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Salman Akhtar, psychoanalyst and one of the editors, asks himself how, for the purpose of treatment, one is to deal in the most beneficial way with the anguish that is associated with the psychotic core of the personality. “In the end, it is not a question of genetic vulnerability or environmental failure or intrapsychic fantasy either in understanding psychopathology or its amelioration. All three aspects have to be taken into account”. As a spokesperson for the authors, he voices the hope that the book will shed light on this message, discussing it with nuances and empathy. In view of this intent, the book is undoubtedly a success. However, I miss an existential perspective, considering that the schizophrenic, e.g., often struggles furiously with the fundamental questions of life and death.
Among the contributors we also find Maurice Apprey, Gabriele Ast (who presents a couple of very vivid and illustrative case studies) and L. Bryce Boyer. The second editor, the psychoanalyst Vamik D. Volkan, formulates the book's intention to explore the sources of madness. In his opening chapter, The Seed of Madness, he wants to show how a “mad seed” develops and how it differs from a “normal” core. Originally, biology and psychology, body and soul, are undifferentiated. If, however, this condition prevails, if no seed of a self develops and the ego functions stay primitive, we are faced with an infantile psychotic self: a “seed of madness”. The primitive ego functions that interest Volkan in this context are the cycle of fusion-defusion that occurs when the self-image is not differentiated from the object-image, as well as the introjective-projective cycle. The psychotic core is saturated with horrible feelings, which may be likened to an infantile depression, different from the adult depression caused by loss. In his intense psychoanalytically oriented, treatment of schizophrenics, the author has gained the experience that a structural change within the infantile, psychotic