Searles,

Harold F. (1958). International Journal of Psycho-Analysis, 39:569-586

Positive Feelings in the Relationship Between the Schizophrenic and his Mother.

Presenter Note: The following is an abbreviated version of the full paper in consideration of the time
available for reading at the December 19, 2012 Scientific Meeting sponsored by Northwestern
Psychoanalytic Society. I have tried my best to retain the essence of Searles thesis in the literature
review and theoretical sections of the paper. The case material is presented in close to its entirety.
The full paper is available for those who have access to the Psychoanalytic Electronic Publishing
(PEP), or in a slightly different version as Chapter 7 (p. 216-253) of Collected Papers on
Schizophrenia and Related Subjects (1965). My annotations are indicated in footnotes (whereas the
authors footnotes are shown within the text).
Caron Harrang, LICSW, FIPA

Introduction

My experience in the psychotherapy of chronic schizophrenic patients has
convinced me that, in the patient's relationship with his mother, the basic feelings,
those which more than any others determine the structure of the relationship and
the development of the patient's illness, are positivefondness, adoration,
compassion, solicitude, and loving loyalty and dedication. In this relationship, which
is regarded by many psychodynamically-oriented researchers as being of central
importance in the etiology of most cases of schizophrenia1, I have found that it is not
the often-emphasized mutual hatred and rejection and self-seeking dependence
which forms its foundation, but rather genuine love for one anotherlove largely
maintained in the unconscious through intense denial-mechanisms, and love which
finds extremely warped expression, but love nonetheless. Further, I have found that
it is essential for the patient to become aware of the presence of this love between
his mother and himself, in order to develop both a healthy self-esteem and a
thorough-going resolution of his schizophrenic illness.2

The views I shall present have grown out of eight years of work devoted
predominantly to the intensive psychotherapy of schizophrenic patients at Chestnut
Lodge; interviews with the parents of schizophrenic patients, occurring sporadically
during these eight years, and in relatively great number during one year when I
served as admitting physician at the Lodge; observations of the work of the many
colleagues with whom I have worked here during this time; and, last but very
important, my family-life experience with my wife and our threerelatively normal,
I believechildren, aged eleven years, eight years, and three months3.

1 Although Searles focus is on schizophrenia, the mother-infant (child) relationship
2 In a related paperThe Evolution of the Mother Transference in Psychotherapy
with the Schizophrenic PatientSearles comments that his discovery of love in the
transference is the most important insight I have reached in ten years of work with
schizophrenic patients, and which stands, as [this paper shows], in marked contrast
to a voluminous literature on the relationship between the schizophrenic patient
and his mother.
3 Searles was age 40 in 1958 when this paper was first published.


Review of Literature

There is a great deal of literature concerning this subject, the bulk of it in agreement
as to the predominantly and basically hateful nature of the relationship in
questiona view from which this paper marks a sharp departure. A paper by
Suzanne Reichard and Carl Tillman in 1950, provides an exhaustive review of the
then-existing literature concerning this and closely related subjects; it includes a
summary of about thirty previous writings. There is a total emphasis herenot only
in the authors' report of their own work, but also throughout the earlier reports of
other writers which their paper summarizeson parental hostility, with no
mention whatever of any genuine love on the part of the parent toward the child.
[Searles goes on to cite other authors who support this point of view, including Ruth
and Theodore Lidz (1952), Lewis B Hill (1955), and Davide Limetani (1956)]

In the literature, despite its very predominant emphasis upon the negative aspects
of the mother-child relatedness, we occasionally come upon a paper which pays
somewhat greater heed to the positive factors involved. For example, Margaret S.
Mahler says that a symbiotic mother-infant relatedness is essential to healthy
infancy, and reports that the more severe of two types of psychosis found in young
children, the autistic type, occurs in those who have never shared such a mother-
infant symbiosis. [The author includes Carl Whitaker and Thomas Malone (1953),
Abrahams and Varon (1953) and Murray Bowen (1956) as recognizing to some degree
the schizophrenic individuals loving feelings toward the mother or primary
caretaker.]

Still, to the best of my knowledge, no one has gone so far as I am going here in
stressing the importance of the positive feelings in this mother-child relationship
in portraying such feelings as its most powerful determinants, and in regarding the
overlying intense, mutual hostility as consisting in unconscious, mutual denial of
these deeply-repressed positive feelings. The crucial data supporting my theoretical
concepts have come from transference phenomena, often of a non-verbal nature,
encountered in very long-range psychotherapy with schizophrenic patients. It is the
evolution of the transference which reveals, usually only after a duration of
intensive psychotherapy which in most institutions is utterly infeasible, that behind
what has appeared for literally years to be rock-bottom hatred and rejection toward
the therapist as a parent-figure, there exist very deep-lying, very powerful and
utterly genuine feelings of love toward the parentsincluding, as is seen last of all
but entirely convincingly, the mother. The schizophrenic illness now becomes
basically revealed as representing the child's loving sacrifice of his very
individuality for the welfare of the mother who is loved genuinely, altruistically, and
with the wholehearted adoration which, in the usual circumstances of human living,
only a small child can bestow.

