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I recommend this enjoyable book not only to mental health professionals but also to anyone interested in the nature of madness. It addresses a gap in the market where
there is very little accessible literature applying psychoanalytic ideas to frontline experience.
Marcus Evans has a great deal of experience in mental health. He qualified as a nurse in 1983 and over time developed a strong conviction about the importance of psychoanalytic understanding. In recent years he has been working at the Tavistock Clinic, becoming both the Head of Nursing and the Associate Clinical Director of the Adult Department. He currently works psychodynamically with some of the most challenging patients treated in the NHS.
In his book Evans talks with authenticity about working, supervising and consulting to frontline services in mental health. He clearly understands the intense level of disturbance, complexity and pressure that clinicians have to cope with in the current health service, with an ever-increasing demand to provide a high standard of care for a growing number of seriously disturbed patients, and reducing resources.
The book's main theme is the difficulty working within this heart of madness - that sanity is fragile and the health professional can easily get lost in mania and the wish to rescue patients.
Evans shows that the historical split between psychiatry and psychoanalysis is unhelpful. Throughout the book he uses material from his work over the years to illustrate the value of applying psychoanalytic ideas to psychiatric work:
… in the treatment of ill patients psychiatry needs psychotherapy, and psychoanalytic psychotherapy needs psychiatry. When they work well together they act as the parents of the clinical setting with the listening approach of psychotherapy complementing the objective and scientific approach of psychiatry. (p. 203)
In the introduction, Evans emphasizes that a psychoanalytic understanding can help us to see the powerful unconscious dynamics that und