpatients living with (initially) hostile and critical families (Goldstein 1995;Pharoah et al. 2010). For example, in 1939, Jung noted the ‘enormous change’that has taken place in the average mental hospital in his lifetime. Specifically,‘That whole desperate crowd of utterly degenerate catatonics has practicallydisappeared, simply because they have been given something to do’ (1939/1960,para. 539). This observation is supported by studies demonstrating that the levelof negative (i.e., deficit) symptoms observed in hospitalized patients is inverselyrelated to the amount of positive stimulation on the ward (Oshima et al. 2003,2005; Wing & Brown 1970), and that the level of expression of psychoticsymptoms is related to the degree to which discriminative stimuli on aninpatient unit suggest a medical as opposed to a social environment (Zarlock,1966). Jung also commented: ‘The results of occupational therapy in mentalhospitals have clearly shown that the status of hopeless cases can beenormously improved’ (1939/1960, para. 540). This is consistent with muchresearch demonstrating that long-stay hospital patients can demonstratesignificant improvements in the context of evidence-based behaviouraltreatment (e.g., Paul & Lentz, 1977; Silverstein et al. 2006a, 2006b; Corrigan& Liberman 1994). However, he also noted that, in many cases, noimprovement, or minimal improvement occurs, a situation that continues tobe true today, despite the availability of evidence-based practices (which arerarely used) for ‘treatment-refractory’ patients (Silverstein et al. 2013a,2013b; Silverstein & Bellack, 2008; Insel, 2010).Jung believed that much treatment failure was due to the negative interpersonal

milieus in which hospitalized patients lived. For example, when, referring to aformerly high functioning patient who was preoccupied with physical symptoms,he noted that


she suffers under the discipline imposed by the doctors, and under the treatment shereceives from the ward-personnel, she is not recognized, and she does not get her desertsdespite the fact that she has achieved the best of everything. The complex of deathexpectation is of great significance in determining some of the stereotypies….(1907/1960, p. 133, para. 276).

Today, it is recognized that the quality of staff-patient interaction is critical to treatmentoutcomes, and that negative staff behaviours towards patients (e.g., criticism, neglect)can lead to poor treatment outcomes (Berry et al. 2000). Consistent with the idea ofa normalizing rationale noted in the section above, Jung also noted about this patientthat ‘[a]ny person with a lively sense of his ownworth, who for any reason was forcedinto such a hopeless and morally destructive situation, would probably dream in asimilar way’ (1907/1960, para. 276).Contrary to many of his peers, Jung maintained that the emergence of strong

affect in a given situationcan be gainfully understood when interpreted within thecontext ofthe patient’s past and recent history. This is similar to his observation thatthe content of psychotic symptoms can be understood as reflecting the person’shistory, as noted in the section above. Although Jung believed there was often adisconnection between affective and cognitive functions in schizophrenia, hecautioned that ‘We see them far too little, a factwhich every psychiatrist will confirm.It is therefore possible that their excitements often remain incomprehensible to usonly because we do not see their associative causes’ (1907/1960, para. 35).Therefore, he noted ‘one may, by careful analysis, sometimes find the psychologicalclue that leads to the cause of the excitement…we have absolutely no reason tosuppose that no sufficient connection exists’ (1907/1960, para. 149). Thisframework for investigating the antecedents and (sustaining) consequences ofabnormal behaviours is exactly the rationale for functional assessment as it ispracticed today as the basis for designing behavioural interventions for chronicallypsychotic patients (Hunter et al. 2008). Jung also made the point that even healthypeople do not always understand the causes of their own reactions, so we can beexpected to understand even less the reactions of people we do not see very often.This again stresses parallels in psychological functioning between neurotic andpsychotic states, and provides a rationale for psychotherapeutic intervention.

Heterogeneity and the schizophrenia spectrum

Although schizophrenia is often discussed as if it is a single disease, it is in fact aheterogeneous set of syndromes, such as epilepsy or cancer (Carpenter 2013;Silverstein et al. 2013a, 2013b; Williams & Gott, 2013, in press). This was notedby Jung in 1906when he wrote: ‘Dementia praecox…denotes a group of illnesseswhich have not yet been clearly defined clinically’ (1906/1981, footnote 22).Currently, the etiologies of the syndromes within the category of schizophrenia,or even how many there are, remain largely unknown, and are the foci of much


active research.Many typologies have been proposed over the years, andmost havebeen found to lack validity. In an early attempt at typology, Jung posited ‘theexistence of two groups of schizophrenia: one with a weak consciousness and theother with a strong unconscious’ Jung1939/1960, para. 531). To date, thishypothesis has not been tested. However, another of Jung’s hypotheses hasreceived support. In 1958, Jung estimated that the ratio of cases of latent or potentialschizophrenia to diagnosable cases was 10:1 (Jung1958a/1960, para. 558).Remarkably, this was the same base rate for schizotypy estimated by Meehl(1962), who pioneered modern research on subsyndromal forms of schizophrenia.Moreover, much later researchusing varying subject samples, different scales ofschizotypic experiences and symptoms, different cultures, and different statisticalprocedures, has also estimated the schizotypy taxon to have a base rate ofapproximately 10% (reviewed in Fossati & Lenzenweger 2009), whereas the rateof schizophrenia has consistently been estimated at ~1% (Perälä et al. 2007), allsupporting Jung’s claims based on his clinical experience.In the epilogue toThe Psychology ofDementia Praecox (para. 315), Jung noted