THE WRITERS VIEWS ON THIS SUBJECT

The formulation which I shall present must inevitably emerge as an over-

simplification of the relationship between the schizophrenic patient and the mother,
for two reasons. First, I am trying to generalize, and generalizations can never do
justice to the manifold individual differences between any one such patient-parent
relationship and another. Secondly, I am focusing upon the love-element in that
relationship, a relationship which comprises various other important ingredients.
But, in the latter connexion, I must emphasize that I consider this love-element to be
the most influential among all these various ingredients. That is, I think that the
whole relationship between the patient and his mother can be described most
adequately as a function not of mutual efforts at warding off anxiety, or of a mutual
conflict between dependence needs and efforts towards individuation, but rather as
a function of both persons' efforts to express love towards one another. My whole
conceptual structure rests upon a conviction that the most powerful driving force in
human beings, including schizophrenic patients and their mothers, is nothing so
negative as an effort to avoid anxiety, but rather is the effort to express himself or
herself in a loving, constructive way.

[Before presenting case material supporting his thesis, Searles describes the factors in
the mothers personality that thwarts a normal mother/infant relationship, the childs
experience of that relationship, and how this developmental picture manifests, later
on, in the transference relationship with the analyst.]

The Psychodynamics in the Mother

First I wish to note [the mothers] evident fear of her own love-feelings, her reacting
to them as being the most destructive component within herself, that which
requires the most vigorous repression. It appears that this fear developed primarily
as a result of her having found, in childhood, that her expressions of love rendered
her mother anxious and psychologically withdrawn. Further, in many instances,
tragic early-life experiences of beloved persons dying, or otherwise departing
permanently from the scene, tended to confirm the child's fear that her own love
had an annihilating effect upon others. In consequence, her love feelings became
subjected to growingly complete repression, so early in the child's life that these
feelings were still in a relatively primitive form, poorly differentiatedin line with
the immaturity of her young egofrom other, potentially quite different, affects,
such as murderous feelings, dependence feelings, and so on, which became largely
repressed along with the love feelings, in a poorly-differentiated complex of what
one might call the child's deepest passions. This repressed feeling-complex, being
largely cut off from the conscious ego, failed to mature and to become more fully
differentiated into qualitatively very distinct feelings... Thus when the mother's love
does at times succeed in breaking through the repression and emerging into
awareness, it surges up in a frighteningly primitive form (often an oral-
incorporative form, as is chronically acted out in these mothers' 'smothering'
maternal behaviour), and associated, moreover, with frustration-rage and various
other primitive emotions from which the love-feelings have never become clearly
differentiated.


The mother of a schizophrenic young man, in the course of an unusually illuminating
two-hour interview with me, poignantly revealed her anxiety concerning her
feelings of maternal loveanxiety which had evidently operated with regard not
only to her schizophrenic son, but to her other two children, a few years older than
he, both of whom were functioning well, apparently quite free from schizophrenic
symptoms. She said, with regard to all her children as infants, that she had wanted
intensely to hold them; but, knowing that she herself had been nervous in childhood
and adolescence, she had been afraid that her holding them would cause them to
become nervous. 'I enjoyed it so intensely, holding them, that I wondered if there
were something wrong with me. You knowhaving a baby's head on your shoulder,
and cuddling it.' She said this in a tone of unmistakably genuine yearning to express
her love. She went on, in a pathetically uncertain way, 'Over the years I've
wondered' about the feeling, wondered whether it were a normal feeling. She said
that in recent years she had been pleased to find that she had felt this same feeling
towards her grand-children while holding them; these experiences, occurring
several years after her own reproductive life was over, she had found reassuring, for
'I felt it was me, and not because of my glands, like a mother kitten.'3 It seemed that
she regarded her own maternal feelings as being subhuman, and threatening,
therefore, to have a dehumanizing effect upon her babies.

