Book Review
Practice of Psychiatry 
Dialogue avec le sujet psychotique Marc-Alain Wolf. Montréal (QC): Tryptique; 2005. 258 p. CDN $25.00.
Reviewer
rating*: Excellent
Review by: Mary V Seeman, MD
Toronto, Ontario
Dr Marc-Alain Wolf, psychiatrist at the Douglas Hospital in Montreal, on staff at McGill University and the University of Quebec, has written a thoughtful, insightful book about the nature of psychosis and what allows therapists to be therapeutic when speaking to patients—not that he has found an easy answer. He describes the self-doubt, curiosity, wonder, and self-reflection that are necessary for the task. He knows through experience that forging a relationship with someone in the throes of psychotic thinking is a slow process, often doomed to failure. He knows that the delusions of the person who perceives differently from the norm are more like mystical revelation than rational belief, convictions not amenable to reason or education. He talks about the need to listen and empathize while not abandoning the medical stance, not ever pretending (for the sake of maintaining the alliance) to buy into the fantasies and idiosyncratic perceptions of a patient suffering from delusions. Wolf talks about the “I–Thou” relationship that is a requisite to a therapeutic attitude, in contrast to the “I–It” mode of the diagnostician or case manager, and about how the 2 parties in a therapy relationship become more “Thou” and less “It” over time. Therapists influenced by Martin Buber’s philosophy need to be transparent and genuine. Wolf acknowledges the need for authenticity and reciprocity but, in the end, recommends a slightly different sort of relationship, one defined by philosopher Emanuel Levinas—not “reciprocal” (since the person with psychosis does not need the burden of an expected mutuality that he or she is, perhaps, not capable of) but, rather, “responsible.” Levinas, his thinking shaped by his proximity to the Holocaust where those of Jewish faith were seen as “the Jew,” the “other,” enunciates a moral philosophy of responsibility and respect for the stranger in our midst. Getting to know the person whose ways are different from our own requires a prior attitude of transcending concern and moral responsibility that must exist even in the absence of reciprocity.
Taking his cue from Levinas, Wolf advocates a face-to-face dialogue with the person suffering from psychosis, the therapist taking responsibility for as long as it takes, a lifetime commitment if need be.
Wolf and Levinas essentially adopt a culturally male stance toward the vulnerable other— that of taking both charge and responsibility—in contrast to a more feminine stance, which would emphasize caring, connecting, and affiliating. But, the contrast is probably only semantic. This book, heavy on philosophy and important facts about psychosis and its treatment, is nevertheless and above all humane. The author enters the experiential world of the sufferer and tries to make sense of that experience. He speculates on the psychological purposes symptoms can serve. Wolf teaches us how to conduct a first diagnostic interview and how to gather information in a therapeutic way. He then discusses various methods of doing longer-term therapy. He knows there is no wrong or right way but strongly advocates entering the world of the person with psychosis and staying connected. Therapy happens in the gap between 2 people and its success depends less on the severity of illness of one, or the skill and experience of the other, than on what is forged in the space between them: an emergent human bond within which healing can sometimes occur. An admirable book for students at all stages of learning.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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