that his case material was mainly from paranoid patients, and therefore it isunclear how much his theories applied to cases of catatonia or hebephrenia.Elsewhere, he claimed that his material consisted of ‘milder, still fluid cases’ (Jung1958a/1960, para. 577), and therefore that there may bemore severe forms of thedisorder ‘for which a psychogenic aetiology can be considered only in minimaldegree or perhaps not at all’ (1958a/1960, para. 577). This again suggests afundamental heterogeneity in aetiology, especially regarding the relativecontributions of a neurodevelopmental process versus a trauma- or stress-inducedsyndrome, and this issue is still being debated today (e.g., Morgan et al. 2013),although it is now recognized that environmental effects operate by altering brainand other biological functions.

Conclusions

Jung was a pioneer: the manner in which he approached understanding,treating, and studying schizophrenia was decades ahead of his time. That hiswork is largely ignored within the psychoanalytic tradition, and byschizophrenia researchers5, is astounding. Outside of Jung scholars, Jung’s rolesin developing the modern concept of schizophrenia, and in setting a standardfor its psychological understanding and treatment (Shamdasani 2003) arelargely forgotten. However, a number of his concepts [e.g., the weakening ofexcitatory andinhibitory functions in cognition; the existence, nature, and

5 Near the end of his life, Jung (1961/1989) recognized that hiswork in schizophreniawas largely ignoredwhen he noted that: ‘It was always astounding to me that psychiatry should have taken so long to lookinto the content of the psychoses’ (p. 127); ‘It seems equally odd to me that my investigations of that timeare almost forgotten today (ibid.) and ‘Already at the beginning of the century I treated schizophreniapsychotherapeutically’ (ibid.).


aetiology of complexes; the emergence and role of archetypal constellation inpsychotic episodes; the hypothesis of a predisposition for intense affect, andits effects on brain function in schizophrenia; the potential for a toxic aetiologyof schizophrenia; the continuum of normal and psychotic phenomena; themeaningfulness of psychotic speech; the role of the therapeutic relationship andpsychotherapy for helping people with schizophrenia; the role of the environmentin symptom expression; heterogeneity within the schizophreniaspectrum, etc.(see above and Silverstein2014) are relevant to currentwork in cognitive neuroscienceand treatment development. Concerning psychotherapy, Jung’s views thatschizophrenia may have a psychological basis, that symptom expression is at leastpartly a function of psychological and environmental determinants, and that thisbehooves clinicians to develop relationships with patients and to use the nature andcontent of symptoms as a guide to treatment may not seem revolutionarytoday. However, it is important to recognize how radical these ideas were in theirtime, how they anticipated clinical approaches to schizophrenia over the past 100years, and how similar they are to contemporary views of the disorder. Despitethis, psychological treatments for schizophrenia are still underutilized (Silversteinet al. 2006a, 2006b), and few Jungian analysts have advanced the field ofpsychotherapy for schizophrenia (Couteau 1988). Concerning research, in Jung’stime, experimental psychological studies of schizophrenia were rare. Now, worksimilar to Jung’s, which focuses on connecting psychological constructs to theirbiological bases, is commonplace.The main theme in Jung’s writings on schizophrenia is that it can and should be

understood at both the psychological and biological levels6. However, onlyrecently have we begun to truly appreciate and embrace biopsychosocial modelsof the disorder, and to appreciate the treatment implications of doing so. For

6 Jung (1958b) wrote: ‘I consider the aetiology of schizophrenia to be a dual one: namely, up to acertain point psychology is indispensable in explaining the nature and the causes of the initial emotionswhich give rise to metabolic alterations. These emotions seem to be accompanied by chemical processesthat cause specific temporary or chronic disturbances or lesions’ (1958b, p. 194); and, schizophrenia‘has two aspects, physiological and psychological, for the disease, so far as we can see today, doesnot permit of a one-sided explanation. Its symptomatology points on the one hand to an underlyingdestructive process, possibly of a toxic nature, and on the other—inasmuch as a psychogenic aetiologyis not excluded and psychological treatment (in suitable cases) is effective—to a psychic factor of equalimportance’(1957/1960, para. 549). Given this, it is interesting to note that, despite Jung’s rejection ofFreud’s wish for him to explain schizophrenia in terms of libido theory (Jung 1912/2011, p. 39), Jungnevertheless adopted a general position that was similar to Freud’s two-sided view regarding neuroses(Silverstein, 1985, 2003). That is, what may have attracted Jung to working with Freud, despite theirdifferences over the nature of the biological basis of psychosis, was their shared view that psychopathologyhad both biological and psychological causes, and that these could be discovered using the science of depthpsychology. Whereas for Freud, circa 1907, the determining biological factor in the neuroses was to befound in increases/decreases and misdirections of nervous system excitation from hypothesized sexualchemistry, related to disruption of normal sexual practices or to the effects of repression ofmaterial relatedto infantile sexual fantasies; for Jung, the organic factor in schizophrenia was not related to sexualfunction, but was the hypothetical toxin X (Silverstein, 2014).


