Schizophrenia is both a commonplace and mystery, and has never ceased to affirm its centrality in psychiatric theory and practice. This book introduces its psychoanalytic enquiry by inviting psychiatrists and allied professionals to plunge into a schismatic and elusive universe which escapes rational ways of understanding.

A history of analytic theories of schizophrenia starts with Freud, who considered afflicted individuals completely lacking transference whilst narcissistically retreating in their ego, and continues with Melanie Klein, who highlighted the importance of the paranoid-schizoid position in schizophrenic thinking. An important hypothesis is proposed by Richard Lucas, that in schizophrenic minds two distinctive parts inhabit, a psychotic and non-psychotic one. Tuning into the ‘psychotic wavelength’ to disentangle the confusing fabric of thoughts and genuinely engage with the patient is considered key part of treatment, as priority is given to understanding and containing rather than eradicating the illness entirely.

Unconscious mental processes are explored and suggested to be at the forefront of understanding symptomatology. In order to protect themselves from intense psychic pain, individuals with psychosis evacuate and project unacceptable mental elements into others, which gives rise to the incomprehensibility and peculiarity of their ‘life-worlds’. I found the exploration of non-psychoanalytic features of treatment such as medication, and cognitive behavioural and family therapies, including the Need-Adapted Approach, essential to maintain balance and to demonstrate how important contextualisation of treatment is within different systems. Medication's role of ‘suspending’ symptoms whilst personality structures are investigated in order to bring to the fore the stable part of a person's psyche is emphasised. Case vignettes illustrate how the content of delusions and hallucinations offers clues to the personal nature of schizophrenic experience which can guide treatment.

Close attention is paid to Dr Michael Robbins's seven therapeutic stages and Psychodynamic Pentapointed Cognitive Construct Model which geometrically illustrates the development of the schizophrenic mind in psychoanalytic psychotherapy, from a psychotic state to integration of reality as a discrete individual. The therapeutic alliance ebbs and flows, fluctuates from hostility then confusion to safety, and eventually grows to reinstate autonomy in a disintegrated mind.

I was left wondering whether there is space and time to incorporate psychoanalytic thinking of schizophrenia in the rigorousness of psychiatric training and whether an optimal psychotherapy ward can be created as a place of containment.

One shortcoming I found was at times an absolutist and reassuring tone concerning the success of such treatment which can carry a degree of uncertainty and ambivalence. The book's invigorating premises of curiosity and introspection lie at the heart of it, with Elvin Semrad's words vigorously summarising the schizophrenic core: ‘An individual's sacrifice of reality to preserve life.’