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

by Ira Steinman

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 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 many years and give up previous extensive antipsychotic medication, as they understood and worked through psychological issues underlying their psychotic orientation.

Treating the’Untreatable’ 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.

240 pages, Hardcover

First published February 1, 2009

Reviews

[Mark Guadagni · Rating 5 out of 5]

Beautiful collection of true stories about how Dr. Ira Steinmann treated numerous patients in SF bay area which who suffered from Schizophenia--a disease which the dominant narrative insists is not curable and demands lifelong treatment with medications. The book makes the point that an uncovering exploratory dynamic psychotherapy can aid in the recovery, healing and cure of even the most disturb schizophrenic and delusional patients across a number of different diagnostic categories. Dr. Stienman asks " Since healing and cures are possible through such an intensive psychotherapy, why is this form of psychotherapy so infrequently practiced, in conjunction with the judicious use of medications?" and humbly admits "...as a field, have lost our way in treating severely disturbed and delusional patients. Dealing with insurance companies, threading our way through the latest pharmaceutical claims and the incessant advertising of drug companies trying to increase their sales, listening to teachers who have not been successful with the intensive psychotherapy of schizophrenia, following psychiatric department chairman who emphasize the 'scientific ' approach, as the generation of the psychoanalytic department chairman has given way to the generation of the biochemist and molecular biologist, reading journals biased towards the biological, the field of psychiatry has concluded that the intensive psychotherapy of schizophrenia cannot be done." Later prefacing, "Antipsychotic medications help many patients. If so, fine; then our task is easier. But if delusions and schizophrenic thinking and hallucinations persist, an attempt should be made to help the patient understand the psychological underpinnings of his or her delusions." He observes "many treating psychiatrists say that the psychotic patient is incapable of making progress and that the antipsychotic medication is the best that can be done. They are wrong". He proves these through multiple stories and referenced studies, but what is most heartwarming (and to end my review), he publishes the thank you notes from patients form years ago who are still cured: "You also have my deep appreciation for your efforts to change the assumption that people who need antipsychotic medication at one point will need to take that medication for the rest of their lives. I have benefited profoundly from your progressive perspectives about the role of medication in supporting therapy, not replacing it". For those who are interested in learning more, try listening to his NPR interview: https://www.kqed.org/forum/407291000/...