example, in the current dominant paradigm, the aetiology of schizophrenia isviewed as the result of an interaction between a person’s life experience, thecognitive schemata and attributional style that are developed about self andothers, the quality of the interpersonal environment, chronic stress and its effectson the brain, and genetic and other biological (e.g., inflammatory, neurocircuitry)factors that may lead to heightened stress reactions and their excitotoxic conse-quences (Morgan et al. 2013; Silverstein et al. 2013b). Based on this, comprehensivetreatment is no longer seen as medication or psychotherapy alone, but as acombination of interventions that improve coping skills, alter the environment toreduce stress (including by educating caregivers), and, via biological and/orpsychological methods, improving a person’s resilience (Kopelowicz et al. 2009;Silverstein et al. 2013a, 2013b; Silverstein et al. 2006a, 2006b).Jung viewed The Psychology of Dementia Praecox as a milestone of sorts, in

terms of a psychological understanding of schizophrenia, although he recognizedits limitations.

I have made it very easy for my critics: my work has many weak spots and gaps,for which I crave the reader’s indulgence. All the same, the critic must be ruthlessin the interests of truth. Somebody, after all, had to take it on himself to start theball rolling.

(1907/1960, para. 316)

After more than 100 years, the ball is still rolling, and very often in thesame directions. However, relegating Jung’s work on schizophrenia to thehistory books does a disservice to both ourselves and our patients. In contrast,increased attention to Jung’s experimental and theoretical work could lead toimportant research on the mind-brain interface in schizophrenia (which wouldbenefit both cognitive neuroscience and analytical psychology), to a betterunderstanding of self-disturbance in the disorder, and to advances in theoreticalmodels and treatment—all of which are recognized by various stakeholder groupsas important goals. Restoring Jung’s status to be on par with that of Bleuler andKrapelin would help ensure that the implications of the convergence of Jung’sideas and modern cognitive neuroscience and psychotherapy for schizophreniaare usefully explored.

TRANSLATIONS OF ABSTRACT

Jung a été le premier à souligner l’importance des facteurs psychiques dans l’étiologie et letraitement de la schizophrénie. Malgré cela, ainsi que d’autres contributions fondatrices,son travail sur la schizophrénie est presque totalement ignoré ou oublié de nos jours. Cetarticle, qui fait suite à un autre sur les théories de Jung sur l’étiologie et la formation dessymptômes dans la schizophrénie (Journal of Analytical Psychology, 59, 1), passe en revueles idées de Jung à propos des approches psychologiques sur la recherche et sur le traitement


de ce trouble. Cinq thémes seront considérés: 1) la psychopathologie expérimentale; 2) lestroubles de l’attention; 3) le traitement psychologique; 4) la relation entre l’environnement(incluant l’hôpital psychiatrique) et l’expression du symptôme; et 5) l’hétérogénéité et ladiversité de la schizophrénie. La revue de ces champs montre que les idées de Jung sur lamaniére de rechercher ce qui pourrait élucider les mécanismes psychiques dans laschizophrénie, et sur l’importance de la psychothérapie chez ceux qui en sont atteints, vontdans le sens des paradigmes contemporains. De plus, l’exploration supplémentaire deplusieurs points de convergence pourrait conduire à des avancées dans ces deux champs,ainsi qu’en psychologie analytique.

Jung war der erste, der die Wichtigkeit psychologischer Faktoren in der Ätiologie und bei derBehandlung der Schizophrenie unterstrich. Ungeachtet dieser Tatsache und anderergrundlegender Beiträge werden seine Arbeiten zum Thema Schizophrenie heute vollständigignoriert oder sind vergessen. Dieser Aufsatz, eine Weiterführung von einer der TheorienJungs über die Ätiologie und Symptombildung der Schizophrenie (Journal of Analytical Psy-chology, 59,1) überprüft Jungs Ansichten über psychologische Herangehensweisen undTherapie der Störung. Fönf Themen werden behandelt: 1. experimentelle Psychopathologie,2. Aufmerksamkeitsstörung, 3. Psychologische Therapie, 4. die Beziehung zwischenUmgebung (einschließlich des psychiatrischen Krankenhauses) und Symptomausdruck und5. Verschiedenartigkeit und Spektrum der Schizophrenie. Betrachtungen dieser Gebiete lassenerkennen, daß Jungs Vorstellungen über die Art von Forschung, die psychologischeMechanismen der Schizophrenie zu erklären vermögen, sowie die Wichtigkeit vonPsychotherapie für Menschen mit dieser Erkrankung, sehr auf der Linie der heutigenParadigmen liegen. Überdies könnten weitere Untersuchungen einiger der Konvergenzpunktezu Fortschritten auf beiden Feldern führen, wie auch innerhalb der Analytischen Psychologie.