-----------------------------------------
3 Her use of the curious phrase 'mother kitten', rather than 'mother cat', is
significant: this woman, like other mothers of schizophrenic patients whom I have
seen, had much about her that was touchingly childlike. The typical mother of the
schizophrenic is, in my experience, a kind of mother-child (mother-kitten).
-----------------------------------------

So far, as regards the mother's psychodynamics which are relevant in this paper, I
have been dealing with her fear of her own love-feelings. The second factor which I
wish to mention is her low self-esteem. Her low self-esteem will come to have, as I
shall shortly show, traumatic effects upon her relationship with her child, on at least
two scores. It will interfere with her receptivity of the child's loving solicitude and
helpfulness, so that the child will be hampered in the development of a sense of
personal worth in relation to the most important individual in his life; he will tend
to feel worthless to, and unneeded by, his mother. And the mother's low self-esteem
will interfere also with the child's idolizing of herwith the development and
maintenance of the kind of relationship which the young child needs to have with
his mother in order to develop constructive identifications with her

At what phase in the patient's life his mother brings these transference feelings to
bear upon him I do not know. My impression is that the timing may vary
considerably in various instances; for some children it is in late infancy, for others in
early infancy, for others at birth, and not a few, I believe, before birth.

The Needs of the Normal Infant and Child


Throughout most of the literature concerning the etiology of schizophrenic illness
and in fact that concerning the psychogenesis of any variety of psychiatric illness
there is an almost exclusive emphasis upon the infant's (and child's) need to receive
love, and upon the failure of those about him to give him the love he needed. What is
usually overlooked is the fact that the infant and child has an equally great need,
from the first, to express his own love to others. Much of this literature portrays the
newborn baby, for example, as being totally receiving, as though those in his
environmentincluding his motherreceived nothing of value from him.

My belief, by contrast, is that the infant and child normally gives, and needs to give,
at least as much as he receives. For example, the lactating mother whose breasts are
painfully swollen with milk has a need to be nursed which is no less urgent than is
the hungry infant's need to nurse. Here we see, in this basic situation, that genuine
receptiveness (as personified by the nursing infant) bestows, in the same process, a
gifta joy, a relief, an enriching experience, on the giver. And in many other ways
the newborn infant offers rich rewards to the parent. He provides one with an object
whom one can wholeheartedly love with a simplicity, a relative freedom from
ambivalence, which is most difficult, if not impossible, of attainment in the more
complex relationships which exist between two many-faceted adults.

I share with W. R. D. Fairbairn and Melanie Klein the conviction that the infant is
object-related from the very beginning; but I do not adhere to Klein's concept of an
innate death instinct, as paraphrased here by Paula Heimann, the infant from the
beginning of life is under the influence of the two primary instincts of life and death.
Their derivatives in the form of self-preservative and libidinal impulses on the one
hand and of destructive and cruel cravings on the other are active from the
beginning of life. (8, p. 35.)

I am convinced, from daily-life observations of infants and young children, and from
psychoanalytic and psychotherapeutic work with neurotic and psychotic adults, that
lovingness is the basic stuff of human personality, that it is with a wholehearted
openness to loving relatedness that the newborn infant responds to the outside
world, with an inevitable admixture of cruelty and destructiveness ensuing only
laterbeing deposited on top of the basic bedrock of lovingnessas a result of
hurtful and anxiety-arousing interpersonal experience.

It seems to me that lovingness is at its most pure, its most wholly pervasive, in the
personality of the newborn infant, and that the adult is loving in proportion as he
can effect contact with the loving infant and young child in himself. That the infant
and the young child express lovingness in not only warmly receptive, but also in
actively outgoing behaviour, is something which, I believe, any thoughful and
observant parent can attest, once he has set about seeing how much he receives
from his children.

The Relationship Between Mother and Infant (Child)


Melanie Klein's writings suggest that she would regard filial love-feelings as I
have described (i.e. solicitude towards the mother, and a struggling to relieve her
personality-difficulties) as being secondary to destructive feelings towards the
mother. I regard these as evidences of basic love, whereas Klein refers to 'making
reparation' in apparently this same regard, as one sees in these passages: the
leading female anxiety situation: the mother is felt to be the primal persecutor who,
as an external and internalized object, attacks the child's body and takes from it her
imaginary children. These anxieties arise from the girl's phantasied attacks on the
mother's body, which aim at robbing her of its contents, i.e. of faeces, of the father's
penis, and of children, and result in the fear of retaliation by similar attacks. Such
persecutory anxieties I found combined or alternating with deep feelings of
depression and guilt, and these observations then led to my discovery of the vital
part which the tendency to make reparation plays in mental life it includes the
variety of processes by which the ego feels it undoes harm done in phantasy,
restores, preserves, and revives objects. The importance of this tendency, bound up
as it is with feelings of guilt, also lies in the major contribution it makes to all
sublimations, and in this way to mental health. (11, p. 15.)

