It was delightful, therefore, to come upon Ira Steinman's wise, wonderful, lively, and engaging book, Treating the 'Untreatable': Healing in the Realms of Madness. Steinman has dedicated himself to working psychodynamically with severely ill, schizophrenic, bipolar, and multiple-personality patients. His description of his work is clear, hard-headed, convincing, and inspirational. Treating the 'Untreatable' is filled with rich clinical detail that is both fascinating and a distinct pleasure to read.

Steinman begins by observing that humane institutions that employ judiciously administered medications together with group and individual psychotherapy are not only few in number at present, but are rapidly disappearing. Even in the best of them, furthermore, the treating personnel do not generally delve deeply into the meaning of psychotic delusions and hallucinations. For many years, he has worked intensively on an outpatient basis with psychotic patients, a large number of whom previously spent years in one or more of those institutions without achieving a major change in their condition. His approach has revolved around the expectation that helping these patients understand the origin and functions of their psychotic symptoms is the most effective way of helping them become able to relinquish them.
Psychoanalytic Quarterly, Book Review Essay by Martin Silverman, M.D. Read review

This book is a beautiful forward development of Frieda Fromm-Reichman's seminal work. It's a creative confirmation of the virtues of psychodynamic psychotherapy in the hands of a virtuoso for the most disturbed patients many of us are reluctant to engage. For our residents who have little psychotherapy training and for seasoned clinicians, the book is an awakening!
Herbert S. Sacks, MD; Past-President, American Psychiatric Association

In bell clear, eloquent language, Ira Steinman shows his deep knowledge and compassion for the mentally ill and their problems. He never falls into the trap of thinking that mentally ill people are only that, and so he pleads for the understanding that will allow therapists to elicit the strength and health in their sickest patients. The word 'cure' is seldom attached to schizophrenia. Dr Steinman dares to use it and sometimes to prove it.
Joanne Greenberg, author of "I Never Promised you a Rose Garden" (under the pseudonym of Hannah Green).

Treating the 'Untreatable' demonstrates in a lucid and impressive way the possibilities for the intensive psychotherapy of severely ill psychiatric patients in a way that can lead to lasting benefit and restoration of full life functioning much beyond the kind of systematic management that can come with the use of psychoactive drugs (though of course such medications are indeed part of Dr Steinman's treatments in selected cases). This kind of treatment was once quite in vogue in psychiatric and psychoanalytic circles back in the mid-20th century associated then with the names of Frieda Fromm-Reichman, Margaret Sechehaye, Gertrud Schwing, Harry Stack Sullivan, and John Rosen, the best known of that generation, but has since been largely eclipsed by the rise of the use of psychoactive drugs, and this I feel has been a major curtailment of the restorative possibilities of these patients.

Ira Steinman's manuscript is an effort, and a substantial one, to redress this imbalance and to bring the intensive psychotherapy possibilities with these very ill patients back into the foreground. As such it can serve a very useful purpose for both the practitioner world and the world of current and potential patients out there.
Robert S. Wallerstein, M.D., Past President of the International Psychoanalytic Association

Alongside psychopharmacological intervention and the benefits it brings, the treatment of seriously disordered individuals requires that their delusional beliefs be addressed psychotherapeutically; otherwise, there is no significant and sustained symptom relief. Ira Steinman provides the most thoughtful, well articulated account available of how such treatment should be conducted, complete with captivating and instructive case examples. I wish we could have used his book in our residency program when I was Director of Training at the Department of Psychiatry, Mount Zion Hospital, San Francisco. As Editor-in-Chief of 'The Psychoanalytic Quarterly' for ten years, and Program Chair of the American Psychoanalytic Association for two terms, I can assure you that clinicians from various backgrounds and with all levels of experience will want to read Treating the 'Untreatable' and will find it enormously useful when they do.
Owen Renik, MD, Past Editor-in-Chief of The Psychoanalytic Quarterly

I am very pleased to enthusiastically recommend Treating the 'Untreatable' by Ira Steinman. This is a most important book. I have no doubt that it will be controversial, but there are a good number of persons, of which I include myself, who are very familiar with the content of the kind of work that Ira Steinman is describing; although we might not all have the degree of success that he has, we do have similar successes and indeed there is a long history of such work from this approach. I think it very exciting to contemplate this kind of book, which will appeal to a wide audience and that focuses on immediate narratives of one person's clinical experiences in a psychodynamic psychotherapy as a treatment for schizophrenia.
Brian Martindale, MD; Past President of ISPS, the International Association for the Psychological Treatment of the Schizophrenias and other Psychoses