Jung fu il primo a porre l’accento sull’importanza dei fattori psicologici per l’eziologia e iltrattamento della schizofrenia. Nonostante ciò e nonostante altri contributi originali, oggi ilsuo lavoro sulla schizofrenia è quasi del tutto ignorato o dimenticato. Questo lavoro, che se-gue uno precedente sulle teorie di Jung riguardanti l’eziologia e la formazione dei sintominella schizofrenia (Journal of Analytical Psychology, 59, 1) riesamina gli approcci psicologicidella ricerca e il trattamento di questo disturbo. Vengono considerati cinque aspetti: 1) lapsicopatologia sperimentale; 2) i disturbi dell’attenzione; 3) il trattamento psicologico; 4) larelazione tra l’ambiente (incluso l’ospedale psichiatrico) e l’espressione dei sintomi; 5)l’etereogeneità e lo spectrum della schizofrenia. Una revisione di queste aree mostrano chele idee di Jung su quale tipo di ricerca può chiarire i meccanismi psicologici nella schizofreniae sull’importanza della psicoterapia per persone in questa condizione, sonomolto in linea coni paradigmi contemporanei. Inoltre una ulteriore esplorazione dei vari punti di convergenzapuò portare ad avanzamenti in entrambi questi campi, così come all’interno della psicologiaanalitica.

Юнг был первым, кто подчеркивал важность психологических факторов в этиологиилечения шизофрении. Несмотря на это и другие конструктивные идеи, его работой о


шизофрении почти полностью пренебрегают сегодня, она практически забыта. Даннаястатья, следуя за теориями Юнга об этиологии и формировании симптомов пришизофрении (Журнал Аналитической Психологии, 59,1) дает обзор взглядам Юнга напсихологические подходы к исследованиям и лечению этого расстройства.Раскрываются пять тем: 1) эмпирическая психопатология; 2) нарушения внимания; 3)психологическая терапия; 4) отношения с окружением (включая психиатрическуюбольницу) и выражение симптомов; и 5) гетерогенность и шизофренический спектр.Обзор этих областей показывает, что идеи Юнга о таком способе исследования,который позволил бы объяснить психологические механизмы возникновенияшизофрении, важность прохождения психотерапии людьми с этим состоянием, оченьтесно согласуются с современными парадигмами. Более того, дальнейшее исследованиенескольких пунктов сходства может привести к находкам и развитию обоих этих полей,равно как и развитию аналитической психологии.

Jung fue el primero en destacar la importancia de los factores psicològicos en la etiologìay el tratamiento de la esquizofrenia. A pesar de esto, y otras aportaciones fundamentales,su trabajo sobre la esquizofrenia es casi completamente ignorado u olvidado hoy día.Este documento, que da seguimiento a una de las teorìas de Jung de la etiologìa y elsíntoma formaciòn en la esquizofrenia (Journal of Analytical Psychology, 59, 1) revisalas opiniones de Jung sobre los enfoques psicològicos en la investigaciòn y el tratamientode la enfermedad. Se cubren cinco temas: 1) psicopatologìa experimental; 2) alteracionesde la atenciòn; 3) tratamiento psicològico; 4) la relaciòn entre el medio ambiente,(incluido el hospital psiquiátrico) y la expresiòn del sìntoma; y 5) heterogeneidad y elespectro de la esquizofrenia. La revisiòn de estos aspectos revela que las ideas de Jungsobre el tipo de investigaciòn que puedan dilucidar los mecanismos psicològicos de laesquizofrenia, y la importancia de la psicoterapia para las personas con esta afecciòn,están muy en consonancia con los actuales paradigmas. Por otra parte, una mayorexploraciòn de varios puntos de convergencia podrìa conducir a avances en ambos cam-pos y en psicologìa analítica.

References

Bachmann, S., Resch, F. & Mundt C. (2003). ‘Psychological treatments for psychosis:history and overview’. Journal of the American Academy of Psychoanalysis andDynamic Psychiatry, 31, 155–76.

Barretto, E.M., Kayo, M., Avrichir, B.S., Sa, A. R., Camargo, M.D., Napolitano, I.C., Nery, F.G., Pinto, J.A. Jr., Bannwart, S., Scemes, S., Di Sarno, E. & Elkis, H.(2009). ‘A preliminary controlled trial of cognitive behavioral therapy inclozapine-resistant schizophrenia’. Journal of Nervous and Mental Disease,197, 865–68.

Bentall, R. (1999). ‘Why there will never be a convincing theory of schizophrenia’. InFrom Brains to Consciousness? Essays on the New Sciences of Mind, ed. S. Rose.London: Penguin Books, 109–36.

Bentall, R.P. &Fernyhough, C. (2009). ‘Social predictors of psychotic experiences:specificity and psychological mechanisms’. Schizophrenia Bulletin, 34, 1012–20.


Berry, K., Barrowclough, C. & Haddock, G. (2000). ‘The role of expressed emotion inrelationships between psychiatric staff and people with a diagnosis of psychosis: areview of the literature’. Schizophrenia Bulletin, 37, 958–72.

Bleuler, E. (1906). Affectivität, Suggestibilität, Paranoia. Halle: Carl Marhold Publishers.Bola, J.R., & Mosher, L.R. (2003). ‘Treatment of acute psychosis without neuroleptics:

two-year outcomes from the Soteria project’. Journal of Nervous and Mental Disease,191, 219–29.

Calton, T., Ferriter, M., Huband, N. & Spandler, H. (2008). ‘A systematic review of theSoteria paradigm for the treatment of people diagnosed with schizophrenia’.Schizophrenia Bulletin, 34, 181–92.

