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Vamik Volkan's clinically rich book contains much new material, for novice and senior clinician alike. It is especially timely, in this period in which dynamic psychiatrists and analysts must struggle against those who would streamline, shorten, and reduce the intensity of treatments,
who would have us consider schizophrenia and related illnesses solely from neurochemical and rehabilitative perspectives. We need texts like this one, that document and explicate an insight-oriented approach, and convince us of its efficacy. The book has four parts: a theoretical section on schizophrenia, two clinical sections (“Other Fates” and “Treatment”), and a brief “Coda.” It could be the basic text for a fruitful training seminar or for a study group of senior clinicians.
In the coda, Volkan comments that this book is his answer to such managed care pronouncements as “no patient needs to be seen more than six times.” He adds that now, because of his involvement in international affairs, which takes him away from his practice for long intervals, he no longer treats severely ill patients. “This book is a memorial of my grief over the loss of something dear to me—my psychoanalytic work with difficult patients.” He acknowledges his predecessors in this work, especially Harold Searles (1965, 1979), whose work he admires, and Bryce Boyer (1983), who “has been like a caring big brother.” Thus, the book may be regarded as a “linking object” (Volkan 1981), connecting its author with this currently closed chapter in his career. If students of psychiatry and psychoanalysis do not study such books and treat such patients, and if managed care initiatives are not modified, the book may come also to be regarded as a memento of an “earlier era,” one in which patient and therapist together grappled with profound psychological upheavals, each gaining in strength and maturity.
I'd have liked the coda expanded and placed as an introduction, so that the reader might “meet” the author before