Be Reasonable

Dear Sir

Anthony Ryle (1993) has, I think, completely missed the point of Betty Joseph's paper ‘Addiction to near-death’ (1982). Following on from Ann Scott's critique (1993), with which I am in broad agreement, I would like to add a few thoughts of my own.

I am familiar with the work of both clinicians from the ‘inside’, so to speak, as they have both been inspiring and influential supervisors at different stages of my professional development. I think that if Ryle knew Joseph's work properly he is someone who would appreciate her incisive mind and her humane, light touch. The statement Ryle makes that Joseph's patient received ‘constant interpretation of gratification in destruction’ is a puzzling one, since it seems to me that the avoidance and analysis of such enactments is one of the very issues that she is addressing in the paper. In fact one of Joseph's major contributions to clinical psychoanalysis is her detailed attention to the fine grain of transference and countertransference patterns. A tendency to find oneself taking a moral stand with a patient who is submitting masochistically will be a total phenomenon to be observed and itself analysed, as it will give an important insight into the patient's inner world of object relationships.

It would be useful if all patients could be cured by reason. If they (and we, when we are patients!) could be shown rationally what they were doing with the help of diagrams even, and would say, after ten or fifteen sessions, ‘Oh yes, I see what I have been doing, I'll stop now, thank you very much’! This might work if human beings were a) basically well-meaning and nice all the time, really; b) could easily bear the sorts of psychic pain that their defences had so assiduously been developed to cover up; c) were never seriously perverse; d) all had readily available curiosity, concern emotional depth and capacity to mourn. In these circumstances cognitive understanding without major opportunity for working-through might be eno