Cancro, R. (1983). ‘Some preliminary thoughts on the psychotherapy of theschizophrenias’. In Psychosocial Intervention in Schizophrenia: AnInternational View, eds. H. Stierlin, L.C. Wynne, W. Wirsching. Berlin:Springer-Verlag, 143–48.

Carpenter, W. T., Jr. (2013). ‘How the diagnosis of schizophrenia impeded the advanceof knowledge (and what to do about it)’. In Schizophrenia: Evolution and Synthesis:Strüngmann Forum Reports, Vol. 13, eds. S.M. Silverstein, B. Moghaddam, T. Wykes,J. Lupp, series ed. Cambridge: MIT Press.

Carson, R.C. (1962). ‘Proverb interpretation in acutely schizophrenic patients’. Journalof Nervous and Mental Disease, 135, 556–64.

Chadwick, P. (2006). Person-Based Cognitive Therapy for Distressing Psychosis.Chichester, UK: Wiley.

Chadwick, P., Birchwood, M.J. &Trower, P. (1999). Cognitive Therapy for Delusions,Voices, and Paranoia. New York: Wiley.

Corrigan, P.W. & Liberman, R.P. (Eds.). (1994). Behavior Therapy in PsychiatricHospitals. New York: Springer.

Couteau, R. (1988). ‘Jungian social neglect’. Spring: A Journal of Archetype and Culture,197–202.

Docherty, N.M. (2012). ‘On identifying the processes underlying schizophrenic speechdisorder’. Schizophrenia Bulletin, 38, 1327–35.

Drake, R.E. & Sederer, L.I. (1986). ‘The adverse effects of intensive treatment of chronicschizophrenia’. Comprehensive Psychiatry, 27, 313–26.

Elser, H. (1982). ‘Bibiotherapy in practice’. Spring, 647–59.Fossati, A. & Lenzenweger, M.F. (2009). ‘Naturafacitsaltus: Discontinuities in the latent

liability to schizophrenia and their implications for clinical psychiatry’. GiornaleItalioni Di Psicopatologia, 15, 219–30.

Freud, S. (1896). ‘Further remarks on the defense neuro-psychoses’. In EarlyPsychoanalytic Writings, ed. P. Rieff. New York: Collier Books, 151–74.

Frosch, J.P., Gunderson, J.G., Weiss, R. & Frank, A. (1983). ‘Therapists who treatschizophrenic patients: Characterization’. In Psychosocial Intervention in Schizophrenia: AnInternationalView, eds.H. Stierlin, L.C.Wynne,M.Wirsching.Berlin: Springer-Verlag,169–76.

Fuller Torry, E. (2006). Surviving Schizophrenia. New York: Harper Perennial.Fuster, J.M. (2003). Cortex and Mind. New York: Oxford University Press.Goldstein, M.J. (1995). ‘Psychoeducation and relapse prevention’. International Clinical

Psychopharmacology, 9 Suppl. 5, 59–69.Gorissen, M., Sanz, J.C. & Schmand, B. (2005). ‘Effort and cognition in schizophrenia

patients’. Schizophrenia Research, 78, 199–208.Granholm, E., Verney S.P., Perivoliotis, D., Miura, T. (2007). ‘Effortful cognitive resource

allocation and negative symptom severity in chronic schizophrenia’. SchizophreniaBulletin, 33, 831–42.

Greek, M. (2010). ‘How a series of hallucinations tells a symbolic story’. SchizophreniaBulletin, 36, 1063–65.


Hains, A.B., Arnsten, A.F. (2008). ‘Molecular mechanisms of stress-induced prefrontalcortical impairment: implications for mental illness’.Learning andMemory, 15, 551–64.

Hamm, J.A., Hasson-Ohayon, I., Kukla, M. & Lysaker, P.H. (2013). ‘Individualpsychotherapy for schizophrenia: trends and developments in the wake of the recoverymovement’. Psychology Research and Behavior Management, 6, 45–54.

Harrow, M. & Prosen, M. (1978). ‘Intermingling and disordered logic as influences onschizophrenic ’thought disorders’. Archives of General Psychiatry, 35, 1213–18.

——— (1979). ‘Schizophrenic thought disorders: bizarre associations andintermingling’. American Journal of Psychiatry, 136, 293–96.

Havens, L. (2000). ‘Treating psychoses’. In The Real World Guide to PsychotherapyPractice, eds. A.N. Sabo, L. Havens. Cambridge, MA: Harvard University Press, 149–62.

Heinrichs, R. W. (2001). In Search of Madness: Schizophrenia and Neuroscience. NewYork: Oxford University Press.

Hokama, H., Hiramatsu, K., Wang, J., O’Donnell, B.F. & Ogura, C. (2003). ‘N400abnormalities in unmedicated patients with schizophrenia during a lexical decisiontask’. International Journal of Psychophysiology, 48, 1, 1–10.

Hunter, R. Wilkniss, S.M., Gardner, W. & Silverstein, S.M. (2008). ‘The MultimodalFunctional Model--Advancing case formulation beyond the “diagnose and treat”paradigm: improving outcomes and reducing aggression and the use of controlprocedures in psychiatric care’. Psychological Services, 5, 11–25.

