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‘As a field we have lost our way in treating severely disturbed and delusional patients’. So writes Dr. Ira Steinman, a San Francisco psychiatrist, at the end of his new book Treating the Untreatable. The book is provocatively titled, and what Dr. Steinman
presents is a direct challenge to clinicians working with schizophrenic and very dissociated patients: to reclaim the lost art of psychotherapy as the treatment of choice. Furthermore, he insists upon the success, even the superiority, of in-depth therapy with these highly disturbed patients.
Steinman decries what he sees as mainstream psychiatry's current claim that our most ill patients are untreatable by therapy and amenable only to medication. Rather, intensive psychodynamic psychotherapy on an out-patient basis is the heart and soul of the work, which his book aims to demonstrate with twelve examples of the often ‘hopeless’ cases he is called in to treat as the physician of last resort. Steinman does not eschew the use of medications or hospitalization when necessary, but for him they serve their more traditional adjunctive purpose. Not so radical as the anti-psychiatry movement of Ronald Laing, with whom he did some training, Steinman does not view schizophrenia as a sane response to an insane world. But he is no less dedicated to understanding psychosis and multiple personality psychologically rather than biochemically. To those who suggest that medications are ‘the best that can be done’, Steinman simply states, ‘They are wrong’.
Steinman's philosophy and work is in the humane tradition of Harry Stack Sullivan, Frieda Fromm-Reichmann, D. W. Winnicott, Harold Searles, Laing and so many other clinicians whose outstandingly dedicated work with long-suffering patients embodies the idea, as Sullivan said, that ‘We are all much more simply human than otherwise’. Jung has a crucial historical place here too, as we know, as the first psychoanalytic interpreter of psychosis, via complex theory. As Laing wrote at th