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This collection of essays is an extension of and workbook for Vamik Volkan's earlier formulations of the infantile psychotic self. One of the few psychoanalysts still writing about the application of psychodynamic theory to the severely disturbed patient, he and Salmon Akhtar use the work of six therapists to illuminate the origins and vicissitudes of a so-called psychotic core or ‘seed of madness’. With a couple of exceptions, this is not a book about technique for working with patients who have a psychotic care; rather, it is about how clinicians might think about those patients, especially their earliest lives and its potential relevance for psychotherapeutic interaction.
This contribution is timely, informative and thought-provoking. As we learn more about how experience affects protein synthesis at the neurotransmitter receptor site, the old battles between biological and family aetiology fade. As newer medications mitigate the most debilitating symptoms of severe illness, practitioners are increasingly in touch with fundamental obstacles to adaptive progress with their patients. These are patients whose ‘minds are torn’, who are extremely hard to reach and who may exhibit classic negative therapeutic reactions. Financial constraints often preclude the longer and more intensive work necessary to move beyond symptomatic relief. Fewer training sites and psychoanalytic institutes educate their students in the necessary emotional and instrumental techniques. A vast body of experience, albeit anecdotal, is on the brink of ancient history. A recent book, Madness on the Couch: Blaming the Victim in the Heyday of Psychoanalysis (, 1998, New York: Simon & Schuster), graphically and convincingly represents the misapplication of psychodynamic psychiatry to seriously disturbed patients and their families as a menace at best and deeply destructive at worst.
One of the reasons that psychodynamically orientated therapists continue to be interested in psychotic phenomena,