Insel, T.R. (2010). ‘Rethinking schizophrenia’. Nature, 468, 187–93.Jackson, H.J., McGorry, P.D., Killackey, E., Bendall, S., Allott, K., Dudgeon, P.,

Gleeson, J., Johnson, T. & Harrigan, S. (2008). ‘Acute-phase and 1-year follow-upresults of a randomized controlled trial of CBT versus Befriending for first-episodepsychosis: the ACE project’. Psychological Medicine, 38, 725–735.

Jaffé, A. (1972). ‘The creative phases in Jung’s life’. Spring: Annual of ArchetypalPsychology and Jungian Thought, 162–90.

Jaspers, Karl (1913/1997).General Psychopathology - Volumes 1& 2. Trans. J. Hoenig,M. W. Hamilton. Baltimore & London: Johns Hopkins University Press.

Jung, C.G. (1906/1981). ‘The psychopathological significance of the associationexperiment’. CW2.

Jung, C.G. (1907/1960). The Psychology of Dementia Praecox. CW 3.——— (1912/2011). Jung Contra Freud: The 1912New York Lectures on the Theory of

Psychoanalysis. Trans. R.F.C. Hull; Introduction by S. Shamdasani). Bollingen Series/Philemon Series (Book 20). Princeton: Princeton University Press.

——— (1915). ‘On psychological understanding’. Journal of Abnormal Psychology, 9,385–99.

——— (1939/1960). ‘On the psychogenesis of schizophrenia’. CW 3.——— (1957/1960). ‘Recent thoughts on schizophrenia’. CW 3.——— (1958a). ‘Schizophrenia’. CW 3.——— (1958b). Appendix. CW 3.——— (1961/1989). Memories, Dreams, Reflections. New York: Random House.Kates, J. & Rockland, L. (1994). ‘Supportive psychotherapy of the schizophrenic

patient’. American Journal of Psychotherapy, 48, 543–61.Kopelowicz, A., Liberman, R.P. & Silverstein, S.M. (2009). ‘Psychiatric rehabilitation’.

In Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th edn., eds. B. J.Sadock, V.A. Sadock. Baltimore: Lippincott Williams & Wilkins, 4329–70.

Kopelowicz, A., Liberman, R.P. & Stolar, D. (2011, January 4). ‘Clinical experience withthe Friendship and Intimacy Module’. Retrieved from: http://www.health.am/psy/more/clinical-experience-with-the-friendship-and-intimacy-module/ on August 25, 2013.

Kreher, D.A., Goff, D. & Kuperberg, G.R. (2009). ‘Why all the confusion? Experimentaltask explains discrepant semantic priming effects in schizophrenia under "automatic"


http://www.health.am/psy/more/clinical-experience-with-the-friendship-and-intimacy-module/

http://www.health.am/psy/more/clinical-experience-with-the-friendship-and-intimacy-module/

conditions: evidence from Event-Related Potentials’. Schizophrenia Research, 111,174–181.

Kuperberg, G.R., Sitnikova, T., Goff, D. & Holcomb, P.J. (2006). ‘Making sense ofsentences in schizophrenia: electrophysiological evidence for abnormal interactionsbetween semantic and syntactic processing’. Journal of Abnormal Psychology, 115,251–65.

Lehtinen, V., Aaltonen, J., Koffert, T., Räkköläinen, V. & Syvälahti, E. (2000). ‘Two-yearoutcome in first-episode psychosis treated according to an integrated model. Isimmediate neuroleptisation always needed?’ European Psychiatry, 15, 312–20.

Leif, A. (Ed.). (1948). The Commonsense Psychiatry of Dr. Adolf Meyer. New York:McGraw Hill.

Lysaker, P.H., Glynn, S.M., Wilkniss, S.M. & Silverstein, S.M. (2010). ‘Psychotherapyand recovery from severe mental illness: A review of potential applications and needfor future study’. Psychological Services, 7, 75–91.

Lysaker, P.H. & Lysaker, J.T. (2008). Schizophrenia and the Fate of the Self. Oxford:Oxford University Press.

Lysaker, P.H. & Silverstein, S.M. (2009). ‘Psychotherapy of schizophrenia: A briefhistory and the potential to promote recovery’. Clinical Case Studies, 8, 417–23.

Masselon, R. (1902). Psychologie des DémentsPrécoces. Paris: L. Boyer.McGuire, W. (1960). Editorial note. CW 3.McGuire, W. (Ed). (1974). The Freud-Jung Letters: The Correspondence Between

Sigmund Freud and C. G. Jung. Princeton: Princeton University Press.Medalia, A. &Choi, J. (2009). ‘Cognitive remediation in schizophrenia’.Neuropsychology

Review, 19, 353–64.Medalia, A., Revheim, N., Casey, M. (2002). ‘Remediation of problem-solving skills in

schizophrenia: evidence of a persistent effect’. Schizophrenia Research, 57, 65–71.Meehl, P.E. (1962). ‘Schizotaxia, schizotypy, schizophrenia’. American Psychologist, 17,

827–38.Meyer, A. (1910). ‘The dynamic interpretation of dementia praecox’. American Journal

of Psychology, 21, 385–403.Moe, A.M. & Docherty, N.M. (2013, in press). ‘Schizophrenia and the sense of self’.

