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Silver, A.S. (1998). The Infantile Psychotic Self and Its Fates: Understanding and Treating Schizophrenics and Other Difficult Patients. By Vamik D. Volkan. Northvale, NJ: Jason Aronson, 1995, 352 pp., $40.00. J. Amer. Psychoanal. Assn., 46(3):946-951.

(1998). Journal of the American Psychoanalytic Association, 46(3):946-951

The Infantile Psychotic Self and Its Fates: Understanding and Treating Schizophrenics and Other Difficult Patients. By Vamik D. Volkan. Northvale, NJ: Jason Aronson, 1995, 352 pp., $40.00

Review by:
Ann-Louise S. Silver

Vamik Volkan's clinically rich book contains much new material, for novice and senior clinician alike. It is especially timely, in this period in which dynamic psychiatrists and analysts must struggle against those who would streamline, shorten, and reduce the intensity of treatments, who would have us consider schizophrenia and related illnesses solely from neurochemical and rehabilitative perspectives. We need texts like this one, that document and explicate an insight-oriented approach, and convince us of its efficacy. The book has four parts: a theoretical section on schizophrenia, two clinical sections (“Other Fates” and “Treatment”), and a brief “Coda.” It could be the basic text for a fruitful training seminar or for a study group of senior clinicians.

In the coda, Volkan comments that this book is his answer to such managed care pronouncements as “no patient needs to be seen more than six times.” He adds that now, because of his involvement in international affairs, which takes him away from his practice for long intervals, he no longer treats severely ill patients. “This book is a memorial of my grief over the loss of something dear to me—my psychoanalytic work with difficult patients.” He acknowledges his predecessors in this work, especially Harold Searles (1965, 1979), whose work he admires, and Bryce Boyer (1983), who “has been like a caring big brother.” Thus, the book may be regarded as a “linking object” (Volkan 1981), connecting its author with this currently closed chapter in his career.

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