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Treatment Resistance and Patient Authority is a compilation of papers by members of the staff of the Austen Riggs Center, all previously published in journals under the guidance of Eric M. Plakun, its Director of Admissions and Professional Relations. Plakun credits the inspiration for the project to a comment by Otto Kernberg, who “wondered why we at Riggs had not developed a coherent voice within the field, articulating our distinctive way of working and what we were learning.” Kernberg in fact contributes a brief foreword that brilliantly articulates that way of working and learning.
The volume honors its visionary leader, Edward R. Shapiro, who retired as Medical Director after twenty years at the helm. During this period he boldly and creatively shepherded Riggs through a perilous period when comparable institutions were going under, and he has managed to lead the institution in such a way as to safeguard its astounding energy and to retain its preeminence as the major psychoanalytically oriented psychiatric hospital in the country. He richly deserves the honor this superb volume bestows on him. The general psychoanalytic reader can only be grateful to Plakun and Kernberg for their roles in the project.
The title aptly anticipates its major premise, which J. Christopher Fowler, Plakun, and Shapiro elegantly present in their opening chapter and which I will try to summarize, at the risk of some distortion, through the prism of my own clinical experience. The treatment-resistant patient is viewed as having been deprived of a sense of authority, of agency in his family of origin. This deprivation may have been replicated in previous treatments, particularly in institutions that have subjected him to