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In their worthy book, From Breakdown to Breakthrough: Psychoanalytic Treatment of Psychosis, Danielle Knafo and Michael Selzer offer an extended appreciation of the satisfactions and the difficulties involved in trying to be of use to individuals experiencing the ways of being that are commonly referred to as psychosis. The structure of the book mirrors, at least to some extent, the structure of the clinical endeavor itself, moving from the historical context provided by the received wisdom of “elders” on through the process of doing the work from beginning to termination, with many twists and turns along the way. Among the threads that wind through the text, two interlacing themes form the warp and woof of this tribute to the often soul-saving work of psychoanalysis for psychosis: On the one hand, there is the constant presence of a sense of radical loneliness that is experienced by patient and clinician alike and, on the other, there is the extraordinarily fragile and yet surprisingly robust flame of hope that impels the effort to transcend internal and relational isolation. Each of the chapters of the book is woven through with these threads, offering hope to clinicians, paradoxically, by positioning itself as an apt companion in the confrontation with loneliness that is the daily bread of the psychoanalytic therapist of deeply troubled people.
One reason that the text functions so effectively as a companion is that it is so acutely personal, indeed generously so. We are invited to witness the struggles of two mature clinicians as they have learned, through their career-spanning work of a hundred or so years, to fail better in ways that, at their best, have been transformative. It is as if we are overhearing them thinking aloud, reconciling themselves to the pace of the treatment, to the need to tolerate not-knowing, to the steadfast embrace of aspiration as it
is sized to fit the dimensions of real life. They are not theorizing; they are working and are gleani