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Andrew Lotterman’s book ‘Psychotherapy for people diagnosed with schizophrenia’ is an important book, rich in information and reflections, which presents both clear theoretical arguments and clinical descriptions. It is a revised version of Lotterman’s book from 1996, appearing now at an important moment in the ongoing discussion within psychiatry, psychoanalysis and psychology about how to help people who are diagnosed with the severe disturbances of schizophrenia.
For two to three decades, American psychiatry (Lotterman is an American psychiatrist and psychoanalyst) has had a negative attitude towards psychoanalytic and psychodynamic approaches to help those suffering from schizophrenia spectrum psychosis. For instance, Klerman (1984) stated ‘the evidence from at least half a dozen studies would indicate that no further research on the intensive individual psychotherapy of schizophrenics based on psychodynamic or interpersonal principles is warranted’. But Lotterman points out how different psychiatric papers, even in respected journals, refer to each other in their statements that there are indications that psychodynamic psychotherapy may be potentially toxic (as Scott and Dixon expressed it in Schizophrenia Bulletin, 1995) – all based on very few anecdotal cases!
The toxic or aggressive attitude, if one may describe it in these terms, in the US around the status of psychoanalytic psychotherapy for persons with psychiatric diagnoses, especially the severe psychiatric disorders, is a complex matter. It may have historical reasons based on the dominant status psychoanalysis had in the US psychiatry in the 1950s and 1960s, followed by the final descent for psychoanalysis with the arrival of the symptom-, syndrome- and behaviour-based DSM-III (in 1980) and the subsequent promotion of ‘the decade of the brain’ in the 1990s. The negative attitude towards psychoanalytic psychotherapy may also have politico-economical reasons behind it. The health care system in the US may