In some patients the distortion of the body image becomes the focal point of the psychotic transformation. The body image can be studied from three different points of view: (1) as a body schema, or a neurological engram; (2) as a percept, or, in a more general way, as an experience; (3) as a concept, which is altered by the delusional ideation or at least by the psychodynamic conflict of the patient.

The treatment of the schizophrenic cannot consist only of the sessions, but an active participation in his life is necessary, as many authors have reported. The patient needs to feel that many events in his life are shared by the therapist.

In this chapter Arieti reports the cases of two patients who have been treated with intensive and prolonged psychotherapy. The psychodynamics and the psychostructure of the symptomatology are interpreted, and the psychotherapeutic procedure is described in great detail.

In spite of the limitations of the social treatment of chronic schizophrenia, there seems to be no doubt that good social conditions and a spirit of therapeutic community are helpful.

This chapter deals with the major aspects of drug therapy in reference to schizophrenia only. The criteria for selecting drug therapy over other types of treatment or in conjunction with psychotherapy are discussed in The Choice of Treatment.

Physical therapies of schizophrenia are not as frequent as they used to be. However, because they remain in the therapeutic armamentarium of many psychiatrists, a brief description of them and a critical discussion of their use is presented.

Three syndromes that are briefly illustrated in this chapter (paranoia, anorexia nervosa, and childhood schizophrenia) are probably related to schizophrenia.

In the presence of a schizophrenic disorder the therapist’s first duty is to choose the type of treatment. Each therapist must learn to counterbalance his own biases in order to evaluate properly each individual case.

The concept of schizophrenia is useful and should be retained when applied to a particular psychological dysfunction of the human being that manifests itself in many varieties. The disability is real, and in almost all cases painful and harmful. The dysfunction can therefore be included in the medical model, provided this model is enlarged to comprehend those biological functions that are called psychological and are partially related to the social environment.

No psychiatrist can ignore individual psychotherapy of schizophrenia, nor can he escape practicing psychotherapy with schizophrenics even if he is inclined to do so.