Marguerite Sechehaye,Autobiography of a schizophrenic girl

Reviewed by: Ivette Rodríguez-Santana, University of Maryland, Baltimore, MD, USA

First published in 1951, Autobiography of a Schizophrenic Girl is one of the earliest accounts of a person’s struggle with schizophrenia. It is the memoir of Renée (real name Louisa Duess) and her intimate journey through psychosis and her pathway back to life. Written soon after her recovery, Renée relates the inner experiences of her symptoms, which she began to notice at the age of five. Part of this harrowing yet inspiring story is her relationship to “Mama,” her psychoanalyst Marguerite Sechehaye, who, as I found out, later became her adoptive mother. Indeed, the book comprises a second part where Sechehaye presents both her interpretations and how the treatment developed. Sometime before the publication of Renée’s memoirs, Sechehaye (1951b) had related the case and detailed a new psychoanalytical approach, which she called “symbolic realization.” In what follows, I share my reflections on Renée’s memoir and Sechehaye’s presentation of the case.

Reneé’s memoir was once considered a classic in the field of mental health literature. Her case became “an example of how a serious case of schizophrenia could stabilize through long and attentive psychotherapeutic work” (Leader, 2011: 213). The book was published during the heyday of psychoanalysis and, even more, about a case of psychosis in which, despite the medical prognosis, a remarkable transformation took place under the care of a psychoanalyst. Currently, when all persuasions of psychoanalysis have been attacked and discredited from all fronts, especially in the U.S. and Britain, reading Renée’s own account provided me, a psychoanalyst in training, relief.

I first read about this particular case in Darian Leader’s What is Madness? (2011), a fascinating book that challenges current assumptions about “madness” and “mental health” from a Lacanian psychoanalytic perspective. I found myself drawn to Renée’s perceptions and eerie inner world: the story of the onset of her symptoms, descriptions of auditory hallucinations that she in fact did not hear, her loss of spatial perspective and boundaries, the increasing fragmentation of body and mind, as well as her catatonic and autistic states. The vivid language Renée invented to capture the complexity of her suffering and her cycles of recovery and relapse fascinated me. But I also felt anxious as I got a glimpse of her “Unreality,” that progressive loss of contact with life, when objects became huge, detached, cut off from one another; a perception which extended from objects to people and finally to herself.

Before meeting Sechehaye, Renée saw 15 psychiatrists, who presented a bleak prognosis of complete disintegration. After the first year of treatment with Sechehaye, Renée began to desire to battle her “crises of Unreality.” It truly amazed me to read about her path to recovery: how it was Renée who actually offered the terms of her therapy, but also how slow (it took almost 10 years!), how much trial and error incurred, and how many setbacks were involved. I have many questions about Sechehaye’s reading and use of Freudian concepts, and especially her notion of the symbolic, and thus the way she explained her therapeutic success. But whatever she did worked, and I praise her unyielding desire to be of use to Renée.

Renée and Sechehaye’s accounts are not only the intimate tale of schizophrenia and its treatment but are also a testimony of the culture of their time. From beginning to end, I wondered about the title of this book. For Renée never presented herself as “schizophrenic,” nor did she see herself battling with schizophrenia, she may use the word madness, perhaps, but never saw herself as going completely mad. The title says as much about editorial choices (the book was intended for both expert and lay readership), as it does about the clinical paradigms of the time (the case was published in the 1950s, but treatment took place from 1930 to 1938 to be exact). For instance, the title of the first edition in English was Reality Lost and Regained: Autobiography of a Schizophrenic Girl (Sechehaye, 1951a); in the 1970s, it lost the first part of the title and its implied notion of madness. In the 1990s reprint, Autobiography became the title and “The true story of Renée” subtitle was added to it. Today, the label schizophrenic may seem offensive to many, as today the emphasis is to make the condition not an attribute of the sufferer, but something that is external to him or her.

It seems to me that Reneé’s language and experiences of her symptoms, the terrifying sense of discontinuity and lack of boundaries, were somewhat mediated by the prevailing modern Western ideas of madness: as the “Other of Reason” or the “Underside of Reality.” However, madness was not an illness for Renée. In the words of Sechehaye (1951b): “Renée considers reality and madness, which she feels close at hand, as two countries separated by a frontier” (p. 42). While early “madness” promised her a way to escape her intolerable angst and guilt, in time it became “a country, opposed to Reality where reigned an implacable light; an “immense space without boundaries.” Renée adds.

And I – I am lost in it, isolated, cold, stripped purposeless under the light. A wall of brass separates me from everybody and everything. In the midst of desolation, in indescribable distress, in absolute solitude, I am terrifyingly alone … (p. 24)

Renée wrote very little about her family and their circumstances in her memoir. But Sechehaye’s (1951b) case report and previous publication, Symbolic Realization provides the other side of Reneé’s story. The therapist discusses step-by-step the therapy process, including Reneé’s age at the time of the sessions, direct quotes from the sessions and Reneé’s drawings, which I found wonderfully illustrative of her language and inner world. Renée’s history becomes clearer with the pieces of information the analyst collected from her mother and siblings.

