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This book describes forty years of psychotherapeutic involvement with schizophrenic patients in Finland by Professor Alanen. Its aim is the promotion of a concept and therapy based on an integrated psychodynamic approach. His organisational and research abilities resulted in the creation of the Turku Schizophrenia Project, followed by the Finnish National Schizophrenia Project and an Inter-Scandinavian Project.
In his foreword, Stephen Fleck describes the book as the most comprehensive treatise on schizophrenia in twenty-five years, and notes the way in which Alanen's aura of a truly caring physician pervades the book.
In the first chapter, Alanen describes his early contact with schizophrenic patients through visits with his father, a municipal health officer in a rural community in Finland. He comments on the crucial importance of his own analysis, begun in 1955, in helping develop his approach to psychotic patients. As illustration, he gives a moving vignette from his early pre-analytic days in which he felt impelled by a patient to stroke her hair. The patient responded with: ‘Yrjo Alanen is speaking; he has become my guide’.
Alanen uncomfortably withdrew to ordinary conversation but reflected that with his later analytic experience, he would have contained the countertransference feelings to comfort the patient and addressed the delusional transference.
He does, however, criticise both that ‘classical psycho-analytic therapy has engendered a pessimistic attitude towards psychotherapeutic treatment of schizophrenics’ (p. 114) and that training programmes are restricted to experiences with less disturbed patients.
In a chapter reviewing illness models and different treatment approaches to schizophrenia, Alanen argues that all the approaches—biomedical, individual, familial, therapeutic community and rehabilitative—are justified, but that treatment should be based on a case-specific need. Following a masterly condensed review of the literature on organic aspects, hered