Johan Christoffer Cullberg

Our friend, colleague and inspirational professor Johan Cullberg, died after being ill for a short time, on the eve of June 14. Johan was a highly respected Professor of Psychiatry, an excellent researcher, compassionate and skilled clinician, and author, who was deeply engaged in the development of psychiatry and mental health services. It was his brother, the artist Erland Cullberg’s mental health issues that led Johan Cullberg to choose psychiatry for his professional life. His work has circled around understanding and treating people experiencing the mental breakdown described as psychosis. In his clinical work and research, he shared his interest and capacity, mainly through two major life projects, First episode psychosis and the relational, psychodynamic understanding and treatments of such disorders. Firstly, he led the outpatient units in the so-called Nacka project, where the focus was on psychiatric care outside the hospital. He especially studied the interplay between the individual patients and their close environment. Johan fought for more humane care of patients, a reduction in compulsory treatment and the need for lower doses of antipsychotic medication. He also sought to integrate the biological, psychodynamic, subjective/phenomenological and social dimensions of care. He was one of the pioneers of early intervention in psychosis and was active in international organisations which promoted this reform paradigm and psychological and psychosocial treatment strategies. He was especially active in the early and founding years of IEPA (the International Early Intervention in Psychosis Association) and with the ISPS (the International Society for Psychological treatments of Schizophrenia (later Psychosis). In fact, Professor Cullberg was a founding member of ISPS, and became an ISPS Honorary Lifetime Member. These two areas converged in his major research and health service development project, the “Parachute project”. The Swedish Parachute Project (soft landing following psychosis) was started in 1996, with 17 participating clinics covering 1.6 million inhabitants (one-sixth of the Swedish population). Professor Cullberg led the research aspects of this project for 10 years. The program consisted of small, homelike units – mostly outside the hospital. The principles of the Parachute Project included: 1) Early intervention (within 24 hours), 2) Psychotherapeutic and crisis orientation, 3) Family meetings (very important), 4) Continuity and accessibility to service for five years, 5) Use of the lowest effective antipsychotic dose and initial therapy without medications, and 6) Therapeutic inpatient milieu (personal, low stimulus, non-institutional). A three-year follow-up research study showed less antipsychotic usage, less inpatient care and greater functional quality of life (Cullberg et al., 2006). The values and philosophy underpinning his work are described in one of his books, “Psychosis: An integrative Perspective”, where he concludes in the epilogue: ““Working in medical care has an almost irresistible tendency to numb practitioners to the realization that they are treating and tending individuals who are just like themselves. Many claim that they have to dissociate themselves from their feelings in order to function in the wards; this is plainly not the case. There is more to good care than ethical principles and staff training. It also requires an organisation that accords priority to and accordingly finds room for empathy and humanity without any loss of professional standards” (pp. 304–305)”. Ahead of his time, he recognized that culture is critical for recovery-oriented care. PSYCHOSIS 2022, VOL. 14, NO. 4, 380–381 https://doi.org/10.1080/17522439.2022.2132416