Books and theorists on schizophrenia are numerous; however, this title stands out, as having a significantly different story to tell. Psychiatric approaches to psychosis, built on biological determinism, are often criticised for their neglect of meaning, purpose and individuality — here is a counterweight full of all these elements. This is a timely, impressive and provocative book.
Timely, because it is devoted to the meaning of psychotic experience and the process of sustaining committed therapeutic relationships, and is thus in allegiance with the growing emphasis on recovery.
Impressive, because Jackson has spent a professional lifetime bridging the gap between mainstream psychiatry and psychoanalytic psychotherapy and, after retiring from the National Health Service (NHS) in 1987, has been a major contributor, through teaching, support and supervision, to the sophisticated Scandinavian psychosis services, which have emerged as international models of effective treatment.
Provocative, because the jobbing psychiatrist will readily recognise the characters in this anthology of case review seminars, but the pattern and process of treatment are so very far from what we currently regard as ‘treatment as usual’. It confronts us with how little we know about our patients and their lives.
It has clearly been designated to be useful and, moreover, useful to those seeking to help patients in profound psychotic states, looking for understanding of what it (both the psychotic contents and the therapy) all means. Firmly based within the psychodynamic tradition in general and the Kleinian school in particular, it does not presume much previous acquaintance with either, and Jackson's acknowledgement of the complex interrelationships between remembered and actual traumatic experience, narrative and historical truth and the ‘constitutional predisposition to perceptual instability’, may help to keep the general psychiatrist on board.
However, the NHS psychiatrist will have problems with the practicality of its methods, the broad inclusiveness of the definition of psychosis, unfashionably long periods of hospitalisation and the lack of what we currently regard as an ‘evidence base’. But it raises the vital question of whether the parsimonious imperatives of the NHS blind us to what can and should be offered to people experiencing some of the most profound disruptions of self and mind. It also shakes any security we may feel that, in offering low-dose atypical neuroleptics and a brief manualised course of cognitive—behavioural therapy for psychotic symptoms, we have done the business.
This is an important contribution, whether you agree with its perspective or not, as there are few reliable guides for those who would journey into the inner experience of psychosis, and still fewer who can argue for the validity and utility of doing so: Jackson is a passionate and convincing advocate for both.
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