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The title of this book forms a very timely warning. Strong forces in Swedish academic psychiatry and psychology, in collaboration with an influential governmental ideology associated with New Public Management, have succeeded in reducing the opportunities for training in psychoanalytic psychotherapy. 6 out of 18 training Institutes have lost their authorizations . The influential Psykoterapiinstitutet [The Institute of Psychotherapy] of the Karolinska Institutet in Stockholm has been shut down (or “reorganized” for training in CBT methods). In new Swedish National guidelines for the treatment of depression and anxiety disorders, evidence for the effectiveness of psychodynamic psychotherapy has officially been rated as “weak”, while the evidence for pharmacotherapy and CBT has been rated as “strong”. There is a real danger that the skill in conducting psychodynamic treatment together with the knowledge generated from it, can be lost within a generation, if these destructive processes continue unchecked. This means a tremendous loss for future patients, for psychiatry — psychodynamic thinking is the safeguard of humanist influence in psychiatric service — and for culture.
The 205-page, 6-chapters long book, is strongly argued and contains a detailed description of these processes. All the key antagonists to psychodynamic thinking are mentioned by name, their rôles described, their public utterances cited and dated. However, the book also contains very valuable and eye-opening reflections on the nature of psychic suffering and on the ethos of psychodynamic psychotherapy in the first chapter, and a similarly interesting discussion of the “governmental culture of auditing” and of the use of rhetoric in politics, in the concluding chapters.
The chapter on psychic suffering is a tour de force in the presentation of the psychoanalytic perspective, in a brief, succinct, but not at all simplified way, the best introduction imaginable for the “intelligent uninitiated”. However,