In his second visit with New Books in Psychoanalysis, Christopher Bollas elucidates his thinking about schizophrenia. But he also does more than that; because his beginnings as a clinician are intimately intertwined with the treatment of psychosis, the ways in which this early exposure colors all of his clinical thinking becomes apparent.

Indeed, in psychoanalysis we could say that there are two kinds of clinicians–those who treat psychosis and those who don’t. Bollas is clearly in the former camp. One wonders, given the centrality of psychosis in his theoretical work, if he would have been drawn to analytic work had he not started with the most primitive of human experiences?

We meet him as an undergraduate at UC Berkeley, studying history, working at a program for autistic and psychotic children presumably to pay the bills. We follow him to SUNY-Buffalo where, while pursuing his PhD in literature, he encounters psychotic students in a class he is teaching, walks across the campus to the clinic, asks if he might work there as a clinician and is brought on staff. (Those were the days…)

It is worth noting that Bollas, one of the most renown thinkers in psychoanalysis, began as a lay practitioner (he has an MSW which I presume he acquired so as to practice in this country). His longing for a clinical life, pursued while completing his studies in the humanities, seems to have been piqued by his encounters with psychosis.

While Bollas is one of the profession’s strongest critics of the medicalization of psychosis, he always works with a team that includes an MD, a social worker and others when treating schizophrenia. His role on the team is to help the person suffering from psychosis to talk and also, crucially, to historicize. (Interestingly, the book includes a chapter that shows him at work as an American historian.)

He reminds us that seeing psychosis as “other” places those who begin to have nascent-to-florid psychotic experiences at ever greater risk of being lost to us and to themselves, forever.

He minces no words as he argues on behalf of the psychotic persons need for speech. “We all know the wisdom of talking. In trouble, we turn to another. Being listened to inevitably generates new perspective, and the help we get lies not only in what is said but in that human connection intrinsic to the therapeutic process of talking that promotes unconscious thinking.” Indeed the barrage of medications on offer alongside treatment modalities that give short shrift to speech, run the risk of increasing isolation and blurring the mind which in turn increases psychosis. As is his wont, Bollas turns common treatment logic on its head: “the loss of un-selfconscious participation in the everyday …constitutes the gravest tragedy for the adult schizophrenic.” There is a way back, he argues, but, and here I riff on his thinking, only if the culture comes to understand anew what it means to be human.

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