A brilliant story teller of journeys through Madness to Sanity; Ira Steinman has crafted a must read for anyone interested in the work of true psychological healing. These gripping clinical tales combine the artistry of Robert Lindner's "The Fifty Minute Hour" and the clinical brilliance and wisdom of the writings of Harold Searles and Harry Stack Sullivan.
Dr Stanley Prusiner, Nobel Laureate in Medicine, and Dr David Leof, Distinguished Life Fellow of the American Psychiatric Association

I read Treating the 'Untreatable' with fascination, and with awe at your insight, your patience and pertinacity, and above all: your courage. Would anyone else ever have sufficient conviction to continue past scores of setbacks and resistances in the inner certainty that there would be success in the end - the God knows when - and for how long - end? You have confirmed me in my belief that you are essentially an artist, unique in your field, perhaps imitable, but never equalled: Artists are born, not made, not taught.
Wolfgang Lederer, M.D. Author of Dragons, Delinquents and Destiny, Fear of Women, and The Kiss of the Snow Queen

Dr Steinman's book Treating the 'Untreatable' invites the reader to a journey into the realms of madness, as explored in long term psychodynamic psychotherapy with severely disturbed individuals. These are people lost in a dark forest of psychotic terrors, deemed hopeless and untreatable by the psychiatric system. Though these patients have usually undergone many hospitalizations and years of biological and psychosocial treatments they continue to suffer from severe symptoms, and are not able to break free from a marginal and marginalized existence. When these people reach Dr Steinman, many times as a last resort, he starts by asking them a few simple questions: what are you suffering from? When did it all begin? What is the meaning of your symptoms? These questions seem like simple exploratory questions, regularly asked by psychotherapists in the course of treatment, but to these 'untreatable' patients they are quite new. These unasked questions clearly state in their absence that symbolic meaning has nothing to do with psychosis. They imply that an introspective inquiry into the history of delusions and hallucinations is nothing less than a waste of time.

Yet Dr Steinman asks these questions, and these questions are the first foot steps taken together by patient and therapist as they journey into the depths. Escorted by a wise and trustworthy guide, the life histories of these 'untreatable' patients begin to unfold. The stories that are revealed seem to explain why these patients have never been asked about the meaning and history of their psychotic symptoms, for they are tales of intense suffering and pain. Psychic pain has been covered by layer upon layer of psychotic defenses, enabling them to survive but denying them the possibility to live. Based in a strong theoretic stance that psychotic thoughts and feelings are not garbage products of a disturbed brain but have symbolic psychic meaning, Dr Steinman manages to bare his patients' pain with them. Slowly and laboriously he helps his patients to peel the onion of psychosis and work through the memories, thoughts and feelings revealed underneath.

The stories of treatment presented in this book are powerful ones. And perhaps the strongest word that comes to mind while reading is Hope, a word rarely used today in the psychiatric system. Schizophrenic patients and their families are told that the disease is a chronic one, and that medication is a lifelong necessity. There are not many that can say otherwise, and Dr Steinman is one of them. His statement that psychodynamic psychotherapy is a form of treatment that can help even the most psychotic and severely disturbed individuals is not a statement based only on faith and hope, but one arduously reached by years of experience. This is why the words of the title of this book stand out loud and clear, stating that given time, experience, faith, and a stable therapeutic relationship, recovery, even of those deemed 'untreatable', is not a delusion.
PSYCHOSIS, Volume 4, Issue #2, 2012, Treating the 'Untreatable': Healing in the Realms of Madness, Pages: 179-180 Renana Elran, The Hebrew University, Jerusalem; Be'er Yaakov Mental Health Center, Israel

Occasionally, a book is published that carries implication for the reader far beyond its stated purpose. This is one of those books. Dr. Steinman has quite successfully dealt a major blow to the myth that mental maladies involving delusion and thought disorder are beyond treatment with psychodynamic tools. In doing so he has done a great service.
Crittenden Brookes, M.D., Ph. D. American Journal of Dynamic Psychiatry, Vol 39-2

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