Psychotherapeutic Approaches to Schizophrenic Psychoses: Past, Present, and Future edited by Yrjö Alanen, Manuel González de Chávez, Anne-Louise Silver, and Brian Martindale London:  Routledge, 2009,  388 pp.

This book is an excellent historical overview of the rise, fall, and possible future re-emergence of psychodynamic approaches in the management and rehabilitation of schizophrenic conditions. It is divided into three parts: the pioneers of psychotherapeutic approaches, world developments from the 1940s to the present, and future dynamic treatments and interventions.

In the first chapter, Alanen describes the split between the “understanding” and the “explanatory” approaches to research and clinical work. A deep division in the philosophical approach to management of schizophrenic conditions has consequently arisen, with dialectical shifts over time influencing systems of care between reductionist biological—“explanatory,” and humane, psychosocial—” understanding” approaches. The bias in this anthology of articles is definitely in favour of psychosocial rehabilitative approaches to treatment and signals a disturbing ascendance of the biological, medical model that targets the disease, and the decline of the humanistic model that works with an impaired individual's recovery.

The psychosocial approach has a long history dating back to the moral therapy of the Quakers in the York Retreat in the early 1800s. The same principles of treatment still apply in today's version of psychosocial rehabilitation: treating patients as individuals, putting them to work, tolerance for their psychotic symptoms, and developing an understanding of their inner turmoil.

In his study of Schreber's memoirs, Freud was the first to propose a psychoanalytic theory explaining psychosis. A short list of others who followed Freud's lead were: in Germany and Switzerland: Bleuler, Jung, Speilrein, Binswanger, and Abraham; in England: Federn; in the United States, Puttnam, Mayer, White, and Jelliffe. These early pioneers all had important roles in introducing psychoanalytic theory and technique into work with psychotic patients in psychiatric centres and institutions.