It is my impression that the tragedy in the child's relationship with his mother
becomes crystallized, leaving his personality ripe for the development of
schizophrenia, in that phase of his childhood when a child normally experiences a
'crush on' each of his parents [around 1 to 8 years of age]. During this phase, his
two parents are of tremendous importance to his ego-building through his
identifying with them, as regards their admirable personality-traits. This process of
identification, quite different from unconscious, neurotic identification with the
other's objectionable traits as a means of warding off anxiety in the relationship,
needs to proceed in a medium of the child's consciously idolizing the parent, and of
the parent's welcoming the child's admiration of, and desire to be like, him or her.
To focus again upon the mother's relationship with the child, the evidence is that it
is in this 'crush' phase of childhood that the child's relationship with the mother
comes to its greatest grief It is no coincidence that frequently the overt
schizophrenia, later in life, is precipitated by some 'crush' which has an outcome
injurious to the individual's self-esteem. Such an experience reactivates the feelings
of anxiety, rage, worthlessness, despair, and grief which were kindled originally in
the prototype experience with the mother.

The childhood disillusionment involves the mother's failing the child, because of her
low self-esteem and fear of loving relatedness, just when he particularly needs to
perceive her as admirable and worthy of emulation. She reacts to his adoration with
heightened anxiety and, presumably, loosening of her precarious ego-integration.
The child is thus faced with an object for his identificatory strivings who is both low
in self-esteem and somewhat ego-fragmented, and the child does identify with her,
with disastrous results to his own developing ego. He emerges from this phase,
naturally enough, not strengthened but profoundly weakened by his introjection of

a mother-figure who is pervaded by a sense of worthlessness and whose ego-

integration is precarious.

He introjects her not primarily out of hatred or anxiety but out of genuine love and
solicitude for his mother whom he has found, upon the close inspection which this
'crush' phase entails, to be not a person admirably stronger than he, but a
pathetically crippled one who desperately needs relief from the burden of her own
personality-difficulties. He introjects her primarily in an effort to save her by taking
her difficulties, her cross, upon himself. One schizophrenic woman who, I became
convinced after several years of work with her, had gone through such a process in
her childhood, phrased it that 'I was crushed at the age of eight.' Such an experience
with this 'crush' phase of childhood is quite literally crushing to the developing
personality.

The Patient-Therapist Relationship4

The transference-evolution found in the work with the majority of schizophrenic
patients, in my own experience and in my observations of the work of my
colleagues, has been described above.5 The time-span involved in this evolution, in
the work with chronically schizophrenic adults, may be great indeed. More than
once I have had to sweat through approximately two years of being responded to, by
the patient, as a 'bad (hateful, cruel, rejecting) mother' before this atmosphere
gradually shifted to my finding myself in a 'good (loving and beloved) mother'
transference-position in the therapy.

It seems to me that one of the great reasons for this long time-spanone of the
great reasons, that is, for its requiring such a prolonged period of intensive
psychotherapy to help a chronic schizophrenic patient to become free of his
schizophreniais that the 'good mother' transference-relatedness has a basically
symbiotic quality which is anxiety-provoking to both patient and therapist and
therefore arouses great resistance in each of them, which takes many months to
resolve. That is, this symbiotic relatedness involves an intensity of mutual love and
need for one another which is found, normally, only between mother and infant;
which was too anxiety-provoking to this patient and to his mother for them to allow

4 Im omitting most of this section describing the patient/therapist relationship in
favor of focusing on the case material which offers a more direct experience of
Searles clinical work and why he felt that the positive maternal transference was
essential to analyze.
5 Searles summarizes the transference-evolution as comprising the following
sequence: the patient reacts to the therapist as a warm father-figure (while the
maternal transference is difficult or impossible to locate); then as a hostile,
remote, frightening mother-figure; then as a desirable but unavailable mother-
figure owing to an omnipotent King Baby father whose demands interfere with
healthy mother/infant relatedness; and finally as a mother with whom the patient
can share unashamedly fond feelings.

themselves to recognize its presence in the relationship; and which carries with it
into the transference-reenactment this same charge of anxiety

In a recent paper6 I put forward the concept that this symbiotic mother-infant
relatedness tends, inevitably and valuably, to become re-experienced in the
transference relationship, and that the therapist's job is not to avoid its
establishment, but rather to have the courage to recognize its presence once it has
become established, as in successful therapy it inevitably does. What the therapist
can here bring into the patient's life which is new and therapeutic is something
which the mother, with her low self-esteem and her anxiety in the face of loving
interaction, could not provide: an awareness of how greatly the patient loves and
needs oneself, and of how greatly one loves and needs the patient.