Renée came from a middle class background: the mother descended from an old aristocratic family from the south of France while the father was a Swiss gentleman and industrialist. Renée was the oldest of various children, but by far the most neglected. Ideas about gender during the early decades of the 1900s seem to have played a key role in Renée’s experiences of distress. Renée was not a desired child, a fact her mother communicated to her at age 13. At birth, her mother found her ugly and was not able to breastfeed. Since the mother diluted the milk with water, Reneé refused the bottle and cried continuously. Had it not been for the grandmother who discovered how to feed her, Renée would have died from starvation. Yet when she was 11 months old, the grandmother departed unexpectedly and the little girl, greatly shocked, would cry and hit her head looking for her caretaker everywhere.

Reneé’s father left the family early in her life leaving the family in poverty during the Great Depression. Reneé felt a profound hostility toward each member of her family, thus the indomitable guilt and desire for punishment. Most of her significant relationships were women: the mother, the grandmother, an older friend, her therapist, and a nurse. The grandmother was a significant person in Renée’s emotional world and key in introducing her to symbols of love, but when she left the bond was never restored even when she came back to the home. No other relationship occupied such a central role in Renée’s life than that with Sechehaye. Her attention and professional commitment to her patient not only sustained Reneé in her worst moments but also were essential in her recovery and stabilization.

None of the psychiatric treatments available in the early 1930s (sleep cure, readaptation through work, sedatives and baths, suggestion) were successful. Early on, classical psychoanalysis (specifically the principle of “telling everything”) temporarily slowed down the progress of her symptoms and provided some relief to Renée. After the first three months, she would go regularly and had difficulty leaving Sechehaye’s office. “Only near her,” she explained,

I felt secure, especially from the time when she began to sit next to me on the couch and put her arms around my shoulders. Oh what a joy, what a relief to feel the life, the warmth, the reality! (p. 25)

Some readers might think that it was this “maternal love” that was lacking and thus saved Renée. However, reading it from a Lacanian psychoanalytic perspective, I believe that the effectiveness of the treatment went beyond the duality of their relationship. As Reneé explained this was not an “I and you” relationship. She could not stand to be addressed in the second person. If the therapist used the first person Renée would not recognize her, and if she was addressed directly she would be transported to Unreality—only Mama and Renée in the third person, contained affectivity and reality for her. In the process, this allowed Renée not only to be free of guilt, rise in self-regard, and reestablish contact with her own body and life; but in her words: “by degrees I became independent of her, first through feeding, then through cleanliness and personal care. At length I could think differently from her without endangering clear reality perception” (p.100).

Indeed, this memoir is all about the path to recovery and rebirth. The idea is already captured in the name Renée, which in French means reborn. It impressed me the way the analyst was able to establish a conversation on Reneé’s own terms. Moreover, it becomes clear that there is no such thing as a formula or technique for psychoanalytic work, as it needs to be reinvented in each individual case, especially in working with psychosis (Leader, 2011). But how did Sechehaye’s method worked? What did she do? As the psychoanalyst observed, and Renée made evident in her own words, it was the presence of the symbolic games (the use of the third person, the drawings, the dolls, the plush animals, the apples) that made her approach effective. The analyst dropped her place of knowledge and authority and out went the so-called “insights and interpretations.” She placed herself where Renée wanted her to be. Sechehaye helped to create meaning but did not try to force her truth on Reneé. Overall, Sechehaye never lost interest in the case. Symbolically, the therapist became her patient’s source of nourishment. The crucial moment in the therapeutic process was when the analyst understood that for Reneé apples were a symbol of breast milk and allowed her to eat an apple from her breast. According to Sechehaye’s theory, the key was symbolic satisfaction of the primary drives, and especially oral drives. Yet like Leader (2011), I believe that her approach was effective not so much because it satisfied Renée’s oral drives or need for maternal love, but because it introduced her to language and symbolic functioning, thus to meaning, therefore to life and desire.

After seven long years of therapy, Reneé was able to work again and live independently with a friend. Sechehaye reported that she went on to study biology, earned a diploma, and even an academic prize. However, in another source I found that Reneé, code name for Louisa Duess, became a psychoanalyst and published books on psychoanalysis with children (La méthode des fables en psychanalyse infantile, circa 1940). This is important, but I do not think the success of this story survives on the fact that she became “socially functional.” What was truly significant was her newfound enthusiasm and pleasure in life. The outcome of her treatment may not be possible for each person facing mental difficulties, yet her story is one of hope, which helps us recognize that our work is not so much about finding normality as much as finding a safe niche in the world. I enjoyed Sechehaye’s (1951b) presentation of the case in Symbolic Realization, and recommend this as a complementary reading. In times of so many pre-packaged programs and instruction on how to work with patients, to read about the painstaking process of finding a method that works for a specific patient, is truly refreshing. As Sechehaye put it: therapy always entails for both the patient and the therapist an “existential wager.”