Schizophrenia Bulletin.Morgan, C., O’Donovan, M., Bittner, R.A., Cadenhead, K.S., Jones, P.B., McGrath, J.,

Silverstein, S.M., Tost, H., Uhlhaas, P. & Voineskos, A. (In press, 2013). ‘How can riskand resilience factors be leveraged to optimize discovery pathways? ‘ In Schizophrenia:Evolution and Synthesis. Strüngmann Forum Reports, Vol. 13, eds. S. M. Silverstein,B. Moghaddam, T. Wykes, J. Luppseries. Cambridge: MIT Press, 137–64.

Moskowitz, A. (2006). ‘Pierre Janet’s influence on Bleuler’s concept of schizophrenia’. InTrauma, Dissoziation, Persönlichkeit: Pierre Janet’s BeiträgezurModernenPsychiatrie,Psychologie und Psychotherapie, ed. P. Fiedler. Lengerich: Pabst Science Publishers.

Nahor A.B. & Vannicelli, M. (1976). ‘The influence of instructional set on schizophrenicvs. organic concreteness’. ConfiniaPsychiatrica, 19, 89–95.

Oshima, I., Mino, Y. & Inomata, Y. (2003). ‘Institutionalisation and schizophrenia inJapan: social environments and negative symptoms: nationwide survey of in-patients’.British Journal of Psychiatry, 183, 50–56.

——— (2005). ‘Effects of environmental deprivation on negative symptoms ofschizophrenia: a nationwide survey in Japan’s psychiatric hospitals’. PsychiatryResearch, 136, 163–71.

Patterson, C.H. (1984). ‘Empathy, warmth, and genuineness in psychotherapy. A reviewof reviews’. Psychotherapy, 21, 431–38.

Paul, G.L. & Lentz, R.J. (1977). Psychosocial Treatment of Chronic Mental Patients:Milieu vs. Social Learning Programs. Cambridge, MA: Harvard University Press.


Perälä, J., Suvisaari, J., Samuli, I., Kuoppasalmi, K., Isometsä, E., Pirkola, S., Partonen,T., Tuulio-Henriksson, A., Hintikka, J., Kieseppä, T., Härkänen, T., Koskinen, S., &Lönnqvist, J. (2007). ‘Lifetime prevalence of psychotic andbipolar I disorders in ageneral population’. Archives of General Psychiatry, 64, 19–28.

Perivoliotis, D., Grant, P.M. & Beck, A.T. (2009).‘Advances in cognitive therapy forschizophrenia: Empowerment and recovery in the absence of insight’. Clinical CaseStudies, 8, 424–37.

Peterson, F. & Jung, C.G. (1907/1981). ‘Psychophysical investigations with thegalvanometer and pneumograph in normal and insane individuals’. CW2.

Pharoah, F., Mari, J., Rathbone, J. & Wong, W. (2010). ‘Family intervention forschizophrenia. The Cochrane Database of Systematic Reviews, 12, CD000088. doi:10.1002/14651858.CD000088.pub2.

Pratte, M.S., Ling, S., Swisher, J.D., Tong, F. (2013, in press). ‘How attention extractsobjects fromnoise’. Journal of Neurophysiology.

Ragland, J.D., Gur, R.C., Valdez, J.N., Loughead, J., Elliott, M., Kohle, C., Kanes, S.,Siegel, S.J., Moelter, S.T., Gur, R.E. (2005). ‘Levels-of-processing effect onfrontotemporal function in schizophrenia during word encoding and recognition’.American Journal of Psychiatry, 162, 1840–48.

Rector, N.A. & Beck, A.T. (2012). ‘Cognitive behavioral therapy for schizophrenia: anempirical review’. Journal of Nervous and Mental Disease, 200, 832–39.

Reichenberg, A. (2010). ‘The assessment of neuropsychological functioning inschizophrenia’. Dialogues in Clinical Neuroscience, 12, 383–92.

Rodriguez, V. (2003). ‘Jung on schizophrenia: an introductory survey’. Retrieved fromhttp://www.meta-religion.com/Psychiatry/Analytical_psychology/jung_on_schizophrenia.htm on 1.31.06.

Shakeel, M.K. & Docherty, N.M. (2012). ‘Neurocognitive predictors of sourcemonitoring in schizophrenia’. Psychiatry Research, 200, 173–76.

Shamdasani, S. (2003). Jung and the Making of Modern Psychology. Cambridge, UK:Cambridge University Press.

Silver, A.L., Koehler, B. &Karon, B. (2003). ‘Psychotherapy of schizophrenia: its history anddevelopment’. InModels of Madness: Psychological, Social and Biological Approaches toSchizophrenia, eds. J. Read, L. Mosher, R. Bentall. London: Brunner-Routledge, 209–22.

Silverstein, B. (1985). ‘Freud’s psychology and its organic foundation: sexuality andmind-body interactionism’. Psychoanalytic Review, 72, 203–28.

——— (2003). What Was Freud Thinking? A Short Historical Introduction to Freud’sTheories and Therapies. Dubuque, Iowa: Kendall-Hunt.

Silverstein, S.M. (2000). ‘Psychiatric rehabilitation of schizophrenia: Unresolved issues,current trends and future directions’. Applied and Preventive Psychology, 9, 227–48.