In order to make quite clear that what I am describing and advocating is not some
variety of 'love therapy' (in which the therapist manages to convince himself that he
has towards the patient, from the very outset, a kind of superlative, healing love
with which only he and the angels are endowed), I wish to emphasize that it takes a
great deal of time, and a great deal of working through of mutual hostility in the
therapeutic relationship, before the establishment, and recognition by the therapist,
of the symbiotic relatedness in the transference.

Clinical Example

A 38-year-old, single woman was admitted to Chestnut Lodge because of a
schizophrenic illness which had begun insidiously only three years previously, but
had progressed to an extraordinarily profound level of ego-fragmentation and
regression. During my first psychotherapeutic session with her, on the day following
her admission, I found her to have a shockingly unhuman appearance; a nurse had
independently formed and noted down a similar opinion, namely that 'this woman
looks at times like a demon'; and the administrative psychiatrist, a man with
decades of experience in working in state hospitals, recalled in a later staff
conference his initial impression of her: 'Katherine was one of the most repulsive
looking things I've ever seen when she first came in here. She looked more like some
sort of tamed wild animal or something.'

Her history (as provided by her parents on her admission) indicated that she had
always openly idolized her father, with whom, on innumerable occasions, she had
gone horseback riding, hiking, and swimming, and had played tennis and golf. To the
social worker who obtained a portion of the history, the father expressed

6 Searles introduced the term therapeutic symbiosis in Integration and
Differentiation in Schizophrenia: An Over-All View, published a year later (1959),
but written just prior to or concurrently with this paper. In it he postulates that
symbiotic relatedness constitutes a necessary phase in the successful
psychoanalysis or psychotherapy with either neurotic or psychotic patients.

undisguised pride in the fact that his daughter had compared each of her boy-
friends, in a series of broken romances, unfavourably with himself; and to me he
expressed his satisfaction about her not having married any of these men (clearly
indicating that he would rather that she were in her present, tragically psychotic,
state than married to a man whom he considered rather a play-boy, or low-bred, or
what not)

As the patient's hospitalization went on, it continued to be difficult to perceive any
indication of genuine fondness in the mother towards her daughter. I had an
interview with the parents during each of the visits they made, every month or two,
to their daughter. During a visit by the mother and a sister-in-law of the patient 16
months after the patient's admission (the father being away on a business trip), I
was shocked at the chillingly matter-of-fact, offhandedly casual manner in which the
mother interjected, 'Oh, by the way, we've sold her motor-boat. We haven't told her
about it. We thought if she ever got out, we could get her another one anyway.' The
boat had been literally one of the patient's last meaningful links with life outside the
hospital. Later in this session, I was amazed to hear the mother report, with a brittle
laugh, concerning the visit which she and the patient's sister-in-law had just had
with the the patient, 'She just kept us in stitches!', the mother explained, by various
pantomimes; I had often seen the patient to be pantomiming in a grotesque,
dissociated, intensely anxious way. The sister-in-law, a much more perceptive
person and present during this interview, told me how the patient had fallen on the
floor, during their visit to her, 'sobbing her heart out' and begging her mother, 'Don't
scold me, Motherdon't laugh at me!'

As for the patient's feelings towards her mother in past years, it should be
mentioned that not only had she conspicuously preferred her idol-and-pal father;
but also, as her psychosis developed, she became openly harsh, contemptuous, and
(verbally) violently resentful toward her mother. In short, one had little reason to
think that there was any significant degree of mutual fondness in this mother-
daughter relationship.

During the first 2 years of my work with the patient, her unfolding transference to
me was such as to provide most convincing evidence that her relationship with her
mother had been an extra-ordinarily malevolent one.

For the first few months, she reacted to me oftentimes with a gushy effusiveness
which compared closely with that shown by both herself and her mother during the
latter's visits. Her effusiveness toward me had an impact of contempt and hostility
which became less heavily disguised as the months wore on and the effusiveness
slowly dropped away. Meanwhile she often grabbed at one or another of my
garments, demanding that I give them to her; her history showed that she and her
mother had often worn one another's clothing and jewelry, and her mother had
been surprised when the patient, with the advent of the psychosis, antagonistically
refused to continue this practice.

By the end of the first few months, the patient and I had become locked in what I
increasingly felt to be an extraordinarily malevolent relationship. In ways which
were becoming steadily more stereotyped, she was expressing what I felt as an
erodingly persistent rejectingness, contempt, and suppressed but violent
antagonism toward me; at times I would see her as a tragically, pathetically needful
person, but would find that my efforts to be of use met only with seemingly intense
dissatisfaction, contempt, or lack of interest on her part. Judging from her facial
expressions and from her fragmentary verbal comments, I had every impression
that she was immersed oftentimes in fantasies of subjecting me to physical violence,
and on many occasions she gave me to feel that, but for my meeting her hostility
firmly, she would indeed attack me physically. By far the most frequent target of her
hostility was my head.

