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Kenneth Sanders is unusual in being both a Kleinian psychoanalyst and a general practitioner. There can be few like him, and his book of Clinical Notes is therefore written from this hybrid perspective. It is of interest to family doctors because it shows some of the possibilities achievable by a doctor with an understanding of the unconscious mind. It is also of interest to the Psycho-Analytic world in illustrating how this technique can be used effectively in a setting so different from that of the more usual psychoanalytic practice. As his notes show, Kenneth Sanders is essentially a psychoanalyst; in his consultations he does not simply allow patients to express feelings but also understands and interprets their communications in a psychoanalytic manner, making quite detailed links of possible unconscious meaning. It would be impossible to use this deeper and more time-consuming approach with everyone and I wondered about his criteria for selection of patients for once-weekly longer interviews, which is how he tends to work.
His Clinical Notes follow ‘a chronological sequence from infancy through childhood, adolescence, adult life and old age, attempting to focus on the problems of anxiety and its root in the primal experience of infancy’, illustrating various experiences and concepts by additional material from his psychoanalytic practice. He also discusses difficulties arising from resistance, psychosis and psychosomatic illness. This latter is elaborated at some length, particularly using Bion's concept of a ‘protomental system’, seeing difficulties that arise when anxieties have not been modified by a good external object and where psychosomatic illness is a result of unexpressed grief.
A family doctor is confronted with numerous psychological aspects of his patients' problems such as psychosomatic disturbances, morbid grief and hypochondria, and patients and their families become familiar to him during different developmental stages or crises in their lives.