Wider Perspectives

I continued to write about more directly psychoanalytic and psychotherapy topics as in the three papers, here.

1997 Catastrophe, objects and representation: three levels of interpretation.
British Journal of Psychotherapy 13 307-317
During my training I was impressed by the work of Esther Bick, and like others considered that she was postulating some early state of mind that was in addition to the paranoid-schizoid and depressive positions. In this paper I made some comparison of the specific nature of the anxieties and defences in these three states of mind.

1999 Countertransference.
International Journal of Psychoanalysis 80 797-818. Republished 2002 in Robert Michels, Liliane Abensoour, Claudio Laks Eizirik and Richard Rusbridger (eds) Key Papers on Countertransference.  London
This was a paper invited for a didactic section of the International Journal of Psychoanalysis. And subsequently published in a spin-off publication from the Journal. The paper is an exposition of the evolution of ideas of countertransference within the Kleinian tradition

2001 The Di-vidual.
In Valerie Sinason (ed) Trauma. Attachment and Multiplicity – Working with Dissociative Identity Disorder.London: Routledge
The invitation to contribute to this book, gave me an opportunities to think about identity problems, including multiple personality (or DID) in terms of the primitive identifications I was more familiar with.

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However I had the increasing freedom of academic life to follow my interests and several papers tackle the topics of evidenced-based practice which had been establishing itself strongly. Several other topics have interested me to the point of rendering thoughts into formal papers.

1999 The difficult patient: the role of “scientific” psychiatry in understanding patients with chronic schizophrenia or severe personality disorder.
British Journal of Psychiatry 174 187-190
Certain patients cause specific problems for psychiatric staff and teams. This paper started with a short presentation in the parallel sessions at one of the RCPyshc annual meetings. The idea was that the nature of the difficulties of (and the relationships with) patients with long-standing schizophrenia, and with severe personality disorder, clash specifically with the prevailing cultural attitudes of scientific psychiatry.

2000 Alienation: social relations and therapeutic relations.
Psychoanalytic Studies 2 21-30.
This paper goes back to those in the 1980s about alienation, but also follows on the last paper on the alienation of certain psychiatric patients from the attitudes and culture of scientific psychiatry.

2002 Symptoms or relationships. (Comment on Jeremy Holmes’, “All you need is CBT”).
British Medical Journal 324 288-294.
Jeremy Holmes wrote an important discussion piece in the BMJ with a number of invited comments. The importance of NICE was to plant medical practice more solidly in scientific evidence, rather than clinical intuition. This affected the scientific turn impetus in psychiatry. The comment argues that there is good reason for the lack of an evidence-base for psychoanalytic methods based on relationships, rather than those based on more depersonalised techniques.

2003 Group mentality and “having a mind”.
In Malcolm Pines and Bob Lipgar (eds.) Building on Bion- Volume 1, Roots. London: Jessica Kingsley.
Psychoanalysis has always challenged the standard views of what the human mind is, and the notion of the unconscious operating within groups takes the challenge a step further. This paper is a brief view of what a philosophical view of mind would be like if based on Bion’s intersubjective notions of alpha-function and projective identification.

2002 What we can learn from failures.
In Joe Reppen and Martin Schulman (eds) Failures in Psychoanalytic Treatment. New York: International Universities Press
Because psychoanalytic technique has always been a via negativa, i.e. based on a failure of free associations, it seemed an interesting invitation to contribute to this book. The idea is that we learn more from when a psychoanalysis goes wrong – interruptions of the associative stream, or enactments – then when it goes smoothly.

2004 Reflections on psychic ownership and psychoanalytic studies.
In Ann Casement (ed) Who Owns Psychoanalysis? London: Karnac
This was another invitation to contribute to an interesting project about the way psychoanalytic ideas are possessed by Western culture. In the course of possession, the ideas have changed, and evolved in intellectual and popular culture. They are not like physical possessions, and now form a part of the identity everyone has.

2009 Do unconscious processes affect educational institutions?
Clinical Child Psychology and Psychiatry 14 509-522.
Educational institutions have complex anxieties – those from the young learners, and those from mature staff. However little has been written about such organisations, compared with those in health and welfare. This paper questions what unconscious social defences may arise form unacknowledged anxieties and emerge as forms of practice supporting defences.

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Then eventually in 2004, I wrote the book, Suffering Insanity, I had really wanted to write 30 or more years before, about the experience of suffering from a psychosis, and the experience of caring professionally for such people, and how such experiences might be actually useful to the carers.

2004 Suffering Insanity: Three Psychoanalytic Essays on Psychosis.
RD Hinshelwood (London: Routledge).
When I started out as a trainee psychiatrist I became concerned about the treatment of people with psychosis, and the extraordinary difficult in understanding them. And this included the limitations in understanding that exist amongst professional carers. This books became therefore a late culmination of what I had learned in my 30 years in psychiatry. It is in three parts, the first detailing the experience of professional carers. The second deals with some psychoanalytic theories of what it is like to be such a person – the experience of being psychotic. And the third part is an attempt to detail what happens when the suffering of both sides – the professional carers and the afflicted patients – come together, and influence or distort the organisations within which care occurs. In a sense this demonstrates a move during my career from a concern with those people with psychosis, to a concern with how their experiences, affect the carers and then in turn the whole establishment of th e institutions created to care.

2010 Organisational schism: Looking after a psychiatric service.
Psychoanalytic Psychotherapy 24 202-211
This was an invited contribution to a conference on “integration”, and the paper deals with the ways in which well-meaning institutions seem to become at war with themselves. The intended focus in the conference was the schism within psychiatry between biological and pharmacological approaches on one hand, and psychological and relational approaches to personal experience on the other.

2010 (with Enrico Pedriali and Louisa Brunner) Action as a vehicle of learning
Organisational and Social Dynamics 10 22-39.
For a number of years I had worked with Enrico Pedriali in Milan to develop experiential workshops adapted from the Tavistock model of experiential group learning. These workshops however were based on the idea that many long-standing psychiatric patients do not use language competently, and cannot therefore learn as well as others from psychotherapeutic methods of understanding. The Workshops we developed for professional carers to explore the ways in which people with symbolising difficulties could learn from more concrete action, and the relations arising such working and leisure activities.