In memory of Johan Cullberg (1934 – 2022)
It is with sadness and deeply felt loss that we have received the news that Johan Cullberg has passed away. Johan turned 88 years old. He has been a member of the Swedish Psychoanalytical Association for many years since 1968 when he, as a newly graduated psychiatrist, was active at a psychiatric clinic in Stockholm. Like many of us, he was inspired to start the psychoanalytic training by an older member who was active there and held much appreciated seminars for the employees.
As a psychiatrist, Johan developed a strong humanistic view including his psychoanalytic orientation as an essential part. He wrote early on the highly regarded and widespread book ‘Crisis and Development’ (first Swedish edition was published in 1975 and translated to several languages, however not English). In this book he emphasized the understanding of the psychological significance and vicissitudes of psychological trauma. Here, he laid the foundation for his continued activity in clinical practice, and in his accompanying writing he tirelessly emphasized the importance of the psychological perspective on mental suffering.
In the light of his older brother Erland’s mental illness, Johan’s commitment and efforts gradually came to be increasingly focused on patients with severe mental disorders, such as psychotic and schizophrenic. With experience of the care and treatment that Erland and other patients in his situation received, Johan elucidated the restricted medical view of man and the limited resources of psychiatric care, which were largely about custody with electroconvulsive therapy and high dosage of psychotropic drugs. He fought in speech and writing against how the psychiatric care was conducted, which met with resentment among those responsible. Among the Swedish psychoanalysts, unfortunately, there was only a limited interest in the treatment of patients with severe mental disorders, which restricted Johan’s contribution to the Swedish Psychoanalytical Association. Instead, he took on the role of pioneer in the endeavour to support a highly disadvantaged group in Swedish psychiatry. Johan reflects on these experiences in the book ‘My Psychiatric Life: Memoirs’ from 2009 (in Swedish).
As an expression of Johan's innovative aptitude, he participated in the foundation of the Nacka project, an enterprise initiated in 1974, aimed at meeting patients in outpatient care outside the psychiatric inpatient care system as far as possible. With various clinics in the local community, teams were formed consisting of psychiatrists, psychologists, counsellors, nurses, nurses, and secretaries, together collaborating in the treatment work. We were both active in this project and got to experience new opportunities to meet patients in their immediate environment and try out and evaluate psychotherapeutic interventions. The sectorized psychiatry became a battering ram in the development towards a more open psychiatry, and in the book ‘Dynamic Psychiatry in Theory and Practice’ (first Swedish edition from 1984) Johan gave reasons for it.
Based on his experiences of meeting and working with severely mentally ill patients, Johan developed great knowledge and deep understanding of possible ways to improvement and recovery for this disadvantaged group (cf. Cullberg, 1991, 2007). This was especially true of patients with first-episode psychosis, for whom he advocated the earliest possible interventions. He documented his experiences in several scientific publications (cf. Strålin, Skott, & Cullberg, 2019), and in the book ‘Psychoses: An Integrative Perspective’, published in English 2006, he shows many examples of how patients could be helped by adequate care efforts to recover and in several cases leave their psychotic functioning.
For Johan, systematic empirical research was an important part of justification and evaluation of sustainable clinical practice. He started the Psychosocial Research and Development Unit, Stockholm County Council, and initiated several research projects, among others the Swedish Parachute Project (cf. Cullberg et al., 2006), with a special attention to the treatment homes established outside of hospitals. Johan was active as organizer and presenter at the International Symposia for the Psychotherapy of Schizophrenia (as documented, among others, in the book ‘Psychotherapy of Schizophrenia: Facilitating and Obstructive Factors’ from 1992) and he was one of the founders of the International Society for the Psychological Treatments of the Schizophrenias and Other Psychosis (currently the International Society for psychological and Social Approaches to Psychosis).
In addition to his clinical work and research, Johan was interested in the life stories and life problems of several famous Swedish writers and artists, which he tried to shed light on from a psychoanalytic perspective. He documented this in several books and articles (among others about August Strindberg). Writing was one of Johan’s great passions and these works have all received great recognition and became important contributions to the role of psychoanalysis in the Swedish culture.
Although Johan did not actively participate in the Swedish Psychoanalytical Association’s activities, his clinical work, his contributions to the development of new treatment forms for severely mental ill peoples, and the whole body of his writings were permeated with psychoanalytic thinking. His texts have influenced generations of psychiatrists, psychologists and other health care workers in the Nordic countries and left deep traces in Swedish cultural life.
Johan was a warm and loving person who glow with curiosity, genuine interest, and intuitive understanding of other people. We, being his colleagues and close friends, have over the years often collaborated and seen each other, having exciting gatherings, not infrequently with his wife, the Swedish writer Inger Alfvén. Based on these memories, in conjunction with his professional endeavors, he will leave an open void behind. We would like to express a big and warm gratitude you for everything he gave and left behind as his legacy.
Johan Schubert and Andrzej Werbart
The Swedish Psychoanalytical Association
References
Cullberg, J. 1991. “Recovered versus Nonrecovered Schizophrenic Patients among Those Who Have Had Intensive Psychotherapy.” Acta Psychiatrica Scandinavica, 84 (3): 242-245.
Cullberg, J. 2006. Psychoses: An Integrative Perspective (1st ed.) New York, NY: Routledge.
Cullberg, J. 2007. The Use of Psychodynamic Understanding of Psychotic States: Delineating Need-Specific Approaches. In J. O. Johannessen, B. V. Martindale, & J. Cullberg, Editors. Evolving Psychosis (pp. 185-193). New York, NY: Routledge.
Cullberg, J., Mattsson, M., Levander, S., Holmqvist, R., Tomsmark, L., Elingfors, C., & Wieselgren, I. M. 2006. “Treatment Costs and Clinical Outcome for First Episode Schizophrenia Patients: A 3‐Year Follow‐Up of the Swedish ‘Parachute Project’ and Two Comparison Groups. Acta Psychiatrica Scandinavica, 114 (4): 274-281.
Strålin, P., Skott, M., & Cullberg, J. 2019. Early Recovery and Employment Outcome 13 Years after First Episode Psychosis. Psychiatry Research, 271: 374-380.
Werbart, A., & Cullberg, J., Editors. 1992. Psychotherapy of schizophrenia: Facilitating and Obstructive Factors. Oslo: Scandinavian University Press.