My own feelings towards her, as these early years wore on, came more and more to
consist in a sense of helpless dissatisfaction with both myself and with her, and,
above all, a feeling of being helplessly enmeshed in the relationship with her. I found
my feelings varying at the mercy of the responses she was showing toward me.
When she appeared rejecting, I felt hurt and discouraged and often violently hateful
toward her; I felt shocked on many occasions at the vividness of my fantasies of
smashing in her skull. When she was showing contempt and loathing towards me, I
often experienced similar feelings towards her, at a level of intensity which
dismayed me. When she gave me glimpses into the depths of her own despair and
profound anxiety, I felt deeply moved, guilty, and even more profoundly helpless.
Ever more subtle non-verbal communications became charged with significance to
each of us, as I felt it; I hungered for even the tiniest signs of receptiveness on her
part, felt profoundly grateful for the most fragmentary and obscure verbalizations
from her, and felt murderous rage in reaction to tiny indications of her unexpected
withdrawal. Later on, when this long period had come to an end, I realized that my
ego-boundaries in the relationship with her had become very indistinct, so that I
was feeling about as helplessly caught up in ambivalent feelings as she herself was; I
had become, in a sense, deeply immersed in the patient's illness. But at the time, not
yet having broken through to a realization that I, a therapist over here, was dealing
with a deeply ill patient over there, I could experience it, in summary, only as a
growing fear that maybe my hatred was, after all, more powerful than my lovea
fear that, on balance, I was basically evil and basically destructive in all my
relationships with people.

I have seen, over and over again, in a convincing succession of instances, not only in
my own work but in the work of my colleagues, that this kind of profound soul-
struggle is resident in the very nature of work with schizophrenic patients; I doubt
whether any deeply ill patient has gone on to recovery without his or her therapist's
having to undergo, in a phase of the work, this kind of inner doubt and struggle. But,
even given this knowledge as to the nature of such work, when one is involved in the
struggle it is real and immediate and of desperate personal significance. I would put
it now, also, that the patient and I had development a symbiotic relationship with
one another in which we were conscious almost exclusively of the negative side of

10

our mutual feelings, and were subjecting our positive feelings to a severe,
unconscious denial.

Throughout these 2 years there was a second and much minor scheme: the
gradually more direct, though never very frequent, expressions of her fondness, and
even adoration, towards me as a beloved father. In touching ways, sometimes
verbally but more often non-verbally, she let me know that she loved me as being
the reincarnation of her beloved father. These expressions came fleetingly, and in
one of them she let me know that her life with her mother had been 'hell', worse
than life in the disturbed ward where she was now living.

But finally, in the latter part of the third year of our work, our main mode of
relatedness began, little by little, to shift. She revealed feelings of guilt for having let
her mother down, and consequent feelings of worthlessness and self-hatred She
let me know, with this, one reason why she had been so rejecting of the
contributions which I had tried to give to her: 'I was told I wasn't supposed to have
anything here.' Within a few weeks she confided to me, too, her fear of genuine
closeness with me: 'If we got together, we might kill one another.' Hearing this, I felt
a little clearer as to why we had been so persistently out of phase with one another
(I giving at a moment when she could not receive; she asking for something at a
moment when I had withdrawn into sullen resentment or rage; and so on).

As the third year drew to a close I felt that my emotional position toward the patient
had changed qualitatively, from a former predominantly 'bad mother' position to a
present predominantly 'good mother' position. I inferred this from my finding her
able to show me relatively freely her feelings of needfulness, anxiety, and
discouragement, and from my finding myself aware of her as a separate person, a
person over there, a person who was deeply troubled and in need of help, a person
with an illness which existed apart from me I now realized that the fact of her
being grievously ill was not per se a sign of evilness in me; in short, I realized that I
was not her illness.

A few weeks later, just before the beginning of the fourth year, there occurred in one
of the sessions a break-through of intense feelings on her part towards me as being
a father-figure who was maddeningly on her neck and in her hair, a father who had
kept her burdened interminably long with his small-boy demands, like a small boy
who makes insatiable demands on his mother. I now saw clearly the other side of
the I-want-to-be-with-constantly-and-go-everywhere-with-my-idolized-father
situation.

