Keynote Address: Harvesting Today the Fruits of Chestnut Lodge

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Length: 45 minutes


John Kafka, MS, MD

For decades, Chestnut Lodge made possible prolonged and intense clinical work with schizophrenic and other severely disturbed patients. Therapists were encouraged to develop and experiment with their own approaches, to present them to, and discuss them with, their colleagues in organized small groups. These individual approaches frequently combined psychoanalytic, dynamic, and what, today, would be labeled behavioral and cognitive elements. Chestnut Lodge was not only a hospital but also a clinical research and educational institution that, besides scheduling staff time for formal and informal discussions, offered group supervision, mutual supervision, and individual supervision by the most senior staff members. Such an organization attracted a staff who shared the vision that no human being is so different from us as to be inaccessible, incomprehensible, permanently isolated, and unresponsive. It is a fact that many major discoveries in all of science are based on the study of the "exception" that is neglected by a statistical approach that characterizes much of current psychiatry. The importance of the single case study, of the exception, was recognized at Chestnut Lodge.

The fruit of Chestnut Lodge includes the lessons learned from therapeutic successes, therapeutic limitations and failures, the recognition that diagnoses can change during longitudinal studies of a patient. Close observations for a long period allowed therapists to witness patients' descents into, and emergences, from profound psychotic states in which they seemed inaccessible. Those moments offered unique therapeutic and research opportunities then, but the recorded observations can now guide research using new neuro-scientific tools. In this presentation, I will also describe and discuss how insights gained by therapists in their work with psychotic patients can enrich and deepen the treatment of non-psychotic individuals.

In this paper, I will summarize some hypotheses, theories, and therapeutic approaches generated by clinicians who benefited from the opportunities offered at Chestnut Lodge. New vistas have opened up. Today, we can build bridges that connect old and new thinking and insure that the humanistic psychiatric tradition that informed the psychoanalytic and psycho-dynamic approach to schizophrenia and other disorders will not be lost.

See also:

Kafka, J. S.  Chestnut Lodge and the psychoanalytic approach to psychosis. J Am Psychoanal Assoc. 2011 Feb;59(1):27-47 

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