Treating the "Untreatable"

This is a book offering 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. In this era of treating schizophrenic patients with a primarily antipsychotic drug oriented approach, a more thorough exploration of the meaning to the patient of his psychotic productions-with judicious antipsychotic use, when indicated--leads to internal character and external behavioral change that is far more lasting than with antipsychotic use alone. In fact, a number 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. The book provides an overview of the chaotic world of the schizophrenic or delusional patient, a history of intensive psychotherapy with such patients, and thirteen case histories demonstrating varying degrees of recovery, healing and cure. Some of the patients were able to integrate delusional systems that had persisted for decades and give up previous extensive antipsychotic medication, as they understood and worked through the psychological issues underlying their psychotic orientation.

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 in San Francisco 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.