Treating the 'Untreatable': Healing in the Realms of Madness

Author(s) : Ira Steinman

Treating the 'Untreatable': Healing in the Realms of Madness

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Treating the 'Untreatable' offers the hope of recovery, healing and cure for the most severe psychotic disturbances, schizophrenia and delusional disorder. Through a psychotherapeutic exploration of hallucinations, delusions and thought disorder, even the most hopeless and "untreatable" patients have a chance for returning to a life of relationships and function even after years, if not decades, of disturbance. These studies in the intensive psychotherapy of schizophrenia and delusional disorders demonstrate that recovery, healing and cure can be achieved in those most disturbed.

In this era of treating schizophrenic and delusional patients with a primarily antipsychotic drug oriented approach, a more thorough exploration of the meaning to the patient of his psychosis - with judicious antipsychotic use, when indicated - leads to internal character and external behavioral change that is far more lasting than with antipsychotic use alone. With such a psychodynamic approach, some of these previously chaotic, disturbed and heavily medicated people were able to understand the symbolism and the origin of their psychotic productions and go off antipsychotic medication altogether.

Treating the 'Untreatable' provides an overview of the chaotic world of the schizophrenic or delusional patient, a history of intensive psychotherapy with such patients, and twelve case histories demonstrating varying degrees of recovery, healing and cure. Some of the patients were able to integrate delusional systems that had persisted for many years and give up previous extensive antipsychotic medication, as they understood and worked through psychological issues underlying their psychotic orientation.

The book offers compelling stories for the general reader and teaching tales for students and mental health practitioners who want to work in the realm of madness. These clinical cases demonstrate the efficacy of an intensive psychotherapy of schizophrenia and delusional states, combined with the judicious use of antipsychotics. These tales show that even seemingly "untreatable" and "hopeless" psychotic patients may recover and heal in the course of an inquiring psychodynamic psychotherapy aimed at understanding and working through the symbolic meaning of his or her hallucinations, delusions and bizarre thoughts and actions. Such an approach has led to some maintaining their gains for decades.

Treating the 'Untreatable' ultimately questions why patients who responded to an insight oriented psychotherapy were previously viewed as 'untreatable' and given high doses of antipsychotic medication. In addition, the book talks about some of the factors that have led the field of psychiatry to pursue a primarily antipsychotic medication approach in patients so disturbed, rather than integrating a potentially healing dynamic psychotherapy into one's therapeutic armamentarium.

Reviews and Endorsements

'...a beautiful forward development of Frieda Fromm-Reichman's seminal work. It's a creative confirmation of the virtues of psychodynamic psychotherapy in the hands of a virtuoso for the most disturbed patients many of us are reluctant to engage. For our residents who have little psychotherapy training and for seasoned clinicians, the book is an awakening!'
- Herbert S. Sacks, MD, Clinical Professor, Yale Child Study Center, Past-President, American Psychiatric Association"

'In bell clear, eloquent language, Ira Steinman shows his deep knowledge and compassion for the mentally ill and their problems. He never falls into the trap of thinking that mentally ill people are only that, and so he pleads for the understanding that will allow therapists to elicit the strength and health in their sickest patients. The word 'cure' is seldom attached to schizophrenia. Dr Steinman dares to use it and sometimes to prove it.'
- Joanne Greenberg, author of I Never Promised you a Rose Garden (under the pseudonym of Hannah Green).

'I am very pleased to enthusiastically recommend Treating the 'Untreatable' by Ira Steinman. This is a most important book. I have no doubt that it will be controversial, but there are a good number of persons, of which I include myself, who are very familiar with the content of the kind of work that Ira Steinman is describing; although we might not all have the degree of success that he has, we do have similar successes and indeed there is a long history of such work from this approach. I think it very exciting to contemplate this kind of book, which will appeal to a wide audience and that focuses on immediate narratives of one person's clinical experiences in a psychodynamic psychotherapy as a treatment for schizophrenia.'
- Brian Martindale, M.D. Past President of ISPS UK, the International Association for the Psychological Treatment of the Schizophrenias and other Psychoses

'What [this book] does is to demonstrate in a lucid and impressive way the possibilities for the intensive psychotherapy of severely ill psychiatric patients in a way that can lead to lasting benefit and restoration of full life functioning much beyond the kind of systematic management that can come with the use of psychoactive drugs (though of course such medications are indeed part of Dr Steinman's treatments in selected cases). This kind of treatment was once quite in vogue in psychiatric and psychoanalytic circles back in the mid-2Oth century, associated then with the names of Frieda Fromm-Reichman, Margaret Sechehaye, Gertrud Schwing, Harry Stack Sullivan, and John Rosen, the best known of that generation, but has since been largely eclipsed by the rise of the use of psychoactive drugs, and this I feel has been a major curtailment of the restorative possibilities of these patients.

'Ira's manuscript is an effort - and a substantial one - to redress this imbalance and to bring the intensive psychotherapy possibilities with these very ill patients back into the foreground. As such it can serve a very useful purpose for both the practitioner world and the world of current and potential patients out there.'
- Robert S. Wallerstein, M.D., Past President of the International Psychoanalytic Association

'Alongside psychopharmacological intervention and the benefits it brings, the treatment of seriously disordered individuals requires that their delusional beliefs be addressed psychotherapeutically; otherwise, there is no significant and sustained symptom relief. Ira Steinman provides the most thoughtful, well articulated account available of how such treatment should be conducted, complete with captivating and instructive case examples. I wish we could have used his book in our residency program when I was Director of Training at the Department of Psychiatry, Mount Zion Hospital, San Francisco. As Editor-in-Chief of The Psychoanalytic Quarterly for ten years, and Program Chair of the American Psychoanalytic Association for two terms, I can assure you that clinicians from various backgrounds and with all levels of experience will want to read Treating the 'Untreatable' and will find it enormously useful when they do.'
- Owen Renik, M.D.

'A brilliant story teller of journeys through madness to sanity, Ira Steinman has skillfully and sensitively crafted Treating the 'Untreatable', a must read for anyone interested in the work of true psychological healing. These compelling clinical tales combine the artistry of Robert Lindner's The Fifty Minute Hour and the clinical brilliance and wisdom of the writings of Harold Searles and Harry Stack Sullivan.'
- Dr Stanley Prusiner, Nobel Laureate in Medicine and Dr David Leof, Distinguished Life Fellow of the American Psychiatric Association, and Senior Jungian Training Analyst.

'His description of his work is clear, hard-headed, convincing, and inspirational. Treating the 'Untreatable' is filled with rich clinical detail that is both fascinating and a distinct pleasure to read.'
- Martin Silverman, The Psychoanalytic Quarterly

About the Author(s)

Ira Steinman has focused on schizophrenia for 45 years; his early training ranged from studying with R.D. Laing to working at the National Academy of Sciences' Drug Efficacy Study, which evaluated all the antipsychotic medications available at that time. For more than 35 years, he has pursued an out-patient psychiatric practice where he has been able to demonstrate that an intensive psychoanalytic psychotherapy, in conjunction with the judicious use of antipsychotic medication, can help even the most lost and disturbed schizophrenic and delusional patients recover, heal and, at times, achieve a cure. With such an approach, some allegedly ""untreatable"" schizophrenics have been able to work their way off of antipsychotic medication. He has spoken on this subject at length on a local, statewide, national and international level for more than twenty five years. He is a member of the ISPS (International Society for the Psychological Treatments of the Schizophrenias and other Psychoses); the American Psychiatric Association; and the Northern California Psychiatric Association

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