——— (2007). ‘Integrating Jungian and self-psychological perspectives withincognitive-behavior therapy for a young man with a fixed religious delusion’. ClinicalCase Studies, 6, 263–76.

——— (2010). ‘Bridging the gap between extrinsic and intrinsic motivation in thecognitive remediation of schizophrenia’. Schizophrenia Bulletin, 36, 949–56.

——— (2014). ‘Jung’s views on causes and treatments of schizophrenia in light ofcurrent trends in cognitive neuroscience and psychotherapy research: I. Aetiologyand phenomenology’. Journal of Analytical Psychology, 59, 1.

Silverstein, S.M. & Bellack, A.S. (2008). ‘A Scientific agenda for the concept of recoveryas it applies to schizophrenia’. Clinical Psychology Review, 28, 1108–24.

Silverstein, S.M. & Lysaker, P.H. (2009). ‘Progress towards a resurgence and remodelingof psychotherapy for schizophrenia’. Clinical Case Studies, 8, 407–16.

Silverstein, S.M., Moghaddam, B. & Wykes, T. (2013a). ‘Schizophrenia: The nature ofthe problems and the need for evolution and synthesis in our approaches’. In


http://www.meta-religion.com/Psychiatry/Analytical_psychology/jung_on_schizophrenia.htm

http://www.meta-religion.com/Psychiatry/Analytical_psychology/jung_on_schizophrenia.htm

Schizophrenia: Evolution and Synthesis. Strüngmann Forum Reports, Vol. 13, eds. S.M. Silverstein, B. Moghaddam, T. Wykes; series ed. J. Lupp. Cambridge, MA: MITPress, 13–34.

Silverstein, S.M., Moghaddam, B., & Wykes, T. (Eds.) (2013b). Schizophrenia:Evolution andSynthesis. Strüngmann Forum Reports, vol. 13, series ed. J. Lupp.Cambridge, MA: MIT Press.

Silverstein, S.M., Spaulding, W.D. & Menditto, A.A. (2006a). Schizophrenia:Advances in Evidence-Based Practice. Cambridge, MA: Hogrefe & Huber.

Silverstein, S.M., Wong, M-H., Wilkniss, S.M., Bloch, A., Smith, T.E., Savitz, A.,McCarthy, R. & Terkelsen, K. (2006b). ‘Behavioral rehabilitation of the“treatment-refractory” schizophrenia patient: Conceptual foundations, interventions,interpersonal techniques, and outcome data’. Psychological Services, 3, 145–69.

Smith, S.M. & Yanos, P.T. (2009). ‘Psychotherapy for schizophrenia in an ACT teamcontext’. Clinical Case Studies, 8, 454–62.

Spitzer, M. (1993). ‘Associative networks, formal thought disorders and schizophrenia.On the experimental psychopathology of speech-dependent thought processes’(in German). Nervenarzt, 64, 147–59.

Tarrier, N. (2010). ‘Cognitive behavior therapy for schizophrenia and psychosis:current status and future directions’. Clinical Schizophrenia and Related Psychoses,4, 176–84.

Taylor, E. (1998). ‘Jung before Freud, not Freud before Jung: the reception of Jung’swork in American psychoanalytic circles between 1904 and 1909’. Journal ofAnalytical Psychology, 43, 97–114.

Turkington, D., Sensky, T., Scott, J., Barnes, T.R., Nur, U., Siddle, R., Hammond, K.,Samarasekara, N. & Kingdon, D. (2008). ‘A randomized controlled trial ofcognitive-behavior therapy for persistent symptoms in schizophrenia: a five-yearfollow-up.’ Schizophrenia Research, 98, 1–7.

Whitehorn, J.C. & Betz B.J. (1960). ‘Further studies of the doctor as a crucial variable inthe outcome and treatment of schizophrenic patients’. American Journal of Psychiatry,117, 25–223.

Williams, L. M. & Gott, C. (2013, in press). ‘What dimensions of heterogeneity arerelevant for treatment outcome?’ In Schizophrenia: Evolution and Synthesis.Strüngmann Forum Reports, Vol. 13, eds. S.M. Silverstein, B. Moghaddam, T. Wykes;series ed. J. Lupp. Cambridge, MA: MIT Press.

Wing, J.K. & Brown, G.W. (1970). Institutionalism and Schizophrenia. London:Cambridge University Press.

Yanos, P.T., Roe, D., West, M.L., Smith, S.M. & Lysaker, P.H. (2012). ‘Group-basedtreatment for internalized stigma among persons with severe mental illness: findingsfrom a randomized controlled trial’. Psychological Services, 9, 248–58.

Zarlock S.P. (1966). ‘Social expectations, language, and schizophrenia’. Journal ofHumanistic Psychology, 6, 68–74.

Acknowledgments

I thank Barry Silverstein, George Atwood and Matthew Rochéfor theirencouragement to write this paper, and for helpful suggestions regarding itsfinal content and form.


Documents

Jungs views on causes and treatments of schizophrenia in ...ubhc.rutgers.edu/dsr/papers/documents/SilversteinJung2JAP.pdf · Jung’s views on causes and treatments of schizophrenia