It was two months after this session, in the second month of the fourth year, that she
began showing open fondness toward me as a mother-figure to her. Until now, she
had been in constant motion of some sort or other throughout our sessions,
constantly swaying about from one foot to the other, or glancing away, or assuming
grotesque postures, or what not. But now, about two-thirds of the way through a
session in which she had been going through this customary avoidance behaviour,

11

she came over and stood behind and a little to one side of my chair, and stood
quietly for a minute or two. This in itself was something quite new. Then she came
round, sat on the end of her bed immediately in front of me, with her face no more
than two feet from mine, and said simply, while looking me full in the eyes in a
direct and undisguisedly friendly way, 'I'm tired of running away.'

When another month had passed, she had come to be, in occasional sessions, an
attractive, likable, relatively well-groomed girla very marked shift from the
persistently subhuman appearance she had always presented before, since her
admission over three years earlier. In this same month she let me know that 'my
[hallucinatory] daughter and me' were relating to one another, and that I should
stop interfering. She still communicated in largely a fragmentary, obscure way, but
when I commented, 'It seems to me you're saying that you and your daughter have a
relationship with one another that you want me to keep out of, and I keep
interfering, ' she emphatically, but in a not unfriendly tone, said, 'That's right.' This
was an unusual and most welcome consensus which we had thus reached, and I felt
that it clearly spoke of her feeling that her father had interfered grossly and
persistently in her relationship with her mother, although she was not yet able to
make this point in a more direct and conventional fashion.

Six weeks later (in the fifth month of the fourth year), however, she was able to
make it very clear indeed that she felt her father had always been primarily
interested in going on trips or spending time at his club, that he had spent little time
at home, and that he had been neither interested in the home nor appreciative of the
efforts she and her mother had made to keep the home looking attractive for him.
All this came out in the transference, with my being in the position of the father, in
one of the sessions. She kept asking me, sarcastically, if I did not want to travel here
and there; she put her bedspread on the floor as a rug, and put another bedspread
over her chest of drawers as a tablecover, and in other ways endeavoured to make
her room look as attractive as possible for me, indicating meanwhile that she found
me thoroughly unappreciative of these efforts.

Later in this same month, when the parents visited, the mother let me see, for the
first time, depths of subjective worthlessness and self-despair which I had never
perceived before, and which moved me to see her in a friendlier light. I now realized
that this well-groomed, intelligent, and in many ways successful woman had within
her a sense of profound worthlessness which was of much the same awesome depth
as that which I had long seen in her daughter who had been leading a more or less
animal-like existence in a disturbed psychiatric ward for years. The mother revealed
enough of this for me to see that it had roots in her own early childhood. I now saw
in the mother, too, an unmistakably genuine devotion to her daughter which, as I
now realized, had lain behind the artificial effusiveness.

A month later (fourth year, sixth month), the patient was able to express more
directly than ever before a feeling of adoration toward me. Looking toward the
window at first, she said, 'Wait until you see him!, in a tone of breathless

12

admiration, as if some 'dreamboat of a guy', as I then thought of it, were coming; she
had long been hallucinating breathlessly-admired figures during our hours, while
overtly subjecting me to her usual contempt, antagonism, or disregard. I felt like
saying something sardonic, such as, 'Quite a dreamboat, eh?', but held my tongue.
Then in the next moment she turned to me and blurted out, 'Have I ever told you
you're brilliant?' This she said in a wholly sincere, idolizing tone, as if avowing love
for me which she had long kept from revealing.

Then, almost without pausing for breath, she turned on some of the old, saccharine,
pseudo-admiring talk toward me, of the kind which I had so often heard before. But
that moment had been enough to convince me of the presence of this deeper,
genuine adoration in her, and to convince me, too, that this genuine adoration
actually was more disconcerting to me than was her long-accustomed saccharine,
pseudo-admiration. Just as her mother's self-esteem was too low to allow her to
endure open expressions of genuine adoration from the daughter, I too found such
expressions, at first, productive of anxiety in me. I regarded this, at the time, as a
breakthrough, before my very eyes, of the defensive adoration toward her fathera
breakthrough, that is, into her deeper adoration toward the mother.

Three months later (fourth year, ninth month), during an interview with the mother,
I felt deeply moved both by her profound doubts as to her own worth (doubts such
as I had felt so often in my own work with her daughter) and by her genuine
devotion to her daughter, when she suddenly revealed to me, weeping profusely, an
evidently long-pent-up welter of feelings: 'Do you think it would be all right if I said
to Kathy, "Kathy, I'd like to go out to dinner with you. Would you like to go with
me?" Do you think she would want to go with me or do you think she'd say, "I don't
want to go with that old thing!"?'

