Last of the Just: A Novel Highlighting Descriptive Relations Between Trauma-induced Episodes of Dissociation and Psychosis. Does Pathologic Disruption of NMDA Receptor-mediated Neurotransmission Underlie These Relations and Serve as a Promising Therapeutic Target?
Stephen I Deutsch, Jeffrey Elikan, David Spiegel, Mary-Caroline Cockerham, Jessica A Burket
Clinical Neuropharmacology July 31, 2026 DOI: 10.1097/wnf.0000000000000700 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Interventions | D-Cycloserine psychotherapy |
| Keywords | Andre schwarz-bart Nmda receptor Dissociation Phencyclidine Psychosis |
| Key points | The authors propose that brief, strategically timed D-cycloserine combined with psychotherapy may lessen the severity and duration of trauma-related dissociation and psychosis, with a possible niche indication for a narrowly defined dissociative subtype of PTSD. They caution that D-cycloserine has significant limitations and that meta-analyses across psychiatric indications have shown disappointing results. They also argue that translational neuroscience can contribute modestly to disciplines such as history, literature, and theology. |
Abstract
Last of the Just, a novel of historical fiction published in 16 languages and recipient of France's highest literary award, is recognized for its scholarly contribution to Holocaust education and conceptualization of the Lamid Vavnik, one of "36 (largely anonymous) Just Men of Jewish Tradition" responsible for sustaining humanity. The book's main character is Ernie Levy, who has clinical manifestations of dissociation, psychosis, and an anesthetized tolerance of severe pain associated with repeated traumatic exposures to emotional and physical abuse. Clinical investigation of disordered personality structures with heightened sensitivity to dissociation and psychosis; episodes of dissociation and psychosis associated with traumatic exposures; and small numbers of community-dwelling adults endorsing frequent dissociation, whose characterization includes depersonalization and derealization, associated with histories of childhood abuse have probable explanatory relevance to Ernie's presentation. Phencyclidine (PCP), an uncompetitive NMDA receptor antagonist, introduced into human medicine as a novel anesthetic agent precipitates dissociation and a schizophreniform psychosis in susceptible persons. D-Cycloserine (DCS), a partial NMDA receptor agonist, has been explored for several psychiatric indications in dosages with acceptable tolerability and safety. Adjunctive acute "time-limited" administration of DCS in conjunction with psychotherapy may contribute to mitigating severity and lessening duration of episodes of dissociation and psychosis associated with traumatic exposures. However, significant limitations of DCS exist and disappointing results of meta-analyses exploring effectiveness in a variety of psychiatric indications necessitate consideration of strategically targeted, single, or intermittent administration in conjunction with behavioral or cognitive-behavioral interventions. DCS may have a niche indication for a narrowly defined "dissociative" subtype of PTSD. More broadly, a selective review of literature suggests that insights gleaned from translational neuroscience can contribute, albeit modestly, to scholarly considerations in seemingly remote disciplines, such as history, literature, and theology.