The primacy of psychoanalytic intervention in recovery from the psychoses and schizophrenias.

Functional capacities, such as attachment and affect regulation, object relations capacity, symbolic function and language development, now documented by neuroscientific research and epigenetics, are reviewed. Results from this research, together with other factors, are posited to have contributed to effective contemporary psychoanalytic and psychotherapeutic treatments for the psychoses and schizophrenias. Etiological factors involving the schizophrenias and other psychoses are considered both in terms of an epigenetic model, and in terms of how etiology may, or may not, affect clinical treatment. The Lacanian 388 program is reviewed in some detail, as are several psychoanalytic and psychotherapeutic clinical approaches used with this population over the last six decades. All treatments focus on the primacy of psychotherapeutic intervention, and use medications minimally, not at all, or only as informed by an over-arching psychodynamic model of treatment. The author argues that there is now substantial research and outcome data suggesting that the psychoses and schizophrenias are not chronic deteriorating conditions. Recovery is observed in many psychotic and schizophrenic patients treated with approaches that focus on the primacy of psychotherapeutic intervention.