Then in my session with the patient on the day following this visit, Katherine began
evidencing some of the old, spurious effusiveness toward me. At this I asked her,
comfortably and rather amusedly, 'Katherine, do you suppose you'll ever get over
that phony kind of pseudo-admiration, that contemptuous kind of pseudo-
admiration, that you give out towards me?' She laughed warmly. Following some
intervening comments back and forth between us, she looked at me, while sitting
close beside me, and said, 'I'm crazy about you, ' in a low, shy, unmistakably genuine
way. I replied, simply and unanxiously, 'That's a very nice thing for you to say,
Katherine, and I appreciate it.' I then added, 'Perhaps that's the kind of thing you've
never been able to say toI don't know, your motheryour father', with equal
emphasis on each.

She replied, promptly and seriously and emphatically, but without anger, 'Mother'.
Then in the next few moments she stood up, meandered over to the window and
then moved back to a spot near memeanwhile, in returning, going through circles,
backward, looking like an unutterably touching and precious, shy little child who is
head over heels in love. I commented, fondly, 'I've got you going around in circles,
eh?', feeling this as a clear-cut, non-verbal means of her showing me how crazy she

13

was about me. I felt certain that this was a measure of her fondness not only for me
but also for her motherfondness which she dared not express openly to the
mother because the latter's anxiety, based in such low self-esteem as I had seen
revealed in the mother only the day before, forbade it. I now saw the mother's and
daughter's saccharine effusiveness toward one another as not primarily a
manifestation of submerged hatred toward one another, but rather a pathetic and
tragic sign of their inability to express openly their genuine love for one another.

With this patient, the ground which had been won initiallythe replacement, in the
developing transference, of mother-daughter hatred by mother-daughter love
seemed, in several subsequent phases of our work, to be irretrievably lost again,
only to be re-won in a larger and deeper form after much hard struggle. This
struggle went on within me, and in my relationship with the patient, for
approximately one full year after the events which I have detailed above.

In the tenth month of the fourth year, at the end of a session in which we had been
able to communicate much more satisfactorily than usual with one another (during
this she had been able to express to me, among other things, her own sense of
fragmentation into six or eight pieces), she said shyly, but warmly and
appreciatively, as I started to leave, 'She said she had a good time.' I replied in the
same feeling-vein, 'I had a good time, too, Katherine', to which she said, 'Thank you'.
This simple exchange is for me of memorable significance, as an indication of our
hard-won ability to acknowledge, to ourselves and to one another, how deeply fond
of one another we had become.

A month later, she was again able to verbalize an awareness of the ego-
fragmentation which had been acted out, in behaviour, throughout the years of her
hospitalization; she spoke of being 'broken' into 'eight pieces', and later in the same
session expressed it as 'broken into four pieces'. With this last phrase she then
added, insistently and pleadingly, 'Don't let it happen to Mother!' Her tone
unmistakably conveyed her genuine solicitude and protectiveness with regard to
her mother; it was now that I realized, more deeply than ever before, that one facet
of her illness consisted in her own enduring this grievously profound ego-
fragmentation in order to shield her beloved mother from suffering this same
experience herself.

The patient had made this plea, 'Don't let it happen to Mother!', with the demeanour
of a little child. I now understood better how it was that the mother had been able to
come down from a visit with her tragically-ill daughter, with the report which, as I
have mentioned, astonished me at the time: 'She kept us in stitches!' I now realized,
that is, something of the extent to which the patient had been protecting her mother
from seeing the full extent of the ego-fragmentation with which the patient had been
grappling here in the hospital. She had thus shielded the mother above all, I think,
from seeing the fullness of the mother's own ego-fragmentation; she had helped to
keep the mother's loose ego-structure stitched together

14

Katherine and I had a long way yet to go; but the hardest part of the workthe
deepest part of her illnesswas now behind us, and I am convinced that it was the
de-repression of her fondness for her mother, first experienced in terms of myself as
the transference-mother, which was most responsible for her improved integration
and her acceptance of herself as a female human being.

Summary

Concerning the relationship between the schizophrenic and his mother, the bulk of
the existing literature indicates that positive feelings do not exist, or exist only in
much lesser degree than such feelings as mutual hatred and rejection. In this paper I
have presented a markedly differing concept, at which I have arrived in the course
of eight years of intensive psychotherapy with chronic schizophrenic patients:
positive feelings are most importantly present in that relationship, however
intensely denied by both mother and child; such feelings are, in fact, the most
powerful determinants of the structure of the mother-patient relationship, and of
the development and maintenance of the schizophrenic illness. I have documented
this concept with an example of the kind of clinical experience which has convinced
me of its validity.

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