Schizophrenia: Its Origins and Need-Adapted Treatment: Yrjö O. Alanen. London: Karnac Books, 1997
Review by: Svein Friis
This is a fascinating and thought-provoking book. It is written by one of the giants in the treatment of—and research in—schizophrenia: Professor Yrjö Alanen. Through seven chapters, he presents a synopsis of his life-work.
In chapter 1, he starts by sharing with the reader his own early encounters with patients suffering from schizophrenia. Through three small, moving case histories, he highlights various aspects of the relationship between the therapist and the patients and their families. The case histories vividly illustrate how demanding and problematic it can be to conduct dynamicpsychotherapy with psychotic patients, but that it also may be very beneficial for the patient and rewarding for the therapist.
Chapter 2 gives a balanced presentation of the heterogeneity of schizophrenia; the various attempts to explain the disorder, and the variability of treatment approaches. Alanen underlines the need-fear dilemma as the central problem for patients with schizophrenia. However, he also stresses that schizophrenia is not a single unified illness, and as a consequence, he agrees with Ciompi that there is a huge variation in prognosis: “There is no such thing as a specific course of schizophrenia.” The chapter ends with a description of five illness models of schizophrenia (1. Biomedical, 2. Individual psychological, 3. Interactional, 4. Social and ecological, 5. Integrated) and treatment models related to them.
Chapter 3 is a comprehensive discussion of the origins of schizophrenia. Alanen underlines the need for integration of various theories, including both biological, social and psychological factors. He supports the view of Ciompi that emotional problems are of more primary significance than those at the cognitive level, even if they are more difficult to study in a